A community-based intervention study involving family gardens with aromatic herbs on changes in dietary and urinary sodium

OBJECTIVE

To measure dietary and urinary changes in sodium (Na) intake and excretion through the implementation of family gardens with aromatic herbs and workshops for cooking, using the herbs as a substitute for salt and seasoning powder.

METHODS

Thirty-five participants from a neighborhood of Mexico City were included. A general questionnaire was administered to collect information on sociodemographic factors. At baseline and 3 months later, a dietary evaluation was conducted, and 24-hour urine samples were collected. Food items reported were classified according to the NOVA classification. Visits to participants´ houses were conducted to measure the amount of salt and seasoning powder added to food during the preparation of meals as well as a home food inventory. All participants were given a family garden with 6 aromatic herbs and a recipe book. The intervention included 7 cooking and 3 garden care workshops. Qualitative information on the experience was also collected. Linear regression models were run in order to estimate the contribution of each NOVA group, salt, and seasoning powder to total dietary Na intake.

RESULTS

Participants were 44 years old on average and were mainly women (91.4%). The participation compliance in the workshops was 69.5%. After 3 months, there was a Na intake mean reduction of 976 mg. There was also a reduction in the excreted urinary Na of 325 mg per day.

CONCLUSION

A positive level of involvement in this program had a direct influence on dietary habits to lower Na consumption.

Shu 508 A (Levovist)-enhanced Doppler echocardiography improves the assessment of valvular heart disease

OBJECTIVE

To investigate whether intravenous injection of SHU 508 A improves the diagnostic accuracy of Doppler echocardiography in the assessment of valvular pathologies.

METHODS AND RESULTS

One hundred and twenty-five consecutive patients with valvular pathology (aortic stenosis, n = 48; aortic regurgitation, n = 20; mitral stenosis, n = 21; and mitral regurgitation, n = 36) and diagnostically insufficient Doppler signal were enrolled in this multicenter study. The severity of valvular pathology was graded on a four-point scale using unenhanced and contrast-enhanced Doppler echocardiography as well as cardiac catheterization. Agreement with cardiac catheterization findings increased from 63% using the unenhanced examination to 73% using the contrast-enhanced Doppler examination. Grading was possible in all patients using SHU 508 A, whereas the unenhanced Doppler examination remained inconclusive in six patients. The weighted kappa coefficient between contrast-enhanced Doppler and cardiac catheterization for all diagnoses was 0.76 as compared to 0.68 between unenhanced Doppler and cardiac catheterization. Agreement was especially improved in aortic stenosis (kappa 0.69 unenhanced vs 0.81 contrast-enhanced) and in aortic regurgitation (kappa 0.45 unenhanced vs 0.75 contrast-enhanced). Patients with mitral stenosis and mitral regurgitation experienced less improvement.

CONCLUSIONS

In case of an inconclusive unenhanced Doppler echo study, the administration of a left heart contrast agent should be considered. SHU 508 A is especially useful in improving the severity grading of aortic stenosis and aortic regurgitation, while grading of mitral stenosis and mitral regurgitation is less improved.

The role of enhanced Doppler ultrasound in differentiation of benign vs. malignant scar lesion after breast surgery for malignancy

AIM

To evaluate the benefit of echo-contrast-enhanced Doppler sonography in the differentiation of benign vs. malignant breast lesions after surgical removal of a malignant breast mass.

METHODS

Thirty-eight patients referred for biopsy of a palpable, suspicious scar lesion 1-15 years (mean 3.3 years) after surgery for breast cancer were examined. During baseline ultrasound examination a subjective scoring system of the vascularity, the number, the regularity of vessels' course and their Doppler parameters were assessed. After injection of an ultrasound contrast agent (Levovist) the same scoring system was applied to the parameters together with enhancement kinetics, enhancement intensity and enhancement pattern. Any increase in the scoring level of two or more characteristics (vascularity, number of vessels, intensity of enhancement in the tumor or regularity score of vessels in the lesion) was defined as suspicious for malignancy. A marked increase of enhancement in the immediate tumor periphery was also regarded as suspicious for malignancy. The sonographic results were assessed prospectively and correlated with the histology of the lesion.

RESULTS

Of the 38 patients with a clinically-suspicious scar lesion, there were 28 true scars and 10 malignant scar lesions. All scar lesions showed no or slight vascularity on baseline sonography. After Echocontrast-enhancement a significant increase in tumor vascularity and the number of tumor vessels could be demonstrated in all 10 malignant lesions but in only one of the 28 benign scars.

