Reproducibility of computer-quantified carotid plaque echogenicity: can we overcome the subjectivity?

Background And Purpose: We sought to assess the reproducibility, interobserver variability, and application to clinical studies of a new method for the quantitative assessment of carotid plaque echogenicity.

Methods: Carotid plaques were scanned with the use of ultrasound, and their images were stored in a computer. They were normalized by assigning certain gray values to blood and adventitia, and the gray scale median (GSM) was used to quantify their echogenicity.

A myocardial cytotoxic process is involved in the cardiac dysfunction of meningococcal septic shock.

Objective: Myocardial dysfunction is a characteristic component of meningococcal septic shock and contributes to the persisting high mortality from the disease. Specific treatment of the myocardial failure has been hampered by the lack of understanding of its pathophysiology. We were interested to determine whether myocardial cell death was occurring in the presence of meningococcal septicemia and whether it correlated with the degree of left ventricular dysfunction and disease severity.

Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing.

Objective: To examine the value of universal antenatal screening for hepatitis C virus (HCV) infection among an inner London population, with regard to prevalence, uptake, and acceptability of testing, and identification of new cases.

Design: Serum analysis for antibodies against HCV in pregnant women following informed consent ("opt out" policy). Samples positive for HCV antibodies were tested for the presence of HCV RNA by polymerase chain reaction.

Hepatitis C virus infection: co-infection with HIV and HBV.

Hepatitis C shares common routes of infection with hepatitis B (HBV) and the human immunodeficiency virus (HIV). It is, therefore, not surprising to find that some patients with HCV are co-infected with either HIV and/or HBV. Until recently, the effects of HIV on HCV infection have not been investigated--sadly patients with HIV died long before their liver disease became problematic.

Therapeutic options for HCV--management of the infected individual.

Patients with chronic hepatitis C infection should be assessed by liver biopsy prior to consideration of anti-viral therapy. Patients with histologically mild disease should be observed at regular intervals and assessed with a repeat liver biopsy after an interval of 3-4 years. Those with severe disease should receive early treatment with interferon-alpha and ribavirin.

Prospective pregnancy outcome in untreated recurrent miscarriers with thyroid autoantibodies.

The purpose of this study was to determine the prevalence of thyroid antibodies in women with recurrent miscarriage and to observe whether their presence was predictive of future pregnancy outcome. A total of 870 consecutive, non-pregnant women with a history of three or more pregnancy losses and normal parental karyotypes were investigated for the presence of thyroglobulin antibodies (TgAb) and for thyroid microsomal antibodies (TmAb). Thyroid antibodies were found in 162 (19%) women.

Efficacy of chest CT in a pediatric ICU: a prospective study.

Study Objectives: (1) To determine whether chest CT provides additional information compared with chest radiography regarding the nature of intrathoracic disease in critically ill children, (2) to determine whether such information alters clinical management, (3) to assess the role of a low-dose high-resolution CT (HRCT) protocol in pediatric ICU (PICU) patients.

Design: Prospective study.

Setting: Specialized PICU in a teaching hospital serving London and the south of England.

Trials of angioplasty and surgery: CABRI.

The medium term (4-year post randomization) results from CABRI indicate that the principal difference between those randomized to coronary angioplasty and those to coronary surgery has been the much greater need for repeat revascularization in the former. A number of factors may play a role in the greater repeat revascularization rate post coronary angioplasty, these include coronary restenosis, residual coronary artery disease, coronary artery disease progression. In the longer term, graft failure in those who have undergone coronary surgery will be important, and it remains to be seen what the effect of this will be.

Warfarin induced skin necrosis.

Background: Warfarin induced skin necrosis is a rare complication with a prevalence of 0.01-0.1 per cent.

Influence of MHC class II genotype on outcome of infection with hepatitis C virus. The HENCORE group. Hepatitis C European Network for Cooperative Research.

Background: The outcome of infection with hepatitis C virus (HCV) varies substantially among individuals. Host genetic factors are likely to give rise to some of this variability. Polymorphisms in the MHC class II loci may influence the outcome of HCV infection; however, reports of MHC class II allele associations have been inconsistent.

Pasteurella multocida meningitis in infancy - (a lick may be as bad as a bite).

Unlabelled: Pasteurella multocida is the commonest cause of local infection after an animal bite, but is an unusual cause of meningitis. We report a case of P. multocida meningitis occurring in a 7-week-old infant which was contracted after non-traumatic contact with a household pet, that is, without any animal bite or scratch.

The role of duplex scanning in decision making for patients with claudication.

The aim of this study was to compare the accuracy of clinical decisions made for patients presenting with claudication on the basis of the ankle/brachial index (ABI) (at rest and postexercise) and duplex scanning with that made on the basis of angiograms. Fifty-six patients presenting with a history suggestive of claudication had the ABI taken at rest. Seven patients could not be exercised but their resting ABI was <0.

Neuroendocrine responses to levodopa in multiple system atrophy (MSA).

Hypothalamic dopaminergic pathways are involved in the regulation of growth hormone and prolactin release from the anterior pituitary. Neuroendocrine studies in patients with multiple system atrophy (MSA), in whom there is a reported loss of hypothalamic dopamine, are few and contradictory. We therefore studied the neuroendocrine responses to 250 mg levodopa (plus 25 mg carbidopa) in subjects with MSA (n = 15), and compared them with age- and sex-matched healthy control subjects (n = 8).

Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy.

