ABSTRACT
PURPOSE: The purpose of this study was to quantify the distribution of trabeculated (T) and compact (C) left ventricular (LV) myocardium masses in a healthy Caucasian population against age, gender and LV parameters, and to provide normal values for T, C and T/C. MATERIALS AND METHODS: One hundred and forty healthy subjects were prospectively recruited and underwent cardiac MRI at 1.5T with a stack of short-axis cine sequences covering the entire LV. End-diastolic volume (EDV), C and T masses were quantified using a semi-automatic method. Ejection fraction (EF) and T/C ratio were computed. RESULTS: We included 70 men and 70 women with a mean age of 44±14 (SD) years (range: 20-69 years). The mean EF was 63.7±6.3 (SD) % (range: 50.7-82.0%), the mean EDV was 75.9±16.2 (SD) mL/m2 (range: 36.4-112.2mL/m2), the mean C mass was 53.9±11.2 (SD) g/m2 (range: 26.5-93.4g/m2) and the mean T mass was 4.9±2.4 (SD) g/m2 (range: 1.1-11.4g/m2). The T/C ratio was 9.2±4.5% (range: 2.0-29.4%). Multivariate ANOVA test showed that the compact mass was influenced by EDV (P<0.0001), EF (P=0.001) and gender (P<0.0001), and the trabeculated mass depended on EDV (P<0.0001), gender (P=0.002) and age (P<0.0001), while the T/C ratio was only influenced by age (P=0.0003). Spearman test showed a correlation between EDV and C (r=0.60; P<0.0001),T (r=0.46; P<0.0001) and T/C ratio (r=0.26; P=0.0023).T and T/C ratio correlated with EF (r=-0.18, P=0.0373; r=-0.18, P=0.0321, respectively). CONCLUSION: While the compact and trabeculated myocardium masses appear to relate separately to the cardiac function, age and gender, their ratio T/C appears to only decrease with age. Furthermore, we propose here normal values for T, C and T/C in a cohort of healthy Caucasians subjects.
Subject(s)
Cardiac Imaging Techniques , Heart Ventricles/diagnostic imaging , Magnetic Resonance Imaging , Adult , Age Factors , Aged , Female , Humans , Male , Middle Aged , Reference Values , Sex Factors , White People , Young AdultABSTRACT
PURPOSE: To evaluate intra- and inter-observer variability of multidetector computed tomography (MDCT) sizing of the aortic annulus before transcatheter aortic valve replacement (TAVR) and the effect of observer experience, aortic valve calcification and image quality. METHODS: MDCT examinations of 52 consecutive patients with tricuspid aortic valve (30 women, 22 men) with a mean age of 83±7 (SD) years (range: 64-93 years) were evaluated retrospectively. The maximum and minimum diameters, area and circumference of the aortic annulus were measured twice at diastole and systole with a standardized approach by three independent observers with different levels of experience (expert [observer 1]; resident with intensive 6 months practice [observer 2]; trained resident with starting experience [observer 3]). Observers were requested to recommend the valve prosthesis size. Calcification volume of the aortic valve and signal to noise ratio were evaluated. RESULTS: Intra- and inter-observer reproducibility was excellent for all aortic annulus dimensions, with an intraclass correlation coefficient ranging respectively from 0.84 to 0.98 and from 0.82 to 0.97. Agreement for selection of prosthesis size was almost perfect between the two most experienced observers (k=0.82) and substantial with the inexperienced observer (k=0.67). Aortic valve calcification did not influence intra-observer reproducibility. Image quality influenced reproducibility of the inexperienced observer. CONCLUSION: Intra- and inter-observer variability of aortic annulus sizing by MDCT is low. Nevertheless, the less experienced observer showed lower reliability suggesting a learning curve.
