Ecocardiograma sob estresse com dobutamina em pacientes assintomáticos com regurgitação aórtica / Ecocardiografía bajo estrés con dobutamina en pacientes asintomáticos con regurgitación aórtica / Dobutamine-stress echocardiography in asymptomatic patients with aortic regurgitation

FUNDAMENTO: A reserva contrátil diminuída pode já estar presente em pacientes portadores de regurgitação aórtica, assintomáticos com fração de ejeção (FE) normal, indicando a necessidade de avaliações frequentes e acuradas da função ventricular esquerda para detectar disfunção sistólica incipiente. OBJETIVO: Analisar se incrementos na FE em doses baixas de dobutamina podem predizer cirugia e/ou morte em pacientes com regurgitação aórtica. MÉTODOS: Eco de estresse com dobutamina foi realizado em 24 pacientes portadores de regurgitação aórtica para verificar se incrementos da FE em doses baixas de dobutamina seriam capazes de predizer a necessidade de cirurgia e/ou morte nesse grupo de pacientes. RESULTADOS: A idade média foi de 37,8±16,8 anos, e 16 (66 por cento) eram homens. A FE aumentou de um valor basal médio de 62,3±7,9 por cento para 71,5±10,5 por cento, na dose de 20 µg/kg/min de dobutamina (p < 0,001). Os pacientes foram acompanhados por 36,6±20,1 meses: dois pacientes morreram (um de morte cardiovascular) e cinco foram submetidos à cirurgia cardíaca. A FE basal se correlacionou com cirurgia e morte no seguimento de pacientes. CONCLUSÃO: A FE basal se correlacionou com cirurgia ou morte no seguimento de pacientes jovens com regurgitação aórtica. Porém, o incremento percentual na FE com dose baixa de dobutamina não foi capaz de predizer eventos nesses pacientes.

BACKGROUND: Decreased contractile reserve may already be present in asymptomatic patients with aortic regurgitation and normal ejection fraction (EF), thus indicating the need for frequent and accurate assessments of the left ventricular function for the early detection of systolic dysfunction. OBJECTIVE: To analyze if increments in EF with low dose dobutamine could predict surgery and/or death in patients with aortic regurgitation. METHDOS: Dobutamine-stress echocardiography was performed in 24 patients with aortic regurgitation in order to analyze whether EF increments at low dobutamine doses could predict the need for surgery and/or death in this group of patients. RESULTS: Mean age was 37.8±16.8 years and 16 patients (66 percent) were male. EF increased from a mean baseline value of 62.3±7.9 percent to 71.5±10.5 percent at a dobutamine dose of 20 µg/kg/min (p<0.001). The patients were followed-up for 36.6±20.1 months; two patients died (one of cardiovascular death) and five underwent cardiac surgery. Baseline EF was correlated with surgery and death in the follow-up of patients. CONCLUSION: Baseline EF was correlated with surgery or death in the follow-up of young patients with aortic regurgitation. However, the percentage increase in EF at low dobutamine doses did not allow us to predict events in these patients.

FUNDAMENTO: La reserva contráctil disminuida puede ya estar presente en pacientes portadores de regurgitación aórtica, asintomáticos con fracción de eyección (FE) normal, indicando la necesidad de evaluaciones frecuentes y cuidadosas de la función ventricular izquierda para detectar disfunción sistólica incipiente. OBJETIVO: Analizar se incrementos en la FE en dosis bajas de dobutamina pueden predecir cirugía y/o muerte en pacientes con regurgitación aórtica. MÉTODOS: Eco de estrés con dobutamina se realizó en 24 pacientes portadores de regurgitación aórtica para verificar se incrementos de la FE en dosis bajas de dobutamina serían capaces de predecir la necesidad de cirugía y/o muerte en ese grupo de pacientes. RESULTADOS: La edad promedio fue de 37,8±16,8, y 16 (66 por ciento) eran varones. La FE aumentó de un valor basal promedio de 62,3±7,9 por ciento para 71,5±10,5 por ciento, en la dosis de 20 µg/kg/min de dobutamina (p < 0,001). Los pacientes se siguieron por 36,6±20,1 meses: dos pacientes murieron (uno de muerte cardiovascular) y cinco se sometieron a cirugía cardiaca. La FE basal se correlacionó con cirugía y muerte en el seguimiento de pacientes. CONCLUSIÓN: La fe basal se correlacionó con cirugía o muerte en el seguimiento de pacientes jóvenes con regurgitación aórtica. Sin embargo, el incremento porcentual en la FE con dosis baja de dobutamina no fue capaz de predecir eventos en esos pacientes.

