Showing papers by "Rambam Health Care Campus published in 2006"

Perfusion-CT Assessment of Infarct Core and Penumbra Receiver Operating Characteristic Curve Analysis in 130 Patients Suspected of Acute Hemispheric Stroke

Abstract: Background and Purpose— Different definitions have been proposed to define the ischemic penumbra from perfusion-CT (PCT) data, based on parameters and thresholds tested only in small pilot studies. The purpose of this study was to perform a systematic evaluation of all PCT parameters (cerebral blood flow, volume [CBV], mean transit time [MTT], time-to-peak) in a large series of acute stroke patients, to determine which (combination of) parameters most accurately predicts infarct and penumbra. Methods— One hundred and thirty patients with symptoms suggesting hemispheric stroke ≤12 hours from onset were enrolled in a prospective multicenter trial. They all underwent admission PCT and follow-up diffusion-weighted imaging/fluid-attenuated inversion recovery (DWI/FLAIR); 25 patients also underwent admission DWI/FLAIR. PCT maps were assessed for absolute and relative reduced CBV, reduced cerebral blood flow, increased MTT, and increased time-to-peak. Receiver-operating characteristic curve analysis was performe...

Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis.

Abstract: ContextMultidetector computed tomography (MDCT) has been proposed as a noninvasive method to evaluate coronary anatomy.ObjectiveTo determine the diagnostic accuracy of 16-row MDCT for the detection of obstructive coronary disease based exclusively on quantitative analysis and performed in a multicenter study.Design, Setting, and PatientsEleven participating sites prospectively enrolled 238 patients who were clinically referred for nonemergency coronary angiography from June 2004 through March 2005. Following a low-dose MDCT scan to evaluate coronary artery calcium, 187 patients with an Agatston score of less than 600 underwent contrast-enhanced MDCT. Conventional angiography was performed 1 to 14 days after MDCT. Conventional angiographic and MDCT studies were analyzed by independent core laboratories.Main Outcome MeasuresSegment-based and patient-based sensitivities and specificities for the detection of luminal stenosis of more than 50% (of luminal diameter) and more than 70% (of luminal diameter) based on quantitative coronary angiography.ResultsOf 1629 nonstented segments larger than 2 mm in diameter, there were 89 (5.5%) in 59 (32%) of 187 patients with stenosis of more than 50% by conventional angiography. Of the 1629 segments, 71% were evaluable on MDCT. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 50% luminal stenoses was 89%; specificity, 65%; positive predictive value, 13%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 98%; specificity, 54%; positive predictive value, 50%; and negative predictive value, 99%. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 70% luminal stenoses was 94%; specificity, 67%; positive predictive value, 6%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 94%; specificity, 51%; positive predictive value, 28%; and negative predictive value, 98%.ConclusionsThe results of this study indicate that MDCT coronary angiography performed with 16-row scanners is limited by a high number of nonevaluable cases and a high false-positive rate. Thus, its routine implementation in clinical practice is not justified. Nevertheless, given its high sensitivity and negative predictive value, 16-row MDCT may be useful in excluding coronary disease in selected patients in whom a false-positive or inconclusive stress test result is suspected.

The mtDNA legacy of the Levantine early Upper Palaeolithic in Africa.

Abstract: Sequencing of 81 entire human mitochondrial DNAs (mtDNAs) belonging to haplogroups M1 and U6 reveals that these predominantly North African clades arose in southwestern Asia and moved together to Africa about 40,000 to 45,000 years ago Their arrival temporally overlaps with the event(s) that led to the peopling of Europe by modern humans and was most likely the result of the same change in climate conditions that allowed humans to enter the Levant, opening the way to the colonization of both Europe and North Africa Thus, the early Upper Palaeolithic population(s) carrying M1 and U6 did not return to Africa along the southern coastal route of the “out of Africa” exit, but from the Mediterranean area; and the North African Dabban and European Aurignacian industries derived from a common Levantine source

Soy Protein Infant Formulae and Follow-On Formulae: A Commentary by the ESPGHAN Committee on Nutrition.

