Perivascular Fat Attenuation Index on Non-Contrast-Enhanced Cardiac Computed Tomography: Comparison with Coronary Computed Tomography Angiography

Objective: Perivascular fat attenuation index (FAI) measurement on non-contrast-enhanced cardiac computed tomography (NCCT) has not been rigorously validated in previous studies. Herein, we compared perivascular FAI values between NCCT and coronary computed tomography angiography (CCTA). We also investigated the variability and reproducibility of perivascular FAI measurement. Methods: A total of 44 patients who underwent NCCT and CCTA were included in this study. For NCCT, perivascular FAI was measured using three threshold settings: from −30 to −190 Hounsfield Units (HU), −20 to −180 HU, and −10 to −170 HU. For CCTA, perivascular FAI was measured using one threshold setting: from −30 to −190 HU. Perivascular FAI measurements by NCCT were compared with those by CCTA using the paired t-test, and correlations were assessed using Pearson’s correlation coefficient. The intra- and inter-observer variabilities for the measurements with NCCT and CCTA were evaluated with the intraclass correlation coefficient. Results: Perivascular FAI measurements with the threshold setting of −30 to −190 HU were significantly lower on NCCT than on CCTA. There were no significant differences between the perivascular FAI measurements at the remaining thresholds on NCCT and those on CCTA. The perivascular FAI at all thresholds on NCCT correlated significantly with those on CCTA. The intra- and inter-observer agreements were excellent for the measurements on NCCT and CCTA. Conclusion: There were significant differences between the perivascular FAI measurements on NCCT and CCTA. However, the differences could be modified by threshold adjustment.

A Super-Aged Case with Marked Hyponatremia Reaching 98 mEq/L;Clinical Implications of Low Serum Sodium

A 79-year-old man, an in-patient at a long-term hospital suffers from Alzheimer dementia and thyroid hypofunction. Recently, he had also suffered from pneumonia followed by impaired consciousness and referred to our hospital for further examination. At the time of admission, the level of consciousness was JCS III-200 and other vital signs were normal. He had no edema on his limbs but had dry skin. According to chest CT, we detected pneumonia. Based on the laboratory data on admission, we detected low osmolality of 206 mOsm/kg of water and serum Na 98 mEq/L, beside urinary Na 54.1 mEq/L. We confirmed severe hyponatremia of hypersecretion type. Fluid replacement therapy was started mainly with Ringer’s solution which is similar to extracellular fluid. We diagnosed it as SIADH induced by adrenal crisis based on the significant lower serum Na value and low blood sugar. Consequently, the patient was administered Hydrocortisone and Fludrocortisone acetate. On the 14th day, serum Na level improved from 98 mEq/L to 140 mEq/L. After daily monitoring of serum Na and urinary Na, administration of fludrocortisone acetate was terminated. The patient was discharged on 25th day, since serum Na was stabilized with oral administration of hydrocortisone and oral salt supplement. This case report shows that adrenal crisis can be triggered by pneumonia. In cases of impaired consciousness, if hyponatremia and hypoglycemia are observed, we may have to suspect the possibility of adrenal crisis. Therefore, urinary biochemical examination is an important part of the laboratory tests.

To Investigate the Effect of Using Ethanol Containing Wipes in Collecting Blood for the Measurement of Alcohol Concentration

This study was aimed to establish whether the skin preparation using ethanol-containing skin antiseptics causes ethanol contamination through blood collection. Venous blood was collected from 40 healthy volunteers according to the national guidelines for blood sampling, with four sequential procedures as follows: 1) collecting blood immediately (within 5 seconds) after cleaning the skin with an individually packaged type of ethanol-containing wipe, 2) collecting blood 1 minute after cleaning the skin with an individually packaged type of ethanol-containing wipe, 3) collecting immediately (within 5 seconds) after cleaning the skin with a traditional cleaning method (thoroughly ethanol-impregnated wipe, and 4) collecting 1 minute after cleaning the skin with a traditional cleaning method. Each sequential procedure was performed with and without the ethanol-containing wipe used for skin cleaning on the puncture site on their right and left arms at the time the needle was withdrawn, respectively. The collected specimens were subjected to the determination of ethanol by using headspace gas chromatography-mass spectrometry. In every 80 blood specimens obtained from 40 participants, ethanol was undetectable (<0.001 mg/mL). This study demonstrates that disinfection using ethanol-containing skin antiseptics is unlikely to cause ethanol contamination through blood collection regardless of skin preparation technique according to the guidelines for blood sampling. This may have implications in forensic science.

A review of isolated muscular ventricular septal defect

Background Color Doppler echocardiography greatly facilitates the diagnosis of isolated muscular ventricular septal defect with a small shunt.Data sources Original research articles were collected from database,including PubMed and Google scholar.Relevant articles about muscular ventricular septal defect were included.Results The frequency of isolated muscular ventricular septal defect is 5.7%in preterm infants and 1.1-5.3%in term infants.Spontaneous closure in muscular ventricular septal defect occurs with higher frequency and earlier than in perimembranous ventricular septal defect.Approximately 80-90%of isolated muscular ventricular septal defect closes spontaneously by 12 months of age.Midventricular muscular ventricular septal defect is spontaneously closed earlier in the short term,but no site difference is found in the long term.The spontaneous closure mechanism is regarded as aposition of the muscle tissueor fibrous tissue formation in the right ventricular side,but in rare cases involves aneurysm formation of the fibrous tissue.Regarding spontaneous closure of isolated muscular ventricular septal defect diagnosed for the fetus,further studies are needed.Chromosomal microarray analysis of fetuses with isolated muscular ventricular septal defect has revealed that it is not a severe risk factor of chromosomal abnormalities.Conclusions This paper presents a review of the history of the diagnosis and frequency of ventricular septal defect,with discussion of its natural history from the fetal period to after birth in patients with isolated muscular ventricular septal defect.