Evolution of Brain Morphology in Spontaneously Hypertensive and Wistar-Kyoto Rats From Early Adulthood to Aging: A Longitudinal Magnetic Resonance Imaging Study

The influence of hypertension and aging alone on brain structure has been described extensively. Our understanding of the interaction of hypertension with aging to brain morphology is still limited. We aimed to detect the synergistic effects of hypertension and aging on brain morphology and to describe the evolution patterns of cerebral atrophy from spatial and temporal perspectives. In 8 spontaneously hypertensive rats (SHRs) and 5 Wistar-Kyoto rats, high-resolution magnetic resonance imaging scans were longitudinally acquired at 10, 24, 52, and 80 weeks. We analyzed the tissue volumes of gray matter, white matter, cerebral spinal fluid, and total intracranial volume (TIV), and then evaluated gray matter volume in detail using voxel-based morphometry (VBM) and region of interest-based methods. There were interactive effects on hypertension and aging in tissue volumes of gray matter, white matter, and TIV, of which gray matter atrophy was most pronounced, especially in elderly SHRs. We identified the vulnerable gray matter volume with combined effects of hypertension and aging in the septal region, bilateral caudate putamen, hippocampus, primary somatosensory cortex, cerebellum, periaqueductal gray, right accumbens nucleus, and thalamus. We automatically extracted the septal region, anterior cingulate cortex, primary somatosensory cortex, caudate putamen, hippocampus, and accumbens nucleus and revealed an inverted-U trajectory of volume change in SHRs, with volume increase at the early phase and decline at the late phase. Hypertension interacts with aging to affect brain volume changes such as severe atrophy in elderly SHRs.

Evaluation of the antiischemic effect of a prolonged form of trimetazidine in patients with stable angina pectoris using speckle-tracking technique

Studies of global and segmental myocardial contractility using the speckle-tracking technique in patients suffering from stable angina pectoris compared to healthy individuals are presented. It was revealed that, in patients suffering from stable angina pectoris, the values of longitudinal deformation in the anterolateral and apical segments of the left ventricle, as well as global longitudinal deformation, decrease. Differences in longitudinal myocardial deformation in other segments were not observed in the subjects. Possible causes of a decrease in the longitudinal deformation of the myocardium, both in general and in individual segments of the left ventricle, are examined. The data on longitudinal segmental deformity of the left ventricle on the background of anti-ischemic therapy are presented. A direct correlation between the values of the global longitudinal deformation and the distance traveled by patients before the development of an angina attack was revealed.In addition, a direct correlation was found between the longitudinal deformation of the myocardium in the anterior septal region of the left ventricle and exercise tolerance. Adding a prolonged form of trimetazidine to complex anti-ischemic therapy leads to a significant increase in segmental and global deformity of the left ventricle, which is accompanied by a decrease in the daily need for nitroglycerin and an increase in exercise tolerance. The lack of dynamics of the longitudinal strain in the basal parts of the left ventricle during treatment may be due to the development of cardiosclerosis.

Atypical location of Coumel Tachycardia in Adult: Case Report

Coumel Tachycardia or Incessant Junctional Reentrant (IJRT) generally affects the infant-juvenile population and is characterized by tachycardia due to atrioventricular reentry (AV) mediated by an exclusive, slow, decremental retrograde conduction pathway mostly located in the posterosseptal region of the tricuspid ring. Case report: The present study reported the case of an adult, 49 years old, with IJRT of atypical location. The patient reported feeling palpitations for 5 years with worsening in the last 6 months. After one of his seizures, an electrocardiogram (ECG) documented tachycardia due to AV reentry with a long RP ‘interval. Subjected to an electrophysiological study, an accessory pathway of exclusive retrograde conduction with decreasing characteristics was observed, located in the right mid-septal region. There was easy induction of IJRT, remaining sustained throughout the study. A radiofrequency ablation was performed in the mid-septal D region with interruption of tachycardia, with no more atrioventricular retrograde conduction, the procedure ended without complications. Discussion: Interestingly, the case described differs both in terms of the age range of the most frequent involvement of the IJRT (children and young people), as well as the most common location of the accessory pathway (posterior and postero-septal region of the tricuspid ring). Ablation proved to be effective in this case and is the treatment of choice for IJRT despite the anomalous location of the accessory pathway (Middle-septal D: described in bibliographic reviews in only 7% of IJRT cases) and a potentially dangerous region due to proximity to the trunk of the His beam.

Transseptumpellucidumrostrostomy: anatomical considerations and neuroendoscopic approach

PURPOSE: Verify the presence of the rostral lamina of the corpus callosum, and set parameters for neuroendoscopy. METHODS: Relationship of the floor of the frontal horn of lateral ventricle and the hypothalamic-septal region were studied after sagittal and axial sections of the brains. Measurements were compared using F and Student t tests. The correlations between anterior-posterior diameter of the interventricular foramen / anterior-posterior diameter of the fornix column, and between anterior-posterior diameter of the interventricular foramen / length of the rostral lamina were performed by Pearson index test. RESULTS: There was no statistically significant difference in measurements performed in both hemispheres (p<0.05). Positive correlations were observed between the anterior-posterior diameter of the interventricular foramen / anterior-posterior diameter of the fornix column (R = 0.35), and between the anterior-posterior diameter of the interventricular foramen / length of the rostral lamina (R = 0.23). CONCLUSION: Rostral lamina was observed in all brains. It was possible to perform an endoscopic fenestration in the rostral lamina, communicating safely the lateral ventricle with a polygonal subcallosal cistern.

Septal Vein Symmetry: Implications for Endoscopic Septum Pellucidotomy

ABSTRACT BACKGROUND: Endosopic septum pellucidotomy is used for treating patients with unilateral and specific types of bilateral hydrocephalus. The ideal location for septostomy is controversial; however, an avascular region is preferred. OBJECTIVE: As the septal veins (SVs) are viewed only from one side, we studied the symmetry of the SVs in an attempt to define a safe area for septostomy. METHODS: Sixteen cadaver brains were dissected. The septum pellucidum was exposed bilaterally and divided into 3 regions. SVs of both sides were evaluated according to number, size, distribution, and location relative to common markers on both sides. RESULTS: Each side included 1 to 7 large veins (mean ± standard deviation, 2.3 ± 1.4), 0 to 3 small veins (2.05 ± 1.73), and a total of 2 to 7 veins (4.35 ± 1.53). Of the large veins, 88% were located in the anterior septal region (anterior to the foramen of Monro). Among the 10 brains that were extensively dissected, 90% had asymmetric SVs (either in the number of large veins or in the existence of any veins) in at least 1 of the septal regions, and 50% of brains had asymmetric SVs in the anterior region. CONCLUSION: Distribution of the SVs is asymmetric in most cases. We recommend septostomy be performed at the anterior area of the middle septal region, at the level of the foramen of Monro, mid-height between the corpus callosum and fornix. Careful evaluation of preoperative images and thorough coagulation at the septostomy site are essential to avoid injury to a contralateral large SV.