bluuebunny/crossref_metadata_2025 huggingface dataset:
Sources of variation in the determination of distal blood pressure measured using the strain gauge technique
Authors: Arveschoug Anne Kirstine , Revsbech Povl , Brøchner‐Mortensen Jens
Published: March 2003

Using the determination of distal blood pressure (DBP) measured using the strain gauge technique as an example of a routine clinical physiological investigation involving many different observers (laboratory technicians), the present study was carried out to assess (1) the influence of the number of observers and the number of analyses made by each observer on the precision of a definitive value; and (2) the minimal difference between two determinations to detect a real change. A total of 45 patients participated in the study. They were all referred for DBP determination on suspicion of arterial peripheral vascular disease. In 30 of the patients, the DBP curves were read twice, with a 5‐week interval, by 10 laboratory technicians. The results were analysed using the variance component model. The remaining 15 patients had their DBP determined twice on two different days with an interval of 1–3 days and the total day‐to‐day variation (SDdiff) of DBP was determined. The inter‐ and intraobserver variations were, respectively, 5·7 and 4·9 mmHg at ankle level and 3·5 and 2·7 mmHg at toe level. The index values as related to systolic pressure were somewhat lower. The mean day‐to‐day variation was 11 mmHg at ankle level and 10 mmHg at toe level, thereby giving a minimal significant difference between two DBP determinations of 22 mmHg at ankle and 20 mmHg at toe level. To decrease the value of SD (standard deviation) on a definitive determination of DBP and index values, it was slightly more effective if the value was based on two observers performing one independent DBP curve reading than if one observer made one or two DBP curve readings. The reduction in SDdiff was greatest at ankle level. The extent of the Sddiff decrease was greatest when two different observers made a single DBP reading each at both determinations compared with one different observer making two readings at each determination. Surprisingly, about half of the maximum reduction in the SDdiff was achieved just by increasing the number of observers from one to two. We have found variance component analyses to be a suitable method for determining intra‐ and interobserver variation when several different observers take part in a routine laboratory investigation. It may be applied to other laboratory methods such as renography, isotope cardiography and myocardial perfusion single‐photon emission computerized tomography (SPECT) scintigraphy, in which the final result may be affected by individual judgement during processing.
Scintigraphic diagnosis of coronary artery disease: myocardial bull's‐eye images contain the important information
Authors: Lindahl Dan , Palmer John , Pettersson Jonas , White Thomas , Lundin Anders , Edenbrandt Lars
Published: March 2003

The bull's‐eye image, also called polar map image, has been developed as an important display for the visual and quantitative analysis of myocardial perfusion scintigrams. Quantitative analysis can be performed for example by comparing areas in the bull's‐eye image with normal limits or by processing it using artificial neural networks. The usefulness of such methods is highly dependent on the information content of the bull's‐eye image. The purpose of this study was to investigate whether there is more diagnostically important information in a set consisting of the myocardial bull's‐eye image plus tomographic slice image than in the bull's‐eye image alone. A population of 135 patients who had undergone both myocardial scintigraphy and coronary angiography, with no more than 3 months elapsing between the two examinations, was studied retrospectively. Four experienced observers independently classified visually all scintigrams regarding the presence/absence of coronary artery disease in two vascular territories using a four‐grade scale. The observers classified the scintigrams once viewing bull's‐eye images only, and once viewing tomographic slices and bull's‐eye images. Coronary angiography was used as gold standard. The classifications were evaluated using the areas under the receiver operating characteristics (ROC) curves. The classifications based on bull's‐eye images only were slightly more accurate than those based on tomographic slices and bull's‐eye images in one of the two vascular territories (ROC areas of 0·66 vs. 0·64). The opposite relationship was found in the other vascular territory (0·78 vs. 0·81). None of the differences was statistically significant. In conclusion, the diagnostically important information for the diagnosis of coronary artery disease by myocardial perfusion scintigraphy is present in the bull's‐eye image.
Standardized intermittent static exercise increases peritendinous blood flow in human leg
Authors: Langberg  , Bülow  , Kjær
Published: March 2003

Alteration in tendinous and peritendinous blood flow during and after exercise is suggested to contribute to the development of Achilles tendon injury and inflammation. In the present study a method for evaluating the influence of standardized workload on peritendinous flow is presented. The radioactive isotope xenon‐133 was injected just ventrally to the Achilles tendon 5 cm proximal to the tendon's insertion on the calcaneus. The disappearance of 133Xe was used to determine blood flow during intermittent static exercise of the calf muscle (1·5 s exercise/1·5 s rest) for 30 min at a workload equivalent to individual body weight (1 BW) in six healthy volunteers around both Achilles tendons (n = 12). During intermittent static exercise, blood flow was increased from 1·8 ± 0·3 ml 100 g tissue−1 min−1 (mean value and SEM) (rest) to 6·1 ± 1·3 ml 100 g tissue−1 min−1 (exercise) (P<0·05). The exercise induced an average increase in blood flow (3·4‐fold) equivalent to results previously obtained during regular dynamic heel raises (P>0·05). It is concluded that the method is well suited to study the influence of standardized workload on the physiology and pathophysiology of the tissue around the Achilles tendon in humans.
Day‐to‐day variation in oxygen consumption and energy expenditure during submaximal treadmill walking in female adolescents
Authors: Wergel‐Kolmert Ulla , Wohlfart Björn
Published: March 2003

