Inverted left atrial appendage appearing as a left atrial mass with transesophageal echocardiography during cardiac surgery.
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Echocardiography↗
Biomedical subjects
S Aronson
Publications and source records attributed to S Aronson.
Echocardiographic analysis of dysfunctional and normal myocardial segments before and immediately after coronary artery bypass graft surgery.
Echocardiography has revealed evidence of "subnormal" regional contraction patterns that result from myocardial ischemia and are often accompanied by nonadjacent "hyperkinetic" regions. Whether these regions of hyperkinetic wall motion persist unchanged or revert to normal after coronary artery bypass graft (CABG) surgery has not been studied in humans. Using echocardiography, we evaluated both dysfunctional and normal myocardial regions for changes in segmental wall motion and percent of systolic wall thickening that occurred immediately after CABG surgery in 32 patients. Segmental wall motion analysis before CABG surgery in these patients revealed that 170 (66%) of 256 myocardial segments were subnormal, of which 115 (67%) improved and 102 (60%) returned to normal immediately after CABG surgery. Eleven myocardial segments that were hyperkinetic before CABG surgery returned to normal after CABG surgery. Preoperatively, 162 (63%) of 256 myocardial segments had systolic wall thickening less than 30%, which increased from 11.8% +/- 8.9% to 24.3% +/- 14.3% (mean +/- SD) (P less than 0.01) postoperatively. Conversely, a reverse trend was found when systolic wall thickening was greater than 30% before CABG surgery: thickening decreased from 46.2% +/- 13.8% to 33.4% +/- 14.8% after CABG surgery (P less than 0.01). Thus, we conclude that immediately after CABG surgery, there is a recovery of function in some myocardial segments and a reduction in function in others. Furthermore, we conclude that the semiquantitative assessment of percent of systolic wall thickening is a more reliable (consistent) echocardiographic index of myocardial function compared with the qualitative assessment of segmental wall motion immediately after CABG surgery.
Adult↗
A comparison of methods for the detection of myocardial ischemia during noncardiac surgery: automated ST-segment analysis systems, electrocardiography, and transesophageal echocardiography.
Clinicians often fail to detect intraoperative ischemic electrocardiographic (ECG) changes when viewing oscilloscopes. Automated ST-segment monitors promise to increase the detection of such ECG changes. We investigated the capacity of two commercially available ST-segment monitors to detect intraoperative myocardial ischemia in patients at high risk for developing intraoperative myocardial ischemia during vascular and other noncardiac procedures. The ST-segment monitors were compared with two reference monitors: (a) printed eight-lead ECGs, as interpreted by a cardiologist, and (b) the presence of segmental wall motion abnormalities and thickening abnormalities detected by transesophageal echocardiography (TEE). We also examined the capacity of the printed ECG to diagnose myocardial ischemia when compared with TEE. We studied 44 patients who underwent TEE, printed multilead ECG, oscilloscope monitoring of leads V5 and II, and measurement of ST-segment deviation from the baseline using an automated Hewlett Packard ST-segment device. The sensitivities for the Hewlett Packard system were 40% for TEE-diagnosed myocardial ischemia and 75% for ECG-diagnosed ischemia. Comparison of the printed ECG with TEE revealed that ST-segment changes in the printed ECG, as analyzed by a cardiologist, were 25% sensitive and 62% specific for the detection of TEE-diagnosed myocardial ischemia. When T-wave inversions were added to ST-segment depression as a criterion for the diagnosis of myocardial ischemia by the printed ECG, the sensitivity of ECG for the detection of intraoperative myocardial ischemia, as determined by TEE, was 40% and specificity was 58%. Twenty-three of the 44 patients were simultaneously monitored in leads I, II, and V5 with an automated Marquette ST-segment monitor.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
A non-invasive technique for the accurate measurement of leg length in animals.
