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PubMed1976

Role of thyroid hormones in an abnormal grooming behavior in thyroidectomized cats and cats with pontile lesions.

Thyroidectomized cats and cats with pontile lesions exhibit the same abnormal grooming behavior. Investigations were conducted to determine whether the abnormal grooming behavior in cats with pontile lesions was attributable to a hypothyroid condition. Administration of thyroid hormones abolished the abnormal behavior of thyroidectomized cats but was without effect in cats with pontile lesions. Studies of brain and blood levels of thyroid hormones in cats with pontile lesions failed to detect any differences from normal cats, and normal effects of thyroid hormones on evoked potentials to light flashes and to clicks were obtained in cats with pontile lesions. It was concluded that any thyroid dysfunction that may exist in the cats with pontile lesions was not involved in the genesis of the abnormal grooming behavior. Because the abnormal grooming behavior fluctuates rhythmically during the year, an endocrine hypothesis was entertained as the source of the fluctuations; endocrine concomitants of the abnormal behavior were investigated with longitudinal studies. The urinary excretion of 11-hydroxycorticoids exhibited a significant negative correlation with the abnormal behavior. When compared with that of normal cats, the plasma level of 11-hydroxycorticoids of thyroidectomized cats was significantly decreased. Intramuscular injections of 11-hydroxycorticoids abolished the abnormal behavior in both thyroidectomized cats and cats with pontile lesions. These results considered together with previous findings indicate that thyroidectomy and pontile lesions induce similar changes in 11-hydroxycorticoid and serotonergic functions-changes that are critical features of the physiological bases of the abnormal grooming behavior in both groups.

11-Hydroxycorticosteroids↗
PubMed1998

Renal tract abnormalities detected in Australian preschool children.

OBJECTIVE: To quantify the incidence of abnormalities in urinalysis and blood pressure from preschool children and their predictive value in detecting renal disease within an Australian community. METHODOLOGY: Urine samples, blood pressure and height measurements and parental reports of significant medical problems were collected from a total of 9355 South Australian preschool children. Seven hundred and forty-three children with abnormal results were investigated in a nephrology outpatient clinic. A control group of 357 children with no detectable abnormality were also recalled, examined and, where appropriate, investigated. RESULTS: Nine thousand, three hundred and fifty-five children were tested. Of these, 0.81% were shown to have a clinically significant renal tract abnormality. The findings included children with urinary tract infections, vesico-ureteric reflux, glomerular disease, renal calculi, essential hypertension and a renal neoplasm. While dipstick-based methods were the most specific indicators of renal tract abnormalities, measurement of blood pressure and urinary beta2-microglobulin were also important in detecting abnormalities. Screening for glycosuria did not result in the detection of significant undiagnosed abnormalities. In the control group with no abnormality detected at testing, there was one case each of aortic coarctation, polycystic kidney disease and vesico-ureteric reflux diagnosed. CONCLUSION: Undiagnosed renal tract abnormalities are present in many Australian preschool children. Most are detectable by a thorough history, examination and urinalysis.

Blood Pressure Determination↗
PubMed1997

Three-vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening.

The three-vessel view is a transverse view of the fetal upper mediastinum is as simple to obtain as the four-chamber view. It demonstrates the main pulmonary artery, ascending aorta and superior vena cava in cross- or oblique sections. The purposes of this study were to describe the normal anatomy of the three-vessel view and to analyze what anatomical changes would occur in this view when there are lesions of the ventricular outflow tracts and/or great arteries. Sonograms of 29 fetuses with lesions involving the ventricular outflow tracts and/or great arteries were reviewed. Three-vessel views were evaluated in terms of vessel size, number, arrangement and alignment. Twenty-eight of 29 fetuses showed an abnormal three-vessel view that included abnormal vessel size (n = 12), abnormal alignment (n = 8), abnormal arrangement (n = 7) and abnormal vessel number (n = 3). The vessel size was abnormal in obstructive lesions of the right (n = 4) or the left (n = 8) side of the heart. An abnormal alignment was seen in tetralogy of Fallot (n = 6) and double-outlet right ventricle (n = 2) that showed anterior displacement of the aorta. An abnormal arrangement was seen in complete (n = 4) and corrected (n = 1) transposition, double-outlet right ventricle (n = 1) and pulmonary atresia with ventricular septal defect (n = 1). Only two vessels were seen in truncus arteriosus (n = 1). Four vessels were seen in persistent left superior vena cava (n = 2). A fetus with pulmonary atresia and intact ventricular septum showed a normal three-vessel view. In conclusion, most of the lesions involving the ventricular outflow tracts and/or great arteries showed an abnormal three-vessel view.

