Predictive value of early radiographic findings in cementless total hip arthroplasty femoral components: an 8- to 12-year follow-up

Total hip replacement was performed in 119 patients (124 hips) with an uncemented Ortholoc femoral component between 1982 and 1987. Eight patients (9 hips) died, and 13 patients (15 hips) were lost to follow-up, leaving 98 patients (100 hips) followed for 8 to 12 years. Pain scores and anteroposterior and lateral radiographs of the femoral component from the 2-year follow-up visit were evaluated. Twenty-four of the 100 hips were revised for aseptic loosening. Radiographic criteria were highly effective in predicting those cases that would require revision. Radiolucent lines occurred at a higher frequency in all Gruen zones of the revision group radiographs, and the differences were statistically significant in zones 1, 7, 8, and 14 (P < .001). Proximal radiolucent lines were present in all of the revision cases and in 45% of the nonrevision cases. Radiolucent lines occurring on the lateral view alone were a statistically significant predictor of future need for revision (P < .001). Presence of radiolucent lines around the porous coating was 100% sensitive and 55% specific in predicting future revision. Absence of radiolucent lines around the porous coating was 100% sensitive and 45% specific in predicting no need for revision in the first 8 years.     

Development and evaluation of a clinical psychopharmacology educational curriculum

The strength of bone is determined not only by bone density but also by structure. Therefore, quantification of the structure in radiographs by texture parameters may result in a better prediction of fracture risk. Since in radiographs density and structure are strongly correlated, the predictive power of texture parameters should be corrected for the influence of BMD to determine the additional information conveyed by these parameters. In this study, we evaluated the predictive power of various texture parameters based on the Grey-Level Dependence Method and the Morphological Gradient Method. This study was performed on 67 vertebrae obtained from 20 male and 12 female human cadaver thoracolumbar spines. BMD and area of the vertebral body were determined from QCT images and texture parameters were derived from direct magnification (DIMA) radiographs. The fracture force, measured under conditions simulating the in vivo situation, was corrected with the area of the vertebra to yield the fracture stress (FS). Results of the study indicate that BMD correlates significantly with FS r = 0.82 (P < 0. 001, n = 24) and r = 0.94 (P < 0.001, n = 43) for female and male vertebrae, respectively. Correlation coefficients of the investigated texture parameters were as high as 0.80 (P < 0.001) and 0.67 (P < 0.001) for the female and male vertebrae, respectively. Multiple regression analysis showed that in female vertebrae, the addition of one texture parameter to BMD results in a better prediction of strength. The multiple correlation coefficient was 0. 87 (P < 0.001) in this case. In male vertebrae, BMD was the best predictor of fracture stress. These results suggest that texture parameters, as measured in magnification radiographs, can predict bone strength. Whereas in all cases BMD is the best single predictor of bone strength, for women texture parameters contain useful additional information.     

Prospective evaluation of viable myocardium by quantitative dipyridamole-thallium-201 scintigraphy and radionuclide ventriculography

Improvement of myocardial function is a major goal of coronary revascularization. Considerable interest remains in the preoperative identification of viable myocardium. We examined 26 consecutive patients with left ventricular dysfunction undergoing coronary artery bypass grafting. Serial dipyridamole-thallium imaging and radionuclide ventriculography was performed preoperatively and postoperatively. The relationship between preoperative and postoperative thallium perfusion and segmental wall motion was analyzed. The mean preoperative ejection fraction was 32 +/- 9 (21 to 51%) and increased to 41 +/- 12 (17 to 67%) postoperatively (p > 0.01). Seventy-seven percent of patients improved their global ejection fraction postoperatively by > 5%. Thallium perfusion improved postoperatively in 84% of reversible defects vs 63% of partially reversible defects and 35% of fixed defects. Segments with either reversible or partially reversible thallium defects showed an improved postoperative wall motion in 71% and 68%, respectively. Postoperative wall motion improved in 43% of fixed defects. Overall, 67% of hypokinetic segments showed improved postoperative wall motion while only 29% of akinetic or dyskinetic segments improved postoperatively. Preoperative thallium redistribution coupled with preserved wall motion was predictive of improvement in wall motion was predictive of improvement in wall motion postoperatively and indirectly indicates myocardial viability. However, 43% of fixed defects also showed improved postoperative wall motion. A significant improvement in global ejection fraction was found and could be predicted by a linear regression analysis utilizing clinical and thallium parameters.     

