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Coronary flow reserve and myocardial diastolic dysfunction in arterial hypertension.

The aim of this study was to assess the relation between coronary blood flow and left ventricular (LV) myocardial diastolic dysfunction in arterial hypertension. The study population included 30 hypertensive patients who were free of coronary artery disease and pharmacologic therapies. They underwent standard Doppler echocardiography and color tissue Doppler of the middle posterior septum at baseline and with high-dose dobutamine, and second-harmonic Doppler flow analysis of the distal left anterior descending coronary artery at baseline and after vasodilation by dipyridamole (0.56 mg/kg IV in 4'). Coronary flow reserve (CFR) was estimated as the ratio of hyperemic and baseline diastolic flow velocities. According to CFR, hypertensives were divided into 2 groups: 15 patients with normal CFR (>/=2) and 15 patients with reduced CFR (<2). The 2 groups were comparable for sex, age, body mass index, baseline heart rate, and blood pressure. LV mass index was greater in hypertensives with reduced CFR (p <0.01). By color tissue Doppler, baseline and high-dose dobutamine septal systolic velocities did not differ between the 2 groups. The ratio between myocardial velocities in early diastole and at atrial contraction (E(m)/A(m) ratio) was lower in patients with reduced CFR, both at baseline (p <0.05) and with high-dose dobutamine (p <0.00001). After adjusting for age, body mass index, LV mass index, and both high-dose dobutamine diastolic blood rate and heart rate by a multiple linear regression analysis, E(m)/A(m) ratio at high-dose dobutamine was independently associated with CFR in the overall population (beta 0.62, p <0.0005) (cumulative R(2) 0.38, p <0.0005). In conclusion, this study provides evidence of an independent association between CFR and myocardial diastolic function. In hypertensive patients without coronary artery stenosis, CFR alteration may be a determinant of myocardial diastolic dysfunction or diastolic impairment that should be taken into account as possibly contributing to coronary flow reduction.

Adult↗

Optic neuropathy and central nervous system disease secondary to Sjögren's syndrome in a child.

The authors describe a 10-year-old girl in whom optic neuropathy and central nervous system (CNS) disease developed in association with primary Sjögren's syndrome. There was angiographic evidence of cerebral vasculitis and multiple infarcts present on neuroimaging. Results of parotid biopsy, cerebrospinal fluid, and serologic analyses showed abnormalities that were consistent with the diagnosis of Sjögren's syndrome. Although the patient had optic disc pallor on initial evaluation, her color vision and acuity improved with immunosuppressive therapy, as did her other neurologic symptoms. The authors believe this represents the first reported case of optic neuropathy and CNS disease associated with primary Sjögren's syndrome in the pediatric population. The possibility of improvement in visual function with early institution of immunosuppressive therapy makes prompt diagnosis essential.

Brain Diseases↗

Knowledge of treatment to reduce perinatal human immunodeficiency virus (HIV) transmission and likelihood of testing for HIV: results from two surveys of women of childbearing age.

OBJECTIVE: To determine whether knowledge of zidovudine treatment to reduce the risk of mother-to-child transmission of HIV increases the likelihood of HIV testing among women of childbearing age at increased risk for HIV infection. METHOD: Data from two samples were analyzed. The Young Women Survey was a population-based, door-to-door survey of 2,545 women aged 18 to 29 years who were living in lower-income neighborhoods. For the Perinatal Survey, women receiving prenatal care or who had delivered within the previous six months (N = 850) were recruited at randomly selected sites. Most (71.2%) of these participants were covered by public payment sources for their prenatal care. Data were collected within California counties with high rates of HIV among newborns, high rates of HIV among female clients of alternative test sites, and high rates of AIDS among female injection drug users. Most participants from both surveys were women of color. RESULTS: Participants who knew about zidovudine therapy for HIV-positive pregnant women were more likely to have had an HIV test, regardless of race/ethnicity, age, education, or number of previous births. The majority of women (79.3%) from both samples stated that they were more likely to take a test for HIV knowing about zidovudine treatment. CONCLUSIONS: HIV educators should include information on zidovudine therapy in campaigns designed to promote HIV testing among women. Prenatal care providers should incorporate a brief discussion about the benefits of zidovudine treatment when providing HIV counseling to patients.

AIDS Serodiagnosis↗

Use of mental health services among older youths in foster care.