Aortic Valve Stenosis↗
PubMed2000

Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women.

OBJECTIVE: To compare the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonography (SIS) for detecting intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. METHOD: Consecutive premenopausal women who underwent hysterectomy for abnormal uterine bleeding were included. All women underwent TVS and SIS before their hysterectomy. The findings at TVS and SIS were compared with the findings of the hysterectomy specimen. Sensitivity, specificity, and likelihood ratios were calculated. RESULTS: The results of 50 patients with abnormal uterine bleeding were evaluated. Histological examination revealed normal endometrial histology in 27 patients, submucous myomas in 13 patients and intracavitary polyps in 10 patients. The sensitivity of TVS in directly visualizing intracavitary abnormalities was 61% for a specificity of 96%. The likelihood ratio of presence of an intracavitary abnormality was 16 and the likelihood ratio of absence of such a finding was 0.41. When defining abnormality at TVS as direct visualization of an intracavitary abnormality or an increased endometrial thickness (cut-off level 5 mm), the sensitivity of TVS was 87% for a specificity of 56%, with corresponding likelihood ratios of 2 and 0.23, respectively. The sensitivity and specificity of SIS was 100% and 85% with likelihood ratios of 6 and 0.0, respectively. No intracavitary abnormality was missed by SIS. CONCLUSION: The diagnostic accuracy of SIS is higher than the accuracy of TVS. A combined approach using endometrial thickness measurement by TVS and, reserving SIS for patients with increased (> 5 mm) endometrial thickness, or endometrium inadequately visualized on TVS, is the optimal method of reducing the hysteroscopy rate.

Adult↗
PubMed2001

Electroencephalographic abnormalities in aseptic meningitis and noninfectious headache. A comparative study.

BACKGROUND: The finding of abnormalities on electroencephalogram (EEG) during the course of aseptic meningitis is often considered to be indicative of parenchymal brain involvement, even in absence of clinical signs of encephalitis. OBJECTIVE: To investigate if patients with aseptic nonherpetic meningitis who have abnormal EEG recordings during the acute stage of the disease differ in clinical characteristics or cerebrospinal fluid findings from patients with aseptic meningitis and normal EEG recordings. METHODS: The EEG records of 82 patients with aseptic meningitis were reviewed. A comparative group consisted of 41 age-matched patients with severe headaches without evidence of meningeal inflammation. RESULTS: Significantly more patients with aseptic meningitis (28%) demonstrated abnormalities on EEG than controls (12%) (P =.048). Patients with aseptic meningitis and abnormal EEG findings (n = 23) did not differ in age, duration of symptoms, clinical course, cerebrospinal fluid cell count, or protein level from those with normal EEG findings (n = 59). However, all patients with aseptic meningitis who were confused (n = 5) also revealed EEG abnormalities (P<.00012). Patients with headache with normal EEG recordings did not differ from those with abnormal EEGs in age, sex, or duration of symptoms. Nevertheless, patients with common migraine (n = 9) showed abnormalities on EEG (P =.06) more frequently. CONCLUSIONS: The finding of an abnormal EEG in patients with aseptic meningitis, clear mental state and absence of focal neurological signs should not be used as proof of encephalitis. Because pathological examination is usually not performed, it remains unclear if EEG abnormalities in patients with aseptic meningitis indicate a silent parenchymal inflammation, or reflect an infectious encephalopathy.

