Effects of hydrodynamic pressure processing on the marination and meat quality of turkey breasts.

The effects of hydrodynamic pressure processing (HDP) on marination and meat quality characteristics of turkey breasts were investigated. Breast muscles from 45 turkey hens were removed from the carcasses within 30 min postmortem. From each bird, the breast from one side was treated with HDP and the other side served as a nontreated control. Breasts were then marinated in either 15 or 30% brine (water, salt, and phosphate) based on muscle weight with vacuum tumbling for 30 min or nonmarinated. The control and HDP-treated breasts from each bird received the same marination treatment. Brine uptake, processing yield, and cooking loss were measured as processing characteristics and texture, color, and expressible moisture were measured to document changes in meat quality. Hydrodynamic pressure processing increased (P < 0.001) brine uptake after 10 and 30 min of marination and increased (P < 0.001) processing yield compared with controls. The HDP-induced improvements in these processing characteristics were augmented at 30% brine levels compared with 15% brine. Cooking loss was lower (P < 0.001) in marinated breasts compared with nonmarinated samples. Hydrodynamic pressure processing decreased (P < 0.0001) Warner-Bratzler shear force and significantly influenced texture profile parameters, resulting in reduced hardness but increased cohesiveness and springiness compared with controls at both marination levels. Hydrodynamic pressure processing did not influence color (L*, a*, and b*) or expressible moisture values compared with controls at either marination level. Marinated samples (15 and 30% brine levels) had lower (P < 0.001) Warner-Bratzler shear force values and lower (P < 0.05) hardness, cohesiveness, and chewiness values compared with nonmarinated samples. Data from this study suggest that HDP enhances brine absorption, increases processing yield, and improves texture characteristics in marinated turkey breasts.

Congenital absence of the pericardium: displacement of the heart associated with tricuspid insufficiency.

This report describes a patient with congenital absence of the left pericardium with displacement of the heart into the left pleural space and associated tricuspid insufficiency. Excision of the ruptured chordae, plication of the flail anterior leaflet, and tricuspid annuloplasty rendered a competent tricuspid valve.

Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients.

BACKGROUND: The carcinoid syndrome is a rare cause of acquired valvular heart disease. Although the typical echocardiographic features of carcinoid heart disease are well recognized, this large series provides new information about unusual manifestations of the disease as well as the role of Doppler echocardiography. METHODS AND RESULTS: Between 1980 and 1989, 132 patients with carcinoid syndrome underwent echocardiographic study. The echocardiographic, Doppler, and clinical features of the 74 patients (56%) with echocardiographic evidence of carcinoid heart disease are described. Among these patients, 97% had shortened, thickened tricuspid leaflets. Tricuspid regurgitation was present in all 69 patients with carcinoid heart disease who underwent Doppler examination, and it was of moderate or severe degree in 62 patients (90%). Severe tricuspid regurgitation was characterized by a dagger-shaped Doppler spectral profile with an early peak pressure and rapid decline. The pressure half-time was prolonged (mean, 116 msec), which is consistent with associated tricuspid stenosis. The pulmonary valve appeared thickened, retracted, and immobile in 36 patients (49%) and was diminutive to the extent of not being visualized in an additional 29 patients (39%). Among the 47 patients who underwent Doppler evaluation of the pulmonary valve, regurgitation was present in 81%, and stenosis was present in 53%. Left-sided valvular involvement was present in five patients (7%), four of whom had patent foramen ovale or carcinoid tumor involving the lung. Previously undescribed myocardial metastases were present in three patients (4%) and were confirmed by biopsy in each case. Small pericardial effusions were present in 10 patients (14%). Patients with and without echocardiographic evidence of carcinoid heart disease did not differ with regard to sex, age, location of the primary tumor, duration of diagnosis, or duration of symptoms of carcinoid syndrome. However, the mean pretreatment level of urinary 5-hydroxyindoleacetic acid was higher in patients with carcinoid heart disease than in patients without carcinoid heart disease (270 versus 131 mg/24 hrs, p < 0.001). The symptom of dyspnea was more prevalent among patients with carcinoid heart disease than in patients without the disease (54% versus 27%, p = 0.003); as expected, heart murmurs were also noted more frequently in patients with disease (92% versus 43%, p < 0.0001). Treatment regimens and response to therapy were similar in the two groups. Survival of patients with echocardiographic evidence of carcinoid heart disease was reduced compared with those without cardiac involvement (p = 0.0003). ECG and chest roentgenographic findings in patients with carcinoid heart disease were nonspecific. CONCLUSIONS: The broad spectrum of carcinoid heart disease is detailed in this large series. This includes not only right-sided valvular lesions but also left-sided involvement, pericardial effusion, and myocardial metastases.

Marfan syndrome diagnosed in patients 32 years of age or older.

