bluuebunny/crossref_metadata_2025 huggingface dataset:
Initial Clinical Experience with a Miniature Biplane Transesophageal Echocardiography Probe in Adults
Authors: HOPKINS WILLIAM E. , FEINBERG MICHA S. , BARZILAI BENICO
Published: August 2007

Transesophageal echocardiography (TEE) is now routinely used in cardiovascular medicine. With improved technology the size of TEE probes has increased. Recently there has been interest in using smaller probes for adult TEE. We used a miniature 32‐element, phased array biplane probe in 20 consecutive adults who underwent clinically indicated TEE evaluation. The miniature biplane probe was easily inserted without complication in all patients including one with thrombocytopenia and one with an esophageal stricture. Subjectively the probe was easier to insert and better tolerated by patients than standard adult TEE probes. High quality images of near‐, mid‐, and far‐field structures were obtained in a majority of patients. Color Doppler identified mitral regurgitation in 12 (60%) patients, tricuspid regurgitation in ten (50%) patients, and aortic insufficiency in five (25%) patients. The miniature biplane TEE probe used in this study enhanced patient comfort without significant loss of image quality.

miniature biplane TEE probe
Atypical Aortic Dissection Diagnosed by Transesophageal Echocardiography
Authors: MEHTA RAJEN K. , NANDA NAVIN C. , ROYCHOUDHURY DEBASISH , KIM KEE‐SIK , OSMAN KHIDIR , PACIFICO ALBERT D.
Published: August 2007

This case report describes a patient in whom a thin dissection of the proximal aorta was diagnosed by transesophageal echocardiography. Dissection was not firmly diagnosed in our patient with computed tomography, angiography, or magnetic resonance imaging. A definitive diagnosis was made prospectively using intraoperative transesophageal echocardiography by demonstrating the presence of a thin immobile dissection flap located very close to the anterior aortic wall. Color Doppler examination showed absence of flow signals in the small false lumen, suggesting that it may be clotted. At surgery the presence of dissection involving the ascending aorta, as well as a clotted false lumen were confirmed. This finding demonstrates the utility of transeophageal echocardiography in the diagnosis of aortic dissection and the ability of this test to differentiate a thin dissection from intimal thickening. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
Quantification of Cardiac Jets:
Authors: GRIMES RANDALL Y. , BURLESON ARMELLE , LEVINE ROBERT A. , YOGANATHAN AJIT P.
Published: August 2007

Jet flows are consequences of many cardiac lesions. With the advent of color Doppler flow mapping, these jet flows can be visualized noninvasively. Currently, an intense effort is underway to quantify cardiac jet flows as a means to assess the severity of jet forming lesions. Two techniques, PISA and jet centerline decay, have been suggested as methods to quantify jet flow volume. Although both techniques are theoretically sound, both formulations are based on ideal flow conditions that may not be completely realized in cardiac chambers. Thus, the complex dynamics of cardiac jet flows must be considered as they may diminish the accuracy of flow rate calculations. However, realistic in vitro experiments that mimic the impact of cardiac flow conditions on converging flows and jets, combined with carefully controlled in vivo testing ofbothPISA and centerline techniques, may eventually produce clinically useful quantification formulations. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
Doppler Estimation of Pulmonary Artery Systolic Pressure Revisited
Authors: BATTLE ROBERT W. , TISCHLER MARC D.
Published: August 2007

Previous attempts at noninvasive estimation of pulmonary artery systolic pressure (PAS) were limited by the inability to identify adequate spectral signals of tricuspid regurgitation (TR) in a significant proportion of patients. Recently, image and color flow directed continuous‐wave Doppler have enabled spectral mapping of previously undetectable TR jets. Accordingly, 30 consecutive patients underwent two‐dimensional and continuous‐wave Doppler echocardiograms immediately before right heart catheterization. PAS was calculated as ∑ (4V2+ RA) where Vis the maximal velocity of the TR jet in ml sec and RA is right atrial pressure as estimated by the caval respiratory index. Twenty‐eight patients (93%) had detectable signals of TR. Directly measured PAS ranged from 21 to 95 mmHg (mean ± SD, 40 ± 18). Correlation between Doppler and catheter‐measured PAS was R‐sq = 0.93 with a standard error of the estimate of 4.7 mmHg. Accurate results were obtained over a wide range of pulmonary pressures. Thus, noninvasive determination of PAS is feasible in most patients including those with normal PAS, and correlates extremely well with direct measurements.
Can Pleural Effusions Cause Tamponade‐Like Effects?
Authors: KLOPFENSTEIN H. SIDNEY , WANN L. SAMUEL
Published: August 2007

Experimental studies have confirmed the clinical impression that large bilateral pleural effusions are able to raise the pressure in an otherwise hemodynamically insignificant pericardial effusion to a level sufficient to produce right ventricular diastolic collapse (RVDC). The hemodynamic consequences of this syndrome are not as severe as when the intrapericardial pressure is raised to the same level by excess intrapericardial fluid in the absence of pleural effusions. RVDC caused by excess pleural fluid with a minor pericardial effusion is a false positive indication for pericardial fluid drainage. Thoracentesis is more appropriate.
Doppler Echocardiography in Cardiac Tamponade and Constrictive Pericarditis
Authors: ZHANG SHAOWEN , KERINS DAVID M. , III BENJAMIN F. BYRD
Published: August 2007

