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PubMed1984

Is femoral pulse palpation accurate in assessing the hemodynamic significance of aortoiliac occlusive disease?

Palpation of the common femoral artery pulse has been the mainstay in the clinical assessment of the significance of aortoiliac disease for deciding whether to perform a suprainguinal versus an infrainguinal bypass. This study was performed to assess the accuracy of clinical pulse palpation in comparison to intraarterial pressure measurements of 31 common femoral arteries in 21 patients. Pulse palpation was graded as to the presence (abnormal) or absence (normal) of hemodynamically significant aortoiliac occlusive disease while at rest. A femorobrachial index of less than 0.9 was considered hemodynamically significant. Data were analyzed by decision matrix analysis. Results demonstrated pulse palpation to be 100 percent sensitive, 54 percent specific, and 61 percent accurate. The negative predictive value of normal pulse to palpation was 100 percent, but the positive predictive value for an abnormal pulse to palpation was only 29 percent. Even though pulse palpation should remain an integral part in the clinical assessment of the peripheral vascular tree, it should be used with caution in the clinical decision-making process.

Aortic Diseases↗
PubMed1992

Theoretical analysis of pressure pulse propagation in arterial vessels.

An original mathematical model of viscous fluid motion in a tapered and distensible tube is presented. The model equations are deduced by assuming a two-dimensional flow and taking into account the nonlinear terms in the fluid motion equations, as well as the nonlinear deformation of the tube wall. One distinctive feature of the model is the formal integration with respect to the radial coordinate of the Navier-Stokes equations by power series expansion. The consequent computational frame allows an easy, accurate evaluation of the effects produced by changing the values of all physical and geometrical tube parameters. The model is employed to study the propagation along an arterial vessel of a pressure pulse produced by a single flow pulse applied at the proximal vessel extremity. In particular, the effects of the natural taper angle of the arterial wall on pulse propagation are investigated. The simulation results show that tapering considerably influences wave attenuation but not wave velocity. The substantially different behavior of pulse propagation, depending upon whether it travels towards the distal extremity or in the opposite direction, is observed: natural tapering causes a continuous increase in the pulse amplitude as it moves towards the distal extremity; on the contrary, the reflected pulse, running in the opposite direction, is greatly damped. For a vessel with physical and geometrical properties similar to those of a canine femoral artery and 0.1 degree taper angle, the forward amplification is about 0.9 m-1 and the backward attenuation is 1.4 m-1, so that the overall tapering effect gives a remarkably damped pressure response. For a natural taper angle of 0.14 degrees the perturbation is almost extinct when the pulse wave returns to the proximal extremity.

Arteries↗
PubMed1983

Oxygen effect, hydrogen peroxide yields, and time scale of interaction of potentially damaging species in electron pulse irradiated bacterial spores.

A given integrated radiation dose delivered from a LINAC as a train of pulses (50/s), characteristically of 0.1 to 5 microseconds pulse length with dose rates within the pulse between 0.38 and 38 krads/microsecond, inactivates bacterial spores in water suspension more effectively than the same dose given as Co60 gamma rays. This enhancement of radiation damage occurs both in the presence and in the absence of oxygen and is not explained by either pulse dose rate or pulse length alone, but is monotonically related to the product of these pulse parameters, pulse dose. The enhancement appears to result from the interaction, within individual spores, of free radical species of average lifetime of about 2-5 microseconds. The time scale over which these species operate suggests that they are freely diffusable. Prevention, in part, of their damaging effect by the presence of selective scavenging agents is evidence that OH radicals are involved. Measurements of H2O2 yield for irradiation conditions that show a gradation of enhancement of damage correlate strongly with the extent of damage observed.

Bacillus megaterium↗
PubMed2005

Evaluation of Tissue Doppler Tei index for global left ventricular function in mice after myocardial infarction: comparison with Pulsed Doppler Tei index.

