Evolution of systolic function and myocardial perfusion,evaluated by gated-SPECT,in the first year after acute myocardial infarction

INTRODUCTION AND OBJECTIVES: Systolic function and myocardial perfusion are evaluated before hospital discharge and can change during follow-up. The purpose of this study was to evaluate these parameters by gated-SPECT in the first year after acute myocardial infarction. PATIENTS AND METHOD: We studied 74 consecutive patients with a first uncomplicated acute myocardial infarction (49 infero-lateral and 25 anterior) by stress-rest 99mTc-tetrofosmin and rest-gated-SPECT before hospital discharge (6-8 days after admission) and one year after myocardial infarction. RESULTS: The ejection fraction (EF) increased > 5% in 51% of infero-lateral infarcts and 28% of non-revascularized anterior infarcts. EF increased significantly (48.4 8% to 54.6 8.7%; p < 0.0001, mean difference: 6.2; 95% IC, 2.8-9.5) and systolic volume decreased (51.3 19.2 ml to 44.3 19.4 ml; p = 0.001; mean diff.: 7.67; 95% IC, 1.5-13.8) in infero-lateral infarctions. The rest perfusion index in the necrotic region improved (2.3 0.57 to 2.17 0.58; p = 0.004; mean diff.: 0.18; 95% IC, 0.003-0.36) in infero-lateral infarcts and the ischemia index remained unchanged between the first and second studies. CONCLUSIONS: Left ventricular systolic function can change during the first year of evolution, a significant improvement being seen in infero-lateral infarctions. The ejection fraction increased > 5% in half of these patients, as opposed to only a quarter of anterior infarctions. This improvement was associated to increased myocardial perfusion at rest.     

Effect of bronchial colonisation on airway and systemic inflammation in stable COPD

The recovery of potentially pathogenic microorganisms (PPMs) from bronchial secretions is associated with a local inflammatory response in COPD patients. The objective of this study was to determine the relationships between bronchial colonisation and both bronchial and systemic inflammation in stable COPD. In COPD patients recruited on first admission for an exacerbation, bacterial sputum cultures, interleukin (IL)-1β, IL-6 and IL-8 levels, and blood C-reactive protein (CRP) were measured in stable condition. Bronchial colonisation was found in 39 of the 133 (29%) patients and was significantly related to higher sputum IL-1β (median [percentile 25-75]; 462 [121-993] vs. 154 [41-477] pg/ml, p = 0.002), IL-6 (147 [71-424] vs. 109 [50-197] pg/ml, p = 0.047) and IL-8 values (15 [9-19] vs. 8 [3-15] (×103) pg/ml, p = 0.002). Patients with positive cultures also showed significantly elevated levels of serum CRP (6.5 [2.5-8.5] vs. 3.5 [1.7-5.4] mg/l, p = 0.016). Bronchial colonisation by Haemophilus influenzae was associated with higher levels of IL-1β and IL-8 and clinically significant worse scores on the activity and impact domains of the St. George's Respiratory Questionnaire. In conclusion, bronchial colonisation is associated with bronchial inflammation and high blood CRP levels in stable COPD patients, being Haemophilus influenzae related to a more severe inflammatory response and impairment in health-related quality of life.     

Biodegradable stents in gastrointestinal endoscopy

Biodegradable stents (BDSs) are an attractive option to avoid ongoing dilation or surgery in patients with benign stenoses of the small and large intestines. The experience with the currently the only BDS for endoscopic placement, made of Poly-dioxanone, have shown promising results. However some aspects should be improved as are the fact that BDSs lose their radial force over time due to the degradable material, and that can cause stent-induced mucosal or parenchymal injury. This complication rate and modest clinical efficacy has to be carefully considered in individual patients prior to placement of BDSs. Otherwise, the price of these stents therefore it is nowadays an important limitation.     

Evaluation of the effectiveness of an in-office bleaching system and the effect of potassium nitrate as a desensitizing agent

The aims of the study were to evaluate by spectrophotometer the in vivo colour changes resulting from the application of an in-office tooth bleaching system containing 28 % H₂O₂ by light-emitting diode (LED) activation and to determine whether the application of 5 % potassium nitrate 30 min before bleaching decreased tooth sensitivity. Thirty-two individuals were assigned randomly to two groups (n = 16). Group A received 5 % potassium nitrate as a desensitizing agent 30 min before bleaching with 28 % hydrogen peroxide activated by LED. Group B received glycerin as a placebo and the same bleaching protocol was applied. The colour of the right central incisor of each patient was measured visually and by spectrophotometer before bleaching, immediately thereafter, 15 days and 3 months later. Differences in L* a* b* values were tested with a repeated measures analysis of variance (ANOVA). Differences in ΔΕ values were tested with ANOVA statistical analysis at a 0.05 level of significance. Significant (p < 0.05) differences were detected in L*, as well as in b* values, between initial (I) and post bleaching (PB) and between initial (I) and 3 months post-op. In contrast, there was no significant difference between PB and 3 months post-op. The a* values showed no statistically significant differences among the different time points. Tooth sensitivity decreased significantly when potassium nitrate was applied. In-office bleaching system gave quantitatively stable results over a 3-month period. Tooth sensitivity was reduced significantly, when a desensitizing agent was applied 30 min before treatment, but the efficacy of bleaching decreased.     