The symptoms caused by or relating to orthostatic hypotension (over 20 mmHg systolic blood pressure) were evaluated using a questionnaire in 72 patients with primary chronic autonomic failure, 32 of whom had pure autonomic failure (PAF, and 40 multiple system atrophy (MSA). The most common posturally related symptoms were dizziness (84% PAF, 83% MSA), syncope (91% PAF, 45% MSA), visual disturbances (75% PAF, 53% MSA) and suboccipital/paracervical 'coat-hanger' neck pain (8 l% PAF, 53% MSA). Chest pain occurred mainly in patients with PAF (44% PAF, 13% MSA).

Combination of a clinical risk assessment score and rapid whole blood D-dimer testing in the diagnosis of deep vein thrombosis in symptomatic patients.

Purpose: The clinical diagnosis of deep vein thrombosis (DVT) is unreliable in more than 50% of cases, and, in recent years, plasma D-dimer assays have been used to predict the presence of DVT with high sensitivity and negative predictive values. This study investigated the use of a rapid whole blood test that could be performed and interpreted by the bedside in addition to a clinically derived risk assessment score (RAS) to determine whether a practical and cost-effective clinical model could be developed for the diagnosis and exclusion of DVT in symptomatic patients.

Methods: Two hundred consecutive patients who were referred to the vascular laboratory with clinically suspected DVT underwent the following procedures: (1) clinical assessment and stratification into low, moderate, or high risk for DVT on the basis of an RAS related to history, symptoms, and physical examination findings; (2) rapid (5-minute) whole blood D-dimer testing with a semi-qualitative agglutination technique on a fingerprick blood sample; and (3) color flow duplex ultrasound scanning with standard criteria for the diagnosis of proximal and calf DVT.

The role of duplex scanning in the diagnosis of lower limb arterial disease.

Color flow duplex imaging of the iliac and femoropopliteal arteries was performed in patients undergoing angiography. The aim of the study was to determine: (1) in what percentage of patients could the iliac arteries be adequately visualized to enable a diagnosis, (2) the overall accuracy of duplex scanning in the diagnosis of arterial disease, and (3) whether there is a useful duplex criterion for the selection of patients for angioplasty. One hundred and twenty patients (79 males, 41 females; mean age 64.

Understanding the genetic basis of susceptibility to mycobacterial infection.

Genetic factors have long been suspected of determining susceptibility and resistance to mycobacterial infection. The recent identification of families with a unique susceptibility to mycobacterial infection, and the identification of mutations in the genes for either the interferon-gamma (IFN-gamma) receptor or the interleukin (IL)-12 receptor as the cause of the defect, has provided an important clue to the pathways critical for resistance to mycobacterial infection in humans. Although the genetically determined absence of key cytokines or their receptors results in susceptibility to lethal mycobacterial infections in early childhood, it is likely that more subtle mutations that result in only partial dysfunction of macrophage upregulation pathways may play a role in susceptibility to tuberculosis (TB) and leprosy in the general population.

Implications of new diagnostic criteria for abnormal glucose homeostasis in women with previous gestational diabetes.

Objective: To determine the consequences of applying revised American Diabetes Association (ADA) (1997) and World Health Organization (WHO) (1998) recommendations for the classification of glucose intolerance in women with previous gestational diabetes mellitus (GDM).

Research Design And Methods: There were 192 women with previous GDM who took an oral glucose tolerance test (OGTT) 1-86 months after delivery and were classified by WHO (1985), ADA (1997, fasting glucose), and revised WHO (1998) guidelines.

Results: Among the 165 women without a preexisting diagnosis of diabetes, WHO-1985 and ADA-1997 provided similar estimates of diabetes prevalence (13.

Antigen presenting cell function in HIV-1 infected patients.

Antigen presenting cell (APC) function is central to the activation of anti-viral cytotoxic T-cells and antibody production. In previous studies we have evaluated APC function in HIV-1 infected patients as the capacity to present peptide to a well defined panel of CD4 T-cell clones. We found that APC from HIV-1 infected patients were defective in the capacity to present peptide to CD4 T-cell clones.

Investigation of variant Creutzfeldt-Jakob disease and other human prion diseases with tonsil biopsy samples.

Background: Prion diseases are associated with the accumulation of an abnormal isoform of cellular prion protein (PrPSc), which is the principal constituent of prions. Prions replicate in lymphoreticular tissues before neuroinvasion, suggesting that lymphoreticular biopsy samples may allow early diagnosis by detection of PrPSc. Variant Creutzfeldt-Jakob disease (variant CJD) is difficult to distinguish from common psychiatric disorders in its early stages and definitive diagnosis has relied on neuropathology.

Other methods of laparoendoscopic hernia repair: mini-hernia--inguinal hernia repair through a 2-cm incision.

Mini-hernia repair is an endoscopic modification of the Lichtenstein tension-free repair. Clinical trials are warranted to determine the efficacy of this procedure and any advantages it may have over the original operation.

Cell cycle arrest following exposure of EBV-immortalised B-cells to gamma irradiation correlates with inhibition of cdk2 activity.

The exposure of Epstein-Barr virus immortalised B cells (LCLs) to the genotoxic effects of gamma irradiation causes a decreased proliferation of the cells. The early events in this process have been investigated here. The induction of p53 expression correlates with a cell cycle arrest in the G1 and G2/M phases of the cell cycle within 24 h of exposure.

Structure of chordae tendineae in the left ventricle of the human heart.

The bicuspid (mitral) valve complex of the human heart consists of functional units which include the valve leaflets, chordae tendineae and the papillary muscles. The mechanical properties of these functional units depend to a large extent on the link between the muscle and the valve. This link is usually arranged in a branching network of avascular tendinous chordae composed of collagen and elastic fibres, which transmit contractions of the papillary muscle to the valve leaflets.