Biomedical subjects

F Vargas

Publications and source records attributed to F Vargas.

At least 55 records · Page 3Linked to original sources

PubMed2000

Fulminant Guillain-Barré syndrome mimicking cerebral death: case report and literature review.

A 45-year-old woman was admitted to the intensive care unit (ICU) for respiratory arrest. One day prior to admission, she had been nauseated and in a state of total exhaustion. On the night of admission she was unresponsive and developed gasping respiration. The patient was comatose with absent brainstem reflexes and appeared brain dead. Blood chemistry findings and brain magnetic resonance imaging were normal. Electroencephalogram revealed an alpha rhythmical activity unresponsive to painful or visual stimuli. The cerebrospinal fluid showed an albuminocytological dissociation. Guillain-Barré syndrome (GBS) was suspected. The electrophysiological evaluation revealed an inexcitability of all nerves. The pathological findings of the sural nerve biopsy indicated an axonal degeneration secondary to severe demyelination. GBS can very rarely present with coma and absent brainstem reflexes. This case illustrates the importance of electrophysiological tests and laboratory and imaging studies in patients with suspected brain death where a cause is not clearly determined.

Brain Death↗

PubMed2000

5-HT3- and 5-HT2C-antagonist properties of cyamemazine: significance for its clinical anxiolytic activity.

RATIONALE: Cyamemazine is a neuroleptic compound which possesses anxiolytic properties in humans. On the other hand, 5-HT3- and 5-HT2C-receptors have been implicated in anxiety disorders and a previous binding study has shown that cyamemazine possesses high affinity for both serotonin receptor types. OBJECTIVE: The present study was undertaken to establish whether cyamemazine antagonizes 5-HT3- and/or 5-HT2C-mediated responses, and whether it compares with reference compounds. METHODS: Cyamemazine was tested for its ability to antagonize: (i) 5-HT3-dependent contraction of the isolated guinea-pig ileum and bradycardic responses in the rat and (ii) 5-HT2C-dependent phospholipase C (PLC) stimulation in rat brain membranes. RESULTS: In isolated guinea-pig ileum, cyamemazine potently and competitively antagonized 5-HT-dependent contractions (pA2 = 7.52 +/- 0.08; n = 5). In this test, cyamemazine was 5-7 times more potent (pIC50 = 6.75 +/- 0.13) than tropisetron (pIC50 = 6.02 +/- 0.04). In rats, cyamemazine i.v. antagonized 5-HT-dependent bradycardic responses with ID50% = 3.2 +/- 1.5 mg/kg (n = 4). Finally, in rat brain membranes cyamemazine antagonized 5-HT2C-dependent PLC stimulation with Ki = 424 nM (mianserin exhibits a Ki = 113 nM). CONCLUSIONS: Cyamemazine behaves as an antagonist at both 5-HT3- and 5-HT2C-receptors, which compares well with reference compounds. These 5-HT3- and 5-HT2C-antagonistic actions of cyamemazine can be involved, at least in part, in its beneficial therapeutic actions in anxiety disorders.

Animals↗

PubMed2000

Contribution of endothelium-derived relaxing factors to P2Y-purinoceptor-induced vasodilation in the isolated rat kidney.

We examined the role of endothelium-derived relaxing factors nitric oxide (NO), endothelium-derived hyperpolarising factor (EDHF), and prostaglandins (PGs) to P(2Y1)- and P(2Y2)-purinoceptor-induced vasodilation in isolated rat kidney. To do it, we analysed the renal response to ATP, 2-methylthio ATP, and UTP in rat renal vasculature under normal conditions and after the administration of: N(w)-nitro-L-arginine (L-NAME), increased K(+) concentration, indomethacin, and L-NAME and increased K(+) together. Our results indicate that the vasodilator response to P(2Y1)- and P(2Y2)-purinoceptor activation in the isolated perfused kidney of rats is subserved by EDHF and NO.

Animals↗

PubMed2000

Oral administration of losartan influences aminopeptidase activity in the frontal cortex.

Although there is a brain renin-angiotensin system, its mechanisms of control are not fully understood. We studied the effect of oral administration of the AT(1) receptor antagonist losartan on brain aminopeptidase (AP) activity, which plays a major role in neuropeptide metabolism. Six AP activities, related and non-related with the angiotensin (Ang) metabolism, were measured in their soluble and membrane-bound forms in the frontal cortex of control animals and rats treated with losartan, chronically administered via the drinking water. The results demonstrate that soluble pGluAP and membrane-bound AspAP and GluAP increased significantly in losartan-treated animals, indicating that the blockade of the AT(1) receptor stimulates the activity of AP involved in the Ang metabolism. Moreover, the blockade of the AT(1) receptor induces changes not only in the brain angiotensin metabolism, but probably also in that of other neuropeptides.

Administration, Oral↗

PubMed2000

Photochemistry and phototoxicity studies of flutamide, a phototoxic anti-cancer drug.

The phototoxic anti-cancer drug flutamide is photolabile under UV-B light in either aerobic or anaerobic conditions. Irradiation of a methanol solution of this drug produces several photoproducts, one by photoreduction of the nitro group, one by rupture of the aromatic-NO2 bond of the parent compound, two as a result of the rupture of the CO-NH bond and one derived from the photoreduction product by scission of the aromatic-NH2 bond. Flutamide shows a photohemolytic effect on human erythrocytes and photoinduces lipid peroxidation. Studies on peripheral blood polymorphonuclear cells (neutrophils) demonstrated the phototoxicity of flutamide as well as inhibition of the cytotoxicity respiratory burst by the photoproduct derived from its photoreduction. The results suggest that the inhibition of the respiratory burst observed in phorbol myristate acetate (PMA)-activated cells is mediated by photosensitization and concomitant singlet oxygen production and/or formation of toxic photoproducts.

