Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography.

Multidetector row computed tomography (MDCT) with its high spatial and temporal resolution has now become an established and complementary method for cardiac imaging. It can now be used reliably to exclude significant coronary artery disease and delineate complex coronary artery anomalies, and has become a valuable problem-solving tool. Our experience with MDCT imaging suggests that it is clinically useful for imaging the pericardium. It is important to be aware of the normal anatomy of the pericardium and not mistake normal variations for pathology. The pericardial recesses are visible in up to 44% of non-electrocardiogram (ECG)-gated MDCT images. Abnormalities of the pericardium can now be identified with increasing certainty on 64-detector row CT; they may be the key to diagnosis and therefore must not be overlooked. This educational review of the pericardium will cover different imaging techniques, with a significant emphasis on MDCT. We have a large research and clinical experience of ECG-gated cardiac CT and will demonstrate examples of pericardial recesses, their variations and a wide variety of pericardial abnormalities and systemic conditions affecting the pericardium. We give a brief relevant background of the conditions and reinforce the key imaging features. We aim to provide a pictorial demonstration of the wide variety of abnormalities of the pericardium and the pitfalls in the diagnosis of pericardial disease.

Red cell loss following orthopedic surgery: the case against postoperative blood salvage.

BACKGROUND: Expensive devices have been developed for the collection and transfusion of blood salvaged after hip or knee arthroplasty. STUDY DESIGN AND METHODS: The volume of salvaged red cells was measured for the first 6 hours after operation. This volume was compared to total red cell loss during hospitalization and to the volume of allogeneic red cells transfused. RESULTS: Mean postoperative red cell loss in 31 patients following hip replacement was 55 +/- 29 mL and that in 20 patients following knee replacement was 121 +/- 50 mL. The 6-hour wound drainage represented 8.7 and 16.8 percent of overall red cell loss during hospitalization for hip and knee replacement, respectively. The transfusion of postoperatively salvaged red cells would have supplanted transfusion of less than one-third of a unit of allogenic blood after hip replacement and two-thirds of a unit after knee replacement. Only three patients (5.9%) lost red cell volume in the drainage equivalent to or in excess of 1 unit of red cells (180 mL). The volume of red cells salvaged postoperatively bore no relationship to perioperative red cell losses as a whole. CONCLUSION: The relatively small red cell loss in the postoperative period in most arthroplasty patients does not appear to justify the routine use of this technique for the recovery of autologous blood.

BAY K 8644 increases release of acetylcholine at the murine neuromuscular junction.

In this study we describe the stimulatory effects of submicromolar concentrations of BAY K 8644 on neurally evoked and spontaneous release of transmitter at the vertebrate neuromuscular junction, a model cholinergic synapse. BAY K 8644 increases mean quantal content. This effect is blocked by pretreatment with the dihydropyridine (DHP) antagonist, nimodipine, but nimodipine itself had no effect on quantal content. Furthermore, BAY K 8644 induces a marked increase in spontaneous quantal release of transmitter as measured by miniature endplate potential frequency. These results are important in that they indicate that DHP-sensitive Ca2+ channels exist at motor nerve terminals and when activated can participate in transmitter release; second, they imply that these elements do not normally participate in transmitter release; third, they indicate a functional effect of DHPs on neurons under somewhat more relevant physiological conditions than those imposed by prolonged K+-induced depolarization, a technique used to evoke transmitter release in subcellular systems and fourth, they indicate an effect of BAY K 8644 on spontaneous release of transmitter, an effect not reported in previous neurochemical experiments.