A novel, non-invasive technique for accurate measurements in animals (Kyniklometry) is presented. Kyniklometry (derived from greek ŏ kúvikloz the rabbit) determines the distance between soft tissue landmarks in conscious rabbits, in particular the rear lower leg. Each measurement consists of six subsequent and independent estimations of this distance, with a technical error of 79 microns (study I), respectively 83 microns (study II). The angle of the relaxed sitting animal's knee is approximately 45 infinity, and remains individually almost constant during subsequent measurements. The precision of the device was compared with X-ray stereophotogrammetry (technical error 30 microns). Five female New Zealand White rabbits were measured for 13 consecutive days at 24-hour-intervals both by kyniklometry and X-ray stereophotogrammetry (study I). The mean increment of 5 kyniklometric series of ten (3rd to 13th day) 24-hour-increments was 0.988 mm, the mean 24-hour-variance was 0.244 mm2. Sixty point five percent of this variance could be explained by parallel right/left leg soft tissue variation. Only 5% of the variance was explicable by the technical error. The 24-hour-correlation between kyniklometry and X-ray stereophotogrammetry was significant with r = 0.889 and p less than 0.001. Kyniklometric measurements were also performed in 5 female rabbits for 56 days at 24-hour-intervals (study II). We found spontaneous periodicity once every 8 to 14 days. There was a diurnal variation of rear lower leg increment with maxima in the early morning hours.
Animals↗
Cystic renal masses: usefulness of the Bosniak classification.
To determine the usefulness of the Bosniak classification of cystic renal masses, the computed tomographic (CT) and ultrasound findings of 16 pathologically proven cystic renal masses were retrospectively reviewed. All imaging studies were reviewed and categorized utilizing the Bosniak classification without knowledge of the final pathologic diagnosis. There were no category I lesions (classical simple cyst), four category II (minimally complicated), seven category III lesions (more complicated), and five category IV lesions (probable malignant). All category II lesions were benign, all category IV lesions were malignant. Of the seven category III lesions, three were benign and four were malignant. We conclude that the Bosniak classification is extremely useful in the management of cystic renal masses.
Female↗
Assessment of retrograde cardioplegia distribution using contrast echocardiography.
Retrograde cardioplegia has gained popularity in coronary and noncoronary cardiac operations. We have used contrast echocardiography in the open-chest canine model to compare the distribution of cardioplegia delivered antegrade in the aortic root versus retrograde through the coronary sinus, and to determine the effect of coronary occlusion on that delivery. With no coronary occlusion, antegrade cardioplegia was distributed to the entire left ventricle and septum whereas retrograde cardioplegia was distributed to the left ventricular free wall but had inconsistent delivery to the septum. Acute occlusion of the left circumflex coronary artery resulted in 57.06% +/- 9.52% of the left ventricle not being perfused by antegrade cardioplegia and occlusion of both the left circumflex and anterior descending coronary arteries caused a 65.46% +/- 18.5% reduction in perfusion by antegrade cardioplegia. Acute coronary occlusion had no effect on retrograde cardioplegia distribution. We conclude that retrograde cardioplegia is less homogeneous than antegrade cardioplegia in the intact coronary circulation but that retrograde cardioplegia preserves cardioplegia distal to acutely occluded coronary arteries. Furthermore, contrast echocardiography is a useful method of assessing myocardial perfusion and may have useful clinical applications.
Albumins↗
Effects of fenoldopam on renal blood flow and systemic hemodynamics during isoflurane anesthesia.
The authors compared the systemic hemodynamic and renal vascular effects of hypotension induced by fenoldopam with those produced by the most commonly used hypotensive agent, sodium nitroprusside, in 10 dogs. Mean arterial pressure decreased 26% +/- 3% from control following infusion with fenoldopam, and 30% +/- 2% following infusion with sodium nitroprusside (these decreases were not significantly different between the groups). Renal blood flow (RBF) was preserved during fenoldopam-induced hypotension (214 +/- 16 mL/min at baseline and 197 +/- 16 mL/min after fenoldopam-induced hypotension). In contrast, RBF decreased from 223 +/- 17 mL/min to 167 +/- 12 mL/min during sodium nitroprusside-induced hypotension (P less than 0.02). The differences in RBF between the two groups occurred in spite of the fact that cardiac output and pulmonary capillary wedge pressure were kept similar between the two groups. The authors conclude that fenoldopam, a selective dopamine1 (DA1) receptor agonist, preserves blood flow to the kidney during induced hypotension. On the other hand, sodium nitroprusside is a nonselective arteriolar and venous vasodilator that redistributes blood flow away from the kidneys during induced hypotension.
