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PubMed1991

Radiographic pulmonary abnormalities after different types of cardiac surgery.

One aim of this study was to determine the incidence of new radiographic pulmonary abnormalities during hospitalization after cardiac surgery. Another aim was to determine if such abnormalities are more common among patients who had left internal mammary artery (LIMA) grafting. The predictive value of radiographic abnormalities for clinically important pulmonary morbidity was also determined. The anteroposterior chest radiographs of 152 patients obtained by portable equipment were evaluated to determine the incidence of new postoperative radiographic pulmonary abnormalities such as atelectasis, consolidation, infiltrate, and pleural effusion. Clinically important pulmonary morbidity was defined as a delay in tracheal extubation or discharge from the hospital because of a pulmonary reason. Among the 89 patients who had LIMA grafting and left pleurotomy, there was an 88% incidence of left-sided pulmonary abnormalities; a 73% incidence of left-sided atelectasis; and a 55% incidence of left-sided effusion. Among the 63 patients who had saphenous vein grafting only and/or valvular surgery, the respective incidences were 68%, 54%, and 35%, which were lower (P less than or equal to 0.05) than those in the patients who had LIMA grafting. There was no significant difference in abnormalities between the saphenous vein grafting and the valvular surgery groups. The 35% incidence of left-sided pleural effusion when LIMA grafting and pleurotomy were not performed was unexpectedly high. There was no association between radiographic abnormalities and age, the duration of cardiopulmonary bypass, and the duration of aortic occlusion, indicating that cardiopulmonary bypass was not a primary etiology of these radiographic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Use of tissue Doppler imaging to facilitate the prediction of events in patients with abnormal left ventricular function by dobutamine echocardiography.

The extent of abnormality in patients with positive dobutamine echocardiography (DE) is predictive of risk, but the wall motion score (WMS) has low concordance among observers. We sought whether quantifying the extent of abnormal wall motion using tissue Doppler (TD) could guide risk assessment in patients with abnormal DE in 576 patients with known or suspected coronary artery disease; standard DE was combined with color TD imaging at peak dose. WMS was assessed by an expert observer and studies were identified as abnormal in the presence of >/=1 segments with resting or stress-induced wall motion abnormalities. Patients with abnormal DE had peak systolic velocity measured in each segment. Tissue tracking was used to measure myocardial displacement. Follow-up for death or infarction was performed after 16 +/- 12 months. Of 251 patients with abnormal DE, 22 patients died (20 from cardiac causes) and 7 had nonfatal myocardial infarctions. The average WMS in patients with events was 1.8 +/- 0.5, compared with 1.7 +/- 0.5 in patients without events (p = NS). The average systolic velocity in patients with events was 4.9 +/- 1.7 cm/s and 6.4 +/- 6.5 cm/s in the patients without events (p <0.001). The average tissue tracking in patients with events was 4.5 +/- 1.5 mm and was significant (5.7 +/- 3.1 mm) in those without events (p <0.001). Thus, TD is an alternative to WMS for quantifying the total extent of abnormal left ventricular function at DE, and appears to be superior for predicting adverse outcomes.

Coronary Disease↗
PubMed2005

Morphological abnormalities during early-life development of the estuarine mummichog, Fundulus heteroclitus, as an indicator of androgenic and anti-androgenic endocrine disruption.

