MR imaging of the small bowel with a true-FISP sequence after enteroclysis with water solution

RATIONALE AND OBJECTIVES: To evaluate a novel MR enteroclysis technique for small-bowel imaging. METHODS: Twenty-one patients with suspected small-bowel disease underwent both MR and conventional enteroclysis. MR enteroclysis was performed by injecting an iso-osmotic water solution through a nasojejunal catheter with a flow rate of 80 to 150 mL/min. A maximum of 2 L of water solution was administered. A dynamic heavily T2-weighted single-shot turbo spin-echo sequence was applied in coronal orientation to monitor the bowel filling and adequate distention. Twelve 4-mm-thick slices were acquired by using a true fast imaging with steady-state precession (true-FISP) sequence during an 18-second breath-hold interval. Small-bowel distention, wall conspicuity, homogeneity of opacification, and the presence of artifacts were subjectively evaluated by two reviewers using five-point scales. RESULTS: Chemical shift artifacts were low and ghost artifacts were absent. Susceptibility artifacts were more prominent in the ileum; motion artifacts were low in the jejunum, ileum, and ileocecal area. Homogeneity of opacification was very good in the jejunum, good to very good in the ileum, and good in the ileocecal area. Distention was very good to excellent in the jejunum and ileum and very good in the ileocecal area. Wall conspicuity was very good to excellent in the jejunum and ileum. CONCLUSIONS: MR enteroclysis with the true-FISP sequence produced high-quality images of the small bowel. Further clinical studies are required to determine the clinical efficacy of the new technique compared with conventional enteroclysis.     

Comparison of three current viral load assays for the quantitation of human immunodeficiency virus type 1 RNA in plasma

The LCx HIV RNA quantitative assay (Abbott Laboratories, Delkenheim, Germany) was compared with the Versant HIV-1 RNA 3.0 (bDNA) assay (Bayer, Tarrytown, NY) and the COBAS Amplicor HIV-1 Monitor v1.5 test (Roche Diagnostics, Branchburg, NJ), using plasma samples of various viral load levels from HIV-1-infected patients. Considering the lower limit of the linear range of 50 copies/ml of both assays, the detection range of the LCx was 127/151 (84.1%) versus the 131/151 (86.8%) of the bDNA 3.0 assay, while overall agreement between the two assays was 93.4% (141/151). LCx and bDNA 3.0 results were found to be strongly correlated (r = 0.96). The fitted regression line was described by the equation log10(LCx copies/ml) = 0.05 + 1.06 x log10(bDNA 3.0 copies/ml) with 95% CI for the estimated slope and intercept at 1.01, 1.12 and -0.16, 0.26, respectively. Similarly, the detection range of the LCx was 115/148 (77.7%) versus the 128/148 (86.5%) of the Monitor v1.5 test. A 91.2% concordance (135/148) was observed between these two assays at a cut-off of 50 copies/ml. LCx and Monitor v1.5 results were highly correlated (r = 0.96). The fitted regression line was described by the equation log10(LCx copies/ml) = 0.06 + 1.03 x log(10)(Monitor v1.5 copies/ml) with 95% CI for the estimated slope and intercept at 0.97, 1.09 and -0.16, 0.28, respectively.     

Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy

OBJECTIVES: The aim of this study was to evaluate the longterm follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in a large patient cohort. BACKGROUND: PTSMA by alcohol injection into septal branches has shown good acute and short-term results in symptomatic patients with hypertrophic obstructive cardiomyopathy. METHODS: A total of 100 consecutive symptomatic (NYHA class 2.8 +/- 0.6) patients underwent PTSMA. All patients had clinical and non-invasive follow-up at 3 months, 1 year, and annually up to 8 years. RESULTS: One patient died at day 2 after intervention due to fulminant pulmonary embolism following deep venous thrombosis, and eight patients required a permanent DDD-pacemaker due to post-interventional complete heart block. Acute reduction of the left ventricular outflow tract gradient was achieved from 76 +/- 37 to 19 +/- 21 mmHg at rest, from 104 +/- 34 to 43 +/- 31 mmHg during Valsalva maneuver, and from 146 +/- 45 to 59 +/- 42 mmHg post extrasystole (p < 0.0001, each). During follow-up (mean follow-up time: 58 +/- 14 months), three additional patients died (sudden death at 48 months, non-cardiac death at 49 months and stroke-related death at 60 months after the index procedure). All living patients showed clinical improvement to NYHA-class 1.4 +/- 0.6 (after 3 months, n = 99), 1.5 +/- 0.6 (after 1 year, n = 99), and 1.6 +/- 0.7 at final follow-up (n = 96; p < 0.0001, each). Non-invasive follow-up studies documented ongoing outflow tract gradient reduction, decrease of septal and left ventricular posterior wall thickness, and improvement of exercise capacity. CONCLUSIONS: PTSMA is an effective treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy. Follow-up showed ongoing hemodynamic and clinical improvement without increased mortality and morbidity.     