Abstract: :This comment by the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Committee on Nutrition summarizes available information on the composition and use of soy protein formulae as substitutes for breastfeeding and cows' milk protein formulae as well as on t

The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: A prospective three-center pilot study

Abstract: Background and study aims Variceal bleeding is a major complication of cirrhosis, and is associated with a 20 % mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett's esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis. Patients and methods A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient's medical history and EGD findings. Results A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6 % for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy. Conclusions In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.

Feeding preterm infants after hospital discharge : a commentary by the ESPGHAN Committee on Nutrition.

Abstract: Survival of small premature infants has markedly improved during the last few decades. These infants are discharged from hospital care with body weight below the usual birth weight of healthy term ...

The role of FDG-PET/CT in suspected recurrence of breast cancer

Abstract: BACKGROUND. Early diagnosis of recurrent breast cancer is crucial to selection of the most appropriate therapy. The current study evaluated the role of FDG-PET/CT in the assessment of suspected recurrent breast cancer in patients who presented with elevated serum tumor markers. METHODS. Forty-seven consecutive FDG-PET/CT studies of 46 women (aged 32–79 years; mean, 59.9 years) with a history of breast cancer presented with elevated serum tumor markers 1–21 years (mean = 6.2 years) after their initial diagnosis and were retrospectively evaluated. PET/CT results were confirmed by pathology (n = 11), further imaging, and follow-up (mean = 17.2 months; n = 36). Changes in further management based on PET/CT were recorded. RESULTS. Thirty (65%) patients had tumor recurrence, and 16 (35%) patients showed no further evidence of disease. Thirty-one patients had 32 abnormal PET/CT studies, and 15 patients had normal studies with an overall sensitivity, specificity, and accuracy of 90%, 71%, and 83%, respectively. In 37 patients, PET/CT was compared with contrast-enhanced CT and had a higher sensitivity (85% vs 70%), specificity (76% vs 47%), and accuracy (81% vs 59%). PET/CT had an impact on the management of 24 (5l%) patients. Of these, chemotherapy or radiotherapy was started in 16 patients, treatment was modified in 2 patients, and 6 patients were referred to biopsy, followed by referral to surgery for 2 patients. CONCLUSIONS. In patients with breast cancer and rising tumor markers, FDG-PET/CT had high performance indices and was superior to CT for diagnosis of tumor recurrence, which led to changes in the subsequent clinical management of 51% of these patients. Cancer 2006. © 2006 American Cancer Society.

Hyponatremia and Long-term Mortality in Survivors of Acute ST-Elevation Myocardial Infarction

Abstract: Background Hyponatremia, a marker of neurohormonal activation, is a common electrolyte disorder among patients with acute ST-elevation myocardial infarction. The long-term prognostic value of hyponatremia during the acute phase of infarction is not known. Methods We studied 978 patients with acute ST-elevation myocardial infarction and without a history of heart failure who survived the index event. During the hospital stay, sodium levels were obtained on admission and at 24, 48, and 72 hours. The median duration of follow-up after hospital discharge was 31 months (range, 9-61 months). Results Hyponatremia, defined as a mean serum sodium level less than 136 mEq/L, was present during admission in 108 patients (11.0%). In a multivariable Cox proportional hazards model adjusting for other potential clinical predictors of mortality and for left ventricular ejection fraction, hyponatremia during admission remained an independent predictor of postdischarge death (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.3-3.2;P = .002). Hyponatremia during admission was also independently associated with postdischarge readmission for heart failure (HR, 1.6; 95% CI, 1.1-2.6;P = .04). When serum sodium level was used as a continuous variable, the adjusted HR for death or heart failure was 1.12 for every 1-mEq/L decrease (95% CI, 1.07-1.18;P Conclusion Hyponatremia in the early phase of ST-elevation myocardial infarction is a predictor of long-term mortality and admission for heart failure after hospital discharge, independent of other clinical predictors of adverse outcome and left ventricular ejection fraction.

Ischemic mitral regurgitation and risk of heart failure after myocardial infarction.

