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ORIGINAL INVESTIGATIONS (original + investigation)
Selected AbstractsORIGINAL INVESTIGATIONS: Tissue Harmonic Imaging in Echocardiography: Better Valve Imaging, But at What Cost?ECHOCARDIOGRAPHY, Issue 2 2008Karin Hawkins M.D. Background: Tissue harmonic imaging (THI) improves echocardiographic image quality and is widely utilized. Unfortunately it also makes structures appear artificially thickened. We sought to examine its impact on the imaging of left-sided heart valves. Methods: A large echocardiographic database was searched for full, standard transthoracic echocardiographic exams performed 12-month periods before (n = 3,786) and after (n = 3,914) transition to THI at a single institution. Patients with prosthetic valves were excluded. Results: The mean age of patients was 63 ± 17 years and 65% were men. No appreciable difference in demographics was observed between time periods. While inadequate visualization of the mitral valve was reduced by 30% using THI (P = 0.014), reports of leaflet thickening increased by 28% (P = 0.005). Similarly, inadequate aortic valve visualization was reduced by 53% with THI (P < 0.001), at the expense of more aortic sclerosis (+6%, P = 0.034). Among the 480 patients with echocardiograms using each modality (time interval between studies: 370 ± 143 days), THI did not appreciably improve visualization of the either valve. Although no significant increase in mitral thickness was seen with THI, aortic sclerosis was increased by at least one grade in 24.5% (P < 0.006). Conclusion: This study suggests that while THI enhances imaging of difficult to visualize valves, it may overestimate mitral and aortic valve thickness. This could lead to overdiagnosis and unnecessary follow-up studies. Cardiologists interpreting THI echocardiograms should become familiar with the modality's shortcomings. [source] ORIGINAL INVESTIGATIONS: Comparison of Left Atrial Dimensions by Transesophageal and Transthoracic EchocardiographyECHOCARDIOGRAPHY, Issue 10 2005Harshinder Singh M.D. Transesophageal echocardiography (TEE) is an established cardiovascular diagnostic technique. Left atrial (LA) size, as measured by transthoracic echocardiography (TTE), is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke, death, and the success of cardioversion. Assessment of LA size has not been as well validated on TEE as on TTE. We determined LA size measurements in four standard views in 122 patients undergoing TEE and TTE at the same setting. In this study, we found that measurement of LA dimensions by TEE suffers from significant limitations in all views except the basal long-axis view (mid-esophageal level) with transducer plane at 120,150 degrees. This view had the best correlation with transthoracic LA measurements: r = 0.79 for TEE long axis (CI 0.71,0.85), P <.0001. (ECHOCARDIOGRAPHY, Volume 22, November 2005) [source] ORIGINAL INVESTIGATIONS: Different Clinical Features of Aortic Intramural Hematoma Versus Dissection Involving the Descending Thoracic AortaECHOCARDIOGRAPHY, Issue 8 2005Mariano Falconi M.D. Objective: The objective of this study is to test the hypothesis that the absence of flow communication in aortic intramural hematoma (IMH) involving the descending aorta may have a different clinical course compared with aortic dissection (AD). Methods: We prospectively evaluated clinical and echocardiographic data in AD (76 patients) and IMH (27 patients) of the descending thoracic aorta. Results: Patients did not differ with regard to age, gender, or clinical presentation. IMH and AD had the same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Surgical treatment was more frequently selected in AD (39% vs. 22%, P < 0.01) and AD patients who underwent surgical treatment had higher mortality than those with IMH (36% vs. 17%, P < 0.01). There was no difference in mortality with medical treatment (14% in AD vs. 19% in IMH, P = 0.7). During follow-up, of 23 patients with IMH, 11 (47%) showed complete resolution or regression, 6 (26%) increased the diameter of the descending aorta, and typical AD developed in 3 patients (13%). No changes occurred in 14% of the group. Three-year survival rate did not show significant differences between both groups (82 ± 6% in IMH vs. 75 ± 7% in AD, P = 0.37). Conclusion: IMH of the descending thoracic aorta has a relatively frequent rate of complications at follow-up, including dissection and aneurysm formation. Medical treatment with very frequent imaging and timed elective surgery in cases with complications allows a better patient management. [source] Disentangling the Harrisson archive to interpret the spatial and temporal distribution of vertebrate remains at Niah Caves, SarawakINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 4 2009P. J. Piper Abstract During the 1950s and 1960s, excavations by the Sarawak Museum at Niah Cave in northwest Borneo produced an enormous archive of records and artefacts, including in excess of 750,000 macro- and micro-vertebrate remains. The excellent state of preservation of the animal bone, dating from the Late Pleistocene (c. 40,kya) to as recently as c. 500 years ago had the potential to provide unparalleled zooarchaeological information about early hunter-gatherer resource procurement, temporal changes in subsistence patterning, and the impact of peoples on the local and regional environment in Island Southeast Asia. However, the coarse-grained methods of excavation employed during the original investigations and the sheer scale of the archaeological record and bone assemblages dissuaded many researchers from attempting to tackle the Niah archives. This paper outlines how important information on the nature of the archaeological record at Niah has now finally been extracted from the archive using a combination of zooarchaeological analysis and reference to the extensive archaeological records from the site. Copyright © 2009 John Wiley & Sons, Ltd. [source] A qualitative systematic review of peri-operative dextromethorphan in post-operative painACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2006T. H. Duedahl Background:, The N -methyl- d -aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. Methods:, Twenty-eight randomized, double-blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta-analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results:, DM did not reduce the post-operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in about one-half of the oral studies. The decreases were of questionable clinical importance in most comparisons, although a relationship between a decrease in opioid consumption and opioid-related side-effects was established in some studies. Conclusion:, Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post-operative pain management, but the consistency of the potential opioid-sparing and pain-reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post-operative pain. The route of administration may be important for the beneficial effect. [source] | ||||||||||