Doppler echocardiography has greatly facilitated the assessment of patients with compressive cardiac disease. Patients in whom cardiac tamponade or pericardial constriction are suspected should undergo a complete echocardiographic examination including careful Doppler analysis of transmitral flow and inflow through the hepatic vein or superior vena cava (SVC). Monitoring of both the electrocardiogram and the phase of respiration are an integral part of this examination. Patients with cardiac tamponade exhibit a > 25% reduction in E wave velocity during the first inspiratory cardiac cycle; they exhibit predominant systolic inflow through the hepatic vein or SVC (with a predominant X descent with little or no Y descent). In constrictive pericarditis the pattern of transmitral flow variation is comparable to that observed in cardiac tamponade, however, a prominent Y descent is often observed on hepatic vein or SVC Doppler study. Similar changes with respiration may be observed in mitral inflow in obese patients or in those with chronic obstructive pulmonary disease, however, in these conditions the nadir of E wave velocity is observed 2–3 cardiac cycles after the first inspiratory beat. Restrictive cardiomyopathy may produce a similar systemic venous flow pattern, but increased inspiratory flow reversals and lack of respiratory variation in transmitral flow velocity distinguish it from constrictive pericarditis.
Echocardiographic Manifestations of Mediastinal Masses Compressing or Encroaching on the Heart
Authors: D'CRUZ IVAN A. , FEGHALI NASSIF , GROSS CHARLES M.
Published: August 2007

Because of its central position within the thorax, the heart can be encroached upon by masses originating in either anterior, posterior, or superior mediastinum. A distinction may be made between (A) Encroachment: distortion or partial displacement of one or more cardiac chambers by a contiguous mediastinal mass, without adverse hemodynamic effects, and (B) Compression: resulting in clinical manifestations similar to tamponade. Transthoracic and, recently, transesophageal echocardiography have been found useful in detecting mediastinal masses, the information obtained being complementary or preliminary to more complete imaging by CT or MRI. Anterior masses tend to compress the right heart chambers; posterior masses impinge on or compress the left atrium or ventricle, particularly the former. The wide variety of echographic appearances are briefly reviewed. Recently TEE has made it possible to diagnose masses obstructing the superior vena cava or pulmonary veins. A common, though little known, type of posterior mediastinal encroachment that echocardiographers need to be aware of is that of abnormal esophageal Igastric masses including hiatus hernia and esophageal carcinoma, which have typical two‐dimensional echo features and may sometimes simulate left atrial masses.
Perforation of the Right Ventricle After Endomyocardial Biopsy Detected by Color Flow Doppler Echocardiography
Authors: PETEIRO J. , CALVINO R. , VAZQUEZ N. , CASTRO A.
Published: August 2007

Right ventricular perforation after endomyocardial biopsy of a heart transplant patient was established by color flow Doppler echocardiography. Systolic filling and diastolic drainage of the pericardium were seen. Healing of the perforation occurred spontaneously with no Doppler signs of perforation 8 days later.
Coincidental Finding of Cor Triatriatum by Intraoperative Transesophageal Echocardiography in a Patient with Severe Mitral Regurgitation from Myxomatous Degeneration
Authors: FOLK THOMAS G. , KON NEIL D. , NOMEIR A.M. , KITZMAN DALANE W.
Published: August 2007

Cor triatriatum is a rare congenital cardiac anomaly consisting of a left atrial membrane dividing the atrium into proximal and distal chambers. The anomaly usually presents in childhood, but can present later in life, in which case it is often associated with mitral regurgitation. We report a patient in whom cor triatriatum was found coincidentally by intraoperative transesophageal echocardiography before surgery for severe mitral regurgitation. An interesting finding was preservation of antegrade systolic pulmonary vein flow by Doppler possibly due to shielding of the pulmonary veins from the regurgitant jet by the left atrial membrane.
Echocardiography in the Emergency Room
Authors: OH JAE K. , MELOY THOMAS D. , SEWARD JAMES B.
Published: August 2007

Echocardiography in the emergency room presents exciting practice possibilities that can facilitate prompt and reliable diagnostic evaluations in patients with suspected cardiovascular emergencies. Echocardiography has the diagnostic potentials to evaluate the entire spectrum of cardiovascular abnormalities short of delineating coronary anatomy and evaluation of the conduction system. By reliably assessing the global and regional function, visualizing the cardiovascular structures from multiple tomographic planes, and quantitating hemodynamic abnormalities, echocardiography should be able to assist emergency room physician's evaluation and triage of the patients with chest pain syndrome, unexplained dyspnea, hypotension, shock, chest trauma, and cardiac arrest, whereby hopefully minimizing the unnecessary admission to the hospital and facilitating inhospital evaluation of the admitted patients with echocardiographic information. However, the optimal echocardiography practice in the emergency room requires well trained sonongraphers and echocardiographers who can respond to the clinical needs at anytime. Whether an emergency room physician can perform and interpret echocardiographic examinations satisfactorily will depend on his/her level of training and continuing education in this area. Currently, there is no established guideline for performing echocardiography in the emergency room. Further clinical investigations are necessary to define the most optimal and economical utilization of this versatile imaging and hemodynamic diagnostic modality in the emergency room.
Cost‐Effectiveness of Echocardiography
Authors: WANN L. SAMUEL , PASSO THOMAS C.
Published: August 2007