Quality assurance of the multileaf collimator with helical tomotherapy: design and implementation

Quality assurance (QA) of the multileaf collimator (MLC) is a critical step for the delivery of intensity modulated radiation therapy treatment plan. While QA procedures for motor-driven MLC have been published extensively, those for binary MLCs such as the one used for helical tomotherapy have not been presented in the literature, as this is still a fairly new technology. In this study, seven test patterns for the MLC QA of a helical tomotherapy unit have been designed and implemented. The seven test patterns check the MLC alignment, MLC leakage, MLC timing and MLC leaf position error in detail. Those patterns can be easily implemented in any center with a helical tomotherapy unit as part of the routine QA. The QA procedures can be performed using existing QA resources such as solid water phantom and EDR2 film. A software toolkit called "Tomo MLC QA" has been developed to assist in generating the QA procedures and analyzing the results. Our results showed that the helical tomotherapy MLC is very robust, exhibiting interleaf leakage of 0.53% +/-0.09%. Several issues with the MLC have been found and discussed. The QA results also illustrate the utilization and usefulness of the proposed QA procedures.     

An update of luteal phase support in stimulated IVF cycles

Stimulated IVF cycles are associated with luteal phase defect. In order to overcome this, different doses, durations and types of luteal phase support (LPS) have been evaluated. There is still no agreement regarding the optimal supplementation scheme. The aim of this paper is to assess the past and the current clinical practices of luteal supplementation in IVF. The databases of Medline and PubMed were searched to identify relevant publications. LPS with human chorionic gonadotrophin (hCG) [n=262, odds ratio (OR) 2.72 (95%), confidence interval (CI) 1.56-4.90, P<0.05] or progesterone (n=260, OR 1.57 CI 1.13, 2.17, P<0.05) results in an increased pregnancy rate compared with placebo, however, hCG is associated with increased risk of ovarian hyperstimulation syndrome. Natural micronized progesterone is not efficient if taken orally. The data on oral dydrogesterone are still conflicting. Vaginal and intra muscular progesterone have comparable outcomes. The addition of estradiol (E2) seems to be beneficial in long GnRH agonist protocol (implantation rate 39.6% with E2 compared with no E2; P<0.05) but not in the short GnRH agonist and GnRH antagonist protocol. Despite the early promising results, it is too early to recommend the use of GnRH agonist in LPS. LPS should cease on the day of positive HCG. Since the cause of luteal phase defect in IVF appears to be related to the supraphysiological levels of steroids, milder stimulation protocols should be advocated in order to eventually overcome the luteal phase defect.     

Risk assessment scales for pressure ulcers: a methodological review

Much is written about risk-assessment scales (RASs) for pressure ulcers (PU) and their properties demonstrating that they are of limited value. Less is known about the reasons for these limitations and the scope for improvement. This review examines issues such as structure and scoring for the Norton, Waterlow and Braden scales, showing that the equal-weighting technique behind the current RASs is too simplistic and leads to limitations. It concludes that properly trained, experienced nurses should conduct PU risk assessments, whilst more robust data-driven RASs should be developed using the differential weighting scoring method together with advanced statistical techniques.     

Inhibition of peroxynitrite precursors, NO and O2, at the onset of reperfusion improves myocardial recovery

AIM OF STUDY: Previous reports note an increase in both reactive oxygen species (ROS) and nitric oxide (*NO) at the onset of myocardial reperfusion. We tested the hypothesis that inhibition of *NO or ROS production at the time of reperfusion improves recovery of post-ischemic myocardial function. METHODS AND MATERIALS: Isolated rat hearts were perfused with temperature controlled (37.4 degrees C) modified Krebs Henseleit buffer solution at 85 mm Hg. Following 20 min of global ischemia, hearts were reperfused for the first 10 min with: (1) standard buffer (control), (2) buffer with a NOS inhibitor, N-nitro-L-arginine methyl ester (L-NAME), (3) buffer with superoxide dismutase (SOD) or (4) buffer with N-morpholinosydnonimine hydrochloride (SIN-1), a peroxynitrite generator. Tissue O(2) and *NO were continuously measured with thin electrochemical probes embedded in the wall of the LV. ROS was measured with the spin trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) (40 mM). LV contractile function was continuously monitored. RESULTS: Recovery of LV contractile function was significantly improved in hearts initially reperfused with L-NAME and SOD and significantly depressed in hearts reperfused with SIN-1 compared with control (p<0.01, n=5-8 per group). DMPO-adduct during reperfusion (measure of ROS) was significantly decreased with SOD (p<0.001 versus L-NAME and Control, n=4 per group) and unchanged with L-NAME and SIN-1 compared with Control. With L-NAME, tissue *NO and PO(2) were significantly decreased, independent of coronary flow, during reperfusion compared with control and SIN-1. CONCLUSIONS: Inhibition of O(2)*(-) or *NO at the time of reperfusion improves early reperfusion LV function and alters tissue oxygen tension. In contrast to pre-ischemic treatments, intervention to reduce peroxynitrite generation at the onset of reperfusion can effectively improve post-ischemic myocardial recovery.