Relation between serum ferritin and liver and heart MRI T2* in beta thalassaemia major patients.

There is a need for higly accurate non-invasive methods for assessing organ iron content in thalassaemia patients. This study evaluated the relation between serum ferritin level, liver enzyme levels and hepatitis C antibody and liver and heart iron deposition assessed by MRI T2*. Data were obtained from the medical records of 156 thalassemia major patients in Tehran. There was a moderate negative correlation between serum ferritin and liver MRI T2* relaxation time (r = -0.535) and a weak negative correlation between serum ferritin and heart MRI T2* relaxation time (r = -0.361). Hepatitis C infection and liver enzyme levels did not confound or modify the relation between ferritin and liver or heart MRI T2*. Liver and heart MRI T2* readings were poorly correlated (r = 0.281). Routine evaluation of liver and heart iron content using MRI T2* is suggested to better evaluate the haemosiderosis status in thalassemia patients.

Relation between serum ferritin and liver and heart MRI T2 in beta thalassaemia major patients

There is a need for higly accurate non-invasive methods for assessing organ iron content in thalassaemia patients. This study evaluated the relation between serum ferritin level, liver enzyme levels and hepatitis C antibody and liver and heart iron deposition assessed by MRI T2 Data were obtained from the medical records of 156 thalassemia major patients in Tehran. There was a moderate negative correlation between serum ferritin and liver MRI T2 relaxation time [r= -0.535] and a weak negative correlation between serum ferritin and heart MRI T2 relaxation time [r= -0.361]. Hepatitis C infection and liver enzyme levels did not confound or modify the relation between ferritin and liver or heart MRI T2. Liver and heart MRI T2* readings were poorly correlated [r= 0. 281]. Routine evaluation of liver and heart iron content using MRI T2 is suggested to better evaluate the haemosiderosis status in thalassemia patients

Correlation of cardiac MRI T2* with echocardiography in thalassemia major.

BACKGROUND AND OBJECTIVE: Myocardial iron deposition and cardiac failure in thalassemia major (TM) is the most serious reason of morbidity and mortality. Cardiac magnetic resonance imaging (MRI T2*) can indirectly quantified myocardial iron content. Moreover echocardiographic left ventricular diastolic evaluation in comparison to systolic evaluation is more sensitive to detect early myocardial dysfunction secondary to iron overload. The aim was to determine some diastolic and tissue Doppler echo indices correlated with cardiac MRI T2* to predict iron load. PATIENTS AND METHODS: Thirty three TM patients (17F/16M) with history of 15 years transfusion or more were selected. They did cardiac MRI (CMR) with measurement of relaxation time of T2* and also echocardiographic examination with systolic and diastolic evaluation and tissue Doppler imaging. RESULTS: The mean value of cardiac T2* was 20.41 +/- 12.1 ms. Patients with abnormal T2* (< 20 ms) had abnormal ejection fraction (EF) in 10 (53.6%), and abnormal diastolic indices including deceleration time (DT), early (E) and late (A) transmitral peak flow velocity ratio (E/A), E/Em and Tei- index in 13 (72.2%), 12 (66.7%), 18 (100%) and 14 (77.8%) patients respectively. There was a good correlation between DT, Tei index and E/Em index with cardiac T2* values (p < 0.05, r = 0.70-0.81), poor correlation between E/A with T2* (p < 0.05, r = -0.44) and no significant correlation of liver T2* with cardiac T2* (p = 0.819). CONCLUSIONS: In unequipped centres which CMR is not available because of good correlation between diastolic echocardiographic parameters and CMR T2*, the use of echocardiographic diastolic parameters for evaluation of cardiac state could be a replacing tool. In equipped centres we suggest doing CMR T2* as a first step examination in high risk patients, and then doing regular F/U with echocardiographic evaluation of diastolic and tissue Doppler echocardiographic parameters especially DT, E/Em and Tei index.

1-hexyl n-cyanoacrylate compound (Neucrylate™ AN), a new treatment for berry aneurysm. III: Initial clinical results.

INTRODUCTION: As part of an institutionally approved research protocol, patients with cerebral berry aneurysm were enrolled in a clinical trial designed to evaluate the safety of the new moldable liquid embolic agent Neucrylate AN. METHODS: Twelve patients with aneurysms judged to be suboptimal for treatment by standard endovascular or surgical approaches were treated with Neucrylate AN. The agent was injected during temporary balloon occlusion at the neck of the aneurysm. The immediate angiographic percentage of aneurysm occlusion and periprocedural adverse events were assessed for each patient. Six-month follow-up angiographic studies were obtained for nine of the 12 patients. RESULTS: Ten of the 12 aneurysms treated (83%) were large to giant (>1.0 cm in diameter), nine (75%) were wide-necked (dome/neck ratio <2.0) and three (25%) were dissecting aneurysms. There were four (33%) periprocedural neurological events. Immediate aneurysm occlusion of >90% was obtained in nine of the 12 cases (75%). There were five recurrences (55.5%) at 6 months. CONCLUSION: This preliminary clinical series shows that it is feasible to achieve a high percentage of immediate aneurysm occlusion with limited patient morbidity and mortality in the setting of morphologically challenging aneurysms. These preliminary data support larger trials assessing the safety and efficacy of this agent.

