Combining Statistical Tools and Ecological Assessments in the Study of Biodeterioration Patterns of Stone Temples in Angkor (Cambodia).

Biodeterioration is a major problem for the conservation of cultural heritage materials. We provide a new and original approach to analyzing changes in patterns of colonization (Biodeterioration patterns, BPs) by biological agents responsible for the deterioration of outdoor stone materials. Here we analyzed BPs of four Khmer temples in Angkor (Cambodia) exposed to variable environmental conditions, using qualitative ecological assessments and statistical approaches. The statistical analyses supported the findings obtained with the qualitative approach. Both approaches provided additional information not otherwise available using one single method. Our results indicate that studies on biodeterioration can benefit from integrating diverse methods so that conservation efforts might become more precise and effective.

Development and validation of an ultrasonographic activity index of Crohn's disease.

OBJECTIVES: We developed and validated an ultrasonographic index of intestinal inflammatory activity for patients with Crohn's disease. METHODS: Fifty-five patients with Crohn's disease were examined by transabdominal ultrasonography. The pathological findings were classified into three types (A-C) on the basis of wall thickness and wall stratification. To calculate the index, we divided the intestine into eight segments, and the scores for each segment were summed to calculate the index (ultrasonographic activity index of Crohn's disease) as follows: 1 point for type A lesions, [wall thickness (mm) -2] x 2 for type B lesions, and [wall thickness (mm) -2] x 4 for type C lesions. Endoscopic or barium contrast findings were also scored in a similar fashion, with the following parametric scores: 10 for cobblestoning, 5 for longitudinal ulcers, 3 for aphthoid ulcers, and 1 for chronic inflammatory changes. RESULTS: A strong correlation (r2 = 0.62, P<0.01) was found between the ultrasound index and the endoscopic/radiological score, while weak correlations were found between the endoscopic/radiological score and the Crohn's disease activity index or biological indices of inflammation. CONCLUSIONS: Our results show that the ultrasonographic activity index of Crohn's disease can be of value in the ongoing assessment and treatment of patients.

Exercise-induced coronary spasm: comparison of treadmill and bicycle exercise in patients with vasospastic angina.

BACKGROUND: We investigated whether exercise-induced coronary spasms are influenced by the different exercise modes. METHODS: We compared ischaemic ECG responses in 67 patients with vasospastic angina who underwent both treadmill and bicycle ergometer exercise and also coronary angiography. RESULTS: ECG ST-segment elevation was provoked more frequently during treadmill exercise than it was during bicycle exercise (19 versus 9%, P < 0.05). Of 45 patients without significant coronary stenosis (coronary artery luminal diameter narrowing < 75%), 19 patients manifested ST-segment depression during treadmill exercise, whereas only seven patients did during bicycle exercise (42 versus 16%, P < 0.01). All patients with ST-segment elevation or depression during bicycle ergometer exercise also had ST-segment changes during treadmill exercise. Although higher systemic blood pressure levels and lower heart rates were found during bicycle exercise compared with during treadmill exercise the pressure-rate products at peak exercise did not differ between the two exercise tests. CONCLUSIONS: It seems that treadmill and bicycle exercise are different stressors in patients with vasospastic angina, and that coronary spasms are provoked more frequently during treadmill exercise than they are during bicycle exercise. The cause of this difference is not known, but it may be related in part to the difference in systemic haemodynamic or neurohumoral response.

Radionuclide assessment of left ventricular function during dobutamine infusion in patients with coronary artery disease: comparison with ergometer exercise.

The effects of dobutamine on left ventricular function were assessed employing radionuclide ventriculography (RNV) in 7 normal subjects (Group 1) and 21 patients with coronary artery disease (Group 2). After routine bicycle ergometer exercise RNV, dobutamine infusion was started at 5 micrograms/kg/min and the dosage was increased by 5 micrograms/kg/min every 4 minutes to a total of 15 micrograms/kg/min. In Group 1, left ventricular ejection fraction (LVEF) increased by both ergometer exercise and dobutamine infusion. In Group 2, LVEF did not increase during exercise, but increased during dobutamine infusion without evidence of significant myocardial ischemia. Only 2 patients in Group 2 had new regional wall motion abnormality. Left ventricular end-diastolic volume (LVEDV) in Group 2 increased from 191 +/- 19 to 210 +/- 18 ml during ergometer exercise, but decreased from 193 +/- 18 to 153 +/- 19 ml during dobutamine infusion. Short-term low-dose infusion of dobutamine may be used in patients without evidence of significant myocardial ischemia, but probably cannot be substituted for exercise testing in patients with mild to moderate coronary artery disease.

