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J P Roux

Publications and source records attributed to J P Roux.

At least 19 recordsLinked to original sources
PubMed2006

Contribution of the advanced glycation end product pentosidine and of maturation of type I collagen to compressive biomechanical properties of human lumbar vertebrae.

Collagen characteristics contribute to bone biomechanical properties. Yet, few studies have analyzed the independent contributions of bone mineral density (BMD) and post-translational modifications of type I collagen to whole bone strength. Thus, the aim of this study was to determine the relative contributions of BMD and both enzymatic and non-enzymatic collagen crosslink concentration to the biomechanical properties of human vertebrae. Nineteen L3 vertebrae were collected after necropsy (age 26-93; 10 males, 9 females). BMD of the vertebral body was measured by DXA, and the vertebrae were compressed to failure to assess the stiffness, failure load and work to fracture. After mechanical testing, the concentration of both enzymatic crosslinks pyridinoline (PYD), and deoxypyridinoline (DPD) as well as, and the non-enzymatic crosslinks pentosidine (PEN) were analyzed in trabecular and cortical bone by reversed-phase HPLC. The extent of aspartic acid isomerization of type I collagen C telopeptide (CTX) was evaluated by ELISA of native (alpha CTX) and isomerized (beta CTX) forms. BMD was significantly positively related with stiffness (R(2) = 0.74; P < 0.0001), failure load (R(2) = 0.69; P < 0.0001) and work to fracture (R(2) = 0.44; P = 0.002). Bivariate regression analysis showed no association between collagen traits and biomechanical properties. However, in a multiple regression model, BMD and trabecular PEN were both significantly associated with failure load and work to fracture (multiple R(2) = 0.83, P = 0.001 and R(2) = 0.67, P = 0.001, respectively). Similarly, BMD and trabecular alpha/beta CTX ratio were both associated with stiffness (multiple R(2) = 0.83, P = 0.015). These findings indicate that post-translational modifications of type I collagen have an impact on skeletal fragility.

Absorptiometry, Photon↗
PubMed2005

Relationship between compressive properties of human os calcis cancellous bone and microarchitecture assessed from 2D and 3D synchrotron microtomography.

The aim of this study was to determine the contribution of 2D and 3D microarchitectural characteristics in the assessment of the mechanical strength of os calcis cancellous bone. A sample of cancellous bone was removed in a medio-lateral direction from the posterior body of calcaneus, taken at autopsy in 17 subjects aged 61-91 years. The sample was first used for the assessment of morphological parameters from 2D morphometry and 3D synchrotron microtomography (microCT) (spatial resolution=10 microm). The 2D morphometry was obtained from three slices extracted from the 3D microCT images. Very good concordance was shown between 3D microCT slices and the corresponding physical histologic slices. In 2D, the standard histomorphometric parameters, fractal dimension, mean intercept length, and connectivity were computed. In 3D, histomorphometric parameters were computed using both the 3D mean intercept length method and model-independent techniques. The 3D fractal dimension and the 3D connectivity, assessed by Euler density, were also evaluated. The cubic samples were subjected to elastic compressive tests in three orthogonal directions (X, Y, Z) close to the main natural trabecular network directions. A test was performed until collapse of trabecular network in the main direction (Z). The mechanical properties were significantly correlated to most morphological parameters resulting from 2D and 3D analysis. In 2D, the correlation between the mechanical strength and bone volume/tissue volume was not significantly improved by adding structural parameters or connectivity parameter (nodes number/tissue volume). In 3D, one architectural parameter (the trabecular thickness, Tb.Th) permitted to improve the estimation of the compressive strength from the bone volume/tissue volume alone. However, this improvement was minor since the correlation with the BV/TV alone was high (r=0.96). In conclusion, which is in agreement with the statistic's rules, we found, in this study, that the determination of the os calcis bone compressive strength using the 3D bone volume fraction cannot be improved by adding 3D architectural parameters.

Aged↗
PubMed2001

Temporal covariance analysis of first-pass contrast-enhanced myocardial magnetic resonance images.