The day‐to‐day variation in oxygen consumption (V˙O2) and energy expenditure (EE) during horizontal treadmill walking was measured using indirect calorimetry in 20 female adolescents (mean age 17·3 years). Two different walking speeds were used: 5 km h−1and an individually convenient speed of 3·0 km h−1(mean). The two sets of measurements were performed on 2 consecutive days, and great care was taken to minimize possible disturbing factors. The meanV˙O2was 919 ml min−1at 5 km h−1and 622 ml min−1at the individual speed, and the mean values of EE were 4·5 kcal min−1and 3·1 kcal min−1respectively. The individual day‐to‐day variation inV˙O2(at 5 km h−1) was between −11·7% and +12·6% of the meanV˙O2. The coefficient of variation (CV) was 6·4% when values were calculated in ml min−1 kg−1. The energy expenditure varied somewhat less between the 2 days (CV = 5·7%). The corresponding value for EE when walking at the individual speed was 7·2%, and the mean day‐to day variation inV˙O2was 7·5% (CV). The rate of perceived exertion according to Borg's scale was lower on day 2 (11·9) compared with day 1 (13·0) when walking at 5 km h−1. There was no difference in heart rate between the 2 days. It is concluded that EE varies somewhat less thanV˙O2on successive days, probably because of an interchangeable relationship between breathing gases, depending on which substrate is used for combustion. When usingV˙O2and EE for evaluation of physical capacity, the day‐to‐day variation in the measurements must be taken into consideration.
Reduced cardiac sympathetic autonomic tone after long‐term nasal continuous positive airway pressure in obstructive sleep apnoea syndrome
Authors: Roche  , Court‐Fortune  , Pichot  , Duverney  , Costes  , Emonot  , Vergnon  , Geyssant  , Lacour  , Barthélémy
Published: March 2003

The increased sympathetic activation that occurs in obstructive sleep apnoea (OSA) may play an important role in associated morbidity. We investigated the effect of long‐term (3 month) nasal continuous positive airway pressure (CPAP) on the autonomic nervous system assessed by heart rate variability (HRV). Fourteen patients (12 men), mean age 61·4 ± 8·1 years, with OSA underwent continuous synchronized electrocardiographic and polysomnographic monitoring. The apnoea/hypopnoea index (AHI) decreased from 50·6 ± 13·7 to 2·2 ± 2·5 events h−1 after CPAP. HRV analysis showed significant decreases in low frequency (LF; from 7·12 ± 1·06 to 6·22 ± 1·18 ln ms2 Hz−1; P<0·001), high frequency (HF; from 5·91 ± 0·87 to 5·62 ± 0·92 ln ms2 Hz−1; P<0·05) and LF/HF (from 1·21 ± 0·12 to 1·11 ± 0·15 ln ms2 Hz−1; P<0·001) when the patients were asleep. The decrease in LF/HF was prolonged into the daytime (from 1·33 ± 0·22 to 1·24 ± 0·21 ln ms2 Hz−1; P<0·001). Treatment of OSA by CPAP significantly reduced the parameters of cardiac sympathetic tone, a favourable effect.
Effects of breathing exercises on breathing patterns in obese and non‐obese subjects
Authors: Olsén Monika Fagevik , Lönroth Hans , Bake Björn
Published: March 2003

Chest physiotherapy in connection with abdominal surgery includes different deep‐breathing exercises to prevent post‐operative pulmonary complications. The therapy is effective in preventing pulmonary complications, especially in high‐risk patients such as obese persons. The mechanisms behind the effect is unclear, but part of the effect may be explained by the changes in breathing patterns. The aim of this study was therefore to describe and to analyse the breathing patterns in obese and non‐obese subjects during three different breathing techniques frequently used in the treatment of post‐operative patients. Twenty‐one severely obese [body mass index (BMI) > 40] and 21 non‐obese (BMI 19–25) subjects were studied. All persons denied having any lung disease and were non‐smokers. The breathing techniques investigated were: deep breaths without any resistance (DB), positive expiratory pressure (PEP) with an airway resistance of approximately +15 cmH2O (1·5 kPa) during expiration, inspiratory resistance positive expiratory pressure (IR‐PEP) with a pressure of approximately –10 cmH2O (–1·0 kPa) during inspiration. Expiratory resistance as for PEP. Volume against time was monitored while the subjects were sitting in a body plethysmograph. Variables for volume and flow during the breathing cycle were determined. Tidal volume and alveolar ventilation were highest during DB, and peak inspiratory volume was significantly higher than during PEP and IR‐PEP in the group of obese subjects. The breathing cycles were prolonged in all techniques but were most prolonged in PEP and IR‐PEP. The functional residual capacity (FRC) was significantly lower during DB than during PEP and IR‐PEP in the group of obese subjects. FRC as determined within 2 min of finishing each breathing technique was identical to before the breathing manoeuvres.
Blood perfusion hyperaemia in response to graded loading of human heels assessed by laser‐Doppler imaging
Authors: Mayrovitz  , Macdonald  , Smith
Published: March 2003

