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Background Obesity predisposes to left ventricular dysfunction and heart failure, early detection of associated subclinical cardiac changes has important diagnostic and prognostic values. 2D strain and strain rate allow detection of subtle abnormalities of global and regional left ventricular systolic and diastolic functions. The study aimed to assess the effect of obesity on LV function by 2D strain and strain rate. Methods and results 30 obese patients (31.7 ± 6.7 years) without apparent cardiovascular disease were enrolled and fifteen sex and age-matched non-obese healthy individuals were recruited as control group, all patients and controls underwent assessment by complete conventional echo and 2D based strain and strain rate (longitudinal, radial and circumferential). Conventional echo demonstrated that obese patients had increased LV dimension ( P 0.04), LA dimension ( P 0.01) and left ventricular wall thickness, and impairment of diastolic function (E/A 0.98 ± 0.2 vs 1.4 ± 0.3 P 0.002) while no affection of systolic function could be detected. By deformation imaging, there was a reduction in circumferential strain (−17.8 ± 3.4 vs −20.7 ± 2.1 P 0.004) and longitudinal strain (apical 4 view −19.4 ± 2.6 vs −21.4 ± 2.6 P 0.02, apical 3 view −17.5 ± 3.7 vs −20.9 ± 3.8 P 0.01). Similarly systolic strain rate (SRsys) and early diastolic SR (SRe) reduced significantly in longitudinal and circumferential directions. On the contrary radial S and SR did not show any significant changes between both groups and did not correlate with the degree of obesity. Conclusions Although EF was not different between obese patients and controls, LV longitudinal and circumferential strain and strain rate by 2D speckle tracking were lower in the obese group. [ABSTRACT FROM AUTHOR]

Objectives Evaluation of left atrium (LA) mechanical function by speckle tracking based strain (SPTS) in patients with chronic non-valvular atrial fibrillation (AF) and its correlation with CHA 2 DS 2 -VASc risk score. Background AF is a progressive condition that begins with increased hemodynamic load or structural remodeling of the atria, understanding atrial function could lead to better ability to predict the risk of developing stroke and the response to treatment. SPTS is a recently emerged modality that accurately estimates myocardial function. Methods Sixty patients with chronic AF and 20 age and sex matched normal control individuals underwent conventional echo where LV dimensions, wall thickness, EF, LA diameter and volumes were measured. Peak left atrial longitudinal strain (PALS) was measured in apical four (AP4) and two chamber view (AP2) and its correlation with CHA 2 DS 2 -VASc risk score in the AF group was evaluated. Results LA diameter and volumes were greater in AF patients ( P -value < 0.001). PALS in each LA wall and in both AP4 and AP2 views were highly significantly lower in AF patients in comparison with control but did not reach a statistically significant correlation with CHA 2 DS 2 -VASc score. Also, there was no significant difference between PALS in patients with CHA 2 DS 2 -VASc score less than and more than two points. Conclusion AF leads to impairment of LA mechanical function as evidenced by low PALS but PALS was not significantly correlated with CHA 2 DS 2 -VASc score. Also, there was no significantly statistical difference between PALS in patients with low and high CHA 2 DS 2 -VASc scores. [ABSTRACT FROM AUTHOR]

Abstract Background  Surgical correction is often required for cosmetic correction of trigonocephaly. The purpose of this paper was to report the long-term aesthetic outcome as appreciated by the parents/patients themselves. The self-evaluation of cosmetic outcome after trigonocephaly correction has not previously been reported. The management and different surgical techniques utilized over a 16-year period are discussed. Materials and methods  An observational study was undertaken of the clinical outcome, operative data, complications and cosmetic satisfaction of these trigonocephaly patients. The parents/child were asked to rate their satisfaction with the cosmetic outcome both in terms of head shape and scar appearance, on a five-point scale (excellent—5, very good—4, good—3, fair—2 and poor—1). Results  Sixty-three patients presented with non-syndromic trigonocephaly over the 16 years. Nineteen of 63 had a mild form of trigonocephaly and were managed conservatively. The remainder underwent surgical correction. Forty-two of 44 (95%) underwent fronto-orbital advancement with either barrel staving (26/44) or frontal bone rotation/re-modelling (16/44), with 2 of 44 having burring of the metopic ridge. Head shape rating was regarded as excellent in 25 of 63 (40%), very good in 18 of 63 (28%), good in 18 of 63 (28%) and fair in 2 of 63 (4%). Of those that underwent surgery, the scar was zigzag in 32 of 44 and straight in 12 of 44. Scar was rated as being excellent in 21 of 44 (48%), very good in 12 of 44 (28%) good in 11 of 44 (24%). Conclusions  Metopic synostosis can result in varying degrees of severity. Milder forms can be treated conservatively, with more severe forms requiring both frontal bone re-modelling and fronto-orbital advancement. Surgical correction results in a high level of patient/parent satisfaction. [ABSTRACT FROM AUTHOR]

Abstract Introduction  Superior mesenteric artery or Wilkie’s syndrome is defined as compression of the third part of duodenum by superior mesenteric artery. It has not been previously reported in children after neurosurgical procedures. Clinical history  We present the case of a child who had persistent vomiting after surgery for posterior fossa astrocytoma complicated by low pressure hydrocephalus. Conclusion  Despite eventual hydrocephalus control, vomiting persisted, and she was diagnosed with superior mesenteric artery syndrome, this being confirmed radiologically and settled with appropriate nutritional management. [ABSTRACT FROM AUTHOR]

Background: 2D strain imaging has been proved as an accurate technique for the assessment of left ventricular (LV) function using transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) has become a standard and essential technique in clinical practice especially when TTE is inconclusive. Adding 2D strain imaging to TEE might be valuable in the evaluation of cardiac performance. The aim of the present study was to compare 2D strain imaging using TTE and TEE in the assessment of left ventricular deformation in patients with cardiovascular diseases. Results: This study was conducted on sixty patients, who were referred for TEE for various clinical indications. All patients were examined with both TTE and TEE 2D strain imaging. Global and regional strain parameters including longitudinal (LS), circumferential (CS), and radial (RS) were examined. Analysis of 2D strain using TTE was time sparing than TEE (16 ± 1 vs 19 ± 2 min, P < 0.001). From 1020 segments explored using TTE, 97% (LS) and 93% (CS and RS) of the segments were fully analyzed versus 90% and 88% using TEE respectively (P < 0.01). TEE longitudinal strain has an excellent agreement with TTE-derived measurements and a modest agreement in circumferential strain but a notable disparity in radial strain values. Both regional and global LS and RS measured by TTE showed higher values (P < 0.01, < 0.03) compared with its corresponding values measured by TEE. Whereas segmental and global values of CS were higher using TTE modes, the difference with the analogous TEE values did not reach statistical significance. LS and CS measured by TTE and TEE showed excellent but similar correlation with LV EF and wall motion score index. Conclusion: 2D strain using TTE is user friendly compared to TEE. However, because of the good agreement, TEE 2D strain might represent an appropriate alternative in the evaluation of global LV deformation. [ABSTRACT FROM AUTHOR]