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Michael T Yen
PURPOSE OF REVIEW: To review new developments in the medical and surgical treatment options for benign essential blepharospasm (BEB). RECENT FINDINGS: Botulinum toxin injections remain the mainstay treatment for BEB with several formulations currently commercially available. Reports in the medical literature support photochromatic modulation for the symptoms of photophobia, as well as oral medications and surgical myectomy for control of the motor signs of eyelid protractor spasm...
June 18, 2018: Current Opinion in Ophthalmology
Yuichiro Maekawa, Keitaro Akita, Shuichiro Takanashi
Hypertrophic cardiomyopathy (HCM) is a complex and relatively common genetic cardiac disease that has been the subject of intense investigation for over 50 years. Most patients with HCM are asymptomatic, but some develop symptoms, often many years after the appearance of electrocardiographic or echocardiographic evidence of left ventricular hypertrophy. Symptoms due to the left ventricular outflow tract obstruction frequently worsen over time, requiring septal reduction therapy (SRT) despite optimal medical therapy...
June 15, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Peter Magnusson, Fredrik Gadler, Stellan Mörner
Hypertrophic cardiomyopathy is the most common cardiogenetic disease affecting 1/500-1/1 000 individuals. Dyspnea is common but chest pain, dizziness or fainting may also cause considerable limitation for the patient. The diagnosis can be suspected from ECG. Echocardiography confirms hypertrophy of at least 15 mm, usually in the septum. If the obstruction of the outflow tract is severe, myectomy or alcohol ablation can relieve symptoms. Genetic evaluation of family members is advisable. To reduce symptoms, betablockers are used; verapamil or disopyramide are alternatives...
June 11, 2018: Läkartidningen
Long Deng, Xueying Huang, Chun Yang, Bin Lyu, Fujian Duan, Dalin Tang, Yunhu Song
BACKGROUND: The hydrodynamic mechanisms of systolic anterior motion (SAM) of the mitral valve in hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. METHODS: Based on computed tomography (CT) images and clinical data, pre- and post-operative computational models of the left ventricle were constructed for 6 HOCM patients receiving septal myectomy. SAM was abolished in 5 patients and persisted in one after septal myectomy surgery. The obtained simulation results including flow field of the left ventricle and mechanical behaviors of the mitral valve (MV) between pre- and post-operative FSI models were compared...
September 1, 2018: International Journal of Cardiology
R A Collis, M S Rahman, O Watkinson, O P Guttmann, C O'Mahony, P M Elliott
BACKGROUND: Left ventricular outflow tract obstruction (LVOTO) causes exertional symptoms in two thirds of patients with hypertrophic cardiomyopathy (HCM). Consensus guidelines recommend surgical intervention in patients with drug refractory symptoms. The primary aim of this study was to perform a systematic review and meta-analysis to determine morbidity and mortality after surgery. METHODS: Study Selection: Studies reporting outcomes following surgical intervention for symptomatic LVOTO in HCM...
August 15, 2018: International Journal of Cardiology
Takashi Toyonaga, Yoshiko Ohara, Shinichi Baba, Hiroshi Takihara, Manabu Nakamoto, Hitoshi Orita, Junji Okuda
BACKGROUND:  Although endoscopic submucosal dissection has enabled complete tumor resection and accurate pathological assessment in a manner that is less invasive than surgery, the complete resection of lesions with severe fibrosis in the submucosal layer and exhibiting the muscle-retracting sign is often difficult. We have devised a new method, peranal endoscopic myectomy (PAEM), for rectal lesions with severe fibrosis, in which dissection is performed between the inner circular and outer longitudinal muscles, and have examined the usefulness and safety of this new technique...
June 8, 2018: Endoscopy
Yajie Tang, Yunhu Song, Fujian Duan, Long Deng, Jun Ran, Ge Gao, Sheng Liu, Yun Liu, Hao Wang, Shihua Zhao, Shengshou Hu
OBJECTIVES: Surgical strategies for patients with midventricular obstruction remain underappreciated. We sought to assess clinical and haemodynamic results, summarize the surgical technique of extended myectomy and provide reliable pre- and intraoperative methods of evaluating patients with midventricular obstruction. METHODS: The preoperative evaluation process, intraoperative surgical strategy and early outcomes were thoroughly reviewed in 40 patients with midventricular obstruction...