Heel pressure ulcers are important clinical, humanitarian and economic problems arising in part from localized blood flow deficits during loading and inadequate flow recovery. Because there are few data available with regard to the intrinsic physiological responses of heel skin to pressure‐induced ischaemia, the present study was undertaken to characterize the main features of the post‐loading hyperaemic response. Laser‐Doppler perfusion imaging was used to measure hyperaemia in 14 vascularly normal women who were subjected to sequential local heel loading with graded magnitudes (30–140 mmHg) and durations (2·5–20 min). Peak heel perfusion produced by local heating to 44°C for 5 min was used as a comparison standard. All heel loads and durations resulted in hyperaemic responses, with the largest increase in peak response occurring between heel loads of 60 and 120 mmHg. During this transition, peak hyperaemia increased from about 32% to 79% of the local maximal microvascular vasodilatory capacity. Recovery times also increased with both load duration and magnitude, with the longest recovery time being about 7·5 min. Hyperaemic responses and recovery times were analytically dependent on the heel load pressure duration product, with evidence of suppression of the peak response at 1500 mmHg min and a levelling off of recovery time at higher pressure durations. These findings serve to characterize normal physiological perfusion responses to pressure‐induced ischaemia at an anatomical site prone to pressure ulceration. The results suggest the possibility of a ‘critical’ heel loading, above which a near‐maximum response is elicited and beyond which vasodilatory recovery potential is blunted.
Contributory factors to orthostatic intolerance after simulated weightlessness
Authors: Traon A. Pavy‐Le , Louisy  , Vasseur‐Clausen  , Güell  , Gharib
Published: March 2003

Various factors may contribute to orthostatic intolerance (OI) observed after space flights or simulated weightlessness such as bed rest experiments: individual physical and physiological factors (arterial blood pressure (BP), height), physiological changes induced by real or simulated weightlessness (hypovolaemia, increase in venous distensibility), and space flight or simulation conditions (duration and counter‐measure application). Our purpose was to test which of these factors were dominant in contributing to the OI. This was assessed in 47 healthy men participating in bed rest experiments of 4, 14, 28, 30 and 42 days, with or without counter‐measures (medical stockings, lower‐body negative pressure (LBNP), LBNP + muscular exercise). Nineteen subjects did not finish the orthostatic test (60° head‐up tilt or stand test) after bed rest. The occurrence of OI was associated with greater height, low resting BP, greater changes in resting lower‐limb venous distensibility throughout the bed rest, and absence of counter‐measures.
The effect of dietary restriction and menstrual cycle on excess post‐exercise oxygen consumption (EPOC) in young women
Authors: Fukuba  , Yano  , Murakami  , Kan  , Miura
Published: March 2003

The purpose of this study was to evaluate the effect of acute dietary restriction on excess post‐exercise oxygen consumption (EPOC) in young women at two different phases of the menstrual cycle. Five young sedentary women (age 21–22 years) participated in this study. Each subject visited the laboratory eight times for measurement of EPOC. They performed cycle ergometer exercise for 60 min at a work rate corresponding to approximately 70% of V˙O2max under each four different conditions (i.e. standard diet/follicular phase (SF), standard diet/luteal phase (SL), restricted diet/follicular phase (RF) and restricted diet/luteal phase (RL)). The exercise was performed in the morning and V˙O2 was measured for the last 15 min of each hour for 7 h after the exercise. As a control, V˙O2 was also measured with an identical time schedule under the same four conditions but without exercise. EPOC was calculated as the difference of the V˙O2–time integral for 7 h between the exercise and control trial days in each of the four conditions (i.e. SL, SF, RL and RF). The diet was precisely controlled during 2 days (i.e. the test day and the day preceding it). The standard diet was 1600 kcal day–1 and the restricted diet was half of the standard diet. A two‐way (dietary and menstrual cycle factors) ANOVA indicated that EPOC was significantly affected only by the dietary factor. The dietary restriction decreased EPOC compared to the standard dietary condition (SF 8·6 ± 2·1, RF 5·3 ± 1·6, SL 8·9 ± 4·8, RL 4·0 ± 1·2 l). These data indicate that for young sedentary women, EPOC is significantly lowered by prior acute dietary restriction but is not influenced by different phases of the menstrual cycle.
Cardiac output measured by electric bioimpedance compared with the CO2 rebreathing technique at different exercise levels
Authors: Christensen  , Jensen  , Hjerpe  , Kanstrup
Published: March 2003

In the lower range of cardiac output (CO, up to 15 l min−1), we found an excellent agreement between CO measured by bioimpedance and carbon dioxide rebreathing techniques. CO estimated by bioimpedance was generally lower. The bioimpedance method had better reproducibility. Both methods seem valuable for non‐invasive studies in healthy subjects at work.
Lipoproteins and free plasma catecholamines in spinal cord injured men with different injury levels
Authors: Schmid  , Halle  , Stützle  , König  , Baumstark  , Storch  , Schmidt‐Trucksäß  , Lehmann  , Berg  , Keul
Published: March 2003

Persons with spinal cord injury (SCI) are especially prone to atherogenesis. This is partly explained by an unfavourable lipoprotein profile in these individuals. The impairment of the sympathetic nervous system, and the fact that SCI subjects are subject to extreme physical inactivity, may have an influence on their lipid profile and lipoprotein(a) concentration. We made a detailed investigation of the lipid profile as well as serum levels of adrenaline and noradrenaline in 80 men with SCI ranging from tetraplegia to low paraplegia and in 16 control subjects. The lipid profile of tetraplegics was characterized by elevated very low‐density lipoprotein cholesterol and triglyceride levels and reduced high‐density lipoprotein levels. In contrast, paraplegics had significantly higher low‐density lipoprotein and total cholesterol levels. Tetraplegics had lower and the low‐lesion paraplegics had higher adrenaline and noradrenaline levels than the high‐lesion paraplegics and the control subjects. High‐lesion SCI subjects also showed an extreme reduction in VO2max. The lipoprotein profile was dependent on the injury level and serum catecholamine concentrations. The lower the noradrenaline values, the lower the high‐density lipoprotein cholesterol. The low‐density lipoprotein also correlated to catecholamines and particularly adrenaline values. Despite the correlation between lipoprotein(a) and adrenaline, no significant differences in lipoprotein(a) were found within SCI individuals as well as between SCI individuals and control subjects, indicating the predominantly genetic determination of lipoprotein(a) and thus the cardiovascular risk. Different serum catecholamine levels due to impairment of sympathetic nervous system and VO2max levels were observed in SCI subjects. This was associated with a higher lipid risk profile for cardiovascular diseases; however, the risk profile is dependent on the lesion level.
Insulin treatment increases skeletal muscle fibre area in patients with diabetes mellitus type 2
Authors: Cederholm T. , Sylvén C. , Esbjörnsson‐Liljedahl M. , Jansson E.
Published: March 2003