case report of cavernous sinus embolisation for CCF with an overview of treatment options

Carotid-cavernous fistulas [CCFs] are a subtype of intracranial arteriovenous fistulas with symptoms ranging from none to devastating intracranial hemorrhage. This article reviews the two main types of CCFs, the symptomatology, the different drainage patterns and the currently available treatment options. We follow that by a case report of a spontaneous CCF treated successfully by trans-arterial coil embolisation

Radionuclide scrotal imaging: an effective method for detecting varicocele / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate radionuclide scrotal imaging (RSI) in the diagnosis of varicocele.</p><p><b>METHODS</b>We performed physical examination (PE) and RSI for 126 patients with infertility for at least 12 months and seminal abnormality, obtained the scrotal blood-pool index (SBPI), observed the reflux in the spermatic vein during RSI, typed and graded varicocele by color Doppler flow imaging (CDFI) and compared the results of PE and RSI with those of CDFI.</p><p><b>RESULTS</b>The rates of sensitivity and specificity of RSI in the diagnosis of varicocele (96.5% and 97.1%) were both higher than those of PE (71.7% and 69.1%).</p><p><b>CONCLUSION</b>Simple, accurate and noninvasive, RSI is an effective method for the diagnosis of clinical and subclinical varicocele.</p>

Incidental Detection of a Pseudoaneurysm at an Amputation Stump in a Tc-99m HMPAO Labeled Leukocyte Scan / 핵의학분자영상

A 20-year-old man underwent a Tc-99m HMPAO labeled leukocyte scan for the evaluation of an infection at the stump of an AK amputation, which was conducted due to an open communicated fracture of the left lower leg. Blood-flow and blood-pool images demonstrated a pseudoaneurysm with a focus of intense activity medial to the stump, and centered within a large photopenic defect by surrounding hematoma. Delayed image obtained at 3 hours post-injection showed persistent intense and slight increased activity. Contrast angiography confirmed the presence of a pseudoaneurysm arising from a branch of the left superficial femoral artery.

Relation between cardiomyopathy and exercise capacity multicenter trial

The six-minute walk test [6MW lest] is a safe and simple method to assess exercise capacity in patients with left ventricular [LV] dysfunction. Recent studies confirmed its prognostic significance. The aim of this Study: Was to identify determinants of exercise capacity in patients with LV dysfunction as assessed by 6MW test. and 116 Patients with LV dysfunction caused by ischemic heart disease or idiopathic dilated cardiomyopathy [NYHA class l-IIl] underwent 6MW test, M-mode, two dimensional and Doppler transthoracic echocardiographic studies. 115 Patients were able to perform the 6MW test. The mean distance walked was 277 +/- 114m. Univariate analysis revealed that heart rate, systolic and diastolic arterial pressures, NYHA class, left atrial size, LV myocardial mass index, end-systolic and end-diastolic volume indices, ejection fraction, isovolumic relaxation time, peak early [PE] and peak atrial [PA] wave velocities of LV diastolic filling, PE/PA ratio and deceleration nine of early filling were all significantly related lo 6MW test distance [p<0.05]. Multivariate step-wise regression analysis showed that the only independent determinants of 6 MW test distance were PA wave velocity [F to enter 192.71, multiple r=0.79], PE/PA ratio [F to enter 115.22, multiple r=-0.37], and heart rate [F to enter 80.98, multiple r=-0.12]. Doppler-derived indices of LV diastolic function [PA wave velocity and PE/PA ratio] and heart rate are the main determinants of exercise capacity in patients with LV dysfunction as assessed by 6MW test

Comparison of pulmonary perfusion imaging with pulmonary angiography in diagnosis of pulmonary involvement in Takayasu's arteritis / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the diagnostic value of (99)Tc(m)-MAA pulmonary perfusion imaging with that of pulmonary angiography for pulmonary involvement in Takayasu's arteritis.</p><p><b>METHODS</b>Twenty-one patients (19 women, 2 men), with diagnosed Takayasu's arteritis and underwent both (99)Tc(m)-MAA pulmonary perfusion imaging and pulmonary angiography, were retrospectively analyzed.</p><p><b>RESULTS</b>Out of the 21 patients, pulmonary angiography detected 11 patients with pulmonary artery involvement whereas 13 patients were revealed perfusion defects by pulmonary perfusion imaging. The agreement of diagnosis by pulmonary perfusion imaging with that by pulmonary angiography existed in 19 patients (90.5%, Kappa = 0.81, P < 0.0001). There were 331 pulmonary segments consistently diagnosed by pulmonary perfusion imaging and pulmonary angiography in 378 pulmonary segments (87.5%, Kappa = 0.74, P < 0.0001).</p><p><b>CONCLUSIONS</b>Pulmonary perfusion imaging is highly accorded with pulmonary angiography in detecting the pulmonary involvement in Takayasu's arteritis. Therefore, pulmonary perfusion imaging could be used as a non-invasive screening test for the pulmonary artery involvement in Takayasu's arteritis.</p>

Angina estável: como escolher entre as diferentes formas de investigação? / Stable angina: how to choose between the different diagnosis methods?