Acute Disease↗
PubMed2001

Localized right ventricular morphological abnormalities detected by electron-beam computed tomography represent arrhythmogenic substrates in patients with the Brugada syndrome.

AIMS: This study was designed to determine, using electron-beam CT, whether there are morphological abnormalities in patients with the Brugada syndrome and to elucidate the relationship between those abnormalities and arrhythmogenesis. METHODS AND RESULTS: Twenty-six consecutive patients with the Brugada syndrome and 23 age- and gender-matched control subjects (controls) were evaluated for morphological abnormalities using electron beam CT. Electron beam CT demonstrated morphological abnormalities of the right ventricle in 21 (81%) of 26 patients, but in only two (9%) of 23 controls. The sites of morphological abnormalities were the right ventricular outflow tract area in 17 patients and the inferior wall of the right ventricle in four patients. Of the seven patients with monoform premature ventricular contractions recorded only in the acute phase, four of the five patients with premature ventricular contractions from the right ventricular outflow tract area had morphological abnormalities in the right ventricular outflow tract area, and the other two patients with premature ventricular contractions from the inferior wall of the right ventricle had morphological abnormalities in the inferior wall of the right ventricle. CONCLUSION: The sites of morphological abnormalities detected by electron beam CT in patients with the Brugada syndrome were related to the origins of premature ventricular contractions recorded only in the acute phase, which may trigger ventricular fibrillation. These morphological abnormalities may be related to arrhythmogenic substrates in patients with the Brugada syndrome.

Adult↗
PubMed2005

Associations between retinal microvascular abnormalities and declining renal function in the elderly population: the Cardiovascular Health Study.

BACKGROUND: Microvascular abnormalities in the kidney are common histopathologic findings in individuals with chronic kidney disease or renal failure. These abnormalities may represent one manifestation of ongoing systemic microvascular damage. We hypothesized that retinal microvascular abnormalities, when present, would be associated with progressive renal dysfunction in elderly individuals. METHODS: The Cardiovascular Health Study (CHS) is a prospective, multicenter, cohort study initiated in 1989 designed to examine cardiovascular risk factors, morbidity, and mortality in elderly Americans. As part of an ancillary study, CHS participants underwent retinal photography in 1997 and 1998. Retinal microvascular abnormalities were assessed and graded by using standardized measures. Retinal microvascular abnormalities were defined as retinopathy (hard and soft exudates, hemorrhages, or microaneurysms) and/or retinal arteriolar abnormalities (arteriovenous nicking, focal arteriolar narrowing, or lowest quartile arteriole-venule ratio). Associations between these abnormalities and observed 4-year changes in serum creatinine levels and estimated glomerular filtration rates (eGFRs) from study years 5 to 9 (encompassing years 1994 to 2001) were examined by using regression modeling. RESULTS: A total of 1,394 CHS participants had retinal and serum creatinine data. After adjustments for age, race, sex, weight, diabetes, hypertension, angiotensin-converting enzyme inhibitor use, and proteinuria, participants with retinopathy showed a significant increase in serum creatinine level and decline in eGFR compared with those without retinopathy during the 4-year study period (+0.24 mg/dL [+21 micromol/L] versus -0.21 mg/dL [-19 micromol/L] and -0.48 mL/min/1.73 m2 [-0.01 mL/s/1.73 m2] versus +1.74 mL/min/1.73 m2 [+0.03 mL/s/1.73 m2], respectively). Participants with retinopathy also were significantly more likely to have an observed significant deterioration in renal function, defined as a 0.3-mg/dL (27-micromol/L) increase in serum creatinine level or 20% or greater decline in eGFR (odds ratio, 3.20; 95% confidence interval, 1.58 to 6.50; and odds ratio, 2.84; 95% confidence interval, 1.56 to 5.16, respectively). These associations remained in separate stratified analyses of patients with and without diabetes. The presence of retinal arteriolar abnormalities was not associated with deteriorating renal function. CONCLUSION: Retinal microvascular abnormalities defined as retinopathy were significantly associated with renal function deterioration. The observed findings were independent of effects of any associated diabetes or hypertension. These findings suggest that systemic microvascular disease may be associated with progressive renal dysfunction in the elderly population.

