ABSTRACT
BACKGROUND: For a majority of patients undergoing anaesthesia for general surgery, mean arterial pressure (MAP) is only measured intermittently by arm cuff oscillometry (MAPiNIAP). In contrast, the Nexfin(®) device provides continuous non-invasive measurement of MAP (MAPcNIAP) using a finger cuff. We explored the agreement of MAPcNIAP and MAPiNIAP with the gold standard: continuous invasive MAP measurement by placement of a radial artery catheter (MAPinvasive). METHODS: In a total of 120 patients undergoing elective general surgery and clinically requiring MAPinvasive measurement, MAPiNIAP and MAPcNIAP were measured in a 30 min time period at an arbitrary moment during surgery with stable haemodynamics. MAPiNIAP was measured every 5 min. RESULTS: Data from 112 patients were analysed. Compared with MAPinvasive, modified Bland-Altman analysis revealed a bias (sd) of 2 (9) mm Hg for MAPcNIAP and -2 (12) mm Hg for MAPiNIAP. Percentage errors for MAPcNIAP and MAPiNIAP were 22% and 32%, respectively. CONCLUSIONS: In a haemodynamically stable phase in patients undergoing general anaesthesia, the agreement with invasive MAP of continuous non-invasive measurement using a finger cuff was not inferior to the agreement of intermittent arm cuff oscillometry. Continuous measurements using a finger cuff can interchangeably be used as an alternative for intermittent arm cuff oscillometry in haemodynamically stable patients, with the advantage of beat-to-beat haemodynamic monitoring. CLINICAL TRIAL REGISTRATION: NCT 01362335 (clinicaltrials.gov).
Subject(s)
Anesthesia, General/methods , Blood Pressure Monitors , Monitoring, Intraoperative/methods , Adult , Aged , Aged, 80 and over , Blood Pressure Determination/instrumentation , Blood Pressure Determination/methods , Fingers/blood supply , Hemodynamics/physiology , Humans , Middle Aged , Monitoring, Intraoperative/instrumentation , Oscillometry/methods , Radial Artery/physiology , Reproducibility of Results , Young AdultABSTRACT
HISTORY AND ADMISSION FINDINGS: A 28-year-old man without a significant past medical history presented to our emergency department with severe chest pain and dyspnoa. Vital signs and the rest of the physical examination were unremarkable. INVESTIGATIONS: The electrocardiogram showed T-wave inversions and the cardiac enzymes were elevated. TREATMENT AND COURSE: Angiocardiography showed an aneurysm of the right coronary artery and a thrombus formation in its distal part. Intracoronary thrombolytic therapy was attempted an oral anticoagulation was started. Further investigations did not find the cause of the aneurysmatic RCA. The patient had no further episode of chest pain. CONCLUSION: Acute coronary syndrome is a rare finding in patients under the age of 30 years. Coronary aneurysms with associated thrombus can be the cause of it.
Subject(s)
Chest Pain/etiology , Coronary Aneurysm/diagnosis , Coronary Thrombosis/diagnosis , Dyspnea/etiology , Myocardial Infarction/diagnosis , Adult , Angiocardiography , Coronary Aneurysm/drug therapy , Coronary Angiography , Coronary Thrombosis/drug therapy , Diagnosis, Differential , Electrocardiography , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Myocardial Infarction/drug therapy , Signal Processing, Computer-Assisted , Spiral Cone-Beam Computed Tomography , Thrombolytic TherapyABSTRACT
The beneficial effects of cardiac resynchronization therapy (CRT) on morbidity and mortality in advanced heart failure patients have been extensively demonstrated. However, previous single- and multicenter studies demonstrated that approximately 30-40% of CRT patients do not show significant clinical improvement or LV reverse remodeling despite fulfilling current inclusion criteria. In search of novel indices that may help to improve the selection of responders to CRT, non-invasive multimodality imaging has provided further insight into the mechanisms underlying CRT response. LV dyssynchrony, extent and location of myocardial scar and LV lead position have shown to be independent determinants of CRT response. An integrated evaluation of these three pathophysiological mechanisms may provide a more accurate selection of heart failure patients who will benefit from CRT and may maximize the cost-effectiveness of this therapy. The present review article provides a critical appraisal of the role of multimodality imaging in the selection of heart failure patients who are candidates for CRT with special focus on the assessment of LV mechanical dyssynchrony, LV myocardial scar tissue extent and LV lead position.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Cardiac Resynchronization Therapy/methods , Heart Failure/complications , Arrhythmias, Cardiac/diagnostic imaging , Arrhythmias, Cardiac/etiology , Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography , Cardiomyopathies/diagnosis , Cicatrix/diagnosis , Humans , UltrasonographyABSTRACT
Three women aged 45, 37 and 56 underwent MRI imaging of the breast for: breast-cancer screening, pre-operative staging and for monitoring the response on chemotherapy. Breast cancer at an early stage for which breast-saving surgery was possible was discovered in the first woman. In the second woman, the tumour was larger than was seen with mammography or ultrasound and other tumour sites were seen, leading to a more extensive treatment plan. In the year thereafter no metastases were found. In the third woman the response to chemotherapy was monitored. 8 months after therapy she appeared to have skeletal metastases. Mammography and ultrasound are the most commonly used modalities in breast imaging. Over the past few years MRI has been making an increasingly large contribution to the screening, staging and follow-up of patients with breast cancer. MRI can be an important supplementary study but its exact role still needs to be defined.
