[Visualization of the intra-stent lumen in the coronary arteries and detection of restenoses with 64-slices tomography scanners with cardiac synchronization: first experience]. / Visualisation de la lumière intrastent des artères coronaires et détection des resténoses au scanner 64 coupes avec synchronisation cardiaque: première experience.

PURPOSE: to assess the value of the new high spatial resolution 64-slice CT (0.4 mm collimation) technology for non-invasive visualization of coronary artery stent lumen and the characterization of significant in-stent restenosis. MATERIALS AND METHODS: a total of 100 stents were visualized in 50 consecutive patients. All CT examinations were performed with a 64-slice CT (sensation 64; Siemens), with a slice thickness of 0.75 mm at 0.5 mm intervals with retrospective gating. Images were evaluated by two readers and the quality of the in-stent lumen was classified on 5-point scale (1 = not visible; 5 = excellent visibility). Fifty-eight stents in 29 patients were also examined by conventional coronary angiography one week after CT examination. Attenuation values were measured in the vessel upstream from the stent and within the stent, using 1 mm2 regions of interest. The intra stent attenuation ratio (ISAR) was calculated as vessel enhancement/intra stent hypodense area. Interobserver agreement was evaluated by kappa statistics, RESULTS: the interobserver agreement was k= 0.82. The in-stent lumen was visible (score > or =3) in 88 stents (88%), with good visibility (> or = 4) in 54% of stents. Unsatisfactory in-stent lumen visibility was associated with heart rate > 65 beat/min (p < 0.001) and stent size < 3 mm (p < 0.0001). In-stent visibility was also lower in circumflex than other arteries (p= 0.02). Thirteen stenoses or occlusions were detected in 8 patients. In-stent restenosis was associated with hypodense areas within the stent. A ISAR>2 was an accurate criteria (2 false positives, 0 false negative) for detection of significant (> 50%) intra-stent restenosis. CONCLUSION: high resolution 64-slice CT allows reliable in-stent visualization for stents of 3 mm or more in diameter, if heart rate is below 65 bpm. Significant restenosis can be detected with a high sensitivity by determining the ISAR. Arch Mal

Molecular characterization of erythrocyte glucose-6-phosphate dehydrogenase deficiency in Tunisia.

Screening of G6PD deficiency was carried out on 79 unrelated subjects (32 females and 47 males), all coming from out consultation. DNA from deficient subject (11 females and 30 males) was analyzed for the presence of G6PD mutation. Known mutations were studied by the appropriate restriction enzyme digestion of fragment amplified by PCR. Where the mutation could not be identified in this way, the samples were subjected to SSCP analysis and abnormal fragments were sequenced. Through these methods, seven different mutations have been identified. Among deficient females, eight had the African variant A-(tow of them were homozygous) and three had the Mediterranean variant, one of them was homozygous and have had a haemolytic crisis after ingestion of fava beans showing at birth manifestation of neonatal jaundice. Among deficient males, four were hospitalized and transfused after a haemolytic crisis due to ingestion of fava beans. All of them have had manifestation of neonatal jaundice. Of them, one carried the Mediterranean variant and three others had the African variant A-. Among the remaining deficient males, 15 had A-variant, two had the Aurès mutation. SSCP analysis of nine mild deficient males, revealed the presence of the association of 1311 CT/93 TC in two subjects, a newly described silent mutation in the exon 12 associated with the polymorphism in the intron 11 93 TC in one subject and tow single intronic base deletion. The first is IVS V 17 (-C) found in two subjects and the second is IVS VIII 43 (-G) encountered in four subjects.

Pulmonary sarcoidosis: presentation as bilateral spontaneous hydropneumothorax and pulmonary infiltrates.

Pulmonary manifestations in sarcoidosis vary, ranging from asymptomatic chest radiographic abnormalities to progressive destruction of lung parenchyma with respiratory insufficiency. We describe a case of sarcoidosis in a patient with bilateral hydropneumothorax, parenchyma infiltrates, and respiratory insufficiency. Hydropneumothorax is extremely rare, and to our knowledge only two cases have been reported.