To assess the effectiveness, safety and feasibility of the revised, simplified nurse-managed version of our insulin infusion protocol, adapted to the new recommended glycaemic target of 140 to 180 mg/dL (Desio Diabetes Diagram i.v. 140–180). All clinical responses to the Desio Diabetes Diagram i.v. 140–180 in use for 3 years were recorded in patients with diabetes or hyperglycaemia admitted to our intensive cardiac care unit. To assess the feasibility, we asked nurses to complete an ad hoc questionnaire anonymously when the new insulin infusion protocol had been in use for 2 years. From December 2010 to December 2013, 276 patients (173 men, median age 75 years) were treated according to the Desio Diabetes Diagram i.v. 140–180. The median time to reach glycaemic target was 4 h (Q1–Q3 2–8) in 128 patients with blood glucose >180 mg/dL and 2 h (Q1–Q3 1–4) in 82 patients with blood glucose <140 mg/dL. Once the target had been reached, insulin infusion was maintained for a median of 38 h (Q1–Q3 24–48) with blood glucose between 140 and 180 mg/dL for 58.3% of the infusion time. Over a total of 11,863 h of infusion, seven blood glucose <70 mg/dL occurred. The Desio Diabetes Diagram i.v. 140–180 protocol was considered easy to use by 93% of nurses. The Desio Diabetes Diagram i.v. 140–180 protocol, fully managed by nurses, with insulin and glucose intravenous infusion proved effective, safe and feasible in maintaining blood glucose between 140 and 180 mg/dL in patients with diabetes or hyperglycaemia admitted to the intensive cardiac care unit for acute cardiac events.
Congenital abnormalities of coronary arteries are an uncommon cause of sudden cardiac death and are difficult to detect at coronary angiography. We describe two patients with acute coronary syndrome and non-occlusive coronary artery disease in which a 64-multidetector computed tomography (MDCT) coronary angiography showed the presence of a malignant coronary anomaly. Sixty-four-MDCT with the possibility of 3D reconstructions allows for easier diagnosis of coronary anomalies and provides essential details necessary for operative intervention.
The advent of therapies for lymphangioleiomyiomatosis (LAM) has made early diagnosis important in women with tuberous sclerosis complex (TSC), although the lifelong cumulative radiation exposure caused by CT imaging screening should not be underestimated. In 200 TSC outpatients of San Paolo Hospital (Milan, Italy) we retrospectively investigated 1) the role of pulmonary function tests (PFTs) for screening purpose, 2) the association between LAM and other manifestations of TSC (e.g. demography, extrapulmonary manifestations, genetic mutations, etc.), and 3) the features of patients with multifocal micronodular pneumocyte hyperplasia (MMPH). Eighty-six adult women underwent computed tomography for LAM diagnosis; pulmonary involvement was found in 66 patients (77%, 49% LAM with or without MMPH, and 28% MMPH alone). LAM patients were older, with a higher rate of pneumothorax, presented more frequently renal and hepatic angiomyolipomas, and tended to have a TSC2 mutation profile. PFTs, assessed in 64% of women unaffected by cognitive impairments, revealed a lower lung diffusion capacity in LAM patients. In multivariate analysis age, but not PFTs, resulted independently associated with LAM diagnosis. Patients with MMPH alone did not show specific clinical, functional of genetic features. A mild respiratory impairment was most common in LAM-TSC patients; PFTs, even if indicated to assess pulmonary function impairment, are feasible in a limited number of patients, and are not significantly useful as a screening tool in women with TSC.
Objective: To evaluate the efficacy of superselective splenic artery embolization (SAE) using a coaxial catheter technique in patients with blunt splenic injury. Patient Selection and Methods: We retrospectively reviewed cases of 24 consecutive patients undergoing splenic angiography for blunt splenic injury at a Level 1 trauma center. After angiographic confirmation of splenic injury, superselective SAE was performed using gelfoam pledgets (n=15), with or without coils, and liquid embolic materials (n=9). All procedures were performed through a microcatheter advanced coaxially through a selective angiographic catheter. Severity of splenic injury was graded using CT imaging. The angiographic findings were retrospectively divided into four groups. Outcome measures included technical success, complications and recurrence of symptoms requiring additional intervention or surgery despite embolization. Results: All cases were technically successful, with immediate occlusion of targeted vessels after embolization. One patient underwent distal pancreatectomy- splenectomy 3 days after splenic embolization due to symptoms related to distal pancreatic injury, unrelated to the angiographic intervention. A second embolization was performed 1-3 days after initial embolization in 4 patients with clinical suspicion of re-bleeding. One of these four patients underwent splenectomy 3 days after the second embolization, during exploration for associated bowel and diaphragmatic injury. A second patient underwent splenectomy 1 day after a second embolization due to need for continued transfusions. The splenic salvage rate was not significantly related to CT grade of splenic injury (p=1.0) or angiographic classification (p=0.8). Conclusion: Superselective SAE can be performed as a safe alternative to splenectomy in patients with blunt splenic trauma, particularly when there is no additional major organ injury. DOI: http://dx.doi.org/10.3126/njr.v3i2.9606 Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 37-48
The objective of our study was to systematically review the evidence on incidental extracardiac findings on cardiac CT with a focus on previously unknown malignancies.A systematic search was performed (PubMed, EMBASE, Cochrane databases) for studies reporting incidental extracardiac findings on cardiac CT. Among 1099 articles initially found, 15 studies met the inclusion criteria. The references of those articles were hand-searched and 14 additional studies were identified. After review of the full text, 10 articles were excluded. Nineteen studies including 15,877 patients (64% male) were analyzed. A three-level analysis was performed to determine the prevalence of patients with incidental extracardiac findings, the prevalence of patients with major incidental extracardiac findings, and the prevalence of patients with a proven cancer. Heterogeneity was explored for multiple variables. Pooled prevalence and 95% CI were calculated.The prevalence of both incidental extracardiac findings and major incidental extracardiac findings showed a high heterogeneity (I2>95%): The pooled prevalence was 44% (95% CI, 35-54%) and 16% (95% CI, 14-20%), respectively. No significant explanatory variables were found for using or not using contrast material, the size of the FOV, and study design (I2>85%). The pooled cancer prevalence for 10 studies including 5082 patients was 0.7% (95% CI, 0.5-1.0%), with an almost perfect homogeneity (I2<0.1%). Of 29 reported malignancies, 21 (72%) were lung cancers; three, thyroid cancers; two, breast cancers; two, liver cancers; and one, mediastinal lymphoma.Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies, for a pooled estimate of 0.7%; more than 70% of these previously unknown malignancies were lung cancers. Extracardiac findings on cardiac CT require careful evaluation and reporting.
In Vivo Evaluation of the Chemical Composition of Urinary Stones Using Dual-Energy CTGiuseppina Manglaviti1, Silvia Tresoldi2, Chiara Stefania Guerrer3, Giovanni Di Leo4, Emanuele Montanari3 5, Francesco Sardanelli4 6 and Gianpaolo Cornalba2 7Audio Available | Share
