Normal Anatomic Variants on Transthoracic Echocardiogram

Apart from their existence as medical curiosities, anatomic variants also double as diagnostic dilemmas. In the heart, more than in any other location in the body, misinterpretation of normal anatomic variants as pathologic entities can have a profound impact on treatment decisions and clinical consequences. Echocardiography is an easily accessible tool these days and is used routinely in most cardiac evaluations. Thus it becomes imperative for the echocardiographer to be cognizant of normal anatomic variants. Furthermore, echocardiographic findings should always be evaluated in their proper clinical context and diagnoses should never be entertained in a clinical vacuum. The literature is replete with numerous case reports and vignettes on these fascinating structures but is lacking in a formal review of normal anatomic variants. In this article, we have attempted a systemic review of normal variants, their embryologic origins, echocardiographic characteristics, and common pitfalls encountered in their evaluation.     

Role of a second stage partogram in predicting the outcome of normal labour

Background: Management of the second stage of labour is dictated by arbitrary time limits rather than true measures of progress. No partogram is available for second stage of labour.
Objectives: To evaluate a partogram designed for use for the second stage of labour.
Methods: This prospective cross-sectional analytical study included low-risk pregnant women with singleton fetuses with vertex presentations at term. From onset of the second stage, vaginal examinations were performed every 30 min until delivery. A scoring system developed by Sizer et al . was used based on station and position of fetal head. Scores were plotted on a second stage partogram and used to predict labour outcomes, such as duration of second stage and mode of delivery.
Results: Of 79 women examined, 73 had spontaneous vaginal delivery. Of the remaining six, four required oxytocin infusion and other two required vacuum extraction. The median durations of the second stage of labour for primigravidas ( n  = 34) and multigravidas ( n  = 45) were 35 and 25 min, respectively. The median Sizer's partogram score at the onset of second stage was 4. Multiple regression analysis showed that the partogram score ( r ² = 0.27) and gravidity ( r ² = 0.10) were independent predictors of duration of the second stage. There was a significant association between second stage progress plotted to the right of the partogram line and non-spontaneous delivery ( P =  0.01).
Conclusion: The second stage partogram score at onset can predict the duration of second stage. Poor progress plotted on the partogram is associated with non-spontaneous delivery.     

Immunophenotype of c-kit cells in normal human bone marrow: implications for the detection of minimal residual disease in AML

Summary. In the present study, seven normal human bone marrow samples from healthy volunteers have been analysed in order to investigate the immunophenotypic characteristics of the normal CD117⁺ cells and their utility for the detection of minimal residual disease in 71 acute myeloid leukaemia patients.
Our results show that most of normal BM CD117⁺ cells coexpress the HLADR and the myeloid associated CD33 antigen. In addition, almost half of CD117⁺ cells are CD34⁺, these cells displaying a different FSC/SSC distribution when compared to the CD117⁺/CD34⁻ cells. No CD117⁺/CD15⁺ and CD117⁺/CD10⁺ cells were detected and very few CD117⁺ cells (<1 × 10⁻³) expressing the HLADR⁻/CD34⁻, CD33⁺/HLADR⁻ and CD34⁺/HLADR⁻ phenotypes were found to be present in normal BM. In contrast, from the 71 AML patients analysed, 34 had CD117⁺/CD15⁺ blast cells and eight had the CD117⁺ phenotypes detected at low frequencies (<1 × 10⁻³) in normal BM.
In summary, the present study shows that the use of the CD117 antigen in different monoclonal antibodies combinations may be of great help for the detection of minimal residual disease in a high proportion of AML cases, especially in those patients displaying the CD117⁺/CD15⁺ phenotype, because cells coexpressing both antigens in normal BM, if present, are at very low frequencies.     

Comparison of normal saline versus Lactated Ringer's solution for fluid resuscitation in patients with mild acute pancreatitis,A randomized controlled trial

Background/Objectives

Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. However, there are few studies which focus on types of fluid therapy.

Responses to Norepinephrine of Normal and "Ischemic" Canine Purkinje Fibers are Consistent with Activation of Different α1-Receptor Subtypes

α₁-Receptor Subtype Stimulation of Purkinje Fibers. Introduction: Previously we found that WB4101 (WB) 10^-7 M competitively blocks three α₁-adrenergic receptor-effector responses: the increase in normal automaticity occurring in Purkinje fibers (PF) at high membrane potentials: the increase in abnormal automaticity occurring in PF at depolarized membrane potentials; and the prolongation of PF action potential duration. These observations are consistent with two different hypotheses: (1) WB blocks a single α₁-receptor subtype, which subserves different effector pathways; and (2) WB blocks different receptor subtypes, eacb of which subserves an independent patbway. The aim of this study was to test both hypotheses. Methods and Results: We used standard microelectrode techniques to study the concentration-dependent actions of three α₁-adrenoreceptor blockers (WB (α_1A?α_1D], 5-methylurapidil [5-MU] [α_1A, ?α_1D], and UK52,046 [nonselective]) on norepinephrine (NK) effects in normal PF and in PF depolarized with a simulated ischemic solution ([K⁺]_o= 10 mM; pO₂ < 20 mmHg; pH 6.8; maximum diastolic potential -60 ± 1 mV). In normally polarized PF, concentration-dependent actions of all blockers on both the positive cbronotropic response and the prolongation of action potential duration completely coincide. In contrast, the response to NE of abnormal automaticity in “ischemic” PF differs from normals: there is a bigh sensitivity to WB and 5-MU and no response to UK52,046. Conclusions: (1) A single receptor subtype appears responsible for botb the α₁-induced prolongation of repolarization and the positive chronotropic effect in normal PF. (2) Two different receptor subtypes may be responsible for the α₁-induced effects on automaticity in normal and ischemic fibers. It is likely that the latter one is α_1A, and that consideration of antiarrhythmic therapy with α₁-adrenergic blockers should focus on this subtype as a potential target.     

