Direct MR arthrography: a review of current use.
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Ankle Joint↗
Biomedical subjects
J M Elliott
Publications and source records attributed to J M Elliott.
MR appearances of the locked knee.
This review illustrates the MR appearances of commonly encountered problems that can present as a "locked knee", as well as several unusual causes. Internal derangement of menisci, particularly bucket handle tears, predominate. Loose bodies as a result of trauma/degeneration and lesions such as cysts of the cruciate ligaments and focal pigmented villonodular synovitis are also illustrated. While meniscal tears are the major cause of "locked knee" in clinical practice, interference with normal knee kinematics is non-specific with regard to the diagnosis. Emphasis is therefore given to less frequently seen abnormalities that lead to a mechanical block of knee extension.
Anterior Cruciate Ligament↗
MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval.
OBJECTIVE: We describe the MR anatomy of the subcoracoid bursa and findings associated with subcoracoid effusion. CONCLUSION: Fluid in the subcoracoid space, revealed on MR imaging of the shoulder, may lie in the subcoracoid bursa or the subscapularis recess (both structures can be distinguished with MR imaging). In our patients, subcoracoid effusions were often associated with anterior rotator cuff tears, including tears of the rotator interval.
Adult↗
Myocardial infarction with and without reperfusion in sheep: early cardiac and neurohumoral changes.
There are few stable and reproducible large-animal models of chronic heart failure produced by ischaemic damage to the myocardium. Here we characterize a novel method of inducing myocardial damage in closed-chest sheep by catheter delivery of thrombogenic coils, and compare this with a newly described open-artery model of cardiac injury in sheep. Sham controls were compared with animals subjected to (a) 90 min of coronary artery occlusion/reperfusion by PTCA (percutaneous transluminal coronary angioplasty) balloon, and (b) permanent coronary artery occlusion induced by catheter delivery of thrombogenic coils (seven sheep/group). Both balloon occlusion/reperfusion and permanent coil occlusion resulted in well-defined anteroapical infarcts, as documented by ECG changes, significant rises in creatine kinase (both groups P<0.001) and troponin-T (both groups P<0.05), and post-mortem examination. Washout of enzymes was much more rapid in the reperfused group (P<0. 01). Infarction resulted in significant reductions in left ventricular (LV) ejection fraction (both groups P<0.01) and regional wall abnormalities. Ejection fraction 7 days post-coil (21.3+/-4.2%) was significantly lower (P<0.01) than that 7 days post-balloon (38. 8+/-4.5%). Coil-induced infarction was associated with acutely reduced arterial pressure (P<0.05), and increases in heart rate (P<0. 05), atrial pressures (P<0.05), plasma brain natriuretic peptide levels (P<0.05) and adrenaline levels (P<0.05). Rises seen in plasma endothelin levels in sham controls were blunted in the coil group (P<0.001). Haemodynamic changes were less marked in the balloon group. In conclusion, restriction of coronary artery occlusion to 90 min results in infarction, but less LV dysfunction with reduced early remodelling, compared with permanent occlusion. Acute changes in biochemical markers, haemodynamics, neurohormones and LV function confirm that these are excellent models of open- and closed-artery myocardial infarction leading to asymptomatic LV dysfunction.
Analysis of Variance↗
Ultrasound guided compression of femoral artery pseudoaneurysms: modified digital technique shortens repair time.
Ultrasound guided graded manual compression therapy has become the standard treatment for femoral artery pseudoaneurysms. It entails blunt ultrasound probe compression on the neck of the aneurysm for considerable periods of time. We describe a technique using digital compression after ultrasound localization of the neck enabling easier and more effective targeting of the manual pressure. Preliminary experience in six consecutive cases has shown it to be effective, safe and to have relatively short compression times. Ultrasound guided digital compression has the potential to deliver more effective pressure making this often onerous procedure less demanding on both patient and operator.
Aneurysm, False↗
Effects of early captopril administration after thrombolysis on regional wall motion in relation to infarct artery blood flow.