We tested the hypothesis that gross morphological abnormalities are a sensitive indicator of exposure to waterborne androgenic and anti-androgenic compounds during embryonic, larval and juvenile stages of development in the common estuarine killifish, the mummichog (Fundulus heteroclitus; Pisces: Cyprinodontidae). Static exposures with daily renewal were carried out with 10-100,000 ng/L of the androgen agonist, 17alpha-methyltestosterone (MT), or the androgen antagonist, cyproterone acetate (CA), for 60 days post-fertilization (PF) in duplicate exposures. Measured concentrations were 78.4-155.8% of nominal concentrations for MT and 13.5-168.1% for CA. No dose-related or consistent effects of MT or CA were observed before hatch. In 60 days PF juveniles, incidence of skeletal abnormalities (scoliosis, lordosis, head, facial and fin), soft tissue abnormality (anal swelling) and hemorrhaging were significantly increased by MT but only at high concentrations (> or =1000 ng/L). The 10,000 and 100,000 ng/L concentrations of MT produced a wider range of abnormalities than 1000ng/L. Over 90% of fish exposed to 10,000 or 100,000 ng/L were abnormal with an average of over 3.5 abnormalities per fish. CA did not increase the incidence of any type of abnormality. Survival of juveniles to the end of the exposure was reduced by MT at concentrations of 1000 ng/L and greater in the first experiment and at concentrations of 10,000 ng/L and greater in the second experiment. Juvenile length was reduced by high concentrations of MT (> or =10,000 ng/L) in the first experiment and by most concentrations in the second experiment. We conclude that morphological abnormalities in early-life stages of mummichogs are not a sensitive indicator of exposure to androgenic or anti-androgenic waterborne EDSs at environmentally relevant concentrations.

Age Factors↗
PubMed2005

AURKA amplification, chromosome instability, and centrosome abnormality in human pancreatic carcinoma cells.

To test the hypothesis that AURKA amplification contributes to pancreatic tumorigenesis by increasing centrosome abnormality and chromosome instability, the current study explored the associations between AURKA amplification, chromosome instability, centrosome abnormality, and the expression of several important proteins that are involved in cell proliferation (Ki-67), cell cycle regulation (p53, p16), and apoptosis (survivin) in 12 human pancreatic carcinoma cell lines. Using fluorescence in situ hybridization (FISH), we observed that 5 of the 12 cell lines had an AURKA amplification index (AI) (percentage of cells with more than three signals) >60%. Both the AURKA AI and the average number of signals per cell (ANSPC) were significantly associated with the copy number of chromosome 9 but not chromosome 17. The AURKA ANSPC was positively associated with the percentage of cells with the centrosome abnormality. Furthermore, centrosome abnormality was significantly associated with the frequency of cells with abnormal nuclei and abnormal mitotic figures, but no direct association was detected between the frequency of centrosome abnormalities and chromosome instabilities. The AURKA AI was also associated with a lower expression of Ki-67, a higher expression of survivin, and the lack of expression of p16. These associations support our hypothesis that AURKA amplification contributes to pancreatic carcinogenesis by increasing chromosome instability and centrosome abnormality.

Aurora Kinase A↗
PubMed2005

Doppler tissue imaging improves assessment of abnormal interventricular septal and posterior wall motion in constrictive pericarditis.

We hypothesized that Doppler tissue imaging in the short axis would provide enhanced quantitative information for differentiating the pattern and extent of abnormal septal and posterior wall motion in constrictive pericarditis (CP). Using quantitative pulsed wave and color M-mode Doppler tissue imaging, we quantified the pattern of abnormal septal and posterior wall motion and studied its incremental advantage over conventional M-mode and 2-dimensional echocardiography in 40 patients with surgically proven CP. The pattern and extent of abnormalities were compared with 35 age- and sex-matched control subjects and 20 patients with abnormal septal motion of other causes. In 33 patients (82.5%) with CP, the interventricular septum showed high-velocity (>7 cm/s) early diastolic biphasic motion with or without multiple recoil waves (polyphasic diastolic septal fluttering). In the posterior wall, the early diastolic wave was normal but the late diastolic wave was reduced in 24 patients (60%) and absent in 7 (17.5%). In comparison, M-mode and 2-dimensional echocardiography identified abnormal septal or posterior wall motion in 24 patients (60%) ( P = .003). The pattern of abnormal septal motion in CP could be differentiated from abnormal septal motion of other causes in 16 patients (80%). The overall sensitivity and specificity of high-velocity polyphasic septal flutter for differentiating CP from control cases and other diseases was 82.5% and 92.7%, respectively. In CP, Doppler tissue imaging in the short axis provides unique diagnostic information and reliably differentiates CP from control cases and most other causes of abnormal septal motion.

Adult↗
PubMed2005

Self-correction of chromosomally abnormal embryos in culture and implications for stem cell production.

