The potential cardioprotective effects of amifostine in irradiated rats

PURPOSE: The aim of this study is to determine the cardioprotective efficacy of amifostine. The study consists of researching the relationship between plasma brain natriuretic peptide levels and the electrical and morphologic changes in irradiated rats with or without amifostine. METHODS AND MATERIALS: Sixty Wistar albino rats were divided into 4 groups, and their hearts were given 15 Gy/fraction with (60)Co. In Groups I and II, the rats were killed after 24 hours to detect early effects; in Groups III and IV, the rats were killed 100 days after irradiation to detect late effects. Before irradiation, Groups I and III received 0.9% saline solution, whereas Groups II and IV received amifostine (200 mg/kg). Twenty rats were used as a control group. RESULTS: On the 100th day, mild myocardial degeneration was detected in 5 rats (33%) from Group III (no amifostine). This percentage was statistically different from that of Group IV (treated with amifostine) and the controls (p = 0.042). There was no statistically significant difference between the mean plasma brain natriuretic peptide values of the groups (p > 0.05). There was no significant difference in electrocardiographies between the groups. There was no correlation between continuous variables. CONCLUSION: In the amifostine group (IV) on the 100th day, there was no myocardial degeneration, suggesting that amifostine has a cardioprotective effect.     

Infantile Hemangiomas: Complications and follow-up

Objective

To study the risk factors for hemangioma-related complications, treatment indications and analyze the outcome of patients with infantile hemangioma.

Design

Retrospective.

Setting

University hospital.

Patients

Fifty-five patients (1–69 months; median: 12 months) with infantile hemangioma with mean follow-up 19 months. The eligibility was based on the criteria of the International Society for the Study of Vascular Anomalies (ISSVA).

Intervention

The surgical treatment included total excision whereas medical treatment was carried out by interferon and /or corticosteroids.

Main outcome measures

Data was collected including sex, age, prematurity, age at onset, number, anatomic location and size of hemangioma, age at treatment, cause of treatment decision, family history, presence of extra malformations, involvement of internal organs, presence of life altering or life threatening complications, response to treatment, dose and duration of medications, complications associated with treatment, follow-up period, and final outcome.

Results

Thirty-four (62%) patients were followed-up without treatment, whereas 21 others underwent treatment including steroids, interferon, and surgery. The size of hemangioma was a major factor that predicted hemangioma-related complications (P=0.002). Patients with hemangioma related complications had bigger lesions (size ≥40cm² or the longest size on a single plane ≥5 cm). Nineteen patients (34%) had complications, but only 8 (14.5%) out of them had life or function-threatening complications.

Conclusion

Although dosing and treatment protocol is still debatable, steroids and interferon are good options for hemangioma treatment. The management strategy should be individualized for each case.     

Evaluation of carotid intima-media thickness, a marker of subclinical atherosclerosis, in children with cerebral palsy

Background

Respiratory and cardiovascular diseases are the most common causes of death in children with cerebral palsy.

Objective

To evaluate sonographic carotid intima-media thickness, an early marker of atherosclerosis, in children with cerebral palsy and in healthy controls.

Materials and methods

One hundred children with cerebral palsy (65 boys), mean age 6.2 (SD, 2.1) years, and 35 age-matched and sex-matched healthy controls were included. Common carotid artery intima-media thickness was measured sonographically. Differences between patients and controls were evaluated with an independent samples t-test.

Results

Age, sex distribution and levels of serum lipids were comparable between patients and controls. Average, right and left carotid artery intima-media were thicker in patients compared with controls (mean ± SD, 0.61?±?0.13 mm vs 0.40?±?0.03 mm; 0.61?±?0.14 mm vs 0.40?±?0.03 mm; 0.61?±?0.13 mm vs 0.40?±?0.03 mm, respectively; all P?Conclusion Carotid intima-media is sonographically thicker in children with cerebral palsy compared with healthy controls, which may express an increased risk of atherosclerotic diseases.     

