Assessment of Left Ventricular Volumes and Function by Real Time Three‐Dimensional Echocardiography in a Pediatric Population: A TomTec versus QLAB Comparison

Background: Three‐dimensional echocardiography (3DE) allows accurate calculation of ventricular volumes despite a remaining geometric assumption on the ventricular shape. Few studies involving full volume reconstruction software have been performed on children. Our aim was to compare the left ventricular (LV) volume measurements obtained with the most used 3D analysis software in a pediatric population. Methods: Fifty patients (median age: 9.5 years) without cardiac disease were included in the study. 3DE was performed with the X4–2 or X7–2 matrix probe (ie33, Philips). The LV volume analysis was performed with QLAB 6.0 (semiautomated border detection) and TomTec 4D LV (primary manual tracking with semiautomated border detection). Results: TomTec analysis feasibility amounted to 94% whereas QLAB analysis feasibility only reached 80% (P = 0.037). The analysis time was shorter with QLAB than TomTec (5 ± 2 versus 6 ± 3 minutes, P < 0.05). The stroke volume, end diastolic and end systolic LV volume measurements performed on the 40 patients were strongly correlated (r > 0.97; P < 0.0001) with minimal bias. The LV ejection fraction was well correlated (r = 0.79; P < 0.0001). Conclusion: 3D LV volume quantification is feasible either by using manual or automated reconstruction software in a normal pediatric population. LV Measurements are well correlated. Differences in volume reconstruction algorithms provide specific software performance characteristics. TomTec is a more feasible method but requires a longer analysis time. Further studies are needed to validate the accuracy of the method to calculate enlarged LV volumes in patients with congenital heart diseases. (Echocardiography 2010;27:1263‐1273)     

Diagnostic Value of Magnetic Resonance Imaging in Gynaecology

In this study 23 patients with various gynaecological pathologies were evaluated. Ultrasonography and magnetic resonance imaging were performed in all cases, but only 14 were evaluated with computed tomography. On the basis of ultrasonography, 4 patients were labelled as having malignant ovarian tumours, however, this diagnosis was confirmed by magnetic resonance imaging in only 1 of the 4. Magnetic resonance imaging also determined the correct diagnosis in a patient with endometrioma whereas computed tomography showed only a simple cyst, and ultrasonography diagnosed a subserous myoma. Tumour was demonstrated by magnetic resonance imaging in 2 patients with cervical carcinoma although computed tomography and ultrasonography had previously shown no tumour mass in these patients. It was concluded that magnetic resonance imaging is much superior to computed tomography and ultrasonography in gynaecological diagnosis. This advantage results from the correct detection of the contents of ovarian cysts, the number and localization of uterine leiomyomas in T2 scans, invasion of uterine malignancies and differential diagnosis of subserous uterine leiomyomas from ovarian tumours.     

An unusual case of Xanthoma disseminatum.

A 10-year-old boy was admitted to the University Hospital complaining of exhaustion, night sweats, coughing and dyspnea. Physical examination, laboratory findings and histopathological examination led to the diagnosis of Xanthoma disseminatum. Because of dyspnea a tracheostomy was performed 3 months before diagnosis was made. Outline of treatment and management of this patient is discussed in this paper.     

Abnormalities of myocardial perfusion in sickle cell disease in childhood: a study of myocardial scintigraphy

Ischaemic complications are common in SS homozygotic sickle cell disease in children, but the heart does not appear to be the target organ. The early detection of myocardial ischaemic in these children could prevent cardiac complications. The authors undertook a study of myocardial perfusion by myocardial scintigraphy in children with sickle cell disease. Twenty-three patients (average age 12 +/- 5 years) underwent Thallium 201 myocardial scintigraphy. Exercise on a bicycle ergometer and/or intravenous injection of dipyridamole were carried out depending on the age. The images (on exercise and late recovery period) were analysed in the 3 standard projections of the left ventricle: short axis, long axis and 4-chamber view. The left ventricular ejection fraction was measured by gamma angiography. Myocardial perfusion was abnormal in 14 patients (61%). The perfusion defects were reversible in the late recovery period in 9 patients and irreversible in 5 patients. The average left ventricular ejection fraction was 63 +/- 9%. Its value was not related to symptoms, haemoglobin level or the results of myocardial scintigraphy. Four patients with perfusion defects were symptomatic (cardiac failure, angina or ventricular tachycardia); 1 patient died and 3 were treated with hydroxyurea. Myocardial scintigraphy was carried out 6 months later and showed improved perfusion in 3 patients. Abnormalities of myocardial perfusion are therefore common in sickle cell disease. Often asymptomatic in childhood, there is a real risk of ischaemic cardiomyopathy and its complications in adulthood. Specific treatment of sickle cell disease with hydroxyurea should be considered in cases with significant abnormalities of myocardial perfusion.     

