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PubMed2002

Usefulness of magnetic resonance imaging dobutamine stress in asymptomatic and minimally symptomatic patients with decreased cardiac reserve from congenital heart disease (complete and corrected transposition of the great arteries and subpulmonic obstruction).

We explored the effect of dobutamine stress and its possible clinical implications in different groups of asymptomatic patients with chronic right ventricular (RV) pressure overload due to congenital heart disease. Forty-seven asymptomatic and minimally symptomatic patients with chronic RV pressure overload were studied: 24 patients with systemic right ventricles (16 surgically corrected transposition of the great arteries (TGA) (Mustard or Senning), 8 congenitally corrected TGA), 23 patients with chronic pressure overloaded subpulmonic right ventricles, and 11 age- and sex-matched healthy volunteers. Magnetic resonance imaging (MRI) was performed both at baseline and during dobutamine stress to determine RV volumes and ejection fraction. At baseline, RV ejection fraction in patients with surgically corrected TGA was significantly lower than in controls (58 +/- 10% vs 70 +/- 8%, p = 0.02). During dobutamine stress, RV ejection fraction increased significantly in controls and patient groups except for patients with pressure overloaded subpulmonic right ventricles. RV stroke volume increased in controls (21 +/- 21%, p = 0.008); RV stroke volume remained unchanged in patients with congenitally corrected TGA and surgically corrected TGA (2 +/- 17%, p = NS; -8 +/- 29%, p = NS). A significant RV stroke volume decrease was observed in patients with subpulmonic right ventricles (-15 +/- 16%, p = 0.0002). The changes in RV stroke volume were accompanied by a significant decrease in RV end-diastolic volume (-13 +/- 14%, p = 0.001) in patients with subpulmonic right ventricles and in patients with surgically corrected TGA (-23 +/- 16%, p = 0.0001). In controls and in patients with congenitally corrected TGA there was no change in RV end-diastolic volume (3 +/- 15%, p = NS; -5 +/- 11%, p = NS). There is a clear heterogeneity in response to MRI dobutamine stress between different groups of patients with chronic RV pressure overload. Our data suggest impaired filling in surgically corrected TGA and decreased contractility in patients with chronic pressure overloaded subpulmonic right ventricles. Dobutamine stress MRI may facilitate follow-up of RV (dys)function in patients with chronic RV pressure overload due to congenital heart disease.

Adult↗
PubMed1991

Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study. Working Group on Noninvasive Evaluation of Pulmonary Artery Pressure. European Office of the World Health Organization, Copenhagen.

The feasibility, reproducibility and reliability of Doppler echocardiography in evaluation of pulmonary artery pressure in patients with chronic obstructive pulmonary disease (COPD) were determined in a multicentre study. In 100 COPD patients with mean pulmonary artery pressure ranging from 10 to 62 mmHg at cardiac catheterization, pulmonary pressure estimation was attempted by four Doppler echocardiographic methods. These methods comprised the calculation of transtricuspid and transpulmonary pressure gradients from Doppler-detected tricuspid or pulmonary regurgitation, the evaluation of right ventricular outflow tract velocity profiles with the measurement of right ventricular systolic time intervals and the measurement of the right ventricular isovolumic relaxation time. In 98 (98%) patients at least one of the methods could be employed. A tricuspid regurgitation jet was detected in 47 (47%) patients but its quality was adequate for measurement in 30 (30%). Pulmonary regurgitation jet velocity was measured only in five cases. The standard error of estimate in testing intra- and interobserver reproducibility of Doppler systolic time intervals was less than 5%. The predictive value of right ventricular outflow tract acceleration time less than 90 ms in the identification of patients with mean pulmonary artery pressure greater than 20 mmHg was 80%. Of Doppler echocardiographic data, best correlations with mean pulmonary artery pressure were found for the transtricupid gradient (r = 0.73, SEE = 7.4 mmHg), for the right ventricular acceleration time (r = 0.65, SEE = 8 mmHg) and right ventricular isovolumic relaxation time (r = 0.61, SEE = 8.5 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Pulmonary embolism and right heart function: insights from myocardial Doppler tissue imaging.

