A Comparison of Radiation Dose Between Standard and 3D Angiography in Congenital Heart Disease

Background

The use of three-dimensional rotational angiography (3D-RA) to assess patients with congenital heart diseases appears to be a promising technique despite the scarce literature available.

Objectives

The objective of this study was to describe our initial experience with 3D-RA and to compare its radiation dose to that of standard two-dimensional angiography (2D-SA).

Methods

Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA and 2D-SA during diagnostic cardiac catheterization. Radiation dose was assessed using the dose-area-product (DAP).

Results

The median patient age and weight were 12.5 years and 47.5 Kg, respectively. The median DAP of each 3D-RA acquisition was 1093µGy.m² and 190µGy.m² for each 2D-SA acquisition (p<0.01). In patients weighing more than 45Kg (n=7), this difference was attenuated but still significant (1525 µGy.m² vs.413µGy.m², p=0.01). No difference was found between one 3D-RA and three 2D-SA (1525µGy.m² vs.1238 µGy.m², p = 0.575) in this population. This difference was significantly higher in patients weighing less than 45Kg (n=9) (713µGy.m² vs.81µGy.m², P = 0.008), even when comparing one 3D-RA with three 2D-SA (242µGy.m², respectively, p<0.008). 3D-RA was extremely useful for the assessment of conduits of univentricular hearts, tortuous branches of the pulmonary artery, and aorta relative to 2D-SA acquisitions.

Conclusions

The radiation dose of 3D-RA used in our institution was higher than those previously reported in the literature and this difference was more evident in children. This type of assessment is of paramount importance when starting to perform 3D-RA.     

Recurrent Primary Cardiac Lymphoma on Aortic Valve Allograft: Implications for Therapy

Primary malignant cardiac lymphomas associated with grafts are extremely rare: to our knowledge, only 6 cases of prosthesis-associated B-cell lymphoma have been reported. Ours is the first report of recurrent diffuse large B-cell lymphoma associated with aortic valve allografts.We treated a 60-year-old man who presented in early 2007 with aortic valve endocarditis. He underwent aortic valve replacement with an allograft; the resected native valve showed active endocarditis without tumor. In January 2011, the patient underwent repeat aortic valve replacement because of symptomatic aortic regurgitation. The explanted valve specimen displayed diffuse large B-cell lymphoma. In September 2011, the patient presented with fever and a mass around the aortic valve. He died in January 2012. On autopsy, the explanted replacement valve displayed recurrent diffuse large B-cell lymphoma. The recurrent lymphoma on a new graft leads us to believe that this tumor is more aggressive than had been thought. We propose early systemic chemotherapy, in addition to tumor resection, for the possibility of a better prognosis. We discuss our patient''s case and review the relevant medical literature.     

氟哌啶醇与奥氮平治疗精神分裂症疗效和安全性的随机对照研究

目的比较氟哌啶醇与奥氮平治疗精神分裂症的疗效及安全性。方法将符合精神分裂症诊断标准的住院患者按照1:2比例随机分为氟哌啶醇(n=120)和奥氮平治疗组(n=252),进行为期6周的治疗观察;于基线及治疗2、4、6周末评定阳性和阴性症状量表(positive and negative syndrom scale,PANSS),锥体外系副反应量表(rating scale for extrapyramdal side effects,RSESE)、静坐不能评定量表(barnes akathisia rating scale,BARS)和异常不自主运动量表(abnormal involuntary movement scale,AIMS);计算体质量指数(body mass index,BMI);基线及治疗4、6周末测定空腹血糖、血脂和肝功能等指标。结果氟哌啶醇组与奥氮平组基线PANSS总分差异无统计学意义;第6周末氟哌啶醇组PANSS总分低于奥氮平组(53.31±1.64 vs.58.05±1.02),减分率高于后者(60.63±2.86%vs.52.45±1.80%),均P<0.05;两组有效率(66.7%vs.62.7%)差异无统计学意义。第6周末氟哌啶醇组BMI较基线的变化值(0.08±0.20 kg/m2vs.0.91±0.12 kg/m2)、谷丙转氨酶异常病例数比例(16.98%vs.28.07%)均低于奥氮平组(P<0.05);第4周末氟哌啶醇组甘油三酯较基线的变化值低于奥氮平组(0.24±0.12 mmol/L vs.0.57±0.07 mmol/L),P<0.05。氟哌啶醇组锥体外系不良反应发生率(73.3%)明显高于奥氮平组(10.71%),P<0.05。结论在精神分裂症急性期,氟哌啶醇治疗有效率与奥氮平相当,对体重、血脂、转氨酶的影响较小,但锥体外系不良反应发生率较高。     

