Subject(s)
Affective Symptoms/drug therapy , Crying , Dextromethorphan/pharmacology , Excitatory Amino Acid Antagonists/pharmacology , Fluoxetine/pharmacology , Frontotemporal Dementia/complications , Selective Serotonin Reuptake Inhibitors/pharmacology , Affective Symptoms/etiology , Dextromethorphan/administration & dosage , Excitatory Amino Acid Antagonists/administration & dosage , Fluoxetine/administration & dosage , Humans , Male , Middle Aged , Selective Serotonin Reuptake Inhibitors/administration & dosageABSTRACT
STUDY OBJECTIVE: To compare preoperative transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) with intraoperative ultrasound (IOUS) in surgeons first learning to use this technique. DESIGN: A prospective study of IOUS accuracy for mapping the size and location of myomas compared with TVUS or MRI (Canadian Task Force classification II-2). SETTING: Five University of California academic centers (Davis, Irvine, Los Angeles, San Diego, and San Francisco). PATIENTS: Twenty-six premenopausal women seeking uterine-sparing surgical treatment of myomas. Eligible participants could have no more than 6 myomas ≥2 cm and <10 cm and a uterine size no larger than 16 weeks by pelvic examination. INTERVENTIONS: Measurement of myomas by IOUS followed by radiofrequency ablation (RFA) of fibroids. MEASUREMENTS AND MAIN RESULTS: Eligible participants had to have imaging with TVUS or MRI within the last year to assess myoma characteristics. During the RFA operation, surgeons who had undergone a 1-day training on RFA and IOUS measured all myomas visualized with IOUS. Surgeons measured more myomas than were reported on MRI (12 on MRI and 16 on IOUS) or TVUS (41 on TVUS and 62 on IOUS) in all positions (anterior, posterior, lateral, and fundal). In particular, they identified more myomas <2 cm (4 on MRI, 9 on IOUS, 1 on TVUS, and 19 on IOUS). They located 2.3 times as many myomas in the anterior position as TVUS. For the myomas ≥2 cm identified by IOUS and MRI or IOUS and TVUS, there was no statistically significant difference in the mean myoma number or the mean myoma diameter measurements. CONCLUSION: Surgeons first learning to use IOUS detect the same number of myomas ≥2 cm as identified by TVUS and MRI and find a greater number of myomas <2 cm on IOUS compared with radiologist-reported TVUS.
Subject(s)
Gynecologic Surgical Procedures/education , Intraoperative Care/methods , Leiomyoma , Preoperative Care/methods , Ultrasonography/methods , Uterine Neoplasms , Abdomen/diagnostic imaging , Abdomen/pathology , Adult , Catheter Ablation/methods , Clinical Competence , Female , Gynecologic Surgical Procedures/methods , Gynecology/education , Humans , Intraoperative Care/education , Intraoperative Period , Leiomyoma/diagnosis , Leiomyoma/pathology , Leiomyoma/surgery , Magnetic Resonance Imaging/methods , Middle Aged , Monitoring, Physiologic/methods , Postoperative Complications/etiology , Premenopause , Preoperative Care/education , Surgeons , Tumor Burden , Uterine Neoplasms/diagnosis , Uterine Neoplasms/pathology , Uterine Neoplasms/surgery , Vagina/diagnostic imaging , Vagina/pathologyABSTRACT
OBJECTIVE: To identify electrocardiographic findings, especially deep Q and S waves in lead III, that differentiate athletes from patients with hypertrophic cardiomyopathy (HCM). METHODS: Digital ECGs of athletes and patients with HCM followed at the Stanford Center for Inherited Cardiovascular Disease were studied retrospectively. All patients with HCM had an echocardiogram performed. A multivariable logistic regression model was used to calculate ORs for various demographic and ECG characteristics. Linear regression was used to correlate ECG characteristics with echocardiogram findings. RESULTS: We studied 1124 athletes and 240 patients with HCM. The average Q+S wave amplitude in lead III (IIIQ+S) was significantly higher in patients with HCM compared with athletes (0.71±0.69 mV vs 0.21±0.17 mV, p<0.001). In patients with HCM, IIIQ+S directly correlated with interventricular septal (IVS) thickness on echocardiography (ρ=0.45, p<0.001). In a multivariable analysis adjusted for demographic and ECG characteristics, higher IIIQ+S values remained independently associated with HCM compared with athletes (OR=4.2 per 0.5 mV, p<0.001). In subgroup analyses of young patients, African-American subjects and subjects without left axis deviation (LAD), IIIQ+S remained associated with HCM. The addition of IIIQ+S>1.0 mV as an abnormal finding to the International Criteria for athletic ECG interpretation improved sensitivity from 64.2% to 70.4%, with a minimal decrease in specificity. CONCLUSION: Large Q and S waves in lead III distinguished athletes from patients with HCM, independent of axis and well-known ECG markers associated with HCM. The correlation between IVS thickness in patients with HCM and IIIQ+S suggests a partial explanation for this association.
Subject(s)
Athletes , Cardiomegaly, Exercise-Induced , Cardiomyopathy, Hypertrophic/diagnosis , Electrocardiography , Heart Conduction System/physiopathology , Action Potentials , Adaptation, Physiological , Adolescent , Adult , Age Factors , California/epidemiology , Cardiomyopathy, Hypertrophic/ethnology , Cardiomyopathy, Hypertrophic/physiopathology , Diagnosis, Differential , Echocardiography , Female , Heart Rate , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Young AdultSubject(s)
Athletes , Cardiomyopathy, Hypertrophic/physiopathology , Electrocardiography , Electronic Data Processing/methods , Adult , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: There is controversy regarding Q wave criteria for assessing risk for hypertrophic cardiomyopathy (HCM) in young athletes. METHODS: The 12-lead ECGs from Preparticipation screening in healthy athletes and patients with HCM were studied retrospectively. All 12 leads were measured using the same automated ECG analysis program. RESULTS: There were a total of 225 HCM patients and 1124 athletes with 12-lead electrocardiograms available for analysis. Athletes were on average 20 years of age, 65% were male and 24% were African-American. Patients with HCM were on average 51 years of age, 56% were male and 5.8% were African-American. Q waves by either amplitude, duration or area criteria were more prevalent in males than females, in lateral leads than inferior and in HCM patients than athletes. The most striking difference in Q waves between the groups was in Limb lead I and in the females. Tall, skinny Q waves were rare in athletes and had the highest prevalence of only 3.7% in male HCM patients. CONCLUSION: Q waves are more common in males compared to females and in patients with HCM compared to athletes. Q waves of 30 ms or more in limb lead I appear to offer the greatest discriminatory value for separating patients with HCM from athletes.