AIM: The Pulsed Doppler Tei index is a parameter to evaluate combined systolic and diastolic function in humans. However, one major limitation is that the parameters of Pulsed Doppler Tei index cannot be measured within one cardiac cycle. Therefore, accuracy of the Pulsed Doppler Tei index may be affected by anesthesia induced heart rate variation in mice echocardiography. Tissue Doppler Imaging (TDI) enables us to measure both relaxation and contraction velocities simultaneously. Thus, the aim of our study was to validate TDI and Pulsed Doppler Tei index and their reproducibility in mice after experimental anterior myocardial infarction (MI). METHODS AND RESULTS: Pulsed Doppler Tei index and TDI Tei index were assessed before and 4 weeks after MI. Both parameters increased significantly after MI (Pulsed Doppler: 0.4+/-0.04 to 0.7+/-0.03; P<0.001; TDI: 0.2+/-0.03 to 0.5+/-0.04; P<0.0001). In addition, TDI Tei index showed a good correlation with ejection fraction and fractional shortening, and was indicated by better reproducibility than Pulsed Doppler Tei index. CONCLUSION: Tissue Doppler Tei index is appropriate to characterize global left ventricular function in mice after MI.

Animals↗
PubMed2005

Arterial stiffness assessed by pulse wave analysis in essential hypertension: relation to 24-h blood pressure profile.

BACKGROUND: Arterial stiffness is a risk factor for cardiovascular morbidity and mortality and appears to be increased in arterial hypertension. The purpose of the present study was to relate systemic arterial stiffness assessed by pulse wave analysis to variables of 24-h ambulatory blood pressure monitoring (ABPM) in patients with essential hypertension. METHODS: Seventy-two subjects with untreated mild to moderate arterial hypertension underwent evaluation with 24-h ambulatory blood pressure monitoring. In the same subjects, applanation tonometry and pulse wave analysis was performed for evaluation of systemic arterial stiffness expressed as augmentation index and estimated aortic pulse wave velocity. RESULTS: Clinic systolic blood pressure, mean heart rate during 24-h blood pressure monitoring and height were independent predictors of augmentation index and estimated aortic pulse wave velocity. The 41 patients with blunted reduction in nighttime blood pressure (nondippers) showed higher mean systolic blood pressure (p=0.02), lower systolic and diastolic blood pressure variability (p<0.001), higher pulse pressure during 24-h monitoring (p=0.05) and higher estimated aortic pulse wave velocity (p=0.03), indicating stiffer arteries in this group. CONCLUSIONS: These results suggest that blood pressure change from day- to nighttime is an important determinant of arterial stiffness assessed by pulse wave analysis; this association could contribute to the higher cardiovascular risk in nondippers.

Blood Pressure Monitoring, Ambulatory↗
PubMed2003

Pulse pressure is an independent risk factor of cardiovascular disease in renal transplant patients.

Elevated pulse pressure in the general population has been shown to be associated with cardiovascular disease, which is the main cause of death in renal transplant patients. We investigated the effects that a wide pulse pressure has on cardiovascular disease after renal transplantation in a cohort of 532 transplant patients with functioning grafts for more than one year. Patients were classified into two groups depending on whether the one-year pulse pressure was less than or greater than 65 mm Hg. We analyzed patient survival, posttransplant cardiovascular disease and principle causes of death. Five- and ten-year patient survival were lower among the group with higher pulse pressures. The main cause of death was vascular disease in both groups. The presence of posttransplant cardiovascular disease was higher among the group with higher pulse pressures (RR=1.73). In addition, the incidence of an elevated pulse pressure was directly associated with recipient age and posttransplant diabetes mellitus. In conclusion, pulse pressure represents an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant patients.

Blood Pressure↗
PubMed1997

Effects of velocity distribution, diameter measurement and velocity tracing on the accuracy of cardiac output measurement by pulsed Doppler echocardiography in the aortic annulus of pigs.