Dipyridamole radionuclide ventriculography in patients with coronary artery disease: comparison with ergometer exercise.

Intravenous administration of dipyridamole during radionuclide ventriculography (RNV) was performed in 26 consecutive patients with symptomatic coronary artery disease. The authors compared the results of dipyridamole-RNV with those of ergometer exercise-RNV in detecting myocardial ischemia. During exercise, ST depression, regional wall motion (RWM) abnormalities, and decreased left ventricular ejection fraction (LVEF) were observed in 21 (81%), 23 (88%), and 20 (77%) patients, respectively. However, after intravenous dipyridamole, ST depression, RWM abnormalities, and decreased LVEF were observed in 14 (54%), 15 (58%), and 2 (8%) patients, respectively. Although LVEF usually decreases during myocardial ischemia, LVEF did not decrease (57 +/- 11% to 58 +/- 10%), even in patients with ST depression, after intravenous dipyridamole. Maintained left ventricular ejection fraction is considered to be a hemodynamic effect of the potent arterial vasodilatation induced by dipyridamole. These results from dipyridamole-RNV in myocardial ischemia seem to conflict with the results from dipyridamole-thallium studies carried out to determine the capacity to detect coronary artery disease. Unknown mechanisms of dipyridamole other than the coronary steal phenomenon may be operative in the genesis of myocardial ischemia.

Isolated congenital left ventricular diverticulum in an adult. A case report.

A sixty-three-year-old man presented himself with atrial flutter and congestive heart failure. Cardiac catheterization revealed that left ventricular diverticulum was located on the anterobasal wall with narrow connection to the left ventricular cavity. Coronary angiography revealed normal coronary arteries. The patient had been asymptomatic until adult life with no other thoracoabdominal or cardiac anomalies. This is an extremely rare finding in the adult population.

Incidence and clinical course of right ventricular infarction: assessment with radionuclide ventriculography.

The incidence and prognosis of right ventricular infarction were studied by radionuclide ventriculography (RNV) in 50 consecutive cases of acute myocardial infarction. RNV was performed within thirty-six hours of symptoms and one month after onset. Right ventricular infarction was absent in all 25 patients with anterior infarction. It was found in 15 of the 25 patients with inferior infarction, accompanied by a marked reduction in right ventricular ejection fraction (28 +/- 8%), but was notably alleviated one month later with normalization of right ventricular ejection fraction (39 +/- 7%) and wall motion. These phenomena seem to be specific in right ventricular infarction.

[Exercise radionuclide ventriculography in evaluating successful percutaneous transluminal coronary angioplasty (PTCA)].

To evaluate late success of PTCA in 29 patients with coronary artery disease, exercise radionuclide ventriculography was performed. Twenty-nine patients were classified into two groups according to the presence of restenosis (Group N: 19 patients without restenosis, Group R: 10 patients with restenosis). LVEF improved significantly in Group N, and the sensitivity, specificity and overall accuracy for detecting restenosis were 100%, 68% and 79%, respectively. Regional wall motion abnormality during exercise did not worsened in Group N, and the sensitivity, specificity and overall accuracy for detecting restenosis were 89%, 96%, and 94%, respectively. The left ventricular end-systolic volume during exercise increased in group R but decreased in Group N. The exercise response of the ratio of systolic blood pressure to end-systolic volume in Group N was significantly larger than that of Group R, and was considered to be useful parameter for detecting restenosis.

[Clinical significance of reverse redistribution in exercise thallium-201 SPECT after percutaneous transluminal coronary angioplasty].

Clinical significance of reverse redistribution on thallium image was evaluated in 54 patients who had undergone PTCA. Thallium SPECT imaging was performed one week and three to six months after PTCA. Reverse redistribution was detected eight of 54 patients one week after PTCA and five of 38 patients three to six months after PTCA. In the segments with reverse redistribution, reduced regional wall motion and lesser degree of coronary stenosis was common features (p less than 0.05) angiography. In conclusion, reverse redistribution had a tendency to appear in the region with mild myocardial injury and relatively high coronary blood flow after PTCA. But in cases with new occurrence and disappearance of reverse redistribution during follow up period, we can not assess the factors to explain these phenomena. In these segments, "coronary flow reserve", "stunned myocardium", "hibernating myocardium" or other factors may be related.