Abstract: BACKGROUND The development of ischemic mitral regurgitation (MR) after myocardial infarction may impose hemodynamic load during a period of active left ventricular remodeling and promote heart failure (HF). However, few data are available on the relationship between ischemic MR and the long-term risk for HF. METHODS We prospectively studied 1190 patients admitted for acute myocardial infarction. Mitral regurgitation was assessed by echocardiography and was considered mild, moderate, and severe when the regurgitant jet area occupied less than 20%, 20% to 40%, and greater than 40% of the left atrial area, respectively. The median duration of follow-up was 24 months (range, 6-48 months). RESULTS Mild and moderate or severe ischemic MR was present in 39.7% and 6.3% of patients, respectively. After adjusting for ejection fraction and clinical variables (age, sex, Killip class, previous infarction, hypertension, diabetes mellitus, anterior infarction, ST-elevation infarction, and coronary revascularization), compared with patients without MR, the hazard ratios for HF were 2.8 (95% confidence interval [CI], 1.8-4.2; P<.001) and 3.6 (95% CI, 2.0-6.4; P<.001) in patients with mild and moderate or severe ischemic MR, respectively. The adjusted hazard ratios for death were 1.2 (95% CI, 0.8-1.8; P = .43) and 2.0 (95% CI, 1.2-3.4; P = .02) in patients with mild and moderate or severe MR, respectively. CONCLUSIONS There is a graded independent association between the severity of ischemic MR and the development of HF after myocardial infarction. Even mild ischemic MR is associated with an increase in the risk of HF.

16-MDCT Coronary Angiography Versus Invasive Coronary Angiography in Acute Chest Pain Syndrome: A Blinded Prospective Study

Abstract: OBJECTIVE The purpose of our study was to prospectively evaluate the usefulness of CT coronary angiography versus invasive coronary angiography for the detection of clinically significant coronary artery disease in patients hospitalized for acute chest pain syndromeSUBJECTS AND METHODS Sixty-six consecutive patients (52 men and 14 women; average age, 57 ± 11 [SD] years) who were hospitalized for acute chest pain syndrome underwent CT coronary angiography and invasive coronary angiography within an average time interval of 4 days ECG-gated CT coronary angiography was performed with a 16-MDCT scanner (042-sec rotation time, 16 × 075 mm detector collimation) Beta-blockers were not administered routinely, and thus the average heart rate was 71 ± 11 beats per minute CT coronary angiographic images were evaluated concurrently by two radiologists, who were blinded to invasive coronary angiography results, for stenoses having a diameter of 50% or more, using a 15-segment classification, including all segm

FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy

Abstract: To assess 18F-fluorodeoxyglucose (FDG) uptake in bone metastases in patients with and without previous treatment, and compare positive positron emission tomography (PET) with osteolytic or osteoblastic changes on computed tomography (CT). One hundred and thirty-one FDG-PET/CT studies were reviewed for bone metastases. A total of 294 lesions were found in 76 patients, 81 in untreated patients and 213 in previously treated patients. PET was assessed for abnormal FDG uptake localised by PET/CT to the skeleton. CT was evaluated for bone metastases and for blastic or lytic pattern. The relationship between the presence and pattern of bone metastases on PET and CT, and prior treatment was statistically analysed using the chi-square test. PET identified 174 (59%) metastases, while CT detected 280 (95%). FDG-avid metastases included 74/81 (91%) untreated and 100/213 (47%) treated lesions (p<0.001). On CT there were 76/81 (94%) untreated and 204/213 (96%) treated metastases (p NS). In untreated patients, 85% of lesions were seen on both PET and CT (26 blastic, 43 lytic). In treated patients, 53% of lesions were seen only on CT (95 blastic, 18 lytic). Of the osteoblastic metastases, 65/174 (37%) were PET positive and 98/120 (82%), PET negative (p<0.001). The results of the present study indicate that when imaging bone metastases, prior treatment can alter the relationship between PET and CT findings. Most untreated bone metastases are PET positive and lytic on CT, while in previously treated patients most lesions are PET negative and blastic on CT. PET and CT therefore appear to be complementary in the assessment of bone metastases.

