Serum lipids in angiographically assessed coronary atherosclerosis.

Cholesterol, triglycerides, and Lp(a)/pre-beta1 lipoprotein were analyzed in 153 patients typed for liproprotien patterns. Coronary atherosclerosis was determined by selective coronary angiography and graded by a system taking into account proximal, middle and distal segments. Smoking habits, family history and hypertension were also recorded. Normal coronary arteries were encountered in 45, moderate coronary atherosclerosis (less than median score) in 50, and severe changes (greater than median score) in 58 patients. Cholesterol (P less than 0.05), positivity of Lp (a)/pre-beta1 lipoprotein (P less than 0.01), a family history of coronary heart disease (P less than 0.05), and smoking (P less than 0.01) differed between the group of normal arteries and the whole group of luminal obstructions. Serum triglycerides were not associated with coronary atherosclerosis. Cholesterol, positivity of the Lp(a)/pre-beta1 lipoprotein and a family history of coronary heart disease were also associated with the severity of the disease. Smoking was less prevalent in the group with severe changes.

Cardiac involvement in bone marrow transplantation: electrocardiographic changes, arrhythmias, heart failure and autopsy findings.

In order to evaluate cardiac involvement in bone marrow transplantation (BMT) we reviewed serial electrocardiograms, chest X-rays and cardiac pathology at autopsy in 45 consecutive adult patients undergoing BMT for hematologic malignancies at our institution. All patients were pretreated with cyclophosphamide (CY, 120 mg/kg) and total body irradiation (TBI, 10-12 Gy). A total of 15 patients developed electrocardiographic ST-segment or T-wave changes and/or arrhythmias post-BMT; four of them also suffered from congestive heart failure. The arrhythmias included frequent ventricular extrasystoles (two patients), paroxysmal atrial fibrillation (one patient), repeated supraventricular tachycardia (one patient) and QT-prolongation with ventricular tachyarrhythmias (one patient). Twelve patients showed an early drop of the total QRS voltage sum exceeding 15% of the pretransplant reading. In a subgroup of five patients the voltage drop was associated with ST-segment or T-wave changes; three of them developed congestive heart failure. At autopsy in 15 patients, the heart weight was on the average 113% of predicted. Myocardial edema, fibrosis and cellular hypertrophy were the most common microscopic findings. Two patients had marantic endocarditis of the aortic valve. Thus, in our experience clinically significant heart involvement affects 5-10% of patients undergoing BMT after pretreatment with CY and TBI. While cardiac complications are generally not a major problem of BMT, they may have serious consequences for individual patients and should therefore be carefully watched for in the treatment of BMT recipients.

Postmortem pancreatic angiography in 45 subjects with non-insulin-dependent diabetes mellitus and 51 controls.

We evaluated, from 96 postmortem angiographs, the main feeding arteries and degree of vascularity of the pancreas to discover to what extent atherosclerosis affects pancreatic blood supply in subjects with and without non-insulin-dependent diabetes mellitus (NIDDM). Patients with NIDDM more often showed intrapancreatic arteries with irregularities in the body-tail of the pancreas (p = 0.050) and more frequently demonstrated decreased vascularity in both the body-tail and the head of the pancreas (p < 0.001) than did the controls. When the arterial system from the aorta to the intrapancreatic branches was examined as a whole, 26 (58%) of the NIDDM patients and 10 (20%) of the controls (p = 0.0001) showed one or more of the following: >50% stenosis in the celiac or splenic artery, two or more irregular intrapancreatic branches, or a distinctly decreased degree of vascularity in the body-tail portion of the pancreas, the region responsible for most insulin secretion. Only 1 NIDDM patient, compared to 10 controls, showed a totally normal angiogram. In conclusion, vascular disease in the feeding arteries of the pancreas is more common in NIDDM patients than age- and gender-matched controls.

A simplified method for the determination of left atrial size and function using cine magnetic resonance imaging.

