Hemodynamic patterns of women with chronic hypertension during pregnancy

Objective: The purpose of the study was to evaluate the hemodynamic changes during an initial and subsequent gestation of 15 patients with chronic hypertension. Study Design: Data on mean arterial pressure, rapid ejection time, and pulse wave arrival time, recorded at 26 weeks and 37 weeks, were correlated with birth weight and gestational age. Hemodynamic data were acquired with a noninvasive cardiovascular monitor, and blood pressure was recorded with an oscillometric technique. Statistical analyses were performed with the paired Student t test and simple correlation. Results: The birth weights increased in 9 patients and decreased in 6, although more babies were delivered before 37 weeks in the subsequent pregnancy (7 vs 4 patients). No differences were found between the groups of index and repeated pregnancies or among the subgroups whose infant birth weights increased or decreased, except for the pulse wave arrival time at 37 weeks (172 ± 21 ms vs 143 ± 29 ms, P < .05). However, strong correlations emerged between the initial pregnancy’s rapid ejection time versus the mean arterial pressure at week 37 (r = 0.81, P = .0013) and the repeated pregnancy’s rapid ejection time at week 26 versus the gestational age (r = –0.95, P = .00003). Conclusion: These observations suggest that rapid ejection time, an empiric indicator of vascular compliance, may have a role in the evaluation and management of hypertension in pregnancy. (Am J Obstet Gynecol 1999;180:1584-92.)     

Therapy of MS

The era of disease-modifying drugs (DMDs) in multiple sclerosis (MS) treatment began in the 1990s, first with interferon-β (IFNβ), and the number of agents has increased steadily since then. Currently, there are six different parenteral formulations approved for MS treatment and many other oral and parenteral ones are in different stages of investigation or awaiting approval by federal agencies.     

Proton pump inhibitors reduce gallbladder function

Background In the authors’ previous study of gallbladder function before and after fundoplication, 58% of the patients demonstrated preoperative gallbladder motor dysfunction, and 86% of those retested after operation and cessation of proton pump inhibitors (PPIs) normalized. Because no study has directly assessed the impact of antisecretory agents on gallbladder function, this study measured gallbladder ejection fraction (GBEF) in healthy volunteers before and after initiation of PPIs. Methods A total of 19 subjects completed the study, which included baseline determination of GBEF by cholecystokinin-stimulated hepatobiliary acid scan, 30 days of antisecretory therapy with omeprazole (40 mg daily), and repeat GBEF on day 30. Subjects were surveyed regarding compliance and symptoms. Results For 15 of 19 subjects, PPI therapy was associated with reduced gallbladder motility. Evolution of symptoms consistent with a biliary etiology was reported by 26.7% of these subjects. Conclusions Short-term PPI therapy reduces gallbladder motility in healthy volunteers. Chronic PPI therapy may pose a risk for long-term gallbladder dysfunction and biliary complications. Dr. Cahan currently is affiliated with the Department of Surgery at the University of Massachusetts, Worcester, MA, USA Presented at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) meeting in Fort Lauderdale, Florida 15 April 2005     

Foodborne botulism in the Republic of Georgia

Foodborne botulism is a potentially fatal, paralytic illness that can cause large outbreaks. A possible increase in botulism incidence during 2001 in the Republic of Georgia prompted this study. We reviewed surveillance data and abstracted records of patients with botulism who were hospitalized from 1980 to 2002. During this period, 879 botulism cases were detected. The median annual incidence increased from 0.3 per 100,000 during 1980 to 1990 to 0.9 per 100,000 during 1991 to 2002. For 706 botulism patients hospitalized from 1980 to 2002, 80% of their cases were attributed to home-preserved vegetables. Surveillance evaluation verified that botulism incidence varied greatly by region. Georgia has the highest nationally reported rate of foodborne botulism in the world. A strategy addressing individual behaviors in the home is needed to improve food safety; developing this strategy requires a deeper understanding of why botulism has increased and varies by region.     

Compared with 3-dimensional analysis, 2-dimensional gated SPECT analysis overestimates left ventricular ejection fraction in patients with regional dyssynchrony

BACKGROUND: Left ventricular (LV) ejection fraction (EF) is a powerful prognostic predictor in patients with heart disease. However, LVEF calculated by 2-dimensional (2D) modalities such as echocardiography by use of the "modified" Simpson's rule may be incorrect in patients with regional dyssynchrony, presumably because regions of dyssynchrony are excluded from analysis. METHODS AND RESULTS: To elucidate the difference between 2D and 3-dimensional (3D) methods with regard to LVEF calculation in patients with regional dyssynchrony, we compared LVEF derived from 8-frame gated technetium 99m sestamibi stress perfusion tomograms using commercially available 2D single photon emission computed tomography (SPECTEF) software that uses the modified Simpson's rule, 3D QGS, and investigational 3D p-FAST software in 136 left bundle branch block patients. Twenty-four patients had normal wall motion, whereas one hundred twelve showed septal dyssynchrony. Bland-Altman plots demonstrated that compared with QGS and p-FAST, SPECTEF overestimated LVEF in patients with septal dyssynchrony systemically by 8.6% and 11.3%, respectively. CONCLUSIONS: We conclude that compared with 3D modalities, 2D modalities that use the modified Simpson's rule, such as SPECT EF, overestimate LVEF in patients with dyssynchronous septal wall motion. Therefore 3D modalities are preferred to evaluate patients with regional dyssynchrony.     

Continuous assessment of right ventricular ejection fraction: new pulmonary artery catheter versus transoesophageal echocardiography

In 25 cardiac surgical patients, right ventricular ejection fraction was continuously measured with a new pulmonary artery catheter and transoesophageal echocardiography, scanning the 'fractional area change' in a standardised transatrial cross section area. Measurements were recorded at three predefined time points (pre-, intra-, and postoperatively). Both methods were compared using the Bland-Altman analysis. Comparing right ventricular ejection fraction values obtained from the pulmonary artery catheter with those assessed by transoesophageal echocardiography, bias was -3.7%, with a precision of 30.9%. Bias and precision significantly improved when the heart rate was less than 100 beats.min(-1), pulmonary artery pressures were low and cardiac performance adequate. In conclusion, the new continuous pulmonary artery catheter system appears to be a valid and useful bedside monitoring device in the haemodynamic management of critically ill patients.     

2型糖尿病患者左心室功能变化的临床研究

目的：探讨2型糖尿病（DM）对左心室功能的影响及其可能机制。方法：冠状动脉造影和左心室造影证实，有662例冠状动脉狭窄患者，分别按有无DM将其分为冠心病（CHD）合并DM（CHD＋DM）组及CHD组，测定各组左心室射血分数（LVEF）及左心室舒张末压（LVEDP），判断左心室收缩及舒张功能。结果：CHD＋DM组的LVEF值与CHD组无明显差异，根据LVEF〉50％、30％。的％和≤30％将心功能进一步分级后，CHD＋DM组与CHD组在不同心功能分级间亦无统计学差异。CHD＋DM组的LVEDP明显高于CHD组（P〈0．05）。结论：LVEDP是评估左心室舒张功能的敏感指标，CHD合并DM时比单纯CHD的心脏舒张功能受损更明显。产生机制与DM的胰岛素缺乏所致心肌能量代谢紊乱有关。此外，心肌细胞蛋白糖基化作用导致的氧化应激、细胞内Ca^2＋转运机制异常以及心脏局部肾素-血管紧张素系统（RAS）激活等均可损伤心肌的结构和功能。