Subject(s)
Aortic Valve/diagnostic imaging , Multidetector Computed Tomography , Transcatheter Aortic Valve Replacement/methods , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Observer Variation , Retrospective StudiesABSTRACT
OBJECTIVE: In today's context of globalisation of pharmaceutical production and distribution, international and national procurement agencies play a de facto key role in defining the quality of medicines available in sub-Saharan Africa. We evaluated the compliance of a sample of pharmaceutical distributors active in sub-Saharan Africa with the standards of the WHO guideline 'Model Quality Assurance System (WHO MQAS) for procurement agencies', and we investigated factors favouring or hindering the adequate implementation of the guideline. METHODS: We used mixed-methods methodology to analyse quantitative and qualitative data. The quantitative study consisted of a retrospective secondary analysis of data collected by QUAMED (Quality Medicines for all), a partnership that pleads for universal access to quality-assured medicines. The qualitative survey consisted of formal and informal interviews with key informants. We adopted an embedded multiple-case study design. FINDINGS: Our analysis suggests that international distributors based in Europe perform, on average, better than sub-Saharan African distributors. However, some weaknesses are ubiquitous and concern critical processes, such as the initial selection of the products and the ongoing reassessment of their quality. This is due to several different factors: weak regulatory oversight, insufficient human/financial resources, weak negotiating power, limited judicial autonomy and/or lack of institutional commitment to quality. CONCLUSIONS: Our findings suggest that pharmaceutical distributors active in sub-Saharan Africa generally do not apply stringent criteria for selecting products and suppliers. Therefore, product quality is not consistently assured but depends on the requirements of purchasers. While long-term solutions are awaited, the WHO MQAS guideline should be used as an evaluation and training tool to upgrade current standards.
Subject(s)
Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/secondary , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/secondary , Heart Ventricles , Kidney Neoplasms/pathology , Tomography, X-Ray Computed , Cardiac Imaging Techniques , Female , Humans , Middle Aged , Radiography, Dual-Energy Scanned Projection , Tomography, X-Ray Computed/methodsSubject(s)
Aortic Aneurysm/diagnostic imaging , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Heart Defects, Congenital/diagnostic imaging , Multidetector Computed Tomography/methods , Sinus of Valsalva/diagnostic imaging , Aged , Angina Pectoris/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Humans , Male , Pulmonary Edema/diagnostic imaging , Respiratory Insufficiency/diagnostic imagingSubject(s)
Angiography , Image Processing, Computer-Assisted , Incidental Findings , Isolated Noncompaction of the Ventricular Myocardium/diagnosis , Isolated Noncompaction of the Ventricular Myocardium/genetics , Tomography, X-Ray Computed , Adult , Cardiac Output, Low/diagnosis , Cardiac Output, Low/genetics , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/genetics , Echocardiography , Heart Ventricles/pathology , Humans , Magnetic Resonance Imaging , Male , Myocardium/pathology , Thromboembolism/diagnosis , Thromboembolism/geneticsABSTRACT
The analysis of myocardial perfusion is a key step in the cardiac MRI examination. In routine work, this exploration carried out at rest is based on the qualitative first pass study of gadolinium with an ECG-triggered saturation recovery bFFE sequence. In view of recent knowledge, the analysis of the myocardial perfusion under vasodilator stress may be carried out by scintigraphy or MRI, the latter benefiting from the absence of exposure to ionizing rays and a lower cost. Besides coronary disease, the perfusion sequence provides a rich semiology to compare with the clinics and the data from other sequences. Arterial Spin Labeling (ASL) is an alternative technique used in the animal to quantify myocardial perfusion.
Subject(s)
Magnetic Resonance Imaging , Myocardial Perfusion Imaging/statistics & numerical data , Cardiomyopathies/diagnosis , Humans , Myocardial Perfusion Imaging/methodsABSTRACT
Chronic constrictive pericarditis is defined by an increase in the rigidity of the pericardium resulting in impairment of the ventricular filling conditions. Cardiac MR is both a morphological and functional study always complemented by multi-detector CT. Morphological analysis is based on axial, longitudinal long axis and short axis views on Turbo (fast) SE Dark Blood and CINE sequences. Functional analysis is based on real-time acquisitions in the short axis at the base of the ventricles by comparing spontaneous breathing and deep breathing. The excursion of the interventricular septum is a reliable sign of constriction. The study is supplemented by phase contrast acquisitions. In the setting of persistent inflammation or free pericardial fluid, delayed enhancement 3D and 2D sequences including Phase Sensitive Inversion Recovery (PSIR) are useful.
