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Background: Patients who develop postoperative delirium (POD) have several clinical complications, such as increased morbidity, increased hospital stays, higher hospital costs, cognitive and functional impairment, and higher mortality. POD is a clinical condition preventable by standard non-pharmacological measures An intensive Occupational Therapy (OT) intervention has been shown to be highly effective in preventing delirium in critically ill medical patients, but it is unknown the effect in surgical patients. Thus, we designed a prospective clinical study with the aim to determine whether patients undergoing intervention by the OT team have a lower incidence of POD compared to the group treated only with standard measures. Methods: A multicenter, single-blind, randomized clinical trial was conducted between October 2018 and April 2021, in Santiago of Chile, at a university hospital and at a public hospital. Patients older than 75 years undergoing elective major surgery were eligible for the trial inclusion. Patients with cognitive impairment, severe communication disorder and cultural language limitation, delirium at admission or before surgery, and enrolled in another study were excluded. The intervention consisted of OT therapy twice a day plus standard internationally recommended non-pharmacological prevention intervention during 5 days after surgery. Our primary outcome was development of delirium and postoperative subsyndromal delirium. Results: In total 160 patients were studied. In the interventional group, treated with an intensive prevention by OT, nine patients (12.9%) developed delirium after surgery and in the control group four patients (5.5%) [p = 0.125, RR 2.34 CI 95 (0.75-7.27)]. Whereas subsyndromal POD was present in 38 patients in the control group (52.1%) and in 34 (48.6%) in the intervention group [p = 0.4, RR 0.93 CI95 (0.67-1.29)]. A post hoc analysis determined that the patient's comorbidity and cognitive status prior to hospitalization were the main risk factors to develop delirium after surgery. Discussion: Patients undergoing intervention by the OT team did not have a lower incidence of POD compared to the group treated only with standard non-pharmacological measures in adults older than 75 years who went for major surgery. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03704090.
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The goal of this study is to determine if the annual pollen integral (APIn) for the top tree allergens in the City of Albuquerque is correlated with meteorological variables. This analysis would be the first of its kind for this area. We used 17 consecutive years from 2004 to 2020 and data collected by the city of Albuquerque using a Spore Trap (Burkard) volumetric air sampler in a location designed to represent a typical desert environment. The pollen studied include Juniper, Elm, Ash, Cottonwood, and Mulberry. We found a negative linear correlation with early summer temperatures of the previous year and APIn for Elm, Cottonwood, and Mulberry, and early fall temperatures for Juniper. Linear regression models developed for Elm, Cottonwood, and Mulberry used the monthly mean maximum temperature for the month of June of the prior year as the independent variable to yield a R squared statistic (R 2) of 0.88, 0.91 and 0.78, respectively. For Juniper, the average monthly mean minimum temperature for the previous September and October served as the independent variable and yielded the R 2 value of 0.80. We also observed a positive trend for the annual maximum temperature over time and a negative trend for the total APIn. Summers in New Mexico are hot and dry, and they may be getting hotter and drier because of climate change. Our analysis predicts that climate change in this area may lead to reduced allergies if temperatures continue to increase and if precipitation patterns remain the same.
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Negative allosteric modulation (NAM) of metabotropic glutamate receptor subtype 5 (mGlu5) represents a therapeutic strategy for the treatment of childhood developmental disorders, such as fragile X syndrome and autism. VU0409106 emerged as a lead compound within a biaryl ether series, displaying potent and selective inhibition of mGlu5. Despite its high clearance and short half-life, VU0409106 demonstrated efficacy in rodent models of anxiety after extravascular administration. However, lack of a consistent correlation in rat between in vitro hepatic clearance and in vivo plasma clearance for the biaryl ether series prompted an investigation into the biotransformation of VU0409106 using hepatic subcellular fractions. An in vitro appraisal in rat, monkey, and human liver S9 fractions indicated that the principal pathway was NADPH-independent oxidation to metabolite M1 (+16 Da). Both raloxifene (aldehyde oxidase inhibitor) and allopurinol (xanthine oxidase inhibitor) attenuated the formation of M1, thus implicating the contribution of both molybdenum hydroxylases in the biotransformation of VU0409106. The use of ¹8O-labeled water in the S9 experiments confirmed the hydroxylase mechanism proposed, because ¹8O was incorporated into M1 (+18 Da) as well as in a secondary metabolite (M2; +36 Da), the formation of which was exclusively xanthine oxidase-mediated. This unusual dual and sequential hydroxylase metabolism was confirmed in liver S9 and hepatocytes of multiple species and correlated with in vivo data because M1 and M2 were the principal metabolites detected in rats administered VU0409106. An in vitro-in vivo correlation of predicted hepatic and plasma clearance was subsequently established for VU0409106 in rats and nonhuman primates.
