Search

For hepatobiliary scintigraphy, the radiopharmaceutical drug, ETIFENIN (TECHIDA®), labelled with technetium-99m, is used as a substitute for MEBROFENIN (CHOLEDIAM®). It is generally accepted that radiopharmaceuticals should be checked prior to injection, in particular by determining radiochemical purity, to ensure high-quality images. Radiochromatographic techniques or methods described in the Summary of Product Characteristics (SmPC) and the European Pharmacopeia (Ph. Eur.) for quality control of [99mTc]Tc-ETIFENIN were considered impractical in routine nuclear medicine services (e.g. time-consuming and difficult to use). Following a literature review and screening phase, a quality control method was selected using a two-strip method. For detection and quantification of [99mTc]TcO 4 −, a glass microfiber paper impregnated with silica acid (ITLC-SA®) was used with a NaCl 20% mobile phase (w/v). For [99mTc]TcO 2 , glass microfiber paper impregnated with silica gel (ITLC-SG®) was used together with an absolute methanol mobile phase. The aim of this work was to validate this alternative analytical method. To do so, the recommendations of the European Association of Nuclear Medicine (EANM), adapted from the International Council of Harmonization Q2 (ICH Q2), were followed. Seven parameters were analyzed: specificity, linearity, precision, accuracy, robustness, limit of quantification and range. Additionally, migration time was also evaluated. This two-strip method appears to be specific (Rs mean > 2.0), linear (slope close to 1, R2 ≥ 0.99), precise (CV < 2.0%), accurate (%impurities two-strip method > %impurities reference), robust (CV < 2.0%), with an acceptable LoQ (S/N > 10:1) and a wide range (1.6–540 MBq/mL). Time of analysis appears to be clearly integrable into routine clinical practices (< 20 min). The alternative two-strip method NaCl 20% - ITLC-SA® and Methanol - ITLC-SG® represents an efficient quality control procedure. It allows the identification and quantification of the ratios of labelled [99mTc]Tc-ETIFENIN together with two potential impurities consisting of [99mTc]TcO 4 − and [99mTc]TcO 2. • Recommended methods (Ph. Eur./SmPC) were impractical (e.g., time-consuming), prompting the search for a new quality control method. • Following ICH Q2 and EANM guidelines, validation of an alternative method was done. • Alternative method proved to be specific, linear, precise, accurate, robust and feasible in routine practice. [ABSTRACT FROM AUTHOR]

Evaluation of cannabis abuse and epidemiology in 61 young adults aged less than 35 years old hospitalized for acute coronary syndrome. Introduction before the age of 35, acute coronary syndrome (ACS) are rare. Their epidemiological characteristics are unique. Methods this is a retrospective single-center study at the University Hospital of Brest of patients aged less than 35 years old hospitalized between 01/01/1998 and 31/12/2010 for ACS with or without ST segment elevation. The initial clinical and angiographic data were collected frommedical records. In a second phase, a questionnaire was sent to everypatient to determine their cannabis use at the the time of the onset ofthe ACS. Results 61 patients were included (89,6% male). The mean age of the patients was 31.04+ – 3 years old. Conventionnal cardiovascular risk factors were active smoking in 86.9% of cases, coronary heredity in 40.9% cases and dyslipidemia in 40.9% of patients. There was history of stressin 37% of cases and a regular cannabis use in 22.9% of patients. The STelevation ACS accounted for 68.8% of cases. They occurred during an effort in 14.8% of cases and patient were often inaugural (68.8%). In most of cases, patients had single vessel disease (61.7%), multivessel disease was found in 24.1% of cases. The left anterior descending (LAD) was affected in 58.6% of cases, the circumflex artery (CX) in 17% and right coronary artery (RCA) in 24.6% of cases. The coronarography was normal in the ten patients who were significantly more often cannabis smokers (50%, p<0.05). Angioplasty was the most common method of revascularization (62.7%) with bare metal stents for 34 patients (55%).no patient died during the hospitalization, complications (mainly arrhythmias) occurred in 19.6% of cases. Conclusion ACS in the young have specific epidemiological characteristics. Cannabis users represent 22.9% of this population. [ABSTRACT FROM AUTHOR]

