Chidicon Medical Center

AIM: The application of ultrasound may be suitable for evaluating the effects of intestinal cytoskeletal rearrangement of the duodenum and colon as a result of exposure to live Giardia lamblia trophozoites. We studied the sonographic appearance of the duodenum and colon in giardiasis compared with amebiasis and healthy subjects. METHODS: Sonographic images obtained from 100 consecutive patients with symptomatic giardiasis were compared to those taken from 40 patients with amebiasis and 40 healthy subjects. B-mode ultrasound examination of the duodenum and colon was performed using a 7.5 MHz annular array transducer. Gray scale images with water contrast were acquired. RESULTS: Normal duodenum and colon echoanatomy were demonstrated. Giardial lesions of the duodenum and colon were associated with increased wall thickness when compared with healthy subjects (P < 0.05). Furthermore, giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci (HFF) demonstrating chaotic motility, increased peri-lesional tissue echogenicity, and altered colonic peristalsis. In amebiasis, focal hyperechoic wall thickening was seen at lesion sites identified as amebomas with increased wall echogenicity, but otherwise normal duodenal folds and colonic haustration. There were no HFF with chaotic motility, rather intestinal contents showed bulk motility in patients with amebiasis. There was no focal colonic wall motion abnormality observed. CONCLUSION: B-mode imaging with water contrast demonstrated details of duodenal and colonic echoanatomy. There were sonographic features of giardial lesions of the duodenum and colon that were distinct from those in amebiasis and healthy subjects.

BACKGROUND: This study was designed to determine the minimal mean flow velocity and pressure-flow relation necessary to preserve human consciousness. METHODS: Passive upright tilt provocation was used in conjunction with transcranial Doppler in 80 patients with a history of syncope of unknown etiology. Cerebral blood flow velocity, blood pressure, and heart rate were monitored noninvasively. RESULTS: Forty patients remained asymptomatic, and the rest had clinically induced true syncope or premonitory symptoms. In the asymptomatic group, there was a 23 +/- 16% (p = 0.000) drop in mean flow velocity, but no significant changes in systolic and diastolic blood pressures. In the symptomatic patients, there was a 58 +/- 14% (p = 0.000) drop in mean flow velocity, 37 +/- 23% (p = 0.000) fall in systolic pressure, and 31 +/- 20% (p = 0.000) fall in diastolic pressure. In 80% of symptomatic patients, the critical lower limit of mean flow velocity was at -50% of resting baseline while patients were lying supine. The symptomatic group had lower mean flow velocity and blood pressure responses as compared with the asymptomatic group. The slope and intercept values of the pressure (y axis) to flow velocity (x axis) regression curves indicate a greater degree of impaired autoregulation in the symptomatic group (y = 0.529 x-6.11, r2 = 0.108, p = 0.038) as compared with the asymptomatic (y = 0.317 x + 0.966, r2 = 0.14, p = 0.017). CONCLUSIONS: The critical lower limit of cerebral perfusion lies at 50% below baseline supine mean flow velocity.

OBJECTIVE: To assess the hemodynamic features, including monitoring of cerebral circulation, blood pressure and heart rate, in syncope patients during upright tilt test. DESIGN: Nonrandomized sequential patients with history of syncope of uncertain etiology compared with healthy subjects. SETTING: Noninvasive hemodynamic laboratory of a tertiary referral centre. PATIENTS: Twenty patients with history of syncope and 10 controls without syncope. PROCEDURES: Transcranial Doppler measurement or middle cerebral artery flow velocity, noninvasive and invasive blood pressure monitoring, electrocardiography and pulse oximetry monitoring during upright tilt testing. Measurements were taken in patients at the height of symptoms in supine and upright posture. MAIN RESULTS: Ten patients, while still normotensive, had a drop of 53 +/- 10% (mean +/- SD) in cerebral bloodflow velocity (P = 0.0001) and an increase in heart rate by 58 +/- 35%. The remaining 10 patients had a 58 +/- 15% reduction in cerebral bloodflow velocity (P = 0.0001), a drop in blood pressure of 33 +/- 8% (P = 0.0001) and no change in heart rate. The controls showed no significant changes in cerebral bloodflow velocity and a 25 +/- 12% increase in heart rate (P = 0.0002). CONCLUSIONS: Transcranial Doppler monitoring of cerebral bloodflow velocity during upright tilt testing may improve insight into the complex physiology of syncope.