Effects of the level of asphyxia during delivery on viability at birth and early postnatal vitality of newborn pigs

Newborn pigs (n = 117) were used to provide information on the relationships of degree of asphyxia during delivery, viability at birth, and some striking aspects of postnatal vitality including survival, interval between birth and first udder contact and between birth and first suckling, rectal temperature at 24 h of life (RT24), and growth rate over the first 10 d of life. The degree of asphyxia at birth was estimated from cord blood pCO2, pH, and lactate levels. Onset of respiration, heart rate, skin color, and attempts to stand during the first minute after birth were used to estimate the viability score. Neonatal asphyxia, i.e., decreased blood pH and increased blood pCO2 and lactate, was associated with the production of unusually high levels of catecholamines. The degree of asphyxia increased with late position in the birth order (P < .01) and was higher in piglets born posteriorly (P < 0.5). Further, the average blood pCO2 within a litter increased (P < .05) with litter size. The was an inverse relationship between the degree of asphyxia and the viability score (P < .001). Highly viable piglets reached the udder more rapidly (P < .001) and had a higher RT24 (P < .001) than those of low viability. Plasma glucose concentrations increased with blood pCO2 and plasma epinephrine concentrations (P < .001). Neonatal asphyxia reduced postnatal vitality by delaying the first contact with the udder (P < .03) and was associated with a lower RT24 (P < .05), growth rate (P < .001), and survival over 10 d (P < 0.06). These variables, i.e., interval between birth and first udder contact, RT24, and growth rate, were correlated with birth weight (P < .001); RT24 was also shown to decrease (P < .001) with the time taken to reach the udder. Overall, results suggest that piglet suffering from asphyxia during delivery are less viable at birth and less prone to adapt to extrauterine life.     

Protective activity of propofol, Diprivan and intralipid against active oxygen species

The purpose of this study was to assess the importance of stereolithographic models (SLMs) for preoperative diagnosis and planning in craniofacial surgery and to examine whether these models offer valuable additional information as compared to normal CT scans and 3D CT images. Craniofacial SLMs of 20 patients with craniomaxillofacial pathology were made. A helical volume CT scan of the anatomic area involved delivered the necessary data for their construction. These were built with an SLA 250 stereolithography apparatus (3D-Systems, Valencia, CA, USA), steered by FORM-IT/DCS software (University of Zurich, Switzerland). The stereolithography models were classified according to pathology, type of surgery and their relevance for surgical planning. Though not objectively measurable, it was beyond doubt that relevant additional information for the surgeon was obtained in cases of hypertelorism, severe asymmetries of the neuro- and viscerocranium, complex cranial synostoses and large skull defects. The value of these models as realistic "duplicates" of complex or rare dysmorphic craniofacial pathology for the purpose of creating a didactic collection should also be emphasized. The models proved to be less useful in cases of consolidated fractures of the periorbital and naso-ethmoidal complex, except where there was major dislocation.     

The value of preoperative planning for total hip arthroplasty

To analyse the value and accuracy of preoperative planning for total hip replacement (THR) we digitised electronically and compared the hand-sketched preoperative plans with the pre- and postoperative radiographs of 100 consecutive primary THRs. The correct type of prosthesis was planned in 98%; the agreement between planned and actually used components was 92% on the femoral side and 90% on the acetabular side. The mean (+/- SD) absolute difference between the planned and actual position of the centre of rotation of the hip was 2.5 +/- 1.1 mm vertically and 4.4 +/- 2.1 mm horizontally. On average, the inclination of the acetabular component differed by 7 +/- 2 degrees and anteversion by 9 +/- 3 degrees from the preoperative plans. The mean postoperative leg-length difference was 0.3 +/- 0.1 cm clinically and 0.2 +/- 0.1 cm radiologically. More than 80% of intraoperative difficulties were anticipated. Preoperative planning is of significant value for the successful performance of THR.     

