Accuracy of flow convergence estimates of mitral regurgitant flow rates obtained by use of multiple color flow Doppler M-mode aliasing boundaries: an experimental animal study

The proximal flow convergence method of multiplying color Doppler aliasing velocity by flow convergence surface area has yielded a new means of quantifying flow rate by noninvasively derived measurements. Unlike previous methods of visualizing the turbulent jet of mitral regurgitation on color flow Doppler mapping, flow convergence methods are less influenced by machine factors because of the systematic structure of the laminar flow convergence region. However, recent studies have demonstrated that the flow rate calculated from the first aliasing boundary of color flow Doppler imaging is dependent on orifice size, flow rate, aliasing velocity and therefore on the distance from the orifice chosen for measurement. In this study we calculated the regurgitant flow rates acquired by use of multiple proximal aliasing boundaries on color Doppler M-mode traces and assessed the effect of distances of measurement and aliasing velocities on the calculated regurgitant flow rate. Six sheep with surgically induced mitral regurgitation were studied. The distances from the mitral valve leaflet M-mode line to the first, second, and third sequential aliasing boundaries on color Doppler M-mode traces were measured and converted to the regurgitant flow rates calculated by applying the hemispheric flow equation and averaging instantaneous flow rates throughout systole. The flow rates that were calculated from the first, second, and third aliasing boundaries correlated well with the actual regurgitant flow rates (r = 0.91 to 0.96). The mean percentage error from the actual flow rates were 151% for the first aliasing boundary, 7% for the second aliasing boundary, and -43% for the third aliasing boundary; and the association between aliasing velocities and calculated flow rates indicates an inverse relationship, which suggests that in this model, there were limited velocity-distance combinations that fit with a hemispheric assumption for flow convergence geometry. The second aliasing boundary with an aliasing velocity, of 102 cm/sec, (which was achieved by use of a 4 kHz pulse repetition frequency, a 3.75 MHz transducer, and no color baseline shift), provided the closest fit to the actual regurgitant flow rates (r = 0.99; y = 0.95x + 0.07). The averaged calculated flow rates from all aliasing velocities also resulted in excellent correlation (r = 0.97; y = 0.99x + 0.5). A hemispheric flow convergence method that is based on color Doppler M-mode echocardiography is a feasible and automatable method for quantifying mitral regurgitant rate.(ABSTRACT TRUNCATED AT 400 WORDS)

[Ovulation induction with gonadotropins aided by cervix mucus analysis and echography]

Induction of ovulation was performed in 148 cycles using human menopausal gonadotropins (HMG) in 52 patients, seven with hypothalamic-pituitary failure and 45 suffering dysfunction at this level. Several induction schemes were used beginning on the second day of the cycle, until one or more follicles larger than 14 mm were found, to administrate 10,000 UI of human chorionic gonadotropin (HCG). Clinical valuation of cervical mucus and ultrasound of the ovaries to assess follicular development were done, from day eight of the cycle. Twenty five pregnancies resulted in 23 patients (44%), three in patients with failure and 22 in the dysfunction group. A total of 19 healthy babies were taken home, however three neonatal deaths, four miscarriages and one ectopic pregnancy occurred. Multiple gestation was present in three patients (12%), one was quadruplet, one triplet and one twin. The ovarian hyperstimulation syndrome (OHS) was detected in seven patients (13.4%), three were mild, two moderate and two severe; two cases of OHS had multiple pregnancies. Although induction of ovulation with HMG in patients with anovulation is a complex procedure requiring strict clinical vigilance and advanced technological resources, in this clinical study it was possible to obtain similar results to other series, using high resolution ultrasound only, without daily measurements of hormones.

[Treatment and prevention of the ovarian hyperstimulation syndrome]

Frequency and features of ovarian hyperstimulation syndrome (OHS) were reviewed in 41 women stimulated with human menopausal gonadotropin (HMG) during 130 cycles. There were 7 cases of OHS, since 17% of patients and 5.3% of cycles were affected; 3 cases were mild, 2 moderate and 2 severe. Of these 41 women, 21 pregnancies occurred (51%) and 19 newborns were healthy. The patients with OHS received 1060 +/- 235 (X +/- DE) UI of HMG and there was not a significative difference with the amount of HMG units in remaining subjects. Symptoms began 3-6 days after human chorionic gonadotropin (HCG) administration. Women with mild OHS were treated as out patients with bed rest and 100 mg indomethacin in suppositories two times a day. Moderate and severe OHS were hospitalized with bed rest; careful monitoring of fluid intake and output, weight and abdominal perimeter daily, as well as vital signs were withdrawn. Patients with severe OHS were treated in the intensive care unit for detection and management of complications. One patient was submitted to laparotomy because of a probably ovarian rupture, but it was discarded in the surgery. OHS remained between 6 and 8 days. Patients with OHS presented 3 pregnancies, 2 were twins and the other was ectopic. Emphasis was made in the prophylactic measures to avoid the OHS.

