Two-dimensional and Doppler echocardiographic findings in hypereosinophilic syndrome.
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Adult↗
Biomedical subjects
T Ryan
Publications and source records attributed to T Ryan.
Risk stratification after acute myocardial infarction by means of exercise two-dimensional echocardiography.
To determine whether exercise two-dimensional echocardiography contributes to the prognostic information provided by exercise testing in patients recovering from acute myocardial infarction, 40 patients were prospectively studied by means of pre- and postexercise echocardiography 10 to 21 days after myocardial infarction. Patients were followed for 6 to 10 months or until one of the following clinical end points occurred: death, recurrent myocardial infarction, unstable angina, or coronary artery bypass grafting. Results of treadmill exercise tests were negative in 13 of 20 patients with good clinical outcome (65% specificity) and positive in 11 of 20 patients with poor clinical outcome (55% sensitivity). The resting echocardiogram was abnormal in 37 of 40 patients. The exercise echocardiogram was negative in 19 of 20 patients with good clinical outcome (95% specificity) and positive in 16 of 20 patients with poor clinical outcome (80% sensitivity). We conclude that exercise echocardiography is more sensitive and specific than treadmill exercise testing for predicting the occurrence of subsequent cardiac events after acute myocardial infarction.
Adult↗
Lecithin and piracetam in Alzheimer's disease.
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Aged↗
Effect of prior myocardial infarction and extent and location of coronary disease on accuracy of exercise echocardiography.
Exercise echocardiography is an emerging technique for the evaluation of patients with suspected coronary artery disease. In this study, rest and immediate postexercise echocardiograms were performed in 123 patients who were stratified on the basis of prior myocardial infarction and the number and location of coronary artery stenoses at cardiac catheterization. The location of wall motion abnormalities on rest and postexercise studies was correlated with the location of coronary artery stenoses. The sensitivity of exercise echocardiography for detecting coronary artery disease in patients with multivessel disease was 97% in those with and 86% in those without prior infarction. The corresponding sensitivity for patients with single vessel disease was 100% and 72%, respectively. Multivessel disease was present in 59 patients, but specifically identified as such in only 32 (54%). Normal rest and exercise echocardiograms were seen in 12 patients with coronary artery disease, 8 of whom had single vessel disease. It is concluded that the subjective analysis of the exercise echocardiogram accurately identifies the majority of patients with coronary artery disease. Its sensitivity is greatest in those with multivessel coronary disease. It is limited in those with single vessel coronary disease and in accurately identifying the subset of patients with multivessel disease.
Angiography↗
Doppler echocardiographic detection of a ruptured acquired aneurysm of the sinus of Valsalva. Clinical-morphologic correlations.
Two-dimensional, pulsed Doppler echocardiographic and pathologic features of an unusual form of ruptured aneurysm of the sinus of Valsalva are presented. The presence of an aneurysm of the left sinus of Valsalva protruding into the left atrium complicating acute aortic valvular endocarditis was detected by two-dimensional echocardiography. Rupture of the aneurysm of the sinus of Valsalva into the left atrial cavity was suggested by pulsed Doppler echocardiography. The size and location of the site of the rupture precluded recognition by two-dimensional echocardiography or contrast angiography. This report illustrates the unique value of pulsed Doppler echocardiography to define the location and direction of intracardiac flow patterns in evaluating patients with an aneurysm of the sinus of Valsalva and suspected rupture.
Acute Disease↗
B-mode ultrasonic imaging in the preoperative evaluation of saphenous vein.
