Clinical benefits of aspirin desensitization in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease are not related to urinary eicosanoid release and are accompanied with decreased urine creatinine.

BACKGROUND: Treatment with acetylsalicylic acid (ASA) after desensitization may be a therapeutic option in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD). The mechanisms that lead to improvement in rhinosinusitis and asthma symptoms remain unknown. AIM: To attribute the documented clinical effects of ASA treatment of chronic rhinosinusitis and/or asthma to the release of eicosanoid metabolites in urine. METHODS: Fourteen patients with NERD were successfully desensitized, and, eventually, eight patients were treated with 650 mg of ASA daily for 3 months. In addition to clinical assessments, nuclear magnetic resonance imaging and smell test were performed before and after treatment with ASA. Venous blood and urine were collected before desensitization and after 1 and 3 months of treatment. The levels of urinary leukotrienes (LT) (cysteinyl LT and LTE4) and tetranor PGDM (metabolite of prostaglandin D2) were measured by enzyme-linked immunosorbent assay. RESULTS: Treatment with ASA after desensitization alleviated symptoms of rhinosinusitis, improved nasal patency (mean, 50% decrease in peak nasal inspiratory flow) and sense of smell (fourfold increase in smell test score) in as early as 4 weeks. Clinical improvements were not accompanied by any change in sinonasal mucosa thickness as assessed with nuclear magnetic resonance. Urinary cysteinyl LTs, LTE4, and prostaglandin D2 metabolite remained relatively stable during ASA treatment and did not correlate with clinical improvements. Desensitization was associated with a progressive decrease of urinary creatinine. CONCLUSION: Clinical improvement in rhinosinusitis and/or asthma after ASA desensitization was not related to concentrations of urinary eicosanoid metabolites. A decrease of urinary creatinine requires further study to determine the renal safety of long-term treatment with ASA after desensitization.

2D speckle tracking echocardiography for the assessment of regional contractile reserve after myocardial infarction.

AIMS: To assess whether quantitative resting assessment of local myocardial function by 2D speckle tracking echocardiography may be helpful for the evaluation of myocardial viability in patients after ST-elevation myocardial infarction (STEMI) and for the prediction of left ventricular function recovery after 12-month follow-up. METHODS: The study group comprised 96 patients with first STEMI treated with successful primary percutaneous coronary intervention. Seven to 12 days after STEMI, all patients underwent resting echocardiography and low-dose dobutamine stress echocardiography (LDDSE) with visual assessment of contractile reserve which was the reference method for the evaluation of myocardial viability. After 12 months resting echocardiography with visual assessment of functional recovery was performed. Subsequently, acquired images were analyzed off-line using 2D speckle tracking echocardiography algorithm. Measurements included peak systolic longitudinal and transverse strain (SLS/STS), peak longitudinal and transverse strain (PLS/PTS), systolic longitudinal and transverse strain rate (SLSR/STSR) at baseline and after 12 months. RESULTS: All analyzed longitudinal parameters of strain had a very good diagnostic value, while transverse parameters had only good diagnostic value for predicting myocardial viability defined on the basis of LDDSE. Moreover, SLS and PLS had good, whereas SLSR only satisfactory diagnostic value for predicting function recovery after 12-month follow-up. CONCLUSIONS: 2D speckle tracking analysis applied during resting echocardiography can be helpful for the prediction of myocardial viability and functional recovery in patients after STEMI. Longitudinal strain parameters allow the prediction of local contractile reserve with SLS showing best correlation with DSE results functional recovery after 12-month follow-up.

Echocardiographic quantitative analysis of resting myocardial function for the assessment of viability after myocardial infarction--comparison with magnetic resonance imaging.

