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Government Agencies↗
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Results for “The Right to Reproduce”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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[Automatic, implantible cardioverter-defibrillator in a patient with chronic Chagas cardiopathy and sustained ventricular tachycardia].
We studied a 48 years old woman, with chronic Chagasic cardiopathy, manifested with cardiomegaly, heart failure and syncope, due to a sustained ventricular tachycardia (SVT) of two different configurations (left bundle branch block and right bundle branch block). During electrophysiological testing, both types of ventricular tachycardia were reproduced. Successful ablation therapy of the right branch of His was performed due to suspicion of the bundle branch reentrant tachycardia, with a left bundle branch block. The patient continued to show SVT episodes, now with right bundle branch block pattern. Cardioverter Defibrillator was implanted. We report this case due to the rare frequency of Chagas' disease, where it could be a cause of heart disease, since the existence of the parasite (trypanosoma cruzi) and its vector (Triatoma) has been identified in some rural and suburban zones in the state of Aguascalientes, Mexico.
Chagas Cardiomyopathy↗
[Sialic acid in normal human tears].
PURPOSE: We measured the concentration of sialic acid, the terminal component of mucin, in normal human tears. SUBJECTS AND METHODS: Tear samples were collected from 31 healthy volunteers(50.7 years old on average) using micropipett after instillation of saline. We investigated the correlation of concentration between glycoprotein and sialic acid, the difference between these in the right eye and left eye, and the reproducibility of the sampling procedure. RESULTS: There was significant correlation of concentration between glycoprotein and sialic acid(right eye: r = 0.989, p < 0.0001; left eye: r = 0.988, p < 0.0001). There was no significant difference between these in the right and left eye. Also, the reproducibility was considered acceptable in three measurements of sialic acid with the present procedure. The concentration of sialic acid in normal diluted tears was 37.1 micrograms/ml on average. CONCLUSION: Our data indicates that concentration of sialic acid reflects that of glycoprotein and this method of measurement is applicable to the analysis of disorders with mucin deficiency.
Female↗
Effect of injectate temperature and thermistor position on reproducibility of thermodilution cardiac output determinations.
STUDY OBJECTIVE: The purpose of this study was to evaluate the effect of thermistor position with varying injectate temperatures on the reproducibility of thermodilution cardiac output determination. The key hypothesis to be tested was that the positioning of the proximal thermistor at the right atrial port would improve the reproducibility of thermodilution cardiac output determination, independent of injectate temperature. DESIGN: Prospective randomized trial. SETTING: The study was performed in the cardiac catheterization laboratory of the West Haven Veterans Affairs Medical Center. PARTICIPANTS: Twenty consecutive patients undergoing right and left heart catheterizations were enrolled in the study. INTERVENTIONS: Each patient underwent triplicate determination of thermodilution cardiac output measurements under four experimental conditions: (1) ambient or room temperature injectate using an external thermistor in the injectate reservoir; (2) iced injectate using an external thermistor; (3) room temperature injectate using an internal right atrium (RA) thermistor; and (4) iced injectate using an RA thermistor. Reproducibility was assessed by the coefficient of variation (CV) and standard error of the mean percent (SEM%), of the triplicate measurements. MEASUREMENTS AND RESULTS: Using an internal RA thermistor improved the reproducibility of cardiac output determinations independent of injectate temperature. Using room temperature injectate, the CV was 12.8 percent using an external thermistor and 7.9 percent using an internal RA thermistor (p < 0.05). Using iced injectate, the CV was 10.2 percent using an external thermistor and 5.5 percent using an internal RA thermistor (p < 0.05). CONCLUSIONS: Reproducibility of thermodilution cardiac output determinations is improved when injectate temperature is measured internally, at the RA, as opposed to externally in the reservoir. This has clinical implications for determining significant changes in serial cardiac output determinations.
Analysis of Variance↗
Comparison of right ventricular volume measurement between segmented k-space gradient-echo and steady-state free precession magnetic resonance imaging.
