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Background/aims: Anorectal diseases, including fecal incontinence, are prevalent and have an enormous impact on the quality of life. Therefore, investigating their etiological factors may help to reduce the incidence and/or the severity of the underlying diseases., Materials and Methods: Referral complaints (constipation, strained defecation, and incontinence) and medical and anorectal manometry records of 883 (562 female/321 male, ages 45.17±1.00 and 48.41±0.63 years, respectively) patients were evaluated retrospectively. Maximal resting pressure (MRP) and maximal squeeze pressure (MSP) measured by stationary pull-through technique, volume of rectoanal inhibitory reflex, and sensory threshold to rectal balloon distention (ST) were obtained by water perfusion system. Data were compared according to referral complaints, age, gender, parity, and underlying diseases., Results: Incontinence was the most frequent referral complaint in 61.2% of females and 67.6% of males. MRP and MSP were significantly lower in incontinent females than in the other groups. In incontinent males, MSP was lower than the strained defecation group, and ST was higher than the constipation group. Age was negatively correlated with MRP for both of the genders and in all groups. Obstetric trauma (85%) and number of parity (3.40±2.59) were significantly higher in incontinent females. Moreover, the most prevalent underlying disease was diabetes in incontinent females (13.7%) and neurological diseases, including traumas, in incontinent males (41.5%)., Conclusion: Increasing awareness of labor safety, controlling diabetes mellitus, and preventing obstetric traumas may reduce the prevalence of fecal incontinence.

Group coordination passes through an efficient integration of multimodal sources of information. This study examines complex non-verbal communication by recording movement kinematics from conductors and two sections of violinists of an orchestra adapting to a perturbation affecting their normal pattern of sensorimotor communication (rotation of half a turn of the first violinists' section). We show that different coordination signals are channeled through ancillary (head kinematics) and instrumental movements (bow kinematics). Each one of them affect coordination either at the inter-group or intra-group levels, therefore tapping into different modes of cooperation: complementary versus imitative coordination. Our study suggests that the co-regulation of group behavior is based on the exchange of information across several layers, each one of them tuned to carry specific coordinative signals. Multi-layer sensorimotor communication may be the key musicians and, more generally humans, use to flexibly communicate between each other in interactive sensorimotor tasks.

Non-verbal communication enables efficient transfer of information among people. In this context, classic orchestras are a remarkable instance of interaction and communication aimed at a common aesthetic goal: musicians train for years in order to acquire and share a non-linguistic framework for sensorimotor communication. To this end, we recorded violinists' and conductors' movement kinematics during execution of Mozart pieces, searching for causal relationships among musicians by using the Granger Causality method (GC). We show that the increase of conductor-to-musicians influence, together with the reduction of musician-to-musician coordination (an index of successful leadership) goes in parallel with quality of execution, as assessed by musical experts' judgments. Rigorous quantification of sensorimotor communication efficacy has always been complicated and affected by rather vague qualitative methodologies. Here we propose that the analysis of motor behavior provides a potentially interesting tool to approach the rather intangible concept of aesthetic quality of music and visual communication efficacy.

Objective: The aim of this study was to investigate the relationship between QRS duration, artifactual perfusion abnormalities, and left ventricular function in patients with left bundle branch block (LBBB) using dipyridamole technetium-99m sestamibi electrocardiography-gated single-photon emission computed tomography (SPECT)., Methods: Twenty-three patients (62 +/- 12.2 years, 18 women, 5 men) with complete LBBB were analyzed. All patients underwent rest-dipyridamole gated SPECT (1-day protocol). To exclude patients with true myocardial ischemia and clearly define artifactual abnormalities owing to LBBB, only patients with normal end-diastolic stress images were involved. Four sets of SPECT images representing ungated rest, ungated stress, and end-diastolic and end-systolic stress images were generated, and the summed defect scores were obtained for each [summed rest score (SRS), summed stress score (SSS), end-diastolic score (EDS), and end-systolic score (ESS), respectively]. QRS durations were measured for both rest and dipyridamole stress., Results: The patients with perfusion abnormalities on ungated rest, ungated stress, or end-systolic stress images had significantly longer minimum QRS duration at rest. These QRS values correlated with SRS and SSS (r: 0.528, P: 0.01 and r: 0.47, P: 0.024, respectively). Analysis of perfusion and functional data demonstrated an inverse correlation between left ventricular ejection fraction (LVEF) and ESS (r: -0.671, P < 0.0001). The patients with end-systolic perfusion abnormalities had significantly lower LVEF rates when compared with the patients with normal perfusion on end-systolic images., Conclusions: Our results demonstrated that the presence and severity of artifactual perfusion abnormalities owing to LBBB were significantly related to minimum QRS duration. The magnitude of perfusion abnormalities especially on the end-systolic phase seems to adversely affect systolic function of the left ventricle.