UNLABELLED: The accuracy of cardiac output measurement by pulsed Doppler echocardiography can be affected by several factors, such as the velocity distribution, the measurement of diameter and the method of tracing the pulsed Doppler flow spectrum. This experimental study was designed to find the most accurate way of measuring cardiac output in consideration of all these factors. In 10 open-chest normal piglets (24 +/- 1 kg), the velocity distribution in the aortic annulus was evaluated using Doppler colour flow mapping. Cardiac output was measured by pulsed Doppler echocardiography in the aortic annulus by a number of different ways and compared to the simultaneous result of the thermodilution method. All measurements were made at baseline, after intravenous injection of esmolol and during infusion of dobutamine. RESULTS: (1) the velocity distribution in the aortic annulus in the piglets was just slightly skewed during all three haemodynamic situations; (2) The in vivo measurements of the diameter of the aortic annulus varied throughout the ejection period, but the average of the three largest diameter measurements was almost identical with the diameter measured in vitro (18.5 +/- 0.3 mm vs. 18.6 +/- 0.2 mm; p = NS); (3) Tracing the maximal velocity of the pulsed Doppler flow spectrum produced a cardiac output that was 18%-21% higher than that measured by the thermodilution method, while tracing the brightest part (modal velocity) of the pulsed Doppler flow spectrum yielded a cardiac output very close to the thermodilution measurement. CONCLUSION: The velocity distribution in the aortic annulus in the piglet has little effect on cardiac output measurement by pulsed Doppler. Using the maximal measurable diameter of the aortic annulus and tracing the brightest part of the pulsed Doppler flow spectrum yielded the cardiac output closest to that measured by the thermodilution method.

Adrenergic beta-Antagonists↗
PubMed1998

A noninvasive method to estimate pulse wave velocity in arteries locally by means of ultrasound.

Noninvasive evaluation of vessel wall properties in humans is hampered by the absence of methods to assess directly local distensibility, compliance, and Young's modulus. Contemporary ultrasound methods are capable of assessing end-diastolic artery diameter, the local change in artery diameter as a function of time, and local wall thickness. However, to assess vessel wall properties of the carotid artery, for example, the pulse pressure in the brachial artery still must be used as a substitute for local pulse pressure. The assessment of local pulse wave velocity as described in the present article provides a direct estimate of local vessel wall properties (distensibility, compliance, and Young's modulus) and, in combination with the relative change in artery cross-sectional area, an estimate of the local pulse pressure. The local pulse wave velocity is obtained by processing radio frequency ultrasound signals acquired simultaneously along two M-lines spaced at a known distance along the artery. A full derivation and mathematical description of the method to assess local pulse wave velocity, using the temporal and longitudinal gradients of the change in diameter, are presented. A performance evaluation of the method was carried out by means of experiments in an elastic tube under pulsatile pressure conditions. It is concluded that, in a phantom set-up, the assessed local pulse wave velocity provides reliable estimates for local distensibility.

Arteries↗
PubMed1998

Pulse radiolysis studies indicate that electron transfer is involved in radioprotection by Hoechst 33342 and methylproamine.

PURPOSE: The aim of the study was to obtain evidence to support the hypothesis that the radioprotection by DNA-binding bibenzimidazoles is due to reduction by the DNA-bound ligand of transient radiation-induced oxidizing species on DNA, by following oxidation of the ligand after pulse radiolysis. A second aim was to compare the activities of methylproamine and Hoechst 33342 in the pulse radiolysis system, with the view to seeking a correlation with radioprotective activity. METHODS: Solutions of deoxyguanosine or DNA, with or without Hoechst 33342 or methylproamine, and containing sodium selenate and tert-butanol were subjected to pulse radiolysis, and the oxidation of the ligand followed by time-resolved spectrophotometry. RESULTS: The initial pulse radiolysis experiments using deoxyguanosine (dG) established that pulse radiolysis of sodium selenate produces a transient oxidant SeO3*-, which oxidizes dG to a species (presumably dG*+), with spectral characteristics indistinguishable from those described in previous pulse radiolysis studies using Br2*- as the oxidant. The estimate obtained for the bimolecular rate constant (k2) for the reaction of the selenite radical with dG, was 1.2 x 10(9) M(-1) s(-1). The corresponding reaction of SeO3*- with DNA is much slower (k2 3 x 10(7) M(-1) s(-1)). Although unbound Hoechst 33342 is oxidized directly by SeO3*- (k2 2.3 x 10(9) M(-1) s(-1)), experiments with mixtures of Hoechst 33342 with an excess of dG (or DNA) indicated that ligand oxidation was mediated by dG*+ (or DNAoxid). For example, successive dilution of a DNA-Hoechst solution had little impact on the rate of ligand oxidation, consistent with an intramolecular rate-determining step. When the concentration of DNA was maintained at 1.0 mM DNA bp, increasing the concentration of the ligand resulted in a linear increase in the rate of oxidation; the increase being steeper for methylproamine than for Hoechst 33342. Investigation of the dependence of yield of oxidized ligand on ligand occupancy also indicated that the methylproamine was more active than Hoechst 33342, with the estimates for the range of electron transfer from the ligand to DNAoxid being 14 and 31 bp for Hoechst 33342 and methylproamine, respectively. CONCLUSIONS: At this stage we conclude that radioprotection by these DNA-binding ligands is mediated by electron transfer, and that the improved radioprotective activity of methylproamine may be attributable to the observed kinetic differences. However, further studies are required to confirm the correlation, and if it is sustained, pulse radiolysis could be useful in evaluating new analogues in an attempt to further improve the radioprotective properties of methylproamine, which already has considerable clinical potential.

