Diagnosis of renovascular disease by extra- and intrarenal Doppler parameters

It is still a matter of debate as to which parameters should be used for noninvasive diagnosis of renovascular disease by renal Doppler sonography (RDS). The accuracy of RDS in the detection of renal artery stenosis (RAS) was tested in 95 consecutive, moderate to severe hypertensive patients (I-II World Health Organization [WHO] stages). Reno-aortic ratio (RAR) for peak systolic velocity (PSV) was also calculated to assist in the diagnosis of significant (>50%) RAS. Paired receiver-operating characteristic (ROC) analysis was plotted for evaluating the relationship between sensitivity and specificity for each parameter. In a subset of 57 kidneys, the influence of blood pressure and age on intraparenchymal parameters was evaluated. Measurements of maximal peak systolic velocity (PSV) at the site of stenosis, RAR for PSV, and minimum acceleration index in the main renal artery showed high accuracy (areas under the ROC curve 0.97, 0.88, and 0.80, respectively). Among intraparenchymal parameters, early systolic acceleration showed the best area under the ROC curve (0.90), but provided a low positive predictive value (29%) and was significantly influenced by blood pressure (multiple r=0.56; p=0.001). Pulsatility and resistive indices were found to be less powerful as absolute values, and both significantly influenced by blood pressure and age (multiple r=0.60 and 0.50; p=0.001, p=0.02, respectively). However, interindividual variance of intrarenal indices should be minimized by calculation of side difference, although this procedure would become misleading or impossible in patients with bilateral RAS or a single kidney, respectively. These results support the use of extraparenchymal parameters for noninvasive detection of RAS, and emphasize that intrarenal parameters cannot be considered as absolute values.     

Pulmonary venous flow velocity patterns in 143 normal subjects aged 20 to 80 years old. An echo 2D colour Doppler cooperative study

In order to find out the normal values and to evaluate the effects of age, heart rate, sex, and haemodynamic and standard echocardiographic parameters on pulmonary venous flow velocity obtained by the transthoracic approach. Doppler pulmonary venous flow parameters were measured in 143 healthy subjects aged from 20 to 80 years. Doppler pulmonary venous flow parameters which had the best correlation with age were: the peak velocity of the systolic wave (r = 0.39) and its integral (r = 0.5), the peak velocity of the diastolic wave (r = -0.6) and its integral (r = -0.44); the systolic (r = 0.68) and diastolic fractions (r = -0.68); the systolic/diastolic peak velocity ratio (r = 0.73) and the systolic/diastolic integral ratio (r = 0.7). The atrial reversal wave did not correlate with age; the atrial reversal wave was more difficult and probably less reliable to measure than the systolic and diastolic waves. The correlations of pulmonary venous flow parameters with mitral flow parameters were also examined. This study showed that, in healthy subjects, despite an increase in the early and atrial waves from the annulus to the tips of the mitral leaflets, there is a similar association between pulmonary venous flow and mitral flow measured at the annulus or at the tips of the mitral leaflets. The intra-observer reproducibility of all the pulmonary venous flow parameters considered were found to be excellent. Moderate inter-observer variability was observed for the systolic, diastolic and atrial reversal wave peak velocities and integrals; however, the systolic/diastolic ratio improved the precision of the measurements. Multivariate analysis showed that age is the principal determinant of the Doppler parameters of pulmonary venous flow: heart rate, sex, body surface area, the size of the left atrium in systole and the left ventricular ejection fraction all influence the Doppler parameters of pulmonary venous flow, even if only slightly.     

Anti-GBM glomerulonephritis in mice lacking nitric oxide synthase type 2

To determine the relationship between quantitative Doppler parameters of portal, hepatic, and splanchnic circulation and hepatic venous pressure gradient (HVPG), variceal size, and Child-Pugh class in patients with alcoholic cirrhosis, we studied forty patients with proved alcoholic cirrhosis who underwent Doppler ultrasonography, hepatic vein catheterization, and esophagoscopy. The following Doppler parameters were recorded: time-averaged mean blood velocity, volume flow of the main portal vein flow, and resistance index (RI) of the hepatic and of the superior mesenteric artery. Doppler findings were compared with HVPG, presence and size of esophageal varices, and Child-Pugh class. There was a significant inverse correlation between portal velocity and HVPG (r = -.69), as well as between portal vein flow and HVPG (r = -.58). No correlation was found between RI in the hepatic artery or superior mesenteric artery and HVPG. No correlation was found between portal vein measurements and presence and size of varices. Severe liver failure was associated with lower portal velocity and flow. In patients with alcoholic cirrhosis, only portal vein blood velocity and flow, but neither hepatic nor mesenteric artery RI, are correlated to the severity of portal hypertension and to the severity of liver failure.     