In this paper a temporal covariance method designed to analyze a Magnetic resonance (MR) image sequence of myocardial perfusion is presented. This method is used to map the first-pass transit of a contrast agent (Gd-chelates) through the heart. A map of bolus transit delay is constructed pixel by pixel corresponding to a myocardial reference using a temporal covariance measure. The resulting covariance map is a parametric image representing regions with different temporal dynamics. The proposed method is evaluated in 14 patients with coronary artery disease and eight healthy volunteers. Under rest and stress, covariance method is able to reveal a perfusion defect in stenosed coronary-artery-related myocardium. Furthermore, the method presents the advantage of its easy implementation and real-time parametric map construction.

Analysis of Variance↗
PubMed2001

Genetic analysis reveals different functions for the products of the thyroid hormone receptor alpha locus.

Thyroid hormone receptors are encoded by the TRalpha (NR1A1) and TRbeta (NR1A2) loci. These genes are transcribed into multiple variants whose functions are unclear. Analysis by gene inactivation in mice has provided new insights into the functional complexity of these products. Different strategies designed to modify the TRalpha locus have led to strikingly different phenotypes. In order to analyze the molecular basis for these alterations, we generated mice devoid of all known isoforms produced from the TRalpha locus (TRalpha(0/0)). These mice are viable and exhibit reduced linear growth, bone maturation delay, moderate hypothermia, and reduced thickness of the intestinal mucosa. Compounding TRalpha(0) and TRbeta(-) mutations produces viable TRalpha(0/0)beta(-/-) mice, which display a more severe linear growth reduction and a more profound hypothermia as well as impaired hearing. A striking phenotypic difference is observed between TRalpha(0/0) and the previously described TRalpha(-/-) mice, which retain truncated TRDeltaalpha isoforms arising from a newly described promoter in intron 7. The lethality and severe impairment of the intestinal maturation in TRalpha(-/-) mice are rescued in TRalpha(0/0) animals. We demonstrate that the TRDeltaalpha protein isoforms, which are natural products of the TRalpha locus, are the key determinants of these phenotypical differences. These data reveal the functional importance of the non-T3-binding variants encoded by the TRalpha locus in vertebrate postnatal development and homeostasis.

Animals↗
PubMed2001

Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis.

Long-term treatment with glucocorticoids (GCs) leads to a rapid bone loss and to a greater risk of fractures. To evaluate the specific effects of this treatment on cancellous bone remodeling, structure, and microarchitecture, we compared 22 transiliac biopsy specimens taken in postmenopausal women (65 +/- 6 years) receiving GCs (> or = 7.5 mg/day, for at least 6 months) and 22 biopsy specimens taken in age-matched women with postmenopausal osteoporosis (PMOP), all untreated and having either at least one vertebral fracture or a T score < -2.5 SD. On these biopsy specimens, we measured static and dynamic parameters reflecting trabecular bone formation and resorption. Also, we performed the strut analysis and evaluated the trabecular bone pattern factor (TBPf), Euler number/tissue volume (E/TV), interconnectivity index (ICI), and marrow star volume (MaSV). Glucocorticoid-induced osteoporosis (GIOP), when compared with PMOP, was characterized by lower bone volume (BV/TV), trabecular thickness (Tb.Th), wall thickness (W.Th), osteoid thickness (O.Th), bone formation rate/bone surface (BFR/BS), adjusted mineral apposition rate/bone surface (Aj.AR/BS), and higher ICI and resorption parameters. After adjustment for BV/TV, the W.Th remained significantly lower in GIOP (p < 0.0001). The active formation period [FP(a+)] was not different. Patients with GIOP were divided into two groups: high cumulative dose GCs (HGCs; 23.7 +/- 9.7 g) and low cumulative dose GCs (LGCs; 2.7 +/- 1.2 g). HGC when compared with LGC was characterized by lower W.Th (p < 0.05), BV/TV (p < 0.001), Tb.Th (p < 0.05), trabecular number (Tb.N; p < 0.05), FP(a+)(p < 0.05), and nodes (p < 0.05), and higher E/TV (p < 0.05), ICI (p < 0.005), and TBPf (p < 0.05). When HGC was compared with PMOP, the results were similar except for the MaSV, which was significantly higher (p < 0.005). In summary, GIOP was characterized by lower formation and higher resorption than in PMOP, already present after LGC. With HGCs, these changes were associated with a more dramatic bone loss caused by a major loss of trabecular connectivity.