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Aldehído Oxidasa/metabolismo , Benzamidas/farmacocinética , Antagonistas de Aminoácidos Excitadores/farmacocinética , Hígado/enzimología , Receptores de Glutamato Metabotrópico/antagonistas & inhibidores , Tiazoles/farmacocinética , Xantina Oxidasa/metabolismo , Aldehído Oxidasa/antagonistas & inhibidores , Alopurinol/farmacología , Animales , Benzamidas/administración & dosificación , Benzamidas/sangre , Benzamidas/química , Biotransformación , Cromatografía Liquida , Inhibidores Enzimáticos/farmacología , Antagonistas de Aminoácidos Excitadores/administración & dosificación , Antagonistas de Aminoácidos Excitadores/sangre , Antagonistas de Aminoácidos Excitadores/química , Hepatocitos/enzimología , Humanos , Hidroxilación , Inyecciones Intravenosas , Hígado/efectos de los fármacos , Macaca fascicularis , Espectroscopía de Resonancia Magnética , Masculino , Tasa de Depuración Metabólica , Microsomas Hepáticos/enzimología , Modelos Biológicos , Estructura Molecular , Isótopos de Oxígeno , Clorhidrato de Raloxifeno/farmacología , Ratas , Ratas Sprague-Dawley , Receptor del Glutamato Metabotropico 5 , Especificidad de la Especie , Espectrometría de Masas en Tándem , Tiazoles/administración & dosificación , Tiazoles/sangre , Tiazoles/química , Xantina Oxidasa/antagonistas & inhibidoresRESUMEN
BACKGROUND: Docetaxel is the mainline treatment approved by the FDA for castration-resistant prostate cancer (CRPC) yet its administration only increases median survival by 2-4 months. Docetaxel is metabolized in the liver by hepatic CYP3A4 activity. Piperine, a major plant alkaloid/amide, has been shown to inhibit the CYP3A4 enzymatic activity in a cell-free system. Thus, we investigated whether the co-administration of piperine and docetaxel could increase docetaxel's pharmacokinetic activity in vitro and in vivo. METHODS: Liver CYP3A4 enzymatic activity was measured by fluorescence. In vivo docetaxel pharmacokinetic activity was analyzed by liquid chromatography. An in vivo xenograft model of human CRPC was utilized to assess the anti-tumor effect of docetaxel when co-administered with piperine. RESULTS: Inhibition of hepatic CYP3A4 activity resulted in an increased area under the curve, half-life and maximum plasma concentration of docetaxel when compared to docetaxel alone administration. The synergistic administration of piperine and docetaxel significantly improved the anti-tumor efficacy of docetaxel in a xenograft model of human CRPC. CONCLUSIONS: Docetaxel is one of the most widely used cytotoxic chemotherapeutic agents and is currently the mainstay treatment for metastatic CRPC. Dietary constituents are important agents modifying drug metabolism and transport. In our studies, dietary consumption of piperine increases the therapeutic efficacy of docetaxel in a xenograft model without inducing more adverse effects on the treated mice.
