Epicardial Fat Volume and Aortic Stiffness in Healthy Individuals: A Quantitative Cardiac Magnetic Resonance Study.

PURPOSE: To determine epicardial fat volume (EFV) and aortic stiffness (assessed by aortic pulse wave velocity (PWV)) in healthy individuals, and to investigate the relationship of these parameters, and their association with body mass index (BMI) and age. MATERIALS AND METHODS: 58 subjects (29 men, mean age 44.7 ± 13.9 years[y]) underwent a CMR exam at 1.5 Tesla. A 2 D velocity-encoded CMR scan was acquired to determine PWV. The EFV was measured based on a 3 D-mDixon sequence. Group comparisons were made between younger (age < 45y; n = 30; mean age 33.4 ±â€Š6.6y) and older (> 45y; n = 28; 56.7 ± 8.4y) subjects and between subjects with a BMI < 25 kg/m(2) (n = 28; BMI 21.9 ±â€Š2.5 kg/m(2)) and a BMI > 25 kg/m(2) (n = 30; 28.7 ±â€Š4.0 kg/m(2)). Associations between the determined parameters were assessed by analyses of covariance (ANCOVAs). RESULTS: The mean values of PWV and EFV (normalized to body surface area) were 6.9 ±â€Š1.9 m/s and 44.2 ±â€Š25.0 ml/m(2), respectively. The PWV and EFV were significantly higher in the older group (PWV = 7.9 ±â€Š2.0 m/s vs. 6.0 ±â€Š1.2 m/s; EFV = 54.7 ml/m² vs. 34.5 ml/m²; p < 0.01, each), with no significant differences in BMI or sex. In the overweighted group the EFV was significantly higher than in subjects with a BMI < 25 kg/m² (EFV = 56.1 ±â€Š27.1 ml/m(2) vs. 31.5 ±â€Š14.6 ml/m(2); p < 0.01) but without a significant difference in PWV. ANCOVA revealed a significant correlation between EFV and PWV, also after adjustment for age (p = 0.025). CONCLUSION: An association was found between age and EFV as well as PWV. EFV and PWV were related to each other also after adjustment for age. The metabolic and pro-inflammatory activity found with increased epicardial fat volume may promote the development of atherosclerosis and aortic stiffness. CMR may be valuable for future studies investigating the relationship between EFV and PWV in patients with increased cardiovascular risk. KEY POINTS: • EFV and PWV can be assessed in a single CMR exam.• EFV and aortic stiffness are both associated with cardiovascular risk.• EFV correlates with aortic stiffness, possibly due to similar pro-inflammatory mechanisms. Citation Format: • Homsi R, Thomas D, Gieseke J et al. Epicardial Fat Volume and Aortic Stiffness in Healthy Individuals: A Quantitative Cardiac Magnetic Resonance Study. Fortschr Röntgenstr 2016; 188: 853 - 858.

Three-Dimensional Isotropic Fat-Suppressed Proton Density-Weighted MRI at 3 Tesla Using a T/R-Coil Can Replace Multiple Plane Two-Dimensional Sequences in Knee Imaging.

PURPOSE: To evaluate whether a 3 D proton density-weighted fat-suppressed sequence (PDwFS) of the knee is able to replace multiplanar 2D-PDwFS. MATERIALS AND METHODS: 52 patients (26 men, mean age: 41.9 ±â€Š14.5years) underwent magnetic resonance imaging (MRI) of the knee at 3.0 Tesla using a T/R-coil. The imaging protocol included 3 planes of 2D-PDwFS (acquisition time (AT): 6:40 min; voxel sizes: 0.40 - 0.63 × 0.44 - 0.89 × 3mm³) and a 3D-PDwFS (AT: 6:31 min; voxel size: 0.63 × 0.68 × 0.63mm³). Homogeneity of fat suppression (HFS), artifacts, and image sharpness (IS) were evaluated on a 5-point scale (5[excellent] - 1[non-diagnostic]). The sum served as a measure for the overall image quality (OIQ). Contrast ratios (CR) compared to popliteal muscle were calculated for the meniscus (MEN), anterior (ACL) and posterior cruciate ligaments (PCL). In 13 patients who underwent arthroscopic knee surgery, two radiologists evaluated the presence of meniscal, ligamental and cartilage lesions to estimate the sensitivity and specificity of lesion detection. RESULTS: The CR was higher in the ACL, PCL and MEN in 3D- PDwFS compared to 2D-PDwFS (p < 0.01 for ACL and PCL; p = 0.07 for MEN). Compared to 2 D images, the OIQ was rated higher in 3D-PDwFS images (p < 0.01) due to fewer artifacts and HFS despite the lower IS (p < 0.01). The sensitivity and specificity of lesion detection in 3D- and 2D-PDwFS were similar. CONCLUSION: Compared to standard multiplanar 2D-PDwFS knee imaging, isotropic high spatial resolution 3D-PDwFS of the knee at 3.0 T can be acquired with high image quality in a reasonable scan time. Multiplanar reformations in arbitrary planes may serve as an additional benefit of 3D-PDwFS. KEY POINTS: • 3D-PDwFS of the knee is acquired with high image quality• 3D-PDwFS can be achieved in only one measurement with a reasonable scan time• 3D-PDwFS with the advantage of multiplanar reformation may replace 2D-PD-weighted knee MRI Citation Format: • Homsi R, Gieseke J, Luetkens JA et al. Three-Dimensional Isotropic Fat-Suppressed Proton Density-Weighted MRI at 3 Tesla Using a T/R-Coil Can Replace Multiple Plane Two-Dimensional Sequences in Knee Imaging. Fortschr Röntgenstr 2016; 188: 949 - 956.