BACKGROUND: Acute pulmonary embolism (PE) has significant impact in right heart function. We assess the difference of Doppler tissue parameters among control subjects, patients with pulmonary hypertension, and patients with acute PE. After optimal treatment, the changes of Doppler tissue parameters in patients with PE were assessed. METHODS: A total of 50 patients with acute PE, confirmed by multidetector-row chest computed tomography, were enrolled. Another 70 patients with pulmonary hypertension, but no evidence of PE found by computed tomography, were also enrolled. A total of 100 healthy people without signs of cardiopulmonary dysfunction served as a control group. We assessed left and right ventricular (RV) ejection fraction by Simpson's rule. Doppler tissue parameters were obtained from lateral sides of tricuspid and mitral annulus, and interventricular septum. Myocardial performance index (MPI) of RV was estimated from lateral tricuspid annulus by Doppler tissue imaging, MPI of left ventricle from lateral mitral annulus. RESULTS: The left ventricular and RV ejection fractions in patients with pulmonary hypertension were lower than for the control group and patients with PE. But the RV-MPI in patients with PE was the lowest as a result of significant prolongation of isovolumic relaxation time (IVRT). One month after anticoagulant treatment, the IVRT and RV-MPI recovered in patients with PE. There was no significant correlation between IVRT and pulmonary artery systolic pressure. By bivariate correlation analysis, the most significant factor correlated to pulmonary artery systolic pressure was peak late diastolic velocity of tricuspid annulus with r 0.67, r(2) 0.45, and P less than .0001. CONCLUSIONS: Acute PE has significant impact in systolic and diastolic function of RV. The higher RV-MPI implies that condition. However, optimal anticoagulant treatment corrects RV dysfunction in patients with PE. After a 1-month course of anticoagulant treatment, RV-MPI diminishes as the result of RV-IVRT reduction.

Adult↗
PubMed2006

Exploring the functional and anatomical bases of mirror-image and anatomical imitation: the role of the frontal lobes.

Humans are the most imitative species on earth, but how imitation is accomplished and which areas of the brain are directly involved in different kinds of imitation is still under debate. One view is that imitation entails representing observed behaviours as a set of hierarchically organised goals, which subsequently drive the construction of an action pattern [Bekkering, H., Wohlschläger, A., & Gattis, M. (2000). Imitation of gestures in children is goal-directed. The Quarterly Journal of Experimental Psychology, 53, 153-164; Wohlschläger, A., Gattis, M., & Bekkering, H. (2003). Action generation and action perception in imitation: An instance of the ideomotor principle. Philosophical Transactions of the Royal Society of London, 358, 501-515]. On this view, when working memory resources are limited, only the goals at the top-end of the hierarchy will be accurately reproduced. In the present study, neurologically intact participants and patients with frontal and non-frontal lesions were asked to make imitative responses that were either mirror-image (e.g., the observer's right side corresponding to the model's left side) or anatomically (e.g., the observer's right side corresponding to the model's right side) matching. Experiment 1 confirmed that individuals with brain damage, though globally impaired compared with neurologically intact controls, nevertheless followed the same goal hierarchy. However, there was a selective deficit in performing anatomical imitation for the frontal group. Experiment 2 demonstrated that the problem for frontal patients stemmed from an impaired ability to remember and reproduce incompatible stimulus-response mappings, which is fundamental for the selection of the appropriate frame of reference during anatomical imitation.

Adult↗
PubMed2003

[Validation of the otoacoustic emissions in presbyacusis].

