New guidelines on the use of iodinated contrast media: a report on an implementation project.

PURPOSE: The aim of this paper is to report on the implementation of new guidelines on the use of injectable iodinated contrast media (ICM) at our workplace and specific protocols for the preparation of patients at risk. MATERIALS AND METHODS: Operators received training with continuing medical education (CME) credits. The new documentation (patient history/screening form and informed consent form) is available on the hospital Web site and requests serum creatinine determination with estimation of glomerular filtration rate (GFR) for every patient. Additional tests are required for high-risk patients only. RESULTS: Attendance rates were 57.2% among referring physicians and 74.5% among Radiology Department personnel. The Cockcroft-Gault formula was used to estimate GFR in adults. The main problem encountered in the implementation process was that referring physicians failed to evaluate the GFR in 80% of patients, with low GFR being discovered in the Radiology Department on the day of examination in 20% of patients, resulting in a need to reschedule the examination. CONCLUSIONS: Although not an easy task, implementation of the new guidelines for ICM use is both feasible and necessary. An additional refresher training course for personnel and GFR evaluation of the patient on referral are indispensable to ensure proper preparation of patients at increased risk of adverse reactions to ICM.

Acid-stable serine proteinase inhibitors in the urine of Alzheimer disease subjects.

A comparative study of the levels of acid-stable proteinase inhibitors (kallikrein and trypsin inhibitors) in the urine of healthy and Alzheimer subjects, of both sexes, has been performed. A preliminary characterization of the purified inhibitors indicates that the urinary antitryptic activity is accounted for by the presence of the well known Urinary Trypsin Inhibitor (UTI) while an apparently new molecule appears to be responsible for the antikallikrein activity. The urinary levels of kallikrein inhibitors are very similar in healthy and sick subjects while the levels of trypsin inhibitors appear significatively increased in Alzheimer subjects of both sexes. The data presented here support the hypothesis that unpaired proteolytic processes could be involved in the pathogenesis of Alzheimer's disease and suggest that the levels of urinary acid-stable inhibitors may prove to be useful markers of the disease.

[Transesophageal echocardiography in patients with chronic atrial fibrillation and cerebral ischemia]. / Ecocardiografia transesofagea in pazienti con fibrillazione atriale cronica e malattia ischemica cerebrale.

The authors wanted to verify the possibility of discovering, by means of transesophageal echocardiography, cardiac causes that can't be clearly shown with 2D echocardiography, in patients who suffered a cerebral ischaemic pathology and who had a cronic atrial fibrillation. The left atrial appendage is not well visualized by the 2D echocardiographic approach. Transesophageal echocardiography has been shown to be superior to transthoracic imaging in the evaluation of the mass lesions in the left atrium and his appendage and often the best visualization of the mitral valve leaflets and aortic semilunar cusps.

Non invasive evaluation in cerebrovascular study: possibility and prospects.

The authors outline the importance of the global investigation of the cerebrovascular system in order to obtain more exact information about the ethiopathology of vascular ischaemic brain disease. Each patient is always submitted to the following investigations: Duplex scanner of epiaortic vessels, Transcranial doppler and echocardiographic screening in our vascular laboratory; moreover, when haemodynamic carotid artery stenosis is present, duplex scanner of femoro-popliteal vessels and microcirculatory study of the brain with Zenon133, via inhalation, were undertaken. In the second part of the study the authors refer a relationship between the instrumental doppler signal and the real risk evidenced by techniques which can provide information on the composition, structure and stability of the plaques and correlate this information with the data from the doppler analysis. Instrumental techniques such as thermal analysis, atomic absorption spectroscopy, ICP analysis and IR spectroscopy were used to carry out this study.

Enzyme immunoassay method for total alpha gonadotropin in human urine samples.

OBJECTIVE: To develop and validate an assay for urinary luteinizing hormone (LH) metabolite that can be used for frozen-thawed urine. DESIGN: The study is in two parts: (1) selected urine samples were evaluated to determine all components of urinary LH metabolism, and then (2) 26 complete menstrual cycles were evaluated using daily matched blood and urine samples. SETTING: Urinary and serum samples were collected for normal women undergoing artificial insemination because of the infertility of their partners. PATIENTS: Patients were selected to have normal ovarian function. INTERVENTION: None. MAIN OUTCOME: Serum LH and urinary LH metabolites were measured in daily samples from 25 ovulatory cycles. RESULTS: The midcycle serum LH peak was highly correlated to the measurement of urinary LH metabolites in frozen:thawed urine samples. CONCLUSION: A simple enzyme assay for LH/LH-alpha can be used to detect the midcycle LH surge on frozen-thawed urine samples. This method has practical application in a situation that involves self-collected urine samples stored frozen and later analyzed to determine the day of ovulation.