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Alcaloides/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Benzodioxoles/farmacología , Inhibidores del Citocromo P-450 CYP3A , Piperidinas/farmacología , Alcamidas Poliinsaturadas/farmacología , Neoplasias de la Próstata/tratamiento farmacológico , Taxoides/farmacología , Alcaloides/administración & dosificación , Alcaloides/uso terapéutico , Animales , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Benzodioxoles/administración & dosificación , Benzodioxoles/uso terapéutico , Citocromo P-450 CYP3A/genética , Citocromo P-450 CYP3A/metabolismo , Docetaxel , Interacciones Farmacológicas , Masculino , Ratones , Piperidinas/administración & dosificación , Piperidinas/uso terapéutico , Alcamidas Poliinsaturadas/administración & dosificación , Alcamidas Poliinsaturadas/uso terapéutico , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/patología , Taxoides/administración & dosificación , Taxoides/farmacocinética , Taxoides/uso terapéutico , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
This study investigated whether near-infrared spectroscopy (NIRS) can be used to measure the processing of arithmetic problems in school children. Another aim was to assess whether distinct formats of such problems would lead to different neural processing. Two large samples of school children from different age groups were examined while calculating or reading arithmetic problems that were either presented in numeric or in word format. As expected, we found that, compared to reading, calculation resulted in greater average oxygenation in parietal and posterior frontal regions. Neither format nor age had a significant effect on brain oxygenation. We were able to demonstrate that NIRS measurements can readily be conducted with children and in school settings, which is an indication for the ecological validity of this measurement technique.
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Conducta/fisiología , Encéfalo/fisiología , Conceptos Matemáticos , Oxígeno/metabolismo , Lectura , Pensamiento/fisiología , Adolescente , Análisis de Varianza , Área Bajo la Curva , Niño , Femenino , Lateralidad Funcional , Humanos , Masculino , Espectroscopía Infrarroja Corta , Factores de TiempoAsunto(s)
Electroencefalografía/tendencias , Neurofisiología/instrumentación , Estimulación Magnética Transcraneal/tendencias , Artefactos , Mapeo Encefálico , Electroencefalografía/métodos , Fenómenos Electrofisiológicos , Humanos , Neurofisiología/métodos , Estimulación Magnética Transcraneal/métodosRESUMEN
Panic disorder still remains a pervasive, life quality impairing disorder requiring adequate treatment options. In this case report we present the data of a patient with panic disorder and comorbid depression who was treated with high-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the left prefrontal cortex over a course of 3 weeks. Measurements of the cerebral oxygenation with near-infrared spectroscopy (NIRS) during an emotional Stroop task before and after the rTMS treatment suggests that rTMS may modulate panic-related prefrontal brain dysfunctions in panic patients and that it may serve as a possible treatment option for anxiety disorders.
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Trastorno de Pánico/terapia , Estimulación Magnética Transcraneal/métodos , Inhibidores de Captación Adrenérgica/uso terapéutico , Antagonistas Adrenérgicos alfa/uso terapéutico , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Amitriptilina/uso terapéutico , Bisoprolol/uso terapéutico , Terapia Combinada , Quimioterapia Combinada , Moduladores del GABA/uso terapéutico , Humanos , Masculino , Trastorno de Pánico/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Tamsulosina , Temazepam/uso terapéuticoRESUMEN
Solving arithmetical problems is a core skill which is learned starting early in childhood and has been shown to involve a temporo-parietal network. In this study, we investigated hemodynamic concentration changes in oxygenated (O(2)Hb) and deoxygenated hemoglobin (HHb) within cortical brain regions by means of near-infrared spectroscopy (NIRS). Ten healthy subjects had to calculate or just read two-digit addition tasks that were either presented as numeric formulas or embedded in text. We found higher increases for O(2)Hb in parietal brain regions of both hemispheres for the calculation compared to the reading-only condition. Furthermore, these increases were more pronounced during text-embedded tasks than during numeric tasks. Corresponding decreases of HHb could also be detected. These first NIRS findings on that topic confirm that parietal regions are involved in the processing of arithmetic tasks while the amount of activation seems to depend on task modalities like difficulty or complexity.