A manifestação mais comum da doença isquêmica do coração é a angina estável, que apresenta amplo espectro clínico, de acordo com a idade, a gravidade dos sintomas e a função ventricular esquerda. Atualmente grande variedade de métodos diagnósticos está disponível para avaliação desses pacientes. Os objetivos do presente capítulo são: discutir como optar entre os diferentes recursos disponíveis na prática diária, quais são os critérios utilizados para a escolha entre os diferentes métodos e qual é a seqüência que se deve obedecer buscando racionalizar o atendimento desses pacientes com suspeita de doença arterial coronária.

Malformaçöes arteriovenosas pulmonares - aspectos radiológicos / Pulmonary arteriovenous malformations - radiological aspects

Resumo: neste trabalho os autores apresentam os aspectos radiológicos de tórax, tomografias lineares e computadorizadas e arteriografias de cinco casos de malformaçöes arteriovenosas, assim como discutem a importância de cada método de imagem no diagnóstico dessas lesöes . Dos cinco pacientes estudados, quatro eram adultos e um criança; três eram do sexo feminino e 2 do sexo masculino, com idade variando entra 7 e 53 anos. Em todos os casos eles foram realizadas radiografias de tórax e tomografias lineares. A investigaçäo diagnóstica foi complementada pela realizaçäo de tomografia computadorizada em dois casos e de angiografia em quatro casos. As tomografias lineares foram diagnósticas em todos os casos, sendo ressaltada a importância da sua realizaçäo em centros de recursos mais avançados.

Optimal two-dimensional echocardiographic method for left ventricular ejection fraction calculation in patients with and without regional wall motion abnormalities: a comparison with radionuclide angiography

Serial evaluation of left ventricular [LV] ejection fraction [EF] is important for the management and follow up of cardiac patients. Our aim was to compare LVEF calculated from three different two-dimensional echocardiographic [2DE] methods with multigated radionuclide angiography [RNA], in patients with normal and abnormal shaped ventricles. Therefore, 25 consecutive patients [18 men] referred for RNA underwent precordal 2DE. LVEF was calculated by, [a] Simpson's rule [2DS] through manual endocardial tracing of LV at apical 4-chamber view, [b] single plane ellipse [SPE] using apical 4-chamber view and [c] biplane ellipse [BPE] using apical 4-chamber and apical 2-chamber views. Patients included 2 groups, [A] 17 patients with LV segmental wall motion abnormalities [SWMA], [B] 8 patents with normal LV wall motion [N]. The mean +/- SD of LVEF was 38.9 +/- 6.8, 38.1 +/- 7.1, 37.2 +/- 8.3 and 38.1 +/- 7.8 for RNA. 2DS, SPE and BPE, respectively. For the 25 patients good correlation and non significant differences between LVEF calculated by 2DS, SPE and BPE and values obtained by RNA were found [r=0,94, r=84 and r=0.89] [p=0.7. P=0.4 and p=0.5] respectively. However, 2DS had closer limits of agreement with RNA [-6.4, +7.1] than between both SPE and BPE and RNA [-9.3, +9.7] and [-8.3, +9.1], respectively. There were closer limits of agreements between 2DS and RNA for LVEF calculation in A and B patients subgroup [[-4.5, +5.1] and [-7.8. +8.3]] than that between SPE and RNA [[-8.1, +10.7] and [-9.1, +11.3]], as well as between BPE and RNA [[-6.2, +7.7] and [-8.1, +9.3]], respectively. In patients subgroups, 2DS had better correlation and closer limits of agreement with RNA than SPE and BPE with RNA for LVEF calculation, particularly evident in patients with SWMA [group A]. Finally, it was concluded that no significant difference existed between 2DS. SPE and BPE with RNA for LVEF calculation. 2DS had better correlation and closer limits of agreement than SPE and BPE with RNA for LVEF calculation particularly evident in patients with SWMA. Therefore the use of 2DS for serial accurate LVEF calculation in cardiac patients is recommended

Rapid diagnosis of the thyroid function by the radio angiography

The thyroid function was evaluated by the radio angiography. This method involved the use of intravenous Tc- 99 m gamma camera with the image display of 1 picture/ second or 2 pictures/second has been setup before. The picture and the duration of the first radioactive transfer into the carotid and duration of radioactive transfer from carotid to the thyroid were monitored to evaluate the thyroid function.