Black or African American↗
PubMed2005

Incidence and significance of abnormal hepatic venous Doppler flow velocities before cardiac surgery.

OBJECTIVE: The purpose of this study was to determine the incidence and significance of abnormal hepatic Doppler venous flow velocities as signs of an abnormal right ventricular filling pattern before cardiac surgery. DESIGN: Retrospective and prospective validation study. SETTING: Tertiary care hospital. PARTICIPANTS: Cardiac surgical patients (121 patients). INTERVENTIONS: Not applicable. MEASUREMENTS: Demographic, hemodynamic, and echocardiographic variables; vasoactive support; and difficult separation from bypass were compared between patients with or without abnormal hepatic venous Doppler flow. Logistic regression analysis was performed to identify predictors of difficult separation from bypass. Abnormal hepatic venous flow was observed in 23 (29%) and 17 patients (41%) in the retrospective and prospective study. Abnormal hepatic venous flow before surgery was associated with more vasoactive support in both the retrospective (p = 0.0362) and prospective study (p = 0.0163). In the prospective study, abnormal hepatic venous flow was associated with a higher Parsonnet score (p = 0.0005), more atrial fibrillation (p < 0.0001), pacemaker requirement (p = 0.0124), mitral valve replacement (p = 0.0325), reoperation (p = 0.0050), lower mean arterial pressure to pulmonary artery pressure ratio (p = 0.0127), higher wall motion score index (p = 0.0491), and higher incidence of abnormal right ventricular systolic function (p = 0.0139). Abnormal hepatic venous flow was not found to be an independent predictor of difficult separation from bypass. CONCLUSIONS: Abnormal hepatic venous flow velocities before cardiac surgery are frequent and are associated with increased need for vasoactive support after cardiopulmonary bypass. However, it is not an independent predictor of difficult separation from bypass and worse outcome.

Aged↗
PubMed2004

Are obstetric risk factors and bowel symptoms associated with defaecographic and manometric abnormalities in women awaiting hysterectomy?

Abdominal hysterectomy has been shown to affect anorectal function. These studies are either population-based or have been performed retrospectively. It is not clear from the literature whether those subjects awaiting hysterectomy already have an element of pelvic floor failure and which may be related to obstetric risk factors. A complete anorectal assessment was performed in a group of women awaiting hysterectomy who did not volunteer any bowel symptoms. The patients studied were part of an ongoing study of the functional effects of abdominal hysterectomy. All had their anorectal function assessed before their respective surgery by a questionnaire (functional bowel score), Cleveland continence score, endoanal ultrasound (U/S), anal manometry, defaecatory proctogram and colonic transit. A detailed obstetric history, which included risk factors such as parity, type of delivery, duration of labour and elevated birth weight, were also recorded. Patients with previous bowel disease, bowel surgery and anal sphincter repair were excluded. There were 39 subjects with a median age of 43 years (range 31-65), respectively. Thirty-three rectocoeles and 22 intussusceptions were demonstrated. Two had poor puborectalis function, while five had cough incontinence. Two women had abnormal colonic transit. Thirteen had abnormal anal manometry. Endoanal ultrasound was normal in all patients. None of the obstetric risk factors were associated with rectocoele, intussusception or abnormal anal manometry. Low squeeze pressure was associated significantly with more bowel symptoms (P=0.03). However, rectocoele, intussusception, abnormal colonic transit, abnormal resting anal pressure and maximal tolerated volume were not statistically significantly associated with bowel symptoms. The majority of female subjects who were awaiting hysterectomy had physiological and proctographic abnormalities consistent with pelvic floor failure. Obstetric risk factors were not associated with rectocoele, intussusception, abnormal colonic transit and anal manometry in this cohort of patients. Similarly, the majority of proctographic abnormalities were not associated with bowel symptoms. However, a trend was noted associating bowel symptoms with manometric abnormalities.