Topiramate increases the risk of valproic acid–induced encephalopathy

Metabolic encephalopathy is a rare but serious complication of valproic acid (VPA) therapy that usually presents with impaired consciousness or increased seizure frequency. Although it has been suggested that topiramate (TPM) increases the risk of VPA‐induced encephalopathy, the additional risk in patients receiving TPM therapy has not been evaluated. We reviewed all adult patients who took VPA between January 2005 and February 2009 at the Seoul National University Hospital and identified patients with VPA‐induced encephalopathy based on clinical and electroencephalography (EEG) data. Information on sex, age, serum ammonia level, serum VPA level, liver function test, and EEG was collected from patient registry and medical data. We enrolled 8,372 patients who received VPA therapy and 1,236 patients who received VPA/TPM combination therapy. We identified 11 patients with VPA‐induced encephalopathy (0.13%), 7 of whom received a combination therapy of VPA and TPM. The odds ratio of VPA‐induced encephalopathy with TPM over that without TPM was 10.16. There were no significant differences in sex distribution, number of antiepileptic agents, ammonia level, VPA serum level, underlying diseases, dosage of VPA, duration of VPA treatment, treatment of encephalopathy, and outcomes between the two groups. Our study showed that the prevalence of VPA‐induced encephalopathy is approximately 0.1% among patients treated with VPA and that the risk of this condition, although still low, can increase by approximately 10 times in the presence of TPM therapy. Based on these results, we suggest that TPM should be carefully used in patients receiving VPA treatment.     

Side Effects after Phototherapy Implementation in Addition to Fluoxetine or Sertraline Treatment: A Report of Two Cases

Summary: Serotonergic-type side effects (like diarrhoea, hyperthermia, nausea, confusion) were seen after phototherapy in patients receiving fluoxetine or sertraline. Phototherapy was discontinued and symptoms completely resolved. In the authors' opinion, the symptoms were likely to be associated with specific interaction (serotonin effect potentialisation). To the authors' knowledge this is the first report concerning such an effect.     

中西医结合治疗缺血性脑血管病临床疗效观察

目的 回顾性分析中西医结合治疗缺血性脑血管病的疗效。方法 对126例缺血性脑血管病患者，在早期西医溶栓、抗凝、降低血液粘度、扩张血管和促进脑细胞代谢等治疗基础上，结合中医辩证施治治疗。结果 42例瘫肢肌力恢复达V级；48例肌力≥Ⅳ级，言语流畅；27例生活能基本自理，可依杖散步，肌力≥Ⅲ级：9例与治疗前对比肌力提高Ⅰ～Ⅱ级，但生活仍不能自理。结论 在西药治疗基础上，结合益气活血中药调理可显著提高患者的疗效。     