The transcranial Doppler (TCD) studies performed in 54 patients with various forms of cardiac dysfunction were reviewed and the results compared with those of normal individuals. There were 4 patients with aortic insufficiency, 5 being treated by intra-aortic balloon pumps, 12 patients with atrial fibrillation, 11 with syncope, and 22 undergoing cardiopulmonary resuscitation. In all instances, significantly low or even absent diastolic cerebral perfusion was found. The importance of this parameter, in the future evaluation and management of similar patients, is discussed.

Among the poor in developing countries, up to 20% of an infant's life experience may include diarrhea. This problem is spatially related to the lack of potable water at different sites. This project used risk analysis (RA) methods and geographic information system (GIS) technologies to evaluate the health impact of water source. Maps of Imo State, Nigeria were converted into digital form using ARC/INFO GIS software, and the resulting coverages included geology, hydrology, towns, and villages. A total of 11,537 diarrheal cases were reported. Thirty-nine water sources were evaluated. A computer modeling approach called probabilistic layer analysis (PLA) spatially displayed the water source at layers of geology, hydrology, population, environmental pollution, and electricity according to a color-coded five-point ranking. The water sources were categorized into A, B, and C based on the cumulative scores < 10 for A, 10-19 for B, and > 19 for C. T-test showed revealed significant differences in diarrheal disease incidence between categories A, B, and C with mean +/- SEM values of 1.612 +/- 0.325, 6.257 +/- 0.408, and 15.608 +/- 2.151, respectively. The differences were significant between categories A and B (P = 0.0000022), A and C (P = 0.0000188), and B and C (P = 0.0011348). The PLA enabled estimation of the probability of the risk of diarrheal diseases occurring at each layer and solutions to eliminate these risks.

We performed Fourier analysis of the middle cerebral artery blood flow velocity waveform envelope in 14 normal subjects (group A) and 15 patients, of whom five had arteriovenous malformations (group B), five had cerebral vasospasm (group C), and five had arterial hypertension (group D). Measurements were obtained under conditions of normocapnia, hypercapnia, and hypocapnia. The Fourier coefficients measured in the first five harmonics of the Doppler waveforms of group A were used as the reference baseline and were compared with the coefficients found in the other three groups. Group B showed significantly lower Fourier coefficients, while groups C and D showed higher coefficients (p less than 0.05). The elevation of the Fourier coefficients occurred in an alternating pattern in group C and a decremental pattern in group D. This distinction was attributed to possible differences in the underlying pathophysiological processes. The degree of vascular distensibility of the cerebral arterioles, inferred from the shape of the Fourier analysis curves, was compared in all four groups. Vascular distensibility was characterized as abnormal in arteriovenous malformations, vasospasm, and arterial hypertension. Fourier coefficients may be better indicators of cerebrovascular abnormalities than mean blood flow velocity in hypertension and pulsatility index in arteriovenous malformations, vasospasm, and hypertension.

Simultaneous color contrast and color constancy are memory processes associated with color vision, however, the gender-related differences of 'physiologic color space' remains unknown. Color processing was studied in 16 (8 men and 8 women) right-handed healthy subjects using functional transcranial Doppler (fTCD) technique. Mean flow velocity (MFV) was recorded in both right (RMCA) and left (LMCA) middle cerebral arteries in dark and white light conditions, and during color (blue and yellow) stimulations. The data was plotted in a 3D quadratic curve fit to derive a 'physiologic color space' showing the effects of luminance and chromatic contrasts. In men, wavelength-differencing of opponent pairs (yellow-blue) was adjudged by changes in the RMCA MFV for Yellow plotted on the Y-axis, and the RMCA MFV for Blue plotted on the X-axis. In women, frequency-differencing for opponent pairs (blue-yellow) was adjudged by changes in the LMCA MFV for Yellow plotted on the Y-axis, and the LMCA MFV for Blue plotted on the X-axis. The luminance effect on the LMCA MFV in response to white light with the highest luminous flux, was plotted on the (Z - axis), in both men and women. The 3D-color space for women was a mirror-image of that for men, and showed enhanced color constancy. The exponential function model was applied to the data in men, while the logarithmic function model was applied to the data in women. Color space determination may be useful in the study of color memory, adaptive neuroplasticity, cognitive impairment in stroke and neurodegenerative diseases.

