Hyperthyroidism in a healthy pregnant woman.
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Chorionic Gonadotropin↗
Biomedical subjects
R B Himelman
Publications and source records attributed to R B Himelman.
Fulminant hepatic failure six weeks postpartum.
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Adult↗
The prognostic value of loculations in parapneumonic pleural effusions.
Forty-eight patients with pleural effusions who had sonographically directed thoracocentesis were evaluated retrospectively for radiologic findings, pleural fluid chemistries, and outcome. Loculation was found to be a radiologic marker of diagnostic and prognostic significance. The presence of loculations correlated with exudative pleural fluid chemistries, but no radiologic finding was specific for empyema. "Extreme" pleural fluid chemistries were associated with loculation, but not with empyema. Patients with loculated effusions had larger effusions, longer hospitalizations, and more frequent tube thoracostomy procedures than patients with nonloculated effusions. Light's criteria for tube thoracostomy were found to be unreliable in patients with loculated parapneumonic effusions or in patients treated with prolonged antibiotic therapy prior to thoracocentesis.
Biopsy, Needle↗
Is parathormone a cardiac toxin in uremia?
In uremia, parathormone (PTH) has been associated with inadequate left ventricular hypertrophy, cardiomyopathy, and mitral anular calcification (MAC). We related levels of serum PTH, calcium, phosphate, magnesium, calcium-phosphate product, and systolic blood pressure to average left ventricular wall thickness, left ventricular mass index, ejection fraction, and presence and extent of MAC by echocardiography in 44 patients before and after renal transplantation. Pre-transplant, 18 patients (41%) had MAC; these and the 26 others had similar values for serum PTH, calcium-phosphate product, systolic blood pressure, age, and years of hemodialysis. The patients with PTH levels greater than 1000 mcl eq/ml had higher systolic blood pressures pre-transplant (157 +/- 21 vs 147 +/- 17 mm Hg, p less than 0.05), but not post-transplant as PTH levels normalized. Post-transplant, there were significant decreases in left ventricular mass index (140 +/- 35 to 103 +/- 25 g/m2) and average diastolic left ventricular wall thickness (1.4 +/- 0.2 to 1.2 +/- 0.2 cm, both p less than 0.05); however, ejection fraction and extent of MAC did not change. Left ventricular mass index, average diastolic left ventricular wall thickness, and ejection fraction did not correlate with serum PTH or electrolyte levels before or after renal transplantation. MAC is present in more than one third of uremic pts and does not resolve after renal transplantation. Although PTH does not correlate with left ventricular hypertrophy, cardiac function, or MAC before or after transplantation, elevated levels pre-transplant are associated with a slightly greater degree of hypertension. Thus PTH may be a mild vasoactive pressor in some patients with end-stage renal failure.
Adult↗
Right ventricular infarction: recognition and assessment of its hemodynamic significance by two-dimensional echocardiography.
To evaluate the ability of two-dimensional echocardiographic indexes to determine the hemodynamic significance of the right ventricular infarction, 24 patients with electrocardiographic evidence of right ventricular infarction were studied. Hemodynamic significance was defined as a jugular venous pressure greater than 17 cm H2O or a right atrial pressure greater than 13 mm Hg. Patients with hemodynamically significant right ventricular infarctions (group I, n = 9) had a 56% incidence of hypotension (blood pressure less than 90 mm Hg) with a mean systolic blood pressure of 93 +/- 23 mm Hg, whereas patients with nonhemodynamically significant right ventricular infarctions (group II, n = 15) had no hypotension and a mean systolic blood pressure of 121 +/- 18 mm Hg (p less than 0.01). The ratio of right atrial to pulmonary capillary wedge pressure was 1.1 +/- 0.6 in group I and 0.6 +/- 0.2 in group II (p less than 0.05). Echocardiography demonstrated right ventricular free wall motion abnormalities in seven patients in group I and in 10 patients in group II. The descent of the right ventricular base was 0.7 +/- 0.2 cm in group I, 1.3 +/- 0.4 cm in group II, and 2.0 +/- 0.2 cm in a group of 20 normal control patients (p less than 0.001 for all comparisons). The respiratory caval index (percentage of collapse of the inferior vena cava with inspiration) was 22% +/- 11% in group I, 45% +/- 15% in group II, and 64% +/- 17% in the control subjects (p less than 0.05 for all comparisons).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Septal bounce, vena cava plethora, and pericardial adhesion: informative two-dimensional echocardiographic signs in the diagnosis of pericardial constriction.
To assess the diagnostic value of three different two-dimensional echocardiographic signs of pericardial constriction (early diastolic septal bounce, plethora of the inferior vena cava with blunted respiratory response, and pericardial adhesion), two independent observers retrospectively evaluated echocardiograms in 100 patients, 39 of whom had pericardial constriction, 15 had hemodynamically insignificant pericardial thickening, 16 had restrictive cardiomyopathy, and 30 had normal hearts. Causes of pericardial disease included cardiac surgery, malignancy, and uremia. Sensitivity and specificity of the three signs for constriction were 62% and 93% for septal bounce, 79% and 80% for vena cava plethora, and 79% and 90% for pericardial adhesion, respectively. The presence of either vena cava plethora or pericardial adhesion increased sensitivity, whereas the presence of both plethora and adhesion increased specificity. Between the two readers, septal bounce was the most consistent and pericardial adhesion the least consistent sign. False positive results included right ventricular pacing or left bundle branch block (septal bounce), postpericardiotomy (pericardial adhesion), and right heart failure (vena cava plethora). False negative results were often caused by technical problems with imaging. We conclude that these three two-dimensional echocardiographic signs are useful in differentiating pericardial constriction from hemodynamically insignificant pericardial thickening or restrictive cardiomyopathy.
Aged↗