Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla

OBJECTIVES: The study was done to determine whether patients with pacemakers could safely undergo magnetic resonance imaging (MRI) at 1.5-Tesla (T). BACKGROUND: Because of theoretical risks, it is an absolute contraindication for a patient with a pacemaker to undergo MRI. However, there are times when an MRI is needed to provide valuable clinical information. METHODS: Fifty-four patients underwent a total of 62 MRI examinations at 1.5-T. The type of MRI examination was not limited and included cardiac, vascular, and general MRI studies using various whole-body averaged specific absorption rate (SAR) of radiofrequency power. Restrictions were not placed on the type of pacemaker present in the patient. All pacemakers were interrogated immediately before and after MRI scanning, and patients were continuously monitored. Before and after MRI, interrogation was done, and pacing and sensing thresholds, as well as lead impedances, were all measured. RESULTS: A total of 107 leads and 61 pulse generators were evaluated. No adverse events occurred. Forty (37%) of the leads underwent changes, whereas 10 (9.4%) leads underwent a significant change. Only 2 of the 107 (1.9%) leads required a change in programmed output. Threshold changes were unrelated to cardiac chamber, anatomical location, peak SAR, and time from lead implant to the MRI examination. Electrocardiographic changes and patient symptoms were minor and did not require cessation of MRI. CONCLUSIONS: Safety was demonstrated in this series of patients with pacemakers at 1.5-T.     

The monitoring of the accumulation of protoporphyrin IX in Walker tumours by subcutaneous administration of delta-aminolevulinic acid

Photodynamic therapy with protoporphyrin IX induced by delta-aminolevulinic acid (ALA) is mainly applied for the treatment of human superficial skin cancer. In this paper we present our study on photodynamic therapy (PDT) of the implanted Walker tumours using subcutaneous administration of ALA to improve the availability of ALA in the skin. We determined the accumulation and localization of protoporphyrin IX (PpIX) after subcutaneous administration of different concentrations of ALA in a physiological saline solutions, using fluorescence imaging technique. The results obtained indicate that PpIX accumulation depends on the concentration of ALA. The temporal behavior of PpIX fluorescence has shown a clear demarcation of tumoural zone depending on the post-administration time and the administrated concentration of the ALA solution. Further studies are needed to confirm these encouraging results and to define the PDT protocols using subcutaneous administration of ALA solution     

Importance of mild dyslipidemias determining the cardio-vascular risk factors

The aim of our study was to correlate "medium" dyslipidemias with cardio-vascular diseases, especially essential hypertension (EHT). We selected 488 cases using randomization, from a population of hypertensive people. About 210 cases benefited by lipidograms and risk assessment, using special diagrams. When cholesterol was 200-250 mg/dl, 72% of cases had EHT and over 300 mg/dl, 57% had EHT. Comparing LDL chol with EHT, we obtained that arterial tension over 160 mmHg is correlated with LDL over 190 mg/dl on 12%, when LDL was less than 190 mg/dl but more than 150 mg/dl, we found EHT on 16% cases. EHT was very strong correlated with HDL < 40 mg/dl, 88%. On 5% of cases the only one dyslipidemia was marked by low HDL chol and all this cases had EHT. A particular risk was represented by the dyslipidemia with low HDL chol and high triglycerides (28% of cases). We concluded that the highest prevalence was for medium hypercholesterolemia with/or low HDL chol and, the same time, extreme values had comparable prevalences with medium values.     

Acute diarrhea associated with Cyclospora cayetanensis

Acute diarrhea is a major problem with high morbidity and mortality rates in developing countries, especially in children. Complex laboratory investigations are required to define the etiology because of the broad spectrum of etiological agents and the non-specific clinical signs. In the last decade, Cyclospora cayetanensis--a new acid-fast coccidian species--was pointed to be the cause of watery self-limited or prolonged diarrhea in immunocompetent and immunocompromised patients, with very good evolution after treatment with co-trimoxazole. Unlike Cryptosporidium parvum, nonsporulated Cyclospora oocysts are eliminated in feces, with no risk of human to human transmission. Cyclospora cayetanensis is widely spread, producing endemic infections, in Asia and South America and was reported to produce infections in foreign travellers in these areas and epidemic outbreaks of foodborne diarrhea. We describe the first case of acute diarrhea associated with Cyclospora cayetanensis in an immunocompetent child admitted to Ia?i "Sf. Maria" Hospital.     

Eliminating missing race/ethnicity data from a sexually transmitted disease case registry

Data regarding race and ethnicity are usually requested when conducting public health surveillance. However, such data are frequently not included in case reports by providers. This report describes efforts to reduce the extent of missing race and/or ethnicity data in reports of sexually transmitted diseases in Massachusetts. A list of cases reported to the Department of Public Health between March 1 and May 31 1999 lacking race and/or ethnicity data was generated. A student intern tried contacting the providers with a request for complete information. Of the 2,954 cases of syphilis, gonorrhea, and chlamydia infection reported during the study period, 34.8% (1,028 cases) lacked race/ethnicity data. Despite an average of 2.27 calls and 1.5 transfers per call, data was successfully added to only 143 cases, increasing the percent of reported cases with complete data from 65.2% to 70.0%. The telephone calls, while inefficient for collecting this data, had some advantages. For example, they offered opportunities for communication between the STD Division and providers regarding other provider needs or services that the Division might meet. Consideration can also be given to using surnmame lists, ethnic marketing lists, birth records, and matching the case's address with census block data to infer race and/or ethnicity.     

Metabolic effects of hypolipemic drugs on aged type 2 diabetes

There are multiple lipids anomalies on diabetes. IDDM has, because of insulin lack, increased levels of triglycerides and afferent lipoproteins. NIDDM, especially obese one, linked by insulinoresistance and hyperinsulinemia, has different and complex anomalies by quality and quantity. There is a specific shape for this anomalies named "B phenotype" with high cardiovascular risk: rise LDL-chol charged with TG and low level of HDL-chol. We searched lipoproteins levels and the effects of simvastatin on aged persons (after 60 years). We randomised 158 cases with obese type II diabetes on a case control study. We concluded that only 28% had high TG levels and 71.8% had low levels of HDL-chol. For HDL-chol this percent is higher over 60 years old group (88.75%) (p < 0.001). Cholesterol has no significant high levels (28.55%) (p < 0.5), and aged group has almost normal levels of cholesterol and triglycerides (p < 0.0001). We administered simvastatin (Zocor) on 86% cases, therapeutically doses, during a period of 6 months to one year. Making lipidograms initially, after 6 months and a year, we proved good effects of Zocor, on lipoproteins levels: rise levels of HDL-chol (p < 0.005), moderate effect on LDL-chol (p < 0.01). At the same time the treatment improving the glucose tolerability to both groups (p < 0.002).     

Association of achalasia and pulmonary Mycobacterium fortuitum infection

A case of achalasia complicated by Mycobacterium fortuitum pulmonary infection and empyema is reported. This association has been documented in the medical literature. Possible mechanisms explaining this association are discussed.     

Surgical access to the oral cavity

The treatment goals for surgical management of oral cancers are local control, improved survival, reduced complications and recurrence and to maintain form and function.