Mordecai Koenigsberg

Uterine artery Doppler velocimetry in pregnant women with hypertension

Uterine and umbilical artery velocimetry was carried out on 71 women with hypertensive disorders in pregnancy. Three categories of hypertensive disease were diagnosed: chronic hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. Clinical classifications describe the severity of disease effectively, primarily because the classification is based on the appearance of abnormal physical or laboratory findings. Doppler velocimetry of the uterine arteries shows that normal pregnancy occurs when the systolic/diastolic ratio is less than or equal to 2.6. When the ratio exceeds this level and there is a notch in the waveform, the pregnancy is complicated by stillbirth, premature birth, intrauterine growth retardation, and maternal preeclampsia. The positive and negative predictive value of the examination is 93% and 91%, respectively. It appears that this new technology will be an essential ingredient of optimum pregnancy surveillance.

Usefulness of echocardiographic left ventricular hypertrophy, ventricular tachycardia and complex ventricular arrhythmias in predicting ventricular fibrillation or sudden cardiac death in elderly patients

Abstract Echocardiographic left ventricular (LV) hypertrophy is associated with an increased incidence of new coronary events. 1–3 Ventricular tachycardia (VT) and complex ventricular arrhythmias associated with heart disease are independent risk factors for new cardiac events in elderly patients. 4 We reported in a prospective study that VT was present in 30 of 196 elderly patients (15%) with echocardiographic LV hypertrophy and in 23 of 358 patients (6%) without LV hypertrophy (p 5 Complex ventricular arrhythmias occurred in 147 of 196 patients (75%) with LV hypertrophy and in 157 of 358 patients (44%) without LV hypertrophy (p 5 We are now reporting 27-month follow-up data correlating LV hypertrophy, VT and complex ventricular arrhythmias with development of primary ventricular fibrillation (VF) or sudden cardiac death in these 554 unselected patients older than 62 years in a long-term health care facility.

Diagnostic ultrasound: Effects on the DNA and growth patterns of animal cells

The effects of diagnostic levels of ultrasound on DNA of HeLa cells included: increased immunoreactivity to antinucleoside antibodies in G1 cells, strongly suggestive of unwinding of the helix or single-strand break induction, and low levels of non-semiconservative synthesis in logarithmically growing cells treated with hydroxyurea, indicating repair synthesis. In the C3H mouse cell line 10T-1/2, Cl 8, loss of contact inhibition with a criss-crossed growth pattern was seen. In one experiment, tumors developed in syngeneic mice at the site of injection of ultrasonically treated cells. Ultrasound in the diagnostic range appears to cause detectable effects on DNA and growth patterns of animal cells.

Usefulness of echocardiographic left ventricular hypertrophy in predicting new coronary events and atherothrombotic brain infarction in patients over 62 years of age

Abstract Patients with electrocardiographic left ventricular (LV) hypertrophy have an increased risk of cardiovascular morbidity and mortality. 1−5 Echocardiography is more sensitive and more specific than electrocardiography in detecting LV hypertrophy. 6−8 We performed a prospective study to correlate echocardiographic LV hypertrophy with development of new cardiac events and atherothrombotic brain infarction (ABI) in unselected patients older than 62 years.

Correlation of serum lipids, calcium and phosphorus, diabetes mellitus, aortic valve stenosis and history of systemic hypertension with presence or absence of mitral anular calcium in persons older than 62 years in a long-term health care facility.

Abstract Mitral anular calcium (MAC) is a degenerative process common in elderly patients. 1–6 Roberts and colleagues 1,2 suggested that MAC is accelerated by conditions that increase left ventricular pressure and by conditions that accelerate atherosclerosis. Nair et al 4 reported that patients with MAC had a higher level of serum phosphorus and product of serum calcium and phosphorus and an increased prevalence of systemic hypertension and diabetes mellitus than a control group. During a blinded, prospective study of the prevalence of MAC in an unselected population of persons older than 62 years in a long-term health care facility, we obtained data to correlate serum total cholesterol, high-density lipoprotein cholesterol, triglycerides, calcium, phosphorus, and product of calcium and phosphorus, diabetes mellitus, aortic valve stenosis and history of systemic hypertension with the presence or absence of MAC.