Incidence and outcome of hepatic veno-occlusive disease after blood or marrow transplantation: a prospective cohort study of the European Group for Blood and Marrow Transplantation. European Group for Blood and Marrow Transplantation Chronic Leukemia Working Party

To determine the incidence and outcome of hepatic veno-occlusive disease (VOD) after blood or marrow transplantation (BMT), we prospectively evaluated all consecutive patients receiving a BMT during a 6-month period in participating EBMT centers. All of them were evaluated for occurrence of VOD according to previously defined clinical criteria. The clinical course, outcome, value of prophylactic and therapeutic interventions, and the influence of previously described risk factors were analyzed. During the study period, 1,652 BMT were performed in 73 centers. VOD was diagnosed in 87 patients (5.3%; 95% confidence interval [CI], 4.2% to 6.4%). Fifty-six of 631 allogeneic BMT (8.9%) and 31 of 1,010 autologous BMT (3.1%) developed this complication (P <.0001). VOD was classified as mild in 7 (8%), moderate in 56 (64.4%), and severe in 24 (27.6%) cases. Sixteen patients died of VOD (corresponding to 1% of the whole series, 18.4% of VOD patients, and 66.7% of severe VOD). The use of unfractionated heparin did not significantly decrease the incidence of VOD. Independent variables associated with an increased risk of VOD were allogeneic BMT (relative risk [RR], 2.8; P <.001), pre-BMT elevation of serum aspartate aminotransferase (RR, 2.4; P =.001), high-dose cytoreductive therapy (RR, 2.3; P =.003), Karnofsky performance score less than 90% (RR, 2.7; P =.006), and prior abdominal radiation (RR, 2.9; P =.03). In conclusion, this prospective study shows that (1) the incidence of VOD is lower than that reported in smaller studies from single centers, (2) about one fourth of cases of VOD progress to severe disease, (3) main risk factors have a major impact on incidence of VOD, and (4) the use of prophylactic unfractionated heparin does not seem to reduce the incidence of VOD.     

Mutation of cis-proline 207 in mitochondrial creatine kinase to alanine leads to increased acid stability

SETTING: Hamad General Hospital, the tertiary health centre for Doha, Qatar. OBJECTIVE: The purpose of the study was to define and correlate the role of radiology with clinical and pathological findings in abdominal tuberculosis. MATERIAL AND METHODS: A total of 59 patients (47 males and 12 females) diagnosed bacteriologically and/ or histologically for abdominal tuberculosis were radiologically assessed. Evaluation was based on the analysis of plain abdominal radiographs, gastro-intestinal contrast studies (barium meal follow through and barium enema), ultrasonography and computed tomography. RESULTS: Plain abdominal radiographs performed in 38 patients were positive in 19 cases (50%). Gastrointestinal contrast examinations were positive in 27 out of 34 cases (80%). Ultrasound examinations were abnormal in 25 out of 31 cases (81%), while computed tomography, performed in 24 patients, revealed abnormal findings in 19 cases (80%). Combined radiographic and imaging procedures revealed peritoneal involvement (ascites) in 16 patients (27%), bowel involvement in 36 (61%), mass lesion in 11 (19%), lymphadenopathy in 13 (22%) and organ involvement in 13 (22%). CONCLUSION: There was no single radiological method that provided all necessary information suggestive of abdominal tuberculosis. Although unequivocal diagnosis of abdominal tuberculosis can only be made by culture and histological findings, combined computed tomography and ultrasound findings were the most important imaging tools in the diagnostic process for abdominal tuberculosis, while contrast studies helped to assess the extent of bowel disease, hence influencing decisions concerning surgery.     

Medical care delivery at the 1996 Olympic Games. Centers for Disease Control and Prevention Olympics Surveillance Unit