Aged↗
PubMed2001

[Progressive limb lengthening with a centromedullary nail versus an external fixator: experimental study in sheep].

PURPOSE OF THE STUDY: Progressive limb lengthening with an external fixator often leads to pin-related complications. A new technique allowing progressive lengthening with a centromedullary nail without external fixation has been developed. This original double-locked device consists of matching male and female components fitted with a continuous thread. Lengthening is achieved via a one-way ratchet system. Twelve back-and-forth movements produce 1.25 mm lengthening. MATERIAL AND METHODS: We tested this new device on 20 sheep and compared results with external fixation lengthening in 20 other sheep. The animals were divided into groups for sacrifice on days 5, 10, 20, 45 and 90. Serial x-ray were obtained for all animals. In the 45-day and 90-day groups, histomorphometric (trichrome goldner coloration and polarized light microscopy) and densitometric studies were also performed. Bone mineral density (BMD) was determined and bone trabecular density (BTD) and trabecular bone volume (TBV) were expressed in percent of bone trabecular surface area. RESULTS: Mean lengthening in the 45-day and 90-day groups was 39 mm for the nail and 20 mm for external fixation (1 mm/day). At 90 days, 3 sheep out of 4 had consolidated radiologically with external fixation and 2 out of 4 with the nail. BMD was slightly better for external fixation (0.811 vs 0.695/cm(2)). This difference could probably be attributed to the greater lengthening obtained with the nail. At 45 days, BMD was the same (0.6 g/cm(2)) for both devices. BTD was nearly two-fold higher for the nail compared with external fixation (59.65% vs 32.61% at 90 days), most probably due to primary bone formation. The histomorphometric study allowed an analysis of the osteoid border. Bone quality obtained in the bone regenerate with the nail was superior to that obtained with external fixation. Primary bone formation resulted from membrane ossification with direct transformation of fibroblasts into osteoblasts. CONCLUSION: This work demonstrated that progressive lengthening can be achieved with a specifically designed centromedullary nail without iterative opening of the operative site. Tolerance to this type of device and quality of the bone regenerate are altogether satisfactory.

Absorptiometry, Photon↗
PubMed2000

Effects of alendronate on bone quality and remodeling in glucocorticoid-induced osteoporosis: a histomorphometric analysis of transiliac biopsies.

Effects of alendronate (ALN) on bone quality and turnover were assessed in 88 patients (52 women and 36 men aged 22-75 years) who received long-term oral glucocorticoid exposure. Patients were randomized to receive oral placebo or alendronate 2.5, 5, or 10 mg/day for 1 year and stratified according to the duration of their prior glucocorticoid treatment. Transiliac bone biopsies were obtained for qualitative and quantitative analysis after tetracycline double-labeling at the end of 1 year of treatment. As previously reported in glucocorticoid-induced osteoporosis, low cancellous bone volume and wall thickness were noted in the placebo group as compared with normal values. Alendronate treatment was not associated with any qualitative abnormalities. Quantitative comparisons among the four treatment groups were performed after adjustment for age, gender, and steroid exposure. Alendronate did not impair mineralization at any dose as assessed by mineralization rate. Osteoid thickness (O.Th) and volume (OV/BV) were significantly lower in alendronate-treated patients, irrespective of the dose (P = 0.0003 and 0.01, respectively, for O.Th and OV/BV); however, mineral apposition rate was not altered. As anticipated, significant decreases of mineralizing surfaces (76% pooled alendronate group; P = 0.006), activation frequency (-72%; P = 0.004), and bone formation rate (-71%; P = 0.005) were also noted with alendronate treatment. No significant difference was noted between the changes observed with each dose. Absence of tetracycline label in trabecular bone was noted in approximately 4% of biopsies in placebo and alendronate-treated groups. Trabecular bone volume, parameters of microarchitecture, and resorption did not differ significantly between groups. In conclusion, alendronate treatment in patients on glucocorticoids decreased the rate of bone turnover, but did not completely suppress bone remodeling and maintained normal mineralization at all alendronate doses studied. Alendronate treatment did not influence the osteoblastic activity, which is already low in glucocorticoid-induced osteoporosis.

