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Selected AbstractsLaparoscopic Heller myotomy with Dor fundoplication for achalasia: long-term outcomes and effect on chest painDISEASES OF THE ESOPHAGUS, Issue 4 2010A. Sasaki SUMMARY The aim of the present study was to evaluate the long-term outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD) and its effect on chest pain. Between June 1995 and August 2009, a total of 35 patients with achalasia underwent an LHD. The symptom scores were calculated by combining the frequency and the severity. Pre- and postoperative evaluations included symptom score, radiology, manometry, and 24-hour pH manometry. Median total symptom score was significantly lower than the preoperative score (19 vs 4, P < 0.001) at a median follow-up of 94 months. Among the 35 patients, 18 (51%) had chest pain. The frequency of chest pain was similar for the pre- and postoperative scores, but the severity tended to be less. Median esophageal diameter (5.4 cm vs 3.5 cm, P < 0.001) and lower esophageal sphincter pressure (41 mmHg vs 8.9 mmHg, P < 0.001) were significantly reduced after surgery. Median age, duration of symptoms, esophageal diameter, and lower esophageal sphincter pressure were similar between patients with and without chest pain prior to surgery. No significant differences were observed between the two groups in terms of amplitude, duration, and frequency of contractions from the findings of postoperative 24-hour esophageal manometry. Chest pain resolved in three patients (17%) and improved in seven patients (39%) after surgery. LHD can durably relieve achalasic symptoms of both dysphagia and regurgitation, and it can be considered the surgical procedure of choice. However, achalasic chest pain does not always seem to be related with patient characteristics and manometric findings. [source] Who merits a neck dissection after definitive chemoradiotherapy for N2,N3 squamous cell head and neck cancer?HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2003Scott A. McHam DO Abstract Background. The role of neck dissection (ND) after definitive chemoradiotherapy for squamous cell head and neck cancer is incompletely defined. We retrospectively reviewed 109 patients with N2,N3 disease treated with chemoradiotherapy to identify predictors of a clinical complete response in the neck (CCR-neck), pathologic complete response after ND (PCR-neck), and regional failure. Method. All patients were given 4-day continuous infusions of 5-fluorouracil (1000 mg/m2/d) and cisplatin (20 mg/m2/d) during the first and fourth weeks of either once daily (n = 68) or twice daily (n = 41) radiation therapy. ND was considered for all patients after completion of chemoradiotherapy and was performed in 32 of the 65 patients achieving a CCR-neck after chemoradiotherapy and in all 44 patients with residual clinical evidence of neck disease. CCR-neck, PCR-neck, and regional failure were then correlated with potential predictors, including T, N, largest lymph node size (<3 cm, ,3 cm), primary tumor site, and radiation fractionation schedule. Results. Achievement of a CCR-neck was predicted by N, N2 vs N3 (53 of 80 vs 12 of 29, p = .019) and by largest lymph node size, <3 cm vs ,3 cm (19 of 25 vs 46 of 84, p = .06). Achievement of a PCR-neck could not be predicted by any clinical parameter. Regional failure occurred both in patients undergoing ND and those not dissected (5 of 76 vs 4 of 33, p = .33) and proved more likely only in the ND patients with residual positive pathology compared with those achieving a PCR-neck (5 of 25 vs 0 of 51, p < .001). Primary site was not a useful predictor of CCR-neck, PCR-neck, or regional failure. Most importantly, CCR-neck (vs Cognitive and Mobility Profile of Older Social DancersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2006Joe Verghese MD OBJECTIVES: To define the cognitive and physical attributes of regular social dancing so as to help establish its health benefits and help plan future dance interventions to prevent adverse outcomes in older adults such as falls, slow gait, and dementia. DESIGN: Cross-sectional survey with two-group comparison. SETTING: Bronx County, New York. PARTICIPANTS: Twenty-four cognitively normal older social dancers (OSDs) were compared with 84 age-, sex-, and education-matched older nondancers (ONDs) participating in a community-based study. MEASUREMENTS: Motor and cognitive performance was assessed using validated clinical and quantitative methods. RESULTS: There were no differences in the frequency of participation in other cognitive and physical leisure activities, chronic illnesses, or falls between OSDs and