Recent studies have led to the re-discovery of the protein originally described as macrophage-migration inhibitory factor (MIF) to be both a pituitary hormone and a pro-inflammatory, macrophage cytokine. MIF is a pivotal mediator in endotoxic shock and may serve as a pituitary "stress" hormone that regulates systemic inflammatory responses.

Facial processing was studied in 16 (eight men and eight women) right-handed healthy participants using a new functional transcranial Doppler technique called functional transcranial Doppler spectroscopy (fTCDS). MFV was recorded simultaneously in both right and left middle cerebral arteries in dark condition and during visual processing of object and facial tasks. fTCDS used Fourier analysis of mean flow velocity (MFV) time series to derive spectral density estimates that correlate with expected mental activity. Men were right lateralised for object and facial perception, while women were left lateralised for facial tasks but showed a right tendency or no lateralisation for object perception. For facial perception, men used a category-specific process-mapping system for right cognitive style, but women used same for the left.

Foi realizado um experimento no Departamento de Zootecnia com o objetivo de determinar os melhores valores de balanço eletrolítico (BE) para pintos de corte. Utilizaram-se 2.112 pintinhos da marca comercial Ross, machos, criados em boxes de galpão de alvenaria, cama de maravalha e alimentados com duas rações basais, uma com 20 e outra com 23% de proteína bruta (PB), à base de milho e de farelo de soja, combinadas com níveis de BE de 0, 50, 100, 150, 200, 250, 300 e 350 mq/kg. Foi utilizado delineamento experimental inteiramente casualizado, em esquema fatorial 8x2 (oito níveis de BE e dois níveis de PB), seis repetições e 22 aves por unidade experimental. Avaliaram-se o ganho de peso (GP), o consumo de ração (CR) e a conversão alimentar (CA) de pintos de corte aos 7, 14 e 21 dias de idade. Os melhores valores de BE para o CR, aos 21 dias, foram 185 (20% PB) e 194 (23% PB) mEq/kg. Entretanto, para o GP, os ótimos valores de BE obtidos foram 166 (20% PB) e 177 (23% PB) mEq/kg. Fora desses níveis de BE, houve restrição do CR e provável aumento do consumo de água. A CA não apresentou efeito significativo. Os ótimos valores de BE devem estar na faixa de 166 a 177 mEq/kg para o ótimo desempenho dos pintos de 1 a 21 dias. Foi também verificado que é possível diminuir o nível de PB das rações sem afetar o desempenho das aves, desde que haja adequada suplementação de aminoácidos essenciais, de forma a suprir o requerimento desses animais.

Foi realizado um experimento com o objetivo de determinar os melhores valores de balanço eletrolítico (BE) para frangos de corte de 1 a 42 dias de idade. Na fase inicial, utilizaram-se 2.112 pintinhos machos da linhagem comercial Ross, criados em boxes de galpão de alvenaria cobertos com maravalha e alimentados com duas rações basais, uma com 20 e outra com 23% de proteína bruta (PB) à base de milho e de farelo de soja, combinadas com níveis de BE de 0; 50; 100; 150; 200; 250; 300 e 350 mq/kg. Na fase de crescimento, utilizaram-se 1.728 frangos oriundos da fase inicial e apenas uma ração basal com 20% de PB. Foi utilizado delineamento experimental inteiramente casualizado, em esquema fatorial 8 x 2 (oito níveis de BE e duas seqüências protéicas), seis repetições e 18 aves por unidade experimental na fase de crescimento. Avaliaram-se o ganho de peso (GP), o consumo de ração (CR), a conversão alimentar (CA), o rendimento de carcaça, os cortes nobres e a matéria seca na cama das aves aos 42 dias de idade. Os melhores valores de BE estimados foram 179 (20-20% PB) e 185 (23-20% PB) mEq/kg e valores similares foram encontrados para os maiores CR, 193 (20-20% PB) e 192 (23-20% PB) mEq/kg. A CA teve como melhor valor estimado 159 (23-20%) mEq/kg, um pouco abaixo dos valores de BE obtidos para GP e CR. Para o rendimento de carcaça e de cortes nobres, os melhores valores de BE foram similares aos de desempenho. Os valores de BE obtidos para os maiores teores de matéria seca na cama das aves foram 138 (20-20%) e 148 (23-20%) mEq/kg. Considerando-se os dados obtidos, recomenda-se um valor de BE na faixa de 160 a 190 mEq/kg como ótimo para frangos de corte de 1 a 42 dias de idade.

