Assessment of colour flow imaging in the grading of valvular regurgitation

To assess the accuracy of colour flow imaging in the gradingof valvular regurgitation, we studied 100 consecutive patientswith angiographic mitral regurgitation (55), aortic regurgitation(35) or both (10). The etiology of valve regurgitation was rheumaticin 42 and non-rheumatic in 58 patients. For comparison, 28 subjectswith no structural cardiac disease were studied. Mitral valveregurgitation was assessed with colour flow imaging by measuringthe maximal regurgitant jet area and the maximal jet area normalizedto left atrial area; aortic valve regurgitation was assessedfrom jet area and jet width normalized to ventricular outflowtract width. The best correlation between colour flow imagingand angiography was obtained with normalized measurements forboth mitral (r = 0.82, P<0.0001) and aortic regurgitation(r = 0.94, P<0.0001). A proportion of patients and controlswithout angiographic regurgitation showed evidence of mild mitral(31% and 32%) and aortic (14% and 11%) regurgitation on colourflow imaging. There was a large overlap in the normalized colourflow measurements between angiographically mild and moderatemitral regurgitation: (43%); the overlap was greater when regurgitationwas rheumatic in origin (45% ) rather than non-rheumatic (10%)(P<0.001). There was also overlap in the normalized colourflow findings in patients with angiographic aortic regurgitation,which was greater in rheumatic vs non-rheumatic disease. Knowledgeof the etiology significantly improved the separation of allangiographic grades of aortic regurgitation using colour flowmeasurements (P = 0.006). These findings confirm the high sensitivityof colour flow imaging in the detection of valvular regurgitationand indicate that its accuracy is higher in patients with non-rheumaticthan rheumatic heart disease.     

External Characteristics of Unsteady Spray Atomization from a Nasal Spray Device

The nasal route presents an enormous opportunity to exploit the highly vascularized respiratory airway for systemic drug delivery to provide more rapid onset of therapy and reduced drug degradation compared with conventional oral routes. The dynamics of atomization at low injection pressure is less known as typical spray atomization studies have focused on industrial applications such as fuel injection that are performed at much higher pressure. An experimental test station was designed in house and an alternative method to characterize the external spray is presented. This involved the use of high-speed camera to capture the temporal development of the spray as it is atomized through actuation of the spray device. An image-processing technique based on edge detection was developed to automate processing through the large number of images captured. The results showed that there are three main phases of spray development (prestable, stable, and poststable) that can be correlated by examining the spray width. A comparison with a human nasal cavity is made to put into perspective the dimensions and geometry that the spray atomization produces. This study aimed to extend the current existing set of data to contribute toward a better understanding in nasal spray drug delivery.     

Oral ketamine

Four cases of severely mentally handicapped young adults requiring day care dental treatment are reported. All had required varying degrees of restraint during previous dental treatments, which had been distressing for the patient, the relatives and the ward staff. In all cases, administration of oral ketamine 10 mg/kg, 30-60 minutes before the procedure, facilitated subsequent induction of anaesthesia.     

Diagnostic value of two-dimensional echocardiography in cardiac hydatid disease

Echinococcal infection of the heart is rare. The preoperativefindings, with special attention to two-dimensional echocardiography(2DE), of six patients with cardiac echinococcosis and theirsurgical and pathological correlations are reported. Cardiachydatid cysts (HCs) were located in the cardiac apex in threepatients, in the upper part of the interventricular septum extendingtowards the anterior aspect of the heart in one and in the postero-superiorright atrial wall in another patient. The remaining patienthad multiple intrapericardial cysts. In three patients the cystspresented as well defined, rounded, echolucent masses withinthe myocardial wall bulging into the cardiac chambers. In twopatients, the cysts had ruptured into a cardiac chamber withloss of the characteristic ‘cystic’ appearance;these cysts presented as an echogenic or solid mass protrudinginto a cardiac chamber. Finally, another patient had one HCwith echolucent appearance and another HC in a different locationwith echogenic appearance; this last cyst corresponded to adegenerated HC. In two cases the cyst showed a loculated internalaspect. In one patient the myocardial segment involved by thecyst had a dyskinetic movement. In all six patients, 2DE accuratelydemonstrated the location and morphological details of the cardiaccysts, permitted recognition of the ruptured and/or degeneratedcysts and was superior to thoracic computed tomography and angiographyin the preoperative assessment of these patients. Nuclear magneticresonance imaging (one patient) gave no further informationto that obtained by 2DE. We conclude that 2DE is the techniqueof choice for an early diagnosis of this rare entity.     

Endothelin-1 in children with acute poststreptococcal glomerulonephritis and hypertension

BACKGROUND: Endothelin-1 (ET-1), the most potent vasoconstrictor peptide, is known to play a role in arterial hypertension. In patients with acute poststreptococcal glomerulonephritis (APSGN) an increase in the production of ET-1 is suspected due to damaged endothelium, platelet activation and increased thrombin production in the glomeruli. The aim of the present study was to investigate whether the levels of plasma ET-1 are elevated in children with APSGN. Furthermore, we examined the association between plasma ET-1 levels and blood pressure levels in the same children. METHODS: We studied 18 children (14 boys) with APSGN (mean age 7.44 to approximately 2.82 years). Fourteen healthy children served as controls. The following parameters were evaluated: plasma ET-1, plasma atrial natriuretic peptide (ANP), plasma renin (Rn), serum aldosterone (Aldo), creatinine clearance (Ccr) and fractional excretion of sodium (FENa). RESULTS: The mean plasma ET-1 concentrations were higher in patients with APSGN (3.39 to approximately 1.86 pg/mL) compared to controls (1.40 to approximately 0.15 pg/mL; P=0.0001). Patients with APSGN also had higher plasma ANP concentrations (41.67 to approximately 27.99 pg/mL) than the controls (22.80 to approximately 4.24 pg/mL; P=0.011). Plasma Rn concentrations were lower in patients (24.54 to approximately 16.34 microU/mL) compared to controls (56.76 to approximately 32.36 microU/mL; P=0.027). A positive correlation was found between ET-1 plasma concentrations and the height of systolic or diastolic blood pressure (r=0.57, P=0.013 and r=0.53, P=0.023, respectively). CONCLUSIONS: Our results suggest that increased plasma ET-1 concentrations may play an important role in the pathogenesis of hypertension in children with acute poststreptococcal glomerulonephritis.     

The TFS mini-sling for uterine/vault prolapse repair: A three-year follow-up review

Aims: To assess the three-year prolapse recurrence rate of the tissue fixation system (TFS) posterior mini-sling, an operation that works much like a McCall procedure.
Patients and methods: Patients who originally presented with major symptomatic prolapse were contacted by telephone three years after a posterior TFS mini-sling operation, and invited to attend for review. All patients were questioned as to recurrence of any lumps, 'dragging pain', satisfaction with the procedure and existence of any vaginal discharge.
Results: Of the original group of 39 patients, 35 were interviewed, 22 attended for review and four patients were uncontactable. Symptomatic cure was reported by 30 patients (86%), improvement in two (6%), and failure in three (9%).
Conclusions: The longer-term results from the TFS posterior sling are encouraging. The procedure is evolving, and more studies are required.