PURPOSE: To compare right ventricular volume measurements and their reproducibility between steady-state free precession (SSFP) and conventional turbo gradient-echo (TGE) imaging. MATERIALS AND METHODS: Right ventricular volumes and observer variabilities were compared between SSFP and TGE in 31 subjects (21 normal volunteers and 10 subjects with heart failure). For further internal validation of the right ventricular volumes, the left ventricle (LV) and right ventricle (RV) stroke volumes were compared for the normal volunteers. RESULTS: The volumes as measured by SSFP were significantly larger than for TGE (mean bias end-diastolic volume [EDV] 11.1 +/- 14.2, end-systolic volume [ESV] 9.8 +/- 9.75). SSFP had lower interobserver variability (SSFP EDV -10.1 +/- 11.6 vs. TGE EDV -6.2 +/- 18.5) and intra-observer variability (SSFP EDV -2.0 +/- 6.3 vs. TGE EDV -6.1 +/- 14.8). The mean absolute differences between LV and RV stroke volumes for 21 normal volunteers were: TGE 5.8 +/- 12.9 (r(2) = 0.72), SSFP 4.6 +/- 6.9 (r(2) = 0.92). CONCLUSION: SSFP and TGE yield different measurement values of RV volumes with SSFP, providing a more reproducible measurement.
Case-Control Studies↗
[Arrhythmogenic right ventricular dysplasia as a cause of "sudden cardiac death" with survival].
HISTORY: A 42 year old woman was resuscitated from ventricular fibrillation. 5 months previously she had a syncope. Her nephew had died of sudden cardiac death at the age of 25 years. INVESTIGATIONS: There was no evidence for ST segment elevation, myocardial infarction or pulmonary embolism. The ECG showed right precordial T wave inversion. Coronary artery disease was excluded angiographically. Echocardiography and angiography revealed inferior wall akinesia of the right ventricle with normal left ventricular function and chamber size. Ventricular fibrillation could not be reproduced by programmed stimulation of the right ventricle during an electrophysiologic study. Results of endomyocardial biopsy of the right ventricle showed a focal fibrous infiltration of the myocardium. Magnetic resonance imaging confirmed inferior wall abnormalities of the right ventricle without typical fatty infiltration in the right ventricular myocardium. CLINICAL COURSE: The patient recovered rapidly without neurologic deficits. Arrhythmogenic right ventricular dysplasia was suspected, and a cardioverter defibrillator (ICD) was implanted. Within 6 months after implantation the ICD memory showed no evidence of ventricular fibrillation. CONCLUSION: Arrhythmogenic right ventricular dysplasia is an important cause of ventricular fibrillation with a potential risk of sudden cardiac death in young persons. Concealed arrhythmogenesis as an early manifestation of right ventricular dysplasia is difficult to detect.
Adult↗
Time estimation in patients with right or left medial-temporal lobe resection.
Patients with either left or right antero-medial-temporal lobe (MTL) resection were investigated as to their ability to reproduce and produce three durations (5, 14, or 38 s) in three conditions (silence, counting, articulatory suppression). The results showed that patients with unilateral MTL lesions did not differ from controls when they had to encode the duration of a visual stimulus in order to reproduce it. By contrast, patients with right MTL lesions underestimated all three durations, compared with controls and with patients with left MTL resection, when they had to produce durations given in chronometric units. This finding suggests that the right MTL retains long-term representations of the conventional units necessary to the accurate production of durations.
Adolescent↗
Deep brain stimulation for Parkinson's disease dissociates mood and motor circuits: a functional MRI case study.
