Parameters of left ventricular diastolic function 48 hours after coronary angioplasty and stent implantation.

INTRODUCTION: It has been reported that stent implantation results in an earlier and more pronounced improvement of coronary flow reserve in comparison to conventional balloon angioplasty. Whether this phenomenon translates into hemodynamic changes of left ventricular systolic and diastolic function has not been investigated. This study was designed to determine whether stenting leads to greater changes in measures of diastolic dysfunction than plain angioplasty alone. METHODS: Parameters of diastolic function were ascertained by Doppler echocardiography in 194 patients with single-vessel disease before and 48 hours after elective coronary angioplasty. A total of 116 patients were initially successfully treated with coronary angioplasty. In 78 patients, stents were used to improve an inadequate result after coronary angioplasty. The parameters of left ventricular diastolic function were evaluated before and 48 hours after coronary intervention by Doppler echocardiography. Ejection fraction was determined and used to characterize systolic left ventricular function. RESULTS: Both patient groups (116 patients with coronary angioplasty, 78 patients with combined coronary angioplasty and stent implantation) showed no relevant differences concerning sex, age, atherosclerotic risk factors, exercise capacity and results of exercise electrocardiography. All patients who underwent stent implantation showed an early improvement of left ventricular diastolic function 48 hours after intervention. Surprisingly, there was no significant short-term improvement (48 hours) of diastolic function in patients with initially successful angioplasty. CONCLUSION: Stent implantation results in improved left ventricular diastolic function in comparison to conventional balloon angioplasty. This has to be attributed to a more immediate and increased antiischemic effectiveness due to the scaffolding properties of stents.

Isolated peripheral neurilemoma attached to the tendon of the flexor digitorum longus muscle.

Neurilemomas are benign tumours arising from peripheral nerves with a Schwann cell sheath. They are normally painless and slowly growing, rarely causing motor disturbances. Neurilemomas are most common in the cranial nerves, in the trunk, the upper and lower extremities, but may appear anywhere. Especially rare are neurilemomas of the lateral peroneal nerve in the region of the fibular head and in the foot. We present the first detailed report of a neurilemoma localized between the Achilles tendon and the flexor digitorum longus muscle with separation of the tumour from the tibial nerve.

The angle velocity reproduction test (AVRT) as sensorimotor function of the glenohumeral complex.

BACKGROUND: The purpose of the present study was to develop and evaluate the angle velocity reproduction test (AVRT) in the glenohumeral joint. METHODS: In 46 volunteers with healthy shoulders, a test was devised in order to record the angle velocity perception in the shoulder. One arm was moved passively by means of a Cybex 6000 unit. The subjects were asked to perform the same movement as precisely as possible with the contralateral arm without visual control. The movement was recorded with a contact-free motion analysis system with a digital infrared camera and evaluated by aid of a movement analysis program. Starting at -20 degrees, the movement was an anteversion (anterior flexion) of 110 degrees. The sector between 20 degrees and 90 degrees was analyzed in detail. Different parameters were documented which represented different aspects of the sensorimotor function. The predetermined angle velocity of the Cybex setting on the contralateral arm amounted to exactly 53 degrees /s. In order to observe validity and reliability, 10 additional measurements with visual control as well as 21 double measurements were performed. RESULTS: The comparison of the measurements with and without visual control yielded highly significantly better results for those courses with visual control with regard to all those parameters which represent the perception of velocity. The values which describe the evenness of the movements were weak and/or insignificant. CONCLUSION: The introduced AVRT appears suitable to test dynamic sensorimotor abilities.

Management of infected shoulder replacement.

