Occult sleep-disordered breathing in stable congestive heart failure.

Objective: To determine the prevalence and effect of sleep-disordered breathing in ambulatory patients with stable, optimally treated congestive heart failure.

Design: A prospective, longitudinal study.

Setting: Referral sleep laboratory of a Department of Veterans Affairs medical center.

Characteristics of chronic left ventricular dysfunction induced by coronary embolization in a canine model.

We have characterized the coronary vascular reserve, left ventricular function and inotropic response in dogs with chronic heart failure consequent to intracoronary embolization (EMB) with 50 microns spheres. We conducted studies 12-39 months after embolization and contrasted the findings with normal (CON) dogs. Acute embolization produced sustained LV volume enlargement and increased wall thickness, reduction of LV ejection fraction and elevated end-diastolic pressures; resting catecholamine levels were also increased.

The use of magnetic resonance imaging in adult congenital heart disease.

Magnetic resonance (MR) imaging techniques have evolved sufficiently to produce clinically relevant studies that depict the anatomy and physiology of the heart. Applications to congenital cardiac disease in adult patients are numerous. MR imaging is particularly useful for noninvasive evaluation of the aorta in patients with aortic arch anomalies and coarctations and to study the results of palliative and corrective surgery for transposition of the great arteries and for reconstructive procedures that restore sufficient pulmonary blood flow.

Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study.

The incidence of nephrotoxicity occurring with the nonionic contrast agent, iohexol, and the ionic contrast agent, meglumine/sodium diatrizoate, was compared in 1196 patients undergoing cardiac angiography in a prospective, randomized, double-blind multicenter trial. Patients were stratified into four groups: renal insufficiency (RI), diabetes mellitus (DM) both absent (N = 364); RI absent, DM present (N = 318); RI present, DM absent (N = 298); and RI and DM both present (N = 216). Serum creatinine levels were measured at -18 to 24, 0, and 24, 48, and 72 hours following contrast administration.

Postoperative evaluation of pulmonary arteries in congenital heart surgery by magnetic resonance imaging: comparison with echocardiography.

Palliative and corrective operations for the treatment of cyanotic congenital heart disease frequently involve or potentially influence the size of the pulmonary arteries. Echocardiography and magnetic resonance imaging (MRI) are two noninvasive imaging techniques currently used to assess morphologic abnormalities of the pulmonary arteries. The purpose of this study was to evaluate the role of MRI in comparison with echocardiography for defining morphologic changes of the pulmonary arteries after congenital heart surgery.

Increased risk of neuroectodermal tumors and stomach cancer in relatives of patients with Ewing's sarcoma family of tumors.

Background: Previous studies of the genetic epidemiology of Ewing's sarcoma have shown neither an increased incidence nor a distinct pattern of cancers in family members of Ewing's sarcoma patients.

Purpose: Because of a new biologic and cytogenetic classification of Ewing's sarcoma family of tumors, we wanted to reinvestigate the incidence and distribution of cancers in relatives of probands with Ewing's sarcoma family of tumors.

Methods: Patients treated at the Pediatric Branch and the Radiation Oncology Branch of the National Cancer Institute between 1965 and December 1992, or their next of kin, were asked to complete a questionnaire on the history of cancer in all first- and second-degree relatives.

Lymphocyte depletion during treatment with intensive chemotherapy for cancer.

Recently we have observed an increased incidence of opportunistic infections in patients treated with intensive chemotherapy for cancer. Because T-cell depletion is associated with similar clinical events in human immunodeficiency virus infection and after bone marrow transplantation, we have analyzed peripheral blood lymphocyte populations in a series of patients during treatment with intensive chemotherapy for cancer. Although neutrophil, monocyte, and platelet numbers consistently recovered to greater than 50% of pretreatment values after each sequential cycle of therapy, lymphocyte numbers did not recover within the same time period.

Sarcomas of the hand and foot: analysis of local control and functional result with combined modality therapy in extremity preservation.

Purpose: The records of 28 patients with sarcomas of the hand and foot treated at the National Cancer Institute (NCI) between 1977 and 1992 were reviewed to assess local control and functional results.

Methods And Materials: Histologic types included 15 cases of the Ewing's sarcoma family of tumors, 7 cases of alveolar rhabdomyosarcoma, and 6 cases of nonrhabdomyosarcoma soft tissue sarcomas. Median age of all patients was 18 years (range 4-61), with a median potential follow-up of 114 months following diagnosis.

Pediatric soft tissue sarcomas.

Soft tissue sarcomas are the sixth most common cancer in children and collectively account for about seven percent of all pediatric cancers. The development of increasingly intensive, multimodality treatment protocols for these tumors has led to a steady increase in cure rates for these neoplasms, especially for rhabdomyosarcoma, the most common pediatric soft tissue sarcoma. This article provides an overview of the basic biology, clinical management, and clinical research for pediatric soft tissue sarcomas.

Comparison of iopromide with iohexol and iopamidol in coronary arteriography and left ventriculography.

