PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.
Aorta, Thoracic ; Arrhythmias, Cardiac ; Arrhythmogenic Right Ventricular Dysplasia ; Axis, Cervical Vertebra ; Diagnosis* ; Diaphragm ; Humans ; Magnetic Resonance Imaging*

PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.
Aorta, Thoracic ; Arrhythmias, Cardiac ; Arrhythmogenic Right Ventricular Dysplasia ; Axis, Cervical Vertebra ; Diagnosis* ; Diaphragm ; Humans ; Magnetic Resonance Imaging*

No abstract available.

Background: Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery. Methods: This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope. Results: Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%. Conclusions Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.

Thyroid dysfunction is one of the more prevalent clinical situations encountered by primary care physicians. Thyroid storm is defined as a life-threatening exacerbation of the hyperthyroid state in which there is evidence of decompensation of one or more organ systems. Common precipitants include infection, surgery, diabetic ketoacidosis, vascular accidents, non-compliance with antithyroid medication, and emotional stress, but rarely develop in invasive molar pregnancy. An 18-year-old woman presented to the emergency department complaining of lower abdominal pain and vaginal spotting. She had no previous history of hyperthyroidism. Under the diagnosis of invasive molar pregnancy, dilatation and curettage was performed. However, right after the procedure the patient developed a semi-coma metal status, high grade fever, and tachycardia. Prompt diagnosis of thyroid storm was made and treatment followed immediately. We present a case of thyroid storm and a review of thyroid storm precipitated by invasive molar pregnancy.
Abdominal Pain ; Adolescent ; Diabetic Ketoacidosis ; Diagnosis ; Dilatation and Curettage* ; Dilatation* ; Emergency Service, Hospital ; Female ; Fever ; Humans ; Hydatidiform Mole* ; Hyperthyroidism ; Metrorrhagia ; Molar* ; Physicians, Primary Care ; Pregnancy ; Stress, Psychological ; Tachycardia ; Thyroid Crisis* ; Thyroid Gland*

BACKGROUND: The purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort. METHODS: DSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 microg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a > or = 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group]. RESULTS: There were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 +/- 3.4% vs. -21.0 +/- 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%). CONCLUSION: Assessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dobutamine ; Echocardiography ; Echocardiography, Stress* ; Humans ; Myocardial Stunning ; Sensitivity and Specificity ; Thorax

BACKGROUND AND OBJECTIVES: Endothelial dysfunction and increased vascular inflammation may be associated with variant angina (VA). However, their exact roles remain to be clarified. The aim of the presents study is to investigate whether the level of inflammation markers and the flow-mediated dilation (FMD) are related to VA. SUBJECTS AND METHODS: The study included 46 patients (VA group: 53.9+/-12.0 years, 20 males) with positive spasm provocation tests and they were without significant coronary stenosis, and 14 patients (control group: 46.6+/-13.5 years, 7 males) with negative spasm provocation tests and they were without significant coronary stenosis. The clinical characteristics and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) level, the monocyte count and the von Willebrand factor (vWF) level, and the FMD were compared between the two groups. The FMD and inflammatory markers were measured in the morning before performing the ergonovine provocation coronary angiogram. RESULTS: The level of vWF was significantly higher in the VA group than in the control group (166.5+/-41.9% vs. 118.0+/-65.3%, respectively, p=0.029). The FMD was significantly decreased in the VA group compared with the control group (9.2+/-4.3% vs. 12.4+/-4.2%, respectively, p=0.021). Nitrate-mediated dilation did not differ between the two groups. The levels of the monocyte count, hs-CRP and homocysteine were higher in the VA group than in the control group (554.7+/-261.0/mm3 vs. 440.7+/-136.0/mm3, respectively, p=0.039; 0.3+/-0.4 mg/dL vs. 0.1+/-0.1 mg/dL, respectively, p=0.029; 7.54+/-4.0micronmol/L vs. 5.92+/-1.6micronmol/L, respectively, p=0.033). CONCLUSION: The results of this study suggested that increased inflammatory markers and endothelial dysfunction may be associated with variant angina.
Angina Pectoris ; C-Reactive Protein ; Coronary Stenosis ; Endothelium ; Ergonovine ; Homocysteine ; Humans ; Inflammation ; Monocytes ; Spasm ; von Willebrand Factor

The aim of this study was to evaluate the relationship between coronary artery calcium score (CACS) assessed by multidetector computed tomography (MDCT) and plaque components assessed by virtual histology-intravascular ultrasound (VH-IVUS) in 172 coronary artery disease (CAD) patients with 250 coronary lesions. CACS was assessed according to Agatston scoring method by MDCT and patients were divided into four groups: Group I (CACS = 0 [n = 52]); Group II (CACS = 1-100 [n = 99]); Group III (CACS = 101-400 [n = 84]); and Group IV (CACS > 400 [n = 15]). Total atheroma volume was greatest in Group IV (152 +/- 132 microL vs 171 +/- 114 microL vs 195 +/- 149 microL vs 321+/-182 microL, P < 0.001). The absolute dense calcium (DC) and necrotic core (NC) volumes were greatest, and relative DC volume was greatest in Group IV (5.5 +/- 6.6 microL vs 11.0 +/- 10.3 microL vs 15.6 +/- 13.6 microL vs 36.6 +/- 18.2 microL, P < 0.001, and 14.8 +/- 18.2 microL vs 19.5 +/- 18.9 microL vs 22.5 +/- 19.1 microL vs 41.7 +/- 27.9 microL, P < 0.001, and 6.4 +/- 5.3% vs 11.0 +/- 6.2% vs 14.0 +/- 6.5% vs 20.0 +/- 7.8%, P < 0.001, respectively). The absolute plaque and DC and NC volumes and the relative DC volume correlated positively with calcium score. CAD patients with high calcium score have more vulnerable plaque components (greater DC and NC-containing plaques) than those with low calcium score.
Adult ; Aged ; Calcinosis/*diagnosis/radiography/ultrasonography ; Calcium/*analysis ; Coronary Angiography ; Coronary Artery Disease/*diagnosis/radiography/ultrasonography ; Coronary Vessels/pathology ; Female ; Humans ; Male ; Middle Aged ; *Multidetector Computed Tomography ; Necrosis ; Plaque, Atherosclerotic/*pathology ; *Ultrasonography, Interventional