Attempt to determine the restrictions of ankle — brachial index and usefulness of elevated anklebrachial index in patients treated on an internal medicine ward

Introduction

The ankle-brachial index (ABI) is used in the screening diagnosis of peripheral artery disease (PAD). Lower limb ischemia is diagnosed if ABI≤0.9. However, persons with ABI>1.4 also suffer from leg ischemia. Not taking this into consideration may lead to diagnostic mistakes and an underestimation of cardiovascular risk.

Objectives

This study addresses the analysis of clinical conditions related to an elevated ABI.

Methods

One hundred and twenty-two randomly chosen subjects over 50 were treated in internal medicine ward were studied using questionnaire and ABI determination.

Results

Forty-four (34%) patients had elevated ABI>1.4 and in 23 (19%) subjects ABI was≤0.9. Patients with ABI>1.4, in comparison to individuals with 0.9<ABI≤ 1.4, presented significantly greater BMI, more atherosclerosis risk factors, more prevalent past stroke and angina pectoris. In comparison to patients with ABI≤0.9, they showed higher blood pressure and lower LDL cholesterol concentration. In the diagnosis of ABI>1.4, lack of palpable pulse in at least one lower limb artery had a sensitivity of 6.8%, specificity of 91%, PPV of 30%, NPV of 63.4%, a likelihood ratio positive 0.75 and for negative 1.02; pulse pressure above 55mmHg had similar low diagnostic yield, respectively: 36.4%, 71.8%, 42.1%, 66.7%, 1.29 and 0.89. In logistic regression only LDL value was a significant predictive factor for elevated ABI, but with a very low odds ratio value for separate increments.

Conclusion

In the diagnosis of lower limb ischemia and connected cardiovascular risk, ABI determination should be obligatory, besides atherosclerosis risk factors, peripheral pulse and pulse amplitude determination.     

Coronary atherosclerosis in patients with acquired valvular disease

BACKGROUND: Coronary atherosclerosis often coexists with acquired valvular disorders. There is growing evidence in literature that these two conditions may have common aetiology. AIM: To assess the incidence of coronary atherosclerosis in patients with acquired valvular disorders and to compare clinical parameters as well as the prevalence of risk factors between patients with aortic and mitral valve diseases. METHODS: The study group consisted of 155 patients (101 males, 54 females, mean age 58.2+/-9.7 years) with acquired valvular disorder who between 2000 and 2002 underwent invasive cardiac evaluation in our department prior to planned cardiac surgery. Aortic stenosis was detected in 74 patients, aortic insufficiency -- in 26, mitral stenosis -- in 33, and mitral regurgitation -- in 14 subjects. All patients underwent clinical evaluation, echocardiography, coronary angiography and laboratory tests. RESULTS: Patients with aortic stenosis had similar prevalence of coronary atherosclerosis to patients with aortic insufficiency, and patients with mitral stenosis -- to patients with mitral regurgitation. When the two groups -- patients with aortic valve disease and patients with mitral valve disease were compared, significant coronary lesions were more often detected in patients with aortic valve disease (36% vs 12.8%, p<0.05). Also, patients with aortic valve disorder were older, predominantly of male gender, had more often angina but less often heart failure, and had higher total cholesterol level than patients with mitral valve disease. CONCLUSIONS: Significant coronary lesions are more frequently encountered in patients with aortic valve disorder than in those with mitral valve disease. A high prevalence of atherosclerotic risk factors in patients with aortic valve disease may suggest that this condition has similar aetiology to that of coronary artery disease.     

The relationship between antibiotic therapy in early childhood and the symptoms of allergy in children aged 6–8 years — the questionnaire study results

Introduction

Studies based on the ISAAC questionnaire suggest a correlation between the use of antibiotics and the prevalence of asthma and allergy in children aged 6–7 years. The number of courses of antibiotic therapy is an important factor.

Objectives

To investigate the relationship between the use of antibiotics during the first years of life and the prevalence of allergy and asthma among children (aged 6–8 years) in the urban population of Poland.

Materials and Methods

A survey-based study with a self-completed questionnaire. The respondents were parents of children aged 6-8 years living in Warszawa, Poland. 1461 completed questionnaires were collected.

Results

Asthma was declared in 4.3% of the children. Wheezing and/or sibilant rhonchi within 12 months before the study was observed in 13.5% of the cases. Asthma medication was taken by 21.8% of the children. Allergic rhinitis was declared in 18.7% of the children. Problems with sneezing, rhinorrhea, and nasal congestion not associated with cold or fever were observed in 40.7% of the children. The analysis of the odds ratios between the use of antibiotics and the symptoms of allergic diseases revealed a clear correlation. The highest odds ratio was observed between the completion of over three courses of antibiotic therapy prior to the age of 12 months and the declaration of one of the following: asthma (OR = 5.59, 95% CI: 2.6–12.01), wheezing and/or sibilant rhonchi (OR = 4.68, 95% CI: 3.01–7.27) and taking medicines for breathlessness (OR = 5.12, 95% CI: 3.42–7.68).

Conclusions

There is a direct relationship between antibiotic use in the first 3 years of life and asthma and allergy symptoms in children aged 6–8 years old.     