2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
Assessment of myocardial perfusion during CABG surgery with two-dimensional transesophageal contrast echocardiography.
No reliable, quantifiable index of tissue perfusion is currently available to assess the efforts of coronary artery bypass graft (CABG) surgery. We used two-dimensional transesophageal contrast echocardiography with sonicated Renografin-76 microbubbles to determine the distribution of myocardial blood flow during coronary artery bypass graft surgery in 15 patients. Sonicated Renografin-76 contrast agent was injected into the aortic root of all patients after institution of cardiopulmonary bypass and application of the aortic occlusive clamp. Eight patients had contrast agent injected directly into the free proximal end of the vein-CABG anastomosis. All patients again received aortic root injections during reperfusion after anastomosis of the proximal aortovein and distal coronary artery. Echocardiographic images of the left ventricle short axis at the level of the papillary muscles were obtained in real time and analyzed retrospectively from videotape. Injection of contrast provided information about the magnitude and geometric distribution of coronary artery-vein bypass run-off and enabled identification of poorly perfused myocardial regions. When predicted myocardial perfusion patterns, based on preoperative evaluation of epicardial vessel distribution derived from coronary angiography, were compared to actual perfusion patterns assessed with intraoperative echocardiography, contrast regional myocardial perfusion patterns were predicted 84% of the time (71-97%, 95% confidence limit). Regional myocardial perfusion deficits detected after coronary bypass grafting were associated with regional wall motion abnormalities detected after separation from cardiopulmonary bypass. Our technique makes possible on-line visualization of changes in regional blood flow in the heart before, during, and after CABG.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Roentgen stereophotogrammetric short-term analysis of growth rate in children operated for Crohn's disease.
Roentgen stereophotogrammetry is a new method for short term analysis of growth rate. Growth is measured over the growth zone in the distal fibula and is a fraction of the total statural growth. Normal growth rate in the distal fibula is about 15 micrograms/day at a total growth rate of 5 cm/year. The method was used to follow growth six months before and six months after surgery in six growth retarded children with Crohn's disease. Growth rate increased significantly (p less than 0.01) within three months after surgery from 5.8 microns/day before operation to 15.8 microns/day three months after operation and six months postoperatively had reached 18.0 micron/day. Improved growth could be recorded as early as four weeks after operation. The Roentgen stereophotogrammetric analysis (RSA) gives a unique possibility to follow short-term changes in growth rate in children with disturbed growth and to use growth rate as a quick assessment of response.
Adolescent↗
Current status of imaging indeterminate renal masses.
In 1986 Bosniak proposed a classification of cysts and cystic renal masses in an attempt to define precisely the radiologic findings for lesions not requiring further evaluation and for those that should be explored surgically in an attempt to salvage normal renal parenchyma. This classification has been extremely useful in expanding the number of patients treated conservatively. The following entities can be considered benign and require no further evaluation: the classic simple cyst (Bosniak category 1), a cyst with benign calcification (see Fig. 1A and B), a hyperdense cyst (see Fig. 2), and a cyst with thin (less than or equal to 1mm) septations (see Fig. 5A; Bosniak category 2). When any of the following features are present, further evaluation is warranted: aggressive calcifications (see Fig. 1C-E), abnormal density not fulfilling the criteria of a hyperdense cyst (see Figs. 3 and 4), or nodular septations (see Fig. 5B and C), or wall thickening (see Fig. 7; Bosniak) category 3). Small masses that cannot be characterized accurately also require further evaluation. Multiloculated masses(see Fig. 9) require surgery (Bosniak category 3). Most cases of multiple localized renal cysts can be distinguished from multiloculated masses and do not require surgery (see Fig. 10). Evaluation of cyst fluid by MR imaging has not been proved reliable in differentiating benign and malignant masses. MR imaging will become more useful when its spatial resolution equals that of CT. Masses that remain indeterminate after careful evaluation by ultrasonography and CT scanning can be evaluated additionally by angiography or cyst puncture. Management options for persistent enigmatic masses include follow-up radiologic studies, exploration, local excision, and nephrectomy.