Detection of Acute Gastrointestinal Bleeding by Intra-arterial Scintigraphy: An Experimental Study andPreliminary Clinical Experience

PURPOSE: The purpose of this animal and clinical study was to compare intra-arterial(IA) scintigraphy withangiography in the localization of gastrointestinal (GI) bleeding. MATERIALS AND METHODS: After sedation withintramuscularly administered ketamine, lower GI bleeding was induced in ten rabbits. Using inguinal cut-down, anarterial femoral 3F catheter was placed in the proximal mesenteric artery. Following abdominal incision to exposethe bowel, lower GI bleeding was caused by incising the antimesenteric border of the small bowel wall. Initialangiography was performed, and this was followed by Tc-99m pertechnetate IA scintigarphy. Tc-99m RBC IAscintigraphy involved two patients who had undergone selective mesenteric arterial catheterization for theevaluation of acute lower GI bleeding. RESULTS: Ten rabbits, bleeding at a mean rate of 0.7g/min, were studied.IA scintigraphy was superior to angiography in four cases and equal in six. The sensitivity of angiography was40%(4/10), and IA scintigraphy 80%(8/10). In one patient, Tc-99m RBC was administered directly into the superiormesenteric artery and ulcer bleeding in the transverse colon was identified. Prior to conventional angiography,the bleeding had been occult. In a second patient, in whom angiography had revealed a hypervascular mass,selective injection of Tc-99m RBC into the superior mesenteric artery revealed tumor(leiomyoma) bleeding in thejejunum. CONCLUSION: Selective IA scintigraphy was valuable for detecting intestinal bleeding, occult duringconventional studies and may be useful for detecting acute bleeding at the time of negative angiography.

Giant Cavernous Hemangioma of the Esophagus: One Case Report / 대한흉부외과학회지

Esophageal hemangioma is an extremely rare benign tumor that causes dysphagia and massive upper gastrointestinal bleeding. Although certain abnormalities seen on a barium swallow esophagography or at endoscopy may suggest an esophageal hemangioma, a contrast CT and radionuclide angiography using a blood-pool radiopharmaceutical can characterize the intense vascularity of the tumor. We experienced the ase of a 7x7x3.5 cm in size giant cavernous hemangioma of the lower 1/3 of esophagus in a 40 year old man. A mural cavernous hemangioma was diagnosed with a barium swallowed esophagogaphy, endoscopy, and a contrast CT. It was treated successfully by transthoracic esophagectomy including the tumor and esophagogastrostomy.

Correlation of Left Ventricular Ejection Fraction Measured by Echocardiography and Contrast Cineangiography / 대한내과학회지

OBJECTIVE: Left ventricular ejection fraction is an important clinical variable with respect to diagnosis, treatment and prognosis in various cardiovascular diseases. Measurement of left ventricular ejection fraction is performed by three commonly used methods, M-mode and two dimensional echocardiography, radionuclide angiography and contrast cineangiography. We compared echocardiographic and contrast cinean-giographic ejection fraction by correlation coefficiency to determine the accuracy of echocardiography determined ejection fraction at our institution and to assess the agreement of left ventricular ejection fraction between two methods. METHODS: We measured left ventricular ejection fraction by M-mode, two-dimensional echocardiography and contrast cineangiography in 144 cases of normal and cardiovascular heart disease patients from September 1993 to April 1995 in the cardiology division of Ewha Womans University hospital. The echocar-diography and contraat cineangiography were performed within 7 days of each other. RESULTS: M-mode echocardiographic ejection fraction correlated with contrast cineangiographic ejection fraction (r=0.7841). M-mode echocardiographic ejection fraction corrected with two-dimensional echocardiography in the presence of regional wall motion abnormality correlated with contrast cineangiographic ejection fraction (r=0.8149). By agreement analysis, the difference of mean of ejection fraction measured by M-mode echocardiography and contrast cineangiography was within 95% confidence limits. The mean was 4.08% and the standard deviation was 8.29%. The difference of mean of ejection fraction corrected by two-dimensional echocardiography and contrast cineangiography was within 95% confidence limits. The mean was -3.19% and the standard deviation was 7.74% CONCLUSION: The values of left ventricular ejection fraction by echocardiography showed good correlation with those of contrast cineangiographic ejection fraction, Therefore, echocardiography would be a useful tool as contrast cineangiography in evaluating the left ventricular function.