Echocardiography is essential to the modern practice of cardiology. It is a robust, noninvasive technique, with proven effectiveness in the diagnosis of a multitude of cardiac disorders. However, the true costs of echocardiography and the charges, reimbursement, and collection rates, plus the over all economic value of echocardiography relative to other technical and cognitive services provided by cardiologists, are not so clearly understood or established. The purpose of this article is to provoke thought among echocardiographers about these economical issues.
Complete Echocardiographic Assessment of the Postoperative Fontan Patient
Authors: HAGLER DONALD J. , CORDES TIMOTHY M.
Published: August 2007

Postoperative echocardiographic assessment of the Fontan patient should include both anatomical and physiological parameters. Anatomical features to be defined with two‐dimensional (2‐D) imaging should include a detailed demonstration of the atriopulmonary connection, the pulmonary arterial tree, and the pulmonary venous return. Color flow imaging should be included to provide visual clues for abnormal flow patterns to suggest obstruction or residual shunts. Intracardiac thrombi, pericardial, and pleural effusions should be excluded. Inadequate transthoracic images should mandate the use of transesophageal imaging to adequately detail the extracardiac anatomy and connections. Physiological parameters should include M‐mode and 2‐D studies to assess ventricular systolic function and the degrees of ventricular hypertrophy. Additionally, extensive pulsed Doppler examination should be performed to determine the systemic venous, pulmonary arterial, pulmonary venous, and atrioventricular (AV) valve inflow patterns. Significant information detailing abnormalities of pulmonary artery flow and ventricular diastolic function parameters can be obtained. Doppler color flow imaging should be obtained to assess competency of AV and semilunar valves. Continuous‐wave Doppler should be utilized to determine the presence and severity of aortic outflow obstruction. Complete echocardiographic evaluation should include all facets of echocardiographic study as detailed previously.
Usefulness of Biplanar Transesophageal Echocardiography in Arrhythmogenic Right Ventricular Dysplasia
Authors: MONDUCCI IGOR , TOMASI CORRADO , BACCHI MIRKA , MENOZZI CARLO
Published: August 2007

This study evaluated the clinical usefulness of biplanar transesophageal echocardiography (TEE) in suspected arrhythmogenic right ventricular dysplasia (ARVD). Seven symptomatic subjects (3 male and 4 female: ages 18–64 years, mean 45) with clinical features of ARVD (typical ventricular arrhythmias) underwent comprehensive noninvasive assessment including transthoracic echocardiography (TTE), nuclear magnetic resonance (NMR), and TEE. Other systemic and cardiac diseases were reasonably excluded. TEE identified a significant right ventricular regional alteration in one subject with negative TTE and NMR, and nonsignificant abnormalities in two subjects with negative or no TTE and positive NMR. TEE confirmed the pathological findings detected by TTE in the four remaining patients and visualized several more abnormalities that approximately corresponded to NMR results. On the basis of these initial results, biplanar TEE appears to be comparable to NMR in the assessment of ARVD and a promising technique in identifying ARVD morphological alterations.
Aortic Dissection in Progress Diagnosed by Transthoracic Echocardiography
Authors: OBEID ANIS I.
Published: August 2007

This report describes a patient who presented with vague chest pain, syncope, and seizures. The diagnosis of dissection of the ascending aorta was clearly established by transthoracic echocardiography. The dissection was initially limited to the ascending aorta. Using the suprasternal window, it was possible to monitor the progression of the dissection almost beat by beat as it extended from the ascending aorta and across the aortic arch to the descending thoracic aorta. Surgical intervention was carried out immediately with successful results. Although transesophageal echocardiography is the procedure of choice in aortic dissection, definitive information can be obtained quickly and safely using the transthoracic approach. The suprasternal window in this case showed the dramatic progression of the disease process.
Double Orifice Mitral and Tricuspid Valves
Authors: GOLDBERG NIECA , SCHIFTER DAVID , ARON MICHELLE , SHAPIRO ROBERT S. , KRASNOW NORMAN , STEIN RICHARD A.
Published: August 2007

Atrioventricular valve duplication is a rare congenital cardiac anomaly. The anomaly is usually recognized as an incidental finding at autopsy, open heart surgery, or two‐dimensional echocardiography. In this article we present the transthoracic and transesophageal presentation of a case of mitral and a case of tricuspid valve duplication. The hemodynamic consideration of the lesions is discussed with a review of the literature.
Influence of Echocardiographic Guidance on Positioning of the Buttoned Occluder for Transcatheter Closure of Atrial Septal Defects
Authors: LLOYD THOMAS R. , VERMILION ROGER P. , ZAMORA ROLANDO , LUDOMIRSKY ACHI , BEEKMAN ROBERT H.
Published: August 2007

Ideal position of the buttoned device for occlusion of atrial septal defects was achieved more often with transesophageal than with transthoracic echocardiographic guidance (10/11 vs 7/23; P = 0.001). Patients with ideal device position were less likely to have residual shunts, device unbuttoning, or atrioventricular valve regurgitation (2/17 vs 11/17; P = 0.002). We therefore recommend the use of transesophageal echocardiography to guide implantation of the buttoned device.
Early Recurrence of Malignant Fibrous Histiocytoma of the Heart
Authors: BASRAN YELDA , DEGERTEKIN MUZAFFER , BALKANAY MEHMET , AKINCI ESAT , CELIKEL CIGDEM , DIZDAR HANDAN , TURAN FIKRET , YAKUT CEVAT
Published: August 2007