Clinical outcome and assessment of spontaneous remodeling of slipping angle in SCFE]

38 patients, and 45 hips has undergone treatment for slipped capital femoral epiphysis between 1995 and 2000. On the basis of the measurement of the head shaft angle on X-ray examination done preoperatively, hips were classified to one of the three groups--mild, moderate, and severe slippage. All patients had undergone pinning in situ as a primary treatment. All were checked out periodically, clinically and radiologically. On the last X-ray before physeal plate closure the head shaft angle was evaluated again. Retrospectively the head neck angle was measured as well. After the average 2.5 years long observation there was stated, that according to Southwick clinical and radiological classification 73% of good and very good outcomes were among moderate and severe slippages. On X-ray assessment 38% of initial and final projection were estimated to be comparable. Amount was inversely proportional to escalation of the slippage. On the comparable projections remodeling of the proximal femur occurred in 27% of the head-shaft angle cases, and 39% on the head-neck angle cases. Remodeling often concerned younger patients and greater slippages. Primary in situ stabilization in treatment SCFE is a correct therapy. Because of spontaneous remodeling occurring in a large amount of hips after stabilization making, a decision of realignment procedures should be rescheduled until remodeling is over after physeal plate closure. Conventional X-rays examination is a method of qualitative, not quantitative monitoring of a treatment of SCFE.     

Gated 99mTc-MIBI single-photon emission computed tomography for the evaluation of left ventricular ejection fraction: comparison with three-dimensional echocardiography

Objective  Parameters of left ventricular systolic function directly influence the management of patients with suspected coronary artery disease (CAD). Quantitative gated single-photon emission computed tomography (QGS; Cedars-Sinai Medical Center, Los Angeles, CA, USA) allows the computation of left ventricular ejection fraction (LVEF) from myocardial perfusion imaging studies which are frequently performed on patients with suspected CAD. Three-dimensional (3D) echocardiography is considered to be the echocardiographic “gold standard” for the quantification of LVEF. We sought to compare QGS with 3D echocardiography in the evaluation of EF in patients with suspected CAD. Methods  Ninety-one consecutive patients with suspected CAD, scheduled for coronary angiography, underwent rest electrocardiographic-gated technetium-99m methoxyisobutylisonitrile SPECT (G-SPECT) with measurement of LVEF by QGS and transthoracic 3D echocardiography with off-line measurement of LVEF (Tomtec 4D LV Analysis 1.1). The diagnosis of CAD was based on coronary angiography, performed on every patient. Results  Nine patients were excluded from the analysis owing to unsuitability for 3D echocardiography (8 patients) or G-SPECT (1 patient). In the remaining group of 82 patients, 71 (87%) had significant CAD, 34 (42%) had a history of myocardial infarction, and 50 (61%) had perfusion defects at rest G-SPECT images. The mean LVEF measured by QGS and 3D echocardiography was 53 ± 13% and 53 ± 10%, respectively. The mean difference in LVEF between 3D echocardiography and QGS was 0.1 ± 6.0% (P = 0.87), and the correlation between the values obtained by both methods was high (r = 0.88, P < 0.001). The largest discrepancies were observed in patients with small ventricular volumes. Conclusions  In patients undergoing diagnostic work-up for CAD, the measurement of LVEF by QGS algorithm provides high correlation and satisfactory agreement with the results of reference ultrasound method-3D echocardiography.     

Bone status assessed by quantitative ultrasound in children with inflammatory bowel disease: a comparison with DXA

Background: To determine the bone status in children with inflammatory bowel diseases (IBD) using quantitative ultrasound (QUS) measurement at hand phalanges and compare the obtained results with dual-energy X-ray absorptiometry (DXA).

Methods: Fifty-one children with IBD underwent DXA and QUS measurements at hand phalanges in the year 2013. The control group for the QUS consisted of 460 children. Reference data for DXA comes from Hologic Explorer.

Results: QUS measurements did not differ significantly between IBD patients and healthy controls. There was no difference between UC and CD subjects. DXA measurements in patients with IBD were lower than in the healthy population. Tanner stage and nutritional status correlated with bone status contrary to steroids therapy.

Conclusion: Low bone mineral density often complicates IBD in children. QUS is not an appropriate method for the assessment of bone status in children. Nutritional status seems to have a greater impact on bone status than corticosteroids therapy.     

Higher Muscle Passive Stiffness in Parkinson's Disease Patients Than in Controls Measured by Myotonometry

Marusiak J, Kisiel-Sajewicz K, Jaskólska A, Jaskólski A. Higher muscle passive stiffness in Parkinson's disease patients than in controls measured by myotonometry.

Objective

To assess muscle passive stiffness in medicated Parkinson's disease patients using myotonometry.

Design

Case-control study.

Setting

Kinesiology laboratory.

Participants

Women with Parkinson's disease (PD) (n=8) and healthy matched elderly women (controls) (n=10) (mean age: PD, 77±3y; controls, 77±4y).

Interventions

Not applicable.

Main Outcome Measures

Passive stiffness of relaxed biceps brachii (BB) muscle was measured using myotonometry. Additionally, surface electromyographic and mechanomyographic signals were recorded from the muscle at rest, and amplitude of those signals was analyzed offline.

Results

The values of BB muscle passive stiffness were significantly (P=.004) higher in PD than in the controls, with a statistically significant influence of parkinsonian rigidity score (Unified Parkinson's Disease Rating Scale) on intergroup differences (P<.001). The Spearman correlation coefficient ρ value showed a significant (P=.005) positive relationship (ρ=.866) between the parkinsonian rigidity score and passive stiffness values of BB in PD. The groups did not differ significantly in the electromyogram amplitude (P=.631) and mechanomyogram amplitude (P=.593) of the BB muscle, and values of these parameters did not correlate significantly with rigidity score (P=.555, P=.745, respectively) in the patients.

Conclusions

Myotonometer is a sensitive enough tool to show that PD patients have higher muscle passive stiffness than healthy controls.