OBJECTIVE: To ascertain whether embryos classified by preimplantation genetic diagnosis (PGD) for infertility as abnormal and then plated to obtain stem cells would self-correct partially or totally in culture, producing disomic stem cells. DESIGN: Prospective study to determine the chromosome status of embryos on day 3 and 6, as well as cultured cells derived from inner cell masses from the same embryos when cultured up to day 12. SETTING: Research laboratory. PATIENT(S): Patients undergoing PGD of aneuploidy. INTERVENTION(S): Of 142 embryos classified by PGD for aneuploidy as abnormal, 50 were cultured to the blastocyst stage. At that stage a fraction of the embryos underwent trophectoderm biopsy to reconfirm the PGD diagnosis. After further co-culture with feeders up to day 12, 34 embryos attached to the feeder cells. Of those, 24 were analyzed by fluorescence in situ hybridization (FISH) and the rest for the expression of Oct-4, SSEA-3, SSEA-4, TRA1-60, and TRA1-80. MAIN OUTCOME MEASURE(S): Disomic cells obtained from trisomic embryos. RESULT(S): Analysis by FISH of day-12 cultures showed that 7 were totally normal, 6 were mostly abnormal, and 11 had experienced some chromosome normalization, having between 21% and 88% normal cells. Day-12 culture was positive for Oct-4 expression by reverse transcriptase polymerase chain reaction analysis and for SSEA-3, SSEA-4, TRA1-60, and TRA1-80 by immunocytochemistry. CONCLUSION(S): Chromosome self-normalization occurs in a significant proportion of chromosomally abnormal embryos, possibly because of the loss of a chromosome in trisomic cells after blastocyst stage. Thus chromosomally abnormal embryos are a potential source of disomic stem cells. Not all chromosomally abnormal embryos self-corrected. Abnormal stem cells that might be derived could be used as models to study the effect of chromosomal abnormalities on human development.

Chromosome Aberrations↗
PubMed2004

Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants.

OBJECTIVE: To assess sequential high-resolution cranial ultrasound (US) in high-risk preterm infants to predict cerebral palsy (CP). STUDY DESIGN: Preterm infants were prospectively studied (n=2139), 1636 <or=32 weeks gestational age (GA) (group A) and 503 with a GA of 33 to 36 weeks (group B). US was performed once a week until discharge and at 40 weeks postmenstrual age (PMA), using a 7.5-MHz transducer. Grade III and IV hemorrhage, cystic periventricular leukomalacia (c-PVL), and focal infarction were considered major US abnormalities. A diagnosis of CP was made at a minimum age of 24 months. RESULTS: Seventy-six (5%) of the 1460 survivors in group A developed CP. US abnormalities were present in 70 of 76 (92%) infants, being major in 58 (83%) and minor in 12 (17%). In 29% of the CP cases with major US abnormalities, cysts were first detected beyond day 28. A further 6 infants without US abnormalities developed CP, and 3 of these infants developed ataxic CP. Twenty-nine (6%) of the 469 survivors in group B developed CP. US abnormalities were present in 28 of 29 (96%) infants, being major in 25 (89%) and minor in 3 (11%). One infant without US abnormalities developed CP. Considering the major US abnormalities, a specificity of 95% and 99% and a sensitivity of 76% and 86% were found for group A and B, respectively. The positive predictive value was 48% in group A and 83% in group B. CONCLUSION: Seventy-nine percent of our CP cases had major US abnormalities. To detect c-PVL, the most predictive US marker for CP, sequential scans with a 7.5-MHz transducer are required.

Cerebral Palsy↗
PubMed2006

Retinal vascular abnormalities in adult Chinese in rural and urban Beijing: the Beijing Eye Study.