Noninvasive investigations of the normal ocular circulation in humans

PURPOSE: To compare the reproducibility of laser interferometric measurements of fundus pulsation, pneumatonometric measurement of pulse amplitude (PA) and pulsatile ocular blood flow (POBF), and Doppler ultrasonic measurements of blood flow velocity in the ophthalmic artery (OA) and the posterior ciliary arteries (PCAs) and to investigate the association of the results obtained with these methods and to characterize ocular hemodynamics during Valsalva maneuver and isometric handgrip. METHODS: All studies were performed in healthy subjects. Fundus pulsation (n = 48), POBF (n = 24), and blood flow velocities (n = 24) were measured at baseline and during the Valsalva maneuver and isometric handgrip. Intraclass correlation coefficients were calculated for test/retest variability, for short-term variability, and for interobserver variability. RESULTS: Intraclass correlation coefficients were between 0.95 and 0.98 for fundus pulsation measurements, between 0.54 and 0.76 for pneumatonometric measurements, between 0.44 and 0.88 for Doppler sonographic measurements in the OA and between 0.32 and 0.60 in the PCAs. There was a high degree of association between pneumatonometric parameters and fundus pulsation amplitude. Valsalva maneuver significantly reduced fundus pulsations, PA, and POBF, whereas isometric handgripping did not change these parameters. CONCLUSIONS: The reproducibility of fundus pulsation measurements was excellent. Reproducibility of pneumatonometric parameters and ultrasonographic measurements in the OA was satisfactory. Reproducibility of ultrasonographic measurements in the PCAs was low. Data obtained during the autonomic stimuli experiments argue against the sole use of systems to measure pulsatile blood flow, if no additional data on flow pulsatility are available. At least in cases when changes in blood pressure are likely to occur the ratio of pulsatile to nonpulsatile blood flow might not be constant and POBF might not be an adequate measure of total ocular blood flow.     

Simultaneous measurement of pulmonary venous flow by intravascular catheter Doppler velocimetry and transesophageal Doppler echocardiography: relation to left atrial pressure and left atrial and left ventricular function

OBJECTIVES: The aim of our study was to compare measurements of pulmonary venous flow velocity obtained either by transesophageal Doppler echocardiography or by intravascular catheter Doppler velocimetry. Furthermore, the relation among pulmonary venous flow velocity, left atrial compliance and left atrial pressure was evaluated. BACKGROUND: Data about the relation between left atrial pressure and pulmonary venous flow velocity are controversial. METHODS: A total of 32 patients undergoing elective open heart surgery for coronary artery bypass grafting were included prospectively in the study. Pulmonary venous flow velocity (Doppler catheter) and left atrial pressure (microtip pressure transducer) were recorded simultaneously with recordings of pulmonary venous flow velocity obtained by transesophageal Doppler echocardiography. RESULTS: Agreement between Doppler catheter and Doppler echocardiographic measurements of pulmonary venous flow velocity (n = 18 patients) was analyzed using the Bland-Altmann technique. The 95% limits of agreement were -0.16 to +0.11 m/s for systolic peak velocity, -0.14 to +0.09 m/s for diastolic peak velocity and -0.12 to +0.10 m/s for atrial peak velocity. The closest agreement between both methods was found for the ratio of systolic to diastolic peak velocity, the ratio of systolic to diastolic flow duration and the time from Q deflection on the electrocardiogram to maximal flow velocity. Mean left atrial pressure was strongly correlated with the ratio of systolic to diastolic peak velocity (r = -0.829), systolic velocity-time integral (r = -0.653), time to maximal flow velocity (r = 0.844) and the ratio of systolic to diastolic flow duration (r = -0.556). The ratio of systolic to diastolic peak velocity and the time to maximal flow velocity were identified as strong independent predictors of mean left atrial pressure. Left atrial compliance was not found to be an independent predictor of mean left atrial pressure. CONCLUSIONS: Flow velocity in the left upper pulmonary vein can be reliably recorded by transesophageal pulsed wave Doppler echocardiography. Our data reveal further evidence that mean left atrial pressure can be estimated by the pattern of pulmonary venous flow velocity.     