INTRODUCTION: With the development of medical technology, human life expectancy has increased. This has increased the incidence of senile pathologies and the associated problems for this people. In the field of otolaryngology, one of these pathologies is presbyacusis. This study attempts to find relationships between presbyacusis and different parameters related to it. MATERIAL AND METHODS: A cross sectional study was carried out with 59 volunteers aged between 50-89 from different homes for the elderly in the city of Reus. The subjects presented with or without symptoms of deafness. An AOE test was then performed to determine the different parameters. Significant response criteria were: otoemissions with a signal-noise ratio of 3 dB or greater or 65% reproducibility in < 2 bands. The results obtained were analyzed through a computer statistics program (SPSS) and Microsoft Excel for the graphics. RESULTS: The results of the characteristics of the test are within the acceptable limits of quality. The prevalence of subjects with AOE was 22%, with an average age of the subjects of around 69 years. We did not find statistical differences in the presbyacusis group with respect to the parameters of intensity and reproductability, but there was a correlation in the duration of the test. In the analysis of frequencies in the reproductibility parameters we observed a fall in the 5 KHz. The ratio signal-noise showed a similar tendency. It is necessary to emphasize the worst results in the different parameters from the right ear the left one. CONCLUSIONS: The AOE offers information in frequencies of 1 and 2 KHz, where we can see a reduction in the reproducibility in the presbyacusis group. We see a longer test time, in the presbyacusis group and this may be used to control the development of the disease.

Aged↗
PubMed2005

Agreement between four available algorithms to evaluate global systolic left and right ventricular function from tomographic radionuclide ventriculography and comparison with planar imaging.

BACKGROUND AND AIM: Left and right ventricular ejection fractions (LVEF and RVEF) and end-diastolic and end-systolic volumes (LVEDV, RVEDV, LVESV and RVESV) can be calculated from tomographic radionuclide ventriculography (TRV). The aim of this study was to validate and compare these parameters obtained using four different TRV software programs (QBS, QUBE, 4D-MSPECT and BP-SPECT). METHODS: LVEF obtained from planar radionuclide ventriculography (PRV) was compared with LVEF obtained from TRV using the four different software programs in 166 patients. Furthermore, ventricular volumes obtained using TRV (QBS, QUBE and 4D-MSPECT) were compared with those obtained using BP-SPECT, the latter being the only method with the validation of ventricular volumes in the literature. RESULTS: The correlation of LVEF between PRV and TRV was good for all methods: 0.81 for QBS, 0.79 for QUBE, 0.71 for 4D-MSPECT and 0.79 for BP-SPECT. The mean differences+/-standard deviation (SD) were 3.16+/-9.88, 10.72+/-10.92, 3.43+/-11.79 and 2.91+/-10.39, respectively. The correlation of RVEF between BP-SPECT and QUBE and QBS was poor: 0.33 and 0.38, respectively. LV volumes calculated using QBS, QUBE and 4D-MSPECT correlated well with those obtained using BP-SPECT (0.98, 0.90 and 0.98, respectively), with mean differences+/-SD of 7.31+/-42.94, -22.09+/-36.07 and -40.55+/-39.36, respectively. RV volumes showed poorer correlation between QBS and BP-SPECT and between QUBE and BP-SPECT (0.82 and 0.57, respectively). CONCLUSION: LVEF calculated using TRV correlates well with that calculated using PRV, but is not interchangeable with the value obtained using PRV. Volume calculations (for left and right ventricle) and RVEF require further validation before they can be used in clinical practice.

Algorithms↗
PubMed2000

Effect of the mechanical ventilatory cycle on thermodilution right ventricular volumes and cardiac output.