Calcium handling in embryonic stem cell-derived cardiac myocytes: of mice and men.

Abstract: Excitation-contraction (EC) coupling is fundamental to the function of cardiac myocytes (CMs). In mature myocytes plasma membrane (PM) L-type Ca 2+ channels function in close juxtaposition to ryanodine receptors (RyR) on the sarcoplasmic reticulum (SR) membrane. Action potentials (APs) cause the opening of PM L-type Ca 2+ channels, which in turn provide trigger Ca 2+ for a larger RyR-mediated SR Ca 2+ release. In contrast, developing myocytes have a less well-developed SR. This incomplete development is observed in early stage and mid-maturation stages of murine embryonic stem cell-derived cardiac myocytes (ESC-CMs). Despite the absence of a well-developed t-tubule system, murine ESC-CMs use internal Ca 2+ stores for EC coupling. Direct measures of Ca 2+ handling, including pharmacological studies and investigation of genetically modified mouse ESC-CMs, established an important contribution of RyR-mediated internal Ca 2+ store to cell function. Similarly, early-stage human ESC-CMs use internal Ca 2+ store and partially share Ca 2+ handling characteristics with murine ESC-CMs. For example, elementary Ca 2+ release events are present in both murine and human ESC-CMs, and it is likely that Ca 2+ handling contributes to automatic rhythm generation in these cells. However, in human ESC-CMs, a unique voltage-gated Na + channel window current is critical for spontaneous, rhythmic depolarization. The advent of the murine and human ES cardiomyocyte differentiating systems has provided initial insights into the early steps of development of excitability and electromechanical coupling in the mammalian heart, including patterns of gene expression, myofibrillogenesis, ion channel development and function, and Ca 2+ handling. Here we discuss the information gained from these models to describe the nexus of voltage-gated channel currents and Ca 2+ handling on rhythmic activity.

Appendicitis within a femoral hernia: sonographic appearance.

Abstract: Appendix within a femoral hernia was first described by the Parisian surgeon Rene Jacques Croissant de Garengeot in 1731 and is a rare, often incidental finding at surgery. Appendicitis in a femoral hernia is even more rare, and although it has been well reviewed in the medical literature, its sonographic appearance has been described only once. We report the sonographic findings of appendicitis in a femoral hernia and stress the potential benefits of this imaging modality in cases of acute groin pain and swelling.

Comprehensive multidetector CT assessment of apical hypertrophic cardiomyopathy.

Abstract: 16-slice multidetector CT (MDCT) cardiac findings of a middle-aged man with known apical hypertrophic cardiomyopathy (AHC) and recent atypical chest pain are presented. MDCT enabled comprehensive evaluation of the coronary arteries, diagnosing myocardial bridging of the left anterior descending (LAD) and first diagonal arteries. It also enabled dynamic evaluation of myocardial thickness and left ventricular global and regional function. This case illustrates the full capabilities of MDCT in the evaluation of AHC.

Eight previously unidentified mutations found in the OA1 ocular albinism gene

Abstract: Ocular albinism type 1 (OA1) is an X-linked ocular disorder characterized by a severe reduction in visual acuity, nystagmus, hypopigmentation of the retinal pigmented epithelium, foveal hypoplasia, macromelanosomes in pigmented skin and eye cells, and misrouting of the optical tracts. This disease is primarily caused by mutations in the OA1 gene. The ophthalmologic phenotype of the patients and their family members was characterized. We screened for mutations in the OA1 gene by direct sequencing of the nine PCR-amplified exons, and for genomic deletions by PCR-amplification of large DNA fragments. We sequenced the nine exons of the OA1 gene in 72 individuals and found ten different mutations in seven unrelated families and three sporadic cases. The ten mutations include an amino acid substitution and a premature stop codon previously reported by our team, and eight previously unidentified mutations: three amino acid substitutions, a duplication, a deletion, an insertion and two splice-site mutations. The use of a novel Taq polymerase enabled us to amplify large genomic fragments covering the OA1 gene. and to detect very likely six distinct large deletions. Furthermore, we were able to confirm that there was no deletion in twenty one patients where no mutation had been found. The identified mutations affect highly conserved amino acids, cause frameshifts or alternative splicing, thus affecting folding of the OA1 G protein coupled receptor, interactions of OA1 with its G protein and/or binding with its ligand.