Adult↗
PubMed2000

Dobutamine magnetic resonance imaging predicts contractile reserve of chronically dysfunctional myocardium: comparison with was fluorine-18 fluorodeoxyglucose positron emission tomography.

OBJECTIVE: This study sought to investigate whether low-dose dobutamine-MRI can detect residual myocardial viability in patients with chronic myocardial infarction and, left ventricular dysfunction. METHODS: Eleven patients with chronic myocardial infarction and left ventricular dysfunction were employed for identification of viable myocardium by cine-MRI during dobutamine infusion. All patients underwent coronary angiography and left ventriculography, 18FDG-PET, MRI at rest and stress. The systolic wall thickening measured at rest and during stress was compared with the results of 18FDG-PET, respectively. RESULTS: A significant difference of either dobutamine-induced systolic wall thickening (SWthstress) or dobutamine-induced contractile reserve (deltaSWth = SWthstress - SWthrest) was present between viable and scar regions (1.0 +/- 0.3 versus -0.3 +/- 0.1, P < 0.01; 1.0 +/- 0.3 versus -0.2 +/- 0.2, P < 0.01). CONCLUSIONS: obutamine-induced contractile reserve can be predicted in the regions of akinesia or dyskinesia at rest when systolic wall thickening was > or = 1.0 mm during dobutamine stimulation.

Adult↗
PubMed1999

Different functions for the thyroid hormone receptors TRalpha and TRbeta in the control of thyroid hormone production and post-natal development.

The biological activities of thyroid hormones are thought to be mediated by receptors generated by the TRalpha and TRbeta loci. The existence of several receptor isoforms suggests that different functions are mediated by specific isoforms and raises the possibility of functional redundancies. We have inactivated both TRalpha and TRbeta genes by homologous recombination in the mouse and compared the phenotypes of wild-type, and single and double mutant mice. We show by this method that the TRbeta receptors are the most potent regulators of the production of thyroid stimulating hormone (TSH). However, in the absence of TRbeta, the products of the TRalpha gene can fulfill this function as, in the absence of any receptors, TSH and thyroid hormone concentrations reach very high levels. We also show that TRbeta, in contrast to TRalpha, is dispensable for the normal development of bone and intestine. In bone, the disruption of both TRalpha and TRbeta genes does not modify the maturation delay observed in TRalpha -/- mice. In the ileum, the absence of any receptor results in a much more severe impairment than that observed in TRalpha -/- animals. We conclude that each of the two families of proteins mediate specific functions of triiodothyronin (T3), and that redundancy is only partial and concerns a limited number of functions.

Animals↗
PubMed1999

High-resolution computed tomography for architectural characterization of human lumbar cancellous bone: relationships with histomorphometry and biomechanics.