Malignant fibrous histiocytoma is a pleomorphic soft tissue sarcoma, which constitutes only 2% of all cardiac malignancies and is typically located in the left atrium. We report a young male patient with malignant fibrous histiocytoma located on the right side of the heart. Early recurrence was observed after extensive surgical resection to relieve symptoms of outflow tract obstruction. Noninvasive evaluation and management with regard to the literature are discussed.
Transesophageal Echocardiography in Thoracic Aortic Atherosclerosis
Authors: KRONZON ITZHAK , TUNICK PAUL A.
Published: August 2007

Transesophageal echocardiography opened a new window to the thoracic aorta and for the first time permitted in vivo imaging of aortic atherosclerotic disease. The technique is useful in assessing the extent of the disorder, its complications, and possible treatment modalities. It will also be useful in the assessment of the progression as well as the possible regression of the disorder with appropriate (dietary or chemical) therapy.
Severity of Aortic Regurgitation Assessed by Digital Image Processing of Doppler Spectral Recordings
Authors: TAK TAHIR , MATHEWS SAJEN , CHANDRARATNA P.A.N.
Published: August 2007

Visual estimates of the intensity of the regurgitant signal (RS) obtained by continuous‐wave (CW) Doppler has been used as an indicator of the severity of aortic regurgitation (AR). This study was designed to test this concept quantitatively using digital image processing methods. Twenty‐one patients with AR were studied, 14 of whom had concomitant mitral valve disease. Patients with aortic stenosis were excluded. By angiography, 10 patients had mild (grade 1 or 2), 5 had moderate (grade 3), and 6 severe (grade 4) AR. We digitized three well‐defined AR envelopes and calculated the mean pixel intensity (MPI) of the RS and the systolic flow signal (SFS) using an offline computer analysis system developed in our laboratory. To negate the effects of different gain settings, the ratio of RS to SFS (RS/SFS ratio) was compared to angiographic grade of AR. Thus, each patient served as his own control. The mean RS/SFS ratio was 0.54 ± 0.42 SD (range 0.46‐0.59) for mild AR, 0.76 ± 0.71 SD (range 0.65‐0.82) for moderate AR, and 0.84 ± 0.52 (range 0.77‐0.92) for severe AR. This RS/SFS ratio correlated well with angiographic severity of AR (r = 0.9). A ratio of > 0.6 identified patients with mild AR and < 0.6 correlated with moderate‐to‐severe. AR. We conclude that the ratio of the regurgitant to systolic flow CW Doppler signal is an accurate noninvasive indicator of AR severity.
Nonsurgical Repair of Femoral Artery Pseudoaneurysm with Color Flow Guided Ultrasound Transducer Compression
Authors: FENG YUN‐LING , TRUITT ROBERT E. , COGGINS TINA R. , GURA GEORGE M. , CONN ROBERT D. , GOOD THOMAS H.
Published: August 2007

Arterial pseudoaneurysm is a significant complication following invasive angiographic procedures. A definitive diagnosis is usually obtainable with ultrasound imaging, including color flow Doppler. Treatment modalities include surgical repair or transducer directed compression. In our experience, 26 of 29 patients (89.7%) with femoral artery pseudoaneurysm were successfully treated utilizing transducer directed compression. One pseudoaneurysm thrombosed spontaneously before the procedure was completed. No complications were encountered. Our experience suggests that surgical repair is not required for most femoral artery pseudoaneurysms.
Ultrasonic Tissue Characterization
Authors: SCHECTER STUART O. , TEICHHOLZ LOUIS E. , KLIG VICTOR , GOLDMAN MARTIN E.
Published: August 2007

The determination of myocardial perfusion and myocardial viability has prognostic and therapeutic implications, particularly in the current era of percutaneous transluminal coronary angioplasty and thrombolytic therapy. Several modes of investigation, including positron emission tomography, thallium‐201 scintigraphy, and nuclear magnetic resonance imaging are used to differentiate viable from nonviable myocardium. Though these noninvasive tests are useful diagnostic modalities, they are expensive, time consuming, and too cumbersome to be used in the acute setting. Expeditious distinction between viable and nonviable myocardium, during acute coronary syndromes, is of great importance since reperfusion can minimize the extent ofischemic injury and infarction. An expanding body of evidence confirms that ultrasonic tissue characterization has great potential to become a practical bedside diagnostic tool in the search for salvageable myocardium. Further clinical investigative studies would help accomplish a better understanding of the complex interaction between ultrasound and myocardium.
The Value of Aortic Valve and Aortic Arch Imaging in the Identification of Genetic Syndromes
Authors: LIN ANGELA E.
Published: August 2007

Echocardiographers imaging the aortic valve, root, and arch may observe coincidental extracardiac malformations, unusual facial features or body habitus, and/or mental or growth retardation. The pattern of anomalies may indicate a previously unrecognized genetic malformation syndrome. Echocardiographers also encounter genetic syndromes when clinicians specifically refer patients with certain syndromes for prospective detection of cardiac anomalies. Although aortic valve, root, and arch anomalies occur in a large number of syndromes, this article will focus on the most distinctive associations. In addition to discussing structural congenital cardiovascular malformations, aortic root dilation occurring in inherited disorders of connective tissue will be included.
Detection of Embolism with Doppler Ultrasound
Authors: SPENCER MERRILL P.
Published: August 2007

