ARDMS: July 22, 2011 NewsWire

Ultrasound Can Detect Risk of Psychiatric Disorders in Premature Infants

Infants born prematurely are at risk for injuries to the white and gray matter of the brain that affect cortical development and neural connectivity. Certain forms of these injuries can be detected in the neonatal period using ultrasound, according to Columbia University Medical Center researchers.

Researchers who followed a group of premature infants until age 16 found that those with neonatal ultrasound abnormalities were at increased risk for specific psychiatric disorders, namely, attention deficit hyperactivity, tic disorders, obsessive compulsive disorder, and major depression-all of which are thought to arise from dysfunctions of the subcortical-cortical circuits. The findings were published in the Archives of General Psychiatry.

Premature birth is a growing problem in the United States, adding to the significance of the findings. An increased appreciation of the relation between perinatal brain injuries and later psychiatric disorders could lead to earlier diagnosis and intervention by the pediatricians, psychiatrists, and neurologists who care for these children and adolescents. Future research may also explore the relation of perinatal brain injury to psychiatric disorders, such as schizophrenia, that more commonly come to clinical attention in adulthood

A research group at Columbia University Medical Center/New York State Psychiatric Institute led by Dr. Agnes Whitaker, MD, evaluated more than 400 nondisabled adolescents who had been born prematurely and had had abnormal brain ultrasounds taken at birth. When the researchers administered questionnaires and cognitive tests to the subjects and interviewed their parents, they found a relation between perinatal brain injuries and certain psychiatric disorders at adolescence that could not be explained by other medical or social factors.

Although scientists have speculated for decades that early brain injury can have long-term psychiatric effects, these results provide the first strong empirical evidence of such a relation. "The study," said Whitaker, a clinical professor of psychiatry in the Department of Psychiatry at Columbia University and research psychiatrist in the Division of Child and Adolescent Psychiatry at New York State Psychiatric Institute, "is a beautiful example of interdisciplinary work. The team included researchers from neonatology, pediatrics, psychiatry, and epidemiology. It couldn't have been done otherwise."
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Article written by staff at news-meducal.net. and adapted for the purposes of this newsletter.

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Ultrasound May Determine Heart Attack Risk in HIV Patients

People with HIV are at increased risk for blood vessel blockages, and new research shows heart ultrasounds can help determine if these patients are more likely to suffer a serious or fatal heart attack.

A report from the American Heart Association revealed that the risk for heart attack among people with HIV who have abnormal heart ultrasound tests or "stress echoes" is 10 times greater than in the general population and more than three times higher than in people without HIV who have abnormal heart ultrasounds.

"We looked at whether stress echo can help predict risk in a high-risk group -- HIV patients with known or suspected heart disease -- and determine whether they have a high or low risk of heart attack and death in the future," the study's senior author, Dr. Farooq A. Chaudhry, associate professor of medicine at Columbia University College of Physicians and Surgeons and associate chief of cardiology and director of echocardiography at St. Luke's Roosevelt Hospital Center in New York City, said in an American Heart Association news release.

In conducting stress echoes on 311 HIV patients averaging 52 years of age with known or suspected heart disease, researchers found that 26 % had abnormal ultrasounds. Within an average of about three years, there were 14 cardiac deaths and 17 nonfatal heart attacks.

The study authors concluded that the HIV patients who had normal stress echo tests had on average a less than 1% per year risk for serious or fatal heart attack -- the same risk as in the general healthy population. In sharp contrast, the risk of heart attack among the HIV patients with abnormal stress echo test results was almost 12 percent per year.

The study, published in the current issue of Circulation: Cardiovascular Imaging, found that 100 % of HIV patients with normal heart ultrasounds survived in the year following the test and 98 % were alive at four years. Those survival rates dropped to 92 % at one year and 62 % at four years for people with HIV that had abnormal stress echoes, the report indicated.

"Although we did not study which treatments are most effective for these patients, HIV patients who have abnormal stress echocardiography should probably be monitored and treated more aggressively to prevent heart attack and death," said Chaudhry. "Conversely, patients with a normal stress echo might not need such aggressive interventions."
View the article online.
Article written by staff at health.usnews.com and adapted for the purposes of this newsletter.

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Improving Quality of Life Through Venous Disease Treatment

Originally thought of as primarily a cosmetic concern, varicose veins can greatly affect a patient's quality of life. At East Tennessee Vein Clinic, Andrew M. Douglass, M.D., has for the last 11 years specialized in providing minimally invasive, nonsurgical methods to help patients resolve their varicose veins.

Andrew M. Douglass, M.D., opened the first full-time phlebology practice in Tennessee in 2001 and is a graduate of the University of Tennessee College of Medicine. Dr. Douglass is a member of the original charter class of physicians board certified by the American Board of Phlebology in 2008 and is both Registered in Vascular Technology (RVT)® and a Registered Physician in vascular interpretation (RPVI)®.