Quantitative T2* magnetic resonance imaging for evaluation of iron deposition in the brain of ß-thalassemia patients.

BACKGROUND: Iron overload is a common clinical problem in patients with ß-thalassemia major. The purpose of this study was to assess the presence of excess iron in certain areas of the brain (thalamus, midbrain, adenohypophysis and basal ganglia) in patients with ß-thalassemia major and evaluate the association with serum ferritin and liver iron content. MATERIALS AND METHODS: A cross-sectional study on 53 patients with ß-thalassemia major and 40 healthy controls was carried out. All patients and healthy controls underwent magnetic resonance imaging (MRI) examinations of the brain and liver. Multiecho fast gradient echo sequence was used and T2* values were calculated based on the Brompton protocol. Correlations between T2* values in the brain with T2* values in the liver as well as serum ferritin levels were investigated. RESULTS: There were no significant differences between patients and healthy controls with respect to age and sex. Patients had significantly lower T2* values in basal ganglia (striatum), thalamus and adenohypophysis compared to controls while there were no differences in the midbrain (red nucleus). There were no significant correlations between liver T2* values or serum ferritin with T2* values of basal ganglia (striatum), thalamus and adenohypophysis in patients or healthy controls. There were no significant correlations between T2* values of adenohypophysis and thalamus or basal ganglia (striatum) while these variables were significantly correlated in healthy controls. CONCLUSIONS: Serum ferritin and liver iron content may not be good indicators of brain iron deposition in patients with ß thalassemia major. Nevertheless, the quantitative T2* MRI technique is useful for evaluation of brain iron overload in ß thalassemia major patients.

Radioprotective effects of chlorogenic acid against mortality induced by gamma-irradiation in mice.

The radioprotective effects of the naturally occurring compound chlorogenic acid have been investigated against mortality induced by gamma-irradiation in mice. Chlorogenic acid was administrated at single doses of 100, 200 and 400 mg/kg 1 or 24 h prior to lethal dose of gamma-irradiation (8.5 Gy). At 30 days after treatment, the percentage of survival in each group was as follows: control, 20%; 100 mg/kg, 20% and 15%; 200 mg/kg, 45% and 15%; 400 mg/kg, 25% and 35% for 1 h and 24 h treatment prior gamma-irradiation, respectively. Survival rate was statistically increased in animals treated with this agent at 200 mg/kg at 1 h prior to irradiation as compared with the irradiation only group. Other doses of chlorogenic acid have not showed any enhanced survival when it was administrated at 1 or 24 h before irradiation. Chlorogenic acid exhibited concentration-dependent activity on 1,1-diphenyl-2-picrylhydrazyl free radical to show strong antioxidant activity. It appeared that chlorogenic acid with antioxidant activity reduced mortality induced by gamma-irradiation.

Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation.

AIM: To assess the efficacy of percutaneous osteoid osteoma treatment using a combination of radiofrequency ablation (RFA) and alcohol ablation with regard to technical and long-term clinical success. MATERIALS AND METHODS: From December 2001 to November 2004, RFA and subsequent alcohol ablation was performed on 54 patients with osteoid osteoma, diagnosed clinically using radiography, computed tomography (CT) and symptoms. Under general anaesthesia, treatment was performed via percutaneous access under thin section (2mm) spiral CT guidance in all cases with an 11 G radiofrequency-compatible coaxial needle and 2mm coaxial drill system and 1.0 cm active tip 17 G non-cooled radiofrequency needle. RFA was performed at 90 degrees C for a period of 6 min. After needle removal, 0.5-1.0 ml absolute alcohol (99.8% concentration) was injected directly into the nidus using a 20 G needle. Patients were discharged within 24h and followed up clinically (at 1 week, 1 month and every 3 months thereafter). RESULTS: The technical success rate was 100%. Complications occurred in two patients consisting of local mild cellulitis in entry site and peripheral small zone paresthesia on the anterior part of leg. The follow-up period range was 13-48 months (mean+/-SD, 28.2+/-7.4 months). Prompt pain relief and return to normal activities were observed in 52 of 54 patients. Recurrent pain occurred in two patients after a 1 and 3 months period of being pain free, respectively; a second RFA and alcohol ablation was performed achieving successful results. Primary and secondary clinical success rates were 96.3% (52/54 patients) and 100% (2/2 patients), respectively. CONCLUSION: Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation is safe, effective and minimally invasive with high primary and secondary success rates. Persistent or recurrent lesions can be effectively re-treated.