Carcinoma, Renal Cell↗
Children with chronic renal failure in Sweden 1978-1985.
A survey of chronic renal failure (CRF) in Swedish children was carried out for the period 1978-1985, using age-related cut-off levels for creatinine concentrations corresponding approximately to a glomerular filtration rate of 30 ml/min per 1.73 m2. The mean annual incidence of CRF was 6.9 and of terminal renal failure (TRF) 4.4/million children. The prevalence increased during the study period, for preterminal renal failure from 14.1 (1978) to 26.1 (1985) and for TRF from 12.4 to 16/million children. The main groups of primary renal disease were malformations (42%), hereditary disorders (27%), and glomerular diseases (14%), while pyelonephritis with vesico-ureteral reflux only made up 5%.
Adolescent↗
Preservation of renal blood flow during hypotension induced with fenoldopam in dogs.
The introduction of drugs that could induce hypotension with different pharmacological actions would be advantageous because side effects unique to a specific drug could be minimized by selecting appropriate therapy. Specific dopamine-1, (DA1) and dopamine-2 (DA2) receptor agonists are now under clinical investigation. Fenoldopam mesylate is a specific DA1 receptor agonist that lowers blood pressure by vasodilatation. The hypothesis that fenoldopam could be used to induce hypotension and preserve blood flow to the kidney was tested. Systemic aortic blood pressure and renal blood flow were measured continuously with a carotid arterial catheter and an electromagnetic flow probe respectively, in order to compare the cardiovascular and renal vascular effects of fenoldopam and sodium nitroprusside in ten dogs under halothane general anaesthesia. Mean arterial pressure was decreased 30 +/- 8 per cent from control with infusion of fenoldopam (3.4 +/- 2.0 micrograms.kg-1.min-1) and 34 +/- 4 per cent with infusion of sodium nitroprusside (5.9 micrograms.kg-1.min-1) (NS). Renal blood flow (RBF) increased during fenoldopam-induced hypotension 11 +/- 7 per cent and decreased 21 +/- 8 per cent during sodium nitroprusside-induced hypotension (P less than 0.01). Sodium nitroprusside is a non-selective arteriolar and venous vasodilator that can produce redistribution of blood flow away from the kidney during induced hypotension. Fenoldopam is a selective dopamine-1 (DA1) receptor agonist that causes vasodilatation to the kidney and other organs with DA1 receptors and preserves blood flow to the kidney during induced hypotension.
2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
Contrast echocardiography: a method to visualize changes in regional myocardial perfusion in the dog model for CABG surgery.
The ability of contrast echocardiography to assess regional myocardial perfusion during cardiopulmonary bypass in a dog model for coronary artery bypass surgery was evaluated. Sonicated Renograffin-76 microbubbles (meglumin diatrigoate and sodium diatrigoate) were injected into an aortic root proximal to an aortic occlusion clamp root while dogs were on cardiopulmonary bypass, with the heart arrested in diastole. Echocardiographic contrast-enhanced regions of myocardial perfusion were easily visualized. Differences in contrast-enhanced myocardial regions depended on coronary artery occlusion or patency. The contrast-enhanced images of myocardial perfusion showed that, for a given myocardial segment of the supplying vessel, the presence or absence of contrast effect reliably predicted vessel occlusion or patency (P less than .01). In the future contrast echocardiography may allow the direct assessment of regional myocardial perfusion in the operating room.
Animals↗
The value of routine admission chest radiographs in adult asthmatics.