Subject(s)
Pericarditis, Constrictive/diagnosis , Female , Humans , Middle AgedABSTRACT
PURPOSE: The reported prevalence of cardiac complications is variable in patients with Churg-Strauss syndrome (15-92%) and depends on diagnostic tools. Diagnosis at early stage of heart involvement is crucial, resulting in appropriate management. METHODS: We report three patients who developed cardiac manifestations, revealing Churg-Strauss syndrome. The diagnosis of cardiac involvement was obtained using cardiac magnetic resonance imaging (MRI). RESULTS: Two patients were males and the remaining one was a female. Presenting clinical manifestations were: cardiac failure (n=1) and retrosternal pain (n=2). Laboratory findings disclosed: high blood count of eosinophils (range: 6000-11,000/mm(3)); antineutrophil cytoplasmic antibodies were positive in a single patient. Cardiac MRI demonstrated: (1) late gadolinium enhancement (n=3), involving mainly the apical and mid-cavity left ventricular segments; (2) impaired left ventricular function (n=2), mean left ventricular ejection fraction being: 51%; and (3) pericardial effusion (n=3). Outcome was favourable after institution of combined therapy with prednisone and cyclophosphamide (n=2); one patient also underwent plasma exchanges. CONCLUSION: Our case series underlines that MRI is a helpful tool in the diagnosis of Churg-Strauss syndrome-related cardiac complications. We further suggest that clinical assessment of patients with Churg-Strauss syndrome should include cardiac MRI, in order to detect cardiac involvement at an early stage; indeed, because cardiac manifestations are predictive factors of poor prognosis, diagnosis at early stages of cardiac involvement may result in improvement of patients management.
Subject(s)
Churg-Strauss Syndrome/complications , Heart Diseases/diagnosis , Heart Diseases/etiology , Magnetic Resonance Imaging , Aged , Female , Humans , Male , Middle AgedABSTRACT
PURPOSE: Sleeve gastrectomy is a new bariatric surgical procedure with promising early results and low morbidity and mortality. We have evaluated the early imaging findings and value of upper GI study (UGI) and CT. PATIENTS AND METHODS: Twenty five patients (mean age=38.9 years, mean BMI=51.5 kg/m2) following sleeve gastrectomy for morbid obesity underwent UGI at day 1. CT was immediately performed in patients with suspected leak or as a follow-up examinations in patients with suspected complication. The different imaging features observed were recorded. RESULTS: UGI demonstrated 13 normal examinations (52%), an abnormal appearance in 11 cases (44%) with opacification of a lateral pouch, and one complication (leak confirmed on CT). Two patients underweent CT (day 3 and day 15) for suspected complication, with demonstration of leak in both cases. CONCLUSION: An abnormal appearance after sleeve gastrectomy is frequently observed on UGI. Routine UGI at day 1 is useful to detect large leaks. CT with oral contrast should be performed in all patients with imaging or clinical suspicion of leak.
Subject(s)
Gastrectomy/methods , Stomach/diagnostic imaging , Stomach/surgery , Tomography, X-Ray Computed , Adult , Female , Humans , Male , Middle Aged , Prospective Studies , Time Factors , Young AdultABSTRACT
The circulation of substandard medicines in the developing world is a serious clinical and public health concern. Problems include under or over concentration of ingredients, contamination, poor quality ingredients, poor stability and inadequate packaging. There are multiple causes. Drugs manufactured for export are not regulated to the same standard as those for domestic use, while regulatory agencies in the less-developed world are poorly equipped to assess and address the problem. A number of recent initiatives have been established to address the problem, most notably the WHO pre-qualification programme. However, much more action is required. Donors should encourage their partners to include more explicit quality requirements in their tender mechanisms, while purchasers should insist that producers and distributors supply drugs that comply with international quality standards. Governments in rich countries should not tolerate the export of substandard pharmaceutical products to poor countries, while developing country governments should improve their ability to detect substandard medicines.