To determine the effect of tilt isoproterenol provocation on cerebral perfusion in a patient with denervated heart, transcranial Doppler sonography was used to assess changes in cerebral blood flow velocity during upright tilt test. A 51-year-old man with history of syncopal spells after heart transplantation was evaluated by using upright tilt test with and without isoproterenol for 30 minutes, respectively, at 80 degrees inclined. Mean cerebral blood flow was measured in the main stem of the right middle cerebral artery. Blood pressure and heart rate were noninvasively monitored. Tilt isoproterenol provocation but not tilt alone induced a significant reduction in cerebral blood flow velocity, without remarkable hypotension. There was no change in respiratory activity. This may indicate that vagal reflexes are not implicated in the mechanism of isoproterenol to induce cerebral hypoperfusion and hence neurally mediated syncope.

BACKGROUND AND PURPOSE: The present study was designed to examine the effects of color stimulation on cerebral blood mean flow velocity (MFV) in men and women. METHODS: The study included 16 (8 men and 8 women) right-handed healthy subjects. The MFV was recorded simultaneously in both right and left middle cerebral arteries in Dark and white Light conditions, and during color (Blue, Yellow and Red) stimulations, and was analyzed using functional transcranial Doppler spectroscopy (fTCDS) technique. RESULTS: Color processing occurred within cortico-subcortical circuits. In men, wavelength-differencing of Yellow/Blue pairs occurred within the right hemisphere by processes of cortical long-term depression (CLTD) and subcortical long-term potentiation (SLTP). Conversely, in women, frequency-differencing of Blue/Yellow pairs occurred within the left hemisphere by processes of cortical long-term potentiation (CLTP) and subcortical long-term depression (SLTD). In both genders, there was luminance effect in the left hemisphere, while in men it was along an axis opposite (orthogonal) to that of chromatic effect, in women, it was parallel. CONCLUSION: Gender-related differences in color processing demonstrated a right hemisphere cognitive style for wavelength-differencing in men, and a left hemisphere cognitive style for frequency-differencing in women. There are potential applications of fTCDS technique, for stroke rehabilitation and monitoring of drug effects.

INTRODUCTION: Ability to interpret facial expression is crucial for non-verbal communication among humans, and could be affected by changes in cerebral circulation during exposure to microgravity or its simulation. METHODS: There were 16 subjects (8 men and 8 women) who were exposed to 24 h of -6 degrees head-down rest (HDR). Transcranial Doppler ultrasonography was used to monitor mean blood flow velocity (MBFV) in the middle cerebral arteries bilaterally during processing of facial images before, at 6 and 24 h of HDR, and after HDR (Pre-, 6H-, 24H-, and Post-HDR, respectively). The laterality index was assessed as side-to-side differences in MBFV relative to Pre-HDR for each condition. RESULTS: For Pre-HDR, both objects and faces were right lateralized in men (p < 0.001) and showed a left lateralization tendency in women (p > 0.05). At 6H-HDR, both object and faces were left lateralized in men (p < 0.05), but right lateralized in women (p < 0.001). At 24H-HDR, both men and women were left lateralized (p < 0.05). For Post-HDR, both remained left lateralized for all tasks (p < 0.05). DISCUSSION: HDR alters cerebral lateralization for object and facial stimuli, with opposing tendencies in men and women. The gender differences may reflect peculiarities in processing strategy for object and faces between men and women. Men use a right hemisphere processing strategy for faces and women a left hemisphere strategy. The superiority of processing of faces by women compared with men has been attributed to left hemisphere based strategy. HDR alters lateralization patterns and may thus alter processing strategies for faces.

