Non-contrast CT at comparable dose to an abdominal radiograph in patients with acute renal colic; impact of iterative reconstruction on image quality and diagnostic performance.

OBJECTIVES: The aim was to assess the performance of low-dose non-contrast CT of the urinary tract (LD-CT) acquired at radiation exposures close to that of abdominal radiography using adaptive statistical iterative reconstruction (ASiR). METHODS: Thirty-three patients with clinically suspected renal colic were prospectively included. Conventional dose (CD-CT) and LD-CT data sets were contemporaneously acquired. LD-CT images were reconstructed with 40 %, 70 % and 90 % ASiR. Image quality was subjectively and objectively measured. Images were also clinically interpreted. RESULTS: Mean ED was 0.48 ± 0.07 mSv for LD-CT compared with 4.43 ± 3.14 mSv for CD-CT. Increasing the percentage ASiR resulted in a step-wise reduction in mean objective noise (p < 0.001 for all comparisons). Seventy % ASiR LD-CT images had higher diagnostic acceptability and spatial resolution than 90 % ASiR LD-CT images (p < 0.001). Twenty-seven calculi (diameter = 5.5 ± 1.7 mm), including all ureteric stones, were correctly identified using 70 % ASiR LD-CT with two false positives and 16 false negatives (diameter = 2.3 ± 0.7 mm) equating to a sensitivity and specificity of 72 % and 94 %. Seventy % ASiR LD-CT had a sensitivity and specificity of 87 % and 100 % for detection of calculi >3 mm. CONCLUSION: Reconstruction of LD-CT images with 70 % ASiR resulted in superior image quality than FBP, 40 % ASIR and 90 % ASIR. LD-CT with ASIR demonstrates high sensitivity and specificity for detection of calculi >3 mm. TEACHING POINTS: • Low-dose CT studies for urinary calculus detection were performed with a mean dose of 0.48 ± 0.07 mSv • Low-dose CT with 70 % ASiR detected calculi >3 mm with a sensitivity and specificity of 87 % and 100 % • Reconstruction with 70 % ASiR was superior to filtered back projection, 40 % ASiR and 90 % ASiR images.

Bilateral inferior vena cava filter insertion in a patient with duplication of the infrarenal vena cava.

BACKGROUND: Inferior vena cava (IVC) filter insertion is a commonly performed procedure for indications such as recurrent pulmonary emboli or contraindication to anticoagulation. Symptomatic duplication of the IVC is exceedingly rare with only a handful of cases being described in the literature. AIM: We report an unusual case of a patient with symptomatic duplication of the IVC. RESULT: A 53-year-old woman presented at our hospital for resection of a cerebral metastasis from a non-small cell lung cancer following a recent diagnosis of bilateral lower limb deep venous thrombosis. This required perioperative reversal of anticoagulation and IVC filter insertion. Conventional venography performed during filter insertion documented the existence of a duplicated IVC. CONCLUSION: We present a case of a symptomatic duplication of the IVC requiring filter insertion. We review the developmental anatomy of the IVC along with the diagnostic findings and management strategies available.

Pulmonary embolism in pregnancy: is nuclear medicine imaging still a valid option?

In this study we demonstrate our Radiology Department's experience in utilizing low dose (half the normal dose) lung perfusion radionuclide scanning for pregnant patients as the initial investigation for suspected pulmonary embolism (PE). Secondly; we highlight the radiation dose reduction advantages of nuclear medicine imaging over multi-detector computed tomography in this group. We performed a retrospective study of 21 consecutive pregnant women who presented with suspected PE. These patients underwent either lung perfusion scanning or CT pulmonary angiography (CTPA), over a two-year period (May 2005 to July 2007). 19 patients of the cohort studied underwent low dose perfusion-only scintigraphy, with half the usual dose of radionuclide activity. All scans were considered of diagnostic quality. No patient in our study required a ventilation scan. No patient with a negative perfusion scan represented during the 3 month follow up period with PE. We conclude, nuclear medicine imaging is an effective initial investigation for pregnant patients with suspected PE. While scinitigraphy is associated with a greater fetal radiation dose than CTPA, it imparts a lower maternal dose and significantly lower dose to radiosensitive tissues such as breast.

