O. Halshtok, O. Goitein, R. Abu Sham'a, H. Granit, M. Glikson and E. Konen
Background: Until recently, cardiac pacemakers and implantable cardioverter defibrillators were considered an absolute contraindication for magnetic resonance imaging. Given the significant increase in implanting such devices, these contraindications will preclude MRI scanning in a large patient population. Several recent reports have addressed the safety and feasibility of MRI in the presence of cardiac implantable devices.
Objectives: To summarize our experience with MRI scanning in the presence of pacemakers and implantable cardioverter defibrillators.
Methods: Eighteen patients (15 males and 3 females, median 59) were scanned using a 1.5 T MRI scanner. A clinical discussion was held to verify the absolute medical necessity of the study before performing the scan. Scan supervision included device interrogation and programming beforehand, patient monitoring during, and device interrogation and reprogramming after the scan. Full resuscitation equipment was available outside the MRI suite.
Results: Thirty-four scans were performed, and all but one were of diagnostic quality. Anatomic regions included the brain (N=26), cervical spine (N=2), lumbar spine (N=1), cardiac (N=2), abdomen (N=1), abdomen and pelvis (N=1) and pelvis (N=1). None of the patients reported any side effects and no life-threatening events occurred during or following the scans. Five cases of device spontaneous reversion to backup mode were recorded (four in the same patient). Device replacement was not required in any patient.
Conclusions: In this small cohort of patients MRI scanning in the presence of cardiac implantable devices was safe. MRI in these patients is feasible although not recommended for routine scans. Scans should be considered on a case-to-case basis and performed in a dedicated specialized setup.
L. Barski, R. Nevzorov, J. Horowitz and S. Horowitz
Background: Clinical and epidemiologic features of coronary heart disease may not be explained solely by established risk factors. The role of infectious pathogens in the development and rupture of atherosclerotic plaques remains elusive but an association between Chlamydia pneumoniae, Mycoplasma pneumoniae and CHD[1] has been previously reported
Objectives: To determine whether there is an association between mycoplasmal infections and CHD.
Methods: We conducted a prospective cohort analysis of 150 consecutive hospitalized patients with CHD (85 with acute coronary syndrome and 65 admitted for unrelated reasons) and 98 healthy blood donors. Antibody titers for Mycoplasma pneumoniae, M. fermentans, M. hominis and Ureaplasma urealyticum were measured with the agglutination test or specific enzyme-linked immunosorbent assay in all three groups of patients.
Results: Analysis of the antibody titers did not reveal any significant difference in the presence of mycoplasmal antibodies between the patients with ACS[2], patients with known stable CHD hospitalized for non-CHD reasons, and healthy blood donors.
Conclusions: Determination of specific antibodies did not reveal a significant association among different types of mycoplasmal infection and CHD.
[1] CHD = coronary heart disease
[2] ACS = acute coronary syndrome
D.S. Seidman, A. Yeshaya, A. Ber, I. Amodai, I. Feinstein, I. Finkel, N. Gordon, N. Porat, D. Samuel, E. Shiran-Makler and I. Wolman
Background: Continuous use of combined oral contraceptives is currently attracting growing interest as a means of improving menstrual related symptoms and reducing the number of bleeding days.
Objectives: To evaluate bleeding patterns, menstrual symptoms and quality of life with an extended 84/7 oral contraceptive regimen versus 21/7 cycles.
Methods: In two consecutive run-in cycles, 30 µg ethinyl estradiol and 3 mg drospirenone tablets taken on days 1–21 were followed by a tablet-free period from days 22 to 28 of each cycle and then by two 84 day cycles of pill use with a 7 day tablet-free interval. The primary outcome was the total number of bleeding/spotting days. Secondary outcomes were severity of daily symptoms, general well-being determined by the PGWBI questionnaire, and overall treatment satisfaction.
Results: Of the 137 women invited to participate in the study 109 (aged 18–40 years) were enrolled. The number of bleeding days decreased by about one-third from a calculated 31.8 days of bleeding under a cyclic 21/7 regimen to an expected total of 21.8 days for the extended 84/7 regimen. The incidence of menorrhagia, intermenstrual bleeding, dysmenorrhea, abdominal bloating, breast tenderness, depressive moods and irritability – when compared at enrollment and at the end of the second extended study period – was significantly lower (P < 0.005) among women on the continuous pill regimen. The median (range) global PGWBI scores were not substantially different before and after the extended use cycles: 78.2 (39.1–96.4) and 77.3 (30.9–96.4), respectively. Body weight and skin condition also remained constant. At the completion of the study: 65.5% of the women were either highly satisfied (41.4%) or satisfied (24.1%) with the extended regimen.
Conclusions: The extended 84/7 regimen was found to be satisfactory for the majority of participants and was associated with a decrease in the number of bleeding days and an improvement in menstrual symptoms compared to 21/7 cycles.
M. Haddad, G. Rubin, M. Soudry and N. Rozen
Background: There is controversy as to which is the preferred treatment for distal radius intra-articular fractures – anatomic reduction or external fixation.
Objectives: To evaluate the radiologic and functional outcome following external fixation of these fractures.
Methods: Between January 2003 and March 2005, 43 patients with distal radius intra-articular fractures were treated using a mini-external AO device. Follow-up of 38 of the patients included X-rays at 1 week, 6 weeks and 6 months postoperatively. The Visual Analogue Scale was used to assess pain levels, and the Lidstrom criteria scale to evaluate functional outcome and wrist motion. Clinical and radiographic results were correlated.
Results: According to the Lidstrom criteria, the results were excellent in 31%, good in 61% and fair in 5.5%; 2.5% had a poor outcome. The results of the VAS were good. Thirty-five patients gained a good range of wrist movement, but 3 had a markedly reduced range. We found statistical correlation between the radiographic and clinical results, emphasizing the value of good reduction. There was no correlation between fracture type (Frykman score) and radiologic results or clinical results.
Conclusions: External fixation seems to be the preferred method of treatment for distal radius intra-articular fractures, assuming that good reduction can be achieved. The procedure is also quick, the risk of infection is small, and there is little damage to the surrounding tissues.
G. Neuman, R. Sagi, S. Shalitin and S. Reif
D.I. Nassie, M. Berkowitz, M. Wolf, J. Kronenberg and Y.P. Talmi
I. Arad, B. Bar-Oz, Z. Ergaz, A. Nir and V. Barak
Y. Salit, A. Bitterman, O. Lefel, D. Eisenberg, A. Eden, M. Barzelai, M. Steiner, E. Zuckerman and R. Haddad
A. Nevet, S. Ashkenasi, Z. Samra and G. Livni