Diagnostic accuracy of coronary CT angiography in patients after coronary bypass surgery: evaluation of grafts and native coronary arteries.

OBJECTIVE: To evaluate the diagnostic accuracy in the assessment of both grafts and native coronary arteries in patients after coronary artery bypass grafts (CABG) by coronary CT angiography (CCTA) in comparison to invasive conventional coronary angiography (CCA). MATERIAL AND METHOD: CCTA was performed in 54 symptomatic post-CABG patients. Two independent, blinded observers assessed all grafts and native coronary arteries for significant stenosis. CCA served as a reference standard One hundred seventy two graft segments, 156 distal coronary run-offs, 314 grafted coronary segments, and 18 non-grafted coronary segments were analyzed RESULTS: The diagnostic accuracy of CCTA for exclusion or detection of significant stenosis in venous grafts and non-grafted segments of native coronary arteries was 100%. Sensitivity, specificity, and positive and negative predictive values were all 100%. Sensitivity, specificity, and positive and negative predictive values to detect significant stenosis were 100%, 98%, 91%, and 100%, respectively, in arterial grafts, 100%, 99%, 75%, and 100%, respectively, in distal runoffs, and 100%, 87%, 99%, and 100%, respectively, in grafted segments of native coronary arteries. CONCLUSION: Non-invasive coronary CT angiography provides high diagnostic accuracy for evaluation of both bypass grafts and native coronary arteries, although, CCTA is more effective in evaluation of bypass grafts as compared to heavily calcified native coronary arteries.

Formulation development of morphine sulfate sustained-release tablets and its bioequivalence study in healthy Thai volunteers.

The objectives of this study were to develop morphine sulfate sustained-release tablet formulations and to evaluate the bioequivalence compared with a commercial brand. The physicochemical properties of the formulated and commercial tablets were determined and compared. The bioequivalence investigation was carried out in 15 healthy male volunteers who received a single dose in a randomized two-way crossover design. After dosing, serial blood samples were collected for a period of 24 h. Morphine concentration was assayed by high-performance liquid chromatography with electrochemical detector. The log-transformed C(max) and AUC(s) were statistically compared by analysis of variance, and the 90% confidence intervals (CIs) of the ratio of the log-transformed C(max) and AUC(s) between the most promising developed formulation and the commercial product were determined. It was found that the dissolution rate profile of a developed formulation was similar to the commercial brand. Their similarity and difference factors were well within limits. In the bioequivalence study, the AUC(last) and AUC(inf) between the test and the reference products were not statistically different (p = 0.227 and p = 0.468, respectively), with the 90% CIs of 83.4-102.6% and 87.7-139.4%, respectively. However, the C(max) of the two formulations was significantly different (p = 0.019). The 90% CI of the developed formulation was 72.0-93.0% compared to the commercial product. In vitro dissolution of locally prepared morphine sulfate sustained-release tablets was comparable to commercial brand. However, the results justified the conclusion of lack of bioequivalence of the developed product to the commercial one.

Congenital aortocaval fistula to the superior vena cava: a case report.

Various systemic arteriovenous fistulas have been described. The arteriovenous fistula arising from the ascending aorta and draining separately into the superior vena cava is very uncommon. The authors report a case of congenital aortocaval fistula to the superior vena cava in a 22 year-old woman in whom the fistula was closed successfully.