Introduction: Evidence suggests that elevated plasma levels of B-type natriuretic peptide (BNP) are found in patients with chronic obstructive pulmonary disease (COPD) and right ventricular dysfunction. We examined the effects of exercise on plasma BNP levels in patients with COPD who have normal right ventricular function, Methods: Seventeen patients with a diagnosis of COPD and normal right ventricular function demonstrated by radionuclide ventriculography, and 17 age-and sex-matched healthy subjects underwent a treadmill exercise test. Plasma BNP levels were measured sequentially before, immediately after, and 1 hour after the exercise test, Results: The mean plasma BNP+/-standard deviation levels of the COPD and control groups before exercise were 21.3+/-16 pg/ml and 13.4+/-11 pg/ml, respectively (P>0.05). Mean plasma BNP level measured immediately after exercise was 37.9+/-31 pg/ml in the COPD group, reflecting a statistically significant increase when compared with the initial value (P<0.05). The control group did not show any significant change in plasma BNP levels after the exercise test, Conclusions: Exercise induces an increase in plasma BNP levels in patients with COPD who do not have right ventricular dysfunction at rest. Measurement of exercise-induced BNP levels may be a useful alternative to pulmonary artery catheterisation in identifying the patients who are likely to benefit from long-term oxygen therapy.

Rheumatoid arthritis (RA) is associated with increased cardiovascular mortality. However, cardiovascular findings are mostly subtle, and diastolic function abnormalities are one of the earliest manifestations. The aim of this study was to determine diastolic function abnormalities in RA patients and to make a reevaluation of diastolic function after 5 years of follow-up. Seventy-two RA patients (mean age: 48+/-11 years, F/M: 62/10) without any known cardiac disease and 67 controls (mean age: 46+/-11 years; F/M: 53/14) were recruited. Disease activity score (DAS), lipid values, and C-reactive protein (CRP) levels were determined. Left ventricular mass, isovolumetric relaxation time, mitral annular early (E), and late (A) diastolic filling rate were determined by M-mode two-dimensional color Doppler echocardiography. Mitral annular early (E') and late (A') diastolic velocities were also evaluated by tissue Doppler echocardiography. Twenty-four RA patients were reevaluated after 5 years of follow-up with DAS, biochemical variables, and echocardiography. Fifty five of 72 (76%) RA patients and 12 of the 67 (18%) controls had diastolic dysfunction (DD). Seven of ten patients with DD at baseline continued to have DD, whereas three did not show DD at 5 years. Six of 14 patients without DD at baseline developed DD at follow-up, while eight patients sustained normal diastolic function. Although DAS and lipid values were not altered during the course of 5 years, CRP levels decreased significantly (P<0.05). In conclusion, RA patients have diastolic function abnormalities compared to healthy controls. Five-year follow-up of a subgroup of our patients showed that, although clinical response was unsatisfactory, cardiac function was conserved without a major deterioration. Moreover, DMARDs, such as anti-TNFalpha agents, do not seem to have a major adverse effect on cardiac findings in these patients.

Aim: To assess the role of echo-Doppler ultrasonography in postprandial hyperemia in cirrhotic patients by comparing the results with the hepatic vein catheterization technique., Methods: Patients with cirrhosis, admitted to the portal hemodynamic laboratory were included into the study. After an overnight fast, echo-Doppler ultrasonography (basal and 30 min after a standard meal) and hemodynamic studies by hepatic vein catheterization (basal, 15 min and 30 min after a standard meal) were performed. Ensure Plus (Abbot Laboratories, North Chicago, IL) was used as the standard liquid meal. Correlation analysis of the echo-Doppler and hepatic vein catheterization measurements were done for the basal and postprandial periods., Results: Eleven patients with cirrhosis (5 Child A, 4 Child B, 2 Child C) were enrolled into the study. After the standard meal, 8 of the 11 patients showed postprandial hyperemia with increase in portal blood flow, portal blood velocity and hepatic venous pressure gradient. Hepatic venous pressure gradient in the postprandial period correlated positively with postprandial portal blood velocity (r = 0.8, P < 0.05) and correlated inversely with postprandial superior mesenteric artery pulsatility index (r = -1, P < 0.01)., Conclusion: Postprandial hyperemia can be efficiently measured by echo-Doppler ultrasonography and the results are comparable to those obtained with the hemodynamic studies.

