ABSTRACT
OBJECTIVE: To investigate the regional flow distribution in patients with Fontan circulation by using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We identified 39 children (18 females and 21 males; mean age, 9.3 years; age range, 3.3–17.0 years) with Fontan circulation in whom flow volumes across the thoracic and abdominal arteries and veins were measured by using MRI. The patients were divided into three groups: fenestrated Fontan circulation group with MRI performed under general anesthesia (GA) (Group 1, 15 patients; average age, 5.9 years), completed Fontan circulation group with MRI performed under GA (Group 2, 6 patients; average age, 8.7 years), and completed Fontan circulation group with MRI performed without GA (Group 3, 18 patients; average age, 12.5 years). The patient data were compared with the reference ranges in healthy controls. RESULTS: In comparison with the controls, Group 1 showed normal cardiac output (3.92 ± 0.40 vs. 3.72 ± 0.69 L/min/m2, p = 0.30), while Group 3 showed decreased cardiac output (3.24 ± 0.71 vs. 3.96 ± 0.64 L/min/m2, p = 0.003). Groups 1 and 3 showed reduced abdominal flow (1.21 ± 0.28 vs. 2.37 ± 0.45 L/min/m2, p < 0.001 and 1.89 ± 0.39 vs. 2.64 ± 0.38 L/min/m2, p < 0.001, respectively), which was mainly due to the diversion of the cardiac output to the aortopulmonary collaterals in Group 1 and the reduced cardiac output in Group 3. Superior mesenteric and portal venous flows were more severely reduced in Group 3 than in Group 1 (ratios between the flow volumes of the patients and healthy controls was 0.26 and 0.37 in Group 3 and 0.63 and 0.53 in Group 1, respectively). Hepatic arterial flow was decreased in Group 1 (0.11 ± 0.22 vs. 0.34 ± 0.38 L/min/m2, p = 0.04) and markedly increased in Group 3 (0.38 ± 0.22 vs. −0.08 ± 0.29 L/min/m2, p < 0.0001). Group 2 showed a mixture of the patterns seen in Groups 1 and 3. CONCLUSION: Fontan circulation is associated with reduced abdominal flow, which can be attributed to reduced cardiac output and portal venous return in completed Fontan circulation, and diversion of the cardiac output to the aortopulmonary collaterals in fenestrated Fontan circulation.
Subject(s)
Child , Female , Humans , Male , Anesthesia, General , Arteries , Cardiac Output , Fontan Procedure , Magnetic Resonance Imaging , Protein-Losing Enteropathies , Reference Values , VeinsABSTRACT
Variation in the quality or quantity of nutrients consumed during pregnancy can exert permanent and powerful effects upon the developing fetus. This programming of fetal development is emerging as a new risk factor for non-communicable diseases of adulthood, including coronary heart disease and the metabolic syndrome. Epidemiological studies show that indicators of nutritional deficit in pregnancy are associated with greater risk of diabetes and cardiovascular mortality. The study of programming in relation to disease processes has been advanced by the development of animal models, which have utilized both under- and overfeeding of specific nutrients in pregnancy. Studies of this nature support the nutritional programming hypothesis and provide tools with which to examine the mechanisms through which programming may occur. Studies of animals subject to undernutrition in utero generally exhibit changes in the structure of key organs, such as the kidney and pancreas. These effects are consistent with the concept that programming influences remodel the development of organs. The causal pathways which extend from tissue remodelling to disease processes are relatively well characterised. In contrast, the processes which drive disordered organ development are poorly understood. It is noteworthy that minor perturbation of maternal nutritional status can programme fetal development. It is suggested therefore that programming is a product of altered expression of key genes. This drives the tissue remodelling response and future disease risk
Subject(s)
Humans , Adult , Animals, Laboratory , Nutrition Therapy , Nutrition Assessment , Fetal Nutrition Disorders , Cardiovascular Diseases , Metabolic Syndrome , Embryonic and Fetal Development , Models, AnimalABSTRACT
Calsequestrin (CASQ2) is a high capacity Ca-binding protein expressed inside the sarcoplasmic reticulum (SR). Mutations in the cardiac calsequestrin gene (CASQ2) have been linked to arrhythmias and sudden death induced by exercise and emotional stress. We have studied the function of CASQ2 and the consequences of arrhythmogenic CASQ2 mutations on intracellular Ca signalling using a combination of approaches of reverse genetics and cellular physiology in adult cardiac myocytes. We have found that CASQ2 is an essential determinant of the ability of the SR to store and release Ca2+ in cardiac muscle. CASQ2 serves as a reservoir for Ca2+ that is readily accessible for Ca2+-induced Ca2+ release (CICR) and also as an active Ca2+ buffer that modulates the local luminal Ca-dependent closure of the SR Ca2+ release channels. At the same time, CASQ2 stabilizes the CICR process by slowing the functional recharging of SR Ca2+ stores. Abnormal restitution of the Ca2+ release channels from a luminal Ca-dependent refractory state could account for ventricular arrhythmias associated with mutations in the CASQ2 gene.