Sonographic Comparison of the Tubal Ring of Ectopic Pregnancy With the Corpus Luteum

Objective. Pregnant patients without a sonographically visible intrauterine pregnancy and with a thick‐walled cystic adnexal structure present a dilemma. This study compared the utility of various sonographic features in differentiating between the tubal ring of ectopic pregnancy and the corpus luteum. Methods. Retrospective review of first‐trimester transvaginal sonograms revealed a cystic adnexal structure in 79 women. Each structure was evaluated for 6 specific sonographic characteristics: echogenicity of its wall compared with that of the ovary and endometrium, wall thickness in 2 planes, color Doppler flow distribution and percentage of wall circumference, and internal texture. Results. Forty‐one (52%) of the 79 women had ectopic pregnancies, and 38 (48%) had corpora lutea. Eleven (32%) of 35 ectopic walls were more echogenic than the endometrium, compared with none of the corpora lutea. A cyst wall less echogenic than the endometrium was more likely in corpora lutea (84% versus 31%; P < .0001). More than twice as many ectopic rinds were more echogenic than ovarian tissue compared with corpora lutea (76% versus 34%; P < .0001). The only predictive internal texture feature was a clear pattern, which was more common in the corpora lutea (P < .01, Fisher exact test). There was no significant difference in mural flow distribution or extent between the 2 groups. Conclusions. Ancillary sonographic signs to distinguish between an ectopic pregnancy and a corpus luteum include decreased wall echogenicity compared with the endometrium and an anechoic texture, which suggests a corpus luteum.

The accuracy of sonography in the differential diagnosis of obstructive jaundice: a comparison with cholangiography.

The value of sonography in determining the site and nature of biliary obstruction with surgical jaundice is described in 32 patients. All diagnoses were subsequently established by surgery and pathology. The site of obstruction was delineated in 94%, while the nature of the lesion was established in 81%. In comparison, contrast cholangiography correctly delineated the site in 96%, but helped determine the etiology in only 82%. Sonography is sufficient to adequately evaluate patients prior to surgery, while percutaneous transhepatic cholangiography should probably be used only when satisfactory ultrasound examinations cannot be obtained.

Correlation of complex ventricular arrhythmias detected by ambulatory electrocardiographic monitoring with echocardiographic left ventricular hypertrophy in persons older than 62 years in a long-term health care facility

Abstract The incidence of cardiovascular morbid events is higher in patients with left ventricular (LV) hypertrophy detected by electrocardiography than in those without LV hypertrophy. 1 Hypertensive patients with electrocardiographic LV hypertrophy have more frequent and complex ventricular premature complexes (VPCs) than those without LV hypertrophy. 2 Echocardiography has a greater sensitivity, specificity, positive predictive value and negative predictive value than electrocardiography in diagnosing LV hypertrophy. 3 We performed a prospective study to correlate the prevalence of complex ventricular arrhythmias detected by ambulatory electrocardiographic monitoring with increased LV mass detected by technically adequate M-mode and 2-dimensional echocardiograms in unselected persons older than 62 years in a long-term health care facility.

Understanding the spectral Doppler waveform of the hepatic veins in health and disease.

Duplex Doppler sonography is a fundamental component of the complete ultrasonographic examination of the liver. Accurate interpretation of the spectral Doppler tracing from the hepatic veins is valuable, as it reflects important cardiac and hepatic physiology. Normally, there are four phases: A, S, V, and D; the S and D waves indicate flow in the antegrade direction toward the heart. In hepatic and cardiac disease, these normal waves may be absent, a finding indicative of flow in a nonphysiologic manner. In addition, transient patient factors such as phase of the respiratory cycle may influence the appearance of the spectral tracing. Familiarity with the normal and abnormal spectral Doppler waveforms from the hepatic veins and knowledge of their respective physiology and pathophysiology provide valuable insights. Systematic analysis of the direction, regularity, and phasicity of the spectral tracing and the ratio of the amplitudes of the S and D waves allows one to arrive at the correct differential diagnosis in most situations.

Renal vein thrombosis treated with thrombolytic therapy: Case report and brief review

Renal vein thrombosis (RVT) can occur as a complication of the nephrotic syndrome. We present the case of a young woman with systemic lupus erythematosus with nephrotic syndrome and bilateral RVT with extension of the thrombus into the vena cava to the level of the right atrium and multiple pulmonary emboli. She was treated acutely with streptokinase, with complete resolution of the thrombi. In general, anticoagulation is the mainstay of therapy for RVT. Review of the literature reveals that thrombolytic therapy can be used safely and appears to have been reserved for those patients with the most severe disease or the more grave prognosis. we feel that thrombolytic therapy is warranted in the presence of bilateral RVT with acute renal failure, massive clot size with high risk of acute embolic events, or recurrent pulmonary emboli, in the absence of overriding contraindications.