Limitations of radionuclide ventriculography in the non-invasive diagnosis of coronary artery disease. A correlation with right heart haemodynamic values during exercise.

A consecutive series of 56 patients with chest pain but no evidence of previous myocardial infarction was prospectively studied by radionuclide ventriculography to determine the value of global and regional radionuclide indices in detecting coronary artery disease. The results were correlated with the clinical judgment of chest pain, the results of the exercise electrocardiogram, and the right heart haemodynamic measurements during exercise. As a result of the criteria for entry, the study group was representative of the population seen in such a clinical setting. Only 25% of patients had coronary artery disease. The predictive power of radionuclide ventriculography was limited. The conventionally used criterion that normal subjects have an increase in left ventricular ejection fraction of at least 5% with exercise provided only 78% sensitivity and 57% specificity. Fourier analysis and visual interpretation of radionuclide studies wrongly diagnosed three out of 10 patients with extensive disease requiring surgery. These results suggest that radionuclide ventriculography is of limited value in the non-invasive diagnosis of coronary artery disease.     

Limitations of radionuclide ventriculography in the non-invasive diagnosis of coronary artery disease. A correlation with right heart haemodynamic values during exercise

A consecutive series of 56 patients with chest pain but no evidence of previous myocardial infarction was prospectively studied by radionuclide ventriculography to determine the value of global and regional radionuclide indices in detecting coronary artery disease. The results were correlated with the clinical judgment of chest pain, the results of the exercise electrocardiogram, and the right heart haemodynamic measurements during exercise. As a result of the criteria for entry, the study group was representative of the population seen in such a clinical setting. Only 25% of patients had coronary artery disease. The predictive power of radionuclide ventriculography was limited. The conventionally used criterion that normal subjects have an increase in left ventricular ejection fraction of at least 5% with exercise provided only 78% sensitivity and 57% specificity. Fourier analysis and visual interpretation of radionuclide studies wrongly diagnosed three out of 10 patients with extensive disease requiring surgery. These results suggest that radionuclide ventriculography is of limited value in the non-invasive diagnosis of coronary artery disease.     

Echocardiographic diagnosis of the right tri-atrial heart

In this report we describe the two-dimensional echocardiographic features of a case of cor triatriatum dexter. In this situation the right atrium is divided by a membrane in two chambers. Considering the anatomic characteristics of this case we added a new type in the classical classification proposed by Doucette et al.     

Clinical presentation and diagnosis of osteoporosis and osteomalacia

Osteoporosis and osteomalacia are systemic metabolic bone diseases characterized by an impaired composition, architecture, and quality of bone. In light of the demographic development and the recent use of sensitive tests, both diseases are increasingly diagnosed. Subjects at high risk include elderly, chronically hospitalized patients, and nursing home residents. Patients with gastrointestinal, rheumatologic and endocrine disorders are also at risk for the development of osteoporosis or osteomalacia. In this review, we will discuss practical aspects of the clinical presentation and the diagnosis of osteoporosis and osteomalacia.     

Clinical presentation,diagnosis and staging of cholangiocarcinoma

Cholangiocarcinoma (CCA) is a heterogeneous group of tumours, derived from cells of the biliary tree, which represent the second most frequent primary liver tumour. According to the most recent classifications, CCA can be subdivided into intrahepatic (iCCA) and extrahepatic (eCCA) which include perihilar (pCCA) and distal (dCCA) CCA. CCA are usually identified at advanced stages, when the primary tumour grows enough to produce a large liver mass or when jaundice has developed because of biliary tree obstruction. The ongoing challenges in the identification of risk factors and definition of a specific population at higher risk of developing CCA are the main challenges for the development of screening programs. Therefore, late diagnosis remains an unresolved issue in CCA. Imaging plays an important role in the detection and characterization of CCA, helping with radiological diagnosis, guiding biopsy procedures and allowing staging of the tumour. This review focuses on clinical presentations and diagnosis and staging techniques of CCA.     