Subject(s)
Drug Contamination/prevention & control , Drug Industry/standards , Drug Labeling/standards , Pharmaceutical Preparations/standards , Developing Countries , Drug Contamination/legislation & jurisprudence , Drug Industry/legislation & jurisprudence , Fraud/legislation & jurisprudence , Fraud/prevention & control , Humans , Poverty , Quality Control , World Health OrganizationABSTRACT
OBJECTIVE: To determine the quality, and especially the dissolution properties of rifampicin, of fixed-dose combination (FDC) formulations of anti-tuberculosis agents manufactured by major market holders in the anti-tuberculosis sector and supplied for use in national tuberculosis control programmes. METHODS: Dissolution studies were performed for four formulations supplied by four different manufacturers in four dissolution media (0.1N and 0.01N HCl, phosphate buffer [PB] and 20% vegetable oil in PB), at four different agitation rates using USP apparatus II. The formulations were subjected to 4-week accelerated stability studies (40 degrees C / 75% RH) and evaluated for physical, chemical and dissolution stability. RESULTS: The formulations tested complied with pharmacopeial quality control (QC) tests. The extent of rifampicin release was independent of dissolution medium; however, a slight decrease in the dissolution rate was observed in two products. More than 75% of drug was released in 45 min at all agitation intensities except 30 rpm, and 20% oil in the medium reflected fed state. Formulations were stable in the packaging conditions recommended by the manufacturer for at least 4 weeks. CONCLUSIONS: The formulations tested passed the QC tests and were found to be stable. A decrease in the rate, although not the extent, of dissolution necessitated multiple point dissolution in gastric and intestinal pH conditions to ensure consistency in in vivo bioavailability.
Subject(s)
Antibiotics, Antitubercular/standards , Antitubercular Agents/standards , Drug Industry , Product Packaging , Rifampin/standards , Antibiotics, Antitubercular/chemistry , Antibiotics, Antitubercular/pharmacokinetics , Antitubercular Agents/chemistry , Antitubercular Agents/pharmacokinetics , Biological Availability , Chemistry, Pharmaceutical , Drug Therapy, Combination , Global Health , Humans , Quality Control , Rifampin/chemistry , Rifampin/pharmacokinetics , Solubility , Tuberculosis, Pulmonary/drug therapyABSTRACT
We present further evidence for autosomal recessive inheritance of the bilateral tibial agenesis/ectrodactyly dysostosis. A consanguineous Turkish couple gave birth to three children with malformations. The first, a boy, died neonatally of pulmonary hypertension with congenital alveolar capillary dysplasia and also had tibial agenesis and ectrodactyly. A second child, a girl, died after birth with the same abnormality of the lungs without skeletal malformations. After the birth of three unaffected children, echographic examination at 15 weeks of gestation in the sixth pregnancy documented agenesis of tibiae and symmetrical ectrodactyly of hands and feet. Autopsy did not show additional malformations, and lung development was normal for gestational age. This observation also confirms the autosomal recessive inheritance pattern of congenital alveolar capillary dysplasia.
Subject(s)
Hand Deformities, Congenital/pathology , Tibia/abnormalities , Abnormalities, Multiple/genetics , Abnormalities, Multiple/pathology , Adult , Fatal Outcome , Female , Fetal Death , Fetus/abnormalities , Genes, Recessive/genetics , Hand Deformities, Congenital/diagnostic imaging , Humans , Tibia/diagnostic imaging , Ultrasonography, PrenatalSubject(s)
Antitubercular Agents/economics , Drug Costs , Health Policy , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/prevention & control , Tuberculosis/prevention & control , Antitubercular Agents/therapeutic use , Drug Industry , Drugs, Essential , Humans , Patents as Topic , Pilot Projects , Policy Making , Tuberculosis/drug therapy , Tuberculosis/economics , Tuberculosis, Multidrug-Resistant/economics , Tuberculosis, Multidrug-Resistant/epidemiology , World Health OrganizationABSTRACT
OBJECTIVE: This study was undertaken to investigate a possible link between first-trimester diagnosis of bacterial vaginosis and cessation of pregnancy at < or =20 weeks' gestation. STUDY DESIGN: Women (n = 228) who received routine prenatal care in Flanders, Belgium, during the first trimester (14 weeks' gestation) and had a living singleton fetus were examined for microbiologic flora of the vagina. Bacterial vaginosis was assessed either clinically (Amsel et al criteria), microscopically (clue cells), or by culture of bacterial vaginosis-associated bacteria. Data were analyzed univariately (relative risk) and multivariately. RESULTS: The presence of bacterial vaginosis at the first prenatal visit was strongly associated with subsequent early pregnancy loss (relative risk, 5.4; 95% confidence interval, 2.5-11). After multivariate analysis bacterial vaginosis, Mycoplasma hominis, and Ureaplasma urealyticum but not other microorganisms remained associated with an increased risk of miscarriage. CONCLUSION: Bacterial vaginosis and mycoplasmas may play causative roles in spontaneous abortion and early pregnancy loss.