In female, the prevalence of ER is lower but reported variously and has been poorly studied in aeronautical medicine. Our study described and evaluated the prevalence and long-term (4 years) evolution of ECG ER pattern in the female population of the French aeronautical staff. This is a retrospective single-center study, conducted over a period of 12 years (1998-2010) at the Centre of Medical Expertise in Navigant Personnel of Hospital of Percy, Clamart, France. The study was conducted from clinical data and through the systematic recording of ECG on a digital database (TRACE MASTER VIEW – PHILIPS ©). The study population included asymptomatic subjects aged >18 years and with no cardiovascular disease. An initial ECG (P1) was recorded in all patients at incorporation and a second 4 years later (P2). ECG were interpreted by 2 cardiologists. The presence of ER is rated “ER+” and its absence “ER-”. On each ECG were recorded: the heart rate (HR), the Sokolow-Lyon index and the corrected QT (QTc) interval. The study population included 306 women. The majority was stewardess (in 95.1% of cases; mean age 25.9±3.3 years). Only 170 subjects (56%) practiced sports up to one hour per week. At P1: PR + prevalence was 9.2%. The most common pattern was “slurring” in 64.3% of cases, in the inferior leads (28.3%). The ST segment is horizontal or descending in 53.6% of patients. At P2, the prevalence of RP+ was 7.5% (a loss of RP+ in 5 patients). At P1, the Sokolw-Lyon index was higher in RP+ patients (p <0.05). This difference was not significant at P2. No difference was found in HR and QTc values between the 2 periods. The population remained asymptomatic during the 4 years. In our young female population, the prevalence of ECG ER pattern was predominantly the slurring type and this aspect varied over time. According to our population evolution, no restriction on the workplace is necessary in asymptomatic aircrew with early repolarization pattern. The author hereby declares no conflict of interest [ABSTRACT FROM AUTHOR]

Aim The French military population is a young and athletic population with a high prevalence of early repolarization patterns (ERP) compared to the general population. Screening of military officers at risk of sudden death (SD) is a priority in military medical expertise. The aim of our study was to evaluate the prevalence of ERP and its evolution over a period of 5 years in a specific asymptomatic population, free of heart disease and cardiovascular risk factors. Methods From March to December 2008, we prospectively collected the ECGs of military officers enlisted into the submarine forces of France. For 5 years (until 2012), the military officers included in the study underwent a clinical examination twice per year. A new ECG was carried out 5 years after the initial one. Results 250 male subjects were included (mean age 22.87±0.5 years). The prevalence of ERP was 19.2%. The most common appearance was an elevation of a slurring type J point (31/48 or 64.5%) in inferolateral leads (18/48 or 37.8%). After 5 years, the prevalence of ERP was identical to that of the previous period (19.2%) with no change in appearance, distribution and amplitude in 47 subjects (97.9%). Repolarization changed in 2 patients (1 occurrence of ERP and 1 disappearance). During the 5 years of follow-up, the subjects remained asymptomatic Conclusion ERP is common in our population of young, athletic and asymptomatic military officers and changes little in 5 years [ABSTRACT FROM AUTHOR]

Background Cardiovascular magnetic resonance (CMR) with endocardial delineation of the right ventricle is the gold standard to measure right ventricular ejection fraction (RVEF). Longitudinal shortening is historically known to be the predominant part of its global systolic function and less attention has been paid to the transversal contraction. The aim of this study was to evaluate RV transverse motion in a large cohort of patients referred for CMR and assess its relationship with RVEF. Method We retrospectively analyzed the CMR scans of 300 consecutive patients referred for CMR between January and December 2010. Reference RV ejection fraction was determined from short axis sequence after delineating endocardial contours. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and medial level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) in the four chambers view as a longitudinal reference. Results Population was divided into 2 groups according the RVEF. 250 patients had a preserved RVEF (>40%) and 50 had a RV dysfunction (RVEF=40%). Both transverse and longitudinal motions were significantly reduced in the group with RV dysfunction (p<.0001). After ROC analysis, areas under the curve for FBDC, FMDC and TAPSE, were respectively 0,79, 0,82 and 0,72 with the highest sensitivity and specificity of 68% and 88% for FMDC (threshold at 19.9%) to predict RVEF. Above all, FMDC had a 93% negative predictive value of altered RVEF. Conclusion Right ventricular transversal systolic function markers, especially at the medial level, appear to be accurate for assessment of RV function by CMR. They are reliable to rule out an RV dysfunction in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Longitudinal shortening is traditionally considered the predominant part of global right ventricular (RV) systolic function. Less attention has been paid to transverse contraction. The aim of this study was to evaluate RV transverse motion by cardiovascular magnetic resonance (CMR) in a large cohort of patients and to assess its relationship with RV ejection fraction (RVEF). Study design: We retrospectively analyzed the CMR scans of 300 patients referred to our center in 2010. RVEF was determined from short axis sequences using the volumetric method. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and mid-level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) as a longitudinal reference. Results: Our population was divided into 2 groups according to RVEF. 250 patients had a preserved RVEF (>40%) and 50 had a RV dysfunction (RVEF ≤40%). Transverse and longitudinal motions were significantly reduced in the group with RV dysfunction (p <.0001). After ROC analysis, areas under the curve for FBDC, FMDC and TAPSE, were respectively 0.79, 0.82 and 0.72, with the highest specificity and sensitivity respectively of 88% and 68% for FMDC (threshold at 20%) for predicting RV dysfunction. FMDC had an excellent negative predictive value of 93%. Conclusion: RV fractional diameter changes, especially at the mid-level, appear to be accurate for semi-quantitative assessment of RV function by CMR. A cut-off of 20% for FMDC differentiates patients with a low (EF≤40%) or a preserved RVEF. [Copyright &y& Elsevier]