BACKGROUND: The purpose of the present work is to present treatment options and our own results for patients with infected shoulder alloarthroplasties. METHODS: Twelve patients with an infected shoulder replacement were treated. Their age ranged from 56 to 82 years. Indications for surgical revision were clinical symptoms compatible with an infection or positive serologic tests, especially an elevated C-reactive protein. Aspirated intra-articular fluid with a white blood cell count above 30,000 or positive for bacterial growth was also an important diagnostic feature. Retrospective analysis differentiated three groups with three different treatment regimens. Group 1 with early infection but without soft-tissue involvement (n=1): this particular patient underwent arthroscopic synovectomy. Group 2 with early infection and soft-tissue involvement within 4 weeks after index surgery (n=1): this patient underwent open synovectomy. The largest group was group 3 with late infection (n=10): these patients were treated with two-stage revision and a temporary spacer. RESULTS: The time between explantation and reimplantation ranged between 4 weeks and 6 months. With the temporary spacer, an anatomically stable condition could be established for all patients, and reconstruction of the humeral length even in long implants was possible. All patients underwent physiotherapy with the temporary spacer in place. A positive intraoperative microbiologic specimen was only found in 4 patients. In both group 1 and 2 patients, the infection healed, and thus the original implant could be kept in situ. In 8 patients, the temporary spacer was removed and exchanged for a regular implant. The postoperative raw Constant score at the time of the last follow-up examination was 48, due mainly to a loss of motion and power. All shoulders were stable, and the elbow function was good. CONCLUSION: Use of an antibiotic-loaded spacer allows successful treatment of infected shoulder replacements.

Left ventricular diastolic function in physiologic and pathologic hypertrophy.

BACKGROUND: Patients with hypertensive heart disease and left ventricular hypertrophy demonstrate an impaired left ventricular diastolic filling pattern. The aim of this study was to find out whether physiologic left ventricular hypertrophy induced by endurance training causes disturbances in left ventricular systolic and diastolic filling. METHODS: We examined 49 athletes with left ventricular (LV) hypertrophy due to endurance training, 49 patients with LV hypertrophy due to arterial hypertension, and 26 untrained healthy control subjects by conventional echocardiography. Parameters of LV diastolic filling using pulse wave and color flow Doppler were also assessed. RESULTS: All three study groups showed normal fractional shortening and mid-wall fractional shortening. Conventional echocardiography revealed a higher LV muscle mass index in the two study groups compared with the controls (athletes, 99 +/- 10 g; hypertensive patients, 95 +/- 11 g: controls: 52 +/- 7 g; P < .01 for athletes and hypertensive patients). In patients with arterial hypertension, a diastolic dysfunction consisting of a delayed relaxation pattern with a decrease in maximal early velocity of diastolic filling (0.44 +/- 0.1 m/sec) and a compensatory increase of the maximal late velocity of diastolic filling (0.53 +/- 0.1 m/sec) was demonstrated. In athletes with physiologic LV hypertrophy, a normal LV diastolic filling pattern was documented. CONCLUSIONS: Doppler echocardiographic parameters of LV diastolic function can be of diagnostic importance for discrimination between pathologic and physiologic LV hypertrophy.

Left ventricular hypertrophy and diastolic dysfunction in healthy pregnant women.

OBJECTIVE: The purpose of this study was to examine which hemodynamic parameters change under the natural volume overload of pregnancy. STUDY DESIGN: 46 healthy pregnant women were echocardiographically examined during the course of pregnancy. To evaluate left ventricular diastolic function, mitral inflow and pulmonary venous flow profiles were used. Fractional shortening and left ventricular muscle mass were calculated. RESULTS: In the course of pregnancy the left ventricular muscle mass index increased (from 66 +/- 6 to 96 +/- 9 g/m(2)), fractional shortening decreased (from 38 +/- 4 to 32 +/- 6%) and a disturbed diastolic relaxation pattern was documented. Eight weeks after delivery, all left ventricular systolic and diastolic functional parameters returned to normal values. CONCLUSION: The natural volume overload in pregnancy leads to a reversible 'physiological' left ventricular hypertrophy, a short-term decrease in systolic function and a significant change in left ventricular diastolic function.