Breast phantom for comparison X-ray and polarimetric optical tomography imaging.

Breast phantom made as combination of paraffin and INTRALIPID™ was tested by use of X-ray classical computed tomography and polarimetric optical tomography. The INTRALIPID™ is a liquid commonly used for simulation breast tissues optical properties but it is useless as X-ray phantom. During our tests we have observed that X-ray tomography allows to recognize a proper placement of INTRALIPID™ inclusions inside paraffin medium but we cannot distinguish density of INTRALIPID™ within each inclusions. On the other hand the polarimetric optical tomography allows to distinguish density of INTRALIPID™ (0%, 10%, 20%) in inclusions but with relatively low accuracy of their placement.

Comparison of results from quality control of physical parameters and results from clinical evaluation of mammographic images for the mammography screening facilities in Poland.

The material for this study comprised control protocols from 248 mammography screening facilities, prepared by physicists employed at 16 Regional Coordinating Centres and the results from the clinical evaluation of mammographic images in 248 facilities in Poland. All mammograms were evaluated independently by three experts selected from a list approved by the national consultant of radiology and diagnostic imaging. The requirements for proper breast positioning, selection of appropriate parameters for exposure and absence of artefacts were fulfilled only in 38 % of inspected mammography facilities. The requirements of the clinical audit were met only in 15 % of the mammography facilities. The requirements for the physical parameters of mammographic equipment were met only in 28 % of them. The requirements of the quality control (QC) tests and clinical audit were not fulfilled only in 19 % of the mammography facilities. Results from the QC of physical parameters are comparable with results from clinical evaluation of mammographic images in 57 % of the mammography facilities in Poland.

Angiotensin converting enzyme insertion/deletion polymorphism in French Canadian subjects with premature coronary artery disease.

The insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene has been postulated to be associated with CAD in some populations of European descent. As part of a study investigating metabolic and genetic factors in subjects with premature coronary artery disease (CAD), we examined the I/D polymorphism of the ACE gene in 134 subjects with premature CAD (105 men and 29 women, mean age 49 +/- 6 years) and 116 control subjects selected for health (71 men, 45 women; mean age 39 +/- 7 years). Both patients and controls were of French Canadian descent. As expected, significant differences were found between cases and controls with respect to age, plasma lipoprotein cholesterol, presence of smoking, diabetes and high blood pressure after correction for age. Multivariate analysis confirms the importance of age, HDL-C levels, smoking and apo B levels as determinants of CAD. Allele frequencies of the I and D polymorphism were 43.1% and 57.9% in controls, and 48.5% and 51.5% in CAD cases (chi 2 = 0.622, p = 0.430). No significant association between the I/D polymorphism and conventional cardiovascular risk factors, including plasma levels of lipids, lipoprotein cholesterol, diabetes or smoking, was found in cases or controls. Furthermore, the presence of the I/D polymorphism did not correlate with a history of hypertension or a family history of premature CAD in CAD patients. We conclude that, in our selected population, the I/D polymorphism of the ACE gene is not associated with CAD, conventional risk factors, or a family history of CAD. Although our sample size does not allow sufficient power to ascertain that the ACE I/D polymorphism is not associated with CAD, we do not recommend the routine measurement of the ACE polymorphism in our population to determine cardiovascular risk.

The role of cardiac troponin T and other new biochemical markers in evaluation and risk stratification of patients with acute chest pain syndromes.

BACKGROUND AND HYPOTHESIS: Increased serum creatinine kinase (CK) and CK-MB enzyme levels have been used for years to detect myocardial infarction (MI). However, serum myoglobin and CK-MB mass or protein levels may indicate MI earlier; cardiac troponin T is the most specific marker of myocardial injury and it can detect even minor myocardial necrosis. The diagnostic and prognostic utility of the traditional and new markers of cardiac injury in the emergency evaluation of patients with acute chest pain syndromes were therefore compared. METHODS: One hundred and fifteen consecutive patients with an acute coronary syndrome, and 64 controls recruited during the same period, were examined. The time elapsed from onset of symptoms to blood collection was recorded. Cardiac markers were measured in specimens collected upon arrival (0 h), and 2 and 5-9 h, and later in cases of longer observation. The major cardiac events occurring up to 40 months after the index examination were recorded. RESULTS: cTnT levels provided unique information: they were the most specific indicators of myocardial damage and identified unstable angina patients at high risk of future major events. Up to 6 h after the onset of chest pain, the new markers were elevated more frequently than the traditional ones and permitted earlier MI recognition. The worst prognosis (nonfatal myocardial infarction or death) was noted in subjects with chest pain at rest within 48 h before the index examination and elevated cTnT levels. CONCLUSIONS: The new markers, particularly cardiac troponin T, offer considerable advantages and they should be more widely used in the diagnosis and risk stratification of acute coronary syndromes.

