Relationship between haemodynamics and morphology in pulmonary hypertension. A quantitative intravascular ultrasound study

BACKGROUND: Intravascular ultrasound imaging of the pulmonary arteries has been demonstrated to be a reliable method of quantifying vessel diameter, luminal area and pulsatility. Simultaneous measurement of flow velocity and its response to vasodilators allows the relationship between morphology and functional compromise to be studied, especially endothelial dysfunction. METHODS: In 51 patients (mean age = 49.8 +/- 12.6 years, 17 female) we performed right heart catheterization and simultaneous intravascular ultrasound of pulmonary artery branches. The patients were divided in two groups: group 1 with normal pulmonary artery pressure and pulmonary vascular resistance, and group 2 with pulmonary hypertension (peak pulmonary artery pressure > 30 mmHg and/or mean pulmonary artery pressure > 20 mmHg). Vessel wall and lumen were studied using a 2.9 F intravascular ultrasound catheter with a 30 MHz phased array transducer. Measurement of blood flow velocity was accomplished by a Doppler flow wire (0.018 inch). The maximal flow change during acetylcholine infusion (adjusted to 10(-6); 10(-5), and 10(-4) M concentration in the blood vessel) was measured. RESULTS: There were no significant differences between groups 1 and 2 with respect to age (48.5 +/- 14.3 years vs 50.3 +/- 12.3 years; P = ns), gender (4 female/8 male vs 13 female/26 male; P = ns), luminal area of the vessel segment in which the intravascular ultrasound measurements were obtained (11.8 +/- 6.1 mm2 vs 16.7 +/- 14.3 mm2; P = ns), internal diameter (3.9 +/- 1.2 mm vs 4.2 +/- 1.7 mm; P = ns), and external diameter (6.1 +/- 1.3 mm vs 6.9 +/- 2.1 mm; P = ns). Cross-sectional images of the pulmonary artery wall demonstrated a single ring with high echodensity with a thin inner layer regarded as intima in group 1. In contrast, the majority of patients (n = 35/39) in group 2 demonstrated a thickening of the intimal layer and/or a disturbance of layering of the echogenic arterial wall. The relative wall thickness was higher in group 2 than in group 1 (22.5 +/- 10.4% vs 15.3 +/- 6.5%; P < 0.05). There were no significant correlations between pulmonary artery pressure and wall thickness pulmonary artery pressure and area change in the cardiac cycle, acetylcholine-dependent increase in pulmonary flow and morphological changes in the vessel wall. CONCLUSION: We conclude that intravascular ultrasound is capable of detecting morphological changes in the pulmonary vessel wall in pulmonary hypertension and that vessel wall hypertrophy of small pulmonary segment arteries, as detected by intravascular ultrasound, is not predictive of functional vasodilatory response of resistance vessels of the same vessel area.     

Continuous measurement of cardiac output by the Fick principle in infants and children: comparison with the thermodilution method

OBJECTIVE: To compare a system that continuously monitors cardiac output by the Fick principle with measurements by the thermodilution technique in pediatric patients. DESIGN: Prospective direct comparison of the above two techniques. SETTING: Pediatric intensive care unit of a university hospital. PATIENTS: 25 infants and children, aged 1 week to 17 years (median 10 months), who had undergone open heart surgery were studied. Only patients without an endotracheal tube leak and without a residual shunt were included. METHODS: The system based on the Fick principle uses measurements of oxygen consumption taken by a metabolic monitor and of arterial and mixed venous oxygen saturation taken by pulse- and fiberoptic oximetry to calculate cardiac output every 20s. INTERVENTIONS: In every patient one pair of measurements was taken. Continuous Fick and thermodilution cardiac output measurements were performed simultaneously, with the examiners remaining ignorant of the results of the other method. RESULTS: Cardiac output measurements ranged from 0.21 to 4.55 l/min. A good correlation coefficient was found: r2 = 0.98; P < 0.001; SEE = 0.41 l/min. The bias is absolute values and in percent of average cardiac output was - 0.05 l/min or - 4.4% with a precision of 0.32 l/min or 21.3% at 2 SD, respectively. The difference was most marked in a neonate with low cardiac output. CONCLUSION: Continuous measurement of cardiac output by the Fick principle offers a convenient method for the hemodynamic monitoring of unstable infants and children.     