The dental, craniofacial, and biochemical features of pyknodysostosis: a report of three new cases

1.Near-infrared (IR) spectroscopy is based on the relative transparency of skin, skull and brain to the light in the near-IR region (700-1100 nm) and on the oxygen-dependent tissue absorption changes of haemoglobin.2. We evaluated the most relevant factors (reproducibility, venous return, age and sex) that might affect reliability of near-IR spectroscopy to test CO2 cerebrovascular reactivity.3.Thirty-four healthy volunteers were enrolled in the study. The protocol consisted of a 3-min baseline, a 3-min hypercapnia (5% CO2 in air) and a 2-min recovery. Transcranial Doppler sonography measurements were simultaneously performed. The CO2 reactivity test was repeated on 27 subjects after 1 h to assess reproducibility. CO2 reactivity was also evaluated at different body positions (supine, 35 degrees Trendelenburg and 35 degrees reverse Trendelenburg), and over a gradual increase of the inspired CO2.4. Changes in near-IR spectroscopy and transcranial Doppler sonography parameters were significantly correlated with variations of end-tidal CO2 (P<0.005). A significant correlation between the reactivity indexes of near-IR spectroscopy parameters and flow velocity was also found (P<0.01). A high reproducibility was also found for deoxyhaemoglobin (rI=0.76), oxyhaemoglobin (rI=0.68) and flow velocity (rI=0.60) reactivity indexes. No significant differences between the reactivity indexes of different body positions were found (P>0.05). The reactivity index of oxyhaemoglobin and deoxyhaemoglobin decreased (P<0.05) and increased (P<0.01) with age respectively.5. We found that near-IR spectroscopy is a reliable and reproducible method for the evaluation of cerebrovascular reactivity and might be considered, after appropriate validation, for the assessment of patients with cerebrovascular disease.     

Age-related and vasomotor stimuli-induced changes in renal vascular resistance detected by Doppler ultrasound

Indirect measurement of renal vascular resistance by duplex Doppler waveform analysis was evaluated in relation to aging and some pathophysiological conditions. Baseline renal resistive index (RRI) (peak systolic frequency shift - lowest diastolic frequency shift/peak systolic frequency shift) was measured in healthy controls aged 20 to 85 years by analyzing the blood flow velocity waveform of interlobar arteries. RRI changes induced by sympathetic activation (cold pressor test and handgrip test) or by fluid load were evaluated. Both repeatability and reproducibility were very good, as the intra and interoperator variations were all less than their reproducibility coefficients. RRI showed a significant increase with aging (ANOVA P < .001), particularly evident in subjects older than 50 years. Both the cold pressor test and handgrip test induced in all the subjects (n = 16) a significant increase in RRI (P < .001), from 0.59 +/- 0.04 to 0.69 +/- 0.04 (12 +/- 6%) for the cold pressor test and from 0.57 +/- 0.03 to 0.66 +/- 0.03 (15 +/- 2%) for the handgrip test. In eight subjects intravenous fluid load (0.25 mL/kg/min of 0.9% NaCl for 120 min) caused a significant decrease in RRI (P < .001), from 0.62 +/- 0.02 to 0.53 +/- 0.01 (17 +/- 2%), which was inversely related to mean blood pressure rise (r = 0.71, P < .001). These data show that pulsed wave Doppler analysis is an accurate method for an indirect evaluation of changes in renal vascular resistance induced by common vasomotor stimuli.     

Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging

BACKGROUND: Doppler echocardiography is frequently used to predict filling pressures in normal sinus rhythm, but it is unknown whether it can be applied in sinus tachycardia, with merging of E and A velocities. Tissue Doppler imaging (TDI) can record the mitral annular velocity. The early diastolic velocity (Ea) behaves as a relative load-independent index of left ventricular relaxation, which corrects the influence of relaxation on the transmitral E velocity. METHODS AND RESULTS: We evaluated 100 patients 64+/-12 years old with simultaneous Doppler and invasive hemodynamics. Mitral inflow was classified into 3 patterns: complete merging of E and A velocities (pattern A), discernible velocities with A dominance (B), or E dominance (C). The Doppler data were analyzed at the mitral valve tips for E, acceleration and deceleration times of E, and isovolumic relaxation time. In patterns B and C, the A velocity, E/A ratio, and atrial filling fraction were derived. Pulmonary venous flow velocities were also measured, and TDI was used to acquire Ea and Aa. Weak significant relations were observed between pulmonary capillary wedge pressure (PCWP) and sole parameters of mitral flow, pulmonary venous flow, and annular measurements. These were better for patterns A and C. E/Ea ratio had the strongest relation to PCWP [r=0.86, PCWP=1.55+1.47(E/Ea)], irrespective of the pattern and ejection fraction. This equation was tested prospectively in 20 patients with sinus tachycardia. A strong relation was observed between catheter and Doppler PCWP (r=0.91), with a mean difference of 0.4+/-2.8 mm Hg. CONCLUSIONS: The ratio of transmitral E velocity to Ea can be used to estimate PCWP with reasonable accuracy in sinus tachycardia, even with complete merging of E and A velocities.     

The determination of ultrasound velocity in the os calcis, thumb and patella during childhood

Maximising the accumulation of bone tissue during growth and puberty is one of the most important aims in the prevention of osteoporosis. For prevention studies in children it is necessary to develop methods for skeletal status without radiation. Ultrasonic velocity (speed of sound = SOS) has been proposed as an alternative method. Using a new ultrasonic system (Osteoson K4, Minhorst, Germany), we investigated the reproducibility and age-dependency of SOS in several peripheral bones in 218 children and young adults. Intra-observer (day to day) reproducibility: calcaneus CV = 0.64%, patella CV = 1.18% and thumb CV = 0.43% (n = 25). Inter-observer reproducibility: calcaneus CV = 1.1%, patella CV = 2.48% and thumb CV = 0.62% (n = 16). SOS in thumb and patella increased with age and peaked at 20-25 years. SOS in the calcaneus showed no increase after puberty. Studies in bones from pigs show no dependency of SOS from the thickness of analysed cortical or trabecular bone slices. We conclude that the reproducibility of SOS measurements especially in the thumb is comparable with those of radiation methods. The SOS data in growing, healthy children and the independency from bone dimensions provides more evidence that SOS describes the elastic qualities of the bones.     

Cerana--a new method for the restoration of teeth with prefabricated ceramic inlays

We studied the reproducibility of multifocal electroretinography by repeated measurements in normal subjects. We also analyzed the amplitude and implicit time of the waves. Nine healthy eyes including myopic cases (-4.1 D on average) of 9 normal males, aged 19 to 42 years, were the objects of study. We used a (Visual Evoked Response Imaging System III (VERIS III), by TOMEY Corp.) for multifocal electroretinography. Each eye was examined 4 times on different days. The stimulus elements consisted of 103 hexagons. The net recording time was 4 minutes. We used the coefficient of variation (standard deviation/average) of 4 measurements of response density as index of reproducibility. Poor fixation and blinking were important factors that affected the reproducibility. In all the 9 eyes, reproducibility of multifocal electroretinography, expressed as average of the coefficient of variation of all regions, was 22% on average. In 6 eyes with good fixation and without blinking, the reproducibility was 15% on average. In 6 eyes with good reproducibility, we analyzed three parameters of the focal response waves: all traces, quadrants and rings, as well as the amplitude and latency of the waves. These data served as controls. Our studies showed that the response density correlated closely with the amplitude and not with the latency in normal subjects.     