Adult↗
PubMed1999

The incidence and influence of abnormal styloid conditions on the etiology of craniomandibular functional disorders.

This study aimed to examine the incidence and influence of craniomandibular functional disorders caused by abnormal styloid-stylohyoid chains. Seven hundred sixty-five patients with temporomandibular joint (TMJ) disorders were divided into two groups (with and without radiographically visible abnormal styloid conditions). In the group with abnormal stylohyoid conditions, the etiology of TMJ disorders was further subdivided into poly-, oligo- and monoetiological factors, and, after this classification, evaluated regarding a clear, possible or unlikely involvement of abnormal stylohyoid conditions in TMJ disorders. One hundred thirty-six out of 765 patients presented abnormal styloid-stylohyoid chains. One hundred five of the patients (77.2%) demonstrated polyetiological causes of TMJ symptoms with an unlikely involvement of the abnormal styloid-stylohyoid chain. Twenty-nine of the patients (21.3%) showed oligoetiological causes with possible involvement of the abnormal styloid-stylohyoid chain. In two patients (1.5%), the abnormal styloid conditions showed up as the only definite cause of TMJ symptoms (monoetiological). Detailed knowledge of variations and possible effects of suprahyoid structures is important for an accurate diagnosis of TMJ disorders. All in all, the incidence of a stylohyoid involvement in TMJ disorders is very low. However, after an initial subdivision into abnormal and normal stylohyoid conditions, the incidence of pathological stylohyoid chains gains significant importance in the etiology of TMJ disorders.

Calcinosis↗
PubMed2006

Circulating angiogenic factors and abnormal uterine artery Doppler velocimetry in the second trimester.

OBJECTIVE: Circulating angiogenic growth factors (such as vascular endothelial growth factor [VEGF] and placental growth factor [PlGF]) and their interaction may be associated with vascular remodeling of spiral arteries in normal pregnancy. Soluble Flt-1, an antagonist of both VEGF and PlGF, has been shown to be increased, while PlGF is decreased in women prior to the onset of preeclampsia. The purpose of this study was to compare maternal soluble Flt-1 and PlGF levels in the second trimester with a marker of abnormal placentation, abnormal uterine artery Doppler (UAD). METHOD: A prospective cohort of women, 16 to 24 weeks estimated gestational age (EGA), with singleton pregnancies, underwent UAD and phlebotomy. Maternal soluble Flt-1 and free PlGF were measured by ELISA in samples from women with abnormal UAD with a group, controlled for EGA, with normal UAD. Mann-Whitney Rank-Sum test was used to compare maternal serum levels of both soluble Flt-1 and PlGF between women with abnormal uterine artery Doppler versus women with normal uterine artery Doppler. RESULTS: Of the 222 study subjects enrolled, 34 (15%) had abnormal UAD. The mean EGA at enrollment of subjects in each group was 18 weeks. There was no difference in PlGF between subjects with abnormal UAD (median, 191 pg/mL; range, 187 to 337 pg/mL) versus controls (median, 171 pg/mL; range, 169 to 289 pg/mL) (p = 0.59) or soluble Flt-1 (median, 780 pg/mL; range, 280 to 3200 pg/mL) or between subjects with abnormal UAD versus controls (median, 720 pg/mL; range, 220 to 1980 pg/mL) (p = 0.36). CONCLUSION: Concentrations of maternal soluble Flt-1 and free PlGF in the second trimester do not appear to be altered in women with abnormal UAD. This suggests that these biochemical markers are independent of the increased placental resistance seen with abnormal uterine artery Doppler.

Adult↗
PubMed1991

Correlation of SEP abnormalities with brain and cervical cord MRI in multiple sclerosis.