The aim of the present study on human vertebral cancellous bone was to validate structural parameters measured with high-resolution (150 microm) computed tomography (HRCT) by referring to histomorphometry and to try to predict mechanical properties of bone using HRCT. Two adjacent vertical cores were removed from the central part of human L2 vertebral body taken after necropsy in 22 subjects aged 47-95 years (10 women, 12 men; mean age 79 +/- 14 years). The right core was used for structural analysis performed by both HRCT and histomorphometry. Two cancellous bone specimens were extracted from the left core: a cube for HRCT and a compression test, and a cylinder for a shear test. Significant correlations were found between HRCT and histomorphometric measurements (BV/TV, trabecular thickness, separation and number, and node-strut analysis), but with higher values for most of the tomographic parameters (BV/TV and trabecular thickness determined by HRCT were overestimated by a factor 3.5 and 2.5 respectively, as compared with histomorphometry). The maximum compressive strength and Young's modulus were highly correlated (rho = 0.99, p<0.0005). Significant correlation was obtained between bone mineral density (determined using dual-energy X-ray absorptiometry) and the maximum compressive strength (rho = 0. 64, p = 0.002). In addition the maximum compressive strength and architectural parameters determined by HRCT or histomorphometry showed significant correlations (e.g., for HRCT, BV/TV: rho = 0.88, p<0.0005, N.Nd/TV: rho = 0.73, p<0.001). The shear strength was significantly correlated with BV/TV (rho = 0.62, p = 0.002), Tb.Sp (rho = -0.58, p = 0.004) and TSL (rho = 0.55, p = 0.006) measured by HRCT. In conclusion, an HRCT system with 150 microm resolution is not sufficient to predict the true values of the structural parameters measured by histomorphometry, although high correlations were found between the two methods. However, we showed that a resolution of 150 microm allowed us to predict the mechanical properties of human cancellous bone. In vivo peripheral systems with such a resolution should be of interest and would deliver an acceptable radiation dose to the patient.

Aged↗
PubMed1999

Predictive value of regional left ventricular circumferential shortening in jeopardized myocardium. A two-dimensional SPAMM cine-MRI study in a canine model.

OBJECTIVE: To determine whether myocardial circumferential shortening assessed in the different myocardial layers by SPAMM cine-MRI may help to discriminate between various degrees of myocardial injury in reperfused myocardium. METHODS: Dogs underwent 90 minutes of coronary occlusion and 24 hours of reperfusion. Using a 1.5 T whole-body MR scanner, SPAMM cine-MRI images were acquired before and 24 hours after surgery on the short axis plan of the left ventricle and analyzed to evaluate the mean myocardial circumferential shortening (% MCS) in the different layers. Based on the residual blood flow, animals were assigned to group I (residual flow < 22.5%) or group II (residual flow > 22.5%). RESULTS: Dogs in group I developed larger infarctions (25.3% +/- 14.6 of the area at risk, n = 5) compared with those in group II (5.81% +/- 1.1, n = 7, P < 0.05). In the jeopardized zone, the % MCS of the subendocardium decreased more significantly in group I (-0.03% +/- 3.7 to 2.2% +/- 5.2) compared with group II (14.7% +/- 1.5 to 18.4% +/- 1.4). CONCLUSIONS: SPAMM cine-MRI is a fast and noninvasive means of measuring % MCS. The MR measurement of this parameter in the subendocardial layer appears quite accurate in describing the degree of damage in reperfused myocardium.

Algorithms↗
PubMed1999

[Characterization of arterial stenosis using 3D imaging. Comparison of 3 imaging techniques (MRI, spiral CT and 3D DSA) and 4 display methods (MIP, SR, MPVR, VA) by using physical phantoms)].

INTRODUCTION: Accurate assessment of arterial stenosis is a major public health issue for the diagnosis and treatment of cardiovascular diseases. The number of imaging techniques and types of software for display of imaging data is increasing. Few studies that compare these different techniques are available in the literature. MATERIALS AND METHODS: Using phantoms to reproduce the main types of arterial stenosis, the authors compared three 3D acquisition techniques (MRA, CTA, and 3D DSA) and four types of display methods (MIP, SR, MPVR, and VA). The degree, the shape, and the location of different types of stenoses were analyzed by three experienced observers during two successive readings. Intra- and inter-observer reproducibility were assessed. The results of the various acquisition techniques and display methods also were compared to the digital reference data (CFAO) of the physical phantoms. RESULTS: The degree of intra- and inter-observer reproducibility for the assessment of shape and location of the stenoses was good. Visual assessment of the degree of stenosis showed significant differences between two observers as well as in two readings by one observer. The 3D DSA was the most accurate technique for assessing the degree of stenosis. CTA provided better results than MRA. MPVR provided an accurate assessment of the degree of the stenosis. 3D DSA and CTA assessed stenosis form and localization adequately, with no significant difference; both methods appeared to be more accurate than MRA. SR provided the best information on the eccentric nature of the stenosis. The shape was very well assessed by VA and MPVR. CONCLUSIONS: Even though 3D DSA is the most accurate acquisition technique for visualization, the combined use of SR and MPVR appears to be the best compromise to describe the morphology and degree of stenosis. Further improvements in automatic 3D image processing could offer a better understanding and increased possibilities for assessing arterial stenosis.

