Rest and Dobutamine stress echocardiography in the evaluation of mid-term results of mitral valve repair in Barlow's disease

BACKGROUND: Surgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Debate, however, persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Thus, a basal and Dobutamine echocardiographic (DSE) study was carried out to evaluate these parameters at mid-term follow-up. METHODS AND RESULTS: Twenty patients selected for the study (12 men and 8 women, mean age 60 ± 9 years) underwent pre- and post-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). At mid-term follow-up (20 ± 5 months) all patients underwent rest TTE and DSE (3 min. dose increments up to 40 microg/Kg/min protocol). Pre-discharge and one-month TTE showed absence of MR in 11 pts., trivial or mild MR in 9 pts. and normal mitral valve area and gradients. Mid-term TTE showed decrease in left atrial and ventricular dimension, in pulmonary artery pressure (sPAP) and grade of MR. During DSE a significant increase in mitral valve area, maximum and mean gradients, sPAP, heart rate and cardiac output and a decrease in systolic annular diameter and left ventricular volume were found; in 6 pts. a transient left ventricular outflow tract obstruction was observed. CONCLUSION: Basal and Dobutamine stress echocardiography proved to be valuable tools for evaluation of mid-term results of mitral valve repair. In our study population, the surgical technique employed had a favourable impact on several cardiac parameters, evaluated by these methods

An Arsenal Ship Design

The Navy’s “Arsenal Ship Concept of Operations (CONOPS)” and “Arsenal Ship Capabilities Document (SCD)” address a need for the design of a large missile platform that can carry massive and precise firepower, accomplish long-range strike, and perform flexible targeting and multidimensional theater defense capabilities consistent with the policies of “Forward...From the Sea” and “Operational Maneuver from the Sea.” The ship is designed to be a large missile magazine that receives its launch orders from remote air, land or sea forces. It is fully integrated into the joint command and control structure to assist current forces in the opening days of conflict. A major design goal of the Arsenal Ship is to limit the crew size to 50 personnel through the use of system automation, redundancy and equipment reliability, while imposing an additional constraint of limiting the sailaway price to 550 million dollars

Voyage en Grèce, de Xavier Scrofani, sicilien, fait en 1794 et 1795. [Volume 2] / traduit de l'italien par J. F. C. Blanvillain,...

Titre original : Viaggio in GreciaContient une table des matière

Case Report Sleep Disruption and Proprioceptive Delirium due to Acetaminophen in a Pediatric Patient

We present the case of a 7-year-old boy, who received acetaminophen for the treatment of hyperpyrexia, due to an infection of the superior airways. 13 mg/kg (260 mg) of acetaminophen was administered orally before bedtime, and together with the expected antipyretic effect, the boy experienced sleep disruption and proprioceptive delirium. The symptoms disappeared within one hour. In the following six months, acetaminophen was administered again twice, and the reaction reappeared with similar features. Potential alternative explanations were excluded, and analysis with the Naranjo algorithm indicated a "probable" relationship between acetaminophen and this adverse reaction. We discuss the potential mechanisms involved, comprising imbalances in prostaglandin levels, alterations of dopamine, and cannabinoid and serotonin signalings