Angiography of liver transplantation patients

Over 45 months, 119 angiographic examinations were performed in 95 patients prior to liver transplantation, and 53 examinations in 44 patients after transplantation. Transplantation feasibility was influenced by patency of the portal vein and inferior vena cava. Selective arterial portography, wedged hepatic venography, and transhepatic portography were used to assess the portal vein if sonography or computed tomography was inconclusive. Major indications for angiography after transplantation included early liver failure, sepsis, unexplained elevation of liver enzyme levels, and delayed bile leakage, all of which may be due to hepatic artery thrombosis. Other indications included gastrointestinal tract bleeding, hemobilia, and evaluation of portal vein patency in patients with chronic rejection who were being considered for retransplantation. Normal radiographic features of hepatic artery and portal vein reconstruction are demonstrated. Complications diagnosed using results of angiography included hepatic artery or portal vein stenoses and thromboses and pancreaticoduodenal aneurysms. Intrahepatic arterial narrowing, attenuation, slow flow, and poor filling were seen in five patients with rejection.     

Correlation of scintigraphy and angiography for ventricular volume determinations using realistic cardiac phantoms: the unimportance of self-attenuation

The volumes of the left ventricle (LV) and right ventricle (RV) were determined by scintigraphy, radiography, and weight, using hollow, morphologically accurate cardiac phantoms that ranged from 99-415 ml (RV) and 72-364 ml (LV). Self-attenuation within these simulated ventricles appeared negligible in view of the nearly linear correlation between scintigraphic and weight determined volumes. Scintigraphy compared favorably with radiography for estimating clinically encountered volumes of the RV and LV.     

Automatic needle insertion diminishes pain during growth hormone injection

Non-compliance in children receiving growth hormone (GH) treatment is often caused by pain on injection and difficulties in administration of GH. It has been suggested that automatic needle insertion diminishes pain perception. We quantitatively measured pain intensity on injection with two prototype pens for GH administration, providing either manual or automatic sc needle insertion, using a combined visual analogue/facial scale and a five-item scale in 18 children. With the automatic pen there was a significantly lower maximum pain score compared with the manual pen (median 28.5 versus 52.0mm) as well as a lower mean pain score (mean 13.7 versus 23.5 mm). The five-item scale revealed that automatic needle insertion was significantly less painful than manual insertion and 13 patients chose to continue treatment with the automatic pen. In conclusion, pain during GH injection can be significantly diminished by automatic needle insertion, which may improve compliance in long-term GH treatment.     

Effect of dialysate calcium concentrations on intradialytic blood pressure course in cardiac-compromised patients

To prevent hypercalcemia in the treatment of secondary hyperparathyroidism, low calcium (L-Ca) dialysate is advocated. However, changes in ionized calcium (i-Ca) levels have a pivotal role in myocardial contraction and could influence blood pressure stability during dialysis. Recently, our group found in patients with normal cardiac function a significant decrease in blood pressure (decrease in systolic blood pressure [DSBP]: -13 mm Hg and decrease in mean arterial pressure [DMAP]: -7 mm Hg) during dialysis with L-Ca dialysate compared with high calcium (H-Ca) dialysate, and this was mainly related to a decreased left ventricular contractility with use of L-Ca dialysate. On the basis of these data, it could be expected that changes in i-Ca levels during dialysis are of more clinical importance in cardiac-compromised patients (CCpts), New York Heart Association classifications III and IV. In this study, the effects of L-Ca dialysate (1.25 mmol/L) and H-Ca dialysate (1.75 mmol/L) on arterial blood pressure parameters (systolic [SBP], diastolic [DBP], and mean arterial blood pressure [MAP]), heart rate, stroke distance (SDist), and minute distance (MDist) during 3 hours of a standardized ultrafiltration/hemodialysis (UF+HD) in nine CCpts was investigated. i-Ca levels increased significantly with H-Ca dialysate UF+HD, whereas there was no change with L-Ca dialysate. SBP, DBP, and MAP decreased statistically and clinically significantly during UF+HD with L-Ca dialysate and were significantly lower with the use of L-Ca dialysate compared with H-Ca dialysate. SDist and MDist decreased significantly with L-Ca dialysate, whereas there were no changes in SDist and MDist with H-Ca dialysate. The predialysis and postdialysis index of systemic vascular resistance (SVRI) was similar between L-Ca dialysate and H-Ca dialysate use. Between the two groups, there were no significant differences in changes in SVRI. From this study, we can conclude that changes in i-Ca levels are a very important determinant of the blood pressure response during UF+HD in CCpts, and this response is mediated by changes in myocardial contractility.     

Study of the radio-opacity of base and liner dental materials using a digital radiography system

Objectives:

This study investigated the radio-opacity of commercially available glass ionomer cements (GICs), flowable resin composites (FRCs) and calcium hydroxide cements (CHCs) and compared this with the radio-opacity of enamel, dentine and aluminium stepwedge. 16 GICs, 8 FRCs and 4 CHCs were analysed.

Methods:

Three sets of three samples were prepared: 1 mm, 2 mm and 3 mm thickness for GIC and FRC and 1 mm thickness for CHC. Specimens of enamel and dentine with the same thicknesses were obtained. As a control, an aluminium stepwedge was used. Radiographs were taken with a digital Kodak RVG 5000 (0.32 s, 30 cm). The images were analysed using the Image Tool^® program (v. 2.00; The University of Texas Health Science Center, San Antonio, TV) to obtain the mean grey values.

Results:

Analysis of variance was used to investigate the significance of differences among the groups. For pairwise comparisons, the Tukey test was applied (p < 0.05). The GICs Ionomaster (Wilcos, Petrópolis, Brazil), Maxxion (FGM, Joinville, Brazil), Bioglass R (Biodinâmica, Ibiporã, Brazil), Bioglass F (Biodinâmica), Vidrion R (SS White, Rio de Janerio, Brazil) and Vidrion F (SS White), presented radio-opacity lower than that of dentine. All FRCs and CHCs studied showed radio-opacity higher than that of dentine. Vitro Fil (DFL, Rio de Janeiro, Brazil), Magic Glass (Vigodent, Rio de Janeiro, Brazil), Vitrebond (3M, Sumaré SP, Brazil), Riva Self Cure (SDI, Victoria, Australia), Riva Light Cure (SDI), Fill Magic (Vigodent), Opallis (FGM, Joinville, Brazil), Surefil SDR (Dentsply, Milford, DE), Tetric N (Ivoclar Vivadent, Schaan, Lichtenstein), Tetric (Ivoclar Vivadent), Hydro C (Dentsply, Petrópolis, Brazil), Hydcal (Technew, Madalena, Portugal) and Liner (Vigodent) showed radio-opacity similar to or greater than that of enamel for all thicknesses.

Conclusions:

The increased thickness of the materials studied increases their radio-opacity. Some commercially available GICs used as a base and liner for restorations have a very low radio-opacity (Ionomaster, Maxxion, Bioglass R, Bioglass F, Vidrion R and Vidrion F).