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Hemoglobinas/metabolismo , Lóbulo Parietal/metabolismo , Espectroscopía Infrarroja Corta , Adulto , Corteza Cerebral/metabolismo , Femenino , Humanos , Masculino , Matemática , Pruebas Neuropsicológicas , Oxihemoglobinas/metabolismo , Lectura , Flujo Sanguíneo Regional/fisiología , Conducta Verbal/fisiología , Adulto JovenRESUMEN
Attention-deficit/hyperactivity disorder (ADHD) is more and more focused on, and the awareness of adult patients with ADHD increases. Deficits in inhibitory processes in cortical brain areas are discussed as possible causes for ADHD. An easy measurement of these processes is provided by transcranial magnetic stimulation (TMS). We applied single- and double-pulse TMS to the left motor cortex while an electromyogram (EMG) was taken at the abductor pollicis brevis muscle (APB) of the right hand. Intracortical inhibition (SICI) and facilitation (ICF) were measured in ten adult ADHD patients and ten healthy participants using inter-pulse intervals of 2 and 3ms (SICI), and 8 and 15ms (ICF). Furthermore, resting motor threshold (RMT) and latency of the motor evoked potential (MEP) following magnetic stimulation were compared. t-Tests were calculated for statistical analysis. TMS measurements resulted in impaired inhibition in ADHD patients, whereas there were no differences in facilitation, RMT and MEP-latency between groups. Large variability in the patient group was found. This study expands the findings of deficits in inhibition described in earlier studies in children to an adult population, which could be a hint for similar neurophysiological mechanisms underlying ADHD symptomatology in children and adults.
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Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Potenciales Evocados Motores/fisiología , Corteza Motora/fisiopatología , Inhibición Neural/fisiología , Adulto , Electromiografía , Femenino , Mano/inervación , Mano/fisiología , Humanos , Masculino , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Vías Nerviosas/fisiopatología , Tractos Piramidales/fisiopatología , Tiempo de Reacción/fisiología , Transmisión Sináptica/fisiología , Estimulación Magnética TranscranealRESUMEN
Patients suffering from dementia show altered functional brain activation patterns especially in prefrontal brain regions, as research suggests. The present study follows three aims: to replicate these findings, to investigate treatment effects when administering galantamine, and to put gender differences in focus. We compared 12 patients with dementia to 12 age- and gender-matched healthy subjects regarding changes in haemoglobin concentration in brain tissue while performing a verbal fluency task (VFT). Concentration changes of oxygenated (O(2)Hb) and deoxygenated (HHb) haemoglobin were measured by multi-channel near-infrared spectroscopy (NIRS), an easily applicable and non-invasive method of optical topography. In the patient group, measurement was repeated 4 and 8 weeks after starting treatment with galantamine. The results showed a reduced increase in O(2)Hb during task performance for patients compared to healthy controls. Furthermore, female subjects showed more pronounced activation in O(2)Hb as well as HHb compared to male subjects. Regarding treatment effects, no clear results could be obtained. In HHb, evidence for an entrainment effect was found. In the light of existing literature, the present study suggests an interaction of gender and age regarding brain activation patterns which should be aimed at in future investigations.
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Enfermedad de Alzheimer/tratamiento farmacológico , Nivel de Alerta/efectos de los fármacos , Encéfalo/efectos de los fármacos , Galantamina/uso terapéutico , Nootrópicos/uso terapéutico , Corteza Prefrontal/efectos de los fármacos , Anciano , Enfermedad de Alzheimer/fisiopatología , Nivel de Alerta/fisiología , Encéfalo/fisiopatología , Femenino , Hemoglobina A/metabolismo , Hemoglobinas/metabolismo , Humanos , Masculino , Recuerdo Mental/efectos de los fármacos , Pruebas Neuropsicológicas , Oxihemoglobinas/metabolismo , Corteza Prefrontal/fisiopatología , Valores de Referencia , Factores Sexuales , Espectroscopía Infrarroja Corta , Pensamiento/efectos de los fármacos , Conducta Verbal/efectos de los fármacos , VocabularioRESUMEN
PURPOSE: To determine if duplex ultrasonography (US) can help predict the degree of internal carotid arterial (ICA) stenosis. MATERIALS AND METHODS: ICA peak systolic velocity (PSV) and the ratio of the PSV in the ICA to that in the ipsilateral common carotid artery (VICA/VCCA) were compared with the degree of arteriographically measured stenosis. ICAs were arteriographically subgrouped at 10% incremental levels of stenosis and broader ranges. Mean PSV, VICA/VCCA, and SDs were calculated for each category. Histograms showing the numbers of stenotic ICAs in subgroups and for vessels with stenoses of greater than or equal to or less than 70% narrowing were constructed. The number of vessels correctly subgrouped with typical Doppler US thresholds was calculated. RESULTS: Mean PSV and VICA/VCCA increased with stenosis level (P < .01); SDs were wide. Histograms showed Doppler US values in the central groups across all disease levels. Histograms differentiating at least or less than 70% stenosis showed minimal overlap. PSV and VICA/VCCA helped classify, respectively, 185 and 181 of 204 vessels with stenoses of less than 50%, 15 and 21 of 46 vessels with stenoses of 50%-69%, and 73 and 67 of 84 vessels with stenoses of 70% or greater. When classifying stenoses as 69% or less or 70% or more, PSV and VICA/VCCA were correct in 90.6% and 90.3% of vessels. CONCLUSION: Doppler US is excellent for classifying stenoses as above or below a single degree of severity but does not function well in stenosis subclassification.
