Usefulness of segmented trueFISP cardiac pulse sequence in evaluation of congenital and acquired adult cardiac abnormalities

OBJECTIVE: The purpose of this study is to compare ultrashort TR, segmented trueFISP (fast imaging with steady-state precession) cine MR imaging with segmented FLASH (fast low-angle shot) cine MR imaging for the detection and characterization of congenital and acquired adult cardiac abnormalities. SUBJECTS AND METHODS: Twenty-five patients with known or clinically suspected cardiac abnormalities were imaged on a 1.5-T scanner. Valve plane movies were obtained in patients with suspected valve morphology or function abnormalities or whose horizontal long-axis images showed jets. For each patient, three radiologists independently compared corresponding matched cine FLASH and trueFISP movies for image quality in evaluating anatomy and function of the great vessels and heart. Image quality was rated on a five-point scale, and data were analyzed using both a Wilcoxon's signed rank test and a repeated-measures analysis of variance. RESULTS: Image quality ratings of trueFISP and FLASH showed a statistically significant difference (F = 58.67; df = 1, 72; p < 0.0001), with the average rating for the trueFISP images being significantly higher (mean rating, 4.1 +/- 0.92) than that for the FLASH images (mean, 3.0 +/- 1.0). However, valve architecture in the aortic valves appeared to be better visualized and was more easily measured in valve plane images with FLASH. No statistically significant differences among the ratings of the interpreters (F = 0.018; df = 2, 72; p = 0.9821) were evident, and, therefore, no suggestion of bias was indicated (F = 0.775; df = 1, 2; p = 0.4645). TrueFISP yielded the correct diagnosis prospectively in 13 (100%) of 13 patients, whereas FLASH yielded the correct diagnosis in 12 (92%) of 13 patients. CONCLUSION: TrueFISP images depict morphologic and functional abnormalities with greater clarity and provide greater diagnostic confidence than FLASH images-and in a fraction of the time. A specific exception is in the assessment of valve leaflet architecture and cross-sectional area calculation (i.e., bicuspid aortic valves); in these evaluations, FLASH maintains a complementary diagnostic imaging role.     

Aldicarb poisoning

Aldicarb (2-methyl-2(methylthio) propanal o-[(methylamino)-carbonyl] oxime) is a pesticide manufactured since 1965. This carbamate ester is sold under the tradename, Temik, and is used as insecticide and nematicide. The Environmental Protection Agency has classified aldicarb in the highest toxicity category and has defined a strict control for its delivery and use. In Brazil and the Caribbean island, aldicarb is illegally used as a household rodenticide with a widespread risk of poisoning. Our study presents the first review of aldicarb poisoning circumstances associated with clinical and analytical findings. Moreover, the oxime treatment is discussed. Eighteen patients with cholinergic symptoms admitted to the Emergency Unit and two deceased with a history of aldicarb poisoning were included in the study. As agricultural workers, only two of them could legally use Temik. Seventy percent of the patients was managed by the Emergency Mobil Unit. Serum cholinesterase activity was always lower than 30% of the normal range and aldicarb was identified by UV spectra and retention time after liquid chromatography separation. The most common muscarinic effect was diarrhea, the main nicotinic sign fasciculation and almost half of the poisoned patients had central nervous system (CNS) depression (Glasgow Coma Score lower than 8). Four patients had serious conduction abnormalities and two of them died. These results suggest that aldicarb intoxication is always severe. Oxime treatment did not produce side effects and should be recommended whenever the pesticide involved is unknown. Effective measures should be implemented to stamp out the illicit use of aldicarb.     

