Explore the vast range of titles available.

The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography (CEUS) compared to grayscale B-mode and color Doppler ultrasound in differentiate benign versus malign superficial cervical lymph nodes. In a prospective study ultrasonography (gray scale, color and spectral Dopller, and CEUS) was performed in 161 patients (33 men, 28 women; mean age of 51.2 years, range: 18-81 years), with cervical lymphadenopathy. The nodes were examined and biopsied or surgically removed. CEUS was performed with 2.4 ml intravenous bolus of contrast agent Sono Vue and the results were registered with a special software. ROC analysis confirmed the higher degree of diagnostic accuracy of CEUS in comparison with conventional techniques for some parameters such as enhancement pattern. Evaluation of nodal perfusion with this method can be helpful in the differentiation of benign from malignant nodes but requires further confirmation.

Background delayed gastric emptying is detectable in 20–40% of patients with type 1 and type 2 diabetes. The prevalence of symptoms suggestive for diabetic gastroparesis is much lower. The aim of the study was to evaluate the gastric emptying and to correlate the results with dyspeptic symptoms. Methods we included 55 patients with diabetes mellitus (32F/ 23M; mean age 60.34 ±4.71) and 50 controls (30F/20M; mean age 58.55 ±4.78). Gastric emptying was assessed using gastric emptying scintigraphy (GES). Dyspeptic symptoms were assesed using Gastroparesis Cardinal Symptom Index (GCSI). Results 49% reported one or more gastrointestinal symptoms from the scale. From these, 55,5% reported fullness and/or early satiety, 29,6% reported bloating, 14,8% reported vomiting or nausea. 31 patients (56,33%) had abnormal gastric emptying on scintigraphy at 2 hr and 24 patients had normal GES. From subgroup with abnormal GES, only 53,33% reported gastrointestinal symptoms previous to the evaluation, and only 3 from the 9 symptoms of the GCSI had a significant correlation with the severity of the gastric emptying. Conclusion there was a positive but non significant correlation between symptom score in patients with delayed GE compared to patients with normal GE, except correlation between early satiety and delayed GE.

Cardiovascular autonomic neuropathy is a common form of autonomic dysfunction in diabetes mellitus (DM) and associates abnormalities in heart rate control and in vascular dynamics. This study evaluates the impact of diabetes mellitus on left ventricular diastolic dysfunction (LVDD) and heart rate variability in a group of type 2 diabetes mellitus without signs of cardiovascular disease. The study group consisted of 58 patients, aged 61 ± 8 years, diagnosed with type 2 DM. The subjects were selected from a series of 104 consecutive diabetic patients. All the subjects were on oral therapy or on diet for DM, and ECG was normal for all the subjects. The control group consisted of 45 healthy subjects, matched for age and sex. Heart rate variability was measured using a 24-h ECG monitoring system, and standard 2D and Doppler echocardiography was performed in all the subjects. There are significant differences between groups regarding disease duration, longer in patients with impaired relaxation (11.22 ± 9.17 vs. 8.31 ± 8.95 years), and disease control, worse in impaired relaxation group. Heart rate in impaired relaxation group is significantly higher than in controls, and higher, but not significantly, when compared with normal group (91 ± 10, vs. 88 ± 11 and 71 ± 11, respectively). Cardiac autonomic neuropathy was associated with LVDD in patients with type 2 DM, but without clinically manifest heart disease. Twenty-four-hour ECG monitoring and echocardiography can detect diabetic cardiomyopathy in early stages and should be performed in all subjects.

Recent findings indicate that symptomatic heart disease in patients with diabetes mellitus predicts poor prognosis, but cardiac involvement may occur before clinical manifestation. Diastolic dysfunction may be the first stage of diabetic cardiomyopathy. The aim of this study was to evaluate the cardiovascular function in patients with DM in early stages. we studied a group of 62 patients, males and females, aged between 51 and 65 years old, with well-controlled DM; they were investigated using transthoracic echocardiography (TTE). Two dimensional, pulsed Doppler techniques were used to asses the systolic and diastolic function for left ventricle (LV). none of the patients had any clinical signs of cardiac involvement, nor ECG or TTE systolic function impairment. There are significant differences between DM patients and control group for peak A velocity (0.72 +/- 0.19 vs 0.56 +/- 0.29, P=0.05) and E/A ratio (1.03 +/- 0.29 vs 1.51 +/- 0.26, P = 0.01) which account for filling impairment of LV. the analysis of DM heart disease, mainly at a preclinical level, is important in all the cases as an asymptomatic patient may have diastolic dysfunction which can be treated and should be closer observed.