A haemoperitoneum does not indicate active bleeding in the peritoneum in 50% of hypotensive blunt trauma patients: A study of 110 severe trauma patients

Background

We hypothesised that in blunt trauma patients with haemodynamic instability and haemoperitoneum on hospital admission, the haemorrhagic source may not be confined to the peritoneum. The purpose of this study was to describe the incidence and location of bleeding source in this population.

Methods

The charts of trauma patients admitted consecutively between January 2005 and January 2010 to our level I Regional Trauma Centre were reviewed retrospectively. All hypotensive patients presenting a haemoperitoneum on admission were included. Hypotension was defined by a systolic blood pressure ≤ 90 mm Hg. The haemoperitoneum was quantified on CT images or from operative reports as moderate (Federle score < 3 or between 200 and 500 ml) or large (Federle score ≥ 3 or >500 ml). Active bleeding (AB) was defined as injury requiring a surgical or radiologic haemostatic procedure, regardless of origin (peritoneal (PAB) or extraperitoneal (EPAB)).

Results

Of 1079 patients admitted for severe trauma, 110 patients met the inclusion criteria. Seventy-eight (71%) were male, mean age 35.3 (SD 19) years and mean ISS 36.5 (SD 20.5). Among the 91 patients who had AB, 37 patients (41%) had PAB, 34 (37%) had EPAB and 20 had both (22%). Forty-eight (53%) of them had moderate haemoperitoneum and 43 (47%) had large haemoperitoneum. A large haemoperitoneum had positive predictive value for PAB of 88% (95% CI 75–95%) and negative predictive value of 65% (95% CI 49–79%). The corresponding values in the subgroup of patients with EPAB were 65% (95% CI 38–86%) and 76% (95% CI 59–88%).

Conclusion

Haemoperitoneum was associated with PAB in only 52% of hypotensive blunt trauma patients and 63% of bleeding patients. In contrast, 59% of bleeding patients had at least one EPAB. The screening of a haemoperitoneum as a marker of active haemorrhagic source may be confusing and lead to misdiagnosis and inappropriate strategy. Clinician should exclude carefully the presence of any EPAB explaining haemorrhagic shock, before to decide haemostatic treatment.     

Impact of liver tumour burden,alkaline phosphatase elevation,and target lesion size on treatment outcomes with 177Lu-Dotatate: an analysis of the NETTER-1 study

European Journal of Nuclear Medicine and Molecular Imaging - To assess the impact of baseline liver tumour burden, alkaline phosphatase (ALP) elevation, and target lesion size on treatment outcomes...     

Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy:Role of faecal immunochemical test

BACKGROUND Faecal immunochemical test(FIT) has been recommended to assess symptomatic patients for colorectal cancer(CRC) detection. Nevertheless, some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized. A positive FIT result could be related to other gastrointestinal cancers(GIC).AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients(threshold 10 μg Hb/g faeces) without CRC.METHODS Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection. Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare, underwent a quantitative FIT before undergoing a complete colonoscopy. Patients without CRC were divided into two groups(positive and negative FIT) using the threshold of 10 μg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research. We determined the cumulative risk of GIC,CRC and upper GIC. Hazard rate(HR) was calculated adjusted by age, sex and presence of significant colonic lesion.RESULTS We included 2709 patients without CRC and a complete baseline colonoscopy,730(26.9%) with FIT ≥ 10 μgr Hb/gr. During a mean time of 45.5 ± 20.0 mo, a GIC was detected in 57(2.1%) patients: An upper GIC in 35(1.3%) and a CRC in 14(0.5%). Thirty-six patients(1.3%) died due to GIC: 22(0.8%) due to an upper GIC and 9(0.3%) due to CRC. FIT-positive subjects showed a higher CRC risk(HR 3.8,95%CI: 1.2-11.9) with no differences in GIC(HR 1.5, 95%CI: 0.8-2.7) or upper GIC risk(HR 1.0, 95%CI: 0.5-2.2). Patients with a positive FIT had only an increased risk of CRC-related death(HR 10.8, 95%CI: 2.1-57.1) and GIC-related death(HR2.2, 95%CI: 1.1-4.3), with no differences in upper GIC-related death(HR 1.4,95%CI: 0.6-3.3). An upper GIC was detected in 22(0.8%) patients during the first year. Two variables were independently associated: anaemia(OR 5.6, 95%CI: 2.2-13.9) and age ≥ 70 years(OR 2.7, 95%CI: 1.1-7.0).CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC,regardless of the FIT result. Patients with a positive FIT have an increased risk of post-colonoscopy CRC.