OBJECTIVE: This study examined lifetime, 12-month, and current mental health service use among older youths in the foster care system and examined variations in mental health care by race, gender, maltreatment history, living situation, and geographic region. METHOD: The Service Assessment for Children and Adolescents, the Child Trauma Questionnaire, and the Diagnostic Interview Schedule were used in interviews with 406 youths in Missouri's foster care system who were aged 17 years. RESULTS: Ninety-four percent of the youths had used a mental health service in their lifetime, 83 percent used a mental health service in the past year, and 66 percent were currently receiving a mental health service. Lifetime rates for inpatient psychiatric care (42 percent) and other residential programs (77 percent) were exceptionally high. A quarter of the youths received mental health services before they entered the foster care system. Among youths who received residential services, half did not receive community-based services before receiving residential services. After the analyses controlled for need, predisposing characteristics, and enabling characteristics, youths of color were less likely to receive outpatient therapy, psychotherapeutic medications, and inpatient services, and they were more likely to receive residential services. Youths who had been neglected and youths in kinship care were less likely to receive some types of services. Geographic differences in service use were common and sometimes mediated the effect of race on service use. CONCLUSIONS: The child welfare system was actively engaged in arranging mental health services for youths in the foster care system, but the system was unable to maintain many youths in less restrictive living situations. The variations by race and geography indirectly indicate quality concerns.

Adolescent↗

[History of tuberculosis: a century after the discoveries of Koch and Forlanini].

A century after the discovery of the etiological agent of tubercolosis, the author remembers the steps of study of the disease. Fracastoro supposed the existence of small bodies, epidemiological studies pointed attention to the transmissibility until 1882, when Koch communicated to the Physiological Society of Berlin that bacteria had been evidenced in biological material of the lungs from tuberculosis patients. The method of coloration of Koch rapidly spread, but no therapy was found. In the same year Forlanini proposed the artificial pneumothorax as cure.

Germany↗

Radial artery wall shear stress evaluation in patients with arteriovenous fistula for hemodialysis access.

It has been extensively documented that changes in blood flow induce vascular remodeling and this phenomenon seems to be correlated to the shear forces imposed on the vessel wall by motion of blood. Wall shear stress, the tractive force that acts on the endothelium, has been shown to influence endothelial cell function. To study changes in wall shear stress that develop on the vessel wall upon changes of blood flow, we set up a technique that allows estimation of shear stress in the radial artery of patients on chronic hemodialysis therapy. The technique is based on color-flow Doppler examination of the radial artery before and after surgical creation of radiocephalic fistula for hemodialysis. Calculation of time function wall shear stress and blood flow rate in the radial artery is performed on the basis of arterial diameter, center-line velocity waveform and blood viscosity, using a numerical method developed according to Womersley's theory for pulsatile flow in tubes. The results presented confirm that the model developed is suitable for calculation of the wall shear stress that develops in the radial artery of patients before and after surgical creation of an arteriovenous fistula for hemodialysis. This methodology was developed for characterization of wall shear stress in the radial artery but may be well applied to other vessels that can be examined by echo-Doppler technique.

Arteriovenous Shunt, Surgical↗

Minnesota's Midwest AIDS Training and Education Center: helping health care providers remain current on a rapidly changing epidemic.

Since 1990, the number of people in Minnesota living with HIV/AIDS has been steadily increasing. The demographics of who is infected with HIV have changed, with more women and people of color being diagnosed. In addition, with new therapies and continually updated treatment recommendations, the information needed to provide quality medical care to HIV-infected patients is constantly evolving. Thus, providers who care for patients with HIV/AIDS need ongoing education about the disease. The Midwest AIDS Training and Education Center (MATEC) is a federally funded program that helps health care providers stay abreast of HIV clinical care and management knowledge. Based at the University of Illinois at Chicago, MATEC provides services in seven states, including Minnesota. This article describes how MATEC's HIV/AIDS training and education programs are being implemented in Minnesota and the different ways MATEC is delivering provider education in this important area.

Acquired Immunodeficiency Syndrome↗

[Diagnostic and therapeutic applications of bronchoscopy (author's transl)].

The development of therapeutic bronchoscopy into diagnostic bronchoscopy is described. Based on a personal experience of more than 35,000 bronchoscopies, attention is given to some important points in diagnosis and therapy. In diagnosis, these factors include: 1) color of mucosa, 2) structure of cartilage, 3) minimal tissue changes (nodules, vessels, folds), 4) tonus, 5) secretion, 6) miscellaneous peculiarities. Therapeutic studies involve: 1) recanalisation (from secretion to foreign body and tumor), 2) scrubbing (in treatment of fibrinous bronchitis and tracheitis, 3) bougies, 4) irrigation, 5) washing (for status asthmaticus, aspiration of gastric contents, etc.), 6) tamponade for persistent hemoptysis.

Bronchial Diseases↗

Diagnostic items and treatment of Plummer's disease: a study on 180 patients.

