Haemodynamic Studies During the Management of Severe Tetanus

Detailed invasive haemodynamic studies were performed in 27of 32 patients with severe tetanus. Nineteen had severe uncomplicatedtetanus and eight had associated major complications, chieflyinfection and pulmonary complications. The results were comparedwith those obtained from 15 healthy male volunteers who servedas controls. There were two deaths in 32 patients (mortality6.25 per cent). Severe tetanus without major complications wascharacterized by a high output hyperkinetic circulatory statewith tachycardia (heart rate 131 (19.2) beats/minute), increasedstroke volume index (43.1 (10.7) ml/m²), increased cardiac index(5.48 (0.94)1/min/m²) and a normal left ventricular stroke workindex (60.5 (15.9) g/m/m²). Volume loading demonstrated a significanthaemodynamic response and increased vascular capacitance. Evenso the maximum percent rise from baseline values of these indicesafter volume load was significantly higher in controls (p <0.001). Autonomic cardiovascular disturbances affected bothsympathetic and parasympathetic activity. Hypertension and tachycardiaalternating with hypotension and bradycardia were related tosudden fluctuations in systemic vascular resistance. Our studiessuggested some degree of myocardial dysfunction in patientswith severe uncomplicated tetanus. The haemodynamics of severetetanus were masked and altered by complicating infection, pneumonia,and atelectasis.     

Unknown poisoning amongst serving personnel

Background: Poisoning is recognized as an important health problem in many countries of the world. There is incomplete information on poisoning accidents, which is a major problem in developing countries.     

What does the clinical cardiologist need from noninvasive cardiac imaging: is it time to adjust practices to meet evolving demands?

With the recent emergence of multidetector computed tomography angiography, coronary anatomy can now be assessed noninvasively. Until this advancement, functional noninvasive imaging used to serve as a gatekeeper that governed access to invasive diagnosis by coronary angiography and subsequent therapy. In the current era the threshold for access to coronary anatomy will be lowered. Functional noninvasive imaging will often come second, while anatomy is known already. If appropriate use of revascularization procedures is to be promoted, functional evaluation shall play an even greater role than before as a guide for selection of therapy. In subjects screened while the atherosclerotic disease is still at a preclinical stage, the ability to image plaque activity in the absence of flow-limiting stenosis will be essential in our attempts to prevent sudden ischemic cardiac death and unheralded myocardial infarction. In patients with advanced age and extensive obstructive disease, the diagnostic performance of functional testing will have to be raised by shifting from "per-patient" to "per-vessel" accuracy. Reengineering of currently available methods or the development of novel technologies that provide an integrative evaluation of anatomy and function will be necessary. With the availability of an increasing number of imaging options, it is anticipated that the emphasis will be placed more than ever on cost-effectiveness on a population basis, as well as on segmental predictive accuracy in the individual subject.     

A simple method to estimate cardiac function during routine multi-row detector CT exams

Cardiac dysfunction may be suggested at computed tomography (CT) exams by the presence of morphological abnormalities such as cardiac enlargement and thickening of the pulmonary interlobular septa. However, these morphological signs are non specific. We evaluated whether right-to-left cardiac transit time of contrast during single-level timing scans could predict the cardiac output and ejection fraction. In a consecutive group of 100 patients referred for body CT, a preliminary single-level study was used to measure the right-to-left ventricular transit time of intravenously injected contrast medium. In all these patients, the cardiac index (cardiac output corrected for body surface area, CI) and ejection fraction (EF) were calculated using cardiac magnetic resonance imaging (CMR). Data of the first half (50 patients, group A) were used to establish a method and concept to predict the cardiac index and ejection fraction with CT. The method was validated in the next half (50 patients, group B) by comparing the predicted CT results with those obtained with CMR. There was a good correlation of the observed CI with CMR and observed transit time on CT in group B (P < 0.05; R² 0.70 ). Functional CT estimates of CI and EF in group B correlated well with the CMR results for CI and EF (P < 0.05; R² 0.66 for CI and P < 0.05; R² 0.49 for EF). The presence of a right-to-left ventricular transit time of more than 10.5 s indicated cardiac dysfunction with a specificity and positive predictive value of 100%. Right-to-left transit time obtained during routine body CT exams can provide valuable physiological information on global cardiac function.     

Effect of menstrual cycle phase on dopamine D2 receptor availability in female cynomolgus monkeys

Sex differences have been reported in a variety of affective and neurodegenerative disorders that involve dysfunctional dopamine (DA) neurotransmission. In addition, there is evidence for differences in sensitivity to the abuse-related effects of psychostimulants across the menstrual cycle which may result from effects of ovarian hormones on DA function. The goal of the present study was to extend previous work examining menstrual cycle-related changes in DA D2 receptor availability in humans to drug-naive female cynomolgus monkeys (n=7) using the selective D2-like receptor ligand [(18)F]fluoroclebopride (FCP) and a high-resolution microPET P4 scanner. Menstrual cycle phase was characterized by daily vaginal swabs and measurements of serum progesterone levels. PET studies were conducted once during the luteal phase and once during the follicular phase. Regions of interest in the caudate nucleus, putamen, and cerebellum were defined on coregistered MRIs. Distribution volumes were calculated for FCP in each structure and the distribution volume ratio (DVR) for both brain regions relative to the cerebellum was used as a measure of D2 receptor availability. FCP DVRs were significantly higher in the luteal phase compared to the follicular phase in both the caudate nucleus (11.7% difference, p=0.02) and putamen (11.6% difference, p=0.03). These findings extend earlier work in humans and suggest that changes in DA receptor availability may be involved in the variation in symptoms of various neuropsychiatric disorders across the menstrual cycle, including differences in sensitivity to the abuse-related effects of stimulants.     

Surgical considerations for ‘intrinsic＇ brainstem gliomas： proposal of a modification in classification

BACKGROUND： Brainstem gliomas are highly heterogeneous tumors both in their clinical manifestation and in their pathology. Despite significant advances in the surgery for brainstem gliomas many aspects of this pathology are still unelear. OBJECTIVE： To evaluate the clinical, radiological and surgical outcome of 40 focal ＂intrinsic＂ brainstem gliomas and propose a surgical strategyoriented classification. MATERIALS AND METHODS： A total of 40 focal ‘intrinsie’ （＂expanding variety＂） tumors have been operated over a period of 8.5-years （January 1998-June 2007）. Our criteria included patients with （1） well-defined gadolinium enhancing tumor, （2） relatively long duration of symptoms （〉 six months） and （3） good neurological functional status and independent for all activities of davy living. The cutoff size of 2 cm was not rigidly adhered to. RESULTS： The ＂intrinsic＂ brainstem tumors were classified into three types： Expanding, diffuse infiltrative and pure ventral varieties.     

Successful Treatment of Bone Marrow Failure in Gaucher's Disease with Low-dose Modified Glucocerebrosidase

We report the beneficial effects of enzyme replacement therapywith mannose-terminated human glucocerebrosidase (‘Ceredase’)in a patient suffering from transfusion-dependent bone marrowfailure due to Gaucher's disease. Treatment with low-dose enzymeinfusions, given twice weekly, rapidly reversed the haematopoieticfailure and incapacitating skeletal disease. It appears likelythat prior splenectomy favourably influenced the response tothis therapy.