Angiography, Digital Subtraction↗
PubMed1998

Fractal analysis of bone texture on os calcis radiographs compared with trabecular microarchitecture analyzed by histomorphometry.

Microarchitecture of trabecular bone is an important determinant of bone fragility; to date, its evaluation requires bone biopsy with histomorphometry analysis. Methods of noninvasive characterization of trabecular bone microarchitecture are in development and we have developed and validated a bone texture analysis applied to bone radiographs and based on fractal geometry. The aim of our study was to compare this fractal analysis of trabecular bone texture on radiographs to the trabecular microarchitecture analyzed by bone histomorphometry on os calcis biopsies. Thirty eight ossa calcis from 19 human cadavers were studied. Fractal analysis of the trabecular bone of os calcis radiographs was performed by the maximum likelihood estimator following the fractional brownian motion model. The ossa calcis were dissected, then transcortical biopsy cores focused on the fractal analysis region of interest were obtained. Structural and connectivity parameters were measured with both automatic and semiautomatic analyzers. We have found a significant relationship between the fractal Hmean parameter and structural histomorphometric indices; the best correlation was found with trabecular separation (r = -0.55; P = 0.0004). Based on a stepwise regression analysis, trabecular spacing and trabeculae number together would explain 38% of the variance of the fractal parameter. Although the relationship with connectivity indices was poor, our fractal analysis of os calcis trabecular bone texture on radiographs seemed to partially reflect the trabecular bone microarchitecture.

Aged↗
PubMed1998

Mechanical properties of ewe vertebral cancellous bone compared with histomorphometry and high-resolution computed tomography parameters.

The goal of the present study was to determine if a high-resolution computed tomography (HRCT) system with 150 microns resolution was sufficient to predict mechanical properties in ewe lumbar vertebrae. To answer this question, we used a triangular comparison between: HRCT; biomechanics (compression and shear tests); and histomorphometry, which was the reference method for the measurements of morphometric parameters. Two dissected lumbar vertebrae (L-4 and L-5) from 32 ewes were used. Both compressive and shear properties correlated significantly with amount of bone and structural parameters evaluated by histomorphometry (bone volume/tissue volume, trabecular thickness, trabecular separation), but no significant correlation was found with the trabecular number. With our shear test involving the trabecular architecture itself more significant correlations were found with the node-strut analysis parameters than from the compressive test. Significant correlations were also found between HRCT and histological parameters (bone volume/tissue volume, bone surface/bone volume, trabecular separation, trabecular number, total strut length, number of nodes, and number of termini). Correlations between HRCT structural parameters and mechanical properties on L-4 were of the same magnitude as the correlations between the histomorphometric structural parameters and mechanical results on L-5 but with the remarkable advantage the HRCT is a noninvasive method. In spite of the resolution (150 microns) of our HRCT system, which entailed mainly an enlargement of the thinnest trabeculae or their loss during the segmentation process, we obtained coherent relationships between mechanical and tomographic parameters. The thinnest trabeculae probably had little effect on the mechanical strength. Also, this type of resolution allows us to consider the possibility of perfecting an in vivo HRCT system. However, physical density and bone mineral density correlated much better with strength than either classical histomorphometric or tomographic parameters. The current conclusion is fairly negative with respect to the ability of HRCT to assess mechanical properties nondestructively as compared with dual-energy X-ray absorptiometry. But, the noninvasive nature of the imaging modality and the capacity for three-dimensional imaging at arbitrary orientation make HRCT a promising tool in the quantitative assessment of cancellous architecture.

Animals↗
PubMed1997

The T3R alpha gene encoding a thyroid hormone receptor is essential for post-natal development and thyroid hormone production.