Intellectual and language functions in children of mothers with epilepsy

PURPOSE: To compare the intellectual and language functions of children of mothers with epilepsy (CME) with that of controls matched for age and socioeconomic status. METHODS: Cases were CME, aged six years or more (n = 71), drawn from a prospective cohort in the Kerala Registry of Epilepsy and Pregnancy. Controls were 201 children of parents without epilepsy, matched for age and socioeconomic status. The outcome measures included Indian adaptation of Wechsler Intelligence Scale for children and MLT-a locally developed proficiency test for regional language. All relevant data were abstracted from the registry records. RESULTS: The Full Scale IQ and MLT scores were significantly lower for the cases (87.7 +/- 22.6 and 73.4 +/- 17.3) compared to controls (93.0 +/- 14.4 and 83.2 +/- 11.8). Compared to controls, CME scored poor on all subtests of MLT but their impairment was confined to only some of the subtests of IQ. Maternal education and maternal IQ significantly correlated with low IQ and MLT scores for CME whereas type of epilepsy, seizures during pregnancy or low birth weight did not have any significant association with these outcome measures. Polytherapy and higher dosage of antiepileptic drugs (AEDs) were associated with significant impairment in outcome measures. Infants with low developmental quotient at one year of age continued to have low scores on outcome measures at six years. CONCLUSIONS: Low maternal IQ, maternal education, and antenatal AED exposure were associated with significant impairment of intellectual and language functions for CME at six years.     

利培酮治疗首发精神分裂症的临床疗效观察

目的：观察利培酮治疗首发精神分裂症的疗效，副反应及最佳剂量。方法：首次使用可变剂量的利培酮治疗首发精神分裂症8周，使用阳性和阴性症状量表（PANSS）及不良反应症状量表（TESS）分别评定疗效和副反应。结果：全部病例完成8周治疗。治疗前后PANSS减分率比较，差异有极显著性（P＜0．001），显效率为81．63％，有效率达95．92％，起效时间在第2－4周，最佳剂量≤4mg/d，低剂量组（≤4mg/d)PANSS减分率大于高剂量组（＞4mg/d)，较多见副反应为EPS（20．41％），结论：低剂量利培酮（≤4mg/d)治疗首发精神分裂症安全，有效，病人依从性好。     

Coffee consumption,cigarette smoking and reporting of drowsiness in anxious patients treated with benzodiazepines or placebo

Data obtained from anxious outpatients treated with either chlordiazepoxide or diazepam (n= 533) or placebo (n= 285) were used to explore the impact of coffee/tea and cigarette consumption upon the frequency of reporting of drowsiness after 2 weeks of treatment. Strong evidence was provided that both cigarette smoking and coffee drinking afiect the frequency with which drowsiness is reported by patients receiving the two benzodiazepines. However, not only the magnitude but also the direction of the impact of coffee consumption upon drowsiness depends upon the level of cigarette smoking and vice versa. For patients smoking ≦ 1 pack of cigarettes/day, drowsiness is reported less frequently by heavy coffee users while for patients smoking > 1 pack of cigarettes/day, drowsiness is reported more frequently by heavy coffee users. Similarly, for patients drinking ≦ 2 cups of coflee/day, drowsiness occurs less frequently among heavier smokers while for patients drinking > 2 cups of coffee/day, drowsiness occurs more frequently among heavier smokers. These results are consistent with reports that particular substances contained in coffee and tea and in cigarette smoke stimulate the synthesis of hepatic enzymes which metabolize both the benzodiazepines here studied and the substances which have stimulated enzyme synthesis.     

Executive function late effects in survivors of pediatric brain tumors and acute lymphoblastic leukemia

Background: Survivors of pediatric brain tumors (BT) and acute lymphoblastic leukemia (ALL) are at risk for neurocognitive late effects related to executive function. Procedure: Survivors of BT (48) and ALL (50) completed neurocognitive assessment. Executive function was compared to estimated IQ and population norms by diagnostic group. Results: Both BT and ALL demonstrated relative executive function weaknesses. As a group, BT survivors demonstrated weaker executive functioning than expected for age. Those BT survivors with deficits exhibited a profile suggestive of global executive dysfunction, while affected ALL survivors tended to demonstrate specific rapid naming deficits. Conclusion: Findings suggest that pediatric BT and ALL survivors may exhibit different profiles of executive function late effects, which may necessitate distinct intervention plans.