Epicardial adipose tissue is an ectopic fat storage at the heart surface in direct contact with the coronary arteries. It is considered a metabolically active tissue, being a local source of pro-inflammatory factors that contribute to the pathogenesis of coronary artery disease. The AIM of our study was to establish correlations between echocardiographic assessment of epicardial adipose tissue and anthropometric and ultrasound measurements of the central and peripheral fat depots. The study was conducted on 22 patients with or without coronaropathy. Epicardial adipose tissue was measured using Aloka Prosound α 10 machine with a 3.5-7.5 MHz variable-frequency transducer and subcutaneous and visceral fat with Esaote Megas GPX machine and 3.5-7.5 MHz variable frequency transducer. Epicardial adipose tissue measured by echocardiography is correlated with waist circumference (p < 0.05), visceral adipose tissue thickness measured by ultrasonography (US) and is not correlated with body mass index (p = 0.315), hip and thigh circumference or subcutaneous fat thickness measured by US. Our study confirms that US assessment of epicardial fat correlates with anthropometric and US measurements of the central fat, representing an indirect but reliable marker of the visceral fat.

Physical examination is a crucial part in medical student curricula, but a decline in physical examination skills was noted in the last two decades. The benefic role of ultrasonography (US) as an adjuvant method for clinical examination was evaluated in many studies, but there are different approaches among countries and universities. The aim of this study was to evaluate the role of US in learning physical exam in 3rd year medical students. One hundred and four 3rd year medical students were randomly enrolled. They were divided first in two equal groups (I and II, with and without US, by rotation) and then in smaller groups of 8-9 students. Pairs between smaller groups belonging to group I and II were randomly established in order to be trained and evaluated by the same instructor. We verified the influence of US on the correctness of thyroid palpation, lung percussion (inferior limit of the lung), and liver size estimation. They received no special training on US. After the learning sessions (four sessions, one hour each) a questionnaire was applied to each student. For thyroid palpation, there were no significant differences regarding the gland dimensions. For lung and liver palpation the results showed better results for some points in groups using US as adjuvant, but the most significant difference regarded the appreciation of self confidence (in favor of US-groups). The majority of the students using US appreciated as very useful the informations provided by US. Also, we found a clear improvement in detecting the upper limit of the liver comparing with the inferior limit of the lung, as result of better clinical skills. The results from this pilot study proved the utility of US in learning clinical examination. The students can better understand the regional anatomy and can confirm immediately the physical findings. It is important for students to reach a certain level of knowledge regarding physical exam to better understand the role of US. Overall, we can state that use of US in the daily clinical examination teaching greatly improved the students' clinical examination abilities and that is a strong argument for integrating basic US into the medical school curriculum.

La fel ca și în China, așteptările generale sunt de la sine înțelese și fac parte din cultura populară – rolurile se inversează pe măsură ce părinții îmbătrânesc, iar datoria copilului adult este să-și îngrijească părinții. Cultura mediteraneană, dar și latino-americanii au în centru o mare familie gălăgioasă, mai mult sau mai puțin fericită, dar cu mult mai puțini vârstnici singuri și abandonați. Este o modă răspândită aici ca mai multe generații să trăiască sub același acoperiș și nu doar din motive materiale. Dar și aici, o arată studiile și rapoartele, este în creștere nu doar abandonul, ci și abuzul asupra celor mai în vârstă. În 2017, Gerontological Society of America avertiza că vârstnicii sunt mereu lăsați deoparte, în avalanșa de lupte pentru drepturile minorităților, ale celor de culoare, de tipul BLM, ale celor din comunitățile LGBTI și așa mai departe. Tot Societatea Americană de Gerontologie sublinia faptul că bătrânețea nu este echivalentă cu boala – majoritatea seniorilor sunt sănătoși sau au probleme medicale tratabile și similare cu ale celor din decadele 50-60 ale vieții. Nimeni nu vrea să vorbească despre ele; este ca și cum izolarea celor bătrâni îi ferește pe cei tineri de contaminare.