BACKGROUND AND AIM: The study was set out to assess feasibility and diagnostic value of the echocardiographic quantitative analysis of the resting regional systolic function (i.e. strain and strain rate) with use of the speckle tracking (2D strain) for myocardial viability assessment in patients with acute myocardial infarction (MI) treated with primary angioplasty. The reference method was the late enhancement magnetic resonance imaging (LE MRI). METHODS: The study group consisted of 40 patients (29 men, mean age 61 ± 9 years) in whom resting echocardiographic examination was performed 7-10 days after MI with peak systolic longitudinal strain (STS) and systolic longitudinal strain rate (SLSR) measurement by 2D strain technique on external workstation (EchoPac 6.1.0., GE Vingmed Ultrasound). Within 72 h LE MRI was performed in all patients, with visual assessment of late enhancement in all segments of the left ventricle. Viability of a segment was assessed based on two distinct, frequently adopted criteria: LE extent ≤ 50% or ≤ 75% of the wall thickness. RESULTS: Due to suboptimal image quality 70 (10.9%) of the segments were excluded from 2D strain analysis. In the analysis of akinetic and dyskinetic segments, SLS and SLSR measurements with 2D strain technique had good discrimination value for viability defined as LE extent of ≤ 75% by MRI (area under the ROC curve 0.715 and 0.705, respectively; diagnostic accuracy of the criterion SLS ≤ -7.61% was 72.8%; diagnostic accuracy of the criterion SLSR ≤ -0.79/s was 64.9%). However, when the ≤ 50% viability criterion by LE MRI was used, only SLS measurement could be used for viability assessment, with sufficient diagnostic value (area under the ROC curve 0.620; diagnostic accuracy of the criterion SLS ≤ -9.77% was 57%). In the analysis of all segments, including hypokinetic and normokinetic segments, SLS and SLSR measurements did not provide additional information, beyond that of the visual viability analysis. CONCLUSIONS: Resting quantitative echocardiographic analysis of myocardial function seems to be a promising tool for myocardial viability assessment. There is a trend towards greater diagnostic value of SLS than SLSR measurements.

Comparison of tomographic coronary artery calcification index (calcium score) and ultrasonographic measurement of intima-media complex thickness in diabetic subjects.

BACKGROUND: At present, there is a number of diagnostic imaging procedures allowing for the evaluation of atherosclerosis. The earliest, subclinical stage of atherosclerosis can be visualized with the development of computed tomography (CT) and ultrasound (US) techniques. Therefore, the purpose of this study was to assess the degree of coronary artery calcification and carotid intima-media thickness in diabetic subjects divided into different age groups. MATERIAL/METHODS: Fifty-six men, aged from 18 to 72 were included in the study. Participants were divided into 4 groups according to age (18-30, 31-45, 46-60 and more than 60 years). Two tests were performed: coronary calcium score (CS) determination and intima-media thickness (IMT) in ultrasound. CS was performed using a multi-slice scanner. Images were analyzed using the Agatson method. Ultrasound examinations were performed using a 9-12-MHz linear transducer. RESULTS: The correlation coefficient between calcium score index (CSI) and age of patients was 0.52 (p<0.001). The correlation between duration of diabetes and CSI was significantly lower (r=0.3; p<0.05). The increase of IMT is associated with age to a much greater extent and the correlation coefficient was 0.63 (p<0.001). IMT depended on the duration of diabetes, but the correlation was also weak (r=0.35; p<0.01). CONCLUSIONS: Comparison of the findings obtained in the presented study and in the group of healthy subjects proves that influence of diabetes on vascular deterioration may be observed, even among young individuals. Obtained results allow to make the following conclusions: 1. Calcium score index remains low in the group of male patients with diabetes before the age of 45. 2. Intima-media thickness correlates well with age (r=0.6; p<0.05) and weaker with the duration of diabetes (r=0.35; p<0.05). 3. IMT assessment may be a useful tool to identify the increased predisposition to atherosclerosis, also before the age of 30.

[Brain metabolism alterations in patients with anorexia nervosa observed in 1H-MRS]. / Protonowa spektroskopia rezonansu magnetycznego (1H-MRS) mózgowia u pacjentek z jadlowstretem psychicznym (anorexia nervosa).

The causes of metabolic brain changes in patients with anorexia nervosa are still not fully explained. The purpose of this study was to use the 1H-MRS method in investigating metabolic changes in the brain of patients with anorexia nervosa. We studied 10 patients for visible alternations in brain metabolism and compared the results to healthy controls. 1H-MRS was acquired by the method of single voxels in white and grey matter. Proton MRS was performed after image guided localization using stimulated echo acquisition mode (STEAM) sequence with a short echo time of 20 ms. For data evaluation we used standard Siemens software and the additional PC. Choosing of the MRS sequences was related with particular interest in metabolites of short time echo: myoinositol and lipids. Besides this we evaluated peaks of: N-acetylaspartate (NAN), creatine (Cr) and choline (Cho). The results show significant differences in the levels of metabolites connected with fatty metabolism. In white matter we observed the reduction of lip-peak. The data was evaluated approximately and presented as lip:Cr. We did not observe any differences in other metabolites. As far as we know similar results had been reported and our study confirmed significant disorders in metabolism of these chemicals in patients with anorexia nervosa.