ONDs. Cognitive test performance was not different between OSDs and ONDs. OSDs had better balance but not strength than ONDs. OSDs had a longer mean stride±standard deviation than ONDs (117.8±10.5 cm vs 103.4±20.2 cm, P=.008) on quantitative gait assessment, with a more stable pattern during walking with reduced stance time (63.9% vs 65.9%, P=.01), longer swing time (36.1% vs 34.1%, P=.01), and shorter double support time (27.9% vs 30.9%, P=.03). CONCLUSION: The results of this study suggest that long-term social dancing may be associated with better balance and gait in older adults. [source] The response of Crohn's strictures to endoscopic balloon dilationALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2010T. MUELLER Aliment Pharmacol Ther,31, 634,639 Summary Background, Endoscopic balloon dilation has been shown to be an alternative to surgery in the treatment of Crohn's symptomatic strictures. Aim, To analyse the impact of the type of the strictures ,de novo or anastomotic , their location and their length on the outcome of endoscopic balloon dilation. Methods, Between December 1999 and June 2008, 55 patients underwent 93 balloon dilations for 74 symptomatic strictures. One stricture was located in the duodenum, 39 strictures were in the terminal ileum, 17 at the ileocoecal anastomosis after a preceding resection and 17 in the colon. Results, Endoscopic treatment was successful in 76% of the patients during an observation period of 44 (1,103) months. Of the patients, 24% required surgery. All patients who underwent surgery had de novo strictures in the terminal ileum. These strictures were significantly longer compared with the ileal strictures that responded to endoscopic treatment [7.5 (1,25) cm vs. 2.5 (1,25) cm; P = 0.006]. Conclusions, The long-term success of endoscopic balloon dilation depends on the type of the strictures, their location and their length. Failure of endoscopic treatment was observed only in long-segment strictures in the terminal ileum. [source] Anterior Mitral Valve Length is Associated with Ventricular Tachycardia in Patients with Classical Mitral Valve ProlapsePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2010MURAT AKCAY M.D. Background: The aim of this study was to investigate the electrocardiographic and echocardiographic predictors of ventricular tachycardia (VT) in patients with classical mitral valve prolapse (MVP). Methods: Thirty patients (nine men and 21 women; mean age, 41.5 ± 15 years) in sinus rhythm with mitral valve prolapse who had VT in 24-hour Holter analysis and 30 patients with MVP without VT (eight men and 22 women; mean age, 43 ± 16 years) were included in this study. Transthoracic echocardiography, QT analyses from 12-lead electrocardiography, and 24-hour Holter electrocardiogram recordings were performed. Results: Mitral posterior leaflet thickness (0.48 ± 0.03 cm vs 0.43 ± 0,08 cm, P = 0.025), mitral anterior leaflet length (3.2 ± 0.24 cm vs 2.9 ± 0.36, P < 0.001), mitral posterior leaflet length (2.2 ± 0.3 cm vs 1.9 ± 0.35 cm, P = 0.01), left atrium anteroposterior diameter (4.2 ± 0.8 cm vs 3.5 ± 0.5 cm, P = 0.001), and mitral annulus circumference (15.7 ± 1.3 cm vs 14.6 ± 1.6 cm, P = 0.004) were increased significantly in MVP cases with VT. No significant difference was found between the cases with and without VT in terms of frequency- and time-domain analysis. QT dispersion (72 ± 18 ms vs 55 ± 15 ms, P = 0.0002) and corrected QT dispersion (QTcD) (76 ± 18 ms vs 55 ± 15 ms, P = 0.0002) were significantly increased in cases with VT compared with those without VT. Based on logistic regression analysis for MVP cases, in the case of VT, an enhancement in QTcD (P = 0.01) and the mitral anterior leaflet length (P = 0.003) were the independent predictors of VT. Conclusion: Mitral anterior leaflet length and enhanced QTcD are closely related with VT in patients with classical MVP. (PACE 2010; 33:1224,1230) [source] Effect of Oxytocin Treatment on Artificial Insemination with Frozen,Thawed Semen in Murciano,Granadina GoatsREPRODUCTION IN DOMESTIC ANIMALS, Issue 4 2009MP Viudes-de-Castro Contents The site where the semen is deposited appears to be one of the most important factors affecting pregnancy of inseminated goats. In Murciano,Granadina (MG) goats, post-cervical insemination is achieved in a limited number of females. An effective way to increase fertility rate could be by increasing post-cervical inseminations. Effect of exogenous oxytocin application to facilitate the cervical penetration and its effect on kidding rate and prolificacy in MG goats were investigated. Oestrus was synchronized using progesterone-impregnated sponges for 11 