This prospective study was undertaken to determine if B-mode ultrasonic imaging of the greater saphenous vein can provide reliable information about anatomy, sites of valves, and location of major tributaries or duplicate systems. Preoperative ultrasonic imaging was performed on 15 consecutive patients prior to in situ saphenous bypass. The findings of the ultrasonic evaluations were compared with the intraoperative findings. Preoperative assessment of the greater saphenous vein was performed with a high resolution real-time B-mode ultrasonic imager. The procedure was performed with the patient seated with the leg extended. The saphenous vein was imaged starting at the ankle. A waterproof pen was used to mark the vein. The locations of valves and tributary vessels were marked and the diameter of the saphenous vein was recorded. These results were compared with operative findings. In all 15 patients, the saphenous vein was imaged. There was 100 per cent accuracy in the detection and location of valve sites. In one patient, the proximal portion of the vein was thrombosed and this was detected by the B-mode scan. There was exact correlation in 14 of 15 limbs (93%). The one error was due to the examiners' failure to identify a triple venous system; only a double venous system was identified by scan in this patient. The actual venous diameter was consistently within 0.5 mm of that measured by the ultrasound imager. In all patients, the ultrasound image demonstrated the correct anatomic location and size of the vein. In conclusion, B-mode ultrasonic imaging provides an accurate description of the anatomy of the saphenous vein, without the morbidity associated with contrast venography.
Aged↗
An evaluation of the clinical value of the leucocyte count and sequential counts in suspected acute appendicitis.
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Adolescent↗
Digital averaging to facilitate two-dimensional echocardiographic measurements.
A problem in quantitative two-dimensional echocardiography is myocardial dropout of still frame images. This study was designed to evaluate the ability of digital averaging to overcome myocardial dropout without distorting quantitative measurements. Forty-one percent of 80 digitally averaged images were thought to be improved by five independent observers, whereas 7% showed some deterioration. Measurements obtained from processed images were statistically identical (r greater than or equal to 0.9) to those from three arithmetically averaged, unprocessed images in 60 patients. Digital averaging can improve image quality without measurement distortion and should facilitate two-dimensional echocardiographic quantitation.
Analog-Digital Conversion↗
Quantitative two-dimensional echocardiographic assessment of patients undergoing left ventricular aneurysmectomy.
To evaluate the role of quantitative two-dimensional echocardiography (2DE) in the preoperative assessment of patients undergoing left ventricular (LV) aneurysmectomy, we identified 37 patients who were studied with 2DE 1 to 56 (mean 12.6) days prior to surgery. Diastolic (Dd) and systolic (Ds) minor-axis dimensions at the base were measured and fractional shortening (FS) was calculated. Global and basilar half ejection fraction (EF) as measured from right anterior oblique left ventriculograms. At follow-up (mean 17.9 months), 27 patients were alive and clinically improved (group A) and 10 patients either died or were symptomatically unimproved (group B). Basilar half EF was significantly greater among patients in group A (0.50 +/- 0.09) than in group B (0.37 +/- 0.10) (p less than 0.001). Echocardiographic FS provided the best separation between groups. Mean FS was 0.25 +/- 0.06 in group A and 0.15 +/- 0.04 in group B (p less than 0.001). All seven patients with FS less than 0.17 were in group B while 25 of 27 patients with FS greater than 0.17 were in group A (p less than 0.001). Considering all patients, basilar half EF and FS were highly correlated (r = 0.84).
Adult↗
Doppler echocardiographic evaluation of patients with porcine mitral valves.
The application of Doppler echocardiography to the study of valvular function has recently been extended to include prosthetic valves. We have used Doppler echocardiography to evaluate 40 patients with porcine mitral valves (PMV) implanted 0.5 to 99 months prior to examination. Three parameters of PMV flow were assessed: maximum diastolic left ventricular inflow velocity (Vmax), pressure half-time (P1/2t), and presence or absence of mitral regurgitation (MR). Normally functioning PMV (n = 29) were characterized by Vmax less than or equal to 180 cm/sec and P1/2t less than or equal to 160 msec. Within this group, P1/2t was not correlated significantly with the age of the patient nor with prosthesis size. Doppler correctly identified all 10 patients with MR. Among these 10 patients, Vmax was 206 +/- 53 cm/sec, significantly higher than the mean observed in normally functioning prostheses (136 +/- 24 cm/sec, p less than 0.001). In eight patients with stenosis of the PMV, mean P1/2t was 220 +/- 63 msec, and in seven of eight, it was greater than or equal to 180 msec (p less than 0.001 compared to normals). We conclude that: (1) Vmax less than or equal to 180 cm/sec, P1/2t less than or equal to 160 msec, and absence of systolic turbulence in the left atrium characterize normally functioning PMV; (2) P1/2t greater than or equal to 180 msec identifies patients with stenosis of the PMV; and (3) Doppler echocardiography can detect MR and separate mitral from tricuspid regurgitation.