OBJECTIVE: To assess retinal vascular abnormalities, including focal and generalized arteriolar narrowing, arteriovenous nicking, and arteriolar sheathing, in adult Chinese in rural and urban Beijing, and their associations with self-reported diagnosis of cardiovascular and cerebrovascular diseases. DESIGN: Population-based cross-sectional cohort study. PARTICIPANTS: The study included 4439 subjects out of 5324 subjects invited to participate (response rate, 83.4%) with an age of > or =40 years. It was divided into a rural part (n = 1973 [44.4%]) and an urban part (n = 2466 [55.6%]). Mean age was 56.2+/-10.6 years (range, 40-101 years). METHODS: Color optic disc photographs were morphometrically examined. One eye of each participant was randomly selected. Generalized and focal arteriolar narrowing, arteriovenous nicking (arteriovenous crossing abnormalities), and arteriolar sheathing were assessed. Self-reported histories of cardiovascular and cerebrovascular diseases and habits of smoking and alcohol drinking were obtained from questionnaires. MAIN OUTCOME MEASURES: Frequency of generalized and focal arteriolar narrowing, arteriovenous nicking, and arteriolar sheathing. RESULTS: Optic disc photographs were available for 4228 (95.2%) subjects. Focal arteriolar narrowing was found in 6.3%, arteriovenous nicking in 6.6%, arteriolar sheathing in 4.8%, and generalized narrowing in 4.3% of the subjects. Abnormalities were more common in the temporal quadrant; they were rare in the inferior nasal quadrant. Frequencies and severities of all retinal microvascular abnormalities examined increased with age (P<0.05). The microvascular abnormalities were detected more frequently in the rural population than in the urban population (P<0.05). After controlling for age, gender, area, and habit of drinking alcohol, generalized arteriolar narrowing (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.64, 4.22), focal arteriolar narrowing (OR, 1.51; 95% CI, 1.00, 2.29), and arteriolar sheathing (OR, 1.71; 95% CI, 1.08, 2.71) were significantly associated with the self-reported diagnosis of arterial hypertension. The microvascular abnormalities were not significantly associated with the self-reported diagnosis of coronary heart disease or stroke. CONCLUSIONS: Retinal vascular abnormalities in adult Chinese increase with age and are more commonly found in people living in rural areas. Retinal vascular abnormalities are associated with the self-reported diagnosis of arterial hypertension, and are not related to self-reported diagnosis of coronary heart disease or previous cerebrovascular events such as stroke.

Adult↗
PubMed2005

Incidence of upper tract abnormalities in patients with neurovesical dysfunction secondary to multiple sclerosis: analysis of risk factors at initial urologic evaluation.

OBJECTIVES: To determine the incidence of upper tract abnormalities on renal ultrasonography in patients with multiple sclerosis (MS) referred for urologic evaluation, as well as to identify any risk factors present on the basis of the historical information and urodynamic findings. METHODS: Data were derived from all patients with MS referred to the neurourology clinic during a 4-year period. The database was specifically queried for patients found to have upper tract abnormalities on screening renal ultrasonography. Demographic parameters, as well as laboratory values (creatinine) and urodynamic results, were evaluated for risk factors associated with abnormal upper tract findings. RESULTS: Of the 113 patients referred and evaluated, 66 completed both urodynamic testing and renal ultrasonography. Eleven (16.7%) had abnormal ultrasound findings, with focal caliectasis the most common finding. No demographic parameter (age, sex, time since MS diagnosis, MS pattern) was associated with a greater likelihood of abnormal renal ultrasonography on univariate analysis. Neither serum creatinine nor any urodynamic finding (including the presence of dyssynergia or the threshold and amplitude of detrusor overactivity) was associated with abnormal renal ultrasound findings. CONCLUSIONS: No patients in our series had any indication of obstructive uropathy more severe than mild hydronephrosis. Of the 16.7% of patients with any abnormal findings, most were noted to have minor caliectasis, likely to be of little clinical significance. Although no factors identifying patients at risk of renal abnormalities at presentation were found, ongoing evaluation of patients with baseline findings will serve to identify those at risk of progression.

Diagnostic Techniques, Urological↗
PubMed2006

Role of transperineal six-core prostate biopsy in patients with prostate-specific antigen level greater than 10 ng/mL and abnormal digital rectal examination findings.