days. Females were randomly divided into three groups (n = 190) and received either an i.v. injection of 100 or 200 IU of oxytocin or saline solution 15 min before being inseminated. Data on semen deposition depth were recorded for each animal using a catheter scaled in centimetres (up to 4 cm). Depth of semen deposition was affected by the oxytocin treatment (p < 0.05). Oxytocin enhanced cervical passage only with the dose of 200 IU compared with the control group, increasing the deposition depth (2.9 cm vs 1.9 cm). No significant effect of oxytocin treatment on kidding rate and prolificacy was detected. Depth of semen deposition affected kidding rate (p < 0.01). In conclusion, oxytocin treatment improved the depth of semen deposition in AI of MG goats, but kidding rate and prolificacy was not affected. More studies must be conducted to assess the minimal effective dose required for sufficient cervical dilation, and to determine the effects of such doses of oxytocin on uterine motility, sperm transport and fertility in goats. [source] Riparian Forest Restoration: Increasing Success by Reducing Plant Competition and HerbivoryRESTORATION ECOLOGY, Issue 2 2002Bernard W. Sweeney Abstract The reestablishment of riparian forest is often viewed as "best management practice" for restoring stream ecosystems to a quasi-natural state and preventing non-point source contaminants from entering them. We experimentally assessed seedling survivorship and growth of Quercus palustris (pin oak), Q. rubra (red oak), Q. alba (white oak), Betula nigra (river birch), and Acer rubrum (red maple) in response to root-stock type (bare root vs. containerized), herbivore protection (tree shelters), and weed control (herbicide, mowing, tree mats) over a 4-year period at two riparian sites near the Chester River in Maryland, U.S.A. We started with tree-stocking densities of 988/ha (400/ac) in the experimental plots and considered 50% survivorship (i.e., a density of 494/ha [200/ac] at crown closure) to be an "acceptable or minimum" target for riparian restoration. Results after four growing seasons show no significant difference in survivorship and growth between bare-root and containerized seedlings when averaged across all species and treatments. Overall survivorship and growth was significantly higher for sheltered versus unsheltered seedlings (49% and 77.6 cm vs. 12.1% and 3.6 cm, respectively) when averaged across all species and weed control treatments. Each of the five test species exhibited significantly higher 4-year growth with shelter protection when averaged across all other treatments, and all species but river birch had significantly higher survivorship in shelters during the period. Seedlings protected from weeds by herbicide exhibited significantly higher survivorship and growth than seedlings in all other weed-control treatments when averaged across all species and shelter treatments. The highest 4-year levels of survivorship/growth, when averaged across all species, was associated with seedlings protected by shelters and herbicide (88.8%/125.7cm) and by shelters and weed mats (57.5%/73.5 cm). Thus, only plots where seedlings were assisted by a combination of tree shelters and either herbicide or tree mats exhibited an "acceptable or minimum" rate of survivorship (i.e.,>50%) for riparian forest restoration in the region. Moreover, the combined growth and survivorship data suggest that crown closure over most small streams in need of restoration in the region can be achieved most rapidly (i.e., 15 years or less) by protecting seedlings with tree shelters and controlling competing vegetation with herbicides. [source] Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast-conserving therapy at a single institutionCANCER, Issue 4 2004Helen Pass M.D. Abstract BACKGROUND The authors reviewed changes in the initial clinical presentation, management techniques, and patterns of disease recurrence over time (1981,1996) in patients with breast carcinoma treated with breast-conserving therapy (BCT) at a single institution. The goals of the current study were to determine the frequency and use of optimal local and systemic therapy techniques and to evaluate the impact of these changes on treatment efficacy. METHODS Six hundred seven patients with American Joint Committee on Cancer Stage I or II invasive breast carcinomas treated with BCT at William Beaumont Hospital (Royal Oak, MI) constituted the study population. All patients received at least an excisional biopsy of the primary tumor, an axillary lymph node staging procedure, and postoperative radiotherapy (RT) (a median tumor bed dose of 61 Gray [Gy] was administered). All