Usefulness of tissue Doppler echocardiography for evaluating ventricular function in children without heart disease

Tissue Doppler echocardiographic imaging (TDI) is a novel method for accurately evaluating ventricular function. Currently, scant data are available on the distribution of tissue Doppler indexes in healthy children in the age range of 1 to 18 years. The aims of this study were to assess the distribution of tissue Doppler indexes of systolic and diastolic ventricular function in healthy children, to assess the influence of age on these indexes, and to compare them with conventional Doppler indexes. A total of 151 consecutive children aged 1 to 18 years were enrolled in the study. Nine different (7 diastolic and 2 systolic) TDI parameters were assessed. Peak velocities of systolic and diastolic excursions of the mitral and tricuspid annuli were obtained from the apical 4-chamber view. Mean velocities of early diastolic recoil of mitral and tricuspid annuli were measured from the apical 4-chamber view. The mean velocity of early diastolic relaxation of the left ventricular posterior wall was measured in the parasternal long-axis view. Results showed a statistically significant difference in some of the TDI indexes among the different pediatric age groups. Most of the TDI indexes showed a very weak correlation with age. There was no significant correlation (p >0.05) between peak velocities of the early diastolic mitral inflow Doppler pattern (E wave) and the corresponding TDI index. In contrast, there was a significant (p <0.001) correlation between the corresponding Doppler indexes in the tricuspid annulus. We conclude that TDI is a valuable tool for assessing ventricular function, particularly diastolic function. Establishment of normative data for TDI in the pediatric age group should broaden the clinical applicability of this useful modality for assessing ventricular function.     

Bile-Duct Hamartomas Presenting as Multiple Focal Lesions on Hepatic Ultrasonography

Multiple bile-duct hamartomas are usually diagnosed at autopsy as an incidental finding. We report a case of a 50-yr-old male in whom multiple bile-duct hamartomas were suspected in an abdominal ultrasonography and confirmed by an echo-guided needle liver biopsy. The ultrasonography disclosed multiple scattered hyperechoic lesions with a diameter of up to 1 cm, associated with some anechoic lesions of a larger size and a cystic appearance. Computed tomography demonstrated multiple hypodense lesions that were not modified by the administration of contrast. Bile-duct hamartomas should be included in the differential diagnosis of multiple focal hepatic lesions at ultrasonography or computed tomography.     

EUS-guided mucosectomy for gastrointestinal cancer.

INTRODUCTION: the only way of improving prognosis and survival in gastrointestinal cancer is early diagnosis, with intramucosal localization as confirmed by endoscopic ultrasonography (EUS) or 20-MHz miniprobes (MPs) (T1) being most appropriate. Endoscopic mucosal resection (EMR) has proven effective in the treatment of this sort of lesions. PATIENTS AND METHOD: in a group (18 cases) with 15 cases of superficial gastrointestinal cancer and 3 cases of severe gastric dysplasia, 9 cases (3 esophageal, 4 gastric, 2 rectal) underwent a classic EMR following EUS or a 7.5- and 20-MHz miniprobe exploration. RESULTS: ultrasonographic studies showed a T1 in all but one esophageal case (Tis), and in both gastric dysplasias, with no changed layer structure being demonstrated in the latter (T0). No complications arose with classic EMR, and all 9 patients are alive and free from local or metastatic recurrence, except for one esophageal case, which recurred distally to the esophageal lesion (metachronous). CONCLUSIONS: echoendoscopically-assisted EMR is a safe, effective technique in the endoscopic management of superficial gastrointestinal (esophageal, gastric, colorectal) cancer. Recurrence most likely depends upon cancer multiplicity.     

Acute, short- and long-term efficacy of oral bevantolol in patients with coronary artery disease: a placebo-controlled, randomized, double-blind study

The efficacy and safety of bevantolol (new cardioselective beta-blocking agent without intrinsic sympathetic activity) were evaluated in chronic stable angina pectoris. Acute effects on heart rate (HR) and pulmonary function (forced expiratory volume in the first second, FEV1, and vital capacity, VC) (double-blind placebo, propranolol, 80 mg, and bevantolol, 150 mg) and the antianginal efficacy during early (double-blind placebo period) and chronic bevantolol therapy (long-term follow-up for 52 weeks) were studied. Bevantolol reduces HR in the same way as propranolol (both p less than 0.01). Pulmonary function is modified significantly only by propranolol (decreasing FEV1, p less than 0.05). Bevantolol reduces antianginal attacks and nitroglycerin consumption (p less than 0.01) and improves exercise tolerance (p less than 0.01) during early and chronic therapy.     

Ultrastructure of the intrauterine eggs of the microphallid trematode Maritrema feliui: evidence of early embryonic development

Intrauterine embryonic development in the microphallid trematode Maritrema feliui is examined by means of transmission electron microscopy. Both fertilization and eggshell formation take place in the ootype. The eggshell is formed from a shell globule material derived from the vitelline cells combined with secretions of Mehlis' gland. The proximal uterus is packed with unembryonated eggs of the oligolecithal type, each composed of a fertilized oocyte and several vitelline cells, all surrounded by the shell. Intrauterine embryonic development of the egg is followed to the early stage of outer embryonic envelope formation, resulting in an embryo of ~20 blastomeres of three different types: macromeres, mesomeres and micromeres. The first equal cleavage division of the zygote produces two macromeres. The outer envelope is of cellular origin and formed by the cytoplasmic fusion of two macromeres, which become situated at opposite poles in the peripheral layer of the embryo just beneath the eggshell. Simultaneously, other blastomeres multiply and differentiate, whereas several micromeres exhibit clear signs of degeneration or apoptosis. These results show that the embryonic development of M. feliui starts in utero and represents an example of early stage ovoviviparity. A reduction in the number of blastomeres results from a continued degeneration of micromeres, which after autolysis and re-absorption, appear to represent an important source of nutritive reserves for the embryo. The embryonic development of this digenean is discussed in relation to its life cycle.     

Risk factors for enterococcal urinary tract infections: a multinational,retrospective cohort study

European Journal of Clinical Microbiology & Infectious Diseases - Complicated urinary tract infection (cUTI) is a frequent cause of morbidity. In this multinational retrospective cohort study,...