Subject(s)
Abortion, Spontaneous/etiology , Mycoplasma Infections/complications , Vaginosis, Bacterial/complications , Adult , Female , Humans , Multivariate Analysis , Pregnancy , Risk Factors , Time Factors , Ureaplasma Infections/complications , Ureaplasma urealyticumABSTRACT
As more and more institutions and experts push for the use of fixed-dose combinations (FDC) of anti-tuberculosis drugs, the market will most probably change dramatically in the next few years. Prices should go down, but quality must remain an essential goal for managers in charge of the procurement process. General essential requirements for suppliers submitting for competitive bidding are reviewed, and in particular the WHO certification scheme. Even though the scheme does not dispense with the need to submit drugs to the quality control procedures required in the importing country, it is a very useful tool which should be encouraged in the supply process. Specific requirements for FDCs are discussed, particularly interpretation of the bioavailability tests which are compulsory for rifampicin-containing FDCs.
Subject(s)
Antitubercular Agents/economics , Antitubercular Agents/standards , Drug Industry/standards , Drug and Narcotic Control , Tuberculosis/drug therapy , Adult , Antitubercular Agents/administration & dosage , Biological Availability , Chemistry, Pharmaceutical , Child , Competitive Bidding , Drug Combinations , Drug Industry/economics , Humans , National Health Programs/standards , Quality Control , Tuberculosis/prevention & control , World Health OrganizationABSTRACT
Ascites and pleural effusion associated with "fibroma-like ovarian" benign tumor is described as Meigs syndrome. Tumor extirpation resulted in ascites and pleural effusion resorption. This rather unusual syndrome, should not be overlooked.
Subject(s)
Ascites/etiology , Meigs Syndrome/complications , Pleural Effusion/etiology , Aged , Female , Humans , Meigs Syndrome/diagnosis , Meigs Syndrome/surgery , Tomography, X-Ray ComputedABSTRACT
Although Candida albicans is a frequent inhabitant of the female genital tract, chorioamnionitis is rarely caused by this fungal organism. In this report we present two cases with manifest Candida chorioamnionitis. The first case is a twin pregnancy with premature delivery and survival of both twins. The second case is a pregnancy with intra-uterine contraceptive device in situ ending in a midtrimester abortion, followed by the next pregnancy also ending in an abortion in the second trimester. Possible triggers responsible for the increased invasiveness of otherwise benign Candida vaginitis are discussed. Foreign intra-uterine bodies such as contraceptive devices and cerclage sutures necessitate repetitive search for Candida species infection, and prompt adequate antifungal treatment in cases of documented infection. Both cases of the present report add further substantial evidence to the hypothesis of amniotic infection by ascending transcervical infection. The frequent concomitant cervical infections with other infectious agents as well as antibiotherapy influencing the normal Lactobacillary defence mechanisms are both likely to increase the risk. Systemic debilitating diseases that promote invasiveness are briefly discussed.
Subject(s)
Candidiasis, Vulvovaginal/complications , Candidiasis/etiology , Fetal Diseases/etiology , Pregnancy Complications, Infectious/microbiology , Adult , Amnion/microbiology , Candidiasis, Vulvovaginal/pathology , Female , Humans , Intrauterine Devices , Pregnancy , Pregnancy Complications, Infectious/pathology , Pregnancy Trimester, SecondABSTRACT
The indications and results of percutaneous endoscopic gastrostomy (PEG) were reviewed in 30 consecutive patients, most of whom had problems of deglutition secondary to the treatment of ENT neoplasia. The procedure was successful in all patients but some difficulty was encountered in 4 cases. There were no major complications or fatalities. The benign complications were all amenable to medical therapy and did not require ablation of the gastric tube. In general, PGE was well tolerated and an easy to use method of nutritional assistance, allowing most patients to gain weight. In the authors' experience, this technique has an important role to play in the nutritional assistance of patients with problems of deglutition due to neurological disease or ENT neoplasia. The relative innocuity of PEG gives it a great advantage over surgical gastrostomy.