Adult↗
Gallbladder filling and emptying during cholesterol gallstone formation in the prairie dog. A cholescintigraphic study.
We studied gallbladder bile flow before, during, and after cholesterol gallstone formation in the prairie dog using infusion cholescintigraphy with 99mTc-diethyl iminodiacetic acid. In 18 fasting animals partitioning of bile between gallbladder and intestine was determined every 15 min for 140 min, and gallbladder response to cholecystokinin (5 U/kg X h) was calculated from the gallbladder ejection fraction. Ten prairie dogs were then placed on a 0.4% cholesterol diet and 8 on a regular diet, and the studies were repeated 1, 2, and 6 wk later. The proportion of hepatic bile that entered the gallbladder relative to the intestine varied from one 15-min period to the next, and averaged 28.2% +/- 5.1% at 140 min. Partial spontaneous gallbladder emptying (ejection fraction 11.5% +/- 5.6%) was intermittently observed. Neither the number nor the ejection fraction of spontaneous gallbladder contractions changed during gallstone formation. By contrast, the percent of gallbladder emptying in response to cholecystokinin decreased from 72.1% +/- 5% to 25.9% +/- 9.3% (p less than 0.025) in the first week and was 14.3% +/- 5.5% at 6 wk (p less than 0.01 from prediet values, not significant from first week). Gallbladder filling decreased from 28.2% +/- 5.1% to 6.7% +/- 3% (p less than 0.01), but this change was only observed after 6 wk, when gallstones had formed. This study shows that bile flow into the gallbladder during fasting is not constant; the gallbladder contracts intermittently; gallbladder emptying in response to exogenous cholecystokinin is altered very early during gallstone formation; and gallbladder filling remains unaffected until later stages, when gallstones have formed.
Animals↗
Effect of apomorphine infusion on plasma homovanillic acid in normal subjects.
Previous experiments suggest that pharmacological perturbations of the brain dopaminergic system may be reflected by concentrations of plasma homovanillic acid. This study examined the ability of apomorphine infusion to reduce plasma homovanillic acid concentrations in normal subjects. The data suggests that apomorphine does not reduce plasma homovanillic acid concentration.
Adolescent↗
Prospective evaluation of the left main coronary artery using digital two-dimensional echocardiography.
Recent clinical studies emphasize the importance of identification of patients with left main coronary artery obstruction. Although two-dimensional echocardiography can detect left main coronary artery disease, the technique requires frame by frame analysis, as no single frame provides all the necessary information. To determine if newly available computer-based digital processing techniques could overcome some of these technical difficulties, 119 consecutive patients were prospectively evaluated with two-dimensional echocardiography before coronary angiography. A continuous loop recording of the left main coronary artery was recorded as it passed through the ultrasonic beam in the short-axis view. Starting at a point when the vessel was first visualized, the ensuing eight consecutive fields, each 17 ms apart, were captured in digital format, thus providing a series of parallel, sequential, longitudinal slices of the left main coronary artery as it traversed the imaging plane. This was successfully accomplished in 100 (84%) of the 119 consecutive patients. By angiography, 16 patients (16%) had greater than 50% narrowing of the left main coronary artery. Digital echocardiography correctly identified 15 of these 16 patients (94% sensitivity) and accurately localized the lesion in 12 (80%) of 15. Of 84 patients without significant left main coronary artery obstruction, digital echocardiography correctly identified 78 (93% specificity). It was concluded that computer-based digital processing techniques can be applied to two-dimensional echocardiography to allow reliable visualization of the left main coronary artery. The technique provides more information than a single still frame and allows accurate noninvasive detection and possible localization of left main coronary artery lesions.
Coronary Angiography↗
Plastic wrap for US transducer sterility or sanitization.
Commercially available plastic wrap can be used to encase an ultrasound transducer for sanitization purposes. If sterility is required, an individual piece of plastic wrap can be gas sterilized before the transducer is covered with it. This technique does not degrade or temporally limit the use of the transducer, it is easy to perform, and the materials are readily available.