The diverse functions of thyroid hormones are thought to be mediated by two nuclear receptors, T3R alpha1 and T3R beta, encoded by the genes T3R alpha and T3R beta respectively. The T3R alpha gene also produces a non-ligand-binding protein T3R alpha2. The in vivo functions of these receptors are still unclear. We describe here the homozygous inactivation of the T3R alpha gene which abrogates the production of both T3R alpha1 and T3R alpha2 isoforms and that leads to death in mice within 5 weeks after birth. After 2 weeks of life, the homozygous mice become progressively hypothyroidic and exhibit a growth arrest. Small intestine and bones showed a strongly delayed maturation. In contrast to the negative regulatory function of the T3R beta gene on thyroid hormone production, our data show that the T3R alpha gene products are involved in up-regulation of thyroid hormone production at weaning time. Thus, thyroid hormone production might be balanced through a positive T3R alpha and a negative T3R beta pathway. The abnormal phenotypes observed on the homozygous mutant mice strongly suggest that the T3R alpha gene is essential for the transformation of a mother-dependent pup to an 'adult' mouse. These data define crucial in vivo functions for thyroid hormones through a T3R alpha pathway during post-natal development.

Acetylcholine↗
PubMed1997

Comparison between qualitative and quantitative wall motion analyses using dipyridamole stress breath-hold cine magnetic resonance imaging in patients with severe coronary artery stenosis.

Breath-hold cine magnetic resonance imaging (MRI) at rest and during dipyridamole infusion was used to study wall motion abnormalities in patients with severe coronary artery stenosis proven by coronary angiography. Sixteen patients without myocardial infarction but at least one major coronary artery with > or = 70% diameter narrowing were included. Qualitative "visual" assessment of wall motion, as well as quantitative measurement "wall thickening changes (%)" were compared using receiver operating characteristic curve analysis. 201Tl-single-photon emission computed tomography (SPECT) was also studied for comparison. Using qualitative analysis, coronary artery disease detection rate was comparable when assessing wall motion abnormalities with dipyridamole-MRI (79%) and with dipyridamole-induced perfusion defects with 201-thallium-SPECT (75%). Furthermore, sensitivity and specificity for identification of all diseased coronary territories were comparable for both imaging modalities (sensitivity of dipyridamole-MRI and 201thallium-SPECT, 80% vs. 69%; specificity, 75% vs. 80%). The quantitative method has a substantially higher sensitivity than the qualitative method in identifying all diseased territories (Az = 0.81, p < 0.01 vs. Az = 0.55 and 0.59). In addition, we demonstrated that the quantitative method had higher performance than the qualitative one in identifying the diseased vessels territories related to 1-vessel, 2-vessel, and each of individual coronary artery stenoses.

Aged↗
PubMed1997

[Chylothorax and sarcoidosis].

The association of sarcoidosis and chylothorax is rare. A patient aged 64 presented with mediastinal sarcoidosis. Two years after the diagnosis he developed a right chylothorax. The computed tomographic examination showed a retraction of the right hemithorax associated with large mediastinal nodes, without signs of interstitial lung disease. Pulmonary function tests revealed a restrictive ventilatory defect with a Forced Vital Capacity (FVC) of 53% and a Forced Expired Volume in one second (FEV1) of 54% from the predicted values; the FEV1/FVC ratio was 78%. Steroid therapy was started at 1 mg per kilogram per day for three months then progressively decreased to 15 mg per day. Inspite of the steroid therapy there was as well biological evidence of continued disease activity (bronchoalveolar lavage lymphocytosis and increased serum angiotensin converting enzyme), as persistence of pleural effusion and mediastinal adenopathy; the contraction of the right hemithorax increased. Restrictive ventilatory defect worsened with a FVC of 44% and an FEV1 of 47% of the predicted values. The presence of a significant contraction of the hemithorax and of a severe restrictive ventilatory defect suggested the existence both of pleural fibrosis and of a compression of the main lymphatic pathways responsible for the chylothorax.

Adrenal Cortex Hormones↗