June 2, 2018: European Journal of Cardio-thoracic Surgery
Kenneth A Mayuga, Natalie Ho, Robert W Shields, Paul Cremer, L Leonardo Rodriguez
A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS) after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve...
2018: Case Reports in Cardiology
Yeon Woong Chung, Jun Sub Choi, Sun Young Shin
BACKGOUND: To identify and compare specific protein levels between overacting inferior oblique (IO) muscles in superior oblique (SO) palsy patients and normal IO muscles. METHODS: We obtained 20 IO muscle samples from SO palsy patients with IO overaction ≥ + 3 who underwent IO myectomies (IOOA group), and 20 IO samples from brain death donors whose IO had functioned normally, according to their ophthalmological chart review (control group). We used MyoD for identifying satellite cell activation, insulin-like growth factor binding protein 5 (IGFBP5) for IGF effects, thioredoxin for oxidative stress, and p27 for satellite cell activation or oxidative stress in both groups...
May 30, 2018: BMC Ophthalmology
Gabriela Dostalova, Zuzana Hlubocka, Jaroslav Lindner, Helena Hulkova, Helena Poupetova, Hana Vlaskova, Jakub Sikora, Ales Linhart, Jiri Zeman, Martin Magner
Mucopolysaccharidosis type IVB (MPS IVB) is a very rare lysosomal storage disorder characterized by skeletal dysplasia, hearing disorder, and cardiac valvular disease. Herein, we report an extremely rare manifestation of MPS IVB in a 60-year-old female patient who underwent a successful aortic valve replacement. The patient presented with mild coarse facial features, short stature, mild dyspnea, sternal protrusion, mild lumbar hyperlordosis, and waddling gait owing to bilateral femoral head necroses and bilateral arthrosis of the knees...
April 12, 2018: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Jin-Soo Kim, Han Bum Joe, Myong Chul Park, Hyoeun Ahn, Sook Young Lee, Yun Jeong Chae
BACKGROUND AND OBJECTIVES: Unipolar sternocleidomastoid release with myectomy (USRM) for correction of congenital muscular torticollis in pediatric patients produces moderate to severe postoperative pain. The objective of this trial was to examine the effect of ultrasound-guided intermediate cervical plexus block on postoperative pain after USRM. METHODS: Thirty-two patients (1-7 years old) were enrolled in this parallel-group, patient- and observer-blinded, randomized controlled trial...
May 17, 2018: Regional Anesthesia and Pain Medicine
Nicolás M Maneiro-Melón, Miguel González-Barbeito, Francisco Estévez-Cid, Jesús Peteiro-Vázquez, José J Cuenca-Castillo, Roberto Barriales-Villa
No abstract text is available yet for this article.
May 15, 2018: Revista Española de Cardiología
Hartzell V Schaff, Anita Nguyen
No abstract text is available yet for this article.
April 25, 2018: Journal of Thoracic and Cardiovascular Surgery
Hubert Seggewiß, Angelika Koljaja-Batzner, Kornelia Seggewiß, Malte Meesmann
Hypertrophic cardiomyopathy is the most common genetic cardiac disease. The most important pathophysiological finding is dynamic (outflow tract) obstruction of the left ventricle in about 70% of affected patients. Especially in younger patients, an increased risk of sudden cardiac death has been observed. Syncope and presyncope-in addition to extremely variable cardiac symptoms (dyspnea and angina)-are common. The etiology of syncope is complex. The most important aspect for diagnosis is a detailed history regarding the accompanying circumstances of the syncope...