OBJECTIVES: To determine whether early administration of captopril lessens infarct zone regional wall motion abnormalities when infarct artery blood flow is abnormal. BACKGROUND: The interaction between angiotensin-converting enzyme (ACE) inhibitor therapy, ventricular function and infarct artery blood flow has not been well described. METHODS: A total of 493 patients aged < or = 75 years with first infarctions, presenting within 4 h of symptom onset, were randomized to receive 6.25 mg captopril, increasing to 50 mg t.d.s. or a matching placebo 2.1+/-0.4 h after commencing intravenous streptokinase (1.5 x 10(6) U over 30 to 60 min). Trial therapy was stopped 48 h prior to angiography at 3 weeks, to determine regional wall motion and infarct artery flow. RESULTS: There were no differences in ejection fractions or end-systolic volumes between patients randomized to receive captopril and those randomized to receive a placebo. Among patients with anterior infarction (n = 216), randomization to captopril resulted in fewer hypokinetic chords (40+/-13; vs. 44+/-13; p=0.028) and a trend toward fewer chords >2 SD below normal (26+/-17 vs. 30+/-17; p=0.052) in the infarct zone. In patients randomized to receive captopril who had anterior infarction and Thrombolysis in Myocardial Infarction (TIMI) 0-2, flow there were fewer hypokinetic chords (44+/-12 vs. 50+/-9; p=0.043) and a trend toward fewer chords >2 SD below normal (33+/-15 vs. 39+/-13; p=0.057). Patients receiving captopril who had anterior infarction and corrected TIMI frame counts > 27 had fewer hypokinetic chords (42+/-13 vs. 46+/-12; p=0.015) and fewer chords >2 SD below normal (27+/-17 vs. 32+/-17; p= 0.047). Captopril had no effect in patients with inferior infarction. There were 20 late cardiac deaths (median follow-up 4 years) in the captopril group and 35 in the placebo group (p=0.036). CONCLUSIONS: Randomization to receive captopril 2 h after streptokinase improved regional wall motion at 3 weeks. The greatest benefit was seen in patients with anterior infarction particularly when infarct artery blood flow is reduced.
Adult↗
Neuroendocrine prediction of left ventricular function and heart failure after acute myocardial infarction. The Christchurch Cardioendocrine Research Group.
OBJECTIVE: To determine the relations of plasma levels of brain natriuretic peptide (BNP), atrial natriuretic factor (ANF), N-terminal ANF (N-ANF), cyclic guanosine monophosphate (cGMP; the cardiac peptide second messenger), and plasma catecholamines to left ventricular function and to prognosis in patients admitted with acute myocardial infarction. DESIGN: Plasma hormones and ventricular function (radionuclide ventriculography) were measured 1-4 days after myocardial infarction in 220 patients admitted to a single coronary care unit. Radionuclide scanning was repeated 3-5 months after infarction. Clinical events were recorded over a mean period of 14 months. RESULTS: Both early and late left ventricular ejection fraction (LVEF) were most closely related to plasma BNP (r = -0.60, n = 220, p < 0.001; and r = -0.53, n = 192, p < 0.001, respectively), followed by ANF, N-ANF, cGMP, and the plasma catecholamines. Early plasma BNP concentrations less than twofold the upper limit of normal (20 pmol/l) had 100% negative predictive value for LVEF < 40% at 3-5 months after infarction. In multivariate analysis incorporating all the neurohormonal factors, only BNP remained independently predictive of LVEF < 40% (p < 0.005). Survival analysis by median levels of candidate predictors identified BNP as the most powerful discriminator for death (p < 0.0001). No early deaths (within 4 months) occurred in patients with plasma BNP concentrations below the group median (27 pmol/l), and over follow up only three of 26 deaths occurred in this subgroup. Of all episodes of left ventricular failure, 85% occurred in patients with plasma BNP above the median (p < 0.001). In multivariate analyses, BNP alone gave additional predictive information beyond sex, age, clinical history, LVEF, and plasma noradrenaline for both subsequent onset of LVF and death. CONCLUSIONS: Plasma BNP measured within 1-4 days of acute myocardial infarction is a powerful independent predictor of left ventricular function, heart failure, or death over the subsequent 14 months, and superior to ANF, N-ANF, cGMP, and plasma catecholamines.