Background & objectives: The effects of vitamin K-dependent proteins in bone mineralization and vascular calcification and the implication of vitamin K epoxide reductase gene (VKORC1) 1173C>T polymorphism in warfarin sensitivity are well known. The main objective of the study was to investigate the relationship between VKORC1 1173C>T polymorphism, bone mineral density (BMD), and atherosclerosis (evaluated by intima-media thickness of the carotid artery and the presence of calcified plaques) in patients suspected to have osteoporosis or osteopenia and referred for BMD determination. Methods: VKORC1 1173C>T polymorphism was evaluated in 239 consecutive patients referred by their physicians for BMD measurement (dual energy X-ray absorptiometry at L2-L4 lumbar spine, femoral neck and total hip). Ultrasonography of the carotid arteries was performed, intima-media thickness (IMT) was measured and the presence of atherosclerotic calcified plaques was recorded. Results: In the patients with osteoporosis and osteopenia there was a higher frequency of TT genotype of VKORC1 1173C>T (P=0.04). The TT genotype was significantly more frequent in the osteoporotic group compared to the osteopenic group (P=0.01). The mean age and body mass index were lower in the patients with normal BMD and TT genotype (P=0.02, P=0.03). There was no correlation between the IMT and VKORC1 1173C>T genotype but the TT genotype had a significant association with the presence of calcified atherosclerotic plaques (P=0.05). This finding was not correlated with normal or pathologic BMD. Interpretation & conclusions: VKORC1 1173C>T polymorphism (TT genotype) was associated with osteoporosis and calcified plaques in the carotid artery in patients referred for BMD measurement. Different mechanisms are probably involved in these associations. TT genotype may serve as a potential genetic marker for the risk of OP and ATS.

Chiari networks are present in the right atrium in a minority of the population and are usually of no clinical significance. On the other hand it may associate some pathological changes, as patent foramen ovale, intraatrial thrombus or atrial arrhythmias. We present the case of an asymptomatic young woman diagnosed with Chiari network during a routine echocardiography.

Background & objectives: The effects of vitamin K-dependent proteins in bone mineralization and vascular calcification and the implication of vitamin K epoxide reductase gene (VKORC1) 1173C>T polymorphism in warfarin sensitivity are well known. The main objective of the study was to investigate the relationship between VKORC1 1173C>T polymorphism, bone mineral density (BMD), and atherosclerosis (evaluated by intima-media thickness of the carotid artery and the presence of calcified plaques) in patients suspected to have osteoporosis or osteopenia and referred for BMD determination. Methods: VKORC1 1173C>T polymorphism was evaluated in 239 consecutive patients referred by their physicians for BMD measurement (dual energy X-ray absorptiometry at L2-L4 lumbar spine, femoral neck and total hip). Ultrasonography of the carotid arteries was performed, intima-media thickness (IMT) was measured and the presence of atherosclerotic calcified plaques was recorded. Results: In the patients with osteoporosis and osteopenia there was a higher frequency of TT genotype of VKORC1 1173C>T (P=0.04). The TT genotype was significantly more frequent in the osteoporotic group compared to the osteopenic group (P=0.01). The mean age and body mass index were lower in the patients with normal BMD and TT genotype (P=0.02, P=0.03). There was no correlation between the IMT and VKORC1 1173C>T genotype but the TT genotype had a significant association with the presence of calcified atherosclerotic plaques (P=0.05). This finding was not correlated with normal or pathologic BMD. Interpretation & conclusions: VKORC1 1173C>T polymorphism (TT genotype) was associated with osteoporosis and calcified plaques in the carotid artery in patients referred for BMD measurement. Different mechanisms are probably involved in these associations. TT genotype may serve as a potential genetic marker for the risk of OP and ATS.