May 14, 2018: Herzschrittmachertherapie & Elektrophysiologie
Howard K Song, Jason Turner, Rebekah Macfie, Suwen Kumar, Meghan J Mannello, Danielle Smith, Castigliano Bhamidipati, Jaishankar Raman, Frederick Tibayan, Stephen B Heitner
BACKGROUND: Septal myectomy has been the mainstay of the surgical treatment of obstructive hypertrophic cardiomyopathy (HCM), however recently there is growing appreciation for associated mitral valve abnormalities that contribute to left ventricular outflow tract (LVOT) obstruction. In this study, we describe our experience with combined papillary muscle realignment (PMR) and septal myectomy for the treatment of obstructive HCM. METHODS: We identified 44 patients undergoing surgery for obstructive HCM whose anatomy was amenable to combined PMR and septal myectomy at our institution over a 20-month period...
May 10, 2018: Annals of Thoracic Surgery
Angelos G Rigopoulos, Stefanos Sakellaropoulos, Muhammad Ali, Sophie Mavrogeni, Athanassios Manginas, Matthias Pauschinger, Michel Noutsias
Transcatheter alcohol septal ablation (ASA) treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) is based on the existence and degree of intraventricular obstruction. Patients with significant gradient and symptoms who do not respond to optimal medical therapy are eligible to gradient reduction through a surgical (septal myectomy) or a transcatheter (alcohol septal ablation) septal reduction. The latter encompasses occlusion of a septal branch perfusing the hypertrophied septum, which is involved in the generation of obstruction, by injecting ethanol into the supplying septal branch(es)...
May 8, 2018: Heart Failure Reviews
Milind Y Desai, Nicholas G Smedira, Ashwat Dhillon, Ahmad Masri, Oussama Wazni, Mohamad Kanj, Kimi Sato, Maran Thamilarasan, Zoran B Popovic, Harry M Lever
BACKGROUND: In patients with hypertrophic cardiomyopathy (HCM), the use of an implantable cardioverter defibrillator (ICD) can prevent sudden cardiac death (SCD). In patients with obstructive HCM, we sought to determine the prognostic utility of European Society of Cardiology (ESC) SCD risk score and to evaluate whether additional factors modulate SCD risk. METHODS: We studied 1809 consecutive patients with obstructive HCM (mean age, 50 ± 14 years; 63% males; mean maximal outflow tract gradient, 93 ± 40 mm Hg)...
April 12, 2018: Journal of Thoracic and Cardiovascular Surgery
A Villepelet, A Jafari, B Baujat
The demand for facial feminization is increasing in transsexual patients. Masculine foreheads present extensive supraorbital bossing with a more acute glabellar angle, whereas female foreheads show softer features. The aim of this article is to describe our surgical technique for fronto-orbital feminization. The mask-lift technique is an upper face-lift. It provides rejuvenation by correcting collapsed features, and fronto-orbital feminization through burring of orbital rims and lateral canthopexies. Depending on the size of the frontal sinus and the thickness of its anterior wall, frontal remodeling is achieved using simple burring or by means of the eggshell technique...
May 4, 2018: European Annals of Otorhinolaryngology, Head and Neck Diseases
Anita Nguyen, Hartzell V Schaff, Rick A Nishimura, Joseph A Dearani, Jeffrey B Geske, Brian D Lahr, Steve R Ommen
BACKGROUND: In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality due to risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs following septal myectomy. METHODS: Between March 2007 and July 2015, 656 patients underwent myectomy at our institution and had pre- and postoperative transthoracic echocardiographic (TTE) recording of LA volume index (LAVI)...
April 18, 2018: Annals of Thoracic Surgery
Praveen Kerala Varma, Neethu Krishna, Hisham Ahamed, Sujatha Madassery
Anomalies of the mitral valve apparatus in hypertrophic cardiomyopathy are an important cause of systolic anterior motion. Patients with significant residual obstruction due to systolic anterior motion after myectomy and anterior mitral leaflet plication may end up having mitral valve replacement. We describe the case of a 52-year-old man who underwent posterior mitral leaflet plication to correct residual systolic anterior motion after anterior mitral leaflet plication.
January 1, 2018: Asian Cardiovascular & Thoracic Annals
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