Effect of physical activity on the distensibility of the aortic wall in healthy males

BACKGROUND AND PURPOSE: Diethylenetriamine penta acetic acid (99mTc-DTPA), a substance which indicates glomerular filtration, is distributed equally in blood and tissue after a bolus intravenously injection. Ambulatory Renal Monitor (ARM) is a portable and non invasive device which monitors extracorporeally the clearance of intravenously injected 99mTc-DTPA. We examined correlation between half-time of clearance estimated by ARM and glomerular filtration rare, and clinical usefulness of ARM for a renal function monitoring. MATERIALS AND METHODS: The purposes of this paper are to describe the results obtained through basic analysis experiments and reproducibility in normal control, and its clinical application for 9 renal transplant patients, three drug-induced renal damage, one acute renal failure, one hemolytic uremic syndrome (HUS), two chronic nephritis, one donor of renal transplantation, one ureteral tumor, three renal tumors, two ureteral stones, one bilateral hydronephrosis and two normal controls. The half time of clearance of the tracer measured by an ARM. (ARM-HTC) is compared with the half time of clearance of the tracer measured by repeated blood sampling (Sampling-HTC) as a golden standard, serum creatinine and creatinine clearance. RESULTS: A significant correlation (linear) was detected when ARM-HTC was compared with Sampling-HTC (r = 0.91), 1/serum creatinine (r = 0.85) or creatinine clearance (r = 0.82), although ARM-HTC showed a delay compared with Sampling-HTC. CONCLUSIONS: The reason of this delay may be due to a difference in half-time when the tracer distributed in the blood and tissue. The results indicate that the estimation of 99mTc-DTPA clearance by ARM is valuable for renal function evaluation in wide ranges of renal function and in different origins of renal dysfunction such as in renal transplantation.     

Comparison of the precision of two vertebral morphometry programs for the lunar EXPERT-XL imaging densitometer

Comparative precision tests of the vertebral height measurement function of the Aberdeen Vertebral Morphometry System (AVMS) software and Lunar EXPERT-XL software were undertaken using four vertebrae from the same lateral spine dual energy X-ray absorptiometry (DXA) image of the same subject (male, 67 years). Two of the vertebrae were abnormal and two were normal. Three observers inexperienced in morphometry and one experienced observer took part in the study. Repeatability was obtained from 10 sequential measurements of the posterior, middle and anterior heights at the same sitting by the same observer. Intraobserver reproducibility compared the means of one set of measurements for all vertebrae with another taken 1 week later. Interobserver reproducibility compared the means of one set of measurements for all vertebrae from an experienced and an inexperienced observer, and from two inexperienced observers. The AVMS software had significantly higher (p < 0.05) repeatability (mean coefficient of variability, CV = 3.5%) than the Lunar software (mean CV = 5%), significantly higher (p < 0.01) intraobserver reproducibility (mean CV = 4.6%) than the Lunar software (mean CV = 8.5%), and significantly higher (p < 0.05) interobserver reproducibility (mean CV = 4.7%) than the Lunar software (mean CV = 7.5%). In conclusion, the new AVMS method possessed higher precision when measuring both abnormal and normal vertebrae and when used by both experienced and inexperienced observers.     

Objective markers of condom failure

RATIONALE AND OBJECTIVES: The authors compare the magnetic resonance (MR) phase contrast flow velocity measurements in varying concentric stenoses with invasive measurements obtained with a Doppler guidewire. METHODS: Flow velocity measurements were obtained using a calibrated 0.018 inch 12 MHz Doppler guidewire and a 1.0 T MR imaging system in a pulsatile hydraulic model with variable arterial stenoses. Velocity measurements were performed proximal, intrastenotic, and distal to the stenoses. The cross-sectional area of stenosis was calculated from the data of both methods. For MR imaging measurements, fast low-angle shot two-dimensional phase contrast sequences with different velocity encodings were used. RESULTS: Phase contrast flow measurements correlated well (r = 0.95, Pearson) with Doppler guidewire-based flow velocity data. Generally, flow velocities obtained with MR imaging were lower when compared with the Doppler-based data (P < or = 0.001, Wilcoxon matched pairs test). However, the ratios and the calculated cross-sectional area of stenoses showed a high correlation (r = 0.96) with the predefined area of stenoses. CONCLUSIONS: The assessment of flow alterations in vitro due to variable stenoses using MR phase contrast flow measurements is very well correlated with the Doppler guidewire. Consequently, these results required in vivo measurements of atherosclerotic lesions to evaluate the clinical impact.     