LIF和RANTES在单病原菌性血流感染小鼠模型中的表达及意义

目的探讨4种血流感染常见病原菌分别致小鼠血流感染后白血病抑制因子(leukaemia inhibitory factor,LIF)和活化T细胞调节的、正常T细胞表达和分泌的细胞因子(regulated upon activation,normal T cell expressed and secreted factor,RANTES)的表达及变化规律,为细菌性血流感染的早期诊断提供研究基础。方法建立金黄色葡萄球菌、粪肠球菌、大肠埃希菌和肺炎克雷伯菌标准菌株的CD-1(ICR)小鼠血流感染模型,用蛋白质液相芯片技术检测各实验组和PBS对照组感染后0.5 h、1 h、3 h、6 h、12 h、24 h和48 h时LIF和RANTES的浓度。结果金黄色葡萄球菌、粪肠球菌、大肠埃希菌和肺炎克雷伯菌的致小鼠死亡的半数致死量(LD50)分别约为8.1×108/m L、9.6×108/m L、8.1×108/m L和1.1×109/m L。细菌入血1 h时血清中LIF的浓度明显升高,大肠埃希菌组、肺炎克雷伯菌组、金黄色葡萄球菌组和粪肠球菌组LIF的峰浓度分别为(51.6±5.0)pg/m L、(73.2±20.8)pg/m L、(7.3±0.9)pg/m L和(6.1±1.2)pg/m L,与对照组相比,差异均有统计学意义(P均0.01)。粪肠球菌组、大肠埃希菌组和肺炎克雷伯菌组细菌入血1 h时RANTES浓度明显升高,3 h时升高更明显。且大肠埃希菌组和肺炎克雷伯菌组升高的幅度较金黄色葡萄球菌和粪肠球菌组更为明显。达峰值时浓度分别为(1 929.0±25.2)pg/m L、(1 218.1±227.4)pg/m L、(55.7±10.0)pg/m L和(179.2±9.2)pg/m L,与对照组相比,差异均有统计学意义(P均0.01)。结论 LIF和RANTES的浓度在细菌入血后1 h即明显升高。感染后的2 d内,大肠埃希菌组和肺炎克雷伯菌组LIF和RANTES浓度的升高幅度明显高于金黄色葡萄球菌组和粪肠球菌组。联合检测LIF和RANTES可能在细菌性血流感染早期诊断和区分革兰阴性/革兰阳性菌感染方面有一定作用。     

A critical assessment of uncalibrated respiratory inductance plethysmography (Respitrace®) for the measurement of tidal breathing parameters in newborns and infants

We have compared results obtained with an uncalibrated respiratory inductance plethysmograph (RIP) with those of a face mask and pneumotachograph (PNT) for the computerized measurement of the time to reach peak tidal expiratory flow as a ratio of total expiratory time (t_pTEF:t_E). Simultaneous measurements were made in 32 healthy neonates aged 0–3 weeks, 35 healthy infants aged 5–82 weeks, and 28 infants aged 15–94 weeks with physician diagnosed recurrent wheeze. The group mean (±SD) values of t_pTEF:t_E determined using a PNT were 0.455 (±0.129), 0.263 (±0.077), and 0.232 (±0.089) for the neonates, healthy infants and infants with recurrent wheeze respectively. RIP gave mean (±SD) values that were 0.055 (±0.044) and 0.025 (±0.104) lower than the PNT in healthy neonates and infants with recurrent wheeze respectively; RIP values were 0.002 (±0.073) higher in the healthy infants over 4 weeks of age than measurements by PNT. Although the difference between the two measurements was not related to the thoracoabdominal phase angle, as measured from Lissajous figures, examination of the RIP ribcage and abdominal signals revealed that many healthy subjects, while appearing clinically in phase, had ribcage and abdominal signals that differed markedly from each other in terms of convexity/concavity during early expiration. This may explain the lack of agreement between the two methods. We conclude that uncalibrated RIP should be used with caution for the determination of t_pTEF:t_E, even in subjects whose ribcage and abdomen appear to move synchronously. The measurement of t_pTEF:t_E did not differentiate between the healthy infants and infants with recurrent wheezing. Pediatr Pulmonol. 1995; 20:119–124 . © 1995 Wiley-Liss, Inc.