sides were reviewed by one pathologist. Numerous clinicopathologic and treatment-related factors were analyzed to monitor changes that occurred over time. Changes in patterns of disease recurrence and treatment efficacy over time also were analyzed. RESULTS Over the time period analyzed, changes at initial presentation included an increase in the mean age at diagnosis (age 56.1 years vs. 61.4 years; P < 0.001), a decrease in the number of patients with clinically palpable tumors (78% vs. 36%; P < 0.001), a decrease in the mean tumor size (2.2 cm vs. 1.6 cm; P < 0.001), but no change in the percentage of patients with negative lymph nodes (79% vs. 78%; P = 0.83). No differences over time were observed in mean tumor grade (2.0 vs. 1.9; P = 0.2) or the presence of angiolymphatic invasion (27% vs. 26%; P = 0.25). Changes in surgical management and pathologic assessment included the more frequent use of reexcision (46% vs. 81%; P < 0.001), larger mean total volumes of breast tissue specimens excised (115 cm3 vs. 189 cm3; P = 0.001), a larger percentage of patients with final negative surgical margins (74% vs. 97%; P < 0.001), and a small increase in the mean number of lymph nodes excised (13.8 lymph nodes vs. 14.1 lymph nodes; P = 0.01). The only other significant change in the pathologic management of patients over time included a doubling in the mean number of slides examined (10.6 slides vs. 21.1 slides; P < 0.001). Changes in adjuvant local and systemic therapy included an increase in the percentage of patients treated with > 60 Gy to the tumor bed (66% vs. 95%; P < 0.001), a doubling in the mean number of days from the last surgery to the start of RT (24 days vs. 50 days; P < 0.001), and a decrease in the use of regional lymph node RT (24% vs. 8%; P < 0.001). The use of adjuvant tamoxifen increased from 10% to 61% (P < 0.001). Finally, improvements were observed in the 5-year and 12-year actuarial rates of local disease recurrence (8% vs. 1% and 21% vs. 9%, respectively; P = 0.001) and distant metastases (12% vs. 4% and 22% vs. 9%, respectively; P = 0.006). No changes in the mean number of years to ipsilateral (6.5 years vs. 6.4 years; P = 0.59) or distant disease recurrence (4.6 years vs. 3.8 years; P = 0.73) were observed. CONCLUSIONS The impact of screening mammography and substantial changes in surgical, pathologic, RT, and systemic therapy recommendations were observed over time in the study population. These changes were associated with improvements in 5-year and 12-year local and distant control rates and suggested that improvements in outcome can be realized through adherence to best practice guidelines and continuous monitoring of treatment outcome data. Cancer 2004. © 2004 American Cancer Society [source] Prognostic factors in patients with Hürthle cell neoplasms of the thyroidCANCER, Issue 5 2003Luis Lopez-Penabad M.D. Abstract BACKGROUND Hürthle cell neoplasms, often considered a variant of follicular thyroid neoplasms, represent 3% of thyroid carcinomas. Only a handful of publications have focused on the biologic behavior, prognostic factors, and treatment outcomes of Hürthle cell carcinoma. The objective of the current study was to identify the clinical and pathologic features of Hürthle cell carcinomas that predict disease progression or death. METHODS The authors reviewed medical records of patients who were treated for Hürthle cell carcinoma (HCC) and Hürthle cell adenoma (HCA) at The University of Texas M. D. Anderson Cancer Center from March 1944 to February 1995, including follow-up information. The pathologic diagnosis was confirmed by one of the authors. RESULTS The authors identified 127 patients with Hürthle cell neoplasms, 89 patients with HCC and 38 patients with HCA. Seven patients with HCC had foci of anaplastic thyroid carcinoma. Survival for this subgroup was worse compared with the overall group and was analyzed separately. The HCC group was significantly older (age 51.8 years vs. age 43.1. years) and had larger tumors (4.3 cm vs. 2.9 cm) compared with the HCA group. No differences were seen in gender or previous radiation exposure. Forty percent of patients in the HCC group died of thyroid carcinoma, whereas no patients in the HCA group died of the disease. There has been no improvement in all-cause and disease specific mortality in the past 5 decades for patients with these neoplasms. Conventional staging systems predicted mortality with minor differences. Of the patients with known metastasis, 38% showed radioiodine uptake. Univariate analysis identified older age, higher disease stage, tumor size, extraglandular invasion, multifocality, lymph node disease, distant