Lower Circulating Omega-3 Polyunsaturated Fatty Acids Are Associated with Coronary Microvascular Dysfunction Evaluated by Hyperemic Microvascular Resistance in Patients with Stable Coronary Artery Disease.

The consumption of omega-3 polyunsaturated fatty acids (PUFAs) reduces the incidence of cardiovascular events and sudden cardiac death. Coronary microvascular dysfunction (CMD) is a predictor of cardiac mortality, but little information is known on the relationship between CMD and omega-3 PUFAs. This study aimed to identify the relationship between the serum levels of omega-3 PUFAs and the CMD evaluated by the hyperemic microvascular resistance index (hMVRI) to assess coronary microvascular function in patients with stable coronary artery disease (CAD).Intracoronary physiological variables (fractional flow reserve (FFR), hMVRI, mean distal coronary pressure (Pd), and average peak velocity (APV)) were measured in 108 patients. These parameters were evaluated in 150 coronary arteries with stenosis of intermediate severity and without significant ischemia (FFR > 0.80). The PUFA levels and atherosclerotic risk factors were also measured. Univariate analysis shows that hMVRI was negatively correlated with eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio (ß = -0.31, P = 0.001) and EPA (ß = -0.25, P = 0.009) and was positively correlated with dihomo-γ-linolenic acid (ß = 0.26, P = 0.006). Multivariate regression analysis shows that the EPA/AA ratio was the only independent determinant of hMVRI (ß = -0.234, SE = 0.231, P = 0.024). Furthermore, hMVRI decreased significantly from the lowest to highest tertiles of the EPA/AA ratio (P = 0.007). The EPA/AA ratio was positively correlated with APV at hyperemia (ß = 0.26, P = 0.008) but not with Pd at hyperemia.A lower serum EPA/AA ratio may cause CMD in patients with stable CAD.

Valoración con termografía infrarrojo, de la capacidad vasodilatadora de las diferentes corrientes analgésicas y factores implicados / Assessment of the vasodilatory capacity of different analgesic currents using infrared thermography

Objetivos. Primero, hacer una valoración cuantitativa, mediante termografía infrarrojo (TIR) del proceso de vasodilatación provocado por las corrientes analgésicas; segundo, valorar las diferencias entre ellas, y tercero, comprobar si la vasodilatación es debida al efecto Joule o existen otros mecanismos. Material y método. Incluidos 12 individuos (6 mujeres y 6 varones); edades comprendidas entre los 23 y 47 años (media 34 años y 4 meses) y estudio de TIR, previo al tratamiento, normal. En todos se hizo una valoración con TIR de su columna vertebral, al inicio, después del tratamiento y a los 30 y 60 minutos de finalizado. Corrientes valoradas: bifásica compensada, interferencial, ultraexcitante y diadinámica. Resultados. Tras finalizar el tratamiento aparecía una zona de hiperemia debajo de los electrodos con gradiente de temperatura de +3,7°C±0,82°C (p<0,001), respecto de la inicial. En las zonas interpolares, hiperemia inapreciable, pero con gradiente térmico de +0,9°C±0,2°C (p<0,05). A los 30 y 60 minutos desaparición de la hiperemia local, extendiéndose por la espalda y con gradiente de temperatura a la hora de +1,3°C±0,03°C (p<0,05). Conclusiones. Las corrientes analgésicas provocan una vasodilatación en las zonas polares (mayor en el cátodo en las corrientes monofásicas), que decrece progresivamente y se extiende por toda la región interpolar. No existen diferencias manifiestas a la hora entre las diferentes corrientes. Pueden existir otros mecanismos vasodilatadores además del efecto Joule (AU)

Objectives. To make a quantitative assessment, using infrared thermography (IRT) of the vasodilation process induced by different analgesic currents, and to assess the differences between them. It will also be determined whether the vasodilation is due to the Joule effect or whether there are other mechanisms. Materials and methods. The study included 12 subjects (6 men and 6 women), with an age range of 23-47 years (mean 34 years and 4 months) and who were assessed by infrared thermography prior to the normal treatment. An assessment with infrared thermography of the spinal column was performed on all of them, at the beginning, after treatment and at 30 and 60minutes after the treatment was finished. The currents assessed were, biphasic, interferential, ultra-excitatory and diadynamic. Results. After finishing the treatment an area of hyperaemia appeared beneath the electrodes using a temperature gradient of 3.7°C±0.82°C (P<0.001) from the baseline. Negligible hyperaemia was observed in the interpolar zones with temperature gradient of 0.9°C±0.2°C (P<0.05). At 30 and 60minutes, the local hyperaemia disappeared, being extended across the back and with a temperature gradient at one hour of 1.3°C±0.03°C (P<0.05). Conclusions. Analgesic currents produce vasodilation in the polar areas (higher in the cathode in single-phase currents) that gradually decreases and extends throughout the interpolar area. There are no significant differences between the currents at one hour. There may be other vasodilatory mechanisms as well as the Joule effect (AU)