Can Contrast-Enhanced Multi-Detector Computed Tomography Replace Transesophageal Echocardiography for the Detection of Thrombogenic Milieu and Thrombi in the Left Atrial Appendage: A Prospective Study with 124 Patients.

PURPOSE: To assess the diagnostic value of contrast-enhanced multi-detector computed tomography (MD-CT) for identifying patients with left atrial appendage (LAA) thrombus or circulatory stasis. MATERIALS AND METHODS: 124 patients with a history of atrial fibrillation and/or cerebral ischemia (83 men, mean age 58.6 ±â€Š12.4 years) and with a clinical indication for MD-CT of the heart and for transesophageal echocardiography (TEE) were included in the study. LAA thrombus or thrombogenic milieu was visually identified in TEE and MD-CT. In addition, MD-CT was analyzed quantitatively measuring the Hounsfield units (HU) of the left atrium (LA), the LAA and the ascending aorta (AA), and calculating the HU ratios LAA/AA (HU [LAA/AA]) und LAA/LA (HU [LAA/LA]). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated. RESULTS: The prevalence of a thrombus or thrombogenic milieu as assessed by TEE was 21.8 %. The HU ratio was lower in patients with thrombus or thrombogenic milieu (HU [LAA/AA]: 0.590 ±â€Š0.248 vs. 0.909 ±â€Š0.141; p < 0.001 und HU [LAA/LA] 0.689 ±â€Š0.366 vs. 1.082 ±â€Š0.228; p < 0.001). For the diagnosis of thrombus or a thrombogenic milieu, visual analysis yielded a sensitivity of 81.5 %, a specificity of 96.9 %, a PPV of 87.5 % and a NPV of 95.2 %. By combining visual and quantitative analysis with one criterion being positive, the specificity decreased to 91.8 %, the sensitivity to 77.8 %, the PPV to 72.4 %, and the NPV to 94.9 %. CONCLUSION: Visual analysis of the LAA in the evaluation of thrombus or thrombogenic milieu yields a high NPV of 95.1 % and may especially be useful to rule out LAA thrombi in patients with contraindications for TEE. Additional calculation of HU ratios did not improve the diagnostic performance of MD-CT. KEY POINTS: • MD-CT can reliably exclude atrial appendage thrombi/thrombogenic milieu. • MD-CT is an alternative method in patients with contraindications to TEE. • Calculation of relative HU ratios does not improve the diagnostic value of MD-CT.

Episiotomy: risks of dehiscence and rectovaginal fistula.

The obstetric literature was reviewed to assess the risk of episiotomy dehiscence and rectovaginal fistula formation from routine episiotomy, with and without third- and fourth-degree laceration into the rectal sphincter or rectal mucosa, respectively. Strong evidence suggests that elective episiotomy predisposes to severe 3rd and 4th degree perineal lacerations and that episiotomy dehiscence with rectovaginal fistula formation is strongly related to 3rd and 4th degree perineal lacerations.

Uterus didelphys and unilateral lower limb amelia in a discordant monozygotic twin. A case report.

Uterus didelphys and unilateral lower limb amelia were diagnosed in a discordant identical twin. The discordant occurrence of these anomalies in monozygotic twins suggests a possible coincidence.

Analysis for steroid production of a Sertoli-Leydig cell tumor.