metastasis, extensive surgery, external beam radiation therapy, and chemotherapy as factors that were associated with decreased survival. Tumor encapsulation was associated with improved survival. Although radioactive iodine treatment had no overall effect on survival, subgroup analysis showed that patients who received radioactive iodine for adjuvant ablation therapy had better outcomes compared either with patients who did not receive radioactive iodine or with patients who received radioactive iodine as treatment for residual disease. Multivariate analysis indicated that older age and larger tumor size predicted worse survival through an association with worse behaving tumors (multifocal, less encapsulated, and with extraglandular invasion). The decreased survival in patients with lymph node metastases may be explained by its association with distant metastases. The association of extensive surgery, external beam radiation therapy, and chemotherapy with worse survival also disappeared once those factors were analyzed together with other prognostic factors, such as distant metastases. CONCLUSIONS Several clinical and pathologic prognostic factors were identified in patients with HCC and HCA. Older age and larger tumor size predicted reduced survival. Radioactive iodine therapy may confer a survival benefit when it is used for adjuvant ablation therapy, but not when residual disease is present. The authors could not demonstrate a survival benefit for the use of extensive surgery, external beam radiation therapy, or chemotherapy. Cancer 2003;97:1186,94. © 2003 American Cancer Society. DOI 10.1002/cncr.11176 [source] Improved final height in Turner's syndrome following growth-promoting treatment at a single centreACTA PAEDIATRICA, Issue 9 2003EJ Gault Aims: To examine the final height (FH) outcome of girls with Turner's syndrome (TS) treated at a single Scottish centre (Glasgow group), to compare it with an earlier national analysis (Scottish group) and to suggest reasons for any change. Methods: Retrospective growth and treatment data for 29 Glasgow patients were compared with those of 26 Scottish patients. Results: Age at GH start (mean ± SD) was 10.1 ± 2.6 vs 12.1 ± 1.7 y (p < 0.01) in the Glasgow versus Scottish groups, with overall duration of treatment 6.2 ± 2.4 vs 3.7 ± 1.1 y (p < 0.001) and years of GH treatment before pubertal induction 2.7 ± 2.8 vs 0.3 ± 0.8 y (p < 0.001), respectively. Pubertal induction was at a similar age: 12.7 ± 1.8 vs 12.8 ± 1.8 y (ns). FH was 151.1 ± 4.6 cm in the Glasgow group compared with 142.6 ± 5.6 cm in the Scottish group (p < 0.001), with FH -projected adult height (PAH) 5.7 ± 4.6 cm vs 0.6 ± 3.6 cm (p < 0.001), respectively. Univariate analysis of the Glasgow group's FH , PAH with a number of growth and treatment variables identified no statistically significant relationships. Conclusion: This group's improved FH and FH , PAH, relative to an earlier sample, are attributed to the introduction of GH treatment from a younger age and for longer, overall and before pubertal induction. In addition, the authors believe that compliance with treatment has been enhanced by this single centre's dedicated Turner clinic and the efforts of its established "growth team". These data demonstrate that a favourable FH can be achieved using a safe and financially viable dose of GH, while inducing puberty at a "normal" age. [source] Anorectal three-dimensional endosonography and anal manometry in assessing anterior rectocele in women: a new pathogenesis concept and the basic surgical principleCOLORECTAL DISEASE, Issue 1 2007F. S. P. Regadas Abstract Objective, The anatomy of the anal canal, the anorectal junction and the lower rectum was studied with 3-D ultrasound. Method, Seventeen women with normal bowel transit, without rectocele (group 1) and 17 female patients with a large anterior rectocele (group 2) were examined with a B&K Medical Rawk®. Mean age was 44.5 and 51.6 years respectively. In group 1, one (5.8%) patient was nuliparous, five (29.4%) had a caesarian section, 11 (64.7%) had a vaginal delivery while in group 2, two (11.7%) patients were nuliparous, four (23.5%) had a caesarian section and 11 (64.7%) had a vaginal delivery. Images were reconstructed in midline longitudinal (ML) and transverse (T) planes. The external (EAS) and internal (IAS) anal sphincters were measured in both projections. Results, In the ML plane, the EAS length was longer in group 1 (1.94 cm vs 1.61 cm, P < 0.05), the gap length was shorter (1.54 cm vs 1.0 cm P < 0.01) and the wall thickness was shorter in group 2 (0.40 cm vs 0.50 cm P < 0.01). The IAS (0.18 cm vs 0.23 cm P < 0.01) and EAS