CONTEXT: Mass gatherings like the 1996 Olympic Games require medical services for large populations assembled under unusual circumstances. OBJECTIVE: To examine delivery of medical services and to provide data for planning future events. DESIGN: Observational cohort study, with review of medical records at Olympics medical facilities. SETTING: One large multipurpose clinic and 128 medical aid stations operating at Olympics-sponsored sites in the vicinity of Atlanta, Ga. PARTICIPANTS: A total of 10715 patients, including 1804 athletes, 890 officials, 480 Olympic dignitaries, 3280 volunteers, 3482 spectators, and 779 others who received medical care from a physician at an Olympic medical station. MAIN OUTCOME MEASURES: Number of injuries and cases of heat-related illness among participant categories, medical use rates among participants with official Games credentials, and use rates per 10000 persons attending athletic competitions. RESULTS: Injuries, accounting for 35% of all medical visits, were more common among athletes (51.9% of their visits, P < .001) than among other groups. Injuries accounted for 31.4% of all other groups combined. Spectators and volunteers accounted for most (88.9%, P < .001) of the 1059 visits for heat-related illness. The rates for number of medical encounters treated by a physician were highest for athletes (16.2 per 100 persons, P < .001) and lowest for volunteers (2.0 per 100). Overall physician treatment rate was 4.2 per 10000 in attendance (range, 1.6-30.1 per 10000). A total of 432 patients were transferred to hospitals. CONCLUSIONS: Organizers used these data during the Games to monitor the health of participants and to redirect medical and other resources to areas of increased need. These data should be useful for planning medical services for future mass gatherings.     

Primary anaplastic large-cell lymphoma in adults: clinical presentation, immunophenotype, and outcome

Anaplastic, CD30+, large-cell lymphoma is now a well-recognized pathologic entity that accounts for 2% to 8% of all lymphomas. Recent progress has been made in the understanding of certain biologic features found in anaplastic large-cell lymphoma, but information about its clinical behavior, in comparison to other large-cell lymphomas, is limited. The pathologic review of a large multicenter study of the treatment of aggressive lymphoma identified 146 cases of anaplastic large-cell lymphoma (ALCL) on the basis of morphology and CD30 expression. We compared initial presentation, immunophenotype, and clinical outcome of these cases with those of the 1,695 nonanaplastic diffuse large-cell lymphomas (non-ALCL) included in the same trial. Patients with ALCL were more likely to be male (P = .018) and were younger (P < .0001) than those with non-ALCL. B symptoms were more frequent in ALCL (P = .006). Skin (P < .0001) and lung (P < .05) involvement was also more frequent in ALCL, but frequency of bone marrow involvement was identical (P = . 5). Tumor cell phenotype was B in 56 cases (38%), T in 49 cases (34%), and null in 33 cases (22%). Response to chemotherapy (P = . 001), event-free survival (P = .006), and overall survival (P = . 0004) were better for ALCL than for non-ALCL. Multivariate analyses identified anaplastic character as an independent factor that predicted a longer survival. Tumor cell phenotype did not influence event-free survival (P = .72) or overall survival (P = .83). ALCL in adults is a clinicopathologic entity which, independent of its phenotypic characteristics, has a better outcome than other diffuse large-cell lymphomas.     

MRI evaluation of right ventricular pressure overload in chronic obstructive pulmonary disease

In chronic obstructive pulmonary disease (COPD), the development of pulmonary hypertension is common. This study was performed to assess the signs of right ventricular (RV) pressure overload and RV failure in COPD. In 8 COPD patients without primary cardiac disease, RV wall thickness, mass, and end-diastolic volume were measured by cardiac-triggered cine MRI. MR phase-contrast velocity quantification was used to measure stroke volume and the patterns of flow into and out of the RV. Data of patients were tested versus those of a control group matched for age (n = 8). Results showed that the RV wall thickness was increased (.6 +/- 0.1 vs 0.4 +/- 0.1 cm, P < .001). RV mass was increased (67 +/- 11 vs 57 +/- 5 g, P < .005). RV stroke volume was decreased (57 +/- 13 vs 71 +/- 13 ml, P < .01), but RV ejection fraction was not different. In the main pulmonary artery flow, the quotient of acceleration time divided by ejection time was decreased (33 +/- 5% vs 38 +/- 4%, P < .05), which is indicative of pulmonary hypertension. In conclusion, this MRI protocol provides a tool to assess the effects of RV pressure overload in COPD before heart failure has become manifest.     