The effects of insulin treatment on skeletal muscle characteristics were studied in 18 patients (62 ± 11 years) with poorly controlled diabetes mellitus type 2 (mean duration 7·5 ± 6 years). Skeletal muscle biopsy samples were taken from the lateral portion of the quadriceps muscle before and after a period of insulin treatment of 40 ± 14 days. Enzyme activities (phosphofructokinase, 3‐hydroxyacyl‐CoA dehydrogenase, citrate synthase, lactate dehydrogenase and creatine kinase) and myoglobin content were assessed. In a subgroup of 11 patients (60 ± 11 years), skeletal muscle fibre type composition (type I, IIA, IIB and IIC) and fibre type cross‐sectional area were also analysed. Following insulin treatment there were 32 and 38% increases, respectively, in the cross‐sectional areas of type IIA and IIB fast‐twitch fibres (P<0·02). The fibre type distribution did not change. The myoglobin content in muscle decreased by 20% (P<0·01). Of the enzymes tested, the 3‐hydroxyacyl‐CoA dehydrogenase activity decreased by 10% (P<0·04). Serum glucose, HbA1C and serum triglyceride levels decreased (P<0·001) and body weight and arm muscle circumference increased (P<0·02). In conclusion, insulin treatment of patients with poorly controlled non‐insulin‐dependent diabetes mellitus increased the fast‐twitch fibre area, reduced myoglobin levels and decreased muscle enzyme activity related to fatty acid oxidation.
Cardiac adrenergic innervation within the first 3 months after acute myocardial infarction
Authors: Simula S. , Lakka T. , Kuikka J. , Laitinen T. , Remes J. , Kettunen R. , Hartikainen J.
Published: March 2003

It is widely accepted that myocardial infarction results in adrenergic denervation of the infarcted and peri‐infarcted myocardium. On the contrary, the concept of re‐innervation of adrenergic nerve fibres is less well established. Although there is evidence of partial re‐innervation occuring several months after myocardial infarction, the extent and time scale of re‐innervation are only poorly known. In this study we investigated changes in cardiac adrenergic innervation and myocardial perfusion during the early convalescence period (the first 3 months) after an acute myocardial infarction. Single‐photon emission computed tomographic imaging was conducted in 15 men 1 week and 3 months after an acute myocardial infarction with I123‐metaiodobentzylguanidine (MIBG) and Tc99m‐sestamibi (MIBI) to determine the extent of adrenergic denervation and impaired perfusion, respectively. A MIBG and MIBI defect was determined as regional uptake ≤30% of maximal myocardial activity. The size of the MIBG defect calculated as a percentage of left ventricular mass remained unchanged between 1 week and 3 months after myocardial infarction (31·1 ± 17·3% vs. 30·5 ± 16·8%, respectively). Accordingly, MIBG activity of the infarct and peri‐infarct zones (expressed as a percentage of MIBG activity of the myocardium with normal perfusion) showed no significant change (23·7 ± 10·0% vs. 25·3 ± 11·0% and 39·0 ± 11·3% vs. 40·8 ± 12·8%, respectively) during the follow‐up. On the other hand, the size of MIBI defect decreased significantly during the follow‐up (14·2 ± 11·5% vs. 11·4 ± 9·7%, P<0·05, respectively) indicating improved myocardial perfusion. The results demonstrate that cardiac adrenergic re‐innervation is a slow process; despite a significant increase in myocardial perfusion we found no evidence of adrenergic re‐innervation during the first 3 months after acute myocardial infarction.
Reproducibility of contractile properties of the human paralysed and non‐paralysed quadriceps muscle
Authors: Gerrits H. L. , Hopman M. T. E. , Sargeant A. J. , De Haan A.
Published: March 2003

This study assessed the reproducibility of electrically evoked, isometric quadriceps contractile properties in eight people with spinal cord injury (SCI) and eight able‐bodied (AB) individuals. Over all, the pooled coefficients of variation (CVps) in the SCI group were significantly lower (ranging from 0·03 to 0·15) than in the AB group (ranging from 0·08 to 0·21) (P<0·05). Furthermore, in all subjects, the variability of force production increased as stimulation frequency decreased (P<0·01). In subjects with SCI, variables of contractile speed are clearly less reproducible than tetanic tension or resistance to fatigue. Contractile properties of quadriceps muscles of SCI subjects were significantly different from that of AB subjects. Muscles of people with SCI were less fatigue resistant (P<0·05) and produced force–frequency relationships that were shifted to the left, compared with AB controls (P<·01). In addition, fusion of force responses resulting from 10 Hz stimulation was reduced (P<·05) and speed of contraction (but not relaxation) was increased (P<0·05), indicating an increased contractile speed in paralysed muscles compared with non‐paralysed muscles. These results correspond with an expected predominance of fast glycolytic muscle fibres in paralysed muscles. It is concluded that quadriceps dynamometry is a useful technique to study muscle function in non‐paralysed as well as in paralysed muscles. Furthermore, these techniques can be reliably used, for example, to assess therapeutic interventions on paralysed muscles provided that expected differences in relative tetanic tension and fatigue resistance are larger than ∼5% and differences in contractile speed are larger than ∼15%.
Suspicion of aortic coarctation in an outpatient clinic: How should blood pressure measurements be performed?
Authors: Rahiala E. , Tikanoja T.
Published: March 2003