OBJECTIVE: The aim of this study was to evaluate clinical data of patients who have been undergone to medical, radionuclide, surgical and percutaneous ethanol injection (PEI) treatment of autonomous "hot nodule", to establish the real value of these therapeutical strategies. PATIENTS AND METHODS: The authors analyzed their experience based on 180 Plummer's disease (PD) from January 1990 to December 1997. 49 nodules have been submitted to FNA. RESULTS: The functional stage of PD was partially autonomously in 47 patients, pretoxic nodule in 98 patients and in toxic phase in 35 patients. The more frequent ultrasonographic type has been a solid nodule with abundant intranodular vascularization to color flow duplex Doppler evaluation. The medical therapy has brought to a resolution of the toxic phase in 71.2% of the patients, while 6.4% of the patients developed a recurrent hyperthyroidism. The surgical treatment of the patients with hyperthyroidism has resolved hyperthyroidism symptoms in 87.5% of cases. The therapy with radioactive iodine determined a metabolic normalization in 73.7% of the cases and an hypothyroidism in 89.5% of the cases. Our results, in 12 patients treated with PEI, followed-up through 12 months, have been excellent: total remission in 75% of the patients and no recurrent hyperthyroidism crisis. CONCLUSIONS: It doesn't exist a single therapy to treat the PD. The surgical or radionuclide treatment could be addressed to the big or toxic nodules insensible to pharmacological therapy and the PEI represent a new method to treat the PD because of efficacious, harmless, cheap and practical too.

Adult↗

Optic neuropathy following elcatonin therapy.

A 34-year-old man, who had a 14-year history of hemodialysis, presented with a sudden onset of blurring of vision in both eyes after elcatonin therapy for hypercalcemia. Fundus examination showed well-colored discs without swelling and normal retina in both eyes. Goldmann kinetic perimetry demonstrated central scotomas in both eyes. One month after discontinuance of elcatonin, his best visual acuity returned to 20/20 in both eyes. Although a cause-and-effect relationship between elcatonin and optic neuropathy is not definitive, optic neuropathy is presumably linked to elcatonin therapy.

Adult↗

Color Doppler ultrasound of the hand: observations on clinical utility in rheumatoid arthritis.

The use of ultrasound with color Doppler in the evaluation of rheumatoid arthritis was followed in 25 patients with joint complaints. Small joint ultrasound of the metacarpophalangeal joints (MCPs) as well as the wrists was performed with supplementation by color Doppler. In addition, 6 patients were followed for at least 3 months after start of treatment of rheumatoid arthritis using the same technique. In patients with what appeared to be definite rheumatoid arthritis, ultrasound supported this diagnosis as evidenced by the finding of cortical defects, extensor tendon sheath thickening, and synovial proliferation. Increased activity by color Doppler ultrasonography was the most common finding. Significant decrease in color Doppler activity was noted in the 6 patients who were followed up after 3 months of therapy with disease-modifying agents. Therefore, the use of ultrasound with color Doppler could aid in the diagnosis and follow up of patients with rheumatoid arthritis.

Journal Article↗

Sonographic and color Doppler findings of rupture of liver tumors.

We present six cases of ruptured liver tumor (hepatocellular carcinoma, five cases; liver metastasis, one case) in which gray-scale sonography revealed an ascites containing constantly moving dense high-echo spots, leading to a high suspicion of acutely developing hemoperitoneum. Color Doppler sonography helped in detecting the rupture site by demonstrating a high-velocity jet flow from it. Although four of six patients were dead within 3 months, detection of the rupture site by color Doppler sonography made the initial transarterial embolization therapy easy and prompt.

Adult↗

Direct antilymphoma effects on human lymphoma cells of monotherapy and combination therapy with CD20 and HLA-DR antibodies and 90Y-labeled HLA-DR antibodies.

PURPOSE: Monoclonal antibodies (mAb) in combination and mAbs combined with a radionuclide (radioimmunotherapy) have both been more effective in patients than mAb monotherapy. EXPERIMENTAL DESIGN: Using assays of cell growth and viability, the dose response and temporal characteristics of CD20 (rituximab) and HLA-DR (Lym-1) mAbs, singly and in combination, and of 90Y-conjugated Lym-1 mAb have been characterized in five human lymphoma cell lines (B35M, Raji, SU-DHL-4, SU-DHL-6, and Ramos) spanning Burkitt's to diffuse large cell lymphoma. Although Ramos had a lower HLA-DR density, these cell lines were otherwise selected because of high cell surface CD20 and HLA-DR abundance. Assays of cell growth and death were done using microscopy and trypan blue dye. RESULTS: Lym-1 and rituximab, used singly, showed direct antilymphoma effects; those of Lym-1 were often more potent than those of rituximab. Combinations of these mAbs were more effective, sometimes synergistic, than either mAb singly, even in more resistant SU-DHL-4 cells. Conjugation of 90Y to Lym-1 also augmented potency in all cell lines and overcame resistance to both Lym-1 and rituximab in Ramos cells. CONCLUSIONS: Lym-1 exhibited substantially greater direct antilymphoma effects than rituximab in lymphoma cells in culture. Combination of Lym-1 with rituximab or 90Y increased potency and overcame treatment resistance in lymphoma cells. Greater use of combination therapies of this type to increase potency and range of effectiveness seems likely to improve patient outcome.

