Pulmonary hypertension in patients with end stage renal disease undergoing hemodialysis.

BACKGROUND: Pulmonary hypertension (PH) is a serious cardiovascular complication in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD) via arterio-venous fistulas (AVF). AIM: The aim of this study was to assess pulmonary vascular resistance (PVR), AVF flow volume (AVF-FV) and cardiac output (CO) and to highlight the impact of their augmentation, as well as of the duration of HD, on the occurrence of PH in patients with ESRD. METHODS: Our study group consisted of 51 dialyzed patients, with ESRD, without history of PH. We determined by ultrasonography the systolic pulmonary arterial pressure (PAPs), the left ventricular ejection fraction (EF), the cardiac output (CO), PVR and AVF-FV. RESULTS: We documented PH in 27 (52.94%) patients. All had elevated PVR, higher AVF-FV and CO comparing to patients without PH. They were undergoing HD for a longer period and had lower EF than those without PH. For all patients, we documented strong correlations between PAPs and PVR (r = 0.933, P < 0.001) and the duration of HD (r = 0.702, P < 0.001), but moderate ones with AVF-FV (r = 0.583, P < 0.001) and CO (r = 0.519, P < 0.001). CONCLUSION: In patients with ESRD undergoing HD, PH was a common finding being associated with increased PVR, a longer duration of HD and chronic glomerulonephritis as etiology for ESRD. The majority of patients with PH had altered left ventricular systolic function, predisposing them to an increased risk to develop heart failure.

Alterations of heart rate variability and turbulence in female patients with hyperthyroidism of various severities.

OBJECTIVE: The objective of the this study is to document the existence of statistically significant differences between parameters of heart rate variability (HRV) and heart rate turbulence (HRT), determined in women with overt hyperthyroidism (hT), compared to controls and to highlight their correlations with the level of thyroid hormones and the incidence of arrhythmias. METHODS: We studied the HRV in time and frequency domain, and the HRT in a group of 113 women with overt hT, without other cardiovascular risk factors or comorbidities, admitted to the endocrinology clinic of our hospital, between 2012 and 2016. Depending on the severity and duration of hT and levels of thyroid hormones, the patients were assigned to three groups: mild and moderate forms, severe hT with thyrotoxicosis and persistent cases with a relapse of hT. We performed 24 h Holter monitoring in all patients. RESULTS: HRV parameters in time domain (TD) were significantly depressed in patients comparing to controls. All patients had abnormal, positive values of turbulence onset (TO) with significant statistically differences (P < 0.0001) comparing to controls. Although positive, the values of turbulence slope (TS) decreased according to the severity of hT. CONCLUSION: Patients with hT had depressed values of HRV parameters in TD, correlated with the severity of the thyroid disease and with the incidence of arrhythmias. All patients presented pathological values of TO. TS values were positive, but lower compared to controls.

Hyperthyroidism and sick sinus syndrome, a rare but challenging association: A study of three cases.

Hyperthyroidism is usually associated with sinus tachycardia or supraventricular tachyarrhythmias, but rarely with dysfunction of the sinus node or other conduction disturbances. Evidence of bradyarrhythmia in patients with hyperthyroidism is clinically relevant, but the fact that several drugs with negative chronotropic effects (beta-blockers and calcium channel antagonists) are frequently used in the management of these patients must be taken into account. In the presence of sick sinus syndrome (SSS) or other conductance disturbances, therapy with agents that delay the activity of sinus node or atrioventricular conduction can lead to extreme bradycardia with syncope. In this paper, aspects of diagnosis and therapy in three patients with SSS and hyperthyroidism, admitted in the Clinic of Endocrinology or/and Cardiology of the County Hospital, Timisoara, have been presented.

High-risk pulmonary embolism in a patient with acute dissecting aortic aneurysm.

In the last decades, an increased incidence of pulmonary embolism (PE) and acute dissection (AD) of aortic aneurysms has been registered mostly due to increased availability of advanced imaging techniques. They seldom occur concomitantly in the same patient. In this paper, we present the clinical challenges and controversies of diagnosis and therapy in a 70-year-old male patient with an atypical presentation of high-risk PE occurring concomitantly with a silent AD of a thoracic aortic aneurysm.

Upper Gastrointestinal Bleeding in Chronic Kidney Disease Patients.

Aim: To investigate upper GI bleeding as a particular complication in chronic kidney disease patients. Material and methhod: 30 chronic kidney disease patients admitted to the Nephrology Department for upper gastrointestinal bleeding over a period of 5 years. Results: 16 patients were undergoing hemodialysis (53.3%) and 14 patients were not in a hemodialysis program. There were no patients undergoing peritoneal dialysis. Very high comorbidity rate for all patients, most important being cardiovascular diseases. Only 10% of patients had oral anticoagulant treatment prior to GI bleeding. Conservative treatment was successful for all patients; no endoscopic or surgical haemostasis was needed. Conclusion: Although chronic disease kidney patients have a high risk of upper GI bleeding compared to the general population, the conservative treatment applied has a very high rate of success in stopping the bleeding without the need for endoscopic or surgical haemostasis treatment.

Robust photon locking.

We experimentally demonstrate a strong-field coherent control mechanism that combines the advantages of photon locking (PL) and rapid adiabatic passage (RAP). Unlike earlier implementations of PL and RAP by pulse sequences or chirped pulses, we use shaped pulses generated by phase modulation of the spectrum of a femtosecond laser pulse with a generalized phase discontinuity. The novel control scenario is characterized by a high degree of robustness achieved via adiabatic preparation of a state of maximum coherence. Subsequent phase control allows for efficient switching among different target states. We investigate both properties by photoelectron spectroscopy on potassium atoms interacting with the intense shaped light field.

Adsorption of superheavy elements on metal surfaces.

Fully relativistic four-component density functional theory with the general gradient approximation calculations have been performed to determine the adsorption energy and position of the superheavy element 112 on a Au surface. Extended cluster as well as embedded cluster calculations were used to simulate the surface which allow for the top, bridge, and hollow adsorption sites without losing the advantage of symmetry considerations. Comparison with analogous calculations of the adsorption of the homologue element Hg allows to predict the adsorption of element 112 at a bridge site with a binding energy of 0.67 eV.

Control of ionization processes in high band gap materials via tailored femtosecond pulses.

Control of two basic ionization processes in dielectrics i.e. photo ionization and electron-electron impact ionization on intrinsic time and intensity scales is investigated experimentally and theoretically. Temporally asymmetric femtosecond pulses of identical fluence, spectrum and pulse duration result in different final free electron densities. We found that an asymmetric pulse and its time reversed counterpart address two ionization processes in a different fashion. This results in the observation of different thresholds for surface material modification in sapphire and fused silica. We conclude that control of ionization processes with tailored femtosecond pulses is suitable for robust manipulation of breakdown and thus control of the initial steps of laser processing of high band gap materials.