Feasibility and diagnostic accuracy of a low radiation exposure protocol for prospective ECG-triggering coronary MDCT angiography.

AIM: To compare the feasibility, accuracy, and effective radiation dose (ED) of multidetector computed tomography (MDCT) in the detection of coronary artery disease using a combined ED-saving strategy including prospective electrocardiogram (ECG) triggering with a short x-ray window and a body mass index (BMI)-adapted imaging protocol using adaptive statistical iterative reconstruction (ASIR; group 1), in comparison with a prospective ECG triggering strategy alone (group 2). MATERIALS AND METHODS: One hundred and seventy patients scheduled for invasive coronary angiography (ICA) were evaluated. Fourteen patients were not eligible for MDCT. The remaining 156 patients were randomized to group 1 (78 patients) and group 2 (78 patients). Eight and 11 patients in groups 1 and 2, respectively, were excluded after randomization because the patients' heart rates were >65 beats/min. MDCT images were assessed for feasibility, signal-to-noise ration (SNR), and contrast-to-noise ratio (CNR), accuracy in detection of coronary stenoses >50% versus ICA and for ED. RESULTS: The feasibility, SNR, CNR, accuracy in a segment-based and patient-based model were similar in both groups (97 versus 95%, 14.5 ± 3.9 versus 14.2 ± 4.1, 16 ± 4.6 versus 16.5 ± 4.4, 95 versus 94% and 97 versus 99%, respectively). The ED in group 1 was 72% lower than in group 2 (2.1 ± 1.2 versus 7.5 ± 1.8 mSv, respectively; p<0.01). CONCLUSIONS: The use of a multi-parametric ED saving protocol results in a significant reduction in ED without a negative impact on accuracy.

Severe neonatal renal failure after maternal use of angiotensin II type I receptor antagonists.

Sartans are selective type 1 angiotensin II receptor antagonists that are used for treatment of arterial hypertension. We report a case of severe renal failure required dialysis after the use of olmesartan in the last month of pregnancy. Exposure to sartans during the last period of gestation seems to be associated with high risk of congenital malformations. It is important to stress that the use of these drugs during pregnancy must be avoided, especially in the third trimester.

Bacterial sepsis.

Bacterial sepsis remain a major cause of mortality and morbidity in the newborn. The severe outcome of neonatal sepsis, despite the advances in perinatal and neonatal care and use of potent antibiotics, is related to the neonatal reduced immune defenses and the complex interactions between the infecting microorganism and the host responses. An early diagnosis, based on the clinical picture, the isolation of microorganisms and the positivity of inflammatory indexed, is mandatory. A timely treatment should be aimed to the elimination of pathogens with antimicrobials. Intravenous immunoglobulin and hematopoietic growth factors may be considered to improve the disturbed immune homeostases.

Serine and glycine metabolism in schizophrenic patients.

1. The brain glycine is almost exclusively derived from serine via serine-hydroxymethyltransferase. 17 males schizophrenic inpatients and 10 males healthy volunteers were submitted to the serine tolerance test. 2. Plasma serine and glycine concentration were evaluated before and after 1, 2, 3, 4 hours of an oral load with L-serine to test the interconversion between the two amino acids. 3. The authors did not find any significant difference between schizophrenic patients and control group and concluded that the enzyme serine-hydroxymethyltransferase is not deficient in the conversion of serine to glycine in schizophrenic patients as suggested by other authors.