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Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Ultrasonografía Doppler en Color , Anciano , Angiografía , Velocidad del Flujo Sanguíneo/fisiología , Arteria Carótida Común/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Femenino , Análisis de Fourier , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sístole/fisiologíaRESUMEN
OBJECTIVE: A wide range of Doppler threshold values for carotid stenosis is found in the literature. We undertook this study to compare methods of derivation and to determine if an optimum strategy of threshold selection exists for a high-risk population. MATERIALS AND METHODS: From the sonograms of all patent internal carotid arteries, peak systolic velocity in the internal carotid artery (ICA(PSV)) and the ratio of peak systolic velocity in the internal carotid artery to that of the common carotid artery (ICA(PSV)/ CCA(PSV)) were compared with the percentage of angiographically determined stenosis. Receiver operating characteristic curves were generated for levels of stenosis > or =60% and > or =70%. Doppler thresholds were chosen on the basis of maximum accuracy and on the basis of > or =90% sensitivity and specificity. Patients were then segregated into symptomatic and asymptomatic cohorts, and the above process was repeated. An effectiveness analysis was also conducted using various Doppler thresholds. Thresholds derived using these three methods were compared and optimal values chosen. RESULTS. Of 333 carotid arteries that fit inclusion criteria, 132 were found in asymptomatic patients and 201 in symptomatic patients. Maximum accuracy, > or =90% sensitivity and specificity, and effectiveness analysis each produced different ranges of thresholds. We chose final thresholds that maintained patient outcome profiles. For asymptomatic patients at the > or =60% stenosis level, thresholds were ICA(PSV) = 200 cm/sec and ICA(PSV)/CCA(PSV) = 3.0. For symptomatic patients with stenosis > or =70%, thresholds were ICA(PSV) = 175 cm/sec and ICA(PSV)/CCA(PSV) = 2.5. CONCLUSION: Considerable latitude exists in the choice of carotid Doppler thresholds. We propose a rational strategy for threshold selection based on a combination of three commonly used methods. Our observations indicate that it appears advisable to consider symptomatic and asymptomatic patients separately and to apply appropriately derived thresholds.
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Estenosis Carotídea/diagnóstico por imagen , Ultrasonografía Doppler , Velocidad del Flujo Sanguíneo , Arteria Carótida Común/diagnóstico por imagen , Arteria Carótida Común/fisiopatología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/fisiopatología , Humanos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To investigate the general applicability and interobserver variability of ultrasonographic (US) features in differentiating benign from malignant solid breast masses. MATERIALS AND METHODS: One hundred sixty-two consecutive solid masses with a tissue diagnosis were reviewed. Three radiologists reviewed the masses without knowledge of clinical history or histologic examination results. RESULTS: US features that most reliably characterize masses as benign were a round or oval shape (67 of 71 [94%] were benign), circumscribed margins (95 of 104 [91%] were benign), and a width-to-anteroposterior (AP) dimension ratio greater than 1.4 (82 of 92 [89%] were benign). Features that characterize masses as malignant included irregular shape (19 of 31 [61%] were malignant), microlobulated (four of six [67%] were malignant) or spiculated (two of three [67%] were malignant) margins, and width-to-AP dimension ratio of 1.4 or less (28 of 70 [40%] were malignant). If the three most reliable criteria had been strictly applied by each radiologist, the overall cancer biopsy yield would have increased (from 23% to 39%) by 16%. When US images and mammograms were available, the increase in biopsy yield contributed by US was not statistically significant (2%, P = .73). However, in independent reviews, one to three reviewers interpreted four carcinomas as benign at US. CONCLUSION: The data confirm that certain US features can help differentiate benign from malignant masses. However, practice and interpreter variability should be further explored before these criteria are generally applied to defer biopsy of solid masses.
