Mechanical properties in the human gastric antrum using B-mode ultrasonography and antral distension

The aims of this study were to investigate gastric antral geometry and stress-strain properties by using transabdominal ultrasound scanning during volume-controlled distensions in the human gastric antrum. Seven healthy volunteers underwent stepwise inflation of a bag located in the antrum with volumes up to 60 ml. The stretch ratio and Cauchy stress and strain were calculated from measurements of pressure, diameter, and wall thickness. A second distension series was conducted in three volunteers during administration of the anticholinergic drug butylscopolamine. Analysis of stretch ratios demonstrated positive strain in the circumferential direction, negative strain in the radial direction, and no strain in the longitudinal direction. The stress-strain relation was exponential and did not differ without or with the administration of butylscopolamine. The wall stress was decomposed into its active and passive components. The well-known length-tension diagram from in vitro studies of smooth muscle strips was reproduced. The maximum active tension appeared at a volume of 50 ml, corresponding to a stretch ratio of 1.5. We conclude that the method provides measures of antral biomechanical wall properties and can be used to reproduce the muscle length-tension diagram in humans.

Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations

The non-invasive quantification of regional myocardial function is an important goal in clinical cardiology. Myocardial thickening/thinning indices is one method of attempting to define regional myocardial function. A new ultrasonic method of quantifying regional deformation has been introduced based on the principles of 'strain' and 'strain rate' imaging. These new imaging modes introduce concepts derived from mechanical engineering which most echocardiographers are not familiar with. In order to maximally exploit these new techniques, an understanding of what they measure is indispensable. This paper will define each of these modalities in terms of physical principles and will give an introduction to the principles of data acquisition and processing required to implement ultrasonic strain and strain rate imaging. In addition, the current status of development of the technique and its limitations will be discussed, together with examples of potential clinical applications.

High frame rate strain rate imaging of the interventricular septum in healthy subjects

OBJECTIVE

In the present study the feasibility was assessed of a new strain rate imaging method with a very high frame rate of around 300 frames per second.

METHODS

Digital radio-frequency (RF) data were obtained in nine healthy subjects using a sector of 20-30 degrees in an apical four chamber view. The RF data were analysed using a dedicated software package that displays strain rate images and profiles and calculates strain rate values. With the new method, it is possible to study events and spatial-temporal differences in the heart cycle with duration down to 3.5-3 ms, including the pre-ejection period and the isovolumic relaxation period. Since the interventricular septum (IVS) is of crucial importance for the left and right ventricular function, we assessed changes through the heart cycle of the strain rate in the IVS.

RESULTS

Mean peak systolic strain rate in the healthy subjects was -1.65+/-0.13 s(-1). Mean peak diastolic strain rate during early filling was 3.14+/-0.50 s(-1) and during atrial systole 0.99+/-0.09 s(-1). We found individual differences in the strain rate patterns, but in all subjects, the ventricular contraction started simultaneously in all parts of the septum. After the ejection period, the elongation started before aortic valve closure, in the midinferior septum and propagated towards the apex.

CONCLUSION

High frame rate strain rate imaging makes it possible to study rapid deformation patterns in the heart walls.

Strain rate imaging in normal and reduced diastolic function: comparison with pulsed Doppler tissue imaging of the mitral annulus

OBJECTIVES

The pixel velocity values obtained by color Doppler tissue imaging (DTI) can be processed to velocity gradients as a measure of longitudinal strain rate with a technique termed strain rate imaging (SRI). Color mapping of strain rate does show the spatial-temporal relations of the diastolic phases. The phases of early filling and late filling during atrial systole can be seen to consist of a stretch wave in the myocardium, propagating from the base to the apex. Diastolic function is characterized by both peak strain rate and propagation velocity of this wave. The goals of this study were to establish normal values for these measurements and to study the changes with minimal diastolic dysfunction.

METHODS

Twenty-eight healthy control subjects and 26 patients with hypertension and normal systolic function were studied. The patients had normal blood pressure on treatment, normal ejection fraction, minimal hypertrophy, and moderately prolonged deceleration and isovolumic relaxation times. Real-time SRI color cineloops, ordinary echocardiography and Doppler recordings, and pulsed wave DTI from the mitral ring were acquired and processed.

RESULTS

Patients showed a reduction of systolic and early diastolic tissue velocities and strain rates and no significant increase in late diastolic tissue velocity and strain rate. Propagation velocity of diastolic strain during both early and late filling phases was reduced in the patients. The combination of changes in peak strain rate and propagation velocity of strain rate corresponded with changes in DTI.