This work aimed at developing a rapid and clinically applicable method for the assessment of left atrial size and function using magnetic resonance imaging (MRI). We studied 17 healthy subjects and 26 cardiac patients. Left atrial cine MRI with 50 ms phases was made in 6-12 contiguous long-axis sections encompassing the entire atrial cavity. A volume-time curve was reconstructed to measure the minimum and maximum volumes as well as the fractional volume change, reservoir function, ejection fraction, and mean filling and emptying rates of the left atrium. The image section with the largest left atrial area was then selected and a comparable area-time curve was reconstructed. The atrial phasic areas and functional indices were determined analogously to the volume-based assessment. The contours of atrial area-time and volume-time curves agreed closely in individual subjects. All area-based left atrial measurements distinguished cardiac patients as a group from healthy persons. The combined specificity of the area-based analyses was 92% and the sensitivity, 65%, in identifying abnormal results in individual patients. The accuracy of the area-based data was best for the atrial minimum size, fractional change, reservoir function, and mean filling rate. The estimated time savings with the simplified method were 5 to 6 h per patient. Left atrial size and function can be studied by reconstructing a phasic atrial area-time curve with cine MRI. Atrial enlargement and abnormalities of filling and reservoir function can be reliably identified, but if data on conduit or stroke function are crucial the three-dimensional MRI technique is still recommended.

Multiphase segmented k-space velocity mapping in pulsatile flow waveforms.

The aim of the present study was to obtain the precision of flow measurement in breath-hold segmented k-space flow sequences. The results are based on studies of pulsatile flow in a phantom tube. The ultimate purpose is to use these sequences to measure coronary flow. In abdominal and cardiothoracic magnetic resonance imaging the image quality is degraded due to respiratory motion. In the segmented k-space acquisition method, one obtains many phase-encoding steps or views per cardiac phase. This shortens imaging time in the order of phase-encoding lines and makes it possible to image in a single breath-hold, thereby eliminating respiratory artefacts and improving edge detection. With breath-hold multiframe cine flow images it is possible to evaluate flow in all abdominal and cardiothoracic areas, including the coronary arteries. Our study shows that velocity curves shift in time when the number of k-space ky-lines per segment (LPS) are varied; this shift is linear as a function of LPS. The mean velocity Vmean in the center of mass of the pulsatile peak is constant (Vmean = 40.1 +/- 2.9 cm/s) and time t = -10.1 x LPS + 268 (r = 0.993, p < 0.0001). Correlation between theoretical and experimental flow curves is also linear as a function of LPS: C = -0.977 * LPS (r = 0.987, p < 0.0001). It is concluded that velocity curves move with LPS and are smoothed when the breath-hold velocity mapping is used. The more LPS is gathered the more inaccurate results are. LPS 7 or more cannot be considered clinically relevant.

Acute rhabdomyolysis: evaluation with magnetic resonance imaging compared with computed tomography and ultrasonography.

Fifteen patients with acute rhabdomyolysis were evaluated with low field magnetic resonance (MR) imaging and the results compared with those obtained using computed tomography (CT) and ultrasonography (US). With MR imaging, abnormal muscles with areas of increased signal intensity were seen in every patient, which probably reflects increased water content or increased mobility of water molecules caused by inflammatory reaction and oedema in the injured and necrotic muscles. Computed tomography without intravenous contrast medium demonstrated abnormal muscles in most patients examined with this modality. The CT findings consisted of areas of focal hypodensity in muscles. With US, abnormal muscles were seen in less than half of the patients studied. The normal structure of striated muscle was focally disturbed and areas of both decreased and increased echogenicity were found. Magnetic resonance imaging had a higher sensitivity in the detection of abnormal muscles than CT or US (100%, 62% and 42%, respectively). The findings of all these modalities are non-specific, but together with the clinical and laboratory data they confirm the diagnosis of rhabdomyolysis. The information gained from imaging studies is useful in the assessment of the extent and distribution of rhabdomyolysis. The precise identification of affected muscle compartments by MR imaging is valuable when surgical fasciotomy is considered for treatment; the procedure can then be appropriately directed to the compartments with clearly abnormal muscles.

Arteriography before toe to hand free tissue transfer operation.

During the last two years the hand surgeons performed toe to hand transfer operations on eight patients. Preoperative hand and foot arteriography was carried out in all cases. This is important in order to determine which arteries can be used and which toe should be selected for the transfer. The great toe was transplanted in three patients and the second toe in five. In seven cases the operation was successful but in one the transferred second toe was lost. There was no difference between the diameters of the anastomosed arteries in the successful cases and in the failure, but the diameter of the digital artery in the latter was smaller than in the successful cases.