Benzimidazoles↗
PubMed1987

Femoral artery pulse rise time: an objective test for aorto-iliac disease.

A method is described for assessing stenosis in the aorto-iliac arterial segment using a hand-held variable capacitance pressure transducer to take objective measurements from the common femoral pulse. The aorto-iliac segments were studied in 51 arteriopaths and the common femoral pulse rise time derived. The patients also underwent an independent clinical examination. The rise time results from 88 common femoral pulses were compared with subsequent arteriographic assessment of the aorto-iliac segments, and in 67 cases with direct intra-arterial pressure measurements from the common femoral artery. A highly significant correlation coefficient was found between the common femoral pulse rise time and the degree of aorto-iliac stenosis on the arteriogram (r = 0.80). Similarly, there was good correlation between pulse rise time and the direct common femoral/radial pressure ratios (r = -0.82). The results were analysed in terms of sensitivity, specificity and diagnostic accuracy for determining greater or less than 50% stenosis on the arteriogram. Using a pulse rise time of 200 ms a sensitivity of 97%, specificity of 93% and diagnostic accuracy of 94% were obtained. This was significantly better than clinical examination which gave a diagnostic accuracy of 83% (X2 = 5.57, P less than 0.02). The results suggest that this non-invasive method of objective pulse assessment gives superior accuracy for diagnosing aorto-iliac stenotic disease. The ease of use and relative simplicity of the apparatus are advantages over more complex non-invasive techniques employing microprocessors in the analysis of blood velocity.

Adult↗
PubMed2003

How to program pulse duration or tilt in implantable cardioverter defibrillators.

Implantable cardioverter defibrillators (ICDs) are available with independently programmable duration and tilt of the shock pulse waveform. Manufacturers do not, however, commonly advise how these parameters can be programmed for optimal clinical benefit. From theoretical considerations, the author recommends programming both parameters based on the measured lead system resistance R into which the shock is delivered. Assuming that the defibrillation pulse decline below the defibrillation threshold rheobase is undesirable because of the possibility of refibrillation. Mathematical relationships expressing optimal pulse duration and tilt as functions of the output time constant can be derived that are valid for monophasic pulses and the first phase of biphasic pulses. Two ICD manufacturers provide for programmable tilt (Medtronic GEM III, atrial channel) or both tilt T and pulse duration PD. (St. Jude Medical newest devices). Considering its output capacitance, it is recommended that the Medtronic Gem III should be programmed for T = 50% when R < 75 omega and 65% when R < 38 omega. The author considers programming tilt to 30% or 40% useless in clinical conditions. By the same reasoning, he recommends that the newer St. Jude Medical ICDs should be programmed to T = 50% if R < 75 omega and 60% if R < 41 omega, and PD = 5.5, 5.0, 4.5, 4.0, 3.5, and 3.0 ms for R < 75, 73, 62, 51, 40, and 32 omega, respectively. PD = 6 ms was considered clinically unrealistic. Programmable shock pulse duration and tilt are useful in optimizing defibrillation, but it is suggested that this can best be accomplished by programming these parameters with the guidance of theory as described in this discussion.

Defibrillators, Implantable↗
PubMed2003

Analysis of endothelium-dependent vasodilation by use of the radial artery pulse wave obtained by applanation tonometry.