Evaluation of ProC Global assay in women with a history of venous thromboembolism on hormonal therapy.

Abstract: The risk of thrombosis in women increases significantly during treatment with hormonal therapy (HT). The aim of this study was to evaluate ProC Global assay in women with a history of venous thromboembolism (VTE) while using HT. Protein C activation time normalized ratio (PCAT-NR) levels were significantly lower in 32 women with a history ofVTE while using HT (0.72 ± 0.1) compared with 56 healthy controls without HT, matched by age at blood sampling (0.99 ± 0.2) and 40 healthy controls with HT, matched by age and HT at VTE event (0.94 ± 0.2) (P<0.001 for both).PCAT-NR lower than the cut-off level of 0.8 was found in 23/32 (72%) patients compared with 5/56 (9%) age-matched controls (OR=26, 95%CI: 7–106, P<0.001) and 9/40 (22.5%) of HT-matched controls (OR=9, 95%CI: 2.7–30, P<0.001). Any thrombophilic risk factor was found in 20/32 (62.5%) of patients compared with 12/56 (21.4%) of agematched controls (OR=6, 95%CI: 2.1–10, P<0.001) and 12/40 (30%) of HT-matched controls (OR=4, 95%CI: 1.3–11.8, P=0.006).Out of the variables that are risk factors of VTE as age, HT or thrombophilic risk factor, ProC Global assay was found in the multivariate analysis – logistic regression, as the parameter that was the most associated with patient group [Exp(B)=15.8, 95% CI: 4.2–59.0, P<0.001]. In conclusion, abnormal PCAT-NR is associated with VTE in women using HT. ProC Global assay may potentially serve as a diagnostic tool for evaluating the risk of VTE in women prior to administration of HT.

The ACCF/AHA scientific statement on syncope: A document in need of thoughtful revision

Abstract: The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have recently published, in both the Journal of the American College of Cardiology (JACC) and Circulation, a Scientific Statement on the Evaluation of Syncope (‘Statement’). This Scientific Statement was commissioned to provide guidance for clinicians regarding the evaluation of patients who present with ‘syncope’. The Statement was not intended to be a formal set of practice guidelines. However, in the absence of generally accepted practice guidelines in North America, the Statement’s potential impact on clinical care may be more far-reaching than expected; it may erroneously be considered to be the authoritative ‘de-facto’ guideline document. This commentary, submitted by a multidisciplinary consortium of more than 60 physicians with expertise in the management of transient loss of consciousness (TLOC), points out that in many respects the ACCF/AHA Syncope Statement fails to address long-standing clinical errors associated with the evaluation of episodes of apparent TLOC, including syncope. If not appropriately revised, the current Statement may lead to both inadequate patient care as well as a potentially damaging legal environment for physicians undertaking evaluation of patients who present with transient loss of consciousness.

Comparison of single and boosted protease inhibitor versus nonnucleoside reverse transcriptase inhibitor-containing cART regimens in antiretroviral-naïve patients starting cART after January 1, 2000.