In 31 patients with definite or suspected multiple sclerosis (MS) presenting with a cervical cord syndrome, somatosensory evoked potentials (SEPs) were recorded to median and posterior tibial nerve stimulation, using cephalic and noncephalic reference electrodes. Magnetic resonance imaging (MRI) of the brain and cervical spinal cord was performed, the latter in sagittal and axial views. SEPs were abnormal in 67.7% of patients, whereas MRI showed cervical cord lesions in 74.2% and intracranial lesions possibly involving the somatosensory pathways in 64.5% of cases. A significant correlation was found between abnormalities of cervical (N13) and cortical (N20) potentials following median nerve stimulation with Fz reference and MRI abnormalities involving the ipsilateral or posterior half of the cervical cord, but not the contralateral or anterior half. The N13 potential, recorded from the low cervical region to a supraglottal reference, was most frequently abnormal in patients with MRI lesions at C6 or C7, whereas P14, recorded from the scalp to a clavicle reference, was most often affected by lesions at Cl or the cervicomedullary junction. Abnormalities of the cortical P40 to tibial nerve stimulation were less significantly correlated with cervical MRI lesions. The latency of N20 measured from N9 at the clavicle and the absolute latency of P40 were significantly correlated with the length of MRI abnormalities in the ipsilateral cervical cord. No significant correlation was observed between SEP abnormalities and brain MRI lesions, which it was considered might possibly involve the intracranial somatosensory pathways. It was concluded that (1) the morphological lesions seen in MRI of the cervical cord usually give rise to appropriate electrophysiological deficits, but the occasional finding of a widespread MRI lesion with normal SEP suggests that myelin damage is not the only or the major factor responsible for abnormal MRI signal; and (2) 'clinically silent' lesions apparently involving the radiations and other sensory structures of the brain appear not to give rise to detectable SEP abnormalities, using the methods of the present study.

Adult↗
PubMed1983

Development of a scoring system for the Milani-Comparetti and Gidoni method of assessing neurologic abnormality in infancy.

This article reports the results of using a scoring system designed for the Milani-Comparetti and Gidoni method of neurologic examination of infants. The system was used in the assessment of 999 infants from the neonatal intensive care units affiliated with the Medical College of Wisconsin. The sample included all neonates who spent more than five days in the units from 1975 to 1978. Full assessments were conducted at 6 months and at 15 to 16 months corrected gestational age; additional assessments were scheduled by the physical therapists. For data analyses, the scores from the Milani-Comparetti and Gidoni method were summed; infants were subdivided into normal, transiently abnormal, and abnormal on the basis of the summed scores. Abnormal infants were further categorized on the basis of all information available. Several data analyses were performed to test the contribution of each item in separating normal, transiently abnormal, and abnormal infants and in distinguishing one type of abnormality from another. We conclude that the scoring system is useful in quantifying the degree of abnormality, in separating normality from abnormality, and in distinguishing among types of abnormality.

Aging↗
PubMed2002

Intrathoracic and intra-abdominal Tl-201 abnormalities seen on rotating raw cine data on dual radionuclide myocardial perfusion and gated SPECT.

PURPOSE: The lower thorax and upper abdomen are visualized during cardiac acquisition of rest Tl-201 and stress Tc-99m tetrofosmin gated SPECT. Thus, abnormal Tl-201 localization in these areas and in organs such as parts of the lungs, liver, spleen, and kidneys can be observed, including rotating raw cine data. MATERIALS AND METHODS: Other than cardiac images, the authors retrospectively reviewed Tl-201 rotating (raw data) images of 235 patients. Abnormal findings in the lungs, liver, spleen, and kidneys were identified that correlated with the patients' clinical information; radiographic findings, including computed tomography and ultrasonography of the abdomen; other scintigraphic studies; and laboratory findings. RESULTS: In 53 patients, 54 abnormalities were detected. Intrathoracic abnormalities included focal areas of increased uptake, one in the right lower lung and another in the right upper lung that confirmed lung cancer, in 2 patients; diffuse uptake in both lungs in 11 patients; photopenia in the lung bases, which had resulted from pleural effusions, in 3 patients; and abnormal right liver configuration caused by elevation of the right hemidiaphragm in 1 patient. Of the intra-abdominal abnormalities, 12 patients with splenomegaly were identified. Six patients had focal areas of increased uptake in the gastric area. Nonvisualization of one kidney resulted from a congenitally absent right kidney in 1 patient, from right nephrectomy in 1 patient, from end-stage renal disease in another, and from a lower position of the left or right kidneys in 5 patients. Small and decreased uptake of both kidneys resulted from end-stage renal disease in 1 patient. Small and decreased uptake of one kidney was noted in 1 patient with renal scarring, in 1 patient with a renal stone, in 3 patients with chronic pyelonephritis, and in 5 patients with renal cyst(s). CONCLUSIONS: Discernible intrathoracic and intra-abdominal abnormalities using rotating raw cine data from imaging in three-dimensional displays include diffuse or focal pulmonary uptake, pleural effusion, elevation of a hemidiaphragm, splenomegaly, increased uptake in the gastric area, renal abnormalities including absent or small kidneys, end-stage renal disease, renal scarring, renal cyst(s), and lower position of a kidney. The incidental finding of such abnormalities may prompt further clinical investigation.