thickness (0.68 cm vs 0.77 cm, P < 0.05) (left lateral of the posterior quadrant) was greater in group 2. In group 1, the anterior upper anal canal wall in normal females was an extension of the rectal wall and the circular muscle was thicker in the mid-anal canal to form the IAS. In group 2, however, the wall layers were not identified and the IAS was found to be more distal. The differences were not statistically significant in the anal canal resting and squeeze pressures in the two groups. Conclusion, Obstetric trauma does not seem to play any role in rectocele pathogenesis because the anal sphincter muscles are anatomically and functionally normal and rectocele is also present in nuliparous and in women with caesarian sections. It seems that it is associated with the absence of EAS and thinner IAS in the anterior upper anal canal. Herniation starts at the upper anal canal extending to the lower rectum in high or large rectoceles and maybe produced by rectal intussusception because of excessive and prolonged straining during defecation. In fact, the denomination ,rectocele' should be changed to ,anorectocele'. [source] Regional cerebral blood flow autoregulation in patients with fulminant hepatic failureLIVER TRANSPLANTATION, Issue 6 2000Fin Stolze Larsen The absence of cerebral blood flow autoregulation in patients with fulminant hepatic failure (FHF) implies that changes in arterial pressure directly influence cerebral perfusion. It is assumed that dilatation of cerebral arterioles is responsible for the impaired autoregulation. Recently, frontal blood flow was reported to be lower compared with other brain regions, indicating greater arteriolar tone and perhaps preserved regional cerebral autoregulation. In patients with severe FHF (6 women, 1 man; median age, 46 years; range, 18 to 55 years), we tested the hypothesis that perfusion in the anterior cerebral artery would be less affected by an increase in mean arterial pressure compared with the brain area supplied by the middle cerebral artery. Relative changes in cerebral perfusion were determined by transcranial Doppler,measured mean flow velocity (Vmean), and resistance was determined by pulsatility index in the anterior and middle cerebral arteries. Cerebral autoregulation was evaluated by concomitant measurements of mean arterial pressure and Vmean in the anterior and middle cerebral arteries during norepinephrine infusion. Baseline Vmean was lower in the brain area supplied by the anterior cerebral artery compared with the middle cerebral artery (median, 47 cm/s; range, 21 to 62 cm/s v 70 cm/s; range 43 to 119 cm/s, respectively; P < .05). Also, vascular resistance determined by pulsatility index was greater in the anterior than middle cerebral artery (median, 1.02; range 1.00 to 1.37 v 0.87; range 0.75 to 1.48; P < .01). When arterial pressure was increased from 84 mm Hg (range 57 to 95 mm Hg) to 115 mm Hg (range, 73 to 130 mm Hg) during norepinephrine infusion, Vmean remained unchanged in 2 patients in the anterior cerebral artery, whereas it increased in the middle cerebral artery in all 7 patients. In the remaining patients, Vmean increased approximately 25% in both the anterior and middle cerebral arteries. Thus, this study could only partially confirm the hypothesis that autoregulation is preserved in the brain regions supplied by the anterior cerebral artery in patients with FHF. Although the findings of this small study need to be further evaluated, one should consider that autoregulation may be impaired not only in the brain region supplied by the middle cerebral artery, but also in the area corresponding to the anterior cerebral artery. [source] Comparison of Tissue Doppler Velocities Obtained by Different Types of Echocardiography Systems: Are They Compatible?ECHOCARDIOGRAPHY, Issue 3 2010Mónika Dénes M.D. Background: Both systolic and diastolic tissue Doppler (TD) velocities have an important diagnostic and prognostic role in cardiology. We aimed to compare TD velocities between two different echocardiography systems. Patients: Thirty-one consecutive patients (mean age: 65.2 ± 17.5 years; 12 males) were enrolled. Methods: Systolic (Sa), early (Ea), and late (Aa) diastolic velocities were measured by TD at the lateral mitral annulus by a Sonos 2000 (Hewlett-Packard, Andover, MA, USA) and a Philips iE33 system. The E/Ea ratio was calculated. Results: Ea, Aa, and Sa velocities were higher when measured by the Sonos system (Ea: 13.2 ± 4.1 cm/s vs. 8.3 ± 3.6 cm/s; Aa: 14.8 ± 3.8 cm/s vs. 9.3 ± 2.3 cm/s; Sa: 15.2 ± 3.6 cm/s vs. 8.4 ± 2.0 cm/s; P < 0.0001 all). A significant correlation was found in Ea and in Ea/Aa (r = 0.84 and r = 0.85 resp; P < 0.0001 for both), and a weaker in Aa (r = 0.43; P = 0.02) between the machines. The Bland-Altman analysis showed broad limits of agreement between the measurements for Ea, Aa, and Sa (mean difference: 4.95 cm/s; 5.52 cm/s; 6.73 cm/s, respectively; limits: 0.64,9.25 cm/s; ,1.39,12.39 cm/s; ,0.37,13.83 cm/s, respectively). An E/Ea ratio >5.6 by the Sonos system showed 75% sensitivity and 79% specificity for elevated left ventricular filling pressure, defined as E/Ea >10 by the reference Philips system. Conclusions: Although diastolic TD velocities had excellent correlations between the two machines, there was a systematic overestimation by the Sonos system. Since the limits of agreement do not allow replacing the measurements, we suggest using the same echocardiographic equipment at patient follow-up. (Echocardiography 2010;27:230-235) [source] Evaluation of Atrial Thrombus Formation and Atrial Appendage Function in Patients with Pacemaker by Transesophageal EchocardiographyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2006ABOLFATH ALIZADEH M.D. Background: Physiologic pacing is claimed to be superior to ventricular pacing in as much as it entails lower risk of atrial fibrillation, stroke, and atrial remodeling. There are few data on the relation between atrioventricular (AV) synchrony and atrial clot formation. Utilizing transesophageal echocardiography (TEE), this study sought to evaluate the effect of AV synchrony loss on left atrial physiology, atrial stasis, and clot formation. Methods: We conducted a cross-sectional study on patients with both AV and ventricular pacing with left ventricular ejection fraction (LVEF) >30%. TEE enabled us to explore atrial and pacing leads thrombi and measure left atrial appendage (LAA) flow velocity Results: A total 72 patients (mean age, 65 ± 11.7) were enrolled in the study. The pacing mode was VVI in 53% and AV sequential in 47% of patients. LVEF (mean ± SD; %) was 53.3 ± 6.2% in ventricular pacing mode and 52.2 ± 6.6 in physiologic pacing mode. Thrombus formation on pacing lead (<10 mm in 97% of patients) was observed in 32% of all the patients (23% in patients with AV sequential pacing mode and 39% with VVI mode). Left atrial appendage flow velocity (LAA-FV) was significantly higher among the patients with AV sequential pacing mode (49.44 ± 18 cm/s vs 40.94 ± 19.4 cm/s, P value = 0.02). LAA-FV >40 cm/s was detected in 60% of the patients, 60% of whom were in physiologic mode. Left atrial size was significantly larger among the patients with VVI pacing mode (42.3 ± 2.3 mm vs 37.79 ± 4.5 mm, P = 0.001). Multivariate analysis showed no relation between LAA-FV and age, hypertension, diabetes mellitus, left atrial size, and left ventricular function. Only one patient had right atrial clot. There was no thrombus in the ventricles and atrial appendage. Conclusion: Long-term loss of AV synchrony induced by VVI pacing is associated with the impairment of LAA contraction. Thrombus formation in the LAA is not increased by VVI pacing in patients with relatively good left ventricular (LV) function and sinus rhythm. [source] Levosimendan versus Dobutamine in Heart Failure Patients Treated Chronically with CarvedilolCARDIOVASCULAR THERAPEUTICS, Issue 3 2008Hamza Duygu Introduction: Although beta-blockers are highly effective in the treatment of heart failure (HF), many patients with HF receiving a beta-blocker continue to become decompensated and require hospitalization for worsening HF. Levosimendan and dobutamine are used to manage decompensated HF, but their comparative effects on left ventricular (LV) function in patients prescribed beta-blockers are unknown. Aims: The aim of this study was to compare the effects of dobutamine and levosimendan on LV systolic and diastolic functions in chronic HF patients treated chronically with carvedilol. Forty patients with chronic HF who had NYHA class III to IV symptoms, a LV ejection fraction (LVEF) <40%, and ongoing treatment with carvedilol were enrolled in this randomized (1:1), dobutamine controlled, open-label study. Before and 24 h after treatment, LVEF, mitral inflow peak E and A wave velocity, E/A ratio, the deceleration time of the E wave (DT), isovolumic relaxation time (IVRT), peak systolic (Sm) and early diastolic (Em) mitral annular velocity, and systolic pulmonary artery pressure (SPAP) were measured by echocardiography. Results: Levosimendan produced a statistically significant increase in LVEF (28 ± 5% vs. 33 ± 3%), Sm (6.5 ± 1.2 cm/s vs. 7.4 ± 0.9 cm/s), DT (120 ± 10 ms vs. 140 ± 15 ms), and Em (7.5 ± 0.4 cm/s vs. 8.1 ± 0.5 cm/s) and significant decrease in E/A ratio (2.1 ± 0.3 vs. 1.7 ± 