Sex cord stromal tumors of the ovary can be characterized by the production of virilizing steroid hormones. The authors present a case of a poorly differentiated Sertoli-Leydig cell tumor in which ascitic fluid was found to have a high concentration of androgenic hormones and precursors from the delta steroid pathway (17-OH progesterone, testosterone, and androstenedione). These values correlated with samples taken from the right ovarian vein, draining the ovarian neoplasm, but not with those taken from the left ovarian vein or the peripheral blood sample. Selective peritoneal fluid sampling may aid in the diagnosis of hormonally active tumors.

A comparison of pregnancy care delivered by family physicians versus obstetricians in Lebanon.

BACKGROUND: The provision of prenatal and intrapartum care is an important issue in family practice. Physician specialty as a risk factor for adverse perinatal outcome is of interest to both educators and patients. The purpose of this study is to compare perinatal care provided by family practice and obstetrics residents for low-risk women in Lebanon. METHODS: A study of 400 matched pairs of low-risk pregnant women was conducted at the American University of Beirut Medical Center to compare outcomes of perinatal care provided by family physicians and obstetricians. The medical records of women admitted for delivery at the American University of Beirut Medical Center between October 1, 1986, and October 1, 1990, were reviewed. RESULTS: Obstetricians used oxytocin induction significantly more frequently than family physicians (43% versus 7%, P < .01). A similar significant difference was also noted for artificial rupture of membranes. There were similar episiotomy rates (63%), with a greater number of lacerations reported among women cared for by obstetricians (28% versus 15%, P < .05). The use of forceps was similar in both groups. Vacuum extraction was not used by family physicians. Neonatal outcomes were comparable, although meconium-stained amniotic fluid was more common in the obstetrics group (21% versus 6%, P < .05). During the postpartum period, significantly more women breast-fed (62% versus 45%, P < .01) and used oral contraceptives in the family practice group. CONCLUSIONS: When caring for low-risk pregnant women, family physicians appear to provide comparable care with less intervention than obstetricians.

Bernard-Soulier syndrome in pregnancy; a report of four pregnancies in one patient, and review of the literature.

Bernard-Soulier Syndrome is a rare autosomal recessive bleeding disorder characterized by a normal or low platelets count, the presence of giant platelets, and a prolonged bleeding time. Only five pregnant patients with this disease have been previously reported. Most of the complications seem to occur in the intrapartum or postpartum period. In some patients the disease can go unrecognized until the third or fourth decade. Our patient had two uneventful pregnancies, one pregnancy with early postpartum hemorrhage, and another pregnancy with intrapartum and late postpartum bleeding. Although the optimum mode of delivery is not clear yet, the vaginal route should be considered unless otherwise obstetrically indicated. Management of active bleeding episodes is also debatable; it includes platelets transfusions, desmopressin (DDAVP), antifibrinolytic therapy, and ecbolic agents for postpartum hemorrhage.

Alteraçöes pressóricas sistêmicas na anestesia peridural com bupivacaína a 0.5 por cento: influência da hidrataçäo prévia em pacientes submetidos à cirurgia geral / Systemic blood pressure changes during epidural anesthesia with 0.5 per cents bupivacaine: influence of previous hydratation in patients undergoing general surgery

Quarenta pacientes ASA I, divididos em dois grupos de 20, foram submetidos à anestesia peridural lombar com 25 ml de bupivacaína a 0,5 por cento, com adrenalina a 1:200.000. Os 20 pacientes de um dos grupos (controle - grupo C) receberam infusäo de líquidos apenas para manter permeável a venóclise. Os 20 pacientes do grupo hidratado (grupo H) receberam, rapidamente, 1.000 ml de soluçäo de Ringer, por infusäo venosa, previamente à anestesia peridural. O nível do bloqueio sensitivo foi o mesmo nos dois grupos: T5,1 ñ 0,8 no grupo C e T5,5 ñ 0,8 no grupo H. Os dois grupos apresentaram diminuiçäo significativa das pressöes arteriais sistólica (PAS) e diastólica (PAD), embora o grupo controle tenha mantido a PAS estável aos 10 e 20 min após o bloqueio. A frequência do pulso radial aumentou significativamente aos 10 e 20 min, retornando a níveis basais aos 30 min em mbos os grupos. A expansäo volêmica com 1.000 ml de soluçäo de Ringer previamente à anestesia peridural lombar, com bloqueio sensitivo em T5, näo evita a hipotensäo arterial consequente a esta técnica