Doppler color flow mapping of simulated in vitro regurgitant jets: evaluation of the effects of orifice size and hemodynamic variables

The spatial distribution of simulated regurgitant jets imaged by Doppler color flow mapping was evaluated under constant flow and pulsatile flow conditions. Jets were simulated through latex tubings of 3.2, 4.8, 6.35 and 7.9 mm by varying flow rates from 137 to 1,260 cc/min. Color jet area was linearly related to flow rate at each orifice (r = 0.96, SEE = 3.4; r = 0.99, SEE = 1.6; r = 0.97, SEE = 2.3; r = 0.97, SEE = 3.2, respectively), but significantly higher flow rates were required to maintain the same maximal spatial distribution of the jet at the larger regurgitant orifices. Constant flow jets were also simulated through needle orifices of 0.2, 0.5 and 1 mm, with a known total volume (5 cc) injected at varying flow rates and with differing absolute volumes injected at the same flow rate (0.2, 1.0 and 2.0 cc/s, respectively). Again, maximal color jet area was linearly related to flow rate at each orifice (r = 0.97, SEE = 2.3; r = 0.97, SEE = 2.4; r = 0.92, SEE = 3.9, respectively), but was not related to the absolute volume of regurgitation. Color encoding of regurgitant jets on Doppler color flow maps was demonstrated to be highly dependent on velocity and, hence, driving pressure, such that color encoding was obtained from a constant flow jet injected at a velocity of 4 m/s through an orifice of 0.04 mm diameter with flow rates as low as 0.008 cc/s. Mitral regurgitant jets were also simulated in a physiologic in vitro pulsatile flow model through three prosthetic valves with known regurgitant orifice sizes (0.2, 0.6 and 2.0 mm2). For each regurgitant orifice size, color jet area at each was linearly related to a regurgitant pressure drop (r = 0.98, SEE = 0.15; r = 0.97, SEE = 0.20; r = 0.97, SEE = 0.23, respectively), regurgitant stroke volume (r = 0.77, SEE = 0.55; r = 0.94, SEE = 0.30; r = 0.91, SEE = 0.41, respectively) and peak regurgitant flow rate (r = 0.98, SEE = 0.16; r = 0.97, SEE = 0.21; r = 0.93, SEE = 0.37, respectively), but the spatial distribution of the regurgitant jets was most highly dependent on the regurgitant pressure drop. Jet kinetic energy calculated from the summation of the individual pixel intensities integrated over the jet area was closely related to driving pressure (r = 0.84), but integration of the power mode area times pixel intensities provided the best estimation of regurgitant stroke volume (r = 0.80).(ABSTRACT TRUNCATED AT 400 WORDS)

Potential long-acting contraceptive agents: esters and ethers of testosterone with alpha- and/or beta-chain branching

The synthesis of ten esters and two ethers of testosterone (17 beta-hydroxyandrost-4-en-3-one) is described. All these possess some form of alpha - and/or beta - substitution in the ester/ether side-chain. The work was undertaken in order to evaluate the long-acting antifertility effect of such compounds in males.

[Radiologic indices and measurements in the evaluation of pulmonary artery hypertension in chronic obstructive lung disease]

Radiologic indexes proposed as useful in the non-invasive evaluation of pulmonary arterial hypertension (HAP) were analyzed in a group of 35 patients with stable chronic obstructive pulmonary disease (NOC) and secondary HAP (mean pulmonary artery pressure = 29 +/- 2 mmHg). Indices included the PL/T (L = point of union of the external border of the upper lobe artery with the pars interlobaris; PL = the sum of horizontal distances of the right and left L's to the midline: T = transverse diameter of the thorax), the width of the right pulmonary artery at the pars interlobaris (R) and the relation between R and the transverse diameter of the hemithorax (R/H). Our results were as follows: R index was abnormal (greater than 17 mm) in 25 out of 35 patients (71%). PL/T was found abnormal (greater than 38%) in 16 of the patients (45.7%). R/H was abnormal in 10 of the patients (28%). There was no correlation between any of the indexes, and the levels of HAP or pulmonary arteriolar vascular resistance nor the magnitude of lung over inflation or bronchial obstruction. We conclude that the proposed indexes are also of value in NOC with HAP. The width of the right pulmonary artery (R) will be abnormal in two-thirds of the cases with HAP and NOC.

Long-acting contraceptive agents: esters of norethisterone with alpha- and/or beta-chain branching

The synthesis of eighteen esters of norethisterone (17 alpha-ethynyl-17 beta-hydroxyestr-4-en-3-one) is described. These all possess some form of alpha- and/or beta-substitution in the ester side-chain. The work was undertaken in order to evaluate any long-acting fertility control effect intrinsic in such compounds. A pentamethyl disiloxy ether was also included in the group of substances prepared for testing because of its similar substitution pattern.