OBJECTIVES: To define whether six-core biopsies still have a role in patients presenting with prostate-specific antigen (PSA) levels greater than 10 ng/mL and abnormal digital rectal examination (DRE) findings. Recent studies have suggested that the six-core biopsy is inadequate for the diagnosis of prostate cancer; however, it remains controversial whether an increased number of cores is justified in all patients. METHODS: From June 2002 to February 2005, 122 (18.8%) of 650 patients underwent prostate biopsy because of a PSA level greater than 10 ng/mL and abnormal DRE findings. All patients underwent transperineal ultrasound-guided prostate biopsy in a standardized fashion: a six-core biopsy was performed first, followed by six additional cores during the same session, four in the peripheral and two in the transition zone. RESULTS: The detection rate in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings was 72.1% (88 of 122) and 75.4% (92 of 122) using the 6-core and 12-core biopsy, respectively. One case of tumor was missed by the six-core biopsy among patients with a PSA level greater than 15 ng/mL and abnormal DRE findings. No cases of tumor were missed by six-core biopsy in the group with a PSA level greater than 20 ng/mL and abnormal DRE findings. CONCLUSIONS: Six-core biopsy provided a similar cancer detection rate compared with 12-core biopsy in patients with PSA levels greater than 10 ng/mL and abnormal DRE findings. An initial approach with 6-core biopsy is reasonable in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings and is advocated in those with PSA greater than 20 ng/mL and abnormal DRE findings.

Aged↗
PubMed1997

Pharmacologic stress-induced regional myocardial blood flow heterogeneity and left ventricular wall thickening abnormality: comparison of intravenous adenosine with dipyridamole in a model of critical coronary stenosis.

Variations in reported sensitivity of myocardial perfusion scans or wall motion abnormalities during pharmacologic stress with intravenous adenosine and dipyridamole may be caused by differences in myocardial oxygen demand or myocardial blood flow redistribution induced by each agent. To investigate the physiologic correlates of functional abnormalities during pharmacologic stress testing, regional myocardial blood flow (radiolabeled microsphere technique) and left ventricular segmental wall thickening (quantitative two-dimensional echocardiography) were measured in 9 dogs with an open chest model of critical stenosis of the left circumflex coronary artery. Data were obtained at baseline and peak drug infusion for intravenous adenosine (0.42 mg/kg over a 3-minute period) and for intravenous dipyridamole (0.56 mg/kg over a 4-minute period). Adenosine and dipyridamole induced regional flow abnormality in 7 (77%) of 9 dogs. Myocardial segments with decreased endocardial/epicardial flow ratio were similar for both agents (2.9 +/- 1.8 vs 2.7 +/- 1.3, p = [NS]). Segments with myocardial flow heterogeneity (ratio of endocardial flow to control left anterior descending/left circumflex endocardial flow) were similar for both agents (2.7 +/- 0.9 vs 2.3 +/- 1.0, p = NS). Adenosine-induced wall thickening abnormality (77% vs 55% with dipyridamole) correlated with regional flow abnormality. Significantly lower mean arterial pressure (53 +/- 1.7 mm Hg vs 64 +/- 1.9 mm Hg, p < 0.01) and more prolonged drug effect (18 +/- 6.4 min vs 3 +/- 1.4 min, p < 0.001) were seen for dipyridamole compared with adenosine. Adenosine induces regional flow abnormality similar to dipyridamole but with less hemodynamic perturbation, and adenosine-induced wall thickening abnormality more closely parallels regional flow abnormality.

Adenosine↗
PubMed2000

Association between new electrocardiographic abnormalities after coronary revascularization and five-year cardiac mortality in BARI randomized and registry patients.

There are few data comparing the relative frequency of new electrocardiographic (ECG) abnormalities after coronary artery bypass grafting (CABG) compared with percutaneous transluminal coronary angioplasty (PTCA) and their association with long-term cardiac mortality. The study population consisted of 3,373 patients who were either randomized or eligible to be randomized to CABG or PTCA in the BARI trial. The frequency of new postprocedural ECG abnormalities was significantly greater after a CABG procedure than after PTCA. The incidence of new postprocedural major Q waves, ST-segment elevation, and T-wave abnormalities were significantly more frequent after CABG. After PTCA (n = 1,869), the 5-year cardiac mortality rates associated with the new development of major Q waves, ST-segment elevation, ST-segment depression, T-wave abnormalities, or no abnormality was 18.1%, 8.5%, 8.9%, 6.0%, and 5.4%, respectively. After CABG (n = 1,427), 5-year cardiac mortality rates were 8.0%, 4.2%, 3.8%, 2.8%, and 3.7%, respectively. The adjusted relative risk of 5-year cardiac mortality for new Q-wave abnormalities was 2.6 after CABG (p <0.04) and 4.6 after PTCA (p <0.01). Thus, patients who undergo CABG have more postinitial procedural ECG abnormalities than patients who undergo PTCA. Cardiac mortality is significantly increased by the new development of postprocedural Minnesota code Q-wave abnormalities regardless of whether patients undergo CABG or PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1996