Rationale And Objectives: Low-osmolality contrast agents, ionic and nonionic, are being used more frequently in coronary arteriography. A new nonionic contrast agent, iopromide, has recently become available for use in clinical trials. The purpose of this phase II-phase III Food and Drug Administration (FDA) trial was to compare the side effects and diagnostic quality of iopromide with iohexol and iopamidol for coronary arteriography and left ventriculography.

Spiral CT of renal artery stenosis: comparison of three-dimensional rendering techniques.

Purpose: To evaluate the accuracy of computed tomographic (CT) angiography in the detection of renal artery stenosis (RAS).

Materials And Methods: CT angiography was performed in 31 patients undergoing conventional renal arteriography. CT angiographic data were reconstructed with shaded surface display (SSD) and maximum-intensity projection (MIP).

Magnetic resonance imaging in adult congenital heart disease.

Some patients with congenital cardiac anomalies develop their first symptoms as adults, and many more will survive to adulthood with congenital lesions that have been treated surgically. Magnetic resonance imaging (MRI) currently provides sufficient morphological information to allow the anatomical diagnosis of congenital abnormalities involving the heart and the great arteries. Newer MR techniques have also been developed that provide functional information such as measurements of valve gradients, stroke volumes, regurgitant volumes, and shunt volumes.

Malignant schwannoma with melanocytic and neuroepithelial differentiation in an infant with congenital giant melanocytic nevus: a complex neurocristopathy.

We describe an infant girl, born with a pigmented giant nevus, who developed a malignant schwannoma in the retroperitoneum at 16 months of age. At birth the nevus covered over 50% of her body and histologically was a compound nevus with extension into the deep dermis surrounding dermal appendages. The malignant schwannoma was biphasic with areas composed of spindle and round cells.

Total-body irradiation and autologous bone marrow transplant in the treatment of high-risk Ewing's sarcoma and rhabdomyosarcoma.

Purpose: In an effort to improve outcome in patients with metastatic or high-risk localized Ewing's sarcoma family of tumors (ESF) and rhabdomyosarcoma (RMS), we explored the role of consolidation therapy with total-body irradiation (TBI) plus autologous bone marrow transplantation (ABMT).

Patients And Methods: Ninety-one patients were entered onto one of three consecutive protocols from 1981 to 1986. Induction therapy consisted of four or five cycles of vincristine, doxorubicin, and cyclophosphamide (VAdriaC); in the earlier series, patients received one or two cycles with dactinomycin instead of doxorubicin.

Multicenter trial of ionic versus nonionic contrast media for cardiac angiography. The Iohexol Cooperative Study.

Contrast agents used for cardiac angiography are different in regard to ionicity, osmolality and physiologic effects. The nonionic contrast media have been shown to have less toxic effects and a better safety profile than do higher osmolar agents. To better assess this risk, clinically stable patients undergoing cardiac angiography were stratified according to the presence of diabetes mellitus, and level of serum creatinine, and then randomized to receive either iohexol (Omnipaque 350) or sodium meglumine diatrizoate (Renografin 76).

Long-term survival after central nervous system relapse in a patient with osteosarcoma.

Background: Since the advent of multiagent adjuvant chemotherapy, survival among patients with localized osteosarcoma has improved to 60% or more. Pulmonary relapse, the most common cause of treatment failure, is associated with less than 25% long-term survival; central nervous system (CNS) metastasis, when it occurs, often presents as a catastrophic clinical event in preterminal patients.

Methods: The authors report a patient with osteosarcoma who had an isolated pulmonary relapse and a subsequent isolated CNS relapse.

Recommendations for training in vascular medicine. American College of Cardiology Peripheral Vascular Disease Committee.

Each trainee in vascular medicine must be eligible for the board certification examination of the American Board of Internal Medicine or its equivalent. Training faculty, preferably at least two members, should meet the qualifications and training requirements described in this report. They must be dedicated, effective teachers and should spend most of their time in research, education and patient care related to peripheral vascular diseases.

Cardiac radiology. A survey of its current status.

Rationale And Objectives: A number of pressures have taken their toll on cardiovascular (CV) imaging in radiology. We conducted a survey to develop accurate information about the current status of cardiac radiology (CR) that might guide future responses and initiatives.

Methods: To assess the current status of CR, a survey form was sent to all 117 active radiologist members of the North American Society for Cardiac Imaging (N = 72) and/or the Council on Cardiovascular Radiology of the American Heart Association (N = 98).

Using patient reports to assess health-related quality of life after total hip replacement.

Data on disease severity, co-morbidity, and process of care were obtained from the medical records of 356 patients without rheumatoid arthritis undergoing a first unilateral total hip replacement at four teaching hospitals in California and Massachusetts. Socio-demographic characteristics, functional status prior and subsequent to hospitalization, and improvement in health status were measured with a patient questionnaire 12 months after discharge. Completed questionnaires were received from 284 patients, a response rate of 79.

Guidelines for the performance of outpatient catheterization and angiographic procedures.

Cardiac catheterization and angiography is a safe procedure performed on patients with suspected or potentially serious cardiovascular disorders. Complications of the procedure are related both to heart disease itself and to elements of the procedure. For a variety of social and financial reasons, the performance of cardiac catheterization and coronary angiography on an outpatient basis has increased recently.