[Absorption of calcium by growing goats: effect of oxalates]

The influence of sodium oxalate and calcium oxalate upon calcium digestibility was studied in growing goats. Furthermore, and in the same animals, calcium absorption efficiency was estimated after performing duodenal fistula which allowed us to introduce calcium chloride or calcium oxalate and sodium oxalate, in order to avoid ruminal bacteria action upon the forementioned compounds. Finally, calcium absorption of an isolated intestine loop was studied in conscious goats with a Crocker Markowitz fistula, in the presence or absence of oxalate. The addition of sodium oxalate to the diet did not significantly decrease calcium absorption; but when calcium was given as oxalate, absorption was considerably lower. When calcium was introduced as calcium chloride through duodenal fistula, absorption was the same as when the substance was given in the diet. Calcium absorption drastically decreased when sodium oxalate was introduced directly into the duodenum, this fact is confirmed when calcium absorption is estimated in a jejunal loop, which shows that the differences found in relation to the effect of dietary sodium oxalate or directly introduced in duodenum are due to the substance destruction by ruminal bacteria.

[The nutritive utilization of phosphorus in dietary calcium deprivation (author's transl)]

The influence of alimentary calcium deprivation on the nutritional utilization of phosphorus and its corporal retention, after ingestion of diethylstilbesterol has been studied in quail. When female quail are given a highly calcium-deficient diet, egg-laying stops and there follows a substantial decrease in phosphorus utilization and retention, as well as a clear drop in bone mineralization, with calcium and phosphorus content losses in the femur. In males, deprivation of alimentary calcium shows tangible effects on phosphorus retention only when this situation concurs with prior ingestion of diethylstilbestrol.

[Protein nutritive utilization in goats with and without exclusion of rumen and reticulum (author's transl)]

The digestive utilization of protein in fistulated goats has been studied through a system of three cannulae. The protein digestibility coefficient is greater with casein in the rumen than with it in the abomasum, explainable by a higher ammonium production. On the other hand, with casein in the abomasum the duodenal digest contains more protein, and aminoacid composition improves in quality and quantity. The differences found in the above mentioned results are mainly due to a rumen bacterial action upon aminoacids and the subsequent absorption of the ammonium formed.

[Some aspects of vagal control of exocrine pancreatic secretion in rabbits (author's transl)]

Stimulation of the thoracic vagus nerves in anesthetized rabbit appears to act only by increasing the amylase content of pancreatic juice. Stimulation of the abdominal vagus nerve slightly increased the flow of juice and clearly its amylase content, effects which were respectively reduced and abolished by atropine. The vagal control of the exocrine pancreas in rabbits shows substantial differences when compared with other herbivorous monogastric species such as horse and pig.

[Diet effect on fatty acids composition in trout (salmo gairdnerii). rev. esp. fisiol., (author's transl)]

The effect of diets with different fatty acids composition on muscular and hepatic fatty acids of rainbow trout (Salmo gairdnerii) was studied. The effect was higher on muscular fatty acids than on hepatic ones. The lack of correlation between dietary and liver fatty acids in diets with a high level of linoleic acid, showed a better utilization of this acid by the liver. The change in muscular fatty acids pattern was observed within a week of diet change, showing a significant tendency to approach the new dietary fatty acids pattern.

Calcium balance in the quail (Coturnix coturnix japonica). 1, Influence of sex and diethylstilbestrol

Young adult male and laying female quail, fed with a diet containing 2.64% Ca and 0.70% P, were used to study nutritive utilization, corporal calcium retention and endogenous excretion, calcemia, laying and properties of the egg (including the shell structure), mineralization of the femur bone, as well as the influence of diethylstilbestrol upon these parameters. The coefficient of nutritive utilization (C.N.U.) in the female was high and logically superior to that of the male, while the corporal retention was quite similar for both sexes. Most of the Ca absorbed (81.8%) and not excreted in urine, went to the egg and only 18.2% remained in the body. The diethylstilbestrol caused a big reduction of the C.N.U. in the female, but not in the male, parallel to an inhibition of laying, and an increase of corporal retention of used calcium. In both sexes the calcemia surprisingly increased, and the calcium level of the femur bone was higher, and even though the cortical osseous zone was slightly wider, the effect of treatment was noticeable, particularly in the medular tissue, which incremented in the female and appeared in the male. When quail were fed a calcium-restricted diet, the endogenous excretion of this mineral was small in the case of the female and significantly smaller in the male. This situation suppressed egg laying and resulted in a clearly decreased bone mineralization. The ingestion of diethylstilbestrol before feeding a diet poor in calcium provoked an increase of the endogenous excretion of calcium in both female and male quail.

[Parasympathetic control of secretion of pancreatic juice in the rabbit (author's transl)]

The secretion of pancreatic juice in response to stimulation of the vagus nerves in the neck, and to injection of parasympathomimetic drugs, was studied in anesthetized rabbits. Vagal stimulation caused a marked increase of protein content in pancreatic juice, and also a small increase in flow of juice, highly variable from one amimal to another, preceded by a short period of inhibition. Atropine supressed vagal effect on protein concentration, but failed to abolish the flow response. Injection of parasympathomimetic drugs closely imitated the results of vagal stimulation, with the difference that secretory action was fully abolished by atropine. The possibility that effects the parasympathetic stimulation on the flow of juice were secondary to vasodilatation, was discussed. The obtained data were compared with those described for other mammalian species, and the conclusion was reached that rabbit behaves like carnivora rather than herbivora.