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Biomedical subjects

A Obeid

Publications and source records attributed to A Obeid.

15 recordsLinked to original sources

Mild thickening of the aortic wall: subtle intramural hematoma?

UNLABELLED: Recently published criteria for the diagnosis of intramural hematoma (IMH) of the ascending aorta by transesophageal echocardiogram (TEE) include the presence of a crescent-shaped thickening of the aortic wall of more than 7 mm with an echolucent space. We report a patient whose clinical presentation suggested aortic dissection but whose TEE failed to meet the conventional criteria for such a diagnosis. TEE showed a uniform intimal thickening suspicious of IMH but less than 7 mm in thickness and with no echofree space. One week later, the patient developed frank aortic dissection. CONCLUSION: IMH can present with a subtle echo appearance. The diagnosis should not be totally discounted in the absence of a 7-mm crescentic wall thickness and an echofree space if the clinical presentation is suggestive of dissection.

Aged↗

Microregional blood flow in murine and human tumours assessed using laser Doppler microprobes.

A multichannel laser Doppler system has been used to measure microregional fluctuations in perfusion in the HT29 human tumour xenograft and in patients with advanced malignant disease. A comparison is made with previously obtained data for the SaF, a transplantable murine tumour. The 300 microns diameter probes recorded fluctuations in erythrocyte flux in tumour microregions with an estimated volume of 10(-2) mm3. Of the 66 human tumour microregions sampled, 26% showed a change in erythrocyte flux by a factor of 2 or more over the 60 min measurement period, compared with 37% of HT29 and 48% of SaF microregions. In each of the studies more than 50% of changes were completed within 20 min, although slower changes were more common in the human tumours than in the experimental systems. Within the 1 h monitoring period at least 30% of the changes were reversed (human tumours 30%, HT29 45%, SaF 31%). These findings demonstrate that microregional changes in erythrocyte flux, consistent with transient, perfusion-driven changes in oxygenation, are a feature of human malignancies as well as experimental transplanted tumours.

Aged↗

Labetalol vs. methyldopa in the treatment of pregnancy-induced hypertension.

OBJECTIVE: To assess the efficacy and safety of labetalol compared with methyldopa in the management of mild and moderate cases of pregnancy-induced hypertension (PIH). METHODS: One hundred four primigravidas with PIH were randomly allocated to receive either labetalol (group A) or methyldopa (group B). The dose of the drugs was doubled every 48 h to maintain a mean arterial blood pressure < or = 103.6 mmHg. Clinico-biochemical effects and frequency of side effects were studied. The statistical level of significance was taken at P < 0.05. RESULTS: Ten patients in group B (18.5%) developed significant proteinuria (> 30 mg/dl) whereas none developed proteinuria in group A. Labetalol was quicker and more efficient at controlling blood pressure, having a beneficial effect on renal functions and causing fewer side effects compared with methyldopa. The rate of induction of labor and rate of cesarean section for uncontrolled PIH was less in group A (48% and 1%, respectively) compared with group B (63.0% and 5.6%, respectively). Moreover a higher Bishop score at induction of labor was noticed in group A. CONCLUSIONS: Labetalol is better tolerated than methyldopa, gives more efficient control of blood pressure and may have a ripening effect on the uterine cervix.

Adult↗

Echocardiographic diagnosis and surgical treatment of postpartum pulmonary embolism.

Pulmonary embolism remains a problem in the United States in terms of both morbidity and mortality. New diagnostic modalities to make rapid diagnosis are now available, and allow for bedside diagnosis of pulmonary embolism without the use of pulmonary angiography. As a reference, a case involving a postpartum patient is reviewed. Use of echocardiography, a device readily available even in small institutions, allowed for early diagnosis and institution of therapy in this particular case and in others. Diagnostic features of pulmonary embolism are discussed and the literature is reviewed.

Abdomen↗

Intravenous leiomyomatosis: a rare cause of right sided cardiac obstruction.

Intravenous leiomyomatosis involving the right side of the heart is an unusual cause of outflow obstruction. Evaluation of the patient should be directed not only at intracardiac chambers but also at the inferior vena cava. This should include angiography and MRI or CAT scanning. Echocardiography is an important contributory investigation. Surgical therapy should be directed at complete removal of the tumor as recurrence has been reported if a less than complete resection has been performed. Hormonal manipulation has been attempted with variable results.

Cineangiography↗

Laser Doppler velocimetry: the problem of fibre movement artefact.

The problem of fibre movement artefact in laser Doppler velocimetry recordings of skin blood flow has been investigated. Beat frequency spectra were obtained for a stationary target, unheated skin, heated skin (43.5 degrees C), with and without blood flow occluded for various induced amounts of fibre movement. Possible methods for either eliminating, or obtaining an indicator of, fibre movement artefact were considered. The solution proposed is to incorporate additional fibres terminating within the transducer to permit an index of fibre movement to be obtained that is independent of blood flow.

Adult↗

Systemic and pulmonary hemodynamic effects of saralasin infusion in hypertension. Predictability of plasma renin status from hemodynamic changes.

Hemodynamic measurements were obtained before and after 30 minutes of saralasin infusion in 26 fasting adults with hypertension (25 men and 1 woman). Nine showed a depressor response with a decrease in mean intaarterial pressure greater than 20 mm Hg. Ten were nonresponders and seven had an agonistic response with an increase in mean arterial pressure of greater than 10 mm Hg. Heart rate, pulmonary arterial and wedge pressures and pulmonary vascular resistance were nearly identical in the three groups and remained unchanged. Cardiac index decreased from a mean of 2.76 +/- 0.14 (standard error of the mean) to 2.48 +/- 0.1 liters/min per m2 in the nonresponders (P less than 0.02) but remained unchanged in the groups with a depressor or an agonistic response. The mean systemic vascular resistance decreased from 2,406 +/- 303 to 1,839 +/- 265 dynes sec/cm5 in the group with a depressor response (P less than 0.001) and increased in nonresponders (less than 0.02) and those with an agonistic response (P less than 0.01). However, regardless of the response of mean arterial pressure, systemic vascular resistance decreased only in the 10 patients with a plasma renin activity greater than 5 ng/ml per hour (8 from the depressor response group and 1 each from the nonresponse and agonistic response groups). It is concluded that (1) classification based soley on the response of aterial pressure to saralasin ignores important hemodynamic changes; (2) the response of cardiac index--no change in the patients with a depressor response and a reduction in nonresponders--suggests that endogenous angiotension II supports cardiac output in these groups; (3) a decrease in systemic vascular resistance is better than a decrease in mean arteiral pressure as a predictor of the status of the plasma renin activity; and (4) lack of change in pulmonary vascular resistance suggests that endogenous angiotension II plays an insignificant role in maintaining the resistance of the pulmonary vasculature.

Adult↗

Marketing a health visiting service.

This year's RCN Congress will debate the importance of retaining health visiting as a service available to all. On the basis of her analysis of recent professional and political events, this author predicts the likely capacity of health visiting to market its universal approach to population health.

Community Health Nursing↗