Background: Increased concentrations of serum C-reactive protein (CRP) have been reported to predict major cardiovascular events in patients with coronary artery disease (CAD). Increased concentrations of endothelin-1 (ET-1) are also associated with poor prognosis after myocardial infarction., Hypothesis: We tested the hypothesis that ET-1 might contribute to CRP in prediction of adverse outcome in CAD., Methods: Serum high sensitive CRP and plasma ET-1 levels of 40 patients who have stable CAD and 25 control subjects were measured, and correlation analysis between these molecules was performed., Results: Mean high sensitive CRP was 8.64 +/- 12.73 mg/l, and mean ET-1 was 8.24 +/- 7.06 pg/ml in the CAD group. We found that there was no statistically significant correlation between high sensitive CRP and ET-1 in either CAD group (p = 0.82), or the control group (p = 0.85). In a subgroup of 13 patients who were not under statin treatment, we found a strong correlation between the levels of these molecules (p = 0.01)., Conclusion: Our study does not clearly support or exclude a link between CRP and ET-1 in patients who have stable CAD., (2007 S. Karger AG, Basel)

Background: Patients with conduction abnormalities may have abnormal images on perfusion scintigraphy without evidence of coronary artery disease (CAD). Based on the presence of left ventricular perfusion abnormalities in left bundle branch block and taking advantage of the Tc-99m sestamibi for the assessment of myocardial perfusion of both ventricles, we aimed to evaluate right (RV) and left (LV) myocardial perfusion in patients with right bundle branch block (RBBB)., Methods: This study included 21 patients with RBBB and 21 control subjects without conduction abnormality. None had previous myocardial infarction, known CAD, left ventricular hypertrophy, LVEF <55%, congenital, pulmonary or valvular heart disease. Rest and stress SPECT images were obtained using 1-d Tc-99m sestamibi SPECT protocol. Regional perfusion of LV and RV myocardium was semiquantitatively evaluated. Also, RV/LV uptake ratio was calculated in two different ways., Results: In patients with RBBB, the normality ratios of RV and LV myocardial perfusion were very high (both 90.5%) and not different from those of patients with normal intraventricular conduction. In the comparison of RV/LV uptake ratios, no significant difference was found between the RBBB and control groups., Conclusions: LV perfusion, RV perfusion or R-to-L perfusion ratio were not significantly influenced by the conduction abnormality in this selected patient population with RBBB. Tc-99m sestamibi myocardial scintigraphy could help in the exclusion of myocardial ischemia in patients with RBBB.

Background: Patients with end-stage renal disease have a high risk of premature death, which is due mainly to cardiovascular (CV) events. Elevated cardiac troponin T (cTnT) is related to increased left ventricular mass index (LVMI) and predicts poor outcome in chronic haemodialysis patients. We investigated the prognostic value of cTnT and its relationship with left ventricular mass in continuous ambulatory peritoneal dialysis (CAPD) patients., Methods: Sixty-five CAPD patients (mean age: 56+/-12 years; 36% males) with no evidence of acute coronary syndrome in 28 days prior to the study were examined prospectively. After 48 months of follow-up, we evaluated total and CV mortality., Results: During follow-up, 23 patients (35%) died (70% CV causes, 22% infection, 4% tumour, 4% unknown). In univariate analysis, concentrations of cTnT >/=0.035 ng/ml, increased LVMI, diabetes, serum albumin and age were all strong predictors of total mortality. In multivariate logistic regression analysis, cTnT >/=0.035 ng/ml and age independently predicted total mortality [odds ratio (OR): 4.31; 95% confidence interval (95% CI): 1.16-16.04; P = 0.008 and OR: 1.08; 95% CI: 1.02-1.15; P = 0.002, respectively]. cTnT level >/=0.035 ng/ml was the only independent predictor of CV mortality in multivariate logistic regression analysis (OR: 8.94; 95% CI: 2.23-35.88; P<0.005). There was a significant positive correlation between serum cTnT level and LVMI (rho = 0.41; P<0.002). Neither cTnI, CK nor CK-MB were related to total or CV mortality., Conclusions: Elevated serum cTnT but not cTnI predicted total and CV mortality in CAPD patients. Elevated cTnT levels were also associated with increased LVMI.