Acoustics↗
Effects of sulfur dioxide on pore populations of canine tracheal epithelium.
The bioelectric and barrier properties of the tracheal epithelium in nose-breathing dogs and in dogs that had been exposed for 75 min to compressed air or to two high concentrations of SO2 were measured and compared. We also studied tissues that had been treated with chloroform. Based on a model of restrictive diffusion we demonstrated heteropores (6 and 250 A) in the control tissues. Bioelectric changes due to 100-ppm SO2 were minimal. After exposure to 500 ppm SO2, adverse changes in the bioelectric properties were focal; they were marked in 8 out of 12 animals but were less striking in the other 4. Nonelectrolyte permeability increased with an increase in SO2 concentrations. Small pores were still present in the tissues severely affected by SO2 but they were absent in chloroform-treated tissues. Scanning electron microscopy of tissues from animals exposed to 500 ppm SO2 showed that in the same dog tissue appearance varied from normal to one of repair (normal bioelectric properties) or one of marked exfoliation of ciliated cells (abnormal bioelectric measurements).
Animals↗
Variant chronic granulomatous disease: modulation of the neutrophil defect by severe infection.
The present studies document the cellular and biochemical processes involved in granulocyte O2- production in three patients from two kindreds with variant chronic granulomatous disease (CGD). Rates of O2- production were 9% to 30% of normal, depending on the individual tested and the stimulus; the two brothers from one family responded to each stimulus with rates very similar to each other. Kinetic analysis of NADPH-dependent O2- production in subcellular fractions revealed all three to have NADPH oxidases with both diminished substrate affinity for NADPH (high Kmapp) and decreased maximal velocities of O2- production. Their granulocytes had normal lag times for activation of the respiratory burst but abnormal rates of stimulus-induced membrane depolarization. Cytochrome b was not found in granulocytes or subcellular fractions despite the use of a spectrophotometric assay sensitive enough to detect the cytochrome if its content were proportional to the residual rate of O2- generation. A striking finding in one patient from each kindred was a threefold to tenfold decrease in the rate of O2- production accompanying serious infection. The residual O2(-)-generating activity of CGD variants helps to explain their relative freedom from the recurrent infections of the classic disease. However, the marked decrease described in the present study indicates the potential for a vicious cycle in which an infection, once established, leads to increasing impairment of host defense.
Abscess↗
Neutrophil defect associated with malignant infantile osteopetrosis.
We studied the phagocytes from three infants with malignant osteopetrosis and from their families in an attempt to define further the phagocyte abnormalities associated with this disorder. The rapid membrane potential depolarization in response to the soluble stimuli formylmethionylleucylphenylalanine (FMLP) and phorbol myristate acetate (PMA) served as a measure of neutrophil activation, with 3,3-dipentyloxacarbocyanine (diOC5 [3]) used as the probe. A fluorescence-activated cell sorter (FACS) allowed us to use small volumes of blood in a new quantitative evaluation of neutrophil response. The neutrophils from the infants with malignant osteopetrosis were very minimally activated with either stimulus, as demonstrated by incomplete membrane potential depolarization (10% to 15% of normal controls). This finding indicates that malignant osteopetrosis is accompanied by a significantly reduced neutrophil response to stimulation. The abnormal activation process was also reflected in the respiratory burst response of the patients' neutrophils and monocytes. Fifty percent to 60% of the infants' neutrophils totally failed to reduce nitro blue tetrazolium dye (NBT), 30% to 40% of the cells showed only slight reduction after PMA or FMLP stimulation, and only 5% to 10% demonstrated normal reduction. Peripheral blood monocytes failed to reduce NBT in 35% to 70% of the cells tested. Similar testing of granulocyte-macrophage colonies grown in vitro from circulating progenitor cells also showed an abnormal distribution of response to PMA, with a majority of colonies showing a decrease or absence of NBT reduction. Thus control of expression of the osteopetrotic defect occurs at or before the progenitor cell level.
Flow Cytometry↗
Physostigmine in patients with Alzheimer's disease.
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Aged↗