Behavioral disturbances have been reported with subthalamic (STN) deep brain stimulation (DBS) treatment in Parkinson's disease (PD). We report correlative functional imaging (fMRI) of mood and motor responses induced by successive right and left DBS. A 36-year-old woman with medically refractory PD and a history of clinically remitted depression underwent uncomplicated implantation of bilateral STN DBS. High-frequency stimulation of the left electrode improved motor symptoms. Unexpectedly, right DBS alone elicited several reproducible episodes of acute depressive dysphoria. Structural and functional magnetic resonance imaging (fMRI) imaging was carried out with sequential individual electrode stimulation. The electrode on the left was within the inferior STN, whereas the right electrode was marginally superior and lateral to the intended STN target within the Fields of Forel/zona incerta. fMRI image analysis (Analysis of Functional NeuroImages, AFNI) contrasting OFF versus ON stimulation identified significant lateralized blood oxygen level-dependent (BOLD) signal changes with DBS (P < 0.001). Left DBS primarily showed changes in motor regions: increases in premotor and motor cortex, ventrolateral thalamus, putamen, and cerebellum as well as decreases in sensorimotor/supplementary motor cortex. Right DBS showed similar but less extensive change in motor regions. More prominent were the unique increases in superior prefrontal cortex, anterior cingulate (Brodmann's area [BA] 24), anterior thalamus, caudate, and brainstem, and marked widespread decreases in medial prefrontal cortex (BA 9/10). The mood disturbance resolved spontaneously in 4 weeks despite identical stimulation parameters. Transient depressive mood induced by subcortical DBS stimulation was correlated with changes in mesolimbic cortical structures. This case provides new evidence supporting cortical segregation of motor and nonmotor cortico-basal ganglionic systems that may converge in close proximity at the level of the STN and the adjacent white matter tracts (Fields of Forel/zona incerta).
Adult↗
Recording sagittal condylar angles using a mandibular facebow.
The aim of this study was to determine the average sagittal condylar inclination angles of dentate subjects using a mandibular facebow with pencil tracing styli, to relate these angles to values assigned to articulators, and to assess the repeatability accuracy of drawing a tangent to a traced curve. The right and left sagittal condylar inclination angles of 103 subjects were recorded using a mandibular facebow with pencil tracing styli which marked a graph card during protrusive excursions. Tangents to the tracings were measured with a protractor allowing assessment of reproducibility. The mean left and right sagittal condylar inclination angles were 32 degrees and 31.5 degrees, respectively, with no significant differences (P= 0.609). Individual right and left measurements within each group showed significant differences (P = 0.0000). The mean of the tangents drawn through three sagittal condylar angle tracings by 10 operators was 33.3 degrees, and the mean of 10 tangents drawn through the same three tracings by one of the authors was 32.9 degrees, with no significant difference (P = 0.634). The average sagittal condylar inclination angles found in this study are in agreement with those reported in the literature. In fixed sagittal condylar angle articulators 30 degrees appear to be an appropriate setting. The reproducibility of this method of recording sagittal condylar inclination angles was found to be accurate for the individual operator and between operators.
Adolescent↗
Symptoms and signs of heart failure in patients with myocardial infarction: reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization.
102 patients with myocardial infarction (MI) were examined by three clinicians, who independently recorded the following symptoms and signs: dyspnoea, a displaced apex beat, S3-gallop, rales, neck vein distension, hepatomegaly, and dependent oedema. Chest X-ray, radionuclide ventriculography, and (in 40 patients) right heart catheterization were carried out immediately after the physical examination. The clinicians frequently disagreed as to the presence of physical signs of heart failure in individuals. Moreover, these signs were of limited value in identifying patients with pulmonary vascular congestion on chest X-ray, reduced left or right radionuclide ventricular ejection fractions, enlarged ventricular volumes or haemodynamic evidence of ventricular dysfunction. We conclude that clinicians frequently disagree in the recognition of physical signs of heart failure, and that these signs have an unpredictable relationship to radiographic, radionuclide and haemodynamic measures of ventricular performance in patients with MI. Nevertheless, physical signs are useful in identifying patients with high risk of cardiac death.
Adult↗
Prevention of ventricular tachycardia induction during right ventricular programmed stimulation by high current strength pacing at the site of origin.