Prolongation of repolarization dispersion (QT interval dispersion) measured from the 12-lead surface ECG has been associated with sudden cardiac death and ventricular tachyarrhythmias in a variety of cardiac disorders. The aim of our study was to assess the effects of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) on QT dispersion in end-stage renal disease patients. 20 chronic HD patients (mean age 57.75 +/- 13.79 years) and 20 CAPD patients (mean age 50.79 +/- 14.94 years) who had no complaints and symptoms of cardiac arrhythmias as well as 20 healthy volunteers (mean age 48.74 +/- 10.88 years) underwent ECG testing. All HD patients were on bicarbonate three times weekly with cuprophane capillaries. 12-lead ECGs were recorded on the day after HD. The CAPD patients were on a standard CAPD program (four times daily with 2,000 cm(3) peritoneal fluid). ECGs were recorded when the patients were receiving their regular standard CAPD program. All ECGs were analyzed manually by one observer. There were no statistically significant differences in dialysis duration, blood urea nitrogen, creatinine, sodium, calcium, and parathormone values between the HD and CAPD patients. The serum potassium values were significantly higher in HD patients when compared to CAPD patients. There was no difference in the mean of maximal QT among all three groups. The rate of QT interval dispersions was significantly higher in HD and CAPD patients as compared with healthy controls (p < 0.05). There was no statistically significant difference in the QT dispersion rates between HD and CAPD patients. In conclusion, there is a tendency to cardiac arrhythmias in HD patients during the postdialysis period. Although CAPD patients are receiving dialysis daily, they also have higher rates of QT dispersions and accordingly a tendency to arrhythmias., (Copyright 2002 S. Karger AG, Basel)

Objective: To assess the frequency and clinical relevance of anticardiolipin antibodies (aCL) in Behçet's disease (BD)., Methods: IgG, IgM and IgA aCL isotypes were investigated by ELISA in 128 patients with BD, 143 healthy controls and 20 systemic lupus erythematosus (SLE) patients., Results: The IgA binding index (BI) was slightly elevated in BD compared with healthy controls (120+/-53 vs 107+/-46, P=0.02), whereas IgG and IgM aCL levels were not significantly different (IgG, BD 2.5+/-2.4 G phospholipid (GPL), healthy controls 2.8+/-3.6 GPL, P=0.6; IgM, BD 0.7+/-0.9 M phospholipid (MPL), healthy controls 0.9+/-1.3 MPL, P=0.6). The frequency of aCL positivity was 7% in BD (IgG 0.8%, IgM 1.6%, IgA 4.6%), 50% in SLE and 5.6% in healthy controls. IgA BI was elevated in the HLA-B5-negative group compared with HLA-B5-positive patients (P<0.005). In a literature review, the frequency of aCL was found to be 9.5% in studies from Turkey compared with 25.5% in other series (P<0.0001)., Conclusion: These results do not suggest a primary role for aCL in BD. A significantly lower frequency of aCL in Turkish BD patients than in other series indicate that regional determinants, whether environmental or genetic, might also play a role in controlling aCL production in BD.