Identification of the aberrant hepatic artery with axial spiral CT

PURPOSE: To determine whether axial spiral computed tomography (CT) allows detection of the replaced hepatic artery as part of preoperative planning for pancreatic tumor resection. MATERIALS AND METHODS: Axial spiral CT scans (8-mm section thickness, 4-mm overlapping reconstructions) were obtained in 50 patients with periampullary tumor and were examined by three radiologists. Readers' interpretations were compared with angiographic results. RESULTS: Eight patients had an aberrant hepatic artery. Two of the three readers detected or suspected all of these abnormalities (100% sensitivity), and one reader identified seven of eight aberrant arteries (88% sensitivity). However, readers requested angiographic confirmation in 14 of 24 tests. Sensitivity, specificity, and accuracy were 96%, 87%, and 88%, respectively, for all readers. CONCLUSION: Axial spiral CT may simplify preoperative evaluation of periampullary tumors. However, angiographic support was necessary in most cases in this study. Improvements in CT techniques may eventually allow spiral CT to replace angiography in the examination of these patients.     

Alveolar bone levels in AIDS and HIV seropositive patients and in control subjects

Alveolar bone levels were studied from intraoral radiographs of 24 non-hospitalized patients with AIDS, 17 HIV seropositive subjects, and 39 matched control subjects. The AIDS/HIV subjects were seeking dental care in a faculty practice. The matched control subjects came from those non-HIV-infected patients seeking dental care at the University of Washington. Magnified intraoral radiographs were used to assess the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL). The extent of vertical defects and furcation invasions was also assessed. The mean age of the AIDS, HIV, and control subjects was 38.9 +/- 6.6 years, 37.1 +/- 7.6, and 39.9 +/- 5.6, respectively, and was not statistically different. Among the AIDS patients, 75% were smokers, while 88.2% of the HIV subjects were cigarette smokers. Therefore, the matched control subjects were also smokers to the same extent. The mean difference in distance CEJ-BL was 0.1 mm (mesial) and 0.3 mm (distal) and greater in the HIV/AIDS group than in the control group, but not statistically different. No vertical defects > or = 3.0 mm were found in 69.2% of the control subjects and in 58.5% of the combined HIV/AIDS group. None of the HIV/AIDS subjects had more than 5 defects > 3.0 mm, while 7.6% of the control subjects had such defects. Significant associations were found between smoking and extent of alveolar bone loss (distance) (P < 0.001) as well as the number and extent of vertical defects (P < 0.01), but were not associated with HIV status. The extent of furcation invasions, as read radiographically, did not differ between groups. In conclusion, smoking but not HIV status was the primary factor for alveolar bone loss.     

Neuroradiology case of the day. Burkitt lymphoma

We describe the clinical and laboratory manifestations of human granulocytic ehrlichiosis (HGE) in eight patients for whom cultures were positive for the HGE agent and compare them with 15 patients for whom cultures were negative but who fulfilled a modified New York State Surveillance definition for HGE. Polymerase chain reaction analysis was positive in 8 (100%) of 8 culture-positive cases vs. 3 (20%) of 15 culture-negative cases (P < .001), morulae were detected in 7 (100%) of 7 culture-positive cases in which tests were performed vs. 0 of 15 culture-negative cases (P < .001), and a fourfold change in antibody titer was demonstrated in 6 (75%) of 8 culture-positive cases vs. 9 (69%) of 13 culture-negative cases (P = not significant). Patients for whom cultures were positive had higher mean oral temperatures +/- SD at presentation than did patients for whom cultures were negative (38.6 degrees C +/- 0.7 degree C vs. 37.2 degrees C +/- 0.8 degree C, respectively; P = .002). Other symptoms and signs were not significantly different between the two groups. Multivariate analysis revealed that the lymphocyte count at presentation was significantly lower in culture-positive cases than in culture-negative cases. Clinical response to treatment was similar in the two groups. Culture confirmation of HGE is the gold standard for defining the sensitivity and specificity of other diagnostic tests presently being developed.     