Doppler detection of venous and arterial gas emboli has been recognized since 1968. The technology has been applied using 5‐MHz ultrasound to study decompression sickness and monitor cardiopulmonary bypass and intracranial surgery. Since the advent of transcranial Doppler, which requires the use of lower ultrasonic carrier frequencies to penetrate the temporal bone, the detection of particulates moving in the bloodstream has been available. Using 2 MHz, microembolic signals have been detected in a variety of clinical situations, including cardiac conditions known to have high probabilities to produce embolic stroke. The basic features of a Doppler embolic signal have been clarified, and many investigators are applying the technology to determine the clinical significance of the detected emboli and their use in diagnosis and medical and surgical treatments. The basis for automatic sizing, counting, and characterizing the emboli is under development. The applications of Doppler detection of emboli will range from diagnosis and localization of embolic sources to improvement in surgical techniques and adjustments in medical treatments.
Microembolus Sizing in a Blood‐Mimicking Fluid Using a Novel Dual‐Frequency Pulsed Doppler
Authors: MOEHRING MARK A. , RITCEY JAMES A.
Published: August 2007

Sizing of emboli in a blood‐mimicking fluid is explored with the application of a theoretical description of emboli to embolic signatures obtained in a phantom flow loop. The theoretical predictions for the backscattered power versus embolus size are based on the embolus to blood power ratio (EBR) model. The experimental setup utilizes a customized ultrasound pulsed Doppler that is capable of interrogating a sample volume with two different frequencies concurrently. Polystyrene “emboli” having nominal diameters of 161 μm are placed in a specially constructed flow loop and scattering signatures are recorded. These signatures are investigated and the effect of beam refraction is discussed, which, combined with the EBR theory, yields a method to determine embolus size from an embolic signal. Embolus size determined experimentally is in close agreement with manufacturer's reported size.
The Contribution of the Left Atrioventricular Plane Displacement During Low Dose Dobutamine Stress Echocardiography in Predicting Recovery of Left Ventricular Dyssynergies
Authors: KRANIDIS ATHANASIOS , BOUKI TANIA , KOSTOPOULOS KONSTANTINOS , KAPPOS KOSTAS , SIDERIS ANTHONY , ANTONELLIS JOHN , KARDARAS FOTIS , MARGARIS NIKOS , LOLAS CHRISTOS , ANTHOPOULOS LAMBROS
Published: August 2007

The aim of this study was to assess the significance of the left systolic atrioventricular (AV) plane displacement during low dose dobutamine stress echocardiography (DSE), in predicting the recovery of left ventricular dyssynergies after revascularization. In 30 infarctiers with left ventricular dysfunction scheduled for RE (14 percutaneous transluminal coronary angioplasty and 16 coronary artery bypass graft) and in 25 age‐and sex‐matched healthy subjects, a DSE, using a 16 ventricular segment model and a four‐grade scoring system for the assessment of regional wall motion of the left ventricle was performed. Prior and during DSE, the left systolic AV plane displacement was recorded from the apical four‐and two‐chamber views, by M‐mode echo, at four left ventricular sites, corresponding to the septal, lateral, anterior, and inferior walls, both in patients and controls. The study was repeated in all patients 101 ± 14 days after successful revascularization. Healthy subjects showed a significant increase of left systolic AV plane displacement at all left ventricular sites during dobutamine infusion (DI) (P < 0.001). Patients also exhibited a significant maximum increase of left systolic AV plane displacement during DSE only in the dyssynergic sites with functional improvement in the postrevascularization echocardiogram (P < 0.001). In the remaining dyssynergic sites, without functional improvement after revascularization, the left systolic AV plane displacement did not change (P > 0.05). Selecting a maximum LAVPD increase of > 2 mm at any site of the left ventricule to predict recovery of the regional ventricular dyssynergies, results in a sensitivity of 91%, specificity of 83%, positive predictive value of 88%, and negative predictive value of 87%. When two‐dimensional DSE was used for the detection of reversible dysfunction, sensitivity and specificity were found to be 81.5% and 87.5%, respectively, while the positive and negative predictive values were 90% and 78%, respectively. When the two methods were in agreement the sensitivity was 90%, the specificity 100%, and the positive and negative predictive values were 100% and 84.2%, respectively. The assessment of left systolic AV plane displacement during DI constitutes a new, simple, and accurate method in the prediction of left ventricular dyssynergy recovery after revascularization. The combination of this method and two‐dimensional DSE are basic predictor markers of viability of dysfunctional myocardium.
Intravascular Ultrasound Catheter Evaluation of the Left Ventricle in Mice
Authors: GARDIN JULIUS M. , SIRI FRANCIS , KITSIS RICHARD N. , LEINWAND LESLIE
Published: August 2007

