Sitting maneuver to uncover latent left ventricular outflow tract obstruction in patients without hypertrophic cardiomyopathy.

BACKGROUND: Left ventricular outflow tract obstruction [LVOTO; pressure gradient (PG) ≥30 mmHg] is observed in some patients without hypertrophic cardiomyopathy (HCM), and it may develop especially in older patients without HCM (non-HCM). The aim of this study is to investigate if the Valsalva or an upright sitting maneuver can unveil latent LVOTO in patients with non-HCM. METHODS: A total of 33 non-HCM patients with a late peaking or dagger-shaped pulsed Doppler waveform of the LVOT and PG <30 mmHg were included. The Doppler flow velocity of the LVOT was measured at rest, after the Valsalva and a sitting maneuver. Peak PG of ≥30 mmHg after either maneuver was defined as latent LVOTO. The angle between the left ventricular septum and the aorta in the parasternal long-axis view and the apical three-chamber view was measured. RESULTS: Twenty (61 %) of the 33 patients (mean age 74 ±â€¯9 years) were diagnosed with latent LVOTO. Of these, five (25 %) patients were diagnosed after both the Valsalva and sitting maneuver, and 15 (75 %) were diagnosed only after the sitting maneuver. The latent LVOTO group had a significantly smaller angle than the no-LVOTO group between the ventricular septum and the aorta in the parasternal long axis views (107 ±â€¯8° vs. 117 ±â€¯8°, p < 0.01). CONCLUSION: The sitting maneuver is better than the Valsalva maneuver in unveiling latent LVOTO in older, non-HCM patients.

Validation of the Martin method to estimate low-density lipoprotein cholesterol concentrations in Japanese populations and a modified method for laboratory information system application.

OBJECTIVES: High concentrations of low-density lipoprotein cholesterol (LDL-C) are a risk factor for cardiovascular disease. We validated the efficacy of the Martin method is useful in the estimation of LDL-C concentrations was validated in Japanese populations and derived a modified Martin method for easy laboratory information system applications. METHODS: We created 3 subject groups, including 2664 health check-up participants registered with the Resource Center for Health Science, 29,806 clinical patients (A) in the Gifu University Hospital, and 113,716 clinical patients (B) in the Fujita Health University Hospital. Each method to estimate serum LDL-C concentrations (Friedewald formula, Martin method and modified Martin method) was validated by correlation analysis with serum LDL-C concentrations measured using a direct method. RESULTS: The correlation coefficients with the direct method in terms of the Friedewald formula, Martin method, and modified Martin method were 0.963, 0.972 and 0.970 in the health check-up participants; 0.946, 0.962 and 0.961 in clinical patients A; and 0.961, 0.979 and 0.978 in clinical patients B, respectively. Concordance ratios with using the direct method in the Friedewald formula, Martin method and modified Martin method were 82.8%, 85.5% and 85.3% in the health check-up participants; 76.4%, 80.5% and 80.2% in clinical patients A; and 76.1%, 82.6% and 82.6% in clinical patients B, respectively. CONCLUSION: Our results show that the Martin and modified Martin methods display good performance in terms of the estimation of LDL-C concentrations among triglyceride concentrations of a wide range, and they may thus be useful for estimating LDL-C concentrations.

Sonographic Detection of Subcutaneous Foreign Bodies in 3 Cases.

Subcutaneous masses caused by foreign bodies are frequently encountered in daily practice. Although the majority of foreign bodies such as metals can be detected by radiography, substances such as vegetative materials or wood are difficult to detect. To our knowledge, only a few studies have described the sonographic characteristics of foreign bodies. Herein, we report 3 cases where we studied the sonographic characteristics of the foreign bodies in the dermis and subcutaneous tissue. Our results revealed the following 3 foreign bodies: (1) glass, (2) vegetative material, and (3) a pencil core. Thus, sonographic examination is useful for the detection of foreign bodies.

