RESUMEN
PURPOSE: Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterised by primary hypertrophy of the left and/or right ventricle. The reference standard for imaging diagnosis is echocardiography. The aim of our study was to prospectively compare the diagnostic accuracy of echocardiography and cardiac magnetic resonance (MR) imaging in patients with HCM. MATERIALS AND METHODS: Twenty-two consecutive patients with a known diagnosis of HCM were prospectively evaluated, with echocardiography and cardiac MR imaging performed within 2 weeks of each other (mean interval 7 days, range 2-14 days). Two experienced radiologists blinded to the previous clinical and imaging findings separately reviewed the images. The following parameters were calculated for both techniques: myocardial mass, wall thickness, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), systolic anterior motion (SAM) of the mitral valve and degree of myocardial fibrosis (based on the ultrasonic reflectivity at echocardiography and degree of late enhancement at cardiac MR imaging). The statistical correlation was calculated with Student's t test, Spearman coefficient and Fisher's exact test. A value of p<0.05 was considered significant. RESULTS: The diagnosis of HCM was confirmed in all patients with both techniques, with absolute agreement in terms of the site of disease. The mean value of myocardial mass presented a statistically significant difference between the two techniques (114 g, p<0.001). In contrast, a nonsignificant difference between echocardiography and cardiac MR imaging was found for EDV (102 ml vs 111 ml; p=0.31), ESV (30 ml vs 38 ml; p=0.1), EF (74% vs 68%, p=0.5), SAM (p=0.1) and myocardial fibrosis (p=0.15). CONCLUSIONS: Cardiac MR imaging correlates well with echocardiography in defining the morphological and functional parameters useful for the imaging diagnosis of HCM and therefore, in selected cases (poor acoustic window, doubtful echocardiography findings), it may be a valid alternative to echocardiography.
Asunto(s)
Cardiomiopatía Hipertrófica/diagnóstico , Ecocardiografía/métodos , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Anciano , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Medios de Contraste , Femenino , Humanos , Masculino , Meglumina , Persona de Mediana Edad , Compuestos Organometálicos , Estudios ProspectivosRESUMEN
OBJECTIVE: To evaluate the comparative diagnostic value of harmonic imaging (HI) in the assessment of patients with suspected infective endocarditis (IE). SETTING: Tertiary referral centre. DESIGN: 139 consecutive patients were evaluated with three imaging modalities: transthoracic echocardiography with fundamental imaging (FI); HI; and transoesophageal echocardiography (TOE). Image quality was assessed for each modality by semiquantitative scoring (0, poor, to 3, excellent). Presence, dimension, and characteristics of vegetations were assessed separately for each imaging modality, as well as presence of abscesses. RESULTS: 35 patients had definite IE. TOE was positive in 33 patients, HI in 28, and FI in 12 (p < 0.001 for FI v HI and v TOE). Mean image quality was 1.4 (0.7) for FI, 2.1 (0.6) for HI (p < 0.01 v FI), and 2.6 (0.4) for TOE (p < 0.001 v HI). The association between FI and TOE findings was Phi = 0.35 (chi2 = 17.57, p = 0.0014) and between HI and TOE it was Phi = 0.95 (chi2 = 125.72, p < 0.0001; p < 0.0001 v FI). The global echo score of vegetations was 7.1 (3.3) with FI, 8.5 (3.4) with HI, and 11.3 (3.9) with TOE (p < 0.001 v HI). Compared with TOE, FI identified only one of seven abscesses (sensitivity 14%) and HI identified two of seven abscesses (sensitivity 28%). CONCLUSIONS: HI provides an accurate assessment of suspected IE. TOE achieves superior definition of IE related abnormalities.