We conducted a study on blood pressure (BP) measurements in 40 healthy children (aged 11·0 ± 0·4 years), in 20 healthy students (18·8 ± 0·9 years), and in 19 children with a history of coarctation (9·3 ± 4·0 years). Both a standard sphygmomanometer and an oscillometric device (Dinamap, Critikon Inc, Tampa, FL, USA) were used. BP measurements in the arms, thighs and ankles were performed according to a fixed protocol. Although the site of measuring was switched each time successive measurements in the same limb resulted in lower systolic values than the first measurement. In patients with coarctation all gradient estimates correlated well with each other and with the gradient estimates obtained by Doppler‐echocardiography. In healthy children, the systolic BP measured by Dinamap was 2 mmHg lower in the right arm than in the thighs, and 12 mmHg lower than in the ankles. In young adults, the differences were 12 and 16 mmHg, respectively. The BP difference between the right arm and the thighs by sphygmomanometer was +4 mmHg in children and −4 mmHg in adults. The cut point value to warrant further examinations was similar with both methods: 5–10 mmHg higher readings in the arm than in the leg. The first BP measurement should be ignored. After that, repetitive measurements in the arm with the higher systolic BP and the legs should be performed.
How does quantitative ultrasound compare to dual X‐ray absorptiometry at various skeletal sites in relation to the WHO diagnosis categories?
Authors: Jørgensen H. L. , Warming L. , Bjarnason N. H. , Andersen P. B. , Hassager C.
Published: March 2003

The World Health Organisation (WHO) has proposed a set of guidelines for the diagnosis of osteoporosis in adult women based on a measurement of bone mineral density (BMD) expressed as the number of SD below young adult mean (t‐score). In this study, we investigated the number of subjects classified as either osteopenic or osteoporotic according to these guidelines using dual X‐ray absorptiometry (DXA), at the hip, at the spine and at the lower forearm and quantitative ultrasound (QUS), at the heel. A total of 247 men, 209 postmenopausal women and 195 premenopausal women were included in the study. Furthermore, the study provides the first normative data showing the influence of sex, age and menopause on broadband ultrasound attenuation (BUA) and speed of sound (SOS), as measured by the DTU‐one imaging ultrasound scanner. The difference between the number of patients classified into either diagnosis group by the investigated parameters is large ranging from 25·9% of the women being diagnosed as osteopenic by BUA at the heel to 43·0% by BMD at the femoral neck. For men, the same range is from 20·5% by BUA to 44·1% by BMD at the femoral neck. For the classification into the osteoporotic group, the range is from 2·5% by intertrochanteric BMD to 24·4% by BMD at Ward’s triangle for women and from 0% by SOS to 29·0% by BMD at Ward’s triangle for men. Using total hip BMD as the reference parameter to categorize the subjects as normal, osteopenic or osteoporotic, the agreement of the other parameters with this classification is assessed in terms of sensitivity and specificity. We conclude that there are significant differences in the classification of osteoporosis/osteopenia depending on the site measured and the technique used for the bone mass assessment. Furthermore, we suggest that development of technique and site specific cut‐off values may increase the accuracy of the classification of osteoporosis/osteopenia in both men and women.
Comparison of ultrasound assessment of flow‐mediated dilatation in the radial and brachial artery with upper and forearm cuff positions
Authors: Agewall S. , Doughty R. N. , Bagg W. , Whalley G. A. , Braatvedt G. , Sharpe N.
Published: March 2003

In the published literature relating to flow‐mediated dilatation (FMD), there are substantial differences between centres in terms of normal FMD amongst healthy subjects. This present study attempts to identify the effect of differing methodologies on FMD. High frequency ultrasound was used to measure blood flow and percentage brachial and radial artery dilatation after reactive hyperaemia induced by forearm or upper arm cuff occlusion in 24 healthy subjects, less than 40 years, without known cardiovascular risk factors. FMD of the brachial artery was significantly higher after upper arm occlusion, compared with forearm occlusion, 6·4 (3·3) and 3·9 (2·6)% (P<0·05), respectively. FMD of the radial artery was significantly higher after forearm occlusion, compared with upper arm occlusion, 10·0 (4·6) and 7·9 (3·5)% (P<0·05), respectively. The percentage blood flow increase in the brachial and radial arteries after forearm and upper arm occlusion were similar. After forearm and upper arm occlusion, the radial artery percentage dilatation was greater than the brachial artery. In conclusion dilatation of the brachial artery, after reactive hyperaemia induced by upper arm occlusion, was significantly more pronounced compared with dilatation of the brachial artery after forearm occlusion, despite a similar percentage blood flow increase. The local ischaemia of the brachial artery with a proximal occlusion may explain why the brachial artery dilated more after upper arm occlusion compared with after forearm occlusion. The study has also shown that FMD of the radial artery could be assessed by B‐mode ultrasound technique. FMD was greater using the radial artery compared with the brachial artery, suggesting that the radial artery may be a useful way to assess FMD in future clinical studies.
Renal extraction of insulin and C‐peptide in man before and after a glucose meal
Authors: Samnegård Björn , Brundin Tomas
Published: March 2003