Susceptibility-weighted magnetic resonance imaging detects impaired cerebral hemodynamics in the superior sagittal sinus thrombosis--case report.

An 11-year-old female receiving treatment for acute lymphoblastic leukemia presented with superior sagittal sinus (SSS) thrombosis. T(1)-weighted, T(2)-weighted, and fluid-attenuated inversion recovery magnetic resonance (MR) imaging, and MR venography showed that the SSS was totally occluded by thrombus. Susceptibility-weighted MR imaging showed hypointense thrombus in the SSS and markedly dilated cortical veins over the bilateral cerebral hemispheres. Two days later, her symptoms had slightly resolved. Iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography showed marked decrease of cerebral blood flow in the bilateral frontal lobes, indicating that venous congestion had disturbed the cerebral hemodynamics. MR venography showed that the SSS was still mostly occluded, but susceptibility-weighted imaging showed that the dilation of the cortical veins was less marked, suggesting that collateral venous routes had gradually developed. The finding of dilated cortical veins had almost disappeared at 28 days after the onset. Susceptibility-weighted imaging can be used as a non-invasive method to monitor the severity of venous congestion caused by cerebral venous sinus thrombosis.

Interexaminer reliability of T2-weighted magnetic resonance imaging for lumbar bright facet sign.

OBJECTIVE: The aims of this study were to characterize the bright facet response within the lumbar spine, to identify a constellation of findings associated with the response, and to quantify the interexaminer agreement on the previous objectives. METHODS: A retrospective study of lumbar magnetic resonance images obtained on 105 (N = 105) adult subjects (62 men and 43 women; age range, 18-84 years; mean age, 46.51 +/- 16.01 years) were reviewed by 2 musculoskeletal radiologists for the presence of high signal within the facet articulations (bright facet response) on fast spin echo T2-weighted images. RESULTS: Of the 630 lumbar facet articulations imaged (L3/L4 through L5/S1), 340 (54%) and 346 (55%) respectively, per examiner, did show a bright facet response. Interexaminer agreement with respect to the level and grading of a bright facet response was almost perfect with kappa ranging from 0.85 to 0.91 (SE, 0.06). Prevalence of bright facet responses averaged 40.5% at L5/S1, 56.5% at L3/L4, and 66.5% at the L4/L5 level. There was an association with degenerative facet and disk changes. CONCLUSION: The bright facet response was a common phenomenon on T2-weighted magnetic resonance imaging of the lumbar spine in these cases. There was sufficient agreement with respect to the presence and extent of the bright facet response to conclude that the examiners' determinations were not made by random chance. There exist sufficient repeatability and reliability that a single descriptive term can be applied to unify the bright facet response, the bright facet sign.

Case studies of laser Doppler imaging system for clinical diagnosis applications and management.

The laser Doppler perfusion imager (LDPI) is a recent development in the field of laser Doppler flowmetry. It has great potential in many medical applications for the non-invasive diagnosis of problems based on microvascular perfusion. Established applications include assessment of breast skin blood flow, wound healing, skin burn, and systemic sclerosis. This paper aims to enhance the usability of LPDI for diagnostics testing through the examination of two major issues. The first issue deals with the performance of the LDPI technique. Two case studies are used not only to highlight the potential applications of LDPI, but also to illustrate the general procedure/precautions needed for ensuring the consistency and quality of the captured perfusion images. The first case study deals with the perfusion across the proximal interphalangeal joints of patients with osteoarthritis. The results showed that LDPI could provide an objective and specific assessment of hyperaemia over the interphalangeal joints in patients with rheumatoid arthritis. The second case study deals with the blood flow on the stomach region during acupuncture. The results indicated that LDPI could provide an objective and specific assessment of the stimulation level on acupuncture point. The issues discussed in these case studies would be useful for the evolution of other novel LDPI applications and the standardization of the proper clinical procedure for the capturing of the LDP images. The second issue deals with the intelligent management of the LDPI results to facilitate the prescription of treatment based on analysis of similar cases previously encountered. The framework of an intelligent diagnostics assistant is proposed to automate the search and retrieval of relevant past cases based on the LDPI diagnosis. The paper uses skin burn as an example to discuss the considerations and techniques for the implementation of the proposed intelligent diagnostics system. This work constitutes initial efforts to increase the productivity of the doctors in diagnostics testing using LDPI.