Radiology of aortic dissection: pitfalls in diagnosis.

The diagnosis of aortic dissection can be made with certainty when computed tomography or aortography reveals two lumina and a intimal flap between them. If the false lumen is thrombosed, the differential diagnosis between dissection and aneurysm with intraluminal thrombus is difficult. High resolution computed tomography with dynamic scanning seems more effective in differentiating these two entities than aortography. Two illustrative cases are presented.

Bilateral renal artery dissections: unusual complication of polyarteritis nodosa.

A case of polyarteritis nodosa with the acute complications of multiple bilateral real artery dissection, perirenal haemorrhage and kidney infarction is described. The diagnosis of polyarteritis nodosa was established on the basis of angiographical and clinical findings. Follow-up arteriograms and CT-findings after prednisone therapy are discussed.

Chronic unilateral hyperlucent lung. A consecutive series of 40 patients.

A clinical series of 40 consecutive patients with chronic unilateral hyperlucent lung was analysed. Swyer-James (MacLeod) syndrome turned out to be the most common diagnosis (18 patients, 45%). Other causes were localized emphysema (8 patients, 20%), congenital hypoplastic pulmonary artery (4 patients, 10%), previous massive pulmonary embolism (4 patients, 10%), bronchial carcinoma (3 patients, 7.5%), sequelae of radiation therapy (2 patients, 5%) and benign intrabronchial neoplasm (1 patient, 2.5%). The reduction of pulmonary vasculature was scored (0-9). The most extensive reduction was found in patients with Swyer-James syndrome (mean 5.8), whereas patients with bronchial cancer had the smallest changes (mean 3.0).

Elevated blood acetate as indicator of fast ethanol elimination in chronic alcoholics.

The concentration of acetate was determined in the hepatic and peripheral blood of 10 chronic alcoholics and six healthy non-alcoholic controls after a peroral dose of ethanol (0.8 g/kg b.wt.). The blood acetate concentration was significantly higher in the hepatic vein than peripherally and remained at a rather constant level both in alcoholics and controls during the course of ethanol elimination. However, the level of acetate was significantly (p less than 0.005) higher in alcoholics than in controls both in the hepatic vein (1.79 and 1.15 mM) and peripherally (0.91 and 0.52 mM) (alcoholics and controls respectively). The alcoholics also eliminated ethanol 54% faster than the controls (159 mg/kg b.wt./hr and 103 mg/kg b.wt./hr; alcoholics and controls respectively). Furthermore a highly significant correlation was found between the rate of ethanol elimination and blood acetate level both in the hepatic (r = 0.877, p less than 0.001) and in the peripheral vein (r = 0.799, p less than 0.001). Our results suggest that an increased level of blood acetate during ethanol oxidation may be used as an indicator of enhanced ethanol elimination.

Coronary collateral circulation.

The occurrence and influence of coronary collateral circulation and obstruction of the supplying coronary arteries on left ventricular contractility, prevalence of myocardial infarction, and bicycle exercise ergometer test were studied in a random sample of 286 patients with angiographically documented coronary artery disease. Collaterals appeared increasingly in all three main coronary arteries with grade of obstruction. The highest prevalence of collaterals occurred in stenosis of the right coronary artery (60%), followed by the left descending artery (45%); they occurred least in the left circumflex artery (21%) (p less than 0.001). The frequency of intra-arterial collateral circulation was 42%, 11%, and 12%, respectively (p less than 0.001). With total occlusion of the left anterior descending coronary artery, 22% of the patients had normokinetic anterior and apical left ventricular wall when collaterals were present. More often, the inferior wall showed normal contraction with total occlusion of the right coronary artery and collaterals [52%, p less than 0.001 compared with left anterior descending artery (LAD)]. The prevalence of inferior myocardial infarction was 39%, with collateral circulation to the totally occluded right coronary artery. The respective prevalence of anterior infarction and total occlusion in the left coronary artery was 58% (p less than 0.02). The presence or absence of collaterals had no obvious influence on ST-segment response during bicycle ergometer test. In triple-vessel disease, peak work capacity was better when collaterals to LAD were not jeopardized (427 kpm) than when jeopardized (321 kpm) (p less than 0.02).