The purpose of this study was to evaluate right ventricular (RV) loading and cardiac output changes, by using the thermodilution technique, during the mechanical ventilatory cycle. Fifteen critically ill patients on mechanical ventilation, with 5 cmH(2)O of positive end-expiratory pressure, mean respiratory frequency of 18 breaths/min, and mean tidal volume of 708 ml, were studied with help of a rapid-response thermistor RV ejection fraction pulmonary artery catheter, allowing 5-ml room-temperature 5% isotonic dextrose thermodilution measurements of cardiac index (CI), stroke volume (SV) index, RV ejection fraction (RVEF), RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) indexes at 10% intervals of the mechanical ventilatory cycle. The ventilatory modulation of CI and RV volumes varied from patient to patient, and the interindividual variability was greater for the latter variables. Within patients also, RV volumes were modulated more by the ventilatory cycle than CI and SV index. Around a mean value of 3.95 +/- 1.18 l. min(-1). m(-2) (= 100%), CI varied from 87.3 +/- 5.2 (minimum) to 114.3 +/- 5.1% (maximum), and RVESV index varied between 61.5 +/- 17.8 and 149.3 +/- 34.1% of mean 55.1 +/- 17.9 ml/m(2) during the ventilatory cycle. The variations in the cycle exceeded the measurement error even though the latter was greater for RVEF and volumes than for CI and SV index. For mean values, there was an inspiratory decrease in RVEF and increase in RVESV, whereas a rise in RVEDV largely prevented a fall in SV index. We conclude that cyclic RV afterloading necessitates multiple thermodilution measurements equally spaced in the ventilatory cycle for reliable assessment of RV performance during mechanical ventilation of patients.

Aged↗
PubMed2006

Characterizing radial undersampling artifacts for cardiac applications.

The undersampled radial acquisition has been widely employed for accelerated (by a factor R = N(r)/N(p)) cardiac imaging, but the resulting reduction in image quality has not been well characterized. This investigation presents a method of measuring these artifacts through synthetic undersampling of high SNR images (SNR > or = 30). After validating the method in phantoms, the method was applied to a study of short-axis, long-axis, and coronary MRI imaging in healthy subjects. For 60 projections (60 N(p)), the total artifact is approximately 10% for short and long-axis imaging (R = 2.1) and approximately 15% for coronary MRI (R = 3.7). For 60 N(p), the SD of artifact in the region of the heart is 2% for short- and long-axis imaging (R = 2.1) and 3.5% for coronary MRI (R = 3.7). The artifact content is less in the region of the heart than in the periphery. The artifact is very reproducible among subjects for standard views. A study of coronary MRI at progressively fewer projections (at constant scan time) showed that right coronary MRI images were acceptable if total artifact was <6.5% of image content (N(p) > 120, R = 2.1).

Artifacts↗
PubMed1996

Hemodynamics and oxygenation changes induced by the discontinuation of low-dose inhalational nitric oxide in newborn infants.

OBJECTIVE: To assess changes associated with nitric oxide (NO) discontinuation in neonates receiving inhalational NO therapy as a treatment for pulmonary hypertension of the neonate (PPHN). DESIGN: Prospective study. SETTING: A pediatric PICU in a university hospital. PATIENTS AND METHODS: Ten neonates were included. NO discontinuation was attempted when the oxygenation index fell below 10. The mean NO concentration was 4.9 +/- 0.8 ppm. Each infant was studied over three successive 5-min periods and was assigned to either group 1 (NO1+, NO2+, NO-) or group 2 (NO1+, NO-, NO2+). MEASUREMENTS AND RESULTS: Postductal transcutaneous PO2 (tcPO2), postductal oxygen saturation with pulse oxymetry (SpO2), systolic and diastolic blood pressure (BP), heart rate (HR), left ventricular shortening fraction (LVSF), cardiac output (CO), and ratio of pulmonary artery time to peak velocity and right ventricular ejection time (TPV/RVET) were similar during the two successive NO+ periods (group 1), thus demonstrating that the measurements were reproducible. NO removal (groups 1 and 2) did not modify systolic or diastolic BP, HR, CO, or LVSF but did induce a significant decline in SpO2, tcPO2 (- 25 +/- 5%) and TPV/RVET ratio (- 25 +/- 3%). No reinstitution reversed the effects of NO withdrawal on tcPO2, SpO2 and TPV/RVET ratio (group 2) without any changes in systemic hemodynamics. CONCLUSION: The shut-off of low-dose NO induced in each patient a decrease in oxygen delivery that may be due to increased pulmonary vascular resistances and/or redistribution of pulmonary blood flow with ventilation-perfusion mismatching. The optimum weaning-off procedure of inhalational NO remains to be determined.