It was recently shown that the early rise in arterial insulin concentration after an oral glucose meal is largely because of a decreased extraction of the hormone. The kidney is a major site for extraction of insulin and C‐peptide. We therefore measured the renal extraction of insulin and C‐peptide in eight healthy individuals before and after ingestion of 75 g of glucose. Arterial, renal venous and hepatic venous catheters were inserted. Splanchnic and renal plasma flow were measured, as well as arterial, hepatic venous and renal venous concentrations of insulin and C‐peptide. Renal fractional extraction of insulin increased significantly, from 21% to a maximum of 48% after the meal while the renal fractional extraction of C‐peptide did not change significantly. Renal blood flow decreased slightly but significantly after the meal. It is concluded that renal fractional extraction of insulin increases and that renal blood flow decreases after a glucose meal.
Effects of resistance training on cardiovascular responses to lower body negative pressure in the elderly
Authors: Panton Lynn B. , Franke Warren D. , Bleil Dodie A. , Baier Shawn M. , King Douglas S.
Published: March 2003

The purpose of the present study was to determine whether resistance training alters the cardiovascular responses to submaximal lower body negative pressure (LBNP) in the elderly. Twenty‐one subjects were randomized into a control (C: n=10; 70 ± 3 years, mean ± SD) or a resistance training (TR: n=11; 67 ± 7 years) group. Subjects in the TR underwent 12 weeks of training consisting of three sets of 8–12 contractions at ˜60–80% of their initial maximal one repetition, three times per week, on 10 different machines. Before (Pre) and after (Post) training, all subjects underwent exposures of LBNP of −10, −20 and −40 Torr and muscle biopsy sampling at the vastus lateralis. TR increased (P≤0·05) knee extension (Pre=379 ± 140 N, Post=534 ± 182 N) and chest press (Pre=349 ± 137 N, Post=480 ± 192 N) strength. Neither body weight nor percentage body fat were altered (P >0·05) by training. Resistance training increased (P≤0·05) cross‐sectional area in both Type I (4203 ± 1196 to 5248 ± 1728 μm2) and Type II (3375 ± 1027 to 4286 ± 1892 μm2) muscle fibres. Forearm blood flow, forearm vascular conductance, mean arterial pressure, and heart‐rate responses to LBNP were not altered by the training. These data suggest that the cardiovascular responses of elderly to LBNP are unaffected by 12 weeks of whole‐body resistance training despite increases in muscle strength and size.
Computerized analysing system using the active contour in ultrasound measurement of carotid artery intima‐media thickness
Authors: Schmidt‐Trucksäss Arno , Cheng Da‐chuan , Sandrock Markus , Schulte‐Mönting Jürgen , Rauramaa Rainer , Huonker Martin , Burkhardt Hans
Published: March 2003

Background and purpose B‐mode measurement of the carotid intima‐media (IM) thickness (T) based on manual tracing (MT) procedures are dependent on the subjectivity of the reader and the existing automatic tracing procedures often fail to detect the IM boundaries accurately. The purpose of this study was to compare the tracing results of the IM boundaries of the carotid wall with a new automatic identification (AI) procedure, based on an active contour model, and computer‐assisted manual tracing (MT).

Methods The detection of the IM boundaries was performed with both procedures in 126 ultrasound images [63 each of the common carotid artery (CCA) and carotid bulb] along the far wall of the distal CCA and the carotid bulb. Intra‐ and inter‐reader variability for mean and maximum IMT with AI and MT and accuracy of identification of both IM boundaries were evaluated.

Results Using MT the intra‐ and inter‐reader variability amounted to 0·01–0·03 and 0·03–0·07 mm, respectively. The variability was slightly higher in the carotid bulb than in the CCA. Using AI the variability was almost eliminated. Mean and maximum IMT were measured systematically lower by AI compared with MT in all regions by 0·01 mm. The accuracy of identification was similar for both IM boundaries, but lower in the carotid bulb region than in the CCA.

Conclusions The new AI procedure identifies both IM boundaries in the region of the far wall of the CCA and carotid bulb with high precision, and eliminates most of the intra‐ and inter‐reader variability of the IMT measurement using MT.
Iopromide one‐sample clearance as a measure of glomerular filtration rate
Authors: Hackstein Nils , Langheinrich Alexander C. , Rau Wigbert S.
Published: March 2003

Objective: The pharmacokinetics of iopromide were analysed using a two‐compartment model. The optimal point of time for blood withdrawal for calculation of a one‐sample clearance was determined.

Methods: Plasma concentration of iodine was measured up to 8 h postinjection (p.i.) in 62 adult patients who received 120 ml iopromide for computed tomography (CT). A two exponential function was fitted by a weighted least error square method. As reference method, clearance was calculated from this function and the injected amount of iodine. Empirical parameters for calculation of one‐sample clearance were determined. This one‐sample clearance was compared with one‐sample clearance calculated according to formulas developed for Tc99m‐DTPA by Jacobsson as well as a two sample method.

Results: Total distribution volume of iopromide was calculated as 0·242 Lkg−1± 5·9%. A high correlation of all one‐sample method and the two‐sample method with reference to clearance was found. Best estimation of iopromide plasma clearance was achieved by determining one‐sample clearance 270 or 285 min p. i. with SDy.x of 5·8 ml min–1.