Endometrial thermal balloon ablation using a high temperature, pulsed system: a mathematical model.

A new endometrial thermal balloon ablation treatment for menorrhagia is modeled mathematically to predict its efficacy and safety. A device preheats a fluid to 173 degrees C within a reservoir external to the uterus, and then pulses this fluid without further heating between the reservoir and the balloon for 2.1 min of treatment time. The model predicted this treatment to result in consistent immediate tissue death (coagulation) depths of 3.4 +/- 0.1 mm for uterine cavities of 7 to 26 mL, and that eventual necrosis (tissue death that would occur 1-5 days post burn) may occur to depths of 6.5 +/- 0.2 mm. Whereas, burn depths varied with uterine cavity volume when a low temperature treatment (constant 75 degrees C for 15 min) was modeled (2.3-2.9 mm and 6.8-8.2 mm, for immediate tissue death and eventual necrosis respectively). Similarly, the high temperature, pulsed treatment was less sensitive to blood perfusion rate than the low temperature treatment. Predicted eventual necrosis depth was 1.5 mm less for the high temperature, pulsed treatment than that predicted for a low temperature treatment (constant 87 degrees C for 7 min) for the same immediate tissue death depth (3.5 mm), indicating that the new high temperature treatment may result in less damage to non targeted tissues.

Valoración de la eficacia y seguridad de ciprofloxacino ótico tópico (0,3 por ciento) en el tratamiento de la otitis externa difusa y de la otitis media crónica / Valuation of the effectiveness and security of topic and otic cipofloxacine (0,3 por ciento) in the processing of diffuse external otitis and chronic meddium otitis

El servicio de ORL del Hospital Clínico de Zaragoza, realizó un estudio en el que participaron 60 pacientes, 19 afectos de Otitis Externa Difusa (OED) y 41 afectos de Otitis Media Crónica (OMC), para observar la eficacia clínica y bacteriológica del ciprofloxacino ótico tópico al 0,3 por ciento (Cetraxal Ótico) en el tratamiento de estas patologías, así como la incidencia de efectos adversos, en condiciones asistenciales reales, en las consultas externas del hospital.En la primera visita (V1) los pacientes acudieron a la consulta, donde tras ser confirmado el diagnóstico de otitis externa difusa o de otitis media crónica, se les prescribió Cetraxal Ótico. El tratamiento consistió en la administración de 5 gotas cada 8 horas durante 8 días en el oído afecto. Transcurrido este tiempo, todos los pacientes acudieron a una segunda visita (V2). Sólo en el caso de los pacientes afectos de OMC se realizó una tercera visita de control (V3) al mes de haber finalizado el tratamiento para verificar que no se habían producido recidivas.La finalidad del estudio era observar la eficacia de Cetraxal Ótico frente a la OED y la OMC, así como la incidencia de efectos adversos del tratamiento en condiciones asistenciales reales.En los pacientes afectos de OED, el porcentaje de curaciones al finalizar el tratamiento fue del 100 por ciento.En los pacientes con OMC el porcentaje de curaciones fue superior al 91 por ciento tras el tratamiento, aunque en la visita de control (V3) el porcentaje de curaciones se elevó al 97,6 por ciento. (AU)

Quantitative fluorimetric effects of leeching on a replanted ear.

Leeching is used to relieve venous congestion in microscopically replanted tissues. A quantitative description of the effects of leech application on tissue perfusion has not been reported. We report a case of an ear replantation in which venous congestion was consistently improved with leeching. In four instances, quantitative fluorimetry, which indicated impaired circulation and prompted leech application, showed restoration of normal circulation patterns following leech application. The fluorometric studies suggested that arterial inflow improved and venous congestion was relieved.