The palpal receptor organ of gamasid mites (Mesostigmata: Gamasina)]

PURPOSE: The aim of this prospective study was to evaluate the potentials and limits of Doppler waveform analysis of intrarenal vessels in patients with suspected renal artery stenosis. MATERIAL AND METHODS: In a three-year study we compared our colour Doppler results of 111 patients with the angiography results. Evaluated parameters were acceleration time (AT), acceleration index (AI) and early systolic peak (ESP). RESULTS: The sensitivity of severe stenoses (> or = 70%) was 89%. In moderate stenoses (50-70%) it was possible to increase the sensitivity from 56% to 76% if a comparison with the contralateral side was included. The specificity was 91%. Causes for limited sensitivity and specificity were poor examination conditions, stenoses of accessory renal arteries and moderate stenoses as well as diffuse non-stenosing lesions. CONCLUSION: In comparison with angiography, the diagnostic value of Doppler waveform analysis in the detection of renal artery stenoses has specific limitations. In significant stenoses, however, additional valuable haemodynamic information, useful for PTA, can be obtained by this easy and accessible method.     

Effect of gamma radiation on the foetal haemopoietic system in the mouse

In this study, the wall motion of the common carotid artery was characterized by measuring wall-motion velocity (Wv) with tissue Doppler imaging (TDI) in 78 male and female subjects (16-75 y) with no history of cardiovascular disease. The near and far arterial wall showed essentially different Wv patterns. To assess the vascular systolic distension, the Wv of the near and far arterial walls were measured and a Wv index was calculated by subtracting the far Wv from the near Wv. Aging was associated with a 2.0-2.5-fold decrease of peak Wv index. Corrected for carotid diameter and blood pressure, the peak Wv index and mean systolic acceleration to the peak Wv correlated highly with arterial distensibility (r = 0.81 resp. r = 0.75) and compliance (r = 0.73 resp. r = 0.68). This study demonstrates the feasibility of TDI in the characterization of wall motion patterns and in the assessment of common carotid artery stiffness.     

Non-invasive estimation of pulmonary arterial hypertension in chronic obstructive pulmonary disease

The feasibility and reliability of the combination of several noninvasive methods using a multivariate method of analysis to predict pulmonary artery hypertension (PAH) is evaluated in 20 patients with chronic obstructive pulmonary disease. These methods comprised arterial blood gases (Pao2, Paco2), pulmonary functional parameters (FEV1), echo-Doppler parameters (tricuspid regurgitation jets, acceleration time on pulmonary valve), computed tomography measurements (transhilar distance, hilar thoracic index, and measurement of the descending branch of the right pulmonary artery to the lower lobe). A multiple stepwise regression analysis (including one Doppler parameter, two parameters of arterial blood gases, and one functional parameter) revealed a coefficient of determination (R2) equal to 0.954 for mean pulmonary artery pressure (MPAP) with a standard error of estimate (S.E.E.) of 5.25 mmHg. A stepwise regression analysis including computed tomography and radiographic parameters revealed an R2 equal to 0.970 for PAP with a S.E.E. of 4.26 mmHg. Logistical regression analysis classified correctly 80% of patients with PAH using noninvasive methods such as the diameter of the main pulmonary artery and the diameter of the left pulmonary arterial branch calculated by computed tomography. Not only the presence of PAH but also the level of MPAP can be estimated by the combination of multiple stepwise and logistical regression analyses.     

Effects of taxol and taxol/hyperthermia treatments on the functional polarization of cytotoxic T lymphocytes

We have assessed gravimetric methods for determination of intravascular water, established whole blood-, plasma- and erythrocyte water reference values in a healthy volunteer group (n = 97, 48 females) and correlated these variables with 30 simultaneous hematological, clinicochemical and body parameters. The water standard was 55.56 mol/kg = 100 mass %. For erythrocyte water determination three methods were evaluated: 2 indirect methods were easy to perform, the third, using a hematocrit centrifuge, was the most reliable. Imprecision (within-batch coefficient of variation (CV), %) was excellent: whole blood 0.2, plasma 0.1, erythrocytes 0.7-2.2 and recoveries (means, %) 99.7-100.1. Serum water was found to be slightly higher than plasma water. Volunteer group, mean reference values, mass %: whole blood water 79.7, plasma water 91.2, erythrocyte water, three methods 66.2, 64.6 and 64.2, respectively. Females had mean 1.6 mass % higher whole blood water and 0.9-1.0 mass % higher erythrocyte water than males with no difference in plasma water. In the volunteer group whole blood water correlated strongly with hematocrit (r = -0.96), hemoglobin (r = -0.94) and erythrocytes (r = -0.85) and centrifuge hematocrit (r = -0.91). Plasma water correlated strongly with plasma total protein (r = -0.74, all correlations P < 0.001). Hemoglobin and hematocrit can serve as surrogate parameters for whole blood water when water determination is not available; total protein reflects plasma water.     