Conclusions: After administration of 120 ml iopromide, one‐sample plasma clearance can be calculated with low estimation error taking one blood sample at an appropriate time point. Late phase pharmacokinetics of iopromide found in the present study showed to be virtually identical to results published for iohexol and Tc99m‐DTPA.
Use of bile cytology for early diagnosis of complications in orthotopic liver transplantation
Authors: CARRASCO  , SANCHEZ‐BUENO  , SOLA  , ROBLES  , RODRIGUEZ  , RAMIREZ  , LUJAN  , ACOSTA  , PARrILLA
Published: March 2003

carrasco l., sanchez‐bueno f., sola j., robles r., rodriguez j. m., ramirez p., lujan j. a., acosta f. and parrilla p. (1998)Cytopathology9,406–414

Use of bile cytology for early diagnosis of complications in orthotopic liver transplantation

We conducted a daily analysis of bile cellularity in 25 patients undergoing 29 orthotopic liver transplants (OLT) and correlated the cytological parameters with the clinical outcome of each patient. The 16 patients without complications only showed slides with cells during the first 4–5 postoperative days. The four patients with primary non‐function (PNF) of the graft had a high cell density up to the time of the retransplant, with a preponderance of polymorphonuclear (PMN) leucocytes (59.2%) and epithelial cells (29.2%). During the episodes of sepsis (n = 3) and rejection (n = 7) we noted the sudden appearance of high cellularity, almost exclusively PMN leucocytes (96.5%), and a preponderance of PMN leucocytes (84.2%) with appreciable percentages of mononuclear cells and macrophages as well as the early appearance of lymphoblasts in the rejection episodes. Our results show that bile cytology can be a useful method for diagnosing graft complications in liver transplantation.
The study of the process of fluid‐phase endocytosis in cervical squamous cells using fluorescent microspheres
Authors: Hew W. S. R. , Robertson A. J. , Ross P. , Hopwood D.
Published: March 2003

The study of the process of fluid‐phase endocytosis in cervical squamous cells using fluorescent microspheres

Physiological processes in cervical squamous epithelium have not been extensively studied. Perhaps understandably, most of the research has concentrated on the pathology of the cervix, in particular dysplasia and malignancy. Fluid‐phase endocytosis is a physiological process which has been demonstrated to be important in understanding disease development at other squamous epithelial sites, e.g. oesophagus. In this study, we have demonstrated by a new methodology developed in our laboratory using fluorescent microspheres and flow cytometry that fluid‐phase endocytosis occurs in cervical squamous cells. The process has been shown to be dose‐ and time‐dependent. This novel approach provides a means to improve our understanding of the physiological functions of the cervix and may provide insight into the pathogenesis of cervical neoplastic and non‐neoplastic disease.
Comparison of transformation zone sampling rates— a potentially useful indicator of smear taker performance
Authors: Young W.
Published: March 2003

Comparison of transformation zone sampling rates—a potentially useful indicator of smear taker performance

Retrospective analysis of 18555 routinely collected smears from women in the age range 20–50 years reveals that there is a statistically significant relationship between the overall transformation zone sampling rate achieved in general practice and the detection rates for cervical abnormality. Similar analysis comparing unsatisfactory smear rates with rates for the detection of abnormality demonstrates a negative correlation which fails to achieve statistical significance. Comparison of transformation zone sampling rates achieved by smear takers sending samples to the same laboratory is proposed as a potentially useful performance indicator for smear takers.
An alternative approach to the management dilemma of the mildly dyskaryotic smear based on audit of outcome
Authors: Ifaturoti O. O. , Lockwood S. , Etheridge M. , Ong P. S. , Rashid F. , Jones M. H.
Published: March 2003

An alternative approach to the management dilemma of the mildly dyskaryotic smear based on audit of outcome

We describe a study which takes an alternative approach to the management dilemma of the mildly dyskaryotic cervical smear. Two hundred and fifty women with a smear showing mild dyskaryosis were studied by auditing the clinical outcome as well as the cost. The cost of providing the colposcopy services during the index year was approximately £70 000 for an average size district general Hospital. The proportion of women managed by the current guidelines and avoiding colposcopy after a first mildly dyskaryotic smear was only 30%. The majority of patients will eventually have colposcopy despite a policy of cytological surveillance. The alternative approach, to offer colposcopy immediately after the first mildly dyskaryotic smear, would result in a small increase in cost for our unit, equivalent to one extra colposcopy patient per week.
Fine needle aspiration cytology (FNAC) of adrenal masses
Authors: Fassina A. S. , Borsato S. , Fedeli U.
Published: March 2003

Fine needle aspiration cytology (FNAC) of adrenal masses

Between 1992 and 1998 at the Pathology Section, Cytopathology Unit of the Department of Oncological and Surgical Sciences of the University of Padova, we performed one hundred and twelve FNACs of adrenal masses under radiological guidance and seven intraoperative scrape smears; histological follow‐up was available in 55 cases. Immediate on‐site assessment of smears revealed a satisfactory adequacy rate (92%). With a simple diagnostic tree, we have been able to classify all smears except one as benign or malignant correctly, (accuracy 97.6%), differentiation of primary tumours from metastatic depositions remaining the most difficult task. In our experience FNAC is a safe and accurate tool in the diagnostic characterization of adrenal masses.
Cytological grading of breast cancer in Giemsa‐stained fine needle aspiration smears
Authors: Škrbínc B. , Bábic A. , Cúfer T. , Us‐Krášovec M.
Published: March 2003

Cytological grading of breast cancer in Giemsa‐stained fine needle aspiration smears