Wide- and narrow-band bandpass coplanar filters in the W-frequency band

This paper deals with the design of passive coplanar devices in the W-frequency band. As long as coplanar transmission lines are correctly dimensioned, analytical models based on quasi-TEM approximation can be used. Such models are associated with a correct definition of the reference planes at the junctions and employed for junction discontinuities, T- and cross-junctions. In order to validate these assertions, simulated and experimental data on classical quarter-wavelength shunt-stub filters are first presented. Then the design of traditional coupled-line filters is examined. The problems in terms of insertion loss associated with these kinds of narrow-band applications are discussed here. Minimization of insertion losses requires increasing the width of the strips. Consequently, the design becomes complex and modeling using transmission-line models less accurate. Nevertheless, as an optimization procedure is needed to tune the filter theoretically, such a very fast design method is necessary. Simulated and experimental results in the range 500 MHz to 110 GHz are compared throughout the paper.     

A high-frequency nonquasi-static analytical model including gate leakage effects for on-chip decoupling capacitors

This paper presents a compact model for on-chip decoupling capacitors (decaps) including gate-oxide leakage. The model makes use of only four parameters, namely, channel resistance, gate-oxide capacitance, and two parameters to quantify gate-oxide leakage, to predict the static and dynamic response of decaps. Quality indices have been defined to enable development of decap design guidelines and evaluation of performance of such capacitors. The model shows how the gate leakage and longer channel lengths severely affect the performance of on-chip decaps for both low and high frequencies. The model also shows that lumped models of decaps at high frequencies fail and have to be substituted by a distributed model. Application of the model uncovers tradeoffs for thin- and thick-oxide capacitors in an available 90-nm CMOS technology. For a general-purpose technology, a reference capacitance value has been realized using decaps with a discrete width and length. Our model predicts that thick-oxide n-channel (p-channel) capacitors require /spl sim/3.37x (/spl sim/3.31x) more silicon area and /spl sim/1.70x (/spl sim/1.17x) degraded time response as compared to their thin-oxide versions. The time response is even more degraded (/spl prop/L/sup 2/) when longer channel decaps are used. This paper contributes by defining performance benchmarks for decaps.     

Involvement of the esophagus in the cramp-fasciculation syndrome

A 35-year-old male patient presented with symptoms of a cramp-fasciculation syndrome, but also reported difficulties swallowing. Esophageal manometry showed spontaneous nonperistaltic contractions, pathologically increased amplitudes and duration of the contractile complexes, and an asynchronous propagation. Electromyographic evidence of fasciculations in the sternocleidomastoid and pectoralis muscles was found. Apparently all types of peripheral motor fibers can be involved in this heterogeneous syndrome, including cranial motor nerves, the vagal nerve, and enteric motor fibers of the gastrointestinal tract.     

A case of clofazimine enteropathy

A case of clofazimine enteropathy is described. A young male received clofazimine 200 mg daily for four years. He was admitted in a pigmented, emaciated state with abdominal pain, diarrhoea and weight loss. At laparotomy his abdominal organs were stained with dark brown-black pigment due to heavy infiltration with clofazimine crystals. Despite withdrawal of clofazimine his symptoms failed to settle. He developed oedema and hypoalbuminaemia. He died following a cerebral infarction.     

The uniplanar technology: A convenient way to design multifunction subsystems and application to a biphase (0°–180°) modulator/mixer

This article outlines the high flexibility of the uniplanar technology to design complex multifunction subsystems. Furthermore, a design procedure, based on a subsystem repartition into elementary blocks and very simple electrical modeling, is proposed and applied to a uniplanar biphase (0°–180°) modulator/mixer. To start, this approach has been validated by experimentation on a subsystem up to 20 GHz. Next, preliminary results demonstrate the validity of this subsystem design procedure at millimeter-wave frequencies. © 1996 John Wiley & Sons, Inc.