A non-invasive method which combines the simultaneous measurement of mean arterial blood pressure (MBP), heart rate (HR) and mean cerebral blood flow velocity (MFV) was used to monitor patients with history of syncope, in horizontal and vertical posture tilt at 80 degrees. MFV in the right middle cerebral artery was measured using a transcranial Doppler instrument (TCD). MFV decreased concurrently with the onset of symptoms, and at the time of syncope reached an average of 68% below pre-tilt values. At the same time MBP showed an average decline of 25%, and HR increased by 38%. There was no correlation between MBP and MFV, at the onset of tilt, presyncope and syncope. MFV, but not HR or MBP, showed significant transition from one condition to the other. These data suggest that there may be a useful application of TCD measurements of MFV in aeromedical evaluation of syncope or syncopal tendency. These measurements would necessarily be used in conjunction with a tilt-table procedure. The possibility exists that MFV might be useful to preclude the actual occurrence of syncope in test subjects, or to show an abnormal tendency toward syncope, but will require more extensive testing than that carried out in the present study.

INTRODUCTION: Color processing is a central component of mammalian vision. Gender-related differences of color processing revealed by non-invasive functional transcranial Doppler ultrasound suggested right hemisphere pattern for blue/yellow chromatic opponency by men, and a left hemisphere pattern by women. MATERIALS AND METHODS: The present study measured the accumulation of [18F]fluorodeoxyglucose ([18F]FDG) in mouse brain using small animal positron emission tomography and magnetic resonance imaging (PET/MRI) with statistical parametric mapping (SPM) during light stimulation with blue and yellow filters compared to darkness condition. RESULTS: PET revealed a reverse pattern relative to dark condition compared to previous human studies: Male mice presented with left visual cortex dominance for blue through the right eye, while female mice presented with right visual cortex dominance for blue through the left eye. We applied statistical parametric mapping (SPM) to examine gender differences in activated architectonic areas within the orbital and medial prefrontal cortex and related cortical and sub-cortical areas that lead to the striatum, medial thalamus and other brain areas. The metabolic connectivity of the orbital and medial prefrontal cortex evoked by blue stimulation spread through a wide range of brain structures implicated in viscerosensory and visceromotor systems in the left intra-hemispheric regions in male, but in the right-to-left inter-hemispheric regions in female mice. Color functional ocular dominance plasticity was noted in the right eye in male mice but in the left eye in female mice. CONCLUSIONS: This study of color processing in an animal model could be applied in the study of the role of gender differences in brain disease.

In Space, central cognitive operations are unaffected but humans are slower in perceptual-motor performance. Transcranial Doppler ultrasonography was used to monitor blood flow velocity in both middle cerebral arteries during unilateral and bilateral fingers' movements before, during and after -6 degrees 24 hours of head-down tilt (HDT) in 14 (8 males and 6 females) subjects. Physiologic hemisphere dominance was assessed by breath-holding test. There was a significant main effect of motor task, F(4, 328) = 16.05, p<0.00000001, MSe = 48.2. There was a gender vs head-position interaction F(3,246) = 4.90 p<0.002) MSe = 120. At pre-HDT females were right lateralized and males were left lateralized. A left shift in lateralization pattern was seen during 24hrs-HDT for both genders. There was a significant main effect of breath-holding test and a breath-holding test vs head position vs motor task interaction. HDT alters cerebral lateralization for motor control and this may be responsible for slowing in perceptual-motor performance in Space. TCD monitoring may be required for motor performance tasks in Space.

Background: Worldwide G. lamblia is the third most common agent of diarrheal disease with over 300 million cases annually. Simple technical notes for clinicians are presented on use of high-frequency ultrasound imaging for duodenography and colonography in patients with Giardia lamblia infection. Methods: Ultrasound images were obtained from 100 consecutive patients with symptomatic giardiasis and 40 healthy controls. High-frequency annular array transducer of 7.5 MHz was used to obtain B-mode ultrasound grayscale and color images of the duodenum and colon with and without water contrast. The diagnosis of G. lamblia was based on clinical presentation, serial stool microscopy, and finding of flagellates in duodenal aspirates. Results: We demonstrated normal duodenum and colon echoanatomy in control subjects. In patients with giardiasis, the lesions of the duodenum and colon were associated with increased dimensions and wall thickness compared to healthy controls ( P &lt; 0.05). The ultrasound features of giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci demonstrating chaotic motility, increased perilesional tissue echogenicity, and altered colonic peristalsis. Conclusion: In conclusion, high-frequency B-mode ultrasound imaging with and without water contrast demonstrated the details of duodenal and colonic echoanatomy in normal subjects and patients with giardiasis. The technique could be applied in the clinical setting of rural practitioners.