A potential cytological nuclear grading based on a semi‐quantitative evaluation of three basic nuclear features, size of cell nuclei, anisonucleosis and the proportion of nucleoli‐containing‐nuclei, was tested on 74 Giemsa‐stained fine needle aspiration of breast smears for its reliability in establishing the malignant potential of breast cancer. The prognostic impact of DNA‐ploidy and S‐phase fraction was also assessed. A good correlation between the three basic nuclear features, DNA‐ploidy, S‐phase fraction, cytological nuclear grade and histological grade, was shown. Using the cytological nuclear grade proposed, correct classification of cases between low histological grade (HG I) and high histological grade (HG II + HG III) was achieved in 79.73%. A statistically significant difference in 5‐year survival rate was also observed between low malignancy grade and high malignancy grade breast cancer patients, regardless of the grading method used. DNA‐ploidy and S‐phase fraction were not statistically significant in establishing the malignant potential of breast cancer.
Cytological diagnosis of soft tissue tumours
Authors: Bezabih M.
Published: March 2003

Cytological diagnosis of soft tissue tumours

The aims of this study were to determine the patterns of soft tissue tumours and also to try to assess the utility of fine needle aspiration cytology (FNAC) in diagnosing soft tissue tumours. Of 15 361 patients who visited the cytology diagnostic service of the Pathology Department, Medical Faculty, Addis Ababa University, 623 (4.1%) cases with a diagnosis of soft tissue tumours were retrieved from the department’s records for the years 1991–96. Fifty‐three soft tissue tumours (25 benign and 28 malignant tumours) with combined FNAC and surgical biopsy results were traced for cyto‐histological correlations. Twenty‐two out of 25 benign soft tissue tumours were correctly diagnosed, with three false cytologic diagnoses where one mesenchmal neoplasm, one haemangioma, and one haemorragic lesion were identified; and out of 28 malignant soft tissue, 23 were correctly diagnosed however, the five false cytological diagnoses were one soft tissue sarcoma, one dermatofibrosarcoma, one malignant mesenchymal neoplasm, one spindle cell neoplasm and one menechymal neoplasm. Thus, in this study a sensitivity and specificity of 88.5% and 81.5% respectively for the diagnosis of soft tissue tumours were reported. In conclusion, FNAC of soft tissue tumours is a fast, effective and reliable diagnostic tool that may help in categorizing soft tissue tumours into benign and malignant groups for clinical management.
Aspiration cytodiagnosis of the breast with abundant acellular calcific material indicative of soft tissue calcinosis (a study of 3 cases)
Authors: GUPTA RAJ K. , LALLU SHARDA , NARAN SARLA , FAUCK ROBERT , GASKELL DAVID
Published: March 2003

Aspiration cytodiagnosis of the breast with abundant acellular calcific material indicative of soft tissue calcinosis (a study of 3 cases)

Calcific deposits in soft tissue are rare and may clinically resemble a tumour. It seems feasible, therefore, to investigate them by the non‐invasive technique of fine needle aspiration cytology (FNAC). In this study three cases with extensive accumulation of acellular calcific material in the breast are described in which FNAC was indicative of soft tissue calcinosis. In all cases routine mammogram had shown a partially cystic opacity. All other investigations were normal and no significant family or medical history was present. Cytopreparations in all cases showed only abundant acellular calcium. The patients had no further treatment and on follow up were clinically well with no changes. The cases are interesting, since the cytohistological findings in the aspirate sample appeared to be strongly indicative of soft tissue calcinosis.
Liquid‐based cytology: is this the way forward for cervical screening?
Authors: MOSELEY R. P. , PAGET S.
Published: March 2003

Liquid‐based cytology: is this the way forward for cervical screening?

Liquid‐based cytology (LBC) is currently being marketed as an alternative methodology to replace the conventional PAP smear in cervical cytology. A substantial body of literature exists in support of LBC, some of which is at least partially sponsored by product manufacturers. The majority of published literature in support of LBC employs Bethesda reporting terminology. In this study we have analysed published raw data and presented this in NHSCSP terminology. Claims relating to sensitivity, specificity and smear adequacy have then been considered with reference to this data. Our analysis of existing data does not support the nationwide implementation of LBC at present. Further studies are recommended in order to evaluate the place of this technology within the NHSCSP.
Flow cytometric DNA analysis on fine needle aspiration biopsies of liver lesions
Authors: Granados Rosario , García‐vela Jose‐Antonio , Fenández‐Segoviano Pilar , Aramburu José‐Antonio , Martín Isaac , Murillo Nieves , Camarmo Encarnación , De la Cal Miguel Angel
Published: March 2003

Flow cytometric DNA analysis on fine needle aspiration biopsies of liver lesions

The DNA cell content of 39 fine needle aspiration biopsies (FNAs) from five benign liver lesions, nine hepatocellular carcinomas (HCCs), and 25 metastatic tumours was analysed in a prospective fashion by flow cytometry (FCM). All benign lesions were diploid. Aneuploidy was found in five (55.6%) HCCs and in nine (36%) metastatic tumours. DNA index (DI) differences were not significant. The S‐phase fraction (SPF) was higher in the malignant tumours, both combined (P < 0.02) and separated primary and metastatic (P < 0.05). We could not demonstrate an association between diploidy and percentage of benign hepatocytes in the smears of malignant tumours. The serum alpha‐fetoprotein (AFP) level did not correlate with ploidy, DI, or SPF in the HCCs. In conclusion, ploidy and DI do not discriminate between benign and malignant liver lesions, but the SPF is higher in malignant tumours. DNA analysis does not help to distinguish primary from metastatic liver tumours. The presence of benign hepatocytes in samples from malignant tumours does not seem to influence the analysis of ploidy by FCM.