Atrial Natriuretic Factor↗
Priority points and cardiac events while waiting for coronary bypass surgery.
OBJECTIVE: To assess the risk of important cardiac events while waiting for coronary artery bypass surgery (CABG) in relation to the New Zealand priority scoring system; to compare clinical characteristics of patients referred for CABG in New Zealand with those in Ontario, Canada; and to compare the New Zealand priority scoring system for CABG with the previously validated Ontario urgency score. DESIGN: Analysis of outcomes in a consecutive case series of patients referred for CABG. SETTING: University hospital. PATIENTS: All 324 patients from Christchurch Hospital wait listed for isolated CABG between 1 January 1994 and 31 December 1995. MAIN OUTCOME MEASURES: Death, myocardial infarction, and unstable angina while waiting for CABG; waiting time to surgery. RESULTS: Clinical characteristics at referral were very similar, but median waiting time was longer in New Zealand than in a large Canadian case series (212 days v 17 days). While waiting for elective CABG, 44% (114/257) of New Zealand patients had cardiac events: death 4% (13/257), non-fatal myocardial infarction 6% (16/257), readmission with unstable angina 34% (87/257). Priority scores did not predict cardiac events while waiting for CABG. Indeed, death or non-fatal myocardial infarction occurred in 4% (3/76) and 8% (6/76), respectively, of those with priority scores < 35. These people are no longer eligible for publicly funded surgery in New Zealand. CONCLUSIONS: Very long waiting times for CABG are associated with frequent cardiac events, at considerable cost to both patients and health care providers. Priority scores may facilitate comparison between countries but such scores did not predict clinical events while waiting.
Aged↗
Effect of a long-term low tryptophan diet on the prolactin responses to the 5-HT1A and 5-HT2C agonists, 8-OH-DPAT and mCPP in the male rat.
The study was undertaken to assess the long term effects of tryptophan (TRP) depletion through diet on the prolactin (PRL) responses to the serotonin (5-hydroxytryptophan, 5-HT) agonists m-chlorophenyl-piperazine (mCPP) and 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) in the male rat. The low TRP diet caused significant reductions in both plasma total TRP and brain cortical 5-HT content together with a significant increase in the PRL responses to mCPP. In contrast the PRL responses to 8-OH-DPAT in animals on the low TRP diet for 1 week and 6 weeks were similar to control rats. However, a small but significant increase in PRL was observed at 2 min after dosing in the 1-week group. At the same time the 3H-8-OH-DPAT binding parameters, Kd and Bmax, were similar in both control and TRP depleted animals. The results confirm that long-term TRP depletion causes a deficiency of brain TRP and a subsequent reduction of brain 5-HT. This is associated with an enhanced PRL response to mCPP probably resulting from a functional up-regulation of post-synaptic 5-HT2C receptors. The small or transient changes brought about by long-term TRP depletion on post-synaptic 5-HT1A receptors, suggests that these receptors may be less susceptible to 5-HT depleting effects than the 5-HT2C subtype.
8-Hydroxy-2-(di-n-propylamino)tetralin↗
Ultrasonography of intratesticular lesions: its role in clinical management.
Ultrasound is the primary imaging modality in the investigation of patients with symptoms related to the scrotum, and is pivotal to the diagnosis of suspected testicular malignancy. This retrospective study analysed the results of testicular ultrasound at a large teaching hospital over a five year period. We wished to examine the clinical consequences for patients in whom ultrasound findings were suspicious of testicular cancer, and the accuracy of the ultrasound diagnosis. Real time ultrasound examinations were performed, providing multiplanar imaging of the testis and para testicular tissues. Over a five year period 661 examinations were carried out. An intratesticular lesion was identified in 44 patients; nineteen of these patients were shown to have testicular malignancy following tissue diagnosis. When ultrasound was used to identify testicular malignancy in those patients with an intratesticular lesion, it had a sensitivity of 94.7% and a specificity of 59.1%. A tissue diagnosis was obtained in 93% of those patients thought likely to have a testicular malignancy on sonographic assessment, and in 40% of those in whom a diagnosis of malignancy was possible, but less likely. Our study shows that this modality can be used to aid the clinician in deciding which patients should undergo orchidectomy, invasive biopsy or clinical surveillance.