Differential diagnosis of abnormal uterine bleeding.

The causes of abnormal uterine bleeding include a wide spectrum of diseases of the reproductive system and nongynecologic causes as well. The differential diagnosis of abnormal excessive uterine bleeding includes organic causes that may be subdivided into reproductive tract disease, iatrogenic causes, and systemic disease. Reproductive tract disease that may result in abnormal uterine bleeding comprises the complications of pregnancy (threatened, incomplete, or missed abortion, ectopic pregnancy, trophoblastic disease, placental polyp, and subinvolution of the placental site), malignant tumors (endometrial, cervical, vaginal, vulvar, and oviduct malignancies and granulosa theca cell ovarian tumors), infection (endometritis, salpingitis), and other benign pelvic disorders (traumatic lesions of the vagina, severe vaginal infections, foreign bodies, cervical polyps, cervical erosion, cervicitis, submucous uterine leiomyomas, adenomyosis, endometriosis, and endometrial polyps). Iatrogenic causes of abnormal uterine bleeding include sex steroids, hypothalamic depressants, digitalis, phenytoin, anticoagulants, and intrauterine contraceptive devices. Systemic diseases that may cause abnormal uterine bleeding include hypothyroidism, cirrhosis, and coagulation disorders. Abnormal uterine bleeding that occurs in a woman of reproductive age should be considered the result of complication of pregnancy until proved otherwise. Abnormal uterine bleeding occurring in a woman of perimenopausal or postmenopausal age should be considered the result of a malignancy until proved otherwise. Menorrhagia occurring in an adolescent should be attributed to a coagulopathy until proved otherwise. When an organic cause of abnormal uterine bleeding cannot be found, then by exclusion the diagnosis of dysfunctional uterine bleeding is assumed. Coagulation disorders, particularly von Willebrand disease, are more common than many physicians realize. Women with a history of high-risk factors, all adolescents with menorrhagia, women with anovulatory dysfunctional uterine bleeding who fail medical or surgical therapy, and women with ovulatory dysfunctional uterine bleeding without an anatomic uterine lesion should be screened for a coagulopathy.

Diagnosis, Differential↗
PubMed1997

Intrachoroidal microvascular abnormality: a previously unrecognized form of choroidal neovascularization.

PURPOSE: To evaluate the histopathologic and histochemical characteristics of intrachoroidal microvascular abnormality. METHODS: Forty eyes obtained at autopsy from human donors ranging in age from 20 to 91 years (25 diabetics, 15 nondiabetics) were analyzed. Choroids were processed for alkaline phosphatase flat-embedding. Vascular patterns were examined and analyzed before embedding and serial sectioning. RESULTS: Intrachoroidal microvascular abnormality had the most prominent alkaline phosphatase reaction product of choroidal vessels. These formations appeared as ameboid or cobweb-like vascular networks (area, 0.05 to 4.6 mm2) in the choroidal stroma external to the choriocapillaris. They appeared as both single or groups of formations in the posterior pole and equatorial regions in all subjects. Intrachoroidal microvascular abnormality was found in five subjects with diabetes: four with type I diabetes mellitus, and one with type II diabetes mellitus. One subject had proliferative diabetic retinopathy, three had background retinopathy, and one had no retinopathy. Intrachoroidal microvascular abnormality was connected with all levels of choroidal vasculature. Microaneurysms were observed within intrachoroidal microvascular abnormality formations in most subjects but not in other choroidal vessels. CONCLUSIONS: Intrachoroidal microvascular abnormality is a form of intrachoroidal neovascularization. This neovascularization has features similar to intraretinal microvascular abnormalities found in diabetic subjects but seems to form independently of the status of retinopathy. The presence of microaneurysms in intrachoroidal microvascular abnormalities and not other choroidal vessels supports the view that aneurysms may be aborted attempts at neovascularization.