INTRODUCTION: Lichen simplex chronicus has been defined as a localized skin condition characterized by thickening, hyperpigmentation and accentuated skin markings from chronic itching and from repeated scratching. The affected skin area is usually described as demarcated, and often circumscribed. It has even been defined as a "psychogenic pruritic disorder". The idea of a neurological component has also been suggested, hence the term 'neurodermatitis circumscripta'. However, the pathophysiology of this condition remains unclear. Several associations and etiologies have been reported in literature, including strong links with mental disorders-anxiety and obsessive compulsive disorder to be specific. We report this case, most importantly, to highlight the value of an open-minded approach to patients and the 'old-fashioned' physician character of empathy, the skill of detailed history taking and physical examination, and lastly to suggest that lichen simplex chronicus may not always present as a localized, 'circumscripta' or demarcated area of skin. CASE DESCRIPTION: When a sixty-five year-old Caucasian female presented to our clinic agitated, intensely scratching her entire body and complaining of severe pruritus, an open-minded detailed approach during history taking and physical examination led to the working diagnosis of diffuse lichenification from chronic scratching secondary to a "possible" cutaneous disorder. Her medical history was unremarkable, but her psychiatric history was significant for Anxiety disorder. She remained on her anxiolytic medication. Her presenting symptom was reported to have persisted for more than 9 months. Review of previous unremarkable lab results and a remarkable findings on detailed skin inspection led to an empiric, trial regimen consisting of three topical preparations: an anti-pruritic-to break the itch-scratch cycle, anti-inflammatory-to curb any inflammatory/immune response and a 'last-ditch' scabicidal application. Follow-up was scheduled, but the patient called the office requesting an earlier follow up appointment. The lesions had significantly improved and the hyper-pigmented, indurated and escoriated skin appearance had resolved; and most importantly, the pruritus. CONCLUSION: Thus we conclude that lichen simplex chronicus may not always present as circumscribed or localized area of skin as currently noted in literature. Also, in patients with psychiatric conditions including anxiety and obsessive-compulsive disorder in particular, effort should be made to avoid stereotyping their presentation as part of their mental disorder spectrum. The value of detailed history and physical examination, mixed with empathy is highlighted. We make our recommendation considering the profound turnaround in the patient's condition and quality of life after several months of emotional and psychological suffering.

High-frequency ultrasound imaging was used to evaluate the intestinal walls of the duodenum and colon in patients with intestinal parasitic infections. Ultrasound images were obtained from 100 consecutive patients with symptomatic intestinal parasitic diseases and 40 healthy controls. High-frequency annular array transducer of 7.5 MHz was used to obtain B-mode ultrasound gray-scale and color images of the duodenum and colon with and without water contrast. The diagnosis of parasitic infections was based on clinical presentation, serial stool microscopy, and finding of parasites in duodenal aspirates. We demonstrated normal duodenum and colon echoanatomy in control subjects. In patients with giardiasis, the lesions of the duodenum and colon were associated with increased dimensions and wall thickness compared to healthy controls (p &lt; 0.05). The ultrasound features of giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds, and/or colonic haustration, hyperechoic floating foci demonstrating chaotic motility, increased perilesional tissue echogenicity, and altered colonic peristalsis. In amebic lesions there were hyperechoic floating foci with bulk motility. There is loss of wall thickness at amebic ulcer sites or wall thickening at amebic granuloma. Helminths were visualized as large hyperechoic linear or curvilinear foci with serpentine or jolting motility. In conclusion, high-frequency B-mode ultrasound imaging with water contrast demonstrated details of duodenal and colonic echoanatomy in normal subjects and patients with giardiasis.