To determine whether high current strength pacing at the site of origin of ventricular tachycardia (VT) could prevent induction of VT, we studied 11 VTs in 10 patients with chronic coronary artery disease. The left ventricular site of origin of all VT was determined by endocardial catheter mapping. Reproducible VT induction from the right ventricular apex or outflow tract was demonstrated with a pacing current strength equal to twice diastolic threshold (less than or equal to 2.0 mA) with single (two VTs), double (eight VTs), or triple (one VT) extrastimuli following 8 beats of a drive cycle length of 400 to 600 msec. After determination of the baseline VT induction zone (range 10 to 80 msec), repeat induction was attempted while simultaneous pacing was performed during the 8 beat drive train from the left ventricular site of origin with the use of a high current strength (10 mA [two VTs] or 20 mA [nine VTs]) and from the baseline right ventricular site with a current strength equal to twice diastolic threshold. Extrastimuli were introduced only from the right ventricular site over the same range of coupling intervals that resulted in VT initiation during the baseline state. In five of the 11 trials, no VT could be initiated; in one trial, the VT induction zone was decreased from 80 to 10 msec; in three trials, only VT of a different morphology and a distinct (greater than 4 cm distant) site of origin was initiated; and in two trials, VT of the same morphology was initiated. In four of the five trials in which all VT was prevented by simultaneous pacing with a high current strength at the site of origin, simultaneous pacing at a lower current strength (twice diastolic threshold) at the site of origin (three VTs) or with equally increased current strength (10 to 20 mA) at nonsites of origin (two VTs) did not prevent initiation. We conclude that: high current strength pacing at the site of origin during the drive train can inhibit VT induction with extrastimuli and, successful prevention of VT may depend on the pacing site being the site of origin and the current strength used during pacing.
Aged↗
Diagnostic value of Tl-201 lung uptake is dependent on measurement method.
BACKGROUND: Increased lung uptake during exercise thallium 201 single photon emission computed tomography is related to left ventricular dysfunction and extent of coronary artery disease (CAD). We studied the influence of the lung region of interest (ROI), used to quantify Tl-201 lung uptake, on the diagnostic value of the lung-to-heart uptake ratio (LHR) in detecting CAD with Tl-201 myocardial single photon emission computed tomography. METHODS AND RESULTS: We retrospectively studied 152 consecutive patients referred to our center for stress Tl-201 scanning. Of these, 116 had proven multivessel CAD and 36 had either normal findings on coronary angiogram or a low likelihood (<5%) of CAD. Poststress quantitative analysis was performed from a 4 x 4-pixel ROI over the hottest myocardial region, an 8 x 8-pixel left lung ROI, an 8 x 8-pixel right lung ROI, and a manual ROI encompassing the whole right lung. The LHR was calculated for each lung ROI. Right LHR (R-LHR) provided the best interobserver and intraobserver reproducibility. R-LHR and total R-LHR values were significantly higher in patients with CAD. Only history of myocardial infarction significantly influenced the R-LHR measurement. CONCLUSIONS: The methodology of LHR measurement significantly influences the clinical contribution of Tl-201 lung uptake evaluation. Optimal reproducibility and diagnostic accuracy are provided by a right lung ROI.
Aged↗
Multiple arrhythmogenic substrate for tachycardia in a patient with frequent palpitations.
We report a 26-year-old woman with frequent episodes of palpitation and dizziness. Resting electrocardiography showed no evidence of ventricular preexcitation. During electrophysiologic study, a concealed right posteroseptal accessory pathway was detected and orthodromic atrioventricular reentrant tachycardia incorporating this pathway as a retrograde limb was reproducibly induced. After successful ablation of right posteroseptal accessory pathway, another tachycardia was induced using a concealed right posterolateral accessory pathway in tachycardia circuit. After loss of retrograde conduction of second accessory pathway with radiofrequency ablation, dual atrioventricular nodal physiology was detected and typical atrioventricular nodal reentrant tachycardia was repeatedly induced. Slow pathway ablation was done successfully. Finally sustained self-terminating atrial tachycardia was induced under isoproterenol infusion but no attempt was made for ablation. During 8-month follow-up, no recurrence of symptoms attributable to tachycardia was observed.
Journal Article↗
[Relationship of the movement of mandibular condyle and occlusal force balance].