The Marfan syndrome, a generalized inherited disorder, is usually diagnosed in young patients and is associated with a poor prognosis. With use of our diagnostic-retrieval system, we identified 28 patients with the Marfan syndrome who were 32 years of age or older at the time of diagnosis. These patients had at least two of four major diagnostic criteria for the Marfan syndrome--a confirmed family history, a long-limbed habitus, dislocated lenses, and disease of the aortic root. In these relatively older patients, some clinical findings (the ocular disorder and the family history) corresponded to the expected findings in younger patients with the Marfan syndrome; however, the proportion of those with cardiovascular disease was greater. Echocardiography has improved the potential for detection of the cardiac lesions, the most frequent cause of death in these patients. Early diagnosis of the Marfan syndrome is important so that complications of the cardiac lesions can be prevented or delayed and so that genetic counseling can be done at an appropriate time.

Percutaneous pericardial catheter drainage: report of 42 consecutive cases.

Test results of 42 consecutive patients with pericardial effusion treated with percutaneous pericardial drainage were analyzed. Intermittent (79%) or continuous (21%) drainage through a 60-cm pigtail catheter (No. 6Fr to 8Fr) was used. Clinical indications were urgent or semiurgent treatment of large (38%), life-threatening (24%), recurrent (21%) or acute (traumatic) (17%) pericardial effusion. Sixteen patients had a malignant cause for the effusion. Mean duration of use of the indwelling pericardial catheter was 3.5 days (range less than 1 day to 19 days). Two of the 9 catheters in patients on continuous drainage but only 1 of 33 catheters in patients on intermittent drainage became occluded. There was only 1 possible infective complication. Six patients had subsequent elective surgical intervention for persistent or recurrent effusion. Placement of an indwelling pericardial catheter guided by 2-dimensional echocardiography is safe and effective for initial treatment of selected pericardial effusions.

Primary cardiac tumors: experience with 30 consecutive patients since the introduction of two-dimensional echocardiography.

Experience with 30 consecutive patients who had a total of 32 primary cardiac tumors and who underwent two-dimensional echocardiographic examinations between January 1977 and June 1983 was reviewed. Most of the tumors were atrial myxomas (20 left and 4 right), and 30 were identified on echocardiography. Twenty-five patients, including 21 of 22 with atrial myxoma, underwent surgical resection on the basis of the echocardiographic examination, without preoperative angiocardiography. When the morphologic characteristics of the left atrial myxomas were studied statistically in relation to clinical abnormalities, large tumor size was most closely related to the number and type of associated clinical and laboratory abnormalities. The single exception was embolization, which correlated with echocardiographic tumor consistency. Since the introduction of two-dimensional echocardiography, the yearly incidence of cardiac tumor diagnosis at this clinic has increased several fold and the incidence of unexpected intraoperative diagnosis has been very low (one case). Echocardiography is the method of choice for clinical diagnosis. It has replaced angiocardiography for routine preoperative assessment, permits early diagnosis of cardiac neoplasms and provides insight into the pathophysiology of primary cardiac tumors.

Cardiac tamponade: pericardiocentesis directed by two-dimensional echocardiography.

Symptomatic pericardial effusion has been recognized as a diagnostic and therapeutic problem for many centuries. Although surgical incision and blind needle puncture of the pericardium for removal of the fluid have been available for somewhat more than 150 years, both procedures are associated with serious complications. Echocardiography provides a unique means of diagnosing and managing pericardial effusion. The two-dimensional echocardiographic beam demonstrates the presence of the pericardial effusion and locates an ideal entry point and track for the needle used in pericardiocentesis. At our institution, echocardiography-directed pericardiocentesis has been the procedure of choice for cardiac tamponade for the past 4 years, during which time 132 consecutive pericardial taps have been performed. Our experience has shown that this is a safe, effective technique that can be used by a physician who is familiar with two-dimensional echocardiography. We recommend its wide acceptance and use.

Two-dimensional echocardiographically guided pericardiocentesis: experience in 117 consecutive patients.

Pericardiocentesis guided by 2-dimensional echocardiography has been used at the Mayo Clinic since April 1980. The 2-dimensional examination localizes the pericardial fluid. Particular note is made of the place on the body wall closest to the fluid. An entry track that permits puncture of the pericardial sac without damage to any vital structure is then selected for the pericardiocentesis needle. Between April 1980 and March 1984, 132 consecutive pericardiocenteses in 117 patients were done by this technique. The volume of fluid obtained ranged from 75 to 1,700 ml (mean 650). Seventy percent of the taps were done for therapy, 21% for diagnosis, and 9% for both therapy and diagnosis. A Teflon-sheathed "intracath" needle was used to complete 80% of the pericardiocenteses. In the other 20%, a large catheter was secondarily introduced and connected to a closed drainage system. There were no deaths related to the procedure. One symptomatic pneumothorax occurred. There were 3 minor complications. Two-dimensional echocardiographic imaging of the heart and pericardial fluid permits a safe and effective means of performing pericardiocentesis.

Serial echocardiographic observations in patients with primary systemic amyloidosis: an introduction to the concept of early (asymptomatic) amyloid infiltration of the heart.

