Optimization of CT protocol in polytrauma patients: an update.

Radiologists play a key role in the management of trauma patients. With the improvement of computed tomography (CT), radiologist makes an important contribution to the timely diagnosis of trauma-related findings and the choice of the most suitable treatment, improving patient outcomes. It is important to select the most appropriate imaging technique, which in the trauma patient is CT, and especially the most appropriate CT protocol, to correctly characterize trauma injuries. Currently, there is no agreement on what the optimal protocol is, acquisition times and number of contrast enhanced phases are not standardized. This is a review of the most recent literature on optimizing the CT protocol in polytrauma, with the intent of giving a useful tool for radiologists in the management of trauma patients.

Prolonged hyperinsulinemic hypoglycemia in a small for date preterm.

Hyperinsulinism is an important cause of hypoglycemia in early infancy. Many forms of hyperinsulinemic hypoglycemia are described: transient, prolonged, persistent. Transient forms are well recognized in infants of diabetic mother; prolonged forms are responsible for the hypoglycemia in small-for-date (SGA) infants and asphyxiated newborns. Persistent hyperinsulinemic hypoglycemia occurs in a group of congenital disorders associated with an abnormality of beta-cell regulation throughout the pancreas. Accurate diagnosis and treatment are essential in all various forms of hyperinsulinism also because newborns are at high risk of permanent brain damage. We report a case of prolonged hyperinsulinemic hypoglycemia in a SGA preterm, immediately treated with a high dose of glucose and glucocorticoid and then with diazoxide. Hypoglycemia was continued until 2 months of age when it resolved spontaneously and completely.

Paralytic ileus in a mechanically ventilated preterm infant treated with fentanyl.

The administration of fentanyl for sedation of ventilated newborns can induce several side-effects such as hypertension, respiratory muscle rigidity and, as shown in this report, decreased gastrointestinal motility. We report a case of paralytic ileus in a ventilated preterm infant who was given fentanyl in the first 24 hours of life. To our knowledge, the association of paralytic ileus with fentanyl has not been reported previously in full-term or preterm infants. This study indicates that early recognition is required to shorten the delay in diagnosis.

Detection of human apolipoprotein E genotypes by DNA electrochemical biosensor coupled with PCR.

BACKGROUND: Apolipoprotein E (apoE) is an important constituent of several plasma lipoproteins, mainly VLDL, HDL, and chylomicrons. It is involved in the redistribution of lipids in the liver and is implicated in growth and repair of injured neurons in the nervous system. apoE has also been associated with the risk of developing cardiovascular diseases and in familial type III hyperlipoproteinemia. METHODS: We developed a new procedure for detecting genetic polymorphisms of apoE in human blood samples. The procedure is based on coupling of DNA electrochemical sensors with PCR-amplified DNA extracted from human blood. The DNA electrochemical sensor incorporated single-stranded oligonucleotides immobilized on graphite screen-printed electrodes (SPEs) by adsorption at controlled potential. The hybridization reaction on the electrode surface was monitored by chronopotentiometric stripping analysis (PSA), using daunomycin as indicator. RESULTS: With use of two different probes, it was possible to investigate both DNA positions in which the apoE polymorphism takes place and thus to distinguish different genotypes. Real samples containing only complementary sequences gave a good increase in the area of the daunomycin peak ( approximately 600 ms) compared with the peak observed with the buffer. Samples containing 50% complementary sequences gave a much lower increase, and samples containing only mismatch sequences gave a decrease in the daunomycin area. The procedure was validated by comparison with a method based on polyacrylamide gel electrophoresis. CONCLUSION: The coupling of DNA electrochemical sensors with PCR allowed quick discrimination between the different genotypes of apoE.

Adverse effects of prenatal glucocorticoid treatment in the preterm infant.

Several studies suggest that glucocorticoids given to the mother at risk for preterm delivery, reduce the incidence of respiratory distress syndrome, intraventricular hemorrhage, bronchopulmonary dysplasia and mortality. Only 20% of pregnancies at risk for preterm delivery are actually treated with steroids: this reluctance may be due to the theoretical adverse effect of this therapy in the mother and the newborn. Our aim was to review the studies performed during the past two decades to assess the risk/benefit ratio of antenatal steroid treatment in the preterm infant.

Fast scanning microspectroscopy: an electrodynamic moving-condenser method.

The poor speed performance or the limited optical accuracy of the scanning devices currently employed in microspectroscopy can be substantially improved, for high resolution work, using a method based on the displacement of the condenser by means of an electrodynamic technique. The unit described, for work in the visible range, features random addressing capability for both X and Y scanning axes and focusing by means of arbitrary driving signals. An area up to 500 x 500 microm(2) can be explored with an accuracy of 0.15 microm approximately, while the position settling-time is less than 6 msec. The fast and precise operation is particularly valuable in dual-beam measurements on photosensitive and living samples as well as in more complicated computer assisted experiments.