Dislocation following primary posterior-stabilized total knee arthroplasty

From 1981 through 1991, 3,032 primary total knee arthroplasties were performed using the Insall-Burstein Posterior Stabilized Condylar Prosthesis (IB-I, IB-II, and IB-II modified) (Zimmer, Warsaw, IN). Fifteen posterior dislocations occurred: 4 with the IB-I system occurring 2 or more years after surgery, 10 with the IB-II system (8 occurring 6 months after surgery and 2 occurring 2-3 years after surgery), and 1 with the IB-II modified system occurring 9 months after surgery. Statistically significant differences for the rate of dislocation between both the IB-I and IB-II modified arthroplasties versus the IB-II arthroplasties were found (P < .001). In an attempt to identify a cause for these dislocations, the authors retrospectively assessed the 15 dislocated cases with respect to sex, age, weight, height, preoperative and postoperative Hospital for Special Surgery scores, preoperative and postoperative alignment, preoperative versus postoperative reconstruction dimensions, patellar thickness and height, and postoperative flexion and compared the results with those patients who did not experience dislocation. Possible etiologies and mechanisms of dislocation were sought. There were no significant differences between the control and study groups for any variable assessed, with the exception of postoperative flexion, which averaged 118 degrees for the study group and 105 degrees for the control group (P < .001). Conservative management was successful in 11 cases. In September 1988 the IB-II system was introduced; modification of the tibial insert was made in January 1990.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of cataract extraction on the results of automated perimetry in glaucoma

OBJECTIVE: To investigate the effect of cataract extraction on the results of automated perimetry in persons with glaucomatous visual field loss. SUBJECTS: Subjects from a retrospective study of visual field progression who underwent cataract extraction during follow-up were identified. Subjects came from the glaucoma service of a hospital-based tertiary referral center. METHODS: Subjects had at least 7 Humphrey 24-2 or 30-2 visual fields over 5 years or more, with an abnormal glaucoma hemifield test result on the first 2 examinations. Visual field data were transferred to a microcomputer and comparison of the visual fields immediately before and after cataract extraction was performed. RESULTS: Sixty-five eyes of 50 subjects (mean age, 71.8 years) were included in the analysis. A mean improvement in mean deviation (MD) of 1.68 dB (P<.001), and a mean worsening in corrected pattern SD (CPSD) of 0.54 dB (P=.09) was observed. The mean unweighted change in threshold in the 52 points of program 24-2 was 1.58 dB, corresponding to a 43.9% increase in sensitivity. A significant correlation between improvement in visual acuity and improvement in MD was also found. A mean increase in CPSD of 1.61 dB (P=.005) occurred in subjects with dense scotomas (minimum threshold value < or = 5 dB) and preoperative CPSD of 8 dB or less. CONCLUSIONS: In persons with glaucomatous visual field defects, cataract extraction produces only a modest improvement in MD. After cataract surgery, the CPSD index worsened in many subjects with dense scotomas. This suggests that the development of cataract can mask progressive glaucomatous visual field loss in such persons.     

Hodgkin disease and non-Hodgkin lymphoma: plain chest radiographs and chest computed tomography of thoracic involvement in previously untreated patients

PURPOSE: To provide further information about the presentation of thoracic involvement in Hodgkin disease and non-Hodgkin lymphoma and to compare chest radiography with chest CT findings. MATERIALS AND METHODS: We reviewed the chest radiographs and the CT images of 100 Hodgkin and 100 non-Hodgkin patients, all of them untreated. Our data were compared with those of literature series: the latest study comparing the different patterns of Hodgkin and non-Hodgkin disease appeared in 1976 and it compared chest radiography with conventional tomography, not with CT. RESULTS: Intrathoracic involvement (75% vs 48%) and adenopathy (74% vs 28%) were more frequent in Hodgkin than in non-Hodgkin lymphoma. Ninety-nine per cent of the patients with intrathoracic involvement (74/75) had nodal disease. Paratracheal/prevascular nodes were most frequently involved, namely in 72/74 Hodgkin (97%) and in 27/28 non-Hodgkin patients (96%). The lung parenchyma was more often involved in non-Hodgkin (24%) than in Hodgkin (8%) patients; it was associated with mediastinal/hilar adenopathy in all Hodgkin and in 10/24 (42%) non-Hodgkin cases. Parenchymal involvement was demonstrated with chest radiography in 7/8 Hodgkin (88%) and in 13/24 non-Hodgkin patients (54%). Chest radiography showed paratracheal/prevascular adenopathy more often in Hodgkin (54/72, 75%) than in non-Hodgkin (15/27, 56%) cases. Subcarinal and internal mammary adenopathy was poorly depicted with plain films, while hilar adenopathy was generally identified with both CT and chest radiography. Chest radiography usually missed posterior mediastinal and anterior diaphragmatic adenopathy. CONCLUSIONS: The differences in the presentation of Hodgkin vs non-Hodgkin disease are not sufficiently distinctive to permit radiographic differentiation of the two conditions, but some patterns are helpful. Recognizing the frequency of thoracic involvement and that of the additional CT findings in Hodgkin and non-Hodgkin patients makes a sound basis for lymphoma imaging.     

