Changes in diastolic function in heart rejection: role of Doppler echocardiography]

In acute cardiac rejection, left ventricular diastolic function is altered. To study these abnormalities and their utility in cardiac allograft rejection, we studied 56 cardiac transplant recipients. All patients were assessed with endomyocardial biopsy and Doppler echocardiography done in the same day. A total of 163 Doppler studies were recollected. Cardiac transplant recipients were excluded during the early 6 weeks postoperative period. Totally, 100 biopsies were normal, 48 positive for mild rejection (Billingham Gde I-II) and 15 positive for moderate or severe rejection (Billingham Gde III-IV). Compared to negative biopsies, during acute rejection left ventricular wald thickness significantly increased (p < 0.05); isovolumic relaxation period and pressure half-time significantly decreased (p < 0.05, p < 0.001 respectively). Nevertheless, increase in peak early mitral flow velocity was only significantly associated with severe rejection (p < 0.001). Correlating only progressive shortening of isovolumic relaxation period parameter in the diagnosis of graft rejection, we forward a high sensibility (85%) and low specificity (57%). Thus, Doppler echocardiographic evaluation of left ventricular diastolic function provides a non-invasive tool for early detection of acute rejection monitoring after the early postoperative period.     

The association of cancer survival with four socioeconomic indicators: a longitudinal study of the older population of England and Wales 1981–2000

Background  

Many studies have found socioeconomic differentials in cancer survival. Previous studies have generally demonstrated poorer cancer survival with decreasing socioeconomic status but mostly used only ecological measures of status and analytical methods estimating simple survival. This study investigate socio-economic differentials in cancer survival using four indicators of socioeconomic status; three individual and one ecological. It uses a relative survival method which gives a measure of excess mortality due to cancer.     

Supravalvular aortic stenosis and coronary aneurysm]

A 32-year old woman, with endocarditis caused by Streptococcus mitis, and systolic murmur is presented. The Doppler examination was found a systolic gradient of 150 mmHg. Aortography showed a multiple membranous supravalvular aortic stenosis, with aneurysmal dilatation of the left main coronary artery and circumflex artery, associated with bicuspid aortic valve and mild aortic insufficiency. The patient died suddenly by cardiac arrest in stand by to cardiac surgery. Anatomic comprobation was not possible. The coronary artery anomalies associated with the supravalvular aortic stenosis syndrome are reviewed.     

Three-dimensional bone kinematics in an anterior laxity test of the ankle joint

Questions addressed in this in-vitro study are (1) what are the actual three-dimensional kinematics of talus and calcaneus during an anterior drawer test as performed with the quasi-static anterior ankle tester (QAAT) (2) does laxity measurement with the QAAT represent the true anterior translation of talus relative to the tibia?. Simultaneous measurements were made with the QAAT and a three-dimensional kinematics analysis system in five specimens. The three-dimensional translations and rotations on three axes were analysed at 25, 50 and 100 N of applied anterior load, with increased ligament damage. For four out of five remaining specimens, anterior translation values of talus and calcaneus and values as measured with the QAAT show a significant increase with growing ligament damage and with higher loads. Skeletal motions of talus and calcaneus show great similarity in three different motion axes, with increased ligament damage and at any given load. Skeletal translations and rotations of talus and calcaneus show great similarity during an anterior drawer movement of the ankle joint. Anterior skeletal translation of the talus and calcaneus show fair correlation with the anterior displacements measurements of the QAAT. These QAAT measurements show an overestimation of the laxity value by more than 200% irrespective of the load applied.