Echocardiography was used for the serial assessment of 27 patients with primary systemic amyloidosis. Thirteen patients had no clinical cardiac deterioration between the two echocardiographic studies (group 1), whereas in 14 patients (group 2), congestive heart failure or arrhythmias (or both) appeared or worsened during a mean observation period of 19 months. The only echocardiographic changes in group 1 were a mild increase in left ventricular mass and a mild decrease in left ventricular wall systolic thickening. Patients in group 2 had significant changes in left ventricular wall thickness (mean increase, 34%), in left ventricular mass (mean increase, 42%), in right ventricular wall thickness (mean increase, 78%), in left atrial size (mean increase, 19%), in left ventricular mass/voltage ratio (mean increase, 68%), in left ventricular radius/thickness ratio (mean decrease, 29%), and in left ventricular fractional shortening (mean decrease, 13%). Significant correlations were found in group 2 between changes in systolic and diastolic blood pressure and changes in ventricular wall thickness and mass. Changes in left ventricular systolic function did not correlate significantly with changes in other clinical, electrocardiographic, or echocardiographic measurements. In six cases (two in group 1), in which amyloid infiltration of the heart was proved by myocardial biopsy or autopsy, the only echocardiographic abnormality when the patients were asymptomatic was a moderate increase in left or right ventricular wall thickness. We found that M-mode and two-dimensional echocardiographic examinations can substantiate progressive amyloid infiltration of the heart and are useful tools for the noninvasive serial assessment of patients with primary systemic amyloidosis.

Mitral stenosis associated with valvular tophi.

Chronic tophaceous gout has become less common since the introduction of allopurinol and probenecid. Cardiac tophi have rarely been reported. In this article, we report a case of severe mitral stenosis in which valvular tophi played a major role in the pathogenesis. The case was well substantiated by echocardiography, surgical pathology, and chemical analysis.

Sensitivity of two-dimensional echocardiography in the direct visualization of atrial septal defect utilizing the subcostal approach: experience with 154 patients.

In the standard precordial echocardiographic imaging planes, there is frequent dropout of atrial septal echoes in the region of the fossa ovalis that can be minimized by use of the subcostal imaging approach. The diagnostic sensitivity of this approach was reviewed in 154 patients (mean age 31 years, range 2 months to 74 years) with documented atrial septal defect in whom a satisfactory image of the atrial septum could be obtained. Subcostal two-dimensional echocardiography successfully visualized 93 (89%) of the 105 ostium secundum atrial septal defects, all 32 (100%) ostium primum defects and 7 (44%) of the 16 sinus venosus defects. A defect was not visualized (false negative response) in 12 patients (11%) with an ostium secundum defect and in 9 patients (56%) with a sinus venosus defect. In three of the former and five of the latter, a two-dimensional echocardiographic contrast examination established the presence of the interatrial shunt. Twenty-four patients (16%) with clinical findings of uncomplicated atrial septal defect confirmed by two-dimensional echocardiography underwent surgical repair of the defect without preoperative cardiac catheterization. There were no perioperative complications. Two-dimensional echocardiographic examination of the atrial septum utilizing the subcostal approach is the preferred method for the confident, noninvasive diagnosis and categorization of atrial septal defects. Two-dimensional echocardiographic contrast and Doppler examinations complement the technique and enhance diagnostic accuracy.

Pericardiocentesis assisted by two-dimensional echocardiography.

Pericardiocentesis assisted by two-dimensional echocardiography was performed in 40 patients with effusions of various types and causes; no complications occurred. This approach combines several advantages, including visualization of the fluid-filled sac and determination of its location, estimation of the amount of fluid, and identification of structures intervening between the body surface and the pericardial sac (for example, the liver). The ideal point of needle entry caned. This approach combines several advantages, including visualization of the fluid-filled sac and determination of its location, estimation of the amount of fluid, and identification of structures intervening between the body surface and the pericardial sac (for example, the liver). The ideal point of needle entry caned. This approach combines several advantages, including visualization of the fluid-filled sac and determination of its location, estimation of the amount of fluid, and identification of structures intervening between the body surface and the pericardial sac (for example, the liver). The ideal point of needle entry can be selected to avoid contact with the heart and can be marked on the body wall. This method combines the safety and visibility of the open (surgical) approach with the simplicity of the direct ("blind") puncture method. Locating the optimal point on the body wall, closest to the pericardial fluid, allows a short, plastic-sheathed needle to be used. Pericardiocentesis by this method can be performed with ease and safety.

Echocardiographic features of carcinoid heart disease.

We reviewed the records of the Mayo Clinic patients with known carcinoid syndrome in whom echocardiographic studies had been done. Nineteen patients had M-mode and 2-dimensional echocardiographic examinations, and 1 patient had an M-mode examination only. Of the 20 patients, 8 had no evidence by echocardiogram of carcinoid heart disease; 2 had changes in the tricuspid valve echogram suggestive of early carcinoid heart disease, and the other 10 patients had the following distinctive echocardiographic findings: (1) the pattern of right ventricular volume overload (enlarged right ventricle with abnormal septal motion); (2) abnormal right-sided valves, including (a) a striking appearance of the tricuspid valve, the leaflets appearing thickened, retracted, and fixed in a semiopen position throughout the cardiac cycle, and (b) thickened, retracted pulmonic valve cusps, when visualized; and (3) the left-sided valves and chambers rarely involved. These echocardiographic features are distinctive of advanced carcinoid heart disease and correlate closely with pathologic findings.