Administration, Inhalation↗
PubMed1977

Effect of procainamide, propranolol and verapamil on mechanism of tachycardia in patients with chronic recurrent ventricular tachycardia.

The effect of short-term intravenous administration of procainamide (12 patients), propranolol (4 patients) and verapamil (4 patients) was studied in 12 patients with chronic recurrent sustained ventricular tachycardia. In all patients tachycardia could reproducibly be initiated and terminated with programmed electrical stimulation of the heart. Procainamide (1) lengthened the effective refractory period of the right ventricle, (2) affected the tachycardia zone, (3) reduced ventricular rate during tachycardia, and (4) lengthened the interval between the tachycardia-initiating premature ventricular beat and the first QRS complex of tachycardia. No effect on the refractory period of the right ventricle or the mechanism of tachycardia was seen after administration of propranolol or verapamil. Apart from their therapeutic implications these data suggest that it may be possible to use drugs to study mechanisms of ventricular tachycardia in the human heart.

Adult↗
PubMed1990

Angiographic and electrophysiologic substrates of ventricular tachycardia in chronic Chagasic myocarditis.

Forty-three consecutive symptomatic patients with chronic Chagasic myocarditis and ventricular tachycardia (VT) underwent clinical evaluation, 24-hour Holter monitoring, left ventricular angiography and electrophysiologic testing including programmed ventricular stimulation at 3 drive cycle lengths at 2 sites in the right ventricle. The mean ejection fraction was 42 +/- 10%. Sixteen patients had clinical sustained VT and 27 nonsustained VT. VT was reproducibly initiated in 13 of 16 (81%) patients with sustained VT and in 14 of 27 (52%) patients with nonsustained VT. Electrocardiographic conduction disturbances were seen in 15 of 16 (94%) patients with sustained VT and in 17 of 27 (63%) patients with nonsustained VT (p less than 0.05). Five of 16 (31%) sustained VT and none of nonsustained VT patients had left ventricular aneurysms (p less than 0.05). These data indicate that VT is frequently inducible in patients with sustained VT and nonsustained VT and chronic Chagasic myocarditis. An association appears to be present between conduction disturbances on the electrocardiogram, left ventricular aneurysms and development of sustained ventricular arrhythmias.

Adult↗
PubMed1989

Sequence initiation performance by stutterers under conditions of response competition.

Male stutterers and nonstutterers were compared on their performance of a task that required tapping keys as rapidly and accurately as possible to reproduce different sequences of finger movements as soon as they had been demonstrated on a visual display panel. Testing using the right hand alone confirmed previous findings that stutterers are significantly slower than nonstutterers in initiating new movement sequences and make significantly more errors on initial sequences. Subjects were also tested on this sequence reproduction task while they performed concurrently a manual task with the left hand that required turning a knob in response to signal tones. The hypothesis underlying the study was that associated with stuttering is a dysfunction in the mechanisms regulating interhemispheric communication, and it was predicted that the concurrent task would interfere more with the sequence reproduction task performance of stutterers than with that of nonstutterers. A joint analysis of the speed and accuracy aspects of performance of the two tasks confirmed the prediction. Additional research required to clarify whether the effects are in fact due to the hypothesized interhemispheric mechanisms or to a generally greater susceptibility of stutterers to interference from any concurrent motor or cognitive activity is discussed.

Adult↗
PubMed1991

Experimental Corynebacterium pseudotuberculosis infection in lambs: kinetics of bacterial dissemination and inflammation.