OBJECTIVES: To evaluate applanation tonometry as a method to obtain arterial pulse waves suitable for pulse wave analysis of the height of the diastolic inflection point (IP), and to use this technique to study endothelium-mediated vasodilation by evaluation of the contribution of nitric oxide (NO) to the reduction in the height of the IP induced by beta2-adrenergic stimulation. METHODS: The radial artery pulse waveform was recorded by applanation tonometry in young healthy subjects before and after interventions both locally in the forearm and systemically by different vasodilators and vasoconstrictors, and vasodilatation was analysed as a change in the height of the IP. The mechanism behind the reduction in the height of the IP induced by terbutaline was investigated by systemic interventions with both N(G)-monomethyl-l-arginine (l-NMMA) and noradrenaline (NA). RESULTS: Applanation tonometry was a convenient method to obtain radial artery pulse waves of good quality. The reduction in IP was substantially more pronounced when vasodilators were given systemically than when given locally in the forearm, indicating that the effect was obtained through an effect on peripheral pulse wave reflection. Systemically given l-NMMA, but not NA, increased the IP (P<0.05). Systemically given l-NMMA also caused a more pronounced attenuation than NA of the reduction in IP following terbutaline injection (P<0.05). CONCLUSION: Changes in IP following beta2-adrenergic stimulation appears to be a measurement of pulse wave reflection mainly governed by NO. Applanation tonometry and pulse wave analysis is a minimally invasive method suitable to assess endothelium-dependent vasodilation in large-scale studies.

Adrenergic beta-Agonists↗
PubMed2001

Oral dexamethasone pulse treatment for vitiligo.

BACKGROUND: Oral corticosteroid pulse therapy has provided inconsistent results in the treatment of Indian patients with vitiligo. OBJECTIVE: We wanted to evaluate the efficacy, safety, and tolerability of oral dexamethasone pulse therapy in a cohort of Austrian patients with vitiligo. METHODS: Twenty-nine patients with vitiligo were included in the study. Of these, 25 had progressive and 4 had stable disease. The patients were given weekly pulses of 10 mg dexamethasone each on 2 consecutive days followed by 5 days off treatment for a maximum period of 24 weeks. Clinical response and side effects were evaluated in monthly intervals. Plasma cortisol and corticotropin levels were monitored before and up to 6 days after the dexamethasone pulse in the first and fourth week of treatment in 14 patients. RESULTS: After a mean treatment period of 18.2 +/- 5.2 weeks, the disease activity was arrested in 22 of 25 patients (88%) who had active vitiligo before the study. Marked repigmentation occurred in 2 patients (6.9%) and moderate or slight repigmentation in 3 patients (10.3%) each. No response was noted in 21 patients (72.4%). Side effects were recorded in 20 patients (69%) and included weight gain, insomnia, acne, agitation, menstrual disturbance, and hypertrichosis. Plasma cortisol and corticotropin values were markedly decreased 24 hours after the second dexamethasone dose, yet returned to baseline values within the off treatment period before the next dexamethasone pulse. CONCLUSION: Our data show that oral dexamethasone pulse treatment is effective in arresting progression of vitiligo yet fails to induce satisfactory repigmentation in the great majority of our patient cohort. Mild to moderate side effects are common with this treatment modality; however, sustained suppression of endogenous cortisol production does not occur with the pulse regimen.

Administration, Oral↗
PubMed2000

Pulse pressure: a predictor of cardiovascular mortality among young normotensive subjects.