Purpose: The purpose of this study was to compare the measurements of fractional flow reserve of the myocardium (FFRmyo) with results of quantitative coronary angiography (QCA) and stress single-photon emission computed tomography thallium-201 (SPECT 201Tl) imaging in patients with intermediate-severity coronary artery disease (ISCAD)., Methods: We prospectively evaluated 40 lesions of QCA-determined ISCAD in 30 patients (age, 53.3 +/- 10.2 years; 67% male) using a 0. 014 inch pressure wire during elective coronary angiography and compared the results with those of SPECT 201Tl performed within a week of angiography., Results: There was a moderate negative correlation between percent diameter stenosis (%DS) and FFRmyo (53.1 +/- 13.4% and 0.75 +/- 0.09, respectively; r = -0.40; p = 0.01). Twenty-two out of 40 vascular territories (55%) were found to have perfusion defects (Group 1) and 18 territories (45%) were found to be normal (Group 2). While QCA-determined stenosis severity was not different between Group 1 and Group 2 (56 +/- 12% vs. 50 +/- 16%, respectively; p = 0.3), FFRmyo was found to be significantly different between the two groups (0.68 +/- 0.05 vs. 0.83 +/- 0.05, respectively; p = 0.001). When %DS and FFRmyo results were dichotomized as abnormal by 50% and < 0.75, respectively, and SPECT 201Tl was taken as the gold standard, sensitivity, specificity, positive predictive value and negative predictive value of %DS and FFRmyo were 0.55 vs. 0.91, 0.56 vs. 1.0, 0.60 vs. 1.0 and 0.50 vs. 0. 90, respectively., Conclusion: While FFRmyo seems to accurately predict the presence of ischemia on SPECT 201Tl in patients with ISCAD, QCA does not reliably assess the physiologic impact of the same lesions.

Myocardial fractional flow reserve (FFRmyo) has been demonstrated to be a useful method for determining the physiologic importance of a given coronary lesion. However, the reliability of the FFRmyo measurement is unknown in infarct-related arteries (IRA). The aim of this study was to measure and correlate the FFRmyo results of 14 consecutive patients who had recent acute myocardial infarction (AMI) (Group 1) with 14 consecutive patients who didnOt have AMI (Group 2) before and after percutaneous transluminal coronary angioplasty (PTCA). Quantitative coronary angiography (QCA) and FFRmyo measurements were determined both before and after optimal PTCA for all patients. FFRmyo was measured by use of a 0.014 inch guidewire as the ratio of the pressure distal to the target lesion to the aortic pressure taken during the maximal hyperemia induced by intracoronary adenosine. There were no differences between the two groups related to gender, target artery reference diameter, minimal luminal diameter and percent diameter stenosis of the vessel both before and after PTCA. While FFRmyo results after PTCA were not different between the groups, they were statistically different before PTCA (Group 1: 77.6+/-5.4%, Group 2: 63.3+/-8.4%; p<0.001). Although QCA-determined percent diameter stenosis revealed a significant degree of stenosis (66.5+/-10.5%) for Group 1, FFRmyo values were higher than 75% (77.6+/-5.4%), indicating insignificant stenosis. Thus, it was concluded that FFRmyo measurements before PTCA were significantly different between IRA and non-IRA and that the method may not be valid for the determination of stenosis significance in IRA.

BACKGROUND: Propafenone has been claimed to be effective in converting atrial fibrillation and flutter to sinus rhythm; however, controlled clinical trials have reported variable results, and data about the safety of propafenone in the setting of heart failure are lacking. The aim of the present study was to evaluate the efficacy and safety of intravenous propafenone in converting atrial fibrillation and flutter to sinus rhythm. METHODS: Sixty patients with acute (<72 h) or chronic atrial fibrillation or flutter were included in a randomized, placebo-controlled, conditional cross-over study. Twenty eight patients, of whom 12 were in New York Heart Association class III and IV, had heart failure. Patients received intravenous propafenone (2 mg/kg in 10 minutes) and placebo subsequently at 1 hour intervals if sinus rhythm was not achieved. The patients' rhythms were continuously monitored for 1 hour and a 12-lead electrocardiogram, a 1-minute continuous rhythm strip and vital signs were recorded at baseline and at 15, 30, 45, and 60 minutes after the administration of each drug. RESULTS: Twenty of teh 59 patients (34%) treated with propafenone converted to sinus rhythm, while only 4 of the 50 patients (8%) treated with placebo converted (P <.001). Propafenone was more effective in patients with acute (<72 h) atrial fibrillation (64.5%). The conversion rate with propafenone was not significantly different from placebo in patients with atrial flutter and chronic atrial fibrillation (>72 h). Propafenone significantly decreased (P <.005 vs placebo) mean ventricular rate in nonresponders with a baseline heart rate of more than 100 beats/min. No clinically significant adverse effect occurred. CONCLUSIONS: We conclude that intravenous propafenone treatment is effective for converting acute atrial fibrillation; however, it seems unlikely to be beneficial in atrial flutter and chronic atrial fibrillation. Propafenone decreases ventricular rate in nonresponders, and a single dose of propafenone is relatively safe even in moderate-to-severe heart failure.