Intracameral epinephrine without the addition of intracameral lidocaine in the management of tamsulosin associated intraoperative floppy iris syndrome.

OBJECTIVE: Intracameral mydriatics using epinephrine associated with lidocaine have been reported as efficacious in reducing intraoperative floppy iris syndrome (IFIS) complications during cataract surgery. The aim of this study was to verify the efficacy of intracameral epinephrine without intracameral lidocaine as prophylaxis against IFIS in patients on tamsulosin. MATERIALS AND METHODS: This was a retrospective study on the results of cataract surgery in 18 patients on therapy with tamsulosin. Patients had undergone routine phacoemulsification in one eye. Successively, they underwent phacoemulsifcation in the fellow eye using non preserved intracameral epinephrine 1:4000 diluted with BSS. Intraoperative complications during cataract surgery had been documented and IFIS was graded based on iris billowing, miosis or iris prolapse. Follow-up was 3 months. RESULTS: Thirty-six eyes of 18 patients were included in the evaluation. The incidence of IFIS was significantly higher in the eyes where routine phacoemulsificaton had been performed (100%) with respect to eyes where phacoemulsification was carried out using intracameral epinephrine (33%) (Chi Square test =15.12, p<0.001). In routine phacoemulsification 16 eyes showed iris billowing, 14 eyes had some extent of miosis and 14 eyes had tendency to iris prolapse. In phacoemulsification with the use of intracameral epinephrine 5 eyes showed iris billowing, 4 eyes presented some extent of miosis and 2 eyes had tendency to iris prolapse. There were no serious intraoperative complications. CONCLUSIONS: Intracameral epinephrine without the addition of lidocaine was efficacious in the management of IFIS in patients on tamsulosin.

Dual source CT: state of the art in the depiction of coronary arteries anatomy, anatomical variants and myocardial segments.

Cardiovascular disease is the leading cause of death in adults in western countries. Coronary angiography remains the gold standard for the diagnosis of coronary artery disease, a procedure that carries risks. Nowadays, a significant number of the coronary angiographies performed every year are only diagnostic. Multidetector computed tomography (MDCT) allows non-invasive evaluation of coronary arteries. It is a continuously developing technique, and actually the top technology is represented by Dual Source CT. This scanner of new conception permits an improvement in image quality, and visualization of distal vessels and small collateral branches. The aim of our work is to illustrate the actual state of the art in non-invasive coronary arteries evaluation represented by Dual Source CT, presenting images of coronary arteries normal anatomy, anatomical variants and myocardial segment.

Dual-source CT coronary angiography: prospective versus retrospective acquisition technique.

PURPOSE: The aim of our work was to compare image quality and radiation dose in a group of patients who underwent cardiac dual-source computed tomography (DSCT) with prospective electrocardiographic (ECG) gating with those of a control group studied with retrospective gating. MATERIALS AND METHODS: Sixty patients were randomly assigned to two groups of 30 individuals each. Patients with heart rates >70 bpm and body mass index (BMI) >30 kg/m(2) were excluded. Group A was examined with prospective ECG gating and group B with retrospective gating. The dose-length product (DLP) was recorded to calculate the radiation dose, whereas the effective dose was normalised to a standard 12-cm scan of the heart. RESULTS: Applying the best reconstruction interval, 98.6% of segments in the prospective group and 99.3% in the retrospective group were diagnostic. No significant difference (p>0.05) in image quality was observed between groups. Mean normalised radiation dose was 4.91 ± 0.4 mSv in the prospective-gating group and 14.62 mSv ± 4.36 in the retrospective-gating group (p<0.01). CONCLUSIONS: Coronary CT with prospective ECG gating, a standard feature on new scanners, allows for a significant reduction in radiation dose without causing any significant decrease in image quality or in the number of segments assessed. The prospective technique is thus recommended for patients with heart rates £70 bpm and BMI £30 kg/m(2).

Preliminary experience with abdominal dual-energy CT (DECT): true versus virtual nonenhanced images of the liver.

PURPOSE: The aim of this work was to compare the quality and noise of true non-enhanced (TNE) and virtual non-enhanced (VNE) images in patients undergoing dual-energy computed tomography (DECT) of the liver. MATERIALS AND METHODS: Twenty consecutive patients (mean age 54.7±19.9 years) prospectively underwent abdominal DECT to assess the liver using a triphasic protocol consisting of precontrast, arterial-phase and portal-phase acquisitions. Exclusion criteria were allergy to iodinated contrast material, impaired renal function and a body mass index (BMI) >35 kg/m(2). The DE portal-phase acquisition was performed with automatic dose modulation (CARE Dose 4D). Nonionic iodinated contrast material (Iomeron 400) was administered at 0.625 gI/kg with a flow rate of 3.5 ml/s. Axial VNE images were reconstructed based on the portal data set using a collimation and an increment of 5 mm and were compared with TNE images reconstructed with the same parameters. The average image quality and noise were analysed by two radiologists in separate reading sessions. RESULTS: No statistically significant difference (p>0.05) in image quality was observed between VNE (4.00±0.85) and TNE images (4.35±0.58). A sufficient diagnostic quality was found in 95.0% (19/20) of VNE images and in 100% of TNE images. No statistically significant difference (p<0.05) was observed in the average image noise of VNE (9.5±0.7) and TNE (12.3±1.1) images. CONCLUSIONS: Abdominal DECT allows acquisition of liver VNE images with similar image quality and lower noise than TNE. Nevertheless, a few technical limitations related to the small field of view of the second detector in patients with a high BMI and heterogeneous iodine subtraction restrict the application of this technique to selected patients only.

Global cardiac evaluation without heart rate control: preliminary experience with dual source CT (DSCT).

AIM: The aim of this work was to assess the role of dual source computed tomography (DSCT) in global cardiac evaluation without heart rate control, assessing the effect of average heart rate on coronary image quality, optimal reconstruction interval, ventricular function, and evaluation of left chamber valves. METHODS: Fifteen consecutive patients under-went coronary CT angiography. For coronary evaluation, data sets were reconstructed in 5% steps from 30% to 80% of the RR interval. For the assessment of cardiac function, image were reconstructed with a slice thickness of 2.0 mm and 2.0 mm increment, at 10% steps from 0% to 90% of the RR interval. Two blinded independent readers assessed the image quality of the coronary arteries and left chamber valves. RESULTS: The mean heart rate during the scan was 73+/-11.8 bpm (range 56-97). At the best reconstruction interval excellent diagnostic image quality (score 4) was achieved in 95.5% (43/45) of coronary arteries. Excellent inter-observer agreement was observed for image quality rating (k=0.82). No significant correlation was found between the average heart rate and the mean quality scores (rho=0.29). Comparison of image quality of the coronary arteries in systolic and diastolic reconstructions in each patient showed no statistically significant differences. CONCLUSION: DSCT is an excellent technique for global cardiac imaging, as it allows to obtain coronary arteries of excellent quality and evaluate ventricular function and valvular area independent of the heart rate.