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.     

Millimeter-wave asymmetric Fabry-Perot modulators

We have designed, fabricated, and characterized GaAs-AlGaAs (λ=864 nm) asymmetric Fabry-Perot modulators with ≈37 GHz modulation frequency response, comparable to the fastest waveguide modulators. The modulation response saturates at high optical powers due to saturation of the excitonic absorption and heating effects, but the frequency response is independent of the incident optical intensity, since it depends only on the RC time constant, and not on the carrier transit time. The device design takes advantage of the fact that the quantum-confined Stark effect is more pronounced at some distance from the absorption edge to achieve a modulator with ⩾20 dB contrast and ≈3 dB insertion loss for ±2 V operating voltage, but only 21 fF capacitance. The DC bias used to move the operating point off the absorption edge has the additional benefits of improving the linearity and chirp of the device, as well as the saturation intensity. Here we present measurements of the modulation and photocurrent responses of the modulators, calculate the RC and transit times for the device, analyze the saturation mechanisms, and discuss the linearity and chirp of the device from the perspective of a high-speed digital optical communications system     

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.     

Observations of shadow bands at the total solar eclipse of 16 February 1980

Photoelectric observations of short term light variations (shadow bands) at the 16 Feb. 1980 total solar eclipse have been made using a set of spatially separated PIN diodes. Light variations in a bandpass of 1-500 Hz were detected during the half-minutes preceding and following the total phase. Fourier analysis of the noise spectrum of the variations reveals a sharp drop-off for frequencies above 50 Hz and an overall spectrum quite similar to previously reported power spectra of stellar scintillation. This is consistent with an atmospheric origin for the shadow bands. Cross-correlations between the detector outputs are low, suggesting a short persistence time for the turbulent elements causing the patterns.     

Microcavity interferometry for MEMS device characterization

We have developed a high resolution optical technique to measure the electromechanical properties of MEMS microstructures. The technique is applied to microbridges developed for capacitive switching in coplanar radio frequency (RF) waveguides. The thin metal ground plane on the substrate and the bottom of the bridge together form a microcavity for an optical beam. The wavelength of a cavity mode is a sensitive measure of the bridge position relative to the substrate. The technique is applied to the measurement of resonances and damping times of microbridges of varying lengths. It is also used to measure dc changes in bridge height of tenths of nanometers, driven ac displacements of less than a picometer, and bridge displacement noise of hundreds of femtometers per root Hertz. This extreme sensitivity exceeds previously demonstrated optical characterization methods.     

Aromatase and dual aromatase-steroid sulfatase inhibitors from the letrozole and vorozole templates

Concurrent inhibition of aromatase and steroid sulfatase (STS) may provide a more effective treatment for hormone‐dependent breast cancer than monotherapy against individual enzymes, and several dual aromatase–sulfatase inhibitors (DASIs) have been reported. Three aromatase inhibitors with sub‐nanomolar potency, better than the benchmark agent letrozole, were designed. To further explore the DASI concept, a new series of letrozole‐derived sulfamates and a vorozole‐based sulfamate were designed and biologically evaluated in JEG‐3 cells to reveal structure–activity relationships. Amongst achiral and racemic compounds, 2‐bromo‐4‐(2‐(4‐cyanophenyl)‐2‐(1H‐1,2,4‐triazol‐1‐yl)ethyl)phenyl sulfamate is the most potent DASI (aromatase: IC₅₀=0.87 nM ; STS: IC₅₀=593 nM ). The enantiomers of the phenolic precursor to this compound were separated by chiral HPLC and their absolute configuration determined by X‐ray crystallography. Following conversion to their corresponding sulfamates, the S‐(+)‐enantiomer was found to inhibit aromatase and sulfatase most potently (aromatase: IC₅₀=0.52 nM ; STS: IC₅₀=280 nM ). The docking of each enantiomer and other ligands into the aromatase and sulfatase active sites was also investigated.