One hundred twenty-five consecutive admissions in 102 patients hospitalized for acute bronchospasm were studied to determine the need for routine admission chest radiography in asthmatics. Patients were categorized as complicated or uncomplicated asthmatics based on data recorded in the emergency department. Thirteen admission chest radiographs in 44 complicated asthmatics had an impact on management, whereas none of the 81 radiographs in the uncomplicated group affected patient care (P less than .001). Our study suggests that routine admission chest radiographs in uncomplicated asthmatics may be unnecessary.
Acute Disease↗
Prospective evaluation of human chorionic gonadotropin in the treatment of cryptorchidism.
Of 158 boys consecutively referred for undescended testis, 77 were found to have true cryptorchidism. Human chorionic gonadotropin (HCG) was given to 60 boys (63 undescended testes) in a dose of 5,000 U (patient age 4-6 years) or 10,000 U (7-9 years). The parents of seven others preferred direct referral for orchiopexy. Minor side effects occurred in 18 boys. Significant increase in weight increment velocity was seen among 7-9-year-olds. Descent of testis occurred in 59% (95% cl 46-71%), with the incidence significantly higher in the older group. Mobile testes were more likely to descend. At surgery following failed HCG treatment, hernia or hydrocele was unexpectedly found in 77% of cases, and 19% of the testes were ectopic in the superficial inguinal pouch. The risk of repeat orchiopexy was not less than in a previous series of primary orchiopexy. Although surgery could be avoided in approximately half of the patients in this series, it is not yet decisively established if HCG should be used diagnostically or therapeutically. Improved pre-treatment identification of ectopia and hernia is required.
Child↗
Quantitation of renal blood flow by contrast ultrasonography: preliminary results.
Contrast ultrasonography, employing tracers behaving like red blood cells, is a promising technique to study regional blood flow distribution. Aim of this note is to quantitate renal blood flow in the dog using contrast ultrasonography. Mathematical formulae derived from the classical dye-dilution theory are applied. Ten different renal blood flow levels (ranging from 16 to 125 ml/min) were obtained by means of mechanical (stenosis and reperfusion) and pharmacological interventions (iv infusion of adrenaline, noradrenaline and fenoldopam). Renal blood flow was measured by electromagnetic flow-meter and contemporary calculated by contrast ultrasonography. The correlation coefficient between measured and calculated flow was 0.92 (p less than 0.01). Contrast ultrasonography is a technique capable of measuring renal blood flow at a wide range of different flow levels.
Albumins↗
Recombinant somatropin in treatment of growth hormone deficient children in Sweden and Finland.
A total of 23 previously untreated and 28 previously treated GH deficient children were included for at least 12 months in a trial of recombinant somatropin, 0.1 IU/kg/day given by subcutaneous injection. All the children increased their height velocity over the pretreatment values, to nearly 11 cm/year, corresponding to a significant increase in height of 1 SD score for chronological age. The increase in height SD score for bone age was also statistically significant. No adverse effects were recorded, though one child experienced local itching and redness at the injection site which did not recur after a short cessation of therapy. One child developed detectable antibodies to recombinant somatropin, but the binding capacity was low and no clinical symptoms or growth attenuation occurred. Recombinant somatropin was shown to be safe and effective during the first year of therapy in children with GH deficiency.
Adolescent↗
Venous admixture to radial artery blood samples during cardiopulmonary bypass.
The possibility that venous blood could be withdrawn through a radial artery cannula when venous pressure is high was examined in 30 patients during cardiopulmonary bypass for coronary artery bypass operation. Progressive desaturation of radial artery blood occurred when venous pressure was equal to arterial pressure. Desaturation not only increased with duration of venous obstruction but also occurred immediately if the arterial tree was emptied after occlusion. We believe that these observations result from the transcapillary aspiration of deep venous blood and may produce a potential source of error in measuring arterial oxygen tension during cardiopulmonary resuscitation, cardiac tamponade, and profound right heart failure, as well as cardiopulmonary bypass.
Arm↗