Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis

Background Ultrasound (US) has largely replaced contrast venography as the definitive diagnostic test for deep vein thrombosis (DVT). We aimed to derive a definitive estimate of the diagnostic accuracy of US for clinically suspected DVT and identify study-level factors that might predict accuracy. Methods We undertook a systematic review, meta-analysis and meta-regression of diagnostic cohort studies that compared US to contrast venography in patients with suspected DVT. We searched Medline, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Reviews of Effectiveness, the ACP Journal Club, and citation lists (1966 to April 2004). Random effects meta-analysis was used to derive pooled estimates of sensitivity and specificity. Random effects meta-regression was used to identify study-level covariates that predicted diagnostic performance. Results We identified 100 cohorts comparing US to venography in patients with suspected DVT. Overall sensitivity for proximal DVT (95% confidence interval) was 94.2% (93.2 to 95.0), for distal DVT was 63.5% (59.8 to 67.0), and specificity was 93.8% (93.1 to 94.4). Duplex US had pooled sensitivity of 96.5% (95.1 to 97.6) for proximal DVT, 71.2% (64.6 to 77.2) for distal DVT and specificity of 94.0% (92.8 to 95.1). Triplex US had pooled sensitivity of 96.4% (94.4 to 97.1%) for proximal DVT, 75.2% (67.7 to 81.6) for distal DVT and specificity of 94.3% (92.5 to 95.8). Compression US alone had pooled sensitivity of 93.8 % (92.0 to 95.3%) for proximal DVT, 56.8% (49.0 to 66.4) for distal DVT and specificity of 97.8% (97.0 to 98.4). Sensitivity was higher in more recently published studies and in cohorts with higher prevalence of DVT and more proximal DVT, and was lower in cohorts that reported interpretation by a radiologist. Specificity was higher in cohorts that excluded patients with previous DVT. No studies were identified that compared repeat US to venography in all patients. Repeat US appears to have a positive yield of 1.3%, with 89% of these being confirmed by venography. Conclusion Combined colour-doppler US techniques have optimal sensitivity, while compression US has optimal specificity for DVT. However, all estimates are subject to substantial unexplained heterogeneity. The role of repeat scanning is very uncertain and based upon limited data

Spatial learning by rats across visually disconnected environments

Two spatial tasks were designed to test specific properties of spatial representation in rats. In the first task, rats were trained to locate an escape hole at a fixed position in a visually homogeneous arena. This arena was connected with a periphery where a full view of the room environment existed. Therefore, rats were dependent on their memory trace of the previous position in the periphery to discriminate a position within the central region. Under these experimental conditions, the test animals showed a significant discrimination of the training position without a specific local view. In the second task, rats were trained in a radial maze consisting of tunnels that were transparent at their distal ends only. Because the central part of the maze was non-transparent, rats had to plan and execute appropriate trajectories without specific visual feedback from the environment. This situation was intended to encourage the reliance on prospective memory of the non-visited arms in selecting the following move. Our results show that acquisition performance was only slightly decreased compared to that shown in a completely transparent maze and considerably higher than in a translucent maze or in darkness. These two series of experiments indicate (1) that rats can learn about the relative position of different places with no common visual panorama, and (2) that they are able to plan and execute a sequence of visits to several places without direct visual feed-back about their relative position

The chick embryo heart as an experimental setup for the assessment of myocardial remodeling induced by pacing

The mechanisms regulating remodeling of the heart are not well understood and only rarely investigated for pacing. We therefore developed a model based on the well-established chick embryo heart preparation. Hamburger Hamilton 21 stage Leghorn chick embryos were used. Access to the heart was obtained after having dissected the shell membranes. The electrodes (platinum wires) were placed in ovo: the anode on the vitelline membrane and the cathode at different sites of the heart (sinus venosus, base/apex of the ventricle). Sensing and stimulation thresholds were measured. Survival of the paced chick was studied. Among 30 chick embryonic hearts, the stimulation thresholds were 1.4 mV +/- 0.5 SD for the atrium, 2.6 V +/- 1.4 SD at the base, and 3.2 V +/- 1.5 SD at the apex of the ventricle, while the sensing signals were 1.3 mV +/- 0.5 SD at the atrium, 19.6 mV +/- 4.1 SD at the base, and 21.6 mV +/- 3.9 SD at the apex of the ventricle. Continuous pacing (pacing rate = intrinsic rate + 10%) could be maintained for 1.5 hours +/- 0.5 SD at the atrium, 8.9 hours +/- 0.7 SD at the base of the ventricle, and 7.9 hours +/- 1 SD at the apex of the ventricle up to death of the embryos. By using intermittent electrical stimulation, the association of 5 minutes on/5 minutes off pattern during 18 hours and 5 minutes on/15 minutes off, during 30 hours resulted in an effective pacing period of 19 hours in 60% of the experiments, reflecting 15 cell turnover cycles. This experimental setup will allow the study of morphological, metabolic, and molecular bases of ventricular remodeling induced by electrical stimulation

[Sudden death in hypertrophic obstructive and non-obstructive cardiomyopathy: can it be prevented?]

Sudden cardiac death constitutes the most devastating aspect of obstructive and non-obstructive hypertrophic cardiomyopathy. Loss of consciousness and family history of sudden cardiac death should alert the physician to the risk of sudden death. ECG, morphological and hemodynamic assessment, and exploration of central nervous activity are of little use in stratifying the risk of sudden cardiac death. Loss of consciousness associated with nonsustained ventricular tachycardia and inducible sustained ventricular arrhythmia identify patients at very high risk of sudden cardiac death. Nevertheless, many variable factors are involved in the pathophysiology of sudden cardiac death, and hence risk stratification of sudden cardiac death in patients with hypertrophic cardiomyopathy remains a very difficult clinical challenge

[Cardiac pacemaker dysfunction secondary to outside interference: a review]

Electromagnetic signals from various sources may cause interference with pacemakers. The safety systems developed by manufacturers are generally effective. Nevertheless, some electromagnetic sources, particularly those found in the medical environment, can induce transitory or permanent pacemaker dysfunction. This paper presents the various sources of electromagnetic signals to which a pacemaker may be exposed. Taking into account the available literature, it attempts to clarify those which are really deleterious for the pacemaker and how to avoid them

Dysfonction d'une bioprothese mitrale, hemolyse et insuffisance renale aigue. [Malfunction of a mitral bioprosthesis, hemolysis and acute renal insufficiency]

Intravascular hemolysis is a rare complication following valvular replacement, particularly with bioprostheses. It is generally secondary to prosthetic malfunction and is the cause of anemia. We report a rare case of acute renal insufficiency and severe hemolysis caused by malfunction of a bioprosthesis in the mitral position