右心功能衰竭诊治进展

目前,右心室相关功能研究仍为热点领域。美国国家心肺和血液研究所于2006年将其列为今后心血管领域的重点研究方向,如右心室功能的测定方法、右心室特性、右心室肥厚的机制和作用、肺部疾病对右心室功能的影响、右心功能衰竭（心衰）模型的建立、转录研究、右心室形态发育、特异性治疗方法等。     

The role of non-invasive methods in the diagnosis of heart failure

A survey is given on the validity of the non-invasive methods in the diagnostics of the cardiac insufficiency. Thereby the value of the echocardiography is emphasized not only in the etiologic clarification but also in the judgement of the cardiac (ventricular) function, the results of which can give the indication for invasive diagnostics in patients with cardiac insufficiency at stage III and IV NYHA. In the stages I and II NYHA of cardiac insufficiency this question and that one of the estimation of the functional capacity of the body are clarified by the use of tolerance tests. The ventriculography of radionuclides under conditions of exercise allows a far-reaching insight into the cardiac function, such as with the help of the parameter of the left ventricular ejection fraction.     

Isolated connection of the right superior caval vein to the left atrium: non-invasive neonatal diagnosis.

Isolated anomalous drainage of the right superior caval vein to the left atrium is a very rare cause of cyanosis in the newborn. Herein, the cross-sectional echocardiography and colour Doppler findings of this malformation are described.     

小肠原发性肿瘤的临床表现与诊断

原发性小肠肿瘤在临床上较少见,其临床表现缺乏特异性,可表现为消化道出血、腹痛、腹块、肠梗阻等,因此诊断较为困难.目前常用的诊断方法包括小肠钡灌、多层螺旋CT小肠造影、磁共振小肠造影、胶囊内镜、双气囊小肠镜、经小肠镜超声检查、小肠血管造影等.对于临床怀疑小肠肿瘤的患者,应根据患者的具体情况选用各种检查方法以提高术前诊断率并缩短诊断时间.     

Arrhythmogenic right ventricular cardiomyopathy: clinical presentation, diagnosis, and management

Arrhythmogenic right ventricular cardiomyopathy, also known as right ventricular dysplasia, is a genetically determined heart muscle disease associated with arrhythmia, heart failure, and sudden death. Autosomal dominant inheritance is typical. The identification of causative mutations in cell adhesion proteins has shed new light on its pathogenesis. Fibrofatty replacement of the myocardium, the hallmark pathologic feature, may be a response to injury caused by myocyte detachment. Sudden death is often the first manifestation in probands, emphasizing the importance of evaluating asymptomatic relatives for the disease. Standardized guidelines facilitate the clinical diagnosis of right ventricular dysplasia. However, familial studies have highlighted the need to broaden the diagnostic criteria, which are highly specific but lack sensitivity for early disease. Modifications have been proposed for the diagnosis of right ventricular dysplasia in relatives. Early right ventricular dysplasia is characterized by a "concealed phase" in which electrocardiographic and imaging abnormalities are often absent, but patients may nonetheless be at risk for arrhythmic events. Detection at this stage remains a clinical challenge, underscoring the potential value of mutation analysis in identifying affected persons. Serial evaluation of patients with suspected right ventricular dysplasia is recommended as clinical features may develop during the follow-up period. The onset of symptoms such as palpitation or syncope may herald an active phase of a previously quiescent disease, during which patients are at increased risk for sudden death. Greater awareness of right ventricular dysplasia among physicians and judicious use of implantable cardioverter-defibrillators may help to prevent unnecessary deaths.     