ISO 15189 Accreditation: Requirements for quality and competence of medical laboratories,experience of a laboratory I

AimMedical laboratories are the key partners in patient safety. Laboratory results influence 70% of medical diagnoses. Quality of laboratory service is the major factor which directly affects the quality of health care. The clinical laboratory as a whole has to provide the best patient care promoting excellence.MethodsInternational Standard ISO 15189, based upon ISO 17025 and ISO 9001 standards, provides requirements for competence and quality of medical laboratories. Accredited medical laboratories enhance credibility and competency of their testing services. Our group of laboratories, one of the leading institutions in the area, had previous experience with ISO 9001 and ISO 17025 Accreditation at non-medical sections. We started to prepared for ISO 15189 Accreditation at the beginning of 2006 and were certified in March, 2007. We spent more than a year to prepare for accreditation.ResultsAccreditation scopes of our laboratory were as follows: clinical chemistry, hematology, immunology, allergology, microbiology, parasitology, molecular biology of infection serology and transfusion medicine. The total number of accredited tests is 531. We participate in five different PT programs. Inter Laboratory Comparison (ILC) protocols are performed with reputable laboratories. 82 different PT Program modules, 277 cycles per year for 451 tests and 72 ILC program organizations for remaining tests have been performed. Our laboratory also organizes a PT program for flow cytometry. 22 laboratories participate in this program, 2 cycles per year. Our laboratory has had its own custom made WEB based LIS system since 2001. We serve more than 500 customers on a real time basis. Our quality management system is also documented and processed electronically, Document Management System (DMS), via our intranet.ConclusionPreparatory phase for accreditation, data management, external quality control programs, personnel related issues before, during and after accreditation process are presented. Every laboratory has to concentrate on patient safety issues related to laboratory testing and should perform quality improvement projects.     

Ghrelin,paraoxonase and arylesterase levels in depressive patients before and after citalopram treatment

ObjectivesThe purpose of this study was to examine alterations in lipid profiles and in the serum concentrations of acylated and desacylated ghrelin, paraoxonase and arylesterase in psychiatric patients before and after treatment with 40 mg citalopram daily for 3 months.Design and methodsSamples were collected from 22 healthy controls and 24 psychiatric patients before and after citalopram treatment. Blood levels of acylated and desacylated ghrelin were measured by radioimmunoassay. Paraoxonase and arylesterase activities were determined spectrophotometrically. Lipid parameters were measured on the OLYMPUS-AU400.ResultsIt was found that the levels of acylated, desacylated ghrelin, paraoxonase arylesterase, total cholesterol and triglyceride were lower in depressive patients before citalopram treatment than in the control group. Those parameters were not restored after citalopram treatment except for the arylesterase level.ConclusionDecreased PON1 and ghrelin levels as well as fluctuations in lipid profiles may be involved in the etiology of depressive disorders.     

Experimental Studies With a 9F Forward‐Looking Intracardiac Imaging and Ablation Catheter

Objective. The purpose of this study was to develop a high‐resolution, near‐field‐optimized 14‐MHz, 24‐element broad‐bandwidth forward‐looking array for integration on a steerable 9F electrophysiology (EP) catheter. Methods. Several generations of prototype imaging catheters with bidirectional steering, termed microlinear (ML), were built and tested as integrated catheter designs with EP sensing electrodes near the tip. The wide‐bandwidth ultrasound array was mounted on the very tip, equipped with an aperture of only 1.2 by 1.58 mm. The array pulse echo performance was fully simulated, and its construction offered shielding from ablation noise. Both ex vivo and in vivo imaging with a porcine animal model were performed. Results. The array pulse echo performance was concordant with Krimholtz‐Leedom‐Matthaei model simulation. Three generations of prototype devices were tested in the right atrium and ventricle in 4 acute pig studies for the following characteristics: (1) image quality, (2) anatomic identification, (3) visualization of other catheter devices, and (4) for a mechanism for stabilization when imaging ablation. The ML catheter is capable of both low‐artifact ablation imaging on a standard clinical imaging system and high–frame rate myocardial wall strain rate imaging for detecting changes in cardiac mechanics associated with ablation. Conclusions. The imaging resolution performance of this very small array device, together with its penetration beyond 2 cm, is excellent considering its very small array aperture. The forward‐looking intracardiac catheter has been adapted to work easily on an existing commercial imaging platform with very minor software modifications.