PURPOSE: The present investigation evaluated the relation between the dynamic properties of the bilateral condyle in habitual maximum opening and closing movement and the occlusal force balance with clenching force. METHODS: Nine normal adults participated in this study. The translation of bilateral condyle and the rotation of intercondylar axis in habitual maximum opening and closing movement was measured using Cadiax, (ver. 3.0). The amount of translation and the rotation were converted into percentages and plotted on a graph using the translation-rotation relative chart. The maximun difference (d) between right condyle and left condyle of translation in rotation was calculated. The maximum clenching force was measured using Dental prescale 50H, type R and Occluzer FPD-703 (Fujifilm Co., Ltd.) and the center of gravity of the occlusal force was plotted on the drawings in two dimensions (anterior-posterior, right-left). RESULTS: 1. The reproducibility of the dynamic properties of bilateral condyle in habitual maximum opening and closing movement and (d) were shown on the translation-rotation relative chart. 2. It was observed that the center of gravity of the occlusal force of a number of subjects was almost localized on the median line with right-left dimension and was localized on the molar tooth area with anterior-posterior dimension. 3. The correlation coefficient was 0.33 between the coordinate value of the center of gravity of the occlusal force with right-left dimension and the path of opening's (d). The coefficient was 0.71 between the coordinate value of the center of gravity of the occlusal force with right-left dimension and the path of closing's (d). CONCLUSIONS: The present study showed the correlation between the dynamic properties of the bilateral condyle in habitual maximum opening and closing movement and the occlusal force balance with maximum clenching force.
Adult↗
Ventricular fibrillation without apparent heart disease: description of six cases.
Since 1977, six patients (five males and one female), aged 14 to 35 years, resuscitated from ventricular fibrillation, were referred to our department for detailed evaluation, after exclusion of major cardiac pathologic conditions. Four patients had a family history of heart disease. Basic ECGs showed sinus rhythm in all of them. PR interval was prolonged in one. Two patients had complete and one had incomplete right bundle branch block. One patient had inverted t waves in V1-3 and late potentials. Three had an upsloping ST-T segment elevation in V1-2. The cardiothoracic index was less than 0.5 in five and 0.50 in one. In one of the five patients studied, the clinical episode of ventricular fibrillation was reproduced by stimulation of the right ventricular outflow tract during electrophysiologic study. Results of cross-sectional echocardiography and angiography showed predominantly structural and wall motion abnormalities of the right ventricle in five patients and slight wall motion abnormalities of the left ventricle in two. Two patients also had mitral and tricuspid valve prolapse. Coronary arteries were normal in all five patients examined. Results of endomyocardial biopsy showed no abnormalities in one patient, fibrosis in two, and fibrolipomatosis in one. Two patients died during follow-up: autopsy was performed in one and results showed right ventricular cardiomyopathy. Thus in five of these selected patients with apparent idiopathic ventricular fibrillation, some abnormalities, predominantly of the right ventricle, were documented only after detailed investigation; however, clinical history and some nonspecific ECG abnormalities were factors in the diagnostic procedure.
Adolescent↗
Comparison of right ventricular volume measurements between axial and short axis orientation using steady-state free precession magnetic resonance imaging.
PURPOSE: To compare right ventricular (RV) volume measurements and their reproducibility between axial and short axis orientation acquisition techniques. MATERIALS AND METHODS: Measurements of RV volumes from data sets acquired in axial and short axis orientations were compared in 20 normal subjects. The observer variabilities were assessed and the left ventricle (LV) and RV stroke volumes (SV) were compared. RESULTS: There was a significant and systematic difference in the EDV and ESV volumes between the axial and short axis methods. The latter method resulted in larger volumes (mean bias EDV 7.5 +/- 13.2, 4.7% difference; ESV 7.2 +/- 8.6, 10.7% difference). The axial method had lower intra- and interobserver variability than the short axis method. The standard deviation of the difference (SDD) and the limits of agreement were consistently lower for the axial method. The mean differences between LV and RV stroke volumes expressed as mean +/- 1 SD (r(2) =correlation coefficient) were: axial 7.6 +/- 9.1 (r(2) = 0.93); and short axis 7.4 +/- 10.8 (r(2) = 0.90). CONCLUSION: There is a significant systematic difference between volumes measured using the two different orientations. The axial orientation resulted in better inter- and intraobserver reproducibility.
Adult↗
Dissociation between electrical and mechanical bulbocavernosus reflexes.