Adolescent↗
Serine derived NK1 antagonists. 2: A pharmacophore model for arylsulfonamide binding.
Modifications to the spirocyclic aryl sulfonamide portion of serine derived NK1 antagonists allow a partial pharmacophore model to be developed.
Models, Chemical↗
Serine derived NK1 antagonists. 1: The effect of modifications to the serine substituents.
A series of novel serine derived NK1 antagonists is described. The effect of variations in the N-benzyl, O-benzyl and serine groups are used to define the elements which are necessary for binding.
Neurokinin-1 Receptor Antagonists↗
Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction.
BACKGROUND: Newly discovered circulating peptides, N-terminal pro-brain natriuretic peptide (N-BNP) and adrenomedullin (ADM), were examined for prediction of cardiac function and prognosis and compared with previously reported markers in 121 patients with myocardial infarction. METHODS AND RESULTS: The association between radionuclide left ventricular ejection fraction (LVEF) and N-BNP at 2 to 4 days (r=-.63, P<.0001) and 3 to 5 months (r=-.58, P<.0001) after infarction was comparable to that for C-terminal BNP and far stronger than for ADM (r=-.26, P<.01), N-terminal atrial natriuretic peptide (N-ANP), C-terminal ANP, cGMP, or plasma catecholamine concentrations. For prediction of death over 24 months of follow-up, an early postinfarction N-BNP level > or = 160 pmol/L had sensitivity, specificity, positive predictive value, and negative predictive values of 91%, 72%, 39%, and 97%, respectively, and was superior to any other neurohormone measured and to LVEF. Only 1 of 21 deaths occurred in a patient with an N-BNP level below the group median (Kaplan-Meier survival analysis, P<.00001). For prediction of heart failure (left ventricular failure), plasma N-BNP > or = 145 pmol/L had sensitivity (85%) and negative predictive value (91%) comparable to the other cardiac peptides and was superior to ADM, plasma catecholamines, and LVEF. By multivariate analysis, N-BNP but not ADM provided predictive information for death and left ventricular failure independent of patient age, sex, LVEF, levels of other hormones, and previous history of heart failure, myocardial infarction, hypertension, or diabetes. CONCLUSIONS: Plasma N-BNP measured 2 to 4 days after myocardial infarction independently predicted left ventricular function and 2-year survival. Stratification of patients into low- and high-risk groups can be facilitated by plasma N-BNP or BNP measurements, and one of these could reasonably be included in the routine clinical workup of patients after myocardial infarction.
Adrenomedullin↗
New government, same narrow vision. Health authorities in New Zealand have spin doctors to produce good news.
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Communication↗
Investigation of the presynaptic effects of quinine and quinidine on the release and uptake of monoamines in rat brain tissue.
Quinine and quinidine are reported to potentiate the behavioural effects of serotonergic agents and monoamine uptake inhibitors. We have therefore investigated the presynaptic actions of quinine and quinidine on monoamine uptake and release in rat brain tissue in vitro. Quinidine evoked the release of [3H]5-HT, [3H]noradrenaline and [3H]dopamine from pre-loaded rat brain slices in a concentration dependent manner with EC50 values of 175, 486 and 150 microM, respectively. Quinine induced [3H]monoamine release with similar potencies. Both quinine and quinidine also inhibited the active uptake of [3H]5-HT, [3H]noradrenaline and [3H]dopamine into rat brain synaptosomes with IC50 values in the range 0.13-12.4 microM. The potency of each drug to inhibit [3H]5-HT uptake was significantly higher than that for [3H]noradrenaline or [3H]dopamine. The relative potency of quinidine compared to quinine was more marked in the case of [3H]5-HT (58-fold) than for [3H]noradrenaline (3-fold) or [3H]dopamine (4-fold). The inhibition of [3H]5-HT uptake by quinine and quinidine was competitive in nature and corresponded with the potencies of these drugs to inhibit [3H]paroxetine binding. No correlation was observed between the potencies of quinine and quinidine to induce the release of [3H]monoamines and to inhibit their uptake, suggesting that these effects are mediated by two distinct mechanisms. We conclude that the presynaptic actions of quinine and quinidine on monoamine uptake and release may be implicated in their potentiation of the effects of serotonergic agents and uptake blockers.