Infection and pyogranulomas induced by Corynebacterium pseudotuberculosis were experimentally reproduced in lambs. In two separate experiments, bacterial multiplication and dissemination were studied in 30 male lambs inoculated subcutaneously into the right ear with 1.1 or 1.5 X 10(8) viable C. pseudotuberculosis strain 19R. Infected lambs were necropsied at various times until the 28th day following inoculation. After a transient hyperthermia and a strong local inflammatory reaction, an abscess developed in the right ear from postinoculation day (PID) 6; it enlarged until PID 14 and stabilized thereafter and was associated with adenopathy of lymph nodes draining the head. Three acute phase indicators of inflammation were followed in 14 out of 30 lambs; plasma levels of copper and haptoglobin increased rapidly following inoculation whereas zinc levels decreased. The peaks were reached from PID 1 to 5, and thereafter the values came back slowly to the baseline. Antibodies against C. pseudotuberculosis exotoxin increased from PID 5 and reached a plateau on PID 21. Bacterial dissemination, assessed by the number of infected organs per lamb, was maximal on PID 16 and then stabilized until the end of the experiment. Lungs were infected in seven out of 18 lambs necropsied on PID 28. These results demonstrate a significant relationship between the clinical score of superficial lymph nodes or inoculation site and the infection level of these organs, and an early localization of pyogranulomatous lesions in regional lymph nodes. The subsequent development of the disease was related to the enlargement of these lesions and, in some animals, to a bacterial dissemination from primary sites of infection in the right prescapular lymph node and in the lung.

Animals↗
PubMedDate not supplied

Popliteal aneurysm as a cause of leg pain in a geriatric patient.

OBJECTIVE: To discuss the management of a patient with unilateral lower extremity pain as a consequence of a popliteal aneurysm. CLINICAL FEATURES: An 85-year-old male had difficulty in ambulating due to low back and lower extremity pain. Standard tests demonstrated and reproduced pain at the lower back while inspection, palpation, and auscultation revealed a pulsatile mass in the popliteal fossa of the right knee. INTERVENTION AND OUTCOME: Specific joint manipulation for relief of low back pain was performed. Comanagement of the patient with a vascular surgeon and subsequent surgical intervention resulted in relief of lower extremity pain. CONCLUSION: Resolution of pain and guarded gait was accomplished by a multidisciplinary approach combining conservative care and invasive techniques.

Aged↗
PubMed1963

A QUANTITATIVE DESCRIPTION OF THE RELATIONSHIP BETWEEN THE AREA OF RABBIT VENTRICULAR ACTION POTENTIALS AND THE PATTERN OF STIMULATION.

Intracellular microelectrodes were used to record action potentials from fibres of the isolated rabbit right ventricle and the areas of the action potentials were measured. The action potential area was found to depend in a reproducible way on the preceding pattern of stimulation. A mathematical model reproducing all the observed changes in the action potential area was developed. In the model the action potential area is taken as a linear function of the product of two time and stimulation dependent variables, M and N. The behaviour of each variable between action potentials is described by the solution of a second order differential equation. During each action potential the variables are assumed to change discontinuously, the magnitudes of the discontinuous changes being given by a set of subsidiary equations. It was found that the behaviour of all the fibres tested was described by the same set of equations, each single fibre being characterized by a set of ten independent constants.

Action Potentials↗
PubMed1978

Pulmonary artery catheterization in the rat.

A method of pulmonary artery (PA) catheterization in the closed-chest rat is described. This catheterization is best accomplished with teflon catheters having a "shepherd's crook" tip. Catheter preparation is detailed. The functional advantages of such a PA catheter are: 1) the tip can remain free within the right ventricle (RV) without becoming occluded by contact with the ventricular wall, and 2) entry into the PA is simple and reproducible. Dual catheterization of the RVand PA produced only a small systolic gradient (3 mmHg) across the pulmonic valve. We concluded that the PA catheter does not unduly obstruct blood flow through this valve.

Animals↗
PubMed1982

Effects of antihistamines and indomethacin on hyperosmolar-induced vasodilation.