Diagnosis of adrenergic ventricular tachycardia in two homozygotic twins

The authors report the first case of adrenergic ventricular tachycardia observed in two 11 year old homozygotic twins. Syncope on exercise led to the investigation of the first twin with confirmation of the diagnosis by exercise stress testing. The same investigations led to the demonstration of the condition in the second asymptomatic twin. The two patients were treated with nadolol and there has been no recurrence of syncope with a 2 year follow-up. Adrenergic ventricular tachycardia is a rare arrhythmia with a risk of sudden death which may be prevented by betablocker therapy. An exhaustive familial inquiry is essential, but is only positive in one out of three cases. Mutations in the ryanodine receptor gene (hRyRZ) and also in the calsequestrin gene (CASQ2) have recently been reported. Progress in the understanding of the genetics of this condition should improve primary preventive measures.     

Urinary neutrophil gelatinase-associated lipocalin is associated with preeclampsia in a cohort of Turkish women

Purpose: We investigated the optimal cut-off level for urinary neutrophil gelatinase-associated lipocalin (NGAL) in preeclamptic patients to confirm the diagnosis.

Methods: Urinary NGAL concentrations were measured by specific enzyme-linked immunosorbent assay (ELISA).

Results: Patients with preeclampsia had significantly higher urinary NGAL concentrations than controls (mean: 387 ng/ml vs. 188 ng/ml, respectively; P< 0.001). Using a cutoff value 252 ng/ml for urinary NGAL to confirm diagnosis of preeclampsia, sensitivity, and specificity were 92% and 91%, respectively.

Conclusion: Urinary NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls.     

Clinical evaluation of cefmenoxime in urinary tract and prostatic infections

Cefmenoxime, a new cephalosporin, was given to fifty patients (28 male and 22 female) aged 15 to 86 years with infection of the urinary tract or prostate. Urinary tract infections, i.e. cystitis in 20 cases and pyelonephritis in 21, were usually chronic and associated with urologic anomalies. Nine patients had infection of the prostate. Pathogens recovered from the urine were 26 E. coli, 8 Klebsiella, 16 Serratia, 5 Proteus mirabilis or indole-positive Proteus, 1 Providencia, and 4 Pseudomonas. Minimal inhibitory concentrations of cefmenoxime ranged from 0.015 to 64 micrograms/ml (mean MIC: 0.12 micrograms/ml). Cefmenoxime was given as single drug therapy in all patients but one, in a daily dosage of 2 g divided into two intramuscular injections, for 3 to 28 days (average 22 days). Follow-up after discontinuation of treatment was four weeks. Therapeutic results were as follows: 13 successes and 7 failures by relapse for the 20 cystitis patients, 13 successes and 7 failures by relapse for the 20 interpretable cases of pyelonephritis, and 4 successes and 5 failures by relapse for the 9 patients with prostate infection. Local tolerance was excellent. Skin rash in 2 patients and diarrhea in 1 required withdrawal of the drug. Three other patients with diarrhea were able to continue treatment. Intolerance to ingestion of alcoholic beverages was reported by 10 patients. Hypereosinophilia was recorded in 2 cases and a transient mononucleosic reaction in one. No renal of hepatic side effects were documented.     

Thermal and photoinitiated copolymerization of the cyclic disulfide lipoamide with styrene

Thermal and photoinitiated copolymerizations of lipamide ( 1 ), a cyclic disulfide, with styrene in the absence of initiators were investigated. The thermal copolymerization is initiated via styrene radicals producing a copolymer with sulfide and disulfide linkages in the main chain and with amide and phenyl side groups. In the photopolymerization, the diradical formed by ringopening of 1 through homolytic fission of its strained disulfide bond is the main initiating species, attacking styrene to produce a copolymer with a high content of monomeric units of 1 .