Cambios hemodinámicos en la función sistólica, diastólica y la circulación periférica inducidas por amlodipina en pacientes con hipertensión arterial esencial asociada con disfunción ventricular izquierda / Hemodynamic changes in systolic and diastolic function and in the peripheral circulation induced by amlodipine in patients with essencial hypertension with left ventricular dysfunction

La hipertensión arterial afecta la función y la estructura cardiovascular, con hipertrofia y disfunción ventricular frecuentes, en especial en pacientes con cardiopatía isquémica asociada. Evaluamos 20 pacientes entre 40 y 70 años de edad, con diagnóstico de hipertensión esencial (presión arterial diastólica entre 95 y 115 mmHg) asociada a disfunción ventricular (fracción de eyección ó 45 por ciento). Se estudiaron por angiografía radioisotópica la función sistólica, la función diastólica y la circulación periférica en las siguientes etapas: A) al final del período lavado-placebo (pretratamiento); B) en fase aguda, a las 6 horas de amlodipina (10 mg) por vía oral; C) en fase crónica, al final de 8 semanas de igual tratamiento con monodosis. El tratamiento en fase aguda y crónica mostró una disminución significativa de la presión arterial sistólica, diastólica y de la resistencia periférica total (en un 15 por ciento, 14 por ciento y 20 por ciento respectivamente). El pico de llenado del ventrículo izquierdo basal fue 1,9 ñ 0,4 (VFD/S), mejorando un 21 por ciento en el tratamiento crónico en reposo y 17 por ciento durante el ejercicio ergométrico, lo que evidenció una mejoría de la función diastólica del ventrículo izquierdo (p<0,01). El volumen de fin de sístole o residual, aumentado como expresión de la falla de bomba, disminuyó en 15 y 19 por ciento en reposo y esfuerzo. En el pretratamiento los parámetros hemodinámicos muestran disfunción ventricular sistólica y diastólica del ventrículo izquierdo con compromiso del ventrículo derecho, tanto en reposo como en esfuerzo, con disminución de la reserva cardíaca. El efecto vasodilatador de la amlodipina, con disminución de la poscarga, produjo efectos hemodinámicos favorables, tanto en el control de la hipertensión arterial como en la mejoría de la disfunción biventricular asociada

Neurorretinite idiopática estrelada de Leber / Leber idiopathic stellate neuroretinitis

Os autores apresentam um caso de paciente jovem, do sexo feminino, com a neurorretinite idiopática estrelada de Leber. A paciente apresentou na angiografia fluoresceínica da retina staining do corante na papila e um pequeno defeito hipetfluorescente do epitélio pigmentar da retina

Valor diagnóstico da ecocardiografia com dipiridamol em doença coronária e avaliação de sua potencialidade prognóstica frente à ergometria, cintigrafia de perfusão miocárdica planar com dipiridamol e Tc99m-MIBI e cinecoronariografia / Diagnostic value of dipyridamole echocardiography in coronary artery disease and comparison of its prognostic accuracy with that of exercise stress test, planar dipyridamole Tc99m-MIBI myocardial perfusion scintigraphy and coronary rteriography

PURPOSE--To assess in a consecutive series of patients, the diagnostic accuracy of dipyridamole echocardiography and to compare its prognostic power with that from other tests. METHODS--Seventy eight patients prospectively were underwent to dipyridamole echocardiography (DET) and coronary arteriography for diagnostic and post-infarction investigation. The majority was underwent to treadmill stress test and Tc99MIBI-dipyridamole planar myocardial scintigraphy. Eleven variables with possible prognostic importance were analyzed in a stepwise model to identify independent predictors of events. RESULTS--Sensitivity and specificity for the presence of coronary artery disease (in non-M patients) and multivessel disease (in post-MI patients) were, respectively, 44, 91, 53 and 88. Mean follow-up was 21 +/- 9 months, during which there were four deaths, four unstable angina episodes, four nonfatal myocardial infarctions and eight revascularization procedures. By multivariate analysis, the only independent predictor of events was the change in wall motion score index from rest to peak stress. CONCLUSION--DET is a valuable alternative to exercise stress test and myocardial perfusion scintigraphy. Semiquantitative estimation of ischemic area during pharmacological stress is an important prognostic marker.