The YAG laser used in micromanipulation to transect the zona pellucida of hamster oocytes

Problem Since there has been no reported use of the YAG laser to micromanipulate oocytes, our purpose was to study whether (1) a YAG laser could be used to open the zona pellucida of hamster oocytes; (2) human sperm could reach the ooplasm and (3) under sperm penetration assay conditions, sperm would bind and penetrate the ooplasm.Results A YAG 100 laser was used at 10 W and 0.4-sec pulse width to open eight of eight ooplasm oocytes. The opening in the zonae was 0.25 to 1.0 rad (10 to 40 µm). For the initial eight oocytes and two parallel controls, the coarse appearance of the ooplasm was unchanged after 3 days. Next, in 11 of 12 manipulated oocytes, the sperm clustered at the opening of the zona. When 16 more oocytes were opened and exposed to sperm in sperm penetration assay conditions, each ooplasm bound sperm. There was no penetration noted. Each manipulation time was <1 min. To clarify the laser effect, oocytes were exposed to laser energy then utilized as the interactive surface in the sperm penetration assay. It was found that only 20% bound sperm with no penetration. Conclusion While the time factor compares favorably with other methods of zona opening, further study needs to be performed to minimize effect to the exposed oocyte.     

A case of hyperthyroidism due to metastasis of a thyroid carcinoma

A case of hyperthyroidism, which developed in a patient affected by thyroid carcinoma a few days after thyroidectomy, is described. The symptomatology was caused by a bone metastasis at the left ischiopubic branch, which had a high iodine-uptake capacity and was sensitive to metabolic radiotherapy. Pulmonary metastases were also present; they had a distinct low affinity for iodine and showed no response to repeated administrations of 131I. The case is evaluated on the basis of the evolution of the clinical picture and the hormone dosages administered in a follow-up period of 3 years.     

Investigation on the renal clearance of metylglucamine diatrizoate and of sodium and metylglucamine diatrizoate (author's transl)

In 14 patients the kinetics has been studied of two contrast media labelled with 131I, and namely of MGM diatrizoate and of diatrizoate of sodium and MGM. The clearance was determined both at basal concentrations and in double concentration by means of external counting. The results were statistically studied by means of the linear regression method. The authors conclude that the MGM diatrizoate is exclusively eliminated through the glomeruli both in basal and double concentration. The diatrizoate of sodium and MGM is eliminated in low concentration through the glomeruli, while in double concentration it is partially eliminated through the tubuli.     

Patients' coping strategies during radiotherapy

Cancer is a disease that entails inquiries and a wide range of problems for persons going through this experience, inevitably leading to stress, which is part of human life. There are different ways of adapting to a situation to cope with the stress. What makes a difference in this context are the coping strategies, defined as a process used to control the demands of the relationship between individual and environment, to be elaborated by the individual. In this study, we tried to identify the forms used to cope with the disease and treatment. This is a qualitative study, using Collective Subject Discourse Analysis and the theoretical framework of coping. Sixteen radiotherapy patients were interviewed as part of a convenience sample. When faced with cancer and radiotherapy, the patients elaborated coping strategies that were based on emotion as well as on the problem.     

A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up

SUMMARY BACKGROUND DATA: Axillary dissection, an invasive procedure that may adversely affect quality of life, used to obtain prognostic information in breast cancer, is being supplanted by sentinel node biopsy. In older women with early breast cancer and no palpable axillary nodes, it may be safe to give no axillary treatment. We addressed this issue in a randomized trial comparing axillary dissection with no axillary dissection in older patients with T1N0 breast cancer. METHODS: From 1996 to 2000, 219 women, 65 to 80 years of age, with early breast cancer and clinically negative axillary nodes were randomized to conservative breast surgery with or without axillary dissection. Tamoxifen was prescribed to all patients for 5 years. The primary endpoints were axillary events in the no axillary dissection arm, comparison of overall mortality (by log rank test), breast cancer mortality, and breast events (by Gray test). RESULTS: Considering a follow-up of 60 months, there were no significant differences in overall or breast cancer mortality, or crude cumulative incidence of breast events, between the 2 groups. Only 2 patients in the no axillary dissection arm (8 and 40 months after surgery) developed overt axillary involvement during follow-up. CONCLUSIONS: Older patients with T1N0 breast cancer can be treated by conservative breast surgery and no axillary dissection without adversely affecting breast cancer mortality or overall survival. The very low cumulative incidence of axillary events suggests that even sentinel node biopsy is unnecessary in these patients. Axillary dissection should be reserved for the small proportion of patients who later develop overt axillary disease.