Subject(s)
Animals , Arrhythmias, Cardiac , Calcium/metabolism , Myocytes, Cardiac/metabolism , Myocytes, Cardiac/chemistry , Sarcoplasmic Reticulum/metabolism , Myocardial Contraction , Myocardium/cytology , Myocardium/metabolism , Mutation/physiologyABSTRACT
The aim of this study was to determine evidence of Body Dysmorphic Disorder [BDD] amongst patients attending for orthodontic assessment, in particular to identify those individuals who expressed high facial dissatisfaction, anxiety and depression but who have low levels of orthodontic need as assessed by the clinician. A further aim was to examine discrepancies between the perceptions of clinician and patient in the severity of malocclusion. Prospective, observational, single centre study. Orthodontic department of a district hospital. A total of 69 patients were recruited for the study over a period of four months. Informed consent was obtained from all participants. All the participants were assessed by questionnaire and clinical examination. The data collected included: demographic details, weight, height, expressed reasons for attendance, expectations of treatment, body image and satisfaction with facial appearance [Body Satisfaction Scale], anxiety and depression [Hospital Anxiety and Depression Scale]. The average age of the sample was 12.7 years [SD=-3.33], with a range from 8 to 29 years. On average the participants had a low Body Mass Index [Mean=19.4, SD=4.06: range 13.6 to 33.2]. There was little evidence of Body Dysmorphic Disorder. Clinicians rated the patients' appearance on the IOTN Aesthetic component as higher on average. In 41 cases [59.4%] the clinician's rating was more severe than that of the patient, in 8 cases [11.6%] the ratings coincided, and in 20 cases [29.0%] the respondent rated themselves as more severe than the clinician's rating. The findings suggest that Body Dysmorphic Disorder is uncommon amongst patients presenting for orthodontic treatment. There is evidence that clinicians' judgements of the severity of malocclusions are influenced by crowding and the presence of overjet to a greater extent than patients' judgements
Subject(s)
Humans , Male , Female , Perception , Orthodontics , Personal Satisfaction , Prospective StudiesABSTRACT
Se evaluaron 4500 historias de pacientes a los que se les realizó recto-sigmoidoscopia en la unidad de Endoscopia del Hospital de Clínicas Caracas como parte de una evaluación médica preventiva entre Julio de 1995 y Abril de 1997. Se examina la incidencia de algunas patologías colorectales, como la presencia de pólipos, divertículos, entre otras, así como su relación con la edad y el sexo de los pacientes. En este estudio se demuestra que la recto
Subject(s)
Humans , Male , Female , Preventive Medicine , Rectum , Sigmoidoscopy , VenezuelaABSTRACT
Conjuntamente con la descripción de un caso de miasis otica se revisan en forma breve las manifestaciones, el diagnostico y el tratamiento de la miasis en otorrinolaringologia
Subject(s)
MyiasisABSTRACT
Com base em uma revisäo dos casos de condilomas cervicais estudados clinicamente, colpo-cito-histologicamente e mediante auto-radiografia e microscopia eletrônica, investigou-se o problema dos condilomas atípicos. Descrevem-se as últimas variedades de HPV descobertas, a relaçäo dos condilomas com as CIN e seu possível diagnóstico diferencial. Finalmente, destaca-se a importância do estudo das células de Langerhans e dos mercadores imunológicos para o diagnóstico dos condilomas atípicos
Subject(s)
Humans , Female , Condylomata Acuminata/diagnosis , Papillomaviridae , Uterine Cervical Neoplasms/diagnosis , Antigens, Viral, Tumor , HLA-DR Antigens , Langerhans CellsABSTRACT
En base a estudios personales, se describen las células de Langerhans, su origen, morfología, localización y función en el canal genital, y su relación con el origen del cáncer de cuello uterino
Subject(s)
Humans , Female , Langerhans Cells , Uterine Cervical NeoplasmsABSTRACT
En el presente estudio, 14 pacientes, con dolor biliar caracteristico pero sin litiasis vesicular a la radiologia y a la ultrasonografia, fueron evaluados para investigar la presencia de cristales de colesterol en el drenaje biliar transendoscopico despues de estimular la contraccion vesicular con sincalide. En 13 pacientes se observaron los cristales de colesterol. Los resultados se compararon con 27 pacientes con litiasis vesicular. En todos se observaron cristales. De 17 pacientes asintomaticos, en 5 se observaron cristales. Se concluye que la presencia de cristales de colesterol en el drenaje biliar, virtualmente establece el diagnostico de litiasis vesicular