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Neoplasias de la Mama/diagnóstico por imagen , Enfermedad Fibroquística de la Mama/diagnóstico por imagen , Ultrasonografía Mamaria , Adulto , Anciano , Biopsia con Aguja , Mama/patología , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/patología , Diagnóstico Diferencial , Femenino , Enfermedad Fibroquística de la Mama/patología , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To evaluate the effect of ultrasonographic (US) contrast agents on measurements of peak velocity with spectral Doppler US in stenotic and nonstenotic flow states. MATERIALS AND METHODS: Nonpulsatile flow was established in a flow phantom with 0%, 50%, 75%, and 90% stenoses. SH U 508A, perflenapent emulsion, and perfluorohexane emulsion were the contrast agents evaluated. Before and after administration of each contrast agent, two peak velocity measurements obtained proximal to, at the site of, and distal to the stenosis in each vessel model were averaged. The percentage difference in peak velocity after contrast agent administration was calculated for each site interrogated. The mean, SD, and coefficient of variation of the percentage difference in peak velocity were calculated. RESULTS: Percentage differences in peak velocity after contrast agent administration at different sample volume sites were not significantly different irrespective of the degree of stenosis or the contrast agent evaluated. CONCLUSION: The contrast agents evaluated do not produce a statistically significant increase in peak velocity. If this result is corroborated in clinical practice, contrast agents can be used without reevaluating existing Doppler US thresholds for stenosis.
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Medios de Contraste , Modelos Biológicos , Flujo Sanguíneo Regional , Ultrasonografía Doppler , Constricción Patológica/diagnóstico por imagenRESUMEN
OBJECTIVE: The aim of this study was to assess if patients prefer to talk with a sonologist concerning the results of sonographic examinations. MATERIALS AND METHODS: The study involved outpatients who underwent diagnostic sonography. Technologists offered patients the chance to speak with a sonologist about the results of their sonograms. If requested, a sonologist reviewed the results, and if the study showed an abnormality, its significance was discussed. No treatment recommendations were offered. Patients then filled out a questionnaire. RESULTS: Of the 391 outpatients given the choice, 348 (89%) requested a consultation and 207 of those (60%) returned the completed questionnaire. Of the 207 patients completing the questionnaire, 94% preferred receiving the results from the sonologist rather than from their referring physician. CONCLUSION: We propose a revision of the traditional role of the office-based sonologist to one in which he or she will function as a consultant to both the patient and the patient's physician.
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Satisfacción del Paciente , Revelación de la Verdad , Ultrasonografía , Pacientes Ambulatorios , Derivación y Consulta , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The aim of the study was to determine if an association exists between intracardiac echogenic foci in the second-trimester fetus and trisomy 21. SUBJECTS AND METHODS: Over a 2-year period, targeted fetal sonography was performed for various indications in 1593 second-trimester high-risk pregnant women. Presence or absence of echogenic foci was recorded for each fetus. Amniocentesis for karyotype analysis was performed in 901 subjects immediately after sonography. The findings of these 901 subjects formed the basis of this report. RESULTS: Intracardiac echogenic foci were present in the left ventricle of 24 (3%) of the 901 fetuses. Three (13%) of these 24 fetuses had trisomy 21; no chromosomal abnormalities were found in the other 21 fetuses. Karyotype analysis revealed trisomy 21 in 14 (2%) of the remaining 877 fetuses who did not exhibit intracardiac echogenic foci. The sensitivity, specificity, positive predictive values, and negative predictive values for intracardiac echogenic foci in predicting trisomy 21 were 18%, 98%, 13%, and 98%, respectively. The association of intracardiac echogenic foci and trisomy 21 was significant (p < .009) by the two-tailed Fisher's exact test. CONCLUSION: In a high-risk obstetric population, the association between fetal intracardiac echogenic foci and trisomy 21 was statistically significant. Therefore, women carrying fetuses with intracardiac echogenic foci should be informed of the statistical association with trisomy 21.