With the advent of transgenic technology, it has become increasingly important to find a method for evaluating left ventricular (LV) anatomy and function in intact wild type, intervened, and transgenic mice. Mice are 1/10th the size of rats, and have body masses of 10–60 g, LV masses of 40–150 mg, LV wall thicknesses of 0.5–2 mm, and LV internal dimensions of 1–3 mm. Although the murine LV has been imaged by transthoracic (TTE) two‐dimensional directed M‐mode echocardiography, we explored the use of intravascular ultrasound (IVUS) catheters, with imaging from various positions, to see if better two‐dimensional images of the LV could be obtained by IVUS than TTE. Eight normal mice were anesthetized using pentobarbital or avertin. The mice were studied using a commercially available IVUS system (Endosonics, Inc.). Two IVUS catheters (3.5 and 5.0 Fr) with 20‐MHz multielement array transducers were used. Each catheter had a 4.0‐mm imaging depth of field in all directions (360°) from the mid‐point of the catheter core. Multiple imaging approaches were attempted: transesophageal (TEE); transjugular (TJ); transperitoneal (TP); and open chest, from both epicardial surface (Ep) and via direct LV puncture. TEE and TJ approaches afforded insufficient depth of field to image the entire LV in cross section. TP and Ep approaches resulted in poor images, related both to inadequate depth of field and to relatively small sector angles subtended by imaging elements. LVP (intracavitary imaging) was capable of satisfactorily imaging the LV epicardium, but was unable to image the endocardium, probably because the latter was within the 1.9‐mm “ringdown” catheter artifact. All IVUS approach studies lacked sufficient temporal resolution (10 frames/sec) to reliably display systolic and diastolic frames necessary for evaluation of LV function. In contrast, as previously reported, transthoracic two‐dimensionally directed M‐mode echocardiograms have sufficient temporal and spatial resolution to permit accurate estimates of LV mass and systolic function. Currently, IVUS catheter‐based approaches are not feasible for imaging murine LV anatomy and function. Limitations include: (1) inadequate temporal resolution might be improved by ECG gating; (2) limited depth of field possibly resolvable by lower frequency transducers; and (3) relatively large catheter size.
Color Doppler Transesophageal Echocardiography in Detection of Massive Pulmonary Embolism
Authors: NESKOVIC ALEKSANDAR N. , POPOVIC ALEKSANDAR D. , BABIC RADE , OTASEVIC PETAR , BOJIC MILOVAN
Published: August 2007

In this article, the potential value of color Doppler in improving diagnostic accuracy of transesophageal echocardiography (TEE) in patients with incomplete obstruction of large pulmonary vessels is illustrated, We present an unusual case of massive pulmonary embolism that was unequivocally detected by color Doppler TEE both before and after pulmonary angiography, which failed to demonstrate filling defects in the pulmonary artery.
Color Doppler Visualization of Intramyocardial Coronary Arteries Using a New Echo System
Authors: RIO CARLOS GARCIA DEL , TAYLOR GREGG W. , NANDA NAVIN C. , AGRAWAL DIPAK I. , AGRAWAL GOPAL G. , CARVALHO CLAUDIA , ESPINAL MIGUEL , BECHER HARALD
Published: August 2007

Utilizing a new echocardiographic system, intramyocardial coronary arteries could be demonstrated by color Doppler in a small number of open chest animals. Both intravenous and intracoronary injections of a contrast agent (Levovist) resulted in significant enhancement of color flow signals with an increase in the length, width, and the number of these vessels. Similar results were obtained with intravenous infusion and direct intracoronary injections of a vasodilator (adenosine).
Pediatric Transesophageal Echocardiography by Means of a Miniature 5‐MHz Multiplane Transducer
Authors: CROMME‐DIJKHUIS ADRI H. , DJOA KIE K. , BOM NICOLAAS , HESS JOHN
Published: August 2007

The development of a miniature multiplane transesophageal echocardiographic (TEE) transducer for pediatric use is the latest development in TEE. Horizontal, longitudinal, and all possible intermediate oblique planes can be obtained with minimal transducer manipulation. We studied 48 patients with an experimental 5‐MHz transducer, which contains 48 transmitting elements. The dimensions of the tip are 27 × 10.6 × 7.9 mm. Patients ages ranged from 2 days to 16 years, their weights from 3.6–67 kg. Multiplane TEE proved to be complementary to the single horizontal plane in assessing the right ventricular outflow tract, the left ventricular outflow tract, ascending aorta, the atrial septum, the atrioventricular (AV) valves, especially in AV septal defects, and double inlet left ventricle (DILV). Moreover, multiplane TEE was extremely helpful in judging the outflow tracts and ventricular septal defects in more complex heart defects such as DILV, double outlet right ventricle, and hearts with discordant connections. Multiplane TEE offered superb monitoring of cardiac interventions. We conclude that multiplane TEE provides new imaging planes and enables visualization of every major structure of the heart by unlimited scan planes. Multiplane TEE is indispensable in congenital heart defects. Thus, multiplane TEE adds to diagnostic assurance and enhances decision making for surgery.
Mast cells in vulnerable atherosclerotic plaques – a view to a kill
Authors: Lindstedt Ken A. , Mäyränpää Mikko I. , Kovanen Petri T.
Published: August 2007

Mast cells – an introduction

Mast cell – a potent effector cell

Mast cells and atherosclerosis

Coronary mast cells in acute human myocardial infarction

Animal models of plaque erosion and rupture

Clinical approaches to stabilize mast cells in the atherosclerotic plaque

Conclusions

The aim of the present review is to discuss the participation of mast cells in the pathogenesis of erosion and rupture of atherosclerotic plaques, the major causes behind acute coronary syndromes and myocardial infarction. We present ex vivo observations describing mast cells and their activation in human atherosclerotic plaques and discuss in vitro and in vivo data showing that mast cells are potential regulators of inflammation, immunity and adverse remodeling, including matrix remodeling and cell death. Furthermore, we focus on studies that have been performed with human tissues and human mast cells, but when appropriate, we also discuss observations made in animal models. Finally, we present potential pharmacological means to modulate mast cell responses in the arterial vessel walls.
Zonula occludens‐1 and connexin 43 expression in the failing human heart
Authors: Kostin Sawa
Published: August 2007