Wide pulse pressure has been associated with increased cardiovascular disease events among hypertensive subjects. To test the hypothesis that this association also exists among normotensive subjects, data from the first National Health and Nutritional Examination Survey and the 1992 Epidemiological Follow-up Study were analyzed. The study group included 7346 participants, aged 25-74 years, with baseline blood pressure levels <140/90 mmHg and without a history of hypertension. Deaths from cardiovascular disease and all other causes were determined. At entry, mean age and blood pressure level were 43.4 years and 118/76 mmHg. During an average follow-up period of 17.4 years, there were 1443 (19.6%) deaths, 557 of them ascribed to cardiovascular disease. Age-race-adjusted cardiovascular mortality was significantly higher for those in the highest quartile of pulse pressure (> or = 50 mmHg). However, after stratification into age <55 years and > or = 55 years, and controlling for other cardiovascular risk factors, increased pulse pressure was associated with cardiovascular mortality only in younger men and women. In these subjects, men and women with pulse pressures > or = 48, and > or = 46 mmHg, respectively, had a relative risk (95% confidence in terval) of 2.35 (1.21-4.38) and 2.90 (1.34-4.98) for cardiovascular mortality with those with pulse pressures of less than 36 and 34 mmHg, respectively (p < 0.05) as reference. While systolic blood pressure by itself was a weaker predictor of cardiovascular mortality than pulse pressure, diastolic and mean arterial pressure were not predictive at all. No measure of blood pressure was related to mortality in those aged > or = 55 years. In conclusion, among young subjects, but not older normotensive persons, at very low risk of cardiovascular disease, a wide pulse pressure is associated with increased cardiovascular mortality.

Adult↗
PubMed2004

Non-invasive measures of pulse wave velocity correlate with coronary arterial plaque load in humans.

OBJECTIVE: Arterial stiffness is an emerging major risk factor for cardiovascular morbidity and mortality. The aim of the present study was to assess if coronary artery plaque load correlates with non-invasive measures of arterial stiffness. DESIGN: Prospective investigational study. SETTING: Tertiary university hospital centre. PATIENTS: Patients undergoing elective diagnostic coronary angiography. INTERVENTIONS AND MAIN OUTCOME MEASURES: Coronary artery plaque burden was assessed using a 30 MHz intravascular ultrasound catheter during an automated pullback. Proximal coronary artery plaque volume was determined using a validated edge-detection algorithm following three-dimensional computerized reconstruction. Central arterial stiffness was assessed in each patient using applanation tonometry to radial, carotid and femoral pulses, with derivation of aortic pressure augmentation and pulse wave velocity using pulse wave analysis. RESULTS: In 35 patients (61 +/- 2 years), proximal coronary arterial plaque volume was 5.9 +/- 0.6 mm3/mm of vessel. Plaque volume correlated positively with carotid-radial pulse wave velocity (r = 0.47, P = 0.008) and appeared to correlate with carotid-femoral pulse wave velocity (r = 0.34, P = 0.07). Aortic augmentation (r = 0.24, P = 0.16), augmentation index (r = 0.3, P = 0.08), and pulse pressure (r = 0.22, P = 0.2) did not correlate significantly with proximal coronary artery plaque volume. CONCLUSIONS: Non-invasive measures of carotid-radial pulse wave velocity correlate with the extent of coronary artery plaque volume and may be a useful non-invasive surrogate marker for the extent of coronary atherosclerosis. Our findings are consistent with the suggestion that central aortic stiffness may promote the development of coronary atherosclerosis and ischaemic heart disease.

Aged↗
PubMed2004

Validation of a new non-invasive portable tonometer for determining arterial pressure wave and pulse wave velocity: the PulsePen device.

OBJECTIVE: To validate a new, small portable tonometer (PulsePen) that is able to assess carotid artery pressure and to measure pulse wave velocity (PWV) non-invasively. Its software provides absolute arterial pressure values, an assessment of arterial pulse wave contours, an estimation of reflection waves and measurements of PWV. DESIGN AND METHODS: Two validation studies were carried out. The aim of the first study was to compare arterial pressure values and pulse wave contours recorded in the carotid artery using the PulsePen versus intra-arterial simultaneous measurements in 10 patients undergoing cardiac catheterization. The pulse wave contour was assessed using Fourier analysis. The comparison between the two methods showed no difference in arterial pressure wave spectral moduli from harmonics 1 to 6. The second study compared PWV measurements taken with the PulsePen (one tonometer) and measurements performed with two Millar tonometers in 68 subjects (32 men, 36 women). PulsePen measurements were realized as two consecutive measurements in the carotid and femoral arteries, both synchronized by electrocardiogram. The pulse wave transit time was calculated as the difference between the time delay of the femoral pulse wave and the carotid pulse wave in relation to the R wave of the electrocardiogram. These measurements were compared with PWV obtained by simultaneous carotid and femoral measurements with the two Millar tonometers. No difference between the two methods was found, with a variation coefficient of 7.7%. The variation coefficients of the inter-observer and intra-observer reproducibility for the PulsePen were 7.9 and 7.2%, respectively. CONCLUSIONS: These results show that the PulsePen enables an easy and reliable evaluation of central arterial pressure and stiffness in clinical ambulatory practice, especially in high-risk patients in whom arterial stiffness has been shown to be a significant indicator of morbidity and mortality.