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Síndrome de Down/diagnóstico por imagen , Corazón Fetal/diagnóstico por imagen , Ultrasonografía Prenatal , Adolescente , Adulto , Amniocentesis , Síndrome de Down/diagnóstico , Femenino , Enfermedades Fetales/diagnóstico por imagen , Humanos , Cariotipificación , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embarazo , Segundo Trimestre del Embarazo , Embarazo de Alto Riesgo , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To evaluate the ability of a phase shift contrast agent to improve Doppler sonographic imaging of the main renal arteries in cases of suspected renal artery stenosis. MATERIALS AND METHODS: In 25 patients in whom renal artery stenosis was suspected, baseline Doppler sonography was performed followed by two studies performed after blinded administration of contrast material or placebo (saline). Each kidney (n = 45) was evaluated for (a) visualization of the main renal artery on a scale of 0-4, (b) presence of accessory renal arteries, and (c) direct Doppler sonographic findings suggestive of renal artery stenosis. Correlative magnetic resonance angiography was performed in 24 patients, and angiograms were obtained in eight kidneys with stenosis at one or both imaging studies. RESULTS: Contrast enhancement was observed in 23 patients. Enhancement was 8-20 minutes. Renal artery visualization scores improved from a mean of 2.56 and 2.71 on baseline and noncontrast scans, respectively, to 3.69 after administration of contrast material. Contrast-enhanced images depicted seven kidneys with accessory renal arteries not seen at other studies. Two of eight cases of stenosis were seen only with contrast-enhanced sonography. CONCLUSION: Use of the phase shift contrast agent appears to enable a reduction in the number of equivocal findings of renal artery stenosis.
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Medios de Contraste , Fluorocarburos , Obstrucción de la Arteria Renal/diagnóstico por imagen , Arteria Renal/diagnóstico por imagen , Adulto , Anciano , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Arteria Renal/anomalías , Arteria Renal/patología , Obstrucción de la Arteria Renal/diagnóstico , Sensibilidad y Especificidad , Ultrasonografía DopplerRESUMEN
Eighty-nine male veterans presenting to a vascular surgery clinic with symptomatic lower extremity atherosclerosis were prospectively screened by duplex scan for asymptomatic carotid artery stenosis (CAS). Their chief complaint was: claudication (90%), rest pain (6%), and ischemic ulcer or gangrene (4%). The mean ankle-brachial index (ABI) was 0.77. Twenty-five CAS > 50% were detected in 18 (20%) patients. Twelve CAS > 75% were detected in 11 (12%) patients. There was no difference between patients with and without CAS > 50% with regards to mean ABI, history of angina, diabetes, hypertension, prior coronary artery bypass, or history of smoking. Carotid bruit was associated with ipsilateral CAS > 50% [p < 0.0001, sensitivity (52%), specificity (88%), positive predictive value (41%), negative predictive value (92%)]. As a result of the screening, eight elective carotid endarterectomies have been performed to date in six (7%) patients with one transient twelfth cranial nerve paresis as the only postoperative complication. We conclude that: (1) male patients presenting with symptomatic lower extremity atherosclerosis have a 20% prevalence of asymptomatic CAS > 50%, (2) there is no correlation between the degree of lower extremity ischemia and CAS > 50%, (3) carotid bruit is significantly associated with CAS > 50%, but has a low sensitivity, and (4) routine CAS screening should be considered for all male patients with symptomatic lower extremity atherosclerosis regardless of whether a bruit is present.