Varicose veins occur when a genetic trait causes valves in the venous system to fail, resulting in venous reflux and consequent vein dilation. Over time, the high pressure within the veins leads to white blood cell margination through the vein wall and swelling. This inflammatory response causes leg pain and can damage the skin and nearby lymphatics. If left untreated, varicose veins can result in irreversible leg swelling, skin discoloration and ulceration.

"Often times, physicians and patients mistake varicose veins for a purely cosmetic problem," said Dr. Douglass. "However, the physical appearance of varicose veins is just one of many symptoms resulting from underlying venous disease. If patients are experiencing leg pain in the clinical context of visible varicose veins, a physician is wise to be wary of dismissing pain as simply a consequence of aging. The same is true for swelling, as swelling in the leg can indicate more advanced venous disease requiring treatment."

Understanding the Stages of Venous Disease

Venous disease is by its nature progressive and can be categorized ranging from category one to six, with category one being the mildest form of venous disease. Patients with visible spider veins are classified in the first category, and patients with visible varicose veins are classified in the second category. If swelling is present, patients fall into the third category, and patients fall into the fourth category if skin discoloration is present. At this point in the disease, patients may also notice that the skin on their leg is more easily injured and heals more slowly. Patients with a history of ulceration fall into category five, and patients are diagnosed with category six venous disease if they have an open, active ulcer.

Treatment Indications

If symptoms of leg pain do not remit with use of compression stockings, definitive treatment of venous disease is recommended. Treatment is also indicated if patients have more advanced venous disease characterized by visible swelling, which indicates that the protein-rich fluid that refluxes into the leg due to faulty veins is overwhelming and potentially damaging the patient's lymphatic system. Other indications for treatment are skin discoloration or erythema, bleeding, phlebitis or ulceration.
Minimally Invasive Treatment Modalities

At East Tennessee Vein Clinic, a thorough evaluation, including an ultrasound screening, is performed at each patient's first consultation to determine the severity of venous disease. Depending on the findings, patients may benefit from compression stockings or minimally invasive definitive therapies, which include endovenous laser treatment, microphlebectomy and ultrasound-guided foam sclerotherapy. These three noninvasive therapies serve to eliminate the symptomatic, diseased veins.

While the removal of veins may concern some patients, physicians may reassure their patients that the remaining veins, along with reserve veins, are more than sufficient in conducting proper blood flow, as the veins that fail typically represent approximately 5% of the venous return. "Just as a healthy person may donate one of their two good kidneys for a transplant and do fine with the remaining kidney, so also our legs have a large 'reserve' of veins," said Dr. Douglass.

"The single biggest fallacy that I hear regarding treatment of venous disease is the belief that failing veins should be preserved because patients may need them in the event of a coronary artery bypass," said Dr. Douglass. "A study in Europe actually analyzed the effectiveness of using varicose veins to create bypass grafts. The study was ended because of the high mortality and morbidity rates associated with the practice."

Endovenous Laser Treatment

Endovenous laser treatment involves placing a laser catheter into the saphenous vein responsible for the visible varicose vein. When the laser is activated, heat is used to seal the diseased vein shut, preventing venous reflux. This procedure is performed in the office using ultrasound guidance and only requires local anesthesia. Following the procedure, patients are encouraged to resume normal activities, with little-to-no downtime. In studies, endovenous laser treatment has been found to be as effective as vein stripping, with improved safety rates and shorter recovery times.

Microphlebectomy

Microphlebectomy is indicated for patients with larger, bulging varicose veins that are not resolved after use of endovenous laser treatment. Generally the result of more advanced disease, these veins are often too tortuous for the endovenous laser catheter to easily pass through. To provide treatment for these veins, small punctures are made in the skin surrounding the veins, and the veins are removed through the punctures with an instrument resembling a small knitting hook. The punctures are small enough that patients are able to avoid stitches. The microphlebectomy procedure is also performed in the physician's office with local anesthesia and 
mild sedation, if necessary.

Ultrasound-Guided Foam Sclerotherapy

The most versatile treatment modality, ultrasound-guided foam sclerotherapy can be used in patients with both mild and advanced forms of venous disease. Using ultrasound guidance, a foamed sclerosant is injected into the diseased vein, causing it to close soon after the injection is administered. Over time, the veins will become smaller until they are narrowed to fibrous threads that are no longer visible under the skin.

"Ultrasound-guided foam sclerotherapy is a versatile adjunct for cases where disease is too extensive for endovenous laser treatment alone, as the foamed sclerosant is able to penetrate and seal veins that we could not pass through using a catheter," said Dr. Douglass. "Treatment of these 'remnant' veins is essential in reducing the five year recurrence rate of traditional surgery from 35% to 8%."

Like microphlebectomy and endovenous laser treatment, ultrasound-guided sclerotherapy is also performed on an outpatient basis and results in minimal recovery time, little pain and no scarring.