Animals↗

A comparative study of an estradiol-releasing vaginal ring versus tibolone in postmenopausal women: a transvaginal color Doppler study.

OBJECTIVE: To evaluate endometrial blood flow characteristics in response to estrogen replacement therapy (ERT) and tibolone in postmenopausal women and to correlate the resistance index (RI) with plasma estradiol levels. MATERIALS AND METHODS: Transvaginal color Doppler ultrasound examinations were performed in 72 asymptomatic, postmenopausal women who demonstrated endometrial thickness < or = 5 mm. Thirty-six women receiving tibolone and 36 patients receiving ERT by a vaginal ring comprised the study groups. RESULTS: All postmenopausal women treated with tibolone or ERT showed continuous forward end-diastolic flow. The lowest RI was obtained in women with the vaginal ring inserted. The plasma concentrations of estradiol were found to be significantly higher in the vaginal ring group than those of tibolone. CONCLUSIONS: The data observed suggest that ERT and tibolone modify normal postmenopausal endometrial perfusion. Tibolone had a weaker estrogenic effect on endometrial blood flow resistance, and vaginal ring treatment enhanced endometrial blood perfusion through vasodilatation.

Anabolic Agents↗

SYNOROPTICS.

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Adolescent↗

Achieving functional restorations utilizing a new Ceromer system.

The advent of pressed ceramic restorations (IPS Empress, Ivoclar Williams, Amherst, NY) has driven dental therapy to continuously strive for more aesthetic and functional materials. The dental profession requires restorations to exhibit strength, natural color, wear resistance, marginal integrity, and ease of fabrication in the restorative therapies selected. With the introduction of a new ceromer and fiber-reinforced composite (FRC) system (Targis System, Ivoclar Williams, Amherst, NY), the replacement of a single tooth or multiple teeth with a FRC, metal-free bridge is now a suitable alternative to conventional dental therapy. This presentation will review the clinical protocol, material properties, and aesthetic characteristics of this new generation of restorative material.

Adult↗

Q-switch laser and tattoo pigments: first results of the chemical and photophysical analysis of 41 compounds.

BACKGROUND AND OBJECTIVE: In the Western world, there are at least 20-30 million people with tattoos. Improved self-image and social stigmatization are the main reasons for removing tattoos from skin. Q-switched lasers are applied to destroy the tattoo compounds in the skin. The treatment of tattoos containing ink often gives excellent results, whereas the results of treatments for coloured tattoos are not predictable and usually are worse. The chemical structure and the absorption spectra of the tattoo pigments are usually unknown. However, the efficacy of the treatment by using light of different Q-switched lasers (wavelengths 510, 532, 694, 755, 1064 nm) is correlated to both the chemical structure of the tattooed compounds yielding specific absorption spectra and the laser wavelength used. STUDY DESIGN/MATERIALS AND METHODS: A structural and spectroscopic analysis of 41 coloured pigments was performed. RESULTS: The 41 substances were identified, and they consist of 16 individual chemicals of different structured well-known industrial organic pigments. The absorption spectra of the 16 pigments were measured quantitatively. CONCLUSION: The results of the present analysis explain to some extent the outcome of clinical studies regarding laser therapy of coloured tattoos. Because the laser energy used produces a high temperature in the azo or polycyclic pigments, it is necessary to investigate whether that change causes possibly toxic or cancerogenic compounds.

Coloring Agents↗

Circulating blood volume in patients with subarachnoid haemorrhage.

To establish the fluid management for patients with subarachnoid haemorrhage (SAH), circulating blood volume (BV) was measured by pulse-spectrophotometry using indocyanine green (ICG) in 34 cases with SAH and 20 cases with neurosurgical disorders as control. BV measured immediately after induction of anaesthesia was lower in cases with SAH than that in controls. (62.8+/-12.3 vs. 73.3+/-11.2 ml/kg, p<0.01). In cases with SAH, the BV was significantly decreased in females (p<0.05) but not so significantly in males. In female cases with SAH, reduced BV was increased 3 days after operation (p<0.01). In conclusion BV is decreased in cases with SAH, especially in females. Active fluid therapy may be necessary when temporary vascular occlusion is required during aneurysm surgery. Since hypovolaemia may cause symptomatic vasospasm, BV measurement with pulse-spectrophotometry may provide useful information to insure normovolaemia.

Adult↗