Adult↗
PubMed2002

Cortical functional abnormality assessed by auditory-evoked magnetic fields and therapeutic approach in patients with chronic dizziness.

A long-lasting dizzy sensation is a common complaint in elderly subjects. The pathogenesis and effective treatment of such chronic dizziness (CD), however, have not yet been fully elucidated because of lack of methods for evaluating this sensation. On the basis of assumption that CD may be attributable partly to cortical functional abnormality, we attempted to estimate the function of auditory cortex by measurements of auditory-evoked magnetic fields (AEFs). Magnetic field signals in the parieto-temporal cortex were evoked by 1000-Hz tone-burst with 90-dB normal hearing level sounds, and the highest-amplitude magnetic waveforms at approximately 100-ms (N100m) were analyzed as electrical current arrows in normal subjects (n=11), patients with CD (n=27) and patients with cerebral infarction but no dizzy sensation (n=9). In the normal subjects, the current arrows pointed to a nearly straight line with small directional distortion as indicated by a rotation-degree parameter, dI(rot) of 1.59+/-0.46. In 17 of 27 CD patients, the directions of current arrows were markedly distorted showing abnormally high dI(rot) values greater than 2.50 (the mean plus two standard deviations of normal values) and disclosed a clockwise or counter-clockwise rotation in either side or both sides of parieto-temporal cortex. In all the patients with cerebral infarction, the current arrows exhibited the similar pattern as the normal subjects. None of them exhibited abnormally high dI(rot) values. We hypothesized that the rotational abnormality may be caused by abnormal neuronal excitation, since non-evoked magnetic fields in temporal lobe epilepsy demonstrated the similar current rotational abnormality as reported previously. Seven CD patients were treated with anticonvulsants, and four showed remarkable amelioration of dizzy sensation. In all the four patients with symptomatic amelioration, the disappearance of rotational abnormality in AEFs or the tendency towards disappearance was observed following symptomatic amelioration. The results of the present study suggest that the auditory center may contribute to the maintenance of equilibrium, and its dysfunction may lead to the development of CD. AEFs measurements may make it possible to evaluate the functional abnormality of auditory center and may be useful for studying the pathophysiology and treatment of CD.

Acoustic Stimulation↗
PubMedDate not supplied

[Brain structural abnormalities of bipolar disorder].

The number of structural neuroimaging studies of bipolar disorder have increased during recent years, expanding the literature on the nature of cerebral abnormalities underlying this disorder. The purpose of this paper is to provide a selective review on the main issues concerning this literature. Consistent findings are higher rate of periventricular and deep subcortical white matter hyperintensites seen on MRI. Although there is strong evidence for links between hyper-intense lesions and age or cardio-vascular risk factors, some authors have observed the presence of these abnormalities early in the course of the illness. There are also frequent reports on ventricular enlargement, which has been described as mild and predominant in the right lateral ventricle. Total cerebral volume appears to be preserved. Whereas changes in total grey matter volume are uncertain, evidence suggests that reduced white matter volume reflects genetic factors predisposing to the disorder. Recent studies have reported volume changes in several cortical areas including the subgenual cingular, frontal and temporal cortices. Additionally, a number of reports described morphometric abnormalities in various subcortical structures, such as amygdala, basal ganglia and thalamus. Part of the variability in the morphometric abnormalities might be attributable to differences in clinical status and demographic characteristics of patient groups. Despite some inconsistencies across the studies, it emerges that abnormalities are asymmetrically distributed throughout the two cerebral hemispheres. When increase in volume is reported, it is preferentially localised in the left cerebral hemi-sphere and more specifically in prefrontal and temporal cortices and in amygdala. By contrast, when structural abnormalities concern the right cerebral hemisphere, they are identified as deficits. These latter results are in direct line with those of studies of mania following brain injuries, which report that these secondary mania result mainly from right cerebral lesions. It is also important to notice that most of the abnormalities concern both the cortical and subcortical level, ie frontal, striatal, thalamic and limbic regions. These abnormalities highlight the role in the pathophysiology of bipolar disorder of the loops involved in emotional information processing. The particular role of fronto-limbic loops in the phenomenology of bipolar disorder have been emphasised by recent data from functional neuroimaging studies.