0.4) and SPAP (55 ± 5 mmHg vs. 40 ± 7 mmHg). No significant change occurred in LV systolic and diastolic function parameters, or SPAP with dobutamine treatment. Levosimendan did not significantly alter the heart rate (72 ± 4 bpm vs. 70 ± 3 bpm), systolic (105 ± 5 mmHg vs. 102 ± 4 mmHg), or diastolic blood pressure (85 ± 5 mmHg vs. 83 ± 5 mmHg) whereas with dobutamine treatment, all these parameters significantly increased. Conclusions: Dobutamine and levosimendan have different effects on LV functions in patients treated chronically with carvedilol. These differences should be considered when selecting inotropic therapy for decompensated HF receiving long-term carvedilol. [source] Transthoracic Doppler Echocardiographic Coronary Flow Imaging in Identification of Left Anterior Descending Coronary Artery Stenosis in Patients with Left Bundle Branch BlockECHOCARDIOGRAPHY, Issue 10 2008Ozer Soylu M.D. Background: Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56,0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P=0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB. [source] Relationship between Slow Coronary Flow and Left Atrial Appendage Blood Flow VelocitiesECHOCARDIOGRAPHY, Issue 1 2007Recep Demirbag M.D. Aims: This study was undertaken to assess whether slow coronary flow (SCF)is related to low left atrial appendage (LAA) blood flow velocities. Methods: Study subjects consist of 44 patients with SCF and 11 volunteer subjects with normal coronary angiogram. The diagnosis of SCF was made using the TIMI frame count method. The blood flow velocities were obtained by placing a pulsed-wave Doppler sample volume inside the proximal third of the LAA. Results: The mean LAA emptying velocities (MEV)were significantly lower in patients than control subjects (34.5 ± 9.9 cm/sec vs 84.0 ± 12.1 cm/sec; P < 0.001). In bivariate analysis, significant correlation was found between MEV, and systolic pulmonary venous flow, mean TIMI frame count, deceleration time, and isovolumetric relaxation time (P < 0.05). By multiple linear regression analysis, mean TIMI frame count (ß=,0.865, P < 0.001) was identified as independent predictors of MEV. Conclusion: This study indicates that SCF phenomenon may be related to low LAA blood flows. [source] Comparison of Coronary Flow Velocities Between Patients with Obstructive and Nonobstructive Type Hypertrophic Cardiomyopathy: Noninvasive Assessment by Transthoracic Doppler EchocardiographyECHOCARDIOGRAPHY, Issue 1 2005Seden Celik M.D. Background: We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NHCM) and obstructive hypertrophic cardiomyopathy (HOCM) by using transthoracic Doppler echocardiography (TTDE). Methods and Results: In 11 patients with NHCM and 26 with HOCM, CFV in the distal left anterior descending (LAD) coronary was measured by TTDE (3.5 MHz) under the guidance of color Doppler flow mapping in addition to standard 2D and Doppler echocardiography. The results were compared with 24 normal participants who had no evidence of cardiac disease. Peak diastolic velocity of LAD was also higher in NHCM and HOCM than controls (52 ± 14 cm/sec and 54 ± 20 cm/sec vs 41 ± 11 cm/sec, respectively, P < 0.01). The analysis of systolic velocities revealed abnormal flow patterns in 16 (61%) patients with HOCM (12 systolic-reversal flow and 4 no systolic flow) and 6 (54%) (5 reversal flow and 1 zero flow) patients with NHCM (,11 ± 30 cm/sec and ,13 ± 38 cm/sec, vs 24 ± 9 cm/sec, respectively, P < 0.001). Linear regression analysis demonstrated no correlation between intraventricular pressure gradient and coronary flow velocities in HOCM patients. However, there were significant positive and negative correlations between septal thickness and diastolic and systolic velocities, respectively (r = 0.50, P < 0.002, and r =,0.43, P < 0.005). Conclusion: We conclude that the coronary flow velocity abnormalities are independent from the type of hypertrophic cardiomyopathy. [source] Pseudoexfoliatio capsulae and endothelin-1 plasma levelsACTA OPHTHALMOLOGICA, Issue S232 2000G. L. Possati M. Cellini Summary The authors found an increase of endothelin-1 (ET-1) plasma levels in patients with pseudoexfoliatio syndrome (PXS): 2.730±0.224 pg/ml vs 1.420±0.30S pg/ml. With Color Doppler Imaging (CDI) they found in PXS patients a decrease of peak systolic velocity values in the posterior ciliary arteries that were 12.725 ± 2.536 cm/sec vs 15.450 ± 3.173 cm/sec (p<0.049) while the resistance values were increased 0.640 ± 0.051 vs 0.548 ± 0.058 (p<0.001). The increase of ET-1 plasma levels may assess the vasospasm and uveal tissue hypoxia. 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