Functional evaluation in congenital and acquired heart disease

Conclusions Functional evaluation of the cardiovascular system using rapid imaging (spiral echo planar), chemical shift, and velocity mapping is capable of making the diagnosis in congenital and acquired cardiovascular disease which, between them, cause the largest number of deaths of any disease in the western world and massive morbidity and suffering. Furthermore, for the first time in the history of medicine, there is the opportunity to apply preventive measures to eardicate the epidemic of preventable arterial disease. There needs to be a change of emphasis and a switching of resources to apply to the most common diseases rather than to those which are most easily studied. There also needs to be proper training in cardiovascular MR, not so much for imagers as for cardiologists and experts in vascular disease.     

Mayonnaise production in batch and continuous process exploiting magnetohydrodynamic force

Mayonnaise currently is produced using high shear stirrers. Here we present a new production method using a magnetic emulsification device. According to the new method a stable oil-in-water emulsion is formed by pumping the two immiscible liquids through a magnetohydrodynamic dispersion device consisting of a Venturi provided with an orthogonal permanent magnetic field. As a proof of concept, magnetically emulsified highly viscous mayonnaise was produced in a batch process and in a continuous process. The viscosity of the mayonnaise was significantly enhanced by applying the magnetic field. The oil droplet size distribution of mayonnaise produced using the magnetic emulsification method was similar to mayonnaise produced with conventional high shear mixers. In contrast to conventional processes no fast moving mixers were needed in this new mayonnaise production scheme.     

Social influences related to college students’ use of Macintosh computers on an all-PC campus

In the present qualitative research study, 35 Mac users were interviewed in a university campus that exclusively supports PC machines. We particularly explored the Mac-users’ social influences, saving technological and other influences for future reports. Results showed Mac users to possess significant connections with other Mac users on the university campus. The Mac users in our study indicated that positive, past exposure, including Apple’s advertising of Macs, had sharp influences on their decisions to become and remain Mac users.     

Magnetic resonance imaging of coronary arteries and coronary stenosis

Coronary artery imaging is an important investigation for the management of coronary artery disease. Alternative noninvasive imaging would be useful, but the small caliber and tortuosity of the coronary vessels and cardiac and respiratory motion create formidable imaging problems. We first studied 21 normal subjects and 5 with coronary artery disease established by X-ray contrast angiography, of whom 2 had undergone bypass grafting. Of these, 22 were imaged successfully. Identification of the artery was possible for the left main stem, left anterior descending, right coronary, and left circumflex arteries respectively in 95%, 91%, 95%, and 76%. The arterial diameter at the origin could be measured in 77%, 77%, 81%, and 63%. The mean ±SD arterial diameter in each case (4.8±0.8, 3.7±0.5, 3.9±0.9, and 2.9±0.6 mm) was not significantly different from reference values (allp=ns). The mean length of artery visualized was 10.4±5.2,46.7±22.8,53.7±27.9, and 26.3±17.5 mm. In 12 normal males, the total coronary area was 30.9±9.2 mm² and the ratio compared with body surface area was 16.4±4.4 mm² m^–2 (bothp=ns compared with reference values). In seven patients, with X-ray contrast coronary angiography, the proximal arterial diameter measured by magnetic resonance was 3.9±1.1 mm, and by X-ray contrast angiography 3.7±1.0 mm (p=ns). We then studied 17 patients with angina. Imaging of just the relevant artery was performed and analysis was blinded to the X-ray angiography results. Stenosis was identified on the magnetic resonance (MR) images by localized reduction in vessel signal intensity. Stenosis location by MR was assessed by measurement of its distance from a reference vessel, with correlation to the X-ray findings. X-ray coronary angiography showed 23 stenoses of which 15 (65%) were correctly located by blind assessment of the MR images. Of the eight remaining stenoses, a further 5 (63%) were correctly located on the MR images after retrospective comparison (overall sensitivity 87%). There were three lesions thought to represent stenosis by MR, which on review of the X-ray angiogram proved to be a minor stenosis <50% (two cases) or a tortuous vessel (one case). Greater signal loss was seen in the more severe stenoses. The stenosis length by MRI was greater than by X-ray (8.4 versus 5.1 mm,p<0.001). The overestimation of stenosis length may be due to turbulence.     

