Pulmonary venous flow velocity patterns in 143 normal subjects aged 20 to 80 years old: An echo 2D colour Doppler cooperative study

In order to find out the normal values and to evaluate the effectsof age, heart rate, sex, and haemodynamic and standard echocardiographicparameters on pulmonary venous flow velocity obtained by thetransthoracic approach, Doppler pulmonary venous flow parameterswere measured in 143 healthy subjects aged from 20 to 80 years. Doppler pulmonary venous flow parameters which had the bestcorrelation with age were: the peak velocity of the systolicwave (r=0·39) and its integral (r=0·5), the peakvelocity of the diastolic wave (r=–0·6) and itsintegral (r=–0·44); the systolic (r=0·68)and diastolic fractions (r=–0·68); the systolic/diastolicpeak velocity ratio (r=0·73) and the systolic/diastolicintegral ratio (r=0·7). The atrial reversal wave didnot correlate with age; the atrial reversal wave was more difficultand probably less reliable to measure than the systolic anddiastolic waves. The correlations of pulmonary venous flow parameters with mitralflow parameters were also examined. This study showed that,in healthy subjects, despite an increase in the early and atrialwaves from the annulus to the tips of the mitral leaflets, thereis a similar association between pulmonary venous flow and mitralflow measured at the annulus or at the tips of the mitral leaflets. The intra-observer reproducibility of all the pulmonary venousflow parameters considered were found to be excellent. Moderateinter-observer variability was observed for the systolic, diastolicand atrial reversal wave peak velocities and integrals; however,the systolic/diastolic ratio improved the precision of the measurements. Multivariate analysis showed that age is the principal determinantof the Doppler parameters of pulmonary venous flow; heart rate,sex, body surface area, the size of the left atrium in systoleand the left ventricular ejection fraction all influence theDoppler parameters of pulmonary venous flow, even if only slightly.     

MAML2 rearrangement in Warthin's tumour: a fluorescent in situ hybridisation study of metaplastic variants

J Oral Pathol Med (2012) 41: 615-620 Background: Warthin's tumour (WT) is a common benign lesion of the major salivary glands. The nature of WT remains controversial, with particular regard to the presence of clonal chromosomal abnormalities, including the t(11;19) translocation involving the CRTC1 and MAML2 genes, that have been identified in both WT and mucoepidermoid carcinoma. In this study, we focused our attention on metaplastic WT variants, and we conducted a fluorescent in situ hybridisation (FISH) analysis for the presence of MAML2 gene rearrangement. Methods: Dual-colour FISH analysis was performed on paraffin-embedded sections of eight WTs showing metaplastic changes (five with squamous metaplasia, two with mucinous metaplasia and one with both) using a MAML2 break-apart probe. Results: Presence of split signals indicative of gene rearrangement was identified in a subset of cells in areas of squamous metaplasia in two samples of WT. No rearrangement was observed in the oncocytic epithelium, in lymphocytes and in areas of mucinous metaplasia. Conclusions: The presence of a small subpopulation of cells carrying MAML2 rearrangement in areas of squamous metaplasia within WT could predispose these lesions to malignant transformation in mucoepidermoid carcinoma and could represent a molecular link between the two entities.     

Three-Dimensional Echocardiography: Advancements in Qualitative and Quantitative Analyses of Mitral Valve Morphology in Mitral Valve Prolapse

Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.     

Chronic kidney disease in the type 2 diabetic patients: prevalence and associated variables in a random sample of 2642 patients of a Mediterranean area

ABSTRACT: BACKGROUND: Kidney disease is associated with an increased total mortality and cardiovascular morbimortality in the general population and in patients with Type 2 diabetes. The aim of this study is to determine the prevalence of kidney disease and different types of renal disease in patients with type 2 diabetes (T2DM). METHODS: Cross-sectional study in a random sample of 2,642 T2DM patients cared for in primary care during 2007. Studied variables: demographic and clinical characteristics, pharmacological treatments and T2DM complications (diabetic foot, retinopathy, coronary heart disease and stroke). Variables of renal function were defined as follows: 1) Microalbuminuria: albumin excretion rate > 30 mg/g or 3.5 mg/mmol, 2) Macroalbuminuria: albumin excretion rate > 300 mg/g or 35 mg/mmol, 3) Kidney disease (KD): glomerular filtration rate according to Modification of Diet in Renal Disease < 60 ml/min/1.73 m2 and/or the presence of albuminuria, 4) Renal impairment (RI): glomerular filtration rate < 60 ml/min/1.73 m2, 5) Nonalbuminuric RI: glomerular filtration rate < 60 ml/min/1.73 m2 without albuminuria and, 5) Diabetic nephropathy (DN): macroalbuminuria or microalbuminuria plus diabetic retinopathy. RESULTS: The prevalence of different types of renal disease in patients was: 34.1% KD, 22.9% RI, 19.5% albuminuria and 16.4% diabetic nephropathy (DN). The prevalence of albuminuria without RI (13.5%) and nonalbuminuric RI (14.7%) was similar. After adjusting per age, BMI, cholesterol, blood pressure and macrovascular disease, RI was significantly associated with the female gender (OR 2.20;CI 95% 1.86-2.59), microvascular disease (OR 2.14; CI 95% 1.8-2.54) and insulin treatment (OR 1.82; CI 95% 1.39-2.38), and inversely associated with HbA1c (OR 0.85 for every 1% increase; CI 95% 0.80-0.91). Albuminuria without RI was inversely associated with the female gender (OR 0.27; CI 95% 0.21-0.35), duration of diabetes (OR 0.94 per year; CI 95% 0.91-0.97) and directly associated with HbA1c (OR 1.19 for every 1% increase; CI 95% 1.09-1.3). CONCLUSIONS: One-third of the sample population in this study has KD. The presence or absence of albuminuria identifies two subgroups with different characteristics related to gender, the duration of diabetes and metabolic status of the patient. It is important to determine both albuminuria and GFR estimation to diagnose KD.