Asunto(s)
Ecocardiografía/métodos , Endocarditis Bacteriana/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Femenino , Fiebre de Origen Desconocido/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
1. Renal cortical slices isolated from the kidneys of male Wistar rats were used as an experimental model for studying the nephrotoxicity induced by 1,2-dichloropropane. 2. The solvent causes a depletion of renal reduced glutathione content and slight, but significant, lipid peroxidation. The block of the oxidative pathway with carbon monoxide prevents glutathione content depletion, and shows that this conjugation is the major step in 1,2-dichloropropane metabolism. 3. Loss of organic anion accumulation and release into the incubation medium of tubular enzymes, mainly from the soluble fraction, are the toxic effects of the solvent. The brush border is only slightly affected. 4. The mechanism of nephrotoxicity appears to occur via mercapturic acid metabolism. Acivicin and aminooxyacetic acid, inhibitors of gamma-glutamyltransferase and beta-lyase activity, respectively, partially but significantly prevent the loss of organic anion accumulation induced by 1,2-dichloropropane. Furthermore, alpha-ketobutyrate, an activator of beta-lyase, enhances the effects of 1,2-dichloropropane on the target, but is itself toxic for organic anion accumulation.
Asunto(s)
Corteza Renal/patología , Enfermedades Renales/inducido químicamente , Propano/análogos & derivados , Alanina Transaminasa/sangre , Animales , Monóxido de Carbono/farmacología , Modelos Animales de Enfermedad , Glutatión/metabolismo , Técnicas In Vitro , Corteza Renal/efectos de los fármacos , Corteza Renal/enzimología , Enfermedades Renales/enzimología , Enfermedades Renales/patología , L-Lactato Deshidrogenasa/sangre , Peroxidación de Lípido/efectos de los fármacos , Masculino , Propano/farmacocinética , Propano/toxicidad , Ratas , Ratas Wistar , gamma-Glutamiltransferasa/sangreRESUMEN
Sex- and age-related nephrotoxicity due to 1,2-dichloropropane was studied in vitro by means of renal cortical slices obtained from Wistar rats. Reduced glutathione content, organic anion accumulation (p-aminohippurate), and release of malondialdehyde (to measure the extent of lipid peroxidation), aspartate aminotransferase, gamma-glutamyltransferase and lactate dehydrogenase into the incubation medium were determined. Sex differences in naive rats parameters were slight, but male were more susceptible to toxic effects of 1,2-dichloropropane than female rats; glutathione depletion, lipid peroxidation, and loss of organic anion accumulation were higher in male than in female slices. During senescence, naive male rats showed a progressive decrease of glutathione content (statistically significant from 7-9 months of age), increase of spontaneous lipid peroxidation from the same age, and increase of signs of cytotoxicity (release of aspartate aminotransferase and lactate dehydrogenase into the incubation medium) from 3-4 months of age. A loss of organic anion accumulation started from 7-9 months of age. Slices from rats of 3-4 months old showed the apparently highest susceptibility to 1,2-dichloropropane but depletion of glutathione content and loss of organic anion accumulation were at the same level in the oldest rats. The age decrease of control values caused the differences in the percentage ratio and then, apparently, a lower DCP effect. On the contrary, the increase of aspartate aminotransferase released in the incubation medium by DCP-treated slices corresponded to the age-related increase in cytotoxicity.
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Enfermedades Renales/inducido químicamente , Propano/análogos & derivados , Envejecimiento/metabolismo , Animales , Femenino , Técnicas In Vitro , Corteza Renal/efectos de los fármacos , Corteza Renal/enzimología , Corteza Renal/metabolismo , Enfermedades Renales/metabolismo , Enfermedades Renales/patología , Hígado/efectos de los fármacos , Hígado/enzimología , Masculino , Propano/toxicidad , Ratas , Ratas Wistar , Caracteres SexualesRESUMEN
Here we have outlined the data relative to an environmental survey carried out in a laparoscopy clinic at the hospital of Padua, to determine the environmental concentration of nitrous dioxide (N2O) used for intra-abdominal inflation during diagnostic laparoscopy interventions. The data obtained have revealed cases of considerable N2O environmental pollution. This above all, due to spontaneous loss of gas during the intervention and to the lack of adequate ventilation systems.