Focal disorganization of gap junctional distribution and down‐regulation of the major gap junctional protein connexin 43 are typical features of myocardial remodelling in the failing human heart. Increasing evidence indicates that connexin 43 interacts with zonula‐occludens‐1 (ZO‐1), and it has recently been shown that ZO‐1 promotes the formation and growth of gap junctional plaques. In the present study, distribution patterns of ZO‐1 and connexin 43 were studied in normal and in heart failure patients using double‐label immunohistochemistry and confocal microscopy. ZO‐1 was found to be co‐localized with connexin 43 at intercalated disks. Importantly, in patients with heart failure due to dilated or ischaemic cardimyopathy, areas of diminished connexin 43 expression were characterized by a markedly reduced ZO‐1 staining. Based on these data it is concluded that in patients with heart failure, down‐regulation of ZO‐1 matches the diminished expression levels of connexin 43, suggesting that ZO‐1 plays an important role in gap junction formation and gap junction plaque stability.
Endothelial stomatal and fenestral diaphragms in normal vessels and angiogenesis
Authors: Stan R.V.
Published: August 2007

Introduction

Endothelial phenotypes—morphology

Structure of endothelial stomatal and fenestral diaphragms in normal endothelium

Structures present in the endothelium in neovascularization

Components of the stomatal and fenestral diaphragms

Working model of pv1 integration in the structure of the diaphragms

PV1 and the endothelial diaphragms in ontogeny

Regulation of endothelial specific structures

Function of endothelial diaphragms in normal vessels and angiogenesis

Conclusions

Vascular endothelium lines the entire cardiovascular system where performs a series of vital functions including the control of microvascular permeability, coagulation inflammation, vascular tone as well as the formation of new vessels via vasculogenesis and angiogenesis in normal and disease states. Normal endothelium consists of heterogeneous populations of cells differentiated according to the vascular bed and segment of the vascular tree where they occur. One of the cardinal features is the expression of specific subcellular structures such as plas‐malemmal vesicles or caveolae, transendothelial channels, vesiculo‐vacuolar organelles, endothelial pockets and fenestrae, whose presence define several endothelial morphological types. A less explored observation is the differential expression of such structures in diverse settings of angiogenesis. This review will focus on the latest developments on the components, structure and function of these specific endothelial structures in normal endothelium as well as in diverse settings of angiogenesis.
FORMATION OF CRYSTALS IN THE SPINAL FLUID
Authors: HENRIKSEN ZWINER
Published: August 2007

The formation of crystals by the dehydration of the spinal fluid is in close correlation with its chemical composition which, in the normal spinal fluid, is very constant; seen in comparison with the electrolytes its content of organic ingredients is poor. Very favourable conditions are accordingly present for the formation of crystals by dehydration of the fluid, and it was therefore to be expected that the crystals found would give pictures of diagnostic value.

If the solution of electrolytes is mixed with pathologic colloid substances, the crystal aggregates become very complicated.
SEX STEROID THERAPY IN PSYCHIATRIC DISORDERS
Authors: Sackler Mortimer D. , Sackler Raymond R. , Sackler Arthur M. , Tui Co , Van Ophuijsen, M.D. Johan H. W.
Published: August 2007

The authors gratefully acknowledge the critical review of the manuscript by Dr. H. A. LaBurt, Senior Director, Creedmoor State Hospital, and Dr. Marvin Weinberg, and the co‐operation of Dr. Jack Moore, Pathologist, and Dr. Felix Marti‐Ibanez. The data for this paper were collected on hospitalized psychotic patients at Creedmoor State Hospital. The psychological material was surveyed by Miriam Siegel, Ph.D., of the van Ophuijsen Center. Appreciation is expressed to David Greenberg, who supervised the laboratory procedures, and to members of the staff, particularly Miss Laura Hicks, Mrs. Grace Brue, Mrs. Ann Nicoll, R.N., Miss Imie Lane and Mrs. Florence Levin for their earnest co‐operation. The expenses were defrayed by a grant from the Sackler Foundation.
PRESENILE DEMENTIA (Alzheimer's & Pick's diseases)
Authors: Eitinger Avdelingslege L.
Published: August 2007

Some clinical observations concerning the importance of the premorbid personality, releasing factors and the patients’personal experience of the existing deterioration process on the formation of the symptoms
A RATING SCALE FOR EXTRAPYRAMIDAL SIDE EFFECTS
Authors: SIMPSON G. M. , B. M. , B. GH. , ANGUS J. W. S. , P. F. R. C. , M. D. P.
Published: August 2007

A modification of an earlier rating scale for extrapyramidal system disturbance is described, and evidence for the validity and reliability of the scale is presented. The usefulness of the scale in studies of neuroleptic drugs is discussed. By its application it is possible to quantify extrapyramidal side effects and to separate them into four principal factors.
BOOKS
Authors: Nimb Mogens , Bonde G. J. , Schiødt E. , Poulsen Henning , Reske‐Nielsen Edith
Published: August 2007

WHO Expert Committee on Drug Dependence: Eighteenth Report. World Health Organization Technical Report Series 1970

Measurements of man at work. An appraisal of physiological and psychological criteria in man‐machine systems. Proceedings of a symposium held in Amsterdam in 1969. Edited by Singleton

Pletscher, A., & A. Marino (eds.): Psychotropic Drugs in Internal Medicine. The Theoretic, Experimental and Clinical Bases for a Rational Application of Psychopharmacotherapy in Internal Diseases. International Congress Series

Schwarz, B., K. Weise & A. Thom: Sozialpsychiatrie in der sozialistischen Gesellschaft.