Animals↗
Comparative desensitization of the human 5-HT2A and 5-HT2C receptors expressed in the human neuroblastoma cell line SH-SY5Y.
1. We have used previously characterized clones of the human neuroblastoma cell line, SH-SY5Y. constitutively expressing either the human 5-HT2A or 5-HT2C receptor to compare their desensitization profiles after exposure to 5-HT. 2. 5-HT stimulated [3H]-inositol phosphate ([3H]-IPx) production at both the 5-HT2C (pEC50=8.03+/-0.15) and 5-HT2A receptors (pEC50=7.15+/-0.08), with maximal responses occurring after exposure to 1 microM and 10 microM 5-HT, respectively. 3. Exposure of cells to maximally effective concentrations of 5-HT caused time- and concentration-dependent desensitization of [3H]-IPx formation. The 5-HT2A response desensitized slower (t1/2 = 110 min) and with lower sensitivity than that of the 5-HT2C receptor (t1/2 = 12.5 min). In each case, desensitization was blocked by co-administration of a specific receptor antagonist. Following exposure to 10 microM 5-HT for 2 h, both receptors exhibited extensive desensitization, with subsequent responses to 5-HT reduced by more than 80%. 4. 5-HT stimulated Ins(1,4,5)P3 production with a potency similar to that for [3H]-IPx production at each receptor. In both cases Ins(1,4,5)P3 levels peaked rapidly then returned to basal level within a short time. This peak consistently occurred earlier for the 5-HT2C receptor (5 s) than for the 5-HT2A receptor (20 s). 5. Prior exposure of SH-SY5Y/5-HT2C cells to 5-HT (1 microM/15 min) caused a significant decrease in the 5-HT-stimulated peak in Ins(1,4,5)P3 levels whereas no such change occurred in SH-SY5Y/5-HT2A cells following exposure to 10 microM 5-HT for 15 min. 6 These results indicate that the human 5-HT2A and 5-HT2C receptors both exhibit desensitization at the level of inositol phosphate formation when expressed in the same cellular environment, with the 5-HT2C receptor being more sensitive to 5-HT-mediated desensitization than the 5-HT2A receptor.
Carbachol↗
Class III antiarrhythmic activity in vivo by selective blockade of the slowly activating cardiac delayed rectifier potassium current IKs by (R)-2-(2,4-trifluoromethyl)-N-[2-oxo-5-phenyl-1-(2,2,2-trifluoroethyl)- 2, 3-dihydro-1H-benzo[e][1,4]diazepin-3-yl]acetamide.
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Acetamides↗
Expression, genomic structure and high resolution mapping to 19p13.2 of the human smooth muscle cell calponin gene.
Smooth muscle cells (SMC) express a battery of cell-restricted differentiation genes, many of which are down-regulated during the course of vascular disease. Here, we present the mRNA expression, genomic structure and chromosomal mapping of the gene encoding human smooth muscle cell calponin (SMCC). Human SMCC transcripts are restricted to tissues and cells of SMC origin and, in the latter case, appear to be uniquely controlled in two distinct human SMC lines of uterine and aortic origin. Restriction mapping. Southern blot and PCR analysis of a 70-kb human bacterial artificial chromosome (BAC) revealed a genomic structure (seven exons spanning > 11 kb) very similar to that reported for the mouse SMCC gene. Using a variety of human-rodent somatic cell hybrid and radiation hybrid mapping panels, the human SMCC gene was mapped to a genomic interval of less than 1.32 Mb in 19p13.2. These results provide new information concerning the regulation of SMCC gene expression and demonstrate the utility of two human SMC lines for the further characterization of this gene's expression control. The identification of a BAC harboring the entire human SMCC locus represents an important reagent for future analysis of SMCC regulatory sequences. Finally, the localization of SMCC to a defined genomic interval will facilitate an analysis of its potential as a candidate gene for disease phenotypes mapping to 19p13.2.
Amino Acid Sequence↗