Doppler echocardiography in elderly patients with ejection systolic murmurs.

Thirty-nine elderly patients, mean age 77 years (range 65 to 96), with ejection systolic murmurs were studied to evaluate the functional significance of these murmurs. Subjects were evaluated clinically, by 2-D echocardiography, and by a full Doppler echocardiography study. Good quality Doppler signals were obtained in 35 subjects. Mitral regurgitation was found to be the only significant valvular lesion in 6 patients (17%). Doppler gradients in systole across the aortic valve were less than 30 mmHg in 28 subjects (80%) and were considered not significant. Gradients of greater than 30 mmHg representing significant aortic stenosis were found in 7 subjects (20%). The clinical sensitivity in detecting significant aortic stenosis was 44% and specificity was 81%. Doppler evidence of significant aortic stenosis was found in a substantial proportion of these elderly subjects. Neither clinical assessment nor 2-D echocardiography can be relied on to exclude this condition.

Vibration perception thresholds in 279 diabetic patients.

Generalised peripheral neuropathy is a well recognised complication of diabetes mellitus and early detection is important in order that morbidity can be reduced by interventional therapy at an early stage. Since nerve conduction studies are not a feasible option in a busy diabetic clinic, an alternative technique of detection, superior to clinical examination, is beneficial. In this study vibration perception thresholds were measured in 279 diabetic outpatients. Seventy-eight patients (28%) had abnormal results but only 35 (13%) had clinical evidence of neuropathy. While nerve conduction studies remain the most sensitive technique to detect nerve dysfunction, vibration perception threshold determination is a useful screening test to detect subclinical peripheral nerve dysfunction in a routine diabetic outpatient clinic.