Abdomen↗
PubMed2002

Oesophageal motor and sensitivity abnormalities in non-obstructive dysphagia.

OBJECTIVES: To evaluate oesophageal sensitivity to balloon distension in patients with non-obstructive dysphagia (NOD), and to determine its relationship with the motility pattern in response to food ingestion. PATIENTS AND METHODS: Twenty-one healthy volunteers and 19 consecutive patients complaining of NOD with normal standard manometry were included. An oesophageal sensitivity test was carried out before the manometry study with liquid and solid swallows. RESULTS: The median threshold to distension was 9 ml in control subjects and 5 ml in patients (P < 0.002). Dysphagia or odynophagia were reproduced in 15/19 (78.9%) patients during manometry with solid swallows only. The percentage of swallows with abnormal motility patterns was higher in patients than control subjects (P < 0.001). Compared with control values, sensitivity abnormality was defined by a distension threshold of < 6 ml. Motor abnormality was defined by > 19% of swallows occurring with one or more abnormal motor profiles. A total of 8/19 (42%) patients presented with the association of an abnormal sensitivity threshold and an abnormal motor pattern; 5/19 (26%) presented with isolated motor abnormalities; 4/19 (21%) patients presented with isolated abnormal sensitivity thresholds; and 2/19 (11%) patients presented without any abnormality. CONCLUSION: Manometry with solid swallows and oesophageal balloon distension are useful in characterizing NOD.

Adult↗
PubMed2001

Can the specificity of the FDT for glaucoma be improved by confirming abnormal results?

PURPOSE: To determine whether the specificity of the frequency-doubling technology (FDT) perimeter in the screening mode for glaucoma can be improved by repeating abnormal screening results. METHODS: The FDT perimeter was used in C-20-5 screening mode, and the right eye was tested first. After both eyes were tested, the screening was repeated in eyes with any abnormal visual field defects on FDT perimetry. The printouts were categorized as possible visual field abnormality (zero or one miss), probable visual field abnormality (two to four misses), and definite visual field abnormality (more than five misses). A clinical ophthalmologic examination was conducted on the day of the FDT perimetry screening. RESULTS: Complete data were available for 223 people. The participants ranged in age from 23 to 91 years (mean, 68.5 years; standard deviation. 13.7 years), and 119 (53%) were women. The sensitivity of the FDT perimetry screening was 100%; both cases of glaucoma showed an abnormality on FDT perimetry both times. The specificity improved moderately from the first screening to the second screening. The specificity the first time was 62% (95% confidence interval, 53.1-71.2). The specificity the second time was 68.5% (95% confidence interval, 59.8-77.1). Improvement on FDT perimetry rescreening varied by the language spoken at home. Seven of the 19 non-English speakers without glaucoma improved on rescreening, compared with none of the 23 English speakers (P = 0.002). Seven of the 25 right eyes with FDT perimetry abnormalities both times and no glaucoma had no other detectable diseases. Three of 24 left eyes with FDT perimetry abnormalities both times and no glaucoma had no other detectable diseases. Of the 85 patients who did not have glaucoma but had FDT perimetry abnormalities both times, only one did not have some other detectable disease. DISCUSSION: In summary, the sensitivity for glaucoma of the C-20-5 screening mode is excellent, but a paradigm for screening with the FDT perimeter to improve the overall specificity for glaucoma still must be developed.