The circulatory effects of iv injections of hyperosmolar solutions were studied both in intact dogs with aortic flow probes and in dogs using a standard right heart-bypass preparation. Serial iv injections of 20 ml of 10% NaCl or 50 ml of 25% mannitol produced reproducible episodic vasodilation characterized by falls in mean aortic pressure from 99 +/- 10 (SE) to 61 +/- 6 Torr and increases in aortic flow from 2.20 +/- 0.06 1/min to 3.12 +/- 0.28 (P less than 0.01). Systemic vascular resistance decreased (P less than 0.01) with each injection and serum osmolarity increased (P less than 0.01); however, there was a poor correlation between these two variables (r = -0.24). Because the mechanism of these physiological changes is unclear, the following experiments were performed to determine whether they were due to the release of vasoactive chemical mediators. We measured arterial and venous plasma histamine, a mediator released systemically in IgE-mediated anaphylactic reactions, but found no changes in histamine levels. Furthermore, pretreatment with both H1 and H2 blockers (diphenhydramine and cimetidine), agents that blocked histamine-induced hypotension, did not prevent hyperosmolar vasodilation. Also, indomethacin (a cyclooxygenase pathway inhibitor of prostaglandin synthesis) did not affect hyperosmolar vasodilation or the fall in systemic vascular resistance. Therefore, hyperosmolar vasodilation is not caused by the systemic release of histamine or by the effects of prostaglandins. The mechanism of these reactions is unknown, but it may be due to direct local effects of hyperosmolar solutions on vascular smooth muscle, perhaps mediated by local fluid and electrolyte shifts.

Animals↗
PubMed2002

[Diagnosis of appendicitis with particular consideration of the acupuncture point Lanwei--a prospective study].

BACKGROUND: In almost all Western industrial nations, appendicitis is the most frequent cause for acute abdomen. Nevertheless, the diagnosis of appendicitis is often difficult, which manifests in highly negative laparotomy rates. In a prospective study we aimed to investigate if palpation of the acupuncture point Lanwei (extra point 22, extra point 33) which is located on the right leg may increase the accuracy in the diagnosis of appendicitis. PATIENTS AND METHODS: Presurgically, the Lanwei point was examined for reproducible tenderness on 116 cooperative nonanesthetized patients admitted to hospital for suspected appendicitis. The results were compared with those of histological diagnosis. The examination of tenderness of the Lanwei sign was performed without knowing the results of other examinations. Additionally, other signs and laboratory parameters for appendicitis were examined using a standardized documentation form. Altogether, 17 presurgical variables, 18 clinical signs, and 3 tests were evaluated. RESULTS: A positive Lanwei sign was documented in 65 cases (56%), whereas 51 patients (44%) had a negative Lanwei sign. 65 of the 116 patients were operated. 59 of those had a histologically proven appendicitis. The sensitivity of the Lanwei sign was 64.4%, specificity ranged at 50%. Rates for positive and negative predictive values were 92.7% and 12.5%, respectively. Odds ratio was estimated as 1.8. When comparing these parameters, the Lanwei sign ranged between the 7th and 10th place of the 22 most important clinical signs for appendicitis. The negative laparotomy rate was 9%, of which 4 of 6 patients had other indications for an operation. The rate of perforation was 15%. CONCLUSION: Compared with many conventional signs for appendicitis as for example Mc Burney, tender Sherren triangle, reduced peristalsis, the diagnostic value of the Lanwei sign is not sufficient. Although a reproducible positive Lanwei sign is a good hint for a true appendicitis, in case of a negative Lanwei sign the probability for an appendicitis may be relatively high. Because of the low negative predictive value, the Lanwei sign is not suitable for reducing negative laparatomy rates. As in many other studies, the one and only indicator for appendicitis which yields high results in all statistical parameters was not detected in this study. In comparison to the statistical parameters of traditional signs for appendicitis, the Lanwei sign cannot be regarded as a good diagnostic parameter for appendicitis.

Acupuncture Points↗