Amygdala↗
PubMed1993

Hormonal profiles of early gestations with abnormal karyotype.

OBJECTIVE: To describe the hormonal profiles of chromosomally abnormal pregnancies during the first trimester. DESIGN: A prospective study from 1984 through 1990 in which infertility patients who conceived were monitored weekly with serum E2, P, and beta-hCG levels. SETTING: The infertility practice at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois. PATIENTS: Study included 15 women who had dilatation and curettage for first trimester fetal losses with confirmed abnormal karyotype, 6 women with chromosomally normal male abortuses, and 60 consecutive women whose pregnancies yielded normal term infants. RESULTS: After natural conception, E2 demonstrated a moderate rise in both normal and chromosomally abnormal pregnancies to approximately 300 pg/mL by day 29 (6 weeks of gestation). In normal gestations, E2 continued a steady increase to exceed the level of 1,000 pg/mL by day 64 (11 weeks of gestation). In chromosomally abnormal pregnancies, the mean E2 plateaued and remained at approximately 200 pg/mL until fetal demise was noted. In stimulated conceptions, the rise of E2 was sharp and early (1,200 pg/mL by day 29); in normal pregnancies, E2 steadily increased to an average of 1,400 pg/mL by the end of the first trimester, whereas in karyotypically abnormal gestations, E2 declined to approximately 200 pg/mL by day 64. In pregnancies yielding a male abortus, a sharp decline and plateau at 800 pg/mL by day 56 (10 weeks of gestation) was observed. In both natural and stimulated normal pregnancies, hCG levels first demonstrated a linear rise, followed by a curvilinear increase from day 29 until day 56, with a peak of approximately 110,000 mIU/mL. The beta-hCG in chromosomally abnormal pregnancies, as well as in pregnancies yielding a male abortus, was characterized by a slow and gradual rise to a maximum of 40,000 mIU/mL, which remained relatively linear until day 64 when fetal demise was detected in all cases. Progesterone level data were excluded from analysis because of frequent P supplementation. CONCLUSIONS: There were significant differences in the hormonal profiles of chromosomally normal and abnormal pregnancies. Serial measurements of serum E2 and beta-hCG from the 6th week of gestation may be useful in predicting an abnormal karyotype sooner than other current diagnostic tests.

Abortion, Spontaneous↗
PubMed1995

Prevalences and correlates of ECG abnormalities in the adult Belgian population.

Data from 5,817 men and 5,215 women (age range, 25-74 years) who participated in the Belgian Interuniversity Research on Nutrition and Health were used to determine prevalences and associated variables of different abnormalities on the resting electrocardiogram. Electrocardiographic abnormalities were coded according to the Minnesota classification system. About one third of the subjects showed one or more abnormalities on their electrocardiogram. Major abnormalities occurred in 7.3% of the men and in 4.6% of the women. The prevalence of minor abnormalities was twice as high. Minnesota codes 4 (ST abnormalities) and 5 (T wave changes) were found to be the most prevalent in both sexes (9.6 and 10.5% respectively in women and 8.4 and 9.1% respectively in men), while code 2 (QRS axis deviation, 7.9%) and code 7 (ventricular conduction defect, 8.7%) were quite common in men. Most prevalences were rather log-linearly related with age, except codes 6 (atrioventricular conduction defect) and 9 (miscellaneous items). In the asymptomatic subjects, blood pressure showed the strongest positive correlation with minor ST-T abnormalities in both men and women independent of other factors. Other correlates identified by multivariate analyses were serum potassium, serum phosphor, and serum uric acid levels, as well as the intake of diuretics. However, any major, minor, and ST-T abnormalities were, according to sex, differently related to those correlates.

Adult↗