Sonovue improves endocardial border detection and variability in assessing wall motion score and ejection fraction during stress echocardiography

Background Stress echocardiography is useful for assessing patients with coronary artery disease unable to undergo formal exercise testing. Considerable skill is required to avoid large intra- and inter-observer variability due to poor endocardial definition. Intravenous ultrasound contrast agents are now available which may improve this variability. Aim To study intravenous Sonovue in assessing wall motion score and ejection fraction (EF) during stress echocardiography. Methods Thirty-eight patients undergoing arbutamine stress echocardiography for known or suspected coronary artery disease were studied. Echocardiographic analysis of wall motion score index, endocardial border detection (EBD) and EF was performed at rest and at peak stress before and after intravenous injection of Sonovue, by experienced and inexperienced observers. Results All three observers noted an improvement in endocardial border definition following Sonovue (p=<0.001). At baseline, there was a significant difference in wall motion score index between experienced and inexperienced observers at rest (p=0.01) and at peak stress (p=0.001). Following Sonovue administration this was no longer significant (p=0.07, p=0.114). Intra-observer variability of end diastolic, end systolic volumes (ESV) and EF improved following contrast (p<0.05) at rest and during stress. Conclusion Sonovue significantly improved EBD and reduced intra-observer variability of EF at rest and during peak arbutamine infusion.     

Surgical methods of correction of the renal transplantation complications

Surgical complications were studied, which occurred in 55 (20.37%) of 244 patients, to whom 270 renal allotransplantation (RAT) operations were performed. In 19 (34.6%) of recipients the urological complications were noted, in 20 (34.4%)--spontaneous rupture of the transplant, in 11 (20%)--lymphocele, in 5 (9.1%)--arrosive hemorrhage from the renal transplant artery. The methods of surgical correction of the RAT complications were optimized. Urological complications and spontaneous rupture of the renal allotransplant were revealed most frequently. An acute rejection reaction constitutes the most frequent cause of spontaneous rupture of the renal allotransplant. While the RAT surgical complications occurrence an active surgical tactics is adopted.     

Elective operative procedures in patients with chronic end-stage renal failure

The results of 92 elective operative interventions, performed in 71 patients with chronic renal insufficiency (CRI) in terminal stage, were studied. Performance of elective operative interventions in patients with CRI in terminal stage, to whom the treatment, using chronic hemodialysis, was conducted, allows to increase quality of their medical and social rehabilitation considerably and the efficacy of kidney transplantation (KT). They constitute effective and safety method of treatment in complex surgical program of patients preparation to KT performance.     

Microglia and astrocytes in the adult rat brain: comparative immunocytochemical analysis demonstrates the efficacy of lipocortin 1 immunoreactivity

The distribution of glial cells (microglia and astrocytes) in different regions of normal adult rat brain was studied using immunohistochemical techniques and computer analysis. Lipocortin 1, phosphotyrosine, and lectin GSA B(4), were used for identification of microglia, while S100beta and glial fibrillary acidic protein identified astrocytes. Bioquant computerized image analysis was used to quantify and map the immunostained cells in sections from adult rat brain. If lipocortin 1 was used as a marker, more microglial cells were detected than with phosphotyrosine or lectin. The lipocortin 1-positive microglial population was most numerous (on average, 130+/-5 cells/mm(2) of the brain section area) in neostriatum, and least (51+/-4 cells/mm(2)) in cerebellum and medulla oblongata. In general, the density of lipocortin 1 microglia was higher in the forebrain, and lower in the midbrain, and the least in the brainstem and cerebellum. The number of S100beta astrocytes was two to three times larger than the number of microglial cells, and approximately two times greater than glial fibrillary acidic protein cells. A high density of astrocytes was found in the hypothalamus and hippocampus (more than 260 cells/mm(2)); they were more numerous in the white matter than in the gray matter. Fewer astrocytes were observed in the cerebral cortex, neostriatum, midbrain, medulla oblongata and cerebellum (less than 200 cells/mm(2)). Thus lipocortin 1 and S100beta were shown to be the most specific and reliable markers for microglia and astrocytes, respectively.The regional population differences demonstrated for lipocortin 1 microglia and S100beta astrocytes presumably reflect structural and functional specializations of the certain brain regions.     

Informed Consent

There have been significant changes in the doctor patient relationship with the impact of technology in day-to-day practice. More and more patients are aware of their rights and are keen to make free choice and decision on their treatment. This helps them to choose the treatment of their choice from the options available and to select a physician of their choice. Doctor's decisions are being questioned regarding their correctness and there is a need to educate the patient, on what one offers by way of treatment. In some procedures and types of treatment, patient needs to be educated and informed of the merits and demerits of the treatment available. This will help the patient to make appropriate choice and also to accept some adverse outcome of treatment. Towards this end, all countries are looking afresh at the necessity of Informed Consent. Methods adopted by some countries are highlighted to help our physicians practice them in an appropriate way. A lot of remedial work needs to be done to minimize future litigation, as many doctors misunderstand their legal obligations and haven't caught up with the change in judge's thinking.     

A method choice in the myocardial revascularization in the ischemic heart disease on the basis of clinico-angiographic data on patients]

Of 230 patients, examined by coronarography, in 219 the signs of the ischemic heart disease were revealed. The criterions were elaborated for differentiated choice of the myocardial revascularization method.     

The prevalence of headache with emphasis on tension-type headache in rural Tanzania: a community-based study

The aim of the study was to assess the prevalence of headache with special attention to tension-type headache (TTH) in a rural area in northern Tanzania. A door-to-door study was performed using a standardized and validated questionnaire. A total of 7412 participants were screened. The total headache prevalence during the past year was 12.1%; the overall 1-year prevalence of TTH was 7%; 5% reported episodic TTH and 0.4% chronic TTH. Borderline cases (International Headache Society code 2.3) were described in 1.6%. The prevalence of headache was highest in the 41–50-year-old group in women and in the 61+ age group in men. This is the first account of the prevalence of TTH in a rural Tanzanian population, and shows that headache in general and, more specifically, TTH are prevalent disorders that deserve attention. However, the prevalence of primary headache seems to be lower than in Western countries.