Adult↗
PubMed2005

Pulse total-hemoglobinometer provides accurate noninvasive monitoring.

OBJECTIVE: Rapid noninvasive measurement of total hemoglobin would be extremely useful for various clinical situations. This study determined the clinical accuracy and utility for a pulse total-hemoglobinometer using four wavelengths: 660 nm (reduced hemoglobin), 805 nm (isosbestic point), 940 nm (oxygenated hemoglobin), and 1300 nm (water density). DESIGN: Clinical trial. SETTING: University school of medicine. PATIENTS: Patients were 122 individuals (age, 18-82 yrs; 49.4 +/- 16.0 yrs [mean +/- SD]), including 71 healthy volunteers, 24 patients undergoing surgery, and 27 patients undergoing hemodialysis. INTERVENTIONS: The hemoglobinometer probe, which simultaneously indicated peripheral oxygen saturation, pulse rate, and hemoglobin, was placed on the fingertip similarly to a regular pulse oximeter. The hemoglobin values were compared with those obtained by the co-oximeter or the sodium lauryl sulfate-methemoglobin method. Those hemoglobin values were assigned to either the training set or the validation set for statistical evaluation. MEASUREMENTS AND MAIN RESULTS: Multiple regression analysis including the ratio of the pulsatile optical density (phi(ij)) derived from the four wavelengths and other factors demonstrated that the mean value of the normalized pulse wave obtained from the photodiode at 805 nm (DC805) and the ratios of DC940 and DC1300 (DC940/DC1300) were the pivotal factors in the hemoglobinometer's increased accuracy in the clinically useful range. The coefficient of determination between both methods was r2 = .81 (p < .0001) in the training set and r2 = .75 (p < .0001) in the validation set. When the cutoff value of anemia was set at 10 g/dL, and anemia was defined as <10 g/dL, the respective sensitivity and specificity of hemoglobinometer values to detect anemia in intraoperative patients were 84.3% and 84.6% (n = 20). CONCLUSIONS: The data demonstrated the necessity for consideration of light scattering in red blood cells for pulse-spectrophotometric hemoglobin measurement. This was accomplished with additional factors, such as DC805 and DC940/DC1300. With these improvements, the pulse hemoglobinometer provided noninvasive, clinically acceptable measurement of hemoglobin. The pulse hemoglobinometer is a versatile tool that might be useful for routine health checkups of neonates and young children, intraoperative monitoring of bleeding, and emergency care.

Adult↗
PubMed2006

Combination of pulse therapy with terbinafine tablets and topical terbinafine cream for the treatment of dermatophyte onychomycosis: a pilot study.

We performed a pilot study to assess the safety and efficacy of pulse therapy with terbinafine tablets in 66 patients with dermatophyte onychomycosis. One pulse consisted of oral terbinafine tablets (500 mg/day) given for 1 week followed by a 3-week interval. Topical 1% terbinafine cream was applied daily. The number of pulses was determined by the extent of improvement in the affected nails and by the patient's requests, up to a maximum of six pulses. Efficacy was assessed based on both clinical and mycological examinations 1 year after treatment initiation. We observed a complete cure in 51 patients (77.3%), marked improvement in five patients (7.6%), improvement in five patients (7.6%) and slight improvement in one patient (1.5%). Four patients (6.0%) showed no change. In the patients who were completely cured, the average number of pulses used was 3.7 +/- 1.4 pulses and the treatment duration was 3.3 +/- 1.6 months. Nine patients experienced adverse effects, consisting of gastrointestinal disturbance (eight patients) and drug-induced eruption (one patient). There were no abnormal findings in the laboratory tests, including liver function tests. In summary, terbinafine pulse therapy in combination with topical application of terbinafine cream appeared safe and effective in this pilot study.

Administration, Cutaneous↗