Assessment of Left Ventricular Volume and Function Using Real-Time 3D Echocardiography versus Angiocardiography in Children with Tetralogy of Fallot

BACKGROUND: Evaluation of left ventricular (LV) size and function is one of the important reasons for performing echocardiography. Real time three dimensional echocardiography (RT3DE) is now available for a precise non-invasive ventricular volumetry. Aim of work was to validate RT3DE as a non-invasive cardiac imaging method for measurement of LV volumes using cardiac angiography as the reference technique. METHODS: Prospective study on 40 consecutive patients with tetralogy of Fallot (TOF) referred for cardiac catheterization for preoperative assessment. Biplane cineangiography, conventional 2 dimensional echocardiography (2DE) and RT3DE were performed for the patients. A control group of 18 age and sex matched children was included and 2DE and RT3DE were performed for them. RESULTS: The mean LV end diastolic volume (LVEDV) and LVEDV index (LVEDVI) measured by RT3DE of patients were lower than controls (p value = 0.004, 0.01, respectively). There was strong correlation between the mean value of the LVEDV and the LVEDVI measured by RT3DE and angiography (r = 0.97, p < 0.001). The mean value of LV ejection fraction measured by RT3DE was lower than that assessed by 2DE (50 ± 6.2%, 65 ± 4.6%, respectively, p value < 0.001) in the studied TOF cases. There was good intra- and inter-observer reliability for all measurements. CONCLUSION: RT3DE is a noninvasive and feasible tool for measurement of LV volumes that strongly correlates with LV volumetry done by angiography in very young infants and children, and further studies needed.

Expression of antithyroid antibodies in a large family with high prevalence of thyroid autommune disease and follow-up of patients with Grave's disease

This study included 40 families [179 persons] with familial goiter [more than one member in the family had goiter]. Fifteen families had Grave's disease, 85 had Hashimoto's thyroiditis, 6 in remission [defined as clinical and biochemical euthyroidism for at least one year after withdrawal treatment] and 73 relatives [parents and sibs]. Seventy-two age and sex matched healthy subjects were included as a normal control group. Thyroid function was evaluated at diagnosis by measuring free triiodothyronine [FT3], thyroxine [FT4] and thyroid stimulating hormone [TSH]. Antithyroglobulin [ATG] and antithyroid peroxidase [TPO] antibodies were also measured. At the follow up of patients with Grave's disease, 30 patients with Grave's disease were examined clinically and thyroid profile [FT3, FT4 and TSH] were performed after 4-8 weeks of starting antithyroid drugs [ATDs], then every 2-3 m, thereafter. Thyroid antibodies [ATPO and ATG] were done before the start of treatment and follow up antithyroid antibodies were measured after six months and one year. Thyroid imaging using Tc99m thyroid scan and thyroid ultrasound [US] were performed at diagnosis for all patients. It was concluded that anti TPO and anti TG represent an additional parameter with potential interest in the clinical diagnosis and Hashimoto's thyroiditis. ATDs are safe and remain the treatment of choice of Graves' disease in children and adolescents. However, a long-term follow up is required for these patients as a high relapse rate is observed

effect of antioxidant treatment on pulmonary function in asthmatic children

Sixty asthmatic children, meeting the criteria of American Thoracic Society for the diagnosis of asthma, were included in this study. Out of them, 40 cases received an antioxidant therapy in the recommended daily dose in addition to their regular treatment plan and 20 patients received their regular treatment without supplementary antioxidant. Another control group of 30 normal non-asthmatic children age and sex matched were also included in the study. The antioxidants used are a combination of several vitamins and minerals and have the ability to scavenger and damage free radicals. Pulmonary function tests were done for all children included in the study at the beginning and three months later at the end of the study. The spirometric parameters included vital capacity [VC], forced vital capacity [FVC], forced expiratory volume in the first second [FEV1], the ratio between forced expiratory volume in the first second and forced vital capacity [FEV1/FVC], forced mid expiratory flow [FEF] 25-75% and peak expiratory flow [PEF]. The results of spirometry were expressed as a percentage of predicted value adjusted for age and height. From the results obtained, it was concluded that antioxidants especially vitamin A, C, E, zinc and selenium have a good effect on asthma in both clinical symptoms and pulmonary function showing an improvement in most of its component

Nitric oxide as a marker for diagnosis and follow-up in children with systemic lupus erythematosus and juvenile rheumatoid arthritis

A cross sectional observational study of 56 children with juvenile rheumatoid arthritis [JRA] and systemic lupus erythematosus [SLE] was designed to study nitric oxide [NO] levels and their relation to the disease activity and its value as an indicator for the follow up of these two diseases. Twenty-five healthy age and sex matched children were recruited as controls. Full history taking, proper clinical examination and laboratory investigation of the subjects were done. Blood samples were collected and NO, nitrite and nitrate were measured biochemically. Serum NO, nitrite and nitrate were significantly higher in each of JRA and SLE cases compared with the control group. Patients with active disease showed higher NO levels compared with non-active disease, yet it did not reach significant levels. A positive significant correlation was observed between NO and erythrocyte sedimentation rate [ESR] for patients with active SLE and JRA, respectively. A negative significant correlation was found between NO and lymphocyte count in active SLE; while, a positive significant correlation between NO and steroid therapy duration of JRA with active disease was observed

Prevalence of cytomegalovirus and Epstein Barr virus in patients with juvenile rheumatoid arthritis and childhood systemic lupus erythematosus

The aim of this study was to investigate the possible role of cytomegalovirus [CMV] and Epstein-Barr virus [EBV] infections in the pathogenesis of juvenile rheumatoid arthritis [JRA] and childhood systemic lupus erythematosus [SLE]. The study included 31 JRA patients, 29 childhood onset SLE patients and 21 age and sex matched healthy controls. It was concluded that the prevalence of CMV and EBV is high in pediatric patients with JRA and SLE. These findings supported the hypothesis that these viral infections may be involved in the pathogenesis of autoimmune rheumatic diseases of childhood