Spontaneous pneumothorax in cocaine sniffers

PURPOSE: To evaluate intraobserver and interobserver reproducibility of measurements in images obtained by the 50 MHz Humphrey Ultrasound Biomicroscope. METHODS: The first stored image of central cornea, central anterior chamber, and angle structures obtained at 50 examinations were measured twice by three observers. Nine different parameters were measured in angle images and two in images of central cornea and anterior chamber. Intraobserver reproducibility was assessed by calculating the coefficient of variation and interobserver reproducibility by a two-ways ANOVA. RESULTS: Intraobserver reproducibility was high for all measurements of central cornea thickness and anterior chamber depth with a coefficient of variation (%) < or = 3.8%. In angle images the intraobserver reproducibility of measurements was often lower (coefficient of variation (%) 1.3-52.6%). The lower reproducibility was most noticeable in measurements involving the less defined structures. Interobserver reproducibility was poor. CONCLUSIONS: Comparison of measurements are best done of well defined structures and by only one observer.     

A longitudinal study of vessel wall properties in normotensive and hypertensive renal transplant recipients

The mechanisms responsible for reduced arterial distensibility in renal transplant recipients remain to be evaluated. The present longitudinal study was aimed to evaluate the effect of hypertension on the evolution of vessel wall properties in renal transplant recipients. The mechanical properties of the common carotid artery were determined in 24 normotensive and 24 treated hypertensive renal transplant recipients 6-12 weeks after transplantation. The measurements were repeated after 2 years. Arterial distension was determined by using a multigate pulsed Doppler system, blood pressure (BP) was measured by a mercury sphygmomanometer. BP was 127 +/- 3/80 +/- 2 mm Hg at entry and 133 +/- 3/82 +/- 2 mm Hg after 2 years in the normotensive group, 146 +/- 4/90 +/- 3 mm Hg at entry and 145 +/- 3/87 +/- 2 mm Hg after 2 years in the hypertensive group (P < 0.01, normotensives vs hypertensives). The distensibility coefficient (DC) decreased significantly after 2 years in the hypertensive group (DC 18.3 +/- 1.3 10(-3)/kPa before, 15.1 +/- 1.2 10(-3)/kPa after 2 years, P < 0.05) whereas no significant change was observed in the normotensive group (DC 19.0 +/- 1.4 10(-3)/kPa before, DC 17.8 +/- 1.3 10(-3)/kPa after 2 years, NS). There was a significant correlation between the change of the distensibility coefficient after 2 years and mean arterial pressure (n = 48, r = 0.42, P < 0.01). The results show that the decrease of arterial distensibility after 2 years is accelerated in hypertensive renal transplant recipients despite effective anti-hypertensive treatment. Since BP levels were not different at entry into the study and after 2 years, differences in distending pressure along cannot explain the more pronounced decrease of arterial distensibility over time in hypertensive renal transplant recipients.     

Left ventricular systolic torsion and early diastolic filling by echocardiography in normal humans

This study describes a novel 2-dimensional echocardiographic technique to measure left ventricular (LV) systolic twist in humans and relates this measure to early ventricular filling. LV twist is the counterclockwise rotation of the left ventricle during systole when viewed from the apex. The effect of ventricular twist has been postulated to store potential energy, which ultimately aids in diastolic recoil, leading to ventricular suction. The generated negative early diastolic pressures may augment early ventricular filling. We measured ventricular twist in 40 patients with normal transthoracic echocardiograms. End-systolic twist was determined by measuring rotation of the anterolateral papillary muscle about the center of the ventricle. LV filling was assessed by analysis of transmitral Doppler flow velocities. The mean value obtained was 9 +/- 7 degrees of rotation. Twist measurements were highly reproducible with an intraobserver correlation coefficient of r = 0.881, p <0.001. The magnitude of ventricular twist was strongly correlated positively with acceleration of the mitral E-wave (r = 0.75; p <0.0001) and negatively with the mitral E-wave acceleration time (r = -0.83; p <0.0001).