Clinical and echocardiographic correlations in right heart endocarditis

The echocardiographic findings were correlated with the clinical findings and outcome in 23 patients with tricuspid valve or pulmonary valve endocarditis. There were 15 males and 8 females with a mean age of 33.1 ± 8.4 years. Eighteen patients had tricuspid valve endocarditis, 1 patient had pulmonary valve endocarditis, 3 patients had concomitant mitral valve and tricuspid valve endocarditis, and 1 patient had tricuspid valve and pulmonary valve endocarditis. Twenty of the 23 (87%) patients had a history of intravenous drug abuse. The most common organisms were Staphylococcus aureus (10 of 23 patients or 43%), Streptococcus viridans (5 patients) and Pseudomonas aeruginosa (4 patients). Pulmonary manifestations with septic pulmonary emboli were present in $\text{18}\text{23}$ (80%) patients, and a regurgitant murmur in $\text{16}\text{23}$ (73%) patients. Vegetations on the tricuspid valve or pulmonary valve were detected in all patients who had 2D echo, but they were missed by M-mode echo in 2 patients. Nine of the 23 patients (40%) improved on medical therapy, 5 (21%) expired, and 7 (30%) required surgery (tricuspid valve or pulmonary valve replacement in 3, and tricuspid valve excision without replacement in 4). Conclusions: (1) 11 of 13 patients with persistent infection, multivalvular involvement, fungal or Pseudomonas infection and increasing size of vegetations by echo died or underwent surgery compared to only 1 of 8 patients without these features (P < 0.01). (2) Staphylococcus aureus infection (10 patients) and flail tricuspid valve or pulmonary valve by echo (6 patients) were not predictive of outcome.     

Serial Doppler echocardiographic assessment of left and right ventricular filling for non-invasive diagnosis of mild acute cardiac allograft rejection.

Detection of acute cardiac allograft rejection (AR) remains an important clinical challenge. The role of Doppler echocardiography for the non-invasive diagnosis of AR is controversial, in particular with regard to milder forms of rejection. This study was designed to evaluate the potential of Doppler echocardiography for the non-invasive diagnosis of mild AR. Serial measurements of left and right ventricular filling parameters were performed in 31 heart transplant recipients and compared with simultaneously obtained endomyocardial biopsies. To account for biological and technical variability, consecutive rejection-free studies were used to calculate 95% confidence limits for mitral and tricuspid maximum early flow velocity and pressure half time. Measurements obtained during mild AR were then compared to these data. The study demonstrated that all parameters varied considerably between consecutive rejection-free examinations. Changes in left and right ventricular filling parameters during mild AR rarely exceeded the calculated 95% confidence limits. Thus Doppler echocardiography appears of little value for the non-invasive diagnosis of mild acute cardiac rejection.     

Contrast-color Doppler echocardiography. Improved right heart diagnosis following intravenous injection of Echovist

Flow patterns in the right heart are often difficult to visualize by color-coded Doppler flow imaging. The echogenicity of blood was increased in 48 patients by intravenous injection of 10 ml echovist (200 mg/ml), a saccharide solution with defined size and concentration of microbubbles. Its effect on improving color-coding was compared with the effect of agitated gelifundol (10 ml) in 21 patients with tricuspid valve regurgitation. The non-controlled size and concentration of microbubbles resulted in weaker or uncontrollably exaggerated color-coding in half of the patients. In eight normals biphasic atrial flow was visible only after injection of echovist. In 25 patients with tricuspid regurgitation the blue coded area of reflux was 25 +/- 21% of the atrial area from the parasternal approach and 10 +/- 9% from the apical approach without correlation of these results. After echovist the area of reflux was 57 +/- 31% (p less than 0.001) in the parasternal and 53 +/- 26% (p less than 0.001) in the apical approach (r = 0.83). This was paralleled by an increase of the severity of tricuspid regurgitation as defined by the length or area of reflux (p less than 0.01-0.001). The qualitative diagnosis was safely established in the five patients with VSD in the control color Doppler flow imaging, but only in three out of 10 patients with ASD, and in nine of 10 after injection of echovist. The intravenous injection of echovist, when using color-coded Doppler flow imaging for evaluation of right heart disease, facilitates the qualitative diagnosis of ASD and also of tricuspid regurgitation, particularly in the apical approach.(ABSTRACT TRUNCATED AT 250 WORDS)