Development of a sensitive PCR-dot blot assay to supplement serological tests for diagnosing Lyme disease.

Laboratory diagnosis of Lyme disease is difficult and presently dependent on detecting Borrelia burgdorferi-specific antibodies in patient serum with the disadvantage that the immune response to B. burgdorferi can be weak or variable, or alternatively, the slow and inefficient culture confirmation of B. burgdorferi.

Live births after embryo selection using morphokinetics versus conventional morphology: a retrospective analysis.

The increasing corpus of clinical studies using time-lapse imaging for embryo selection demonstrates considerable variation in study protocols and only limited-sized study cohorts. Outcome measures are based on implantation or clinical pregnancy; some predict blastulation from early cleavage-stage data, and few have evaluated live birth. Erroneously, most studies treat the embryos as independent variables and do not include patient or treatment variables in the statistical analyses.

Hypovitaminosis D and valvular calcification in patients with dilated cardiomyopathy.

Background: In patients with dilated (idiopathic) cardiomyopathy (DCM), little is known about the presence of valvular calcification and its association with hypovitaminosis D, which may predispose affected tissues to calcification. Our objectives were 2-fold: to conduct a retrospective assessment of echocardiographic evidence of valvular calcification in patients with DCM who were known to have hypovitaminosis D (25(OH)D <30 ng/mL) and to conduct a prospective assessment of serum 25(OH)D in patients with DCM, who had demonstrated echocardiographic evidence of valvular calcification.

Methods: The retrospective study consisted of 48 African American patients (34 men, 14 women; 52.

Reduced relative lymphocyte count in african-americans with decompensated heart failure.

Background: A reduction in relative lymphocyte count (%L) has been reported in whites with heart failure that inversely correlated with jugular venous pressure thereby implicating systemic venous hypertension with splanchnic congestion.

Objectives: : To study whether a reduced %L (<20%) occurs in African-Americans (AA) with heart failure and to address pathophysiologic mechanisms having the potential to influence lymphocyte biology and survival, we monitored patients with or without systemic venous hypertension, hypoalbuminemia, hypovitaminosis D, and secondary hyperparathyroidism.

Methods: In 131 AA (90 men; 53 +/- 12 years): 113 were hospitalized, 50 with decompensated biventricular failure (DecompHF), 24 with acute left heart failure, and 39 with heart disease, but no heart failure (HDNHF); and 18 were outpatients with compensated heart failure.

Effusive constrictive pericarditis: 2D, 3D echocardiography and MRI imaging.

The entity of effusive constrictive pericarditis (ECP) combines clinical and echocardiographic features of pericardial effusion and constrictive pericarditis. We describe a case of ECP, of probable tuberculous etiology, with typical hemodynamic findings of pericardial constriction, which persisted after the pericardial effusion was drained. Thickening of parietal and visceral pericardium was seen on 2D and 3D echo, and on MRI.

The right subclavian vein can be used as a surrogate of the inferior vena cava, as an echocardiographic indicator of systemic venous congestion.

Respiratory variations in the caliber of the inferior vena cava, imaged in the subcostal view with the patient supine, correlated well with respiratory variation in the caliber of the right subclavian vein with the patient reclining at a 45 degrees angle. The subclavian vein was imaged by a right supraclavicular approach. We suggest that the right subclavian vein caliber be used as a surrogate of the inferior vena cava caliber when the latter cannot be used because of obesity, epigastric tenderness, or other reasons.

Echocardiographic aspects of hiatal hernia: A review.

It was realized 20 years ago that the sonographic appearance of a diaphragmatic hernia could simulate a left atrial mass. Many papers have appeared on this topic since then, but they mainly consist of single case reports. Clinical symptoms due to cardiac compression by the hernia are uncommon but may occur if the hernia is very large; such patients have presented with episodes of syncope or dyspnea, typically after a large meal.

Three-dimensional echocardiographic appearances of pericardial effusion with tamponade.

A patient with pericardial effusion and tamponade was studied by routine two-dimensional as well as three-dimensional echocardiogram. Chamber "collapses" of the right atrium, left atrium, right ventricle, and inferior vena cava were visualized by both modalities, but were better appreciated on three-dimensional echo imaging, perhaps because three-dimensional echo imaging is more suited to depicting three-dimensional changes in chamber shape.

Unusual superior vena cava thrombus (partly obstructive) extending through right atrium to eustachian valve.

A 50-year-old patient with end-stage renal disease who was being dialyzed with an internal jugular catheter presented with fever. Transthoracic and transesophageal echo demonstrated a thrombus in the inferior vena cava, protruding into the right atrium and extending to the eustachian valve to which it was adherent. Multiple organisms grew from the blood as well as the catheter tip.

Incompetence of the internal jugular venous valve: spectrum of echo-Doppler appearances.

The echocardiographic literature contains very scant reference to incompetence of the valve in the internal jugular vein. However, we found frequent Doppler evidence of such incompetence, especially in patients with congestive failure. This incompetence manifests as a variety of color Doppler and pulsed Doppler patterns, illustrated here in 3 patients.

Predictors of mortality in end-stage renal disease patients with mitral annulus calcification.

Objective: Mitral annulus calcification (MAC) is an independent predictor of cardiovascular mortality in the general population. The purpose of the current historical cohort study is to assess risk factors for long-term mortality in end-stage renal disease (ESRD) patients with MAC (n = 30; age, 62 +/- 2 yr), as compared to ESRD patients without MAC (n = 30; age, 63 +/- 2 yr). Additional analysis compared ESRD patients with MAC to non-ESRD patients with MAC (n = 32; age, 66 +/- 2 yr).

Left ventricular endocardial calcification in a patient with myeloproliferative disease.

The case of a 57-year-old male with a history significant for myeloproliferative disease, chronic renal failure, hypertension, and prostate cancer is described. His complete blood count was remarkable for neutrophilia and, notably, eosinophilia. Subsequent to two syncopal episodes, a transthoracic echocardiogram was performed as part of the workup, which showed an unusual calcified mass in the left ventricular apical region but separate from the apical myocardium, with normal left ventricular systolic function.

Local intense mosaic pattern at site of flail mitral leaflet: report of a new color Doppler sign.

Color flow Doppler has been useful in diagnosing the presence and severity of mitral regurgitation (MR). We noted a hitherto unreported sign of MR due to flail mitral leaflet: intense local mosaic pattern at the site of the flail leaflet. This sign was seen well in 11 of 14 patients (79%) with the two-dimensional echocardiographic features of flail mitral leaflet, all with moderate or severe MR.

Echocardiography of the superior vena cava.

The anatomy and applied echocardiographic anatomy of the superior vena cava (SVC) are briefly described. Right supraclavicular interrogation of the SVC has been in use for many years, but supraclavicular two-dimensional (2-D) imaging of the SVC has been virtually ignored. We have recently shown that supraclavicular 2-D imaging can provide excellent views of the SVC and its main tributaries.

Sonolucent space posterior to left atrium: unusual echocardiographic appearance in a cardiac transplant patient.

The usual echocardiographic appearances of the atria in heart transplant patients are well known. We report a case of an 81-year-old man with a 16-year-old cardiac transplant who showed a "new" echocardiographic left atrial abnormality. Two-dimensional echocardiography showed a large sonolucent space behind the donor left atrium (DLA), which was at first perplexing.