CONCLUSION

Diastolic deformation of the ventricle can be shown as a complex series of events, with temporal sequences in the ventricle. The peak strain rate and the propagation velocities of strain rate can describe the two main diastolic events: early and late filling. In reduced diastolic function, both are reduced during early filling. The velocities of the mitral ring are the result of this combination. This adds information about the physiology and pathophysiology of diastole.

Strain rate imaging by ultrasonography in the diagnosis of coronary artery disease

Regional strain rate in the left ventricle can be assessed in real time and color mapped. The method is termed strain rate imaging (SRI), and findings correspond well with 2-dimensional echocardiography. This study addresses SRI as a method for localizing coronary lesions, compared with standard echocardiography. Twenty patients with acute myocardial infarction who underwent coronary angiography for clinical reasons were examined with SRI and standard echocardiography. Wall motion was graded by SRI color and separately by wall thickening. Strain rate imaging and 2-dimensional echocardiography results agreed well. An infarct-related artery was identified from angiograms combined with electrocardiograms. Both methods identified an infarct-related artery in 19 possible cases and had equal sensitivity and specificity for wall segments affected by lesion. Combining the information from both methods did not change accuracy. The study validates SRI as a method for assessing regional wall function in coronary artery disease. The advantages of SRI are discussed and measurements of strain rates are given.

Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations

The non-invasive quantification of regional myocardial function is an important goal in clinical cardiology. Myocardial thickening/thinning indices is one method of attempting to define regional myocardial function. A new ultrasonic method of quantifying regional deformation has been introduced based on the principles of 'strain' and 'strain rate' imaging. These new imaging modes introduce concepts derived from mechanical engineering which most echocardiographers are not familiar with. In order to maximally exploit these new techniques, an understanding of what they measure is indispensable. This paper will define each of these modalities in terms of physical principles and will give an introduction to the principles of data acquisition and processing required to implement ultrasonic strain and strain rate imaging. In addition, the current status of development of the technique and its limitations will be discussed, together with examples of potential clinical applications.

Real-time strain rate imaging of the left ventricle by ultrasound

The regional function of the left ventricle can be visualized in real-time using the new strain rate imaging method. Deformation or strain of a tissue segment occurs over time during the cardiac cycle. The rate of this deformation, the strain rate, is equivalent to the velocity gradient, and can be estimated using the tissue Doppler technique. We present the strain rate as color-coded 2-dimensional cine-loops and color M-modes showing the strain rate component along the ultrasound beam axis. We tested the method in 6 healthy subjects and 6 patients with myocardial infarction. In the healthy hearts, a spatially homogeneous distribution of the strain rate was found. In the infarcted hearts, all the infarcted areas in this study showed up as hypokinetic or akinetic, demonstrating that this method may be used for imaging of regional dysfunction. Shortcomings of the method are discussed, as are some possible future applications of the method.

Stomatococcus mucilaginosus septicemia in two bone marrow transplanted patients

A 44-year-old man with chronic myeloid leukemia and a 10-year-old boy with adrenoleukodystrophy, both admitted for bone marrow transplantation in December 1992, developed clinical signs of septicemia within 2 weeks after transplantation. Three strains of Stomatococcus mucilaginosus were isolated from blood cultures. These were among the first cases of S. mucilaginosus infection diagnosed at our Laboratory and the first reported from Scandinavia. S. mucilaginosus is part of the endogenous oral flora. Both patients had signs of oral mucositis. All 3 strains were isolated earlier with the Laboratory's present blood culture system, compared with the one in use before spring 1992.

A low molecular weight heparin (KABI 2165) for prophylaxis of postoperative deep venous thrombosis

In a prospective double-blind trial, low molecular weight (LMW) heparin (KABI 2165) 5,000 U (anti-Xa) once daily was compared with conventional heparin 5,000 IU twice daily, both given subcutaneously, as regards prevention of postoperative deep venous thrombosis (DVT) in 52 patients undergoing major abdominal surgery. Radioactive fibrinogen uptake test (FUT) was used for DVT screening. DVT, diagnosed from positive FUT, developed in two patients from each group, but could be phlebographically confirmed in only one (LMW) case. No intergroup differences were found in peroperative blood loss or requirements for blood transfusion. Complications attributable to the prophylactic regimens were few. In the LMW-heparin group, the anti-Xa levels measured during operation showed considerable variation, the higher activities (greater than 0.30 U/ml) being nonsignificantly associated with increased blood loss. Studies with lower doses of LMW-heparin are recommended.

Recurrent central odontogenic fibroma

This article presents a case of a central odontogenic fibroma which recurred 9 years after it was enucleated. Very few cases of this tumor have been recognized and reported. The clinical and histopathologic criteria and the differential diagnosis of the lesion are stressed.