Abstract: Background: Few published studies have considered both the short- and longterm virologic or immunologic response to combination antiretroviral therapy (cART) and the impact of different cART strategies. Purpose: To compare time to initial virologic ( 200/mm 3 cell increase) response in antiretroviral-naive patients starting either a single protease inhibitor (PI; n = 183), a ritonavir-boosted PI regimen (n = 197), or a nonnucleoside reverse transcriptase inhibitor (NNRTI)‐based cART regimen (n = 447) after January 1, 2000, and the odds of lack of virologic or immunologic response at 3 years after starting cART. Method: Cox proportional hazards models and logistic regression. Results: After adjustment, compared to patients taking an NNRTI-regimen, patients taking a single-PI regimen were significantly less likely to achieve a viral load (VL) 200/mm 3 CD4 cell increase after starting cART (p > .3). At 3 years after starting cART, patients taking a single-PI‐based regimen were more likely to not have virologic suppression ( 200/mm 3 increase; p > .15). This model was adjusted for CD4 and VL at starting cART, age, prior AIDS diagnosis, year of starting cART, and region of Europe. Conclusion: Compared to patients starting an NNRTI-based regimen, patients starting a single-PI regimen were less likely to be virologically suppressed at 3 years after starting cART. These results should be interpreted with caution, because of the potential biases associated with observational studies. Ultimately, clinical outcomes, such as new AIDS diagnoses or deaths, will be the measure of efficacy of cART regimens, which requires the follow-up of a very large number of patients over many years. Key words: combination therapy, immunologic success, virologic success

Normal and Abnormal Patterns of 18F-Fluorodeoxyglucose PET/CT in Lymphoma

Abstract: In spite of the high performance of 18F-fluorodeoxyglucose (FDG) PET for the evaluation of lymphoma, inherent limitations of this modality underscore the additional value of PET/CT as an important tool in the assessment of this disease. Accumulating data on the use of PET/CT in lymphoma indicate the contribution of hybrid imaging to improved interpretation accuracy of PET using FDG and CT. Knowledge of the normal and abnormal patterns of FDG-PET/CT imaging and their variability in patients with lymphoma is important to provide a comprehensive clinically significant interpretation that has an impact on patient management and potentially on outcome.

Myeloid dysplasia in familial 3-methylglutaconic aciduria

Abstract: A kindred is reported with four members affected with neurodegenerative disorder and 3-methylglutaconic aciduria. Two siblings developed thrombocytopenia heralding a myelodysplastic syndrome; in one patient it evolved into acute myeloid leukemia with monosomy 7 in the marrow. The hematologic complications have hitherto not been previously reported in other cases of 3-methylglutaconic aciduria and are thus thought to represent a new disease entity. This family adds additional evidence to the genetic heterogeneity of Mendelian disorders in which the primary mutation may have a mutator effect that could give origin to myelodysplastic syndrome and acute myeloid leukemia through acquired chromosomal changes.

Hybrid Cardiac Single Photon Emission Computed Tomography/Computed Tomography Imaging With Myocardial Perfusion Single Photon Emission Computed Tomography and Multidetector Computed Tomography Coronary Angiography for the Assessment of Unstable Angina Pectoris After Coronary Artery Bypass Grafting

Abstract: A 73-year-old man was admitted to the cardiology department because of recent-onset angina pectoris. The patient had undergone coronary artery bypass graft surgery 10 years earlier with a left internal mammary artery graft to the left anterior descending artery and 4 saphenous vein grafts to the distal right coronary, first marginal, ramus intermedius, and first diagonal coronary arterial segments, respectively. Three years before the current admission, the patient developed recurrent angina pectoris and underwent angioplasty with stenting of the saphenous vein graft to the first diagonal artery. Because of recurrent symptoms on admission, the patient was referred for noninvasive assessment of the current status of his coronary artery disease with the use of a combined single photon emission computed tomography (SPECT)/computed tomography (CT) research system (Infinia LightSpeed, GE Healthcare Technologies, Milwaukee, Wis) that includes a dual-head variable-angle gamma camera and a 16-slice CT scanner. These components share a common table and are spatially aligned to enable sequential acquisition of …

Intensive insulin therapy in the intensive cardiac care unit.

Abstract: Treatment in the intensive cardiac care unit (ICCU) enables rigorous control of vital parameters such as heart rate, blood pressure, body temperature, oxygen saturation, serum electrolyte levels, urine output and many others. The importance of controlling the metabolic status of the acute cardiac patient and specifically the level of serum glucose was recently put in focus but is still underscored. This review aims to explain the rationale for providing intensive control of serum glucose levels in the ICCU, especially using intensive insulin therapy and summarizes the available clinical evidence suggesting its effectiveness.