[Serial change of 123I-metaiodobenzylguanidine (MIBG) myocardial concentration in patients with dilated cardiomyopathy].

123I-Metaiodobenzylguanidine (MIBG) is expected to be useful agent for functional evaluation of the myocardial sympathetic innervation. The aim of this paper is to investigate serial change of 123I-MIBG myocardial concentration in patients (pts) with dilated cardiomyopathy (DCM) as compared with 201Tl uptake. Eight pts with DCM and six non-cardiac subjects (controls) were examined. After injection of 111 MBq (3mCi) 201Tl and 111 MBq (3 mCi) 123I-MIBG, simultaneous myocardial imaging in anterior view was performed for both tracers in every 30-60 minutes during 5 hours (6 images). Myocardial uptake ratio per pixel to the injected dose was calculated for each tracer with background and cross-talk correction on each image. In pts with DCM, myocardial uptake ratio of 123I-MIBG did not differ significantly from that of controls. The washout of 123I-MIBG from the myocardium, however, was significantly increased in pts with DCM as compared with controls. The % decrease of the radioactivity in 3 hours was 46.9 +/- 13.8% in DCM, whereas 18.0 +/- 7.7% in controls (p less than 0.05). Especially, the decrease in the early phase (less than 1 hour) was significantly larger in DCM than controls (21.2 +/- 7.5% vs 5.3 +/- 4.0%, p less than 0.01). For 201Tl, on the other hand, neither uptake ratio nor washout rate, differed significantly between the two. In conclusion, the rapid washout of 123I-MIBG in the early phase may reflect some sympathetic dysfunction in pts with DCM.

[Clinical significance of exercise induced ST segment depression after successful percutaneous transluminal coronary angioplasty--assessment by thallium-201 SPECT].

To evaluate the clinical significance of ST segment depression during repeated Treadmill exercise after successful PTCA, Thallium-201 SPECT was performed. The Thallium-201 SPECT was performed before, one week after and 3-6 months after PTCA. All thirty-five patients had one vessel disease and positive Thallium-201 exercise test. During follow-up period for 3-6 months, 11 of 35 patients had persistent ST segment depression. Restenosis of dilated coronary lesion was demonstrated in 6 of 11 patients. In another 3 of 35 patients, exercise induced ST segment depression was disappeared during follow-up Treadmill exercise. In 14 patients with persistent or transient ST segment depression after PTCA, Thallium-201 SPECT demonstrated transient ischemia in 5 of 6 patients with restenosis. In other 8 patients without restenosis, SPECT images did not demonstrate myocardial ischemia and coronary arteriographic findings could not verify side branch stenosis or intimal dissection which might cause myocardial ischemia. The etiology of ST segment depression after successful PTCA in one vessel disease is not produced by exercise induced myocardial ischemia but still unknown mechanisms may be present.

[Coronary artery disease in diabetic patients].

Although it is well known that diabetics have high mortality rates due to ischemic heart disease (IHD), controversies still exist about the severity of coronary artery disease in diabetics compared to nondiabetics. We compared coronary arteriographies of 50 diabetics with IHD to those of 50 nondiabetics with IHD. In regard to coronary risk factors, incidence of obesity was significantly higher in diabetics. Incidence of hypertension, hypercholesteremia, hyperuricemia was higher, although not significant, in diabetics. Incidence of smoking was significantly higher in nondiabetics. The diabetic group showed a significantly higher incidence of patients with more than two or three diseased vessels, and a significantly higher number of diseased coronaries with more than 50% stenosis per patient compared to nondiabetics (5.6 +/- 3.7 vs 3.7 +/- 3.2). The distribution of diseased coronaries with more than 75% stenosis showed no difference between diabetics and nondiabetics. The incidence of coronary spasm was significantly lower in diabetics (12% vs 28%). The high incidence of multiple vessel disease in diabetics was thought to be due to other complicated coronary risk factors, especially hypertension and hypercholesteremia.