Rheologic genesis of discrete subvalvular aortic stenosis: A Doppler echocardiographic study

AbstractTo determine whether morphologic structures or abnormal flow patterns predispose to pathologic proliferation or subvalvular tissue, 26 patients (mean age 19.8 ± 10.3 years) were studied ≥6 months after operation for isolated discrete subvalvular aortic stenosis. The aortic root diameter and the mitral-aortic separation were measured with sector echocardiography. Flow patterns in the left ventricular outflow tract of these patients and control subjects were evaluated with a color flow mapping system optimized for the detection of turbulence.All control subjects had laminar flow throughout systole in the left ventricular outflow tract. By contrast, turbulence originating well below the site where the shelf had previously been resected was observed in 20 (77%) of the 26 patients. In 16 of these 20 patients turbulence was caused by a ridge, which in 13 patients could be identified as the offshoot of a ventricular band. In four patients the turbulence was caused by malalignment of the muscular and membranous septum, resulting in protrusion of the muscular septum into the outflow tract. Except for the latter four patients, the aortic root diameter was 84 ± 10% of values predicted by body surface area, with values in six patients falling below the third percentile (p < 0.01). The mitral-aortic separation was 9.7 ± 3.5 mm, values in 21 patients falling above the 97th percentile (p < 0.001).These data support the theory that discrete subvalvular aortic stenosis may be caused by a chronic flow disturbance, preferably in a small and long outflow tract. Left ventricular bands, if reaching the outflow tract, may be a factor. Because recurrence of subaortic stenosis is a frequent problem, these findings argue for careful echocardiographic and surgical exploration of the outflow tract well below the subvalvular stenosis to detect and resect structures that cause turbulence

Quality of life of patients with chronic lymphocytic leukaemia in the Netherlands: results of a longitudinal multicentre study

Purpose: To describe the health-related quality of life (HRQoL) of an unselected population of patients with chronic lymphocytic leukaemia (CLL) including untreated patients. Methods: HRQoL was measured by the EORTC QLQ-C30 including the CLL16 module, EQ-5D, and VAS in an observational study over multiple years. All HRQoL measurements per patient were connected and analysed using area under the curve analysis over the entire study duration. The total patient group was compared with the general population, and three groups of CLL patients were described separately, i.e. patients without any active treatment (“watch and wait”), chlorambucil treatment only, and patients with other treatment(s). Results: HRQoL in the total group of CLL patients was compromised when compared with age- and gender-matched norm scores of the general population. CLL patients scored statistically worse on the VAS and utility score of the EQ-5D, all functioning scales of the EORTC QLQ-C30, and the symptoms of fatigue, dyspnoea, sleeping disturbance, appetite loss, and financial difficulties. In untreated patients, the HRQoL was slightly reduced. In all treatment stages, HRQoL was compromised considerably. Patients treated with chlorambucil only scored worse on the EORTC QLQ-C30 than patients who were treated with other treatments with regard to emotional functioning, cognitive functioning, bruises, uncomfortable stomach, and apathy. Conclusions: CLL patients differ most from the general population on role functioning, fatigue, concerns about future health, and having not enough energy. Once treatment is indicated, HRQoL becomes considerably compromised. This applies to all treatments, including chlorambucil, which is considered to be a mild treatment

CERVICAL MOTOR DYSFUNCTION AND ITS PREDICTIVE VALUE FOR LONG-TERM RECOVERY IN PATIENTS WITH ACUTE WHIPLASH-ASSOCIATED DISORDERS: A SYSTEMATIC REVIEW

OBJECTIVE: To study the presence of cervical motor dysfunctions in acute whiplash-associated disorders, evaluate their course and assess their predictive value for long-term recovery. DESIGN: Systematic literature review. METHODS: PubMed and Web of Science databases were used to select studies of the presence of cervical motor dysfunctions within the acute stage (< 6 weeks) after whiplash trauma and/or their predictive value for the development of chronic whiplash-associated disorders. RESULTS: The presence of cervical motor dysfunctions in the acute stage after whiplash trauma was investigated in 4 cohorts. The course of cervical motor dysfunctions in whiplash-associated disorders was examined in 4 cohorts, and the predictive value on outcome 1 year post-whiplash trauma was assessed in 3 cohorts. Reduced cervical mobility, disturbed kinaesthesia, and altered muscle activity were found in the acute stage, and these persisted over time in the moderate/severe group. The predictive value of examining the presence of cervical motor dysfunctions was doubtful. The course and predictive value of initial reduced cervical mobility was inconsistent. CONCLUSION: Cervical motor dysfunctions are present soon after whiplash trauma persisting in those with moderate/severe symptoms. However, these dysfunctions have limited predictive value, and hence may not explain the complex clinical picture of whiplash-associated disorders. This systematic review highlights the need for differentiating between patients with acute whiplash-associated disorders taking into account the biopsychological framework.status: publishe

The predictive value of interleukin-8 (IL-8) in hospitalised patients with fever and chemotherapy-induced neutropenia

Aim: To demonstrate whether serum Interleukin-8 (IL-8) is a relevant parameter to select hospitalised patients with chemotherapy-induced neutropenic fever with low or high probability of infection. Results: 90 assessable febrile episodes in 73 patients were evaluated; 46% of the febrile episodes were microbiologically documented infection (MDI), 8% clinical documented infection (CDI), and 47% fever of unknown origin (FUO). Median IL-8 level was lower in the FUO group compared to CDI and MDI (p = 60 ng/l while in 18 of 21 episodes (86%) with IL-8 level = 60 ng/l and responsive on antibiotic treatment showed a decline of IL-8 levels within days in contrast to non-responding patients. Conclusions: Serum IL-8 level can be a useful marker to identify hospitalised FUO patients with low probability of infection. (C) 2008 Elsevier Ltd. All rights reserved