MR high-resolution imaging of arterial intimal hyperplasia at 1.5 T

Intimal hyperplasia is the earliest microscopic change detectable in the arterial wall in the development of arteriosclerosis and atherosclerosis. To enable high-resolution imaging of this, a standard 1.5-T machine was modified using inserted gradient coils of 30 cm internal diameter and surface radio-frequency coils. Six rabbit aorta specimens with injury-induced intimal hyperplasia and two normal rabbit aorta specimens were imaged using a spin-echo sequence of TE 40. Pixel sizes as small as 20 µ×20 µ could be obtained and the area of intimal hyperplasia could be measured at 80 µ×40 µ. The results were compared with those made by a computer-linked microscope. In the injured aortas, there was a low-signal region on magnetic resonance imaging which corresponded to the media of the vessel wall when compared with the histology.T ₁ andT ₂ constants for the media were determined and compared with those of a normal specimen. TheT ₁ constant was shorter for the media of the injured aorta than in the normal. This could be related to the disruption of the internal elastic lamina and migration of muscle cells to the intima which occurs following injury. The popliteal artery of four normal volunteers was imaged and the area of the wall could be measured at a pixel size of 312 µ×160 µ. This suggests thatin vivo studies of intimal hyperplasia arteriosclerosis and atherosclerosis could be made.     

Assessment of regional left ventricular long-axis motion with MR velocity mapping in healthy subjects

We present a case of trichothiodystrophy associated with a hypereosinophilic syndrome. This case had been followed for 30 years. Trichothiodystrophy was characterized by lamellar ichthyosis, hair and nail dystrophies, kyphoscoliosis, congenital luxation of the hip. The hypereosinophilic syndrome was characterized by an itching urticaria-like eruption. Although the patient's general condition had remaining stable for 30 years, during the last year it worsened and the patient suddenly died. The authors discuss about the significance of this association.     

Early postoperative gadolinium-DTPA-enhanced MR imaging after successful lumbar discectomy

Cytotoxic T lymphocytes (CTLs) recognise antigenic peptides in the context of major histocompatibility complex (MHC) class I molecules on virus-infected cells. The formation and transportation of antigenic peptides to class I MHC in the cells are multi-step reactions known as antigen processing. In order to design a good DNA vaccine, it is important to dissect the specificity of antigen processing. Here we describe the construction of an epitope-based plasmid vector as a device to investigate antigen processing in transfected cells. The epitope-based plasmid vector was constructed by insertion of an epitope-encoding minigene into the lacZ gene. We used a CTL epitope on influenza A virus nucleoprotein (NP366-374 epitope) as a model. Upon transfection, the epitope-based plasmid vector induced the expression of NP epitope antigenically as well as immunogenically. Immunization of mice with plasmid-transfected cells was able to induce NP epitope-specific CTLs in vivo. Moreover, the plasmid vector functioned as a gene vaccine; NP epitope-specific CTLs were primed in vivo upon transfection of the vector into dermis by electroporation. The results suggest that this epitope-based DNA delivery system may provide a new strategy for in vivo induction of epitope-specific CTLs to investigate antigen processing and presentation.     

Early results of combined carotid endarterectomy and coronary artery bypass grafting in patients with severe coronary and carotid artery disease

The management of patients with carotid artery disease who require coronary artery bypass grafting (CABG) remains controversial. Several published series from the USA (including one with prospective randomization) advocate a combined approach of carotid endarterectomy (CEA) followed immediately by coronary artery bypass surgery. However, experience of combined carotid endarterectomy and coronary bypass grafting has not been previously reported by a centre from the United Kingdom. Between 1986 and 1991 we performed this combined procedure on 18 patients who required myocardial revascularization and had co-existing severe (> 70%) carotid stenosis. Sixteen patients (89%) had angina and 11 patients (61%) had symptomatic carotid artery disease. The perioperative mortality was 5.5% and the ipsilateral perioperative stroke rate was 5.5%. These early results are encouraging and suggest that further evaluation of combined carotid endarterectomy and coronary artery bypass surgery is warranted.