Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging.

OBJECTIVES: We evaluated the accuracy and reproducibility of contrast echocardiography versus tissue harmonic imaging for measurements of left ventricular (LV) volumes and ejection fraction (EF) compared to magnetic resonance imaging (MRI). METHODS: Digital echo recordings of apical LV views before and after intravenous contrast were collected from 110 consecutive patients. Magnetic resonance imaging of multiple short-axis LV sections was performed with a 1.5-T scanner. Left ventricular volumes and EF were calculated offline by method of discs. Thirty randomly selected patients were reanalyzed for intraobserver and interobserver variability. RESULTS: Compared with baseline, contrast echo increased feasibility for single-plane and biplane volume analysis from 87% to 100% and from 79% to 95%, respectively. The Bland-Altman analysis demonstrated volume underestimation by echo, but much less pronounced with contrast. Limits of agreement between echo and MRI narrowed significantly with contrast: from -18.1% to 8.3% to -7.7% to 4.1% (EF), from -98.2 to -11.7 ml to -59.0 to 10.7 ml (end-diastolic volume), and from -58.8 to 21.8 ml to -38.6 to 23.9 ml (end-systolic volume). Ejection fraction from precontrast echo and MRI differed by > or =10% (EF units) in 23 patients versus 0 after contrast (p < 0.001). At intraobserver and interobserver analysis, limits of agreement for EF narrowed significantly with contrast. CONCLUSIONS: The two-dimensional echocardiographic evaluation of LV volumes and EF in non-selected cardiac patients was found to be more accurate and reproducible when adding an intravenous contrast agent.     

Quality of life assessed with EQ-5D in patients undergoing glioma surgery: What is the responsiveness and minimal clinically important difference?

Purpose

To evaluate the responsiveness of EQ-5D 3L in patients undergoing intracranial glioma surgery and estimate the minimal clinically important difference (MCID).

Materials and methods

EQ-5D 3L index values from 164 patients who underwent glioma surgery in the period 2007–2012 were analysed. Responsiveness and MCID were estimated using a combination of distribution-based and anchor-based methods. Karnofsky performance status served as an anchor.

Results

Patients who improved functionally did not report significantly higher EQ-5D 3L scores post operatively with a standardized response mean (SRM) of 0.04 (p = 0.13). Patients who deteriorated functionally reported significantly lower EQ-5D 3L scores post operatively with a SRM of 0.72 (p < 0.001). With different approaches, we determined a range of MCID values from 0.13 to 0.15.

Conclusions

EQ-5D 3L is responsive to changes when glioma patients are deteriorating functionally after surgery but not responsive when the patients are improving. The MCID values for EQ-5D 3L in glioma surgery seem higher than reported MCID values for other types of cancers.     

Simultaneous EMGs From Six Sites During Muscular Relaxation: A Comparison Between Forehead and Forearm Feedback

In light of the continuing popularity of frontalis EMG feedback for general relaxation purposes, a pertinent question is whether this procedure is superior to feedback from other muscles. This question was addressed by comparing a frontalis feedback group (n = 12) with a forearm feedback group (n = 10) in a one-session experiment. The experimental session included a 10-min rest period preceded by verbal relaxation instructions and demonstration of the respective feedback contingencies, and followed by a 30-min feedback period. EMG records were obtained from forehead, forearm, neck, masseter, sternomastoid, and lower leg. In the two target muscles, significant group differences developed during rest, but no additional significant effects were produced during feedback. Regarding the four untrained sites, EMG tended to decrease in the forehead group, but not significantly below the levels of the forearm group. Simultaneous EMG cross-correlations within 5-min intervals based on successive 1-sec averages showed significant covariation between muscles in the head and neck area; the source of this covariation was uncertain, however—electrical “crosstalk” and generalized muscular responding were two possibilities discussed.     

Heart rate and finger pulse amplitude during muscular relaxation with frontalis versus forearm EMG feedback.

Twenty-nine volunteers participated in a one-session experiment consisting of 10 min rest followed by a 30 min treatment period. Brief relaxation instructions were given at the beginning of the rest period. The treatment was either frontalis EMG feedback, forearm EMG feedback, or non-contingent stimulation. The two feedback groups showed EMG decreases in their respective target muscles during the no-feedback rest period, with no further decrease during feedback training, indicating that feedback was no more effective than relaxation instructions. Heart rate decreased significantly in both feedback groups. Finger pulse amplitude decreased significantly in the forearm feedback group. It is pointed out that the latter change does not necessarily indicate peripheral vasoconstriction, but may be due to a fall in pulse pressure as a consequence of increased blood flow to the relaxing muscles. The results are unsupportive of the assumption that frontalis relaxation is particularly effective in inducing a generalized relaxation.     

Are there predilection sites for intracranial meningioma? A population-based atlas

Neurosurgical Review - Meningioma is the most common benign intracranial tumor and is believed to arise from arachnoid cap cells of arachnoid granulations. We sought to develop a population-based...     

Brain infarction following meningioma surgery—incidence,risk factors,and impact on function,seizure risk,and patient-reported quality of life

Neurosurgical Review - In this study, we seek to explore the incidence of and potential risk factors for postoperative infarctions after meningioma surgery, in addition to the possible association...     

Dependence of EDR Recovery Times and Other Electrodermal Measures on Scale of Measurement: A Methodological Clarification

Edelberg (1970) and Boucsein and Hoffmann (1979) found shorter recovery times with a constant voltage method as compared with a constant current method. In the present paper it is pointed out that this effect may be due to the use of different scales of measurement rather than to any electrophysiological aspects of the recording procedure. The mathematical relationship between resistance and conductance implies that recovery times are shorter for SCRs than for corresponding SRRs. For demonstration purposes, recovery times were computed from an SR record and compared with those computed from the same record after computerized transformation to SC. Research implications of the demonstrated effect are discussed, and the relevance of measurement scale to two other electrodermal measures, area below the curve and range-corrected amplitude, is pointed out.