Left ventricular mass and diastolic function in normotensive young adults with autosomal dominant polycystic kidney disease

Left ventricular hypertrophy is often found very early in the course of autosomal dominant polycystic kidney disease (ADPKD). Diastolic dysfunction has been shown in hypertensive adult patients with ADPKD with increased left ventricular mass (LVM), but there are no data about diastolic function in the young ADPKD population without hypertension and with normal renal function. To evaluate very early alterations in cardiac structure and diastolic function in young normotensive patients with ADPKD, color Doppler echocardiography was performed in 46 young normotensive patients with ADPKD and 35 healthy subjects. LVM, transmitral pulsed Doppler flow (diastolic function), and valvular abnormalities were studied. Patients with ADPKD showed higher LVM indices (LVMIs) than controls (89.7+/-17.3 v 68.5+/-17.2 g/m2; P < 0.0001). Peak early diastolic velocity (E wave) deceleration time and isovolumic relaxation time were significantly prolonged in patients with ADPKD compared with controls (E wave deceleration time, 182.5+/-51.3 v 149.4+/-34 msec; P=0.002; isovolumic relaxation time, 97.7+/-17.5 v 79+/-15 msec; P=0.0001). No differences were found in valvular abnormalities in the two groups. In conclusion, young normotensive patients with ADPKD showed increased LVMIs and Doppler abnormalities consistent with early diastolic dysfunction.     

Reduction of sound levels with antinoise in MR imaging

A combination of active and passive techniques was used to reduce the sound levels in magnetic resonance imagers. These techniques were integrated into an existing audio system. Measurements of sound reduction varied with the protocol being used and averaged 9.9 dB with coaxial cabling and 14.2 dB with fiberoptic conduction of the feedback signal to a controller. Patient comfort and communication were improved.     

Failure of ablation of a mediastinal parathyroid adenoma by repeated contrast staining

In a patient with primary hyperparathyroidism an attempt was made to ablate a middle mediastinal parathyroid gland by forceful staining with radiographic contrast material. The gland was stained on two separate occasions, two weeks apart. Both times the serum calcium level temporarily fell to the normal range but reverted to abnormal levels. The patient ultimately required surgery for correction of hypercalcemia. The mechanism of staining and possible reasons for failure as well as potential complications are discussed.     

Effect of the Toll-like receptor 4 (TLR-4) variants on intima-media thickness and monocyte-derived macrophage response to LPS

OBJECTIVES: Toll-like receptor 4 (TLR-4) is believed to contribute to the initiation and progression of atherosclerosis. The association of the D299G polymorphism of the TLR-4 gene with the progression of coronary and carotid atherosclerosis, risk of cardiovascular events and myocardial infarction is controversial. We have investigated whether the presence of the D299G polymorphism and the co-segregated T399I polymorphism affects the intima-media thickness (IMT) in the general population. SUBJECTS: The PLIC study population (n = 1256) was genotyped for the D299G and the T399I polymorphisms. RESULTS: The presence of both the D299G and T399I alleles was observed in the 13.0% of the population, carriers of the T399I alone were 1.8% and of the D299G alone were 0.9%. No difference in IMT was detected within the carriers of the D299G and T399I alleles and the wild-type subjects in the PLIC population. Furthermore, we investigated whether monocyte from D299G to T399I subjects present a defective response to CD40, interleukin (IL)-6, monocyte chemotactic protein (MCP)-1, cyclo-oxygenase (COX)-2 and PTX3 expression induced by lipopolysaccharide (LPS). When the monocyte-derived macrophages of these subjects were challenged with LPS (1 mug mL(-1)), no impact of the polymorphisms on the induction of CD40, MCP-1 and PTX3 was observed. Only IL-6 and COX-2 induction by LPS resulted reduced in the D299G/T399I carriers. CONCLUSION: The presence of the D299G and T399I polymorphisms of the TLR-4 gene does not play a major role on the progression of carotid atherosclerosis. Macrophages from the subjects carrying the polymorphisms show an impaired response to LPS limited only to a IL-6 and COX-2.     

Infantile spasms and West syndrome

West syndrome, an epileptic encephalopathy of infancy and early childhood with variable etiology, consist of the triad of infantile spasms, arrest or regress of psychomotor development and specific EEG pattern of hypsarrhythmia. Infantile spasms occur within the first year of life. West syndrome has proved to be resistant to treatment, although VPA and benzodiazepines have been shown to be helpful. Then is general agreement that ACTH or oral corticosteroids remain the treatment of choice, especially in idiopathic cases, which have a better prognosis.     

Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study

Background  

This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services.     

Development and application of virtual reality technology to improve hand use and gait of individuals post-stroke

Development and application of virtual reality (VR) systems for rehabilitation is an iterative process produced by collaboration of an inter-disciplinary team of engineers, neuroscientists and clinician-scientists. In this paper the use of virtual reality technology for the rehabilitation of individuals post-stroke is described. The development of the hardware is based on principles of motor control. Development of the software uses findings from the enrichment and motor plasticity and training literatures as well as principles of motor learning. Virtual environments are created to afford individuals post-stroke opportunities to practice tasks for which they require rehabilitation. These tasks, related to hand function and gait, are trained both at the impairment and functional level. The training engages users to allow for the repetitive intensive practice required for behavioral motor plasticity. Results from a series of upper and lower extremity studies indicate that use of VR technology to augment rehabilitation of individuals post-stroke merits further study.