Ambulatory blood pressure monitoring during pregnancy. Comparison with mercury sphygmomanometry

There is little information concerning the relationship between blood pressures obtained by standard mercury sphygmomanometry and ambulatory blood pressure monitoring (ABPM) in pregnancy. We compared readings obtained with these two methods using an Hawksley random zero mercury sphygmomanometer and an Accutracker II ABPM device. Blood pressures were compared over 90 min with the pregnant woman seated and, in a separate study, over 30 min during standing and ambulation. When pregnant women were seated, the ABPM overestimated the systolic blood pressure (BP) by 5 (3,6) mm Hg (mean, 95% confidence limits) (P < .001) and underestimated diastolic phase IV readings by 7 (-9, -6) mm Hg (P < .001) and phase V readings by 3 (-5, -1) mm Hg (P < .01). Eighty-three percent of systolic readings agreed within 10 mm Hg. Seventy-six percent of diastolic phase V (but only 45% of phase IV) readings agreed within 6 mm Hg. When pregnant women were ambulatory, the ABPM overestimated systolic BP by 7 (4,10) mm Hg (P < .001) and underestimated diastolic phase IV readings by 6 (-8, -4) mm Hg (P < .001) and phase V readings by 4 (-6, -2) mm Hg (P < .01). Eighty percent of systolic readings agreed within 10 mm Hg. Fifty-five percent of diastolic phase V and 50% of diastolic phase IV readings agreed within 6 mm Hg. The Accutracker II blood pressure readings are reasonably comparable to those of mercury sphygmomanometry in pregnant women, particularly when assessing group data.(ABSTRACT TRUNCATED AT 250 WORDS)     

Duplex scanning alone is not sufficient imaging before secondary procedures after lower extremity reversed vein bypass graft

PURPOSE: Duplex surveillance of lower extremity reversed vein bypass grafts (LERVG) is a means of identifying patients at risk for occlusion. The perceived accuracy of duplex scan as a means of identifying stenoses has led many surgeons to perform graft revision on the basis of duplex scan alone. This may result in missing additional lesions that are threatening patency. To assess the role of duplex scan as the sole imaging method before revision of LERVGs, we reviewed consecutive patients undergoing revisions who underwent preoperative arteriography after identification of duplex scan abnormalities. METHODS: Duplex scan results, operative reports, and preoperative arteriograms for patients undergoing LERVG revision from January 1990 to December 1997 were reviewed. A standard duplex scan surveillance protocol was followed, and attempts were made to survey the entire graft, including inflow and outflow. Duplex scan results were compared with the results of preoperative arteriograms and the operation performed to determine if all significant lesions were identified by means of duplex scan alone. RESULTS: Two hundred five LERVG revisions were performed. The 5-year assisted primary patency rate was 91%. In 119 cases (58%), arteriography did not contribute significantly to duplex scan findings. Arteriography significantly contributed to operative planning in 86 cases (42%). In 38 cases (19%), only a low-flow state was identified by means of duplex scan, and a correctable stenosis was identified by means of arteriography. In 48 cases (23%), additional significant lesions corrected at operation were identified by means of arteriography. These included 26 inflow, 16 graft, and 8 outflow lesions. Arteriography was most useful as a means of determining the revision procedure performed when there were inflow lesions (P <.05) or when the proximal anastomosis was to the profunda or superficial femoral arteries (P <.05). All frequently performed bypass graft configurations had some discrepancy between arteriographic and duplex scan findings. CONCLUSION: Available data do not permit prediction of which LERVG are immune from missed lesions in a duplex scan surveillance protocol. This suggests to us that arteriography is mandatory before LERVG revisions.