W. J. C. Verhaart: Studies in Neuro‐Anatomy No. 8: Comparative Anatomical Aspects of the Mammalian Brain Stem and the Cord.
A STUDY OF DIAGNOSTIC DIFFERENCES OF SOME FUNCTIONAL PSYCHOSES BY MEANS OF SELF‐REPORT TECHNIQUE AND BEHAVIOUR RATING WITH AN EXAMINATION OF PUNITIVENESS AS A VARIABLE IN THE PSYCHOTIC DISORDERS
Authors: Verma R. M.
Published: August 2007

Eighty‐eight psychotic patients of both sexes were studied in order to examine the relationship between the symptom‐complexes assessed on the Inpatient Multidimensional Psychiatric Scale and the diagnostic classifications estimated by means of the Symptom‐Sign Inventory. The results show some significant associations between the two assessments, but these associations do not present a differential picture for the different psychotic disorders. Further, a factor‐analytic treatment of the correlations between various symptom‐complexes and hostility assessments from the Hostility and Direction of Hostility Questionnaire yields five interpretable factors which can describe some of the functional psychotic disorders.
REINSTATEMENT OF SPEECH IN MUTE SCHIZOPHRENICS BY OPERANT CONDITIONING
Authors: Cliffe M. J.
Published: August 2007

Student nurses trained in the use of operant shaping and positive reinforcement of imitative behaviour attempted to reinstate speech in 13 schizophrenics who had been mute from 11 to 42 years. Six of the 13 subjects showed improved speech after 15 sessions. Speech improvement was significantly greater under contingent reinforcement conditions than in a control condition using non‐contingent reinforcement. Five of the six improved subjects had substantially retained their reacquisition of speech at 1‐year follow‐up. There was no evidence that age or duration of mutism influenced treatment outcome.
DEAFNESS AND MENTAL HEALTH: PSYCHIATRIC AND PSYCHOSOMATIC ILLNESS IN THE DEAF
Authors: Mahapatra S. B.
Published: August 2007

The prevalence of psychiatric and psychosomatic diseases amongst patients who had become deaf in adolescence or in adult life due to otosclerosis was studied. This was to test the hypothesis that the deaf would be more susceptible to suffer from psychiatric disorders than control subjects. Assessment of 49 deaf patients who had a bilateral hearing loss of 40 dB or more and 40 control subjects who had a unilateral hearing loss of 40 dB or more by the Cornell Index N2 Questionnaire and psychiatric interview showed psychiatric illness to be significantly more common in the deaf than in the control subjects. Amongst the deaf patients, depressive illness was found to be the predominant type of psychiatric illness. There was, however, no significant difference in the prevalence of psychosomatic disorders between the two groups.

The relationship of psychiatric illness in the deaf and such factors as positive psychiatric family history, the severity of deafness, living alone, duration of deafness were investigated. On the basis of the findings of this study, the significance of deafness as a psychological precipitant is discussed.
URINARY SCREENING FOR DRUGS IN A HOSPITAL FOR THE MENTALLY SUBNORMAL
Authors: Ballinger B. R. , Simpson E. , Stewart M. J.
Published: August 2007

Urine specimens were collected from 117 patients in a mental subnormality hospital and tested for various psychotropic drugs and anticonvulsants. In 12 individuals, prescribed drugs were not detected and in three individuals non‐prescribed drugs were detected. Various characteristics of the patients are described and possible reasons for these discrepancies are discussed.
PSYCHIATRIC EMERGENCY SERVICE
Authors: Ideström C.‐M.
Published: August 2007

The psychiatric emergency service of the Karolinska Hospital is the only facility of this kind for an urban‐suburban population of 150,000 people. The policies and procedures of the emergency ward as well as its staff and background facilities are described. During the years 1967 to 1970, 20,567 consultations were made, and 4,557 of these patients were admitted to the ward. The patients were studied with respect to sex, age versus marital status, psychiatric diagnosis versus reason for admission, days in the ward and marital status.
A CASE OF THE CAPGRAS SYNDROME IN ASSOCIATION WITH PSEUDO‐HYPOPARATHYROIDISM
Authors: Hay G. G. , Jolley D. J. , Jones R. G.
Published: August 2007

Two brief episodes of psychosis in a patient with pseudo‐hypoparathyroid syndrome are described. The psychotic phenomena occurred in clear consciousness and were schizophrenia‐like and included the Capgras symptom. Both episodes followed a course of electro‐convulsive treatment given for depressive symptoms, and electroencephalograph recordings showed evidence of reduced stability. The content of these psychotic episodes, especially the Capgras symptom, was understandable in view of the patient's restricted social situation. It is suggested that the effect of electro‐convulsive treatment acting on a previously abnormal central nervous system, was sufficient to produce these schizophrenia‐like psychosyndromes.
MAINTENANCE TREATMENT OF CHRONIC SCHIZOPHRENIA WITH NEUROLEPTIC DRUGS
Authors: Morgan R. , Cheadle J.
Published: August 2007

The difficulties for the short‐stay doctor of managing the drug treatment of long‐stay schizophrenic patients are discussed. Some principles to follow are suggested. The results of following these principles for 7 years are analysed. Only 74 out of a population of 475 chronic schizophrenics had been considered suitable for trial without drugs. Only five of these still remained off drugs. The relapses of the other 69 patients occurred after an average of about 4 1/2 months. Possible reasons for the widely different results of drug withdrawl trials are suggested.