Intermittent antegrade warm versus cold blood cardioplegia: a prospective, randomized study.

A prospective, randomized study was performed in 200 patients undergoing coronary artery bypass grafting to compare the myocardial protection obtained with intermittent antegrade warm versus cold blood cardioplegia. Preoperative and surgical characteristics of the two cohorts were similar. Intermittent antegrade infusion of warm blood cardioplegia failed to achieve sustained electromechanical arrest of the heart in 13%. The only difference in clinical outcomes was the more frequent spontaneous return to sinus rhythm after the unclamping of the aorta in the warm group (88% versus 70%, p = 0.002). Mortality (1% each) and myocardial infarction (2% and 4%) rates were similar. Rates of increase in serum activity of the isoenzyme of creatine kinase (CK-MB), CK-MB mass concentration, and cardiac troponin-T level as well as total release of troponin T were significantly lower in the warm group, and fewer patients in this group had a clinically significant increase in serum CK-MB mass (20% versus 39%, p = 0.005) and troponin T (20% versus 56%, p = 0.00001). Thus, intermittent antegrade warm blood cardioplegia is appropriate and clinically safe; the lower release of biochemical markers of myocardial damage suggests improved protection during first-time coronary artery bypass grafting.

Relation of coronary artery disease in women < 60 years of age to the combined elevation of serum lipoprotein (a) and total cholesterol to high-density cholesterol ratio.

After age 40 years, coronary artery disease (CAD) is the leading cause of death in both women and men, yet in women the factors associated with, or leading to, CAD have been less extensively studied. This study examined the strength of association of a number of risk factors to CAD in groups of women < 60 years of age with (n = 108) and without (n = 66) angiographically documented significant narrowing of coronary arteries. In univariate analyses, there were significant differences between control subjects and patients with regard to age (49 +/- 6 vs 52 +/- 7 years) and total lipids and apolipoproteins measured. The relative frequency of cigarette smoking and diabetes was higher and that of estrogen replacement therapy lower in patients with CAD than in control subjects. In multivariate analysis the following factors were independently associated with CAD (adjusted odds ratios and 95% confidence intervals): total cholesterol to high-density lipoprotein (HDL) cholesterol (1.91; 1.56 to 2.34); lipoprotein (a) (10.66; 3.51 to 32.35); estrogen replacement (0.24; 0.11 to 0.54); age (1.12; 1.04 to 1.18); and smoking (1.50; 0.98 to 2.29). The nonadjusted odds ratio of CAD, based on combined tercile values of lipoprotein (a) serum level and total cholesterol to HDL cholesterol ratio, was very low (0.15; 0.06 to 0.36) when both values were within the first tercile, but very high (16.63; 3.54 to 78.07) when both were in the third tercile.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors of venous aortocoronary bypass graft disease noted at late symptom-directed angiographic study.

One hundred and nineteen consecutive patients who had undergone venous aortocoronary bypass surgery 95.1 +/- 46.0 months earlier and in whom symptom-directed late graft angiography was performed were studied. Patients were designated 'controls' if their graft(s) appeared intact or revealed only minimal irregularities; they were designated 'cases' if one or several grafts showed at least 25% stenosis or complete occlusion. Controls and cases did not reveal significant differences in the frequency of classic nonlipoprotein risk factors or medication, including the use of acetylsalicylic acid. In multivariate analysis, significant graft narrowing or occlusion was most strongly related to elevated serum apolipoprotein B and lipoprotein(a) levels, as well as to the age of the grafts.