Adult↗
PubMed2001

Evolution of cervical abnormalities among women with HIV-1: evidence from surveillance cytology in the women's interagency HIV study.

OBJECTIVE: To determine incidence, progression, and regression rates for abnormal cervical cytology and their correlates among women with HIV. METHODS: In a multicenter prospective cohort study conducted October 1, 1994, through September 30, 1999 at university, public, and private medical centers and clinics, 1639 HIV-seropositive and 452 seronegative women were evaluated every 6 months for up to 5 years using history, cervical cytology, T-cell subsets, and quantitative plasma HIV RNA. Human papillomavirus (HPV) typing at baseline was determined by polymerase chain reaction. Cytology was read using the Bethesda system, with any smear showing at least atypia considered abnormal. Poisson regression identified factors associated with incident cytologic abnormalities whereas logistic regression identified those associated with progression and regression after an abnormality. RESULTS: At least one abnormal smear was found during all of follow-up among 73.0% of HIV-seropositive patients and 42.3% of seronegatives (p <.001). Only 5.9% of seropositives ever developed high-grade lesions, and the proportion with high-grade findings did not rise over time. Incidence of atypical squamous cells of uncertain significance (ASCUS) or more severe lesions among HIV-seropositive patients and seronegative patients was 26.4 and 11.0/100 woman-years (rate ratio [RR], 2.4; 95% confidence interval [CI], 1.9-3.0), whereas that of at least low-grade squamous intraepithelial lesions (SIL) was 8.9 and 2.2/100 (RR, 4.0; CI, 2.6-6.1). HIV status, detection of the presence of human papillomavirus (HPV), CD4 lymphocyte count, and HIV RNA level predicted incidence of abnormal cytology (p <.05); HPV detection and HIV RNA level predicted progression (p <.01); and HPV detection, CD4 lymphocyte count, and HIV RNA level predicted regression (p <.001). Rates of incidence, progression, and regression of abnormal cytology did not differ between HIV seronegative women and seropositive women with CD4 lymphocyte counts >200/mm(3) and HIV RNA levels <4000/ml of similar HPV status. CONCLUSIONS: Although HIV infected women were at high risk for abnormal cytology, high-grade changes were uncommon. HIV status, HPV detection, CD4 lymphocyte count, and HIV RNA level predicted the incidence of cervical cytologic abnormalities. Progression was significantly increased only among the most immunosuppressed women, while regression was significantly reduced in all HIV seropositive women except those with the best controlled HIV disease.

Adult↗
PubMed1976

Abnormal fibrin polymerization in liver disease.

Although there have been isolated reports of an acquired abnormal fibrinogen in patients with liver disease, its frequency and clinical significance is not known. In this study 121 consecutive patients with a wide spectrum of hepatic disorders were screened for abnormal fibrin polymerization. A simple colorimetric method using Reptilase was employed. Of 32 patients with proven cirrhosis, 16 (50%) showed abnormal fibrin polymerization. The incidence in decompensated alcoholic cirrhosis was particularly high. The abnormality was also detected in all patients with acute liver failure and seven of 15 with chronic active liver disease. Clinical improvement often correlated with its disappearance. Two patients with primary liver cell tumours demonstrated the abnormal polymerization. In patients with bleeding oesophageal varices the detection of abnormal fibrin polymerization was associated with a poor prognosis. None of the patients with surgical obstructive jaundice (26) or miscellaneous liver disorders (37) had abnormal fibrin polymerization. The occurrence of abnormal fibrin polymerization in liver disease is more frequent than previously suspected and usually signifies severe primary hepatocellular dysfunction. Evidence is presented to support the presence of a primary abnormality of fibrinogen as the cause of impaired fibrin monomer polymerization.

Batroxobin↗