CONCLUSION

Scars pose inherent technical problems for optimal mammography. Sonographic evaluation of the vascularity of the lesion with contrast enhancing agents showed improved diagnostic accuracy in the hands of an experienced examiner.

Contrast-enhanced colour Doppler ultrasonography in suspected breast cancer recurrence

BACKGROUND

Postoperative scarring and radiotherapy changes in the conservatively treated breast often mimic breast cancer recurrence, resulting in many unnecessary biopsies. Local breast cancer recurrence may be detected more accurately with contrast-enhanced colour Doppler imaging.

METHODS

Fifty-eight women with suspected local breast cancer recurrence were evaluated prospectively by means of conventional and contrast-enhanced colour Doppler imaging before surgical biopsy.

RESULTS

Sensitivity for the detection of breast cancer recurrence using contrast enhancement was 94 per cent (specificity 67 per cent). Contrast enhancement significantly increased overall diagnostic accuracy, from 80 to 90 per cent (P < 0. 04).

CONCLUSION

Contrast-enhanced colour Doppler imaging is a highly accurate method for detecting local breast cancer recurrence. Its adoption may substantially reduce biopsy rates.

Signal-enhanced color Doppler sonography of deep venous thrombosis in the lower limbs and pelvis

Detection of Doppler signal tends to be more difficult in peripheral veins owing to low flow velocity. This can be caused by nonoccluding thrombosis, post-thrombotic wall changes, or a deep anatomic location of pelvic veins. The last-mentioned frequently is accompanied by interference by bowel gas. In addition, inappropriate insonation angles adversely affect the outcome of color-coded Doppler interrogation. The purpose of the present study was to evaluate the effectiveness of signal-enhanced color Doppler sonography on peripheral veins in 31 patients clinically suspected of having deep vein thrombosis. As a result of diagnostic uncertainty, additional enhanced studies were performed on 43 venous segments. The enhancement led to a decrease in false-positive results (from four patients to one patient) and false-negative results (from four patients to two patients) compared to unenhanced studies. Evaluation of the deeply located pelvic veins profited the most through signal enhanced Doppler sonography.

Ultrasound in the investigation of tubal patency. A meta-analysis of three comparative studies of Echovist-200 including 1007 women

DESIGN

This study is a meta-analysis of the results of three clinical studies of the ultrasound echo-contrast agent Echovist-200 with transvaginal contrast sonography (HyCoSy) in the demonstration of tubal patency. Results from 1007 patients were included in the analysis, of whom 986 patients were examined for tubal patency. The HyCoSy findings were compared with those of chromolaparoscopy in 428 cases and with those of hysterosalpingography (HSG) in 202.

RESULTS

The results of HyCoSy and chromolaparoscopy were identical in 294 of 428 patients (68.7%) or in 688 of 828 individual tubes (83.1%). HyCoSy showed "false" occlusion in 85 tubes (10.3%) and "false" patency in 55 (6.7%). The results of HyCoSy and HSG were identical in 138 of 202 patients (68.3%) or in 320 of 384 individual tubes (83.3%). HyCoSy showed "false" occlusion in 49 tubes (12.8%) and "false" patency in 15 (3.9%). The findings of chromolaparoscopy and HSG agreed in 49 of 77 patients (63.6%) or in 116 of 152 tubes (76.3%). HSG showed "false" occlusion in 19 (12.5%) tubes and "false" patency in 17 (11.2%).

TOLERANCE

Echovist-200 was well tolerated. The most frequent adverse event was pain, which was mild in 42.3% of patients and severe in 10.1%. Pain was clearly related to tubal occlusion. Other adverse events such as vasovagal reactions or nausea occurred in 7.0% of patients, but the events required treatment in only 1.9%.

Outcomes of mature primiparas in an out-of-hospital birth center

This is a retrospective chart review of perinatal outcomes of all primiparas over the age of 24 delivering at Maternity Center Associates, an out-of-hospital birth center, from January 1985 through May 1988 (N = 228). Chi-square analysis was used to determine whether mature primiparas, aged 35 to 43 (n = 27), had significantly more adverse outcomes than younger primiparas, aged 25 to 34 (n = 201). There was a significant difference between the groups in rate of transfer to hospital; however, there were no significant differences in rate of cesarean section, infant birth weight, apgar scores, and length of second stage labor. Implications for practice and future study are examined.