Silver modification of polyethylene terephthalate textiles for antimicrobial protection.

The safety and in vitro effectiveness of applying silver to polyethylene terephthalate fabric mechanical heart valve (MHV) sewing cuffs for the prevention of prosthetic valve endocarditis (PVE) were evaluated. PVE is an infrequent but grave complication of cardiac surgery associated with mortality rates potentially exceeding 50%. A poor response to antibiotic therapy is partly responsible for the high mortality rates. Silver is a well known antimicrobial agent with broad effectiveness. Preliminary in vitro microbial challenge studies of the coated fabric using the New York State 63 bacteriostatic test and Dow Corning Shake Flask test showed a > or = 97% reduction for most organisms tested. Sheep mitral valve replacement studies suggest comparable tissue ingrowth of uncoated and coated fabric with a more organized, thinner pannus formed on silver coated fabric. Low levels of silver were present in the serum at all time periods. These results indicate MHVs with silver coated cuffs may provide additional protection against PVE.

Effects of background stress and anxiety on postoperative recovery.

The effects of background stress and anxiety on both short- and long-term recovery were measured in 30 healthy patients undergoing general anaesthesia for day-case dental extractions. Standardised questionnaires presented pre-operatively, assessed psychological status in terms of trait and state anxiety and stress levels. State anxiety was again measured postoperatively; recovery was assessed with pre- and postoperative batteries of cognitive tasks. Correlation coefficients revealed that the level of background stress in the preceding 6 months correlated with physical parameters of recovery such as time taken for patients to open their eyes, perceived pain and increased postoperative morbidity. The study also demonstrated that high levels of state anxiety after surgery correlated with postoperative pain. Trait and state anxiety before surgery did not correlate with any parameters of recovery or postoperative morbidity.

A jet nebuliser for delivery of topical anesthesia to the respiratory tract. A comparison with cricothyroid puncture and direct spraying for fibreoptic bronchoscopy.

Topical anesthesia of the respiratory tract for fibreoptic bronchoscopy was compared, in a single-blind study, inhaled from a simple and inexpensive jet nebuliser, administered by cricothyroid injection or by a 'spray-as-you-go technique'. Each technique was supplemented by spraying lignocaine through the fibrescope and intravenous fentanyl-droperidol sedation. Inhaled nebulisation was successfully used for 96% (46 of 48) of patients, was safe, effective and acceptable to the patient and bronchoscopist. The cricothyroid injection method produced better conditions than nebulisation in patients who had diagnostic bronchoscopy. The nebuliser technique is as satisfactory as the spraying technique in patients for diagnostic bronchial lavage in whom bleeding from a cricothyroid puncture is unacceptable. Patients who used the nebuliser were more satisfied. This technique may also be a useful method for 'awake' intubation.

A lysosomal storage disorder in the BALB/c mouse: bone marrow transplantation.

The morphological and biochemical consequences of transplanting affected bone marrow from donor BALB/c mice with a lysosomal storage disorder (BALB/c LSD) into normal recipient mice were studied. Bone marrow was removed from normal BALB/c and BALB/c LSD mice and transfused into normal BALB/c recipient mice four hours after the mice received 850 rads of irradiation. Tissues of the recipient mice were examined 240 days later. This study revealed that the defective cells that constituted the visceral lesions of BALB/c LSD could be transplanted to normal BALB/c mice by the use of bone marrow from affected BALB/c LSD homozygote; that the defective cells of BALB/c LSD proliferated and disseminated throughout the mononuclear phagocytic system of the recipient; that there were increases in cholesterol, sphingolipids, and cystine with decreases in sphingomyelinase and glucocerebrosidase activity in tissues of the recipients; and that the recipients survived substantially longer than BALB/c LSD homozygotes and their lifespan was compromised mainly by the secondary effects of irradiation. These lesions, although not as extensive as in homozygous BALB/c LSD, paralleled the lesions which develop in BALB/c LSD. Since the recipient mice were not compromised by the short life span (70 days) of the BALB/c LSD mice, they may be used to study the long-term chronic effects of these metabolic lesions.