[Effects of Aging and Sex Differences on the Median Nerve: Relationship Between Nerve Conduction Study and Ultrasonographic Cross-Sectional Nerve Area].

OBJECTIVE: The aim of this study was to evaluate the relationship between nerve conduction and sonographic measurements of the median nerve, and to investigate the effects of aging and sex on nerve structure. METHODS: Measurements from both hands of 82 healthy volunteers were included in this study (45 men and 37 women, 38.9 ?17.7 years). The cross-sectional area(CSA) of the median nerve was evaluated at the carpal tunnel inlet (MA) and at the midpoint of the forearm (MB). RESULTS: The CSA of the median nerve at the MA was significantly correlated with age (r=0.501, P< 0.001), and distal motor latency (r=0.269, P<0.001). Although this study demonstrated the effects of the sex dif- ferences and aging on the CSA of the median nerve at MA, there was no significant effect at the MB. CONCLUSIONS: Our study suggests that aging could affect median nerve structure, especially at the anatomical entrapment point. [Original].

Sonographic Findings of Subcutaneous Sarcoidosis in 3 Cases.

Subcutaneous sarcoidosis occurs infrequently among cases of cutaneous sarcoidosis. To our knowledge, few studies have described the sonographic characteristics of subcutaneous sarcoidosis. Here we report the sonographic characteristics of 3 cases of this condition. Our results revealed 4 features: (1) an irregular hypoechoic appearance, (2) heterogeneous echogenicity, (3) perilesional hyperechoic changes, and (4) abnormal Doppler signals. Sonography is a rapid, simple, and noninvasive procedure that is useful for initial evaluation of granulomatous lesions such as subcutaneous sarcoidosis.

[Evaluation of peripheral neuropathy in the patients with type 2 diabetes mellitus by laboratory examination: relationship between albuminuria and ankle-brachial index].

The aim of this study was to investigate the influence of peripheral neuropathy on laboratory examinations and to evaluate the relationship between nerve conduction velocity (NCV), albuminuria, and ankle-brachial index (ABI) results in patients with type 2 diabetes mellitus (DM). One hundred twenty-six patients with type 2 DM who had undertaken the nerve conduction study for an initial screening test of diabetic complications were included in our study. We divided patients to 4 groups according to the stage of microalbuminuria and ABI results. Two factors negative (2FN) group (n = 75), urinary albumin creatinine ratio (A/C) < 30 mg/gCr and ABI > or = 1.0; A/C group (n = 25), A/C > or = 30 mg/gCr and ABI > or = 1.0; ABI group (n = 14), A/C < 30 mg/gCr and ABI < 1.0; two factors positive (2FP) group (n = 12), A/C > or = 30 mg/gCr and ABI < 1.0. Neuropathy, retinopathy, hypertension, macroangiopathy, and hyperlipidemia were seen in 57.9%, 38.1%, 59.5%, 22.2%, and 56.3%, respectively. Lower leg NCV in 2FP group was significantly lower than other groups. Our study indicated that impaired diabetic peripheral neuropathy may be detected by combining decreased ABI with increased A/C results.

[Diagnostic ability of ultrasonography for the rotator cuff tear: comparison with ultrasonography and MRI findings].

Ultrasonography (US) is a non-invasive method which can assess not only solid tissue organs but also soft tissues such as tendons and nerves. However, it has not been fully understood that US is a useful tool for the depiction of periarticular structure. We compared the diagnostic accuracies between US and magnetic resonance imaging (MRI) in the patients with rotator cuff tear (RCT). Seventy patients, who underwent arthroscopic surgery, preoperative US and MRI examinations at Gifu University Hospital from January 2010 to April 2013 (49 male, 21 female, mean age 59.7 +/- 15.9) were included in this study. The diagnostic accuracy, sensitivity and specificity of US and MRI were 94.3% and 94.3%, 95.8% and 97.9%, 90.9% and 84.6%, respectively, when the intraoperative finding was regarded as a gold standard. These results suggest that US is useful for the diagnosis of RCT as equal as MRI.