AIMS: To record reflex motor responses, elicited by mechanical stimulation of the penis or clitoris, in each bulbocavernosus muscles and to compare left and right reflex pathways in normal subjects, then to compare electrical and mechanical responses in various neurological diseases. METHODS: Two groups of patients were studied: 22 patients without neurological disease considered as normal subjects; and 25 patients with neurological disease (three multiple sclerosis, six spina bifida, nine conus medullaris syndrome, three peripheral neuropathies, two lumbosacral lesions, one multisystem atrophy, and one syringomyelia). Electrical bulbocavernosus reflex (EBCR) was evoked by orthodromic stimulation of the dorsal nerve of the penis at the penile base or the clitoris. Mechanical bulbocavernosus reflex (MBCR) was elicited with an electromechanical hammer, tapping directly on the clitoris zone or on the ventral part of glans penis. For EBCR and MBCR, bulbocavernosus muscle contractions were successively recorded in the left and in the right side with a needle inserted under visual guidance. RESULTS: Mean left mechanical latency was 31.7 msec (SD = 4.5) and right one 31.6 msec (SD = 3.8). The reproducibility of the responses was excellent (P < 0.0001). ). The mean difference between left and right latencies was 2 msec (SD = 1.2). In the neurological group, 22 EBCR (six right, nine left, seven bilateral) and 19 MBCR (eight right, nine left, two bilateral) were considered abnormal. The mean reflex latencies in patients with neurological lesions (lower motor neuron lesions) were statistically longer (P < 0.0001) than in normal subjects. Exact concordance (side of lesion) between MBCR and EBCR was observed in 15/25 cases (60%), poor concordance (presence of a sacral reflex alteration) in 3/25 (12%) cases, and in 7/25 (28%) cases there was a significant difference between the two techniques. CONCLUSIONS: MBCR may provide a good alternative for electrical stimulation and can be used to evaluate urinary disorders when a neurological etiology is suspected. However, the presence of false negatives with MBCR suggest that it may be more useful as a screening test.
Clitoris↗
Risk of detrusor denervation in antireflux surgery demonstrated in a neurophysiological animal model.
PURPOSE: Earlier anatomical studies have shown a close connection between the ureterovesical junction and detrusor innervation. It prompted us to develop an animal model to demonstrate the risk of partial or complete impairment of this neuronal connection during antireflux surgery. MATERIALS AND METHODS: Six female Göttinger minipigs were anesthetized and laminectomized. After placement of the S3 sacral nerves into separate electrode compartments of a modified Brindley electrode the lower urinary tract was exposed by an abdominal midline incision. After bladder instillation with 150 ml NaCl 1 bilateral and 2 unilateral stimulations (left and right sides) were performed and intravesical pressure was recorded urodynamically. The left ureter was then prepared circularly in 3 steps 10, 5 and 1 cm, respectively, proximal to the ureterovesical junction. After each preparation step bilateral and unilateral stimulation was repeated. Results were recorded urodynamically and video documented. RESULTS: Bilateral stimulation before preparation of the left ureter led to a concentric detrusor contraction with an average maximum detrusor pressure of 51 cm H(2)O. Unilateral stimulation resulted in ipsilateralbound bladder tilting with an intravesical pressure of 18 and 19 cm H(2)O on the right and left sides, respectively. After preparation of the left ureter 10, 5 and 1 cm from the ureterovesical junction a maximum detrusor pressure of 17, 10 and 1 cm H(2)O was documented, respectively. While there was almost no stimulation response of the bladder after the last preparation step at 1 cm on the left ureter, the initial bladder pressure of 18 cm H(2)O could be reproduced under stimulation on the right side. CONCLUSIONS: Analogous to human cadaver studies, we were able to prove neurophysiologically strictly unilateral detrusor innervation, drawing from the pelvic plexus dorsomedial to the ureterovesical junction into the bladder. Preparation of this ureterovesical junction during antireflex surgery, coagulating measures in this area or the affixation of anchor sutures after a Vest suture involves the risk of unilateral or bilateral detrusor decentralization.
Animals↗