Antineoplastic Agents, Hormonal↗

PubMed2000

Catecholamines-evoked cytosolic Ca2+ rise in endothelial cells from bovine adrenal medulla.

The effects of catecholamines on intracellular Ca2+ concentrations ([Ca2+]i) in single acutely dissociated bovine adrenal medulla endothelial cells (BAMECs) were measured using the intracellular fluorescent probe Fluo-3 AM. 100 microm epinephrine or norepinephrine induced a biphasic [Ca2+]i rise with an initial peak followed by a delayed phase. 10 microm phenylephrine (alpha1-adrenergic agonist) caused a [Ca2+]i rise similar to that evoked by catecholamines. The increase in [Ca2+]i induced by 10 microm phenylephrine was reverted by 10 microm phenoxybenzamine (alpha-adrenergic antagonist). Neither isoproterenol (beta-adrenergic agonist) nor clonidine (alpha2-adrenergic agonist) induced [Ca2+]i rise. The initial peak was insensitive to zero external Ca2+ and it was abolished after Ca2+ internal storages were emptied by 10 mM caffeine. The delayed phase was reduced to near zero by external Ca2+ removal. These results indicate that BAMECs possess alpha1-adrenergic receptors associated to both the release of caffeine-sensitive intracellular Ca2+ stores and the entry of extracellular Ca2+. We suggest that chromaffin cell secretion may activate BAMECs in vivo through an increase in [Ca2+]i which could induce the secretion of vasoactive factors allowing a rapid entry of hormones into the circulation.

Adrenal Medulla↗

PubMed2000

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses.

Methods of noninvasive pressure support ventilation (NIPSV) are not always easy to apply in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). The assistance time spent by nurses in relation to ventilatory time was prospectively studied, when NIPSV was used, in a sequential mode, in COPD patients with either acute exacerbations (58 patients, group I) or postextubation hypercapnic respiratory insufficiency (42 patients, group II) in a medical intensive care unit. During the first 24 h after enrolment, NIPSV was used for 6.7+/-3.2 h (mean+/-SD) in group I and 5.6+/-3.1 h in group II; the duration of NIPSV sessions and the nurse time consumption per session were respectively 47+/-12 and 11+/-7 min in group 1, and 46+/-12 and 11+/-6 min in group II. After the first 24 h of the study, the duration of NIPSV was 4.7+/-3.2 h x day(-1) in group I and 4.9+/-3.5 h x day(-1) in group II, and the nurse time consumption dropped significantly: the duration of NIPSV sessions and the nurse time consumption per session were respectively 44+/-10 and 7+/-4 min in group I, and 47+/-14 and 7+/-3 min in group II. Between the first 24 h and the subsequent period of 24 h, the nursing time dropped significantly (98 versus 59 min in group I (p<0.05), and 85 versus 52 min in group II (p<0.05)). There was no difference in the duration of NIPSV sessions, or in the overall assistance time per session, between the two groups of patients. In conclusion, the study seems to favour a quite low assistance time spent by nurses in relation to ventilatory time when noninvasive pressure support ventilation is used in chronic obstructive pulmonary disease patients with either acute exacerbations or postextubation hypercapnic respiratory insufficiency.

Aged↗

PubMed2000

Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates.

OBJECTIVE: To analyze the impact of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) on guiding the treatment and intensive care unit (ICU) clinical outcome in neutropenic patients with pulmonary infiltrates admitted to the ICU. DESIGN: Prospective collection of data. SETTING: Medical ICU in a teaching hospital. PATIENTS: During a 6-yr period, we analyzed the results of 93 fiberoptic bronchoscopies plus BALs performed in 93 consecutive neutropenic ICU patients. We separated the patients into two groups according to the cause of neutropenia (high-dose chemotherapy [n = 41] or stem cell transplantation [SCT; n = 52]). RESULTS: Of the 93 BALs, 53 were performed to evaluate diffuse infiltrates and 42 were performed on mechanically ventilated patients. Forty-nine percent of BALs (46 patients) were diagnostic, with a significantly better yield in ICU patients with high-dose chemotherapy-induced neutropenia (26 of 41 BALs). The number of cases of proven infectious pneumonia was significantly higher in this group of ICU neutropenic patients. In patients who underwent SCT, diffuse infiltrates were statistically correlated with a negative result of BAL. Twenty-six patients who underwent diagnostic BALs changed therapy. Sixteen complications (17%) occurred with only two intubations. The overall mortality rate in the ICU and the mortality rate in mechanically ventilated neutropenic patients were 71% and 93%, respectively. In neutropenic patients who underwent SCT, the mortality rate was statistically higher in patients in whom no diagnosis was established. Patients who had a diagnostic BAL that changed therapy did not have an increased probability of survival compared with patients who had a BAL that did not change therapy. CONCLUSIONS: The use of routine diagnostic BAL in ICU neutropenic patients with pulmonary infiltrates is difficult to establish, even if BAL is helpful in the management of these critically ill patients. BAL in our ICU neutropenic patient population had an acceptable overall diagnostic yield (49%), which was higher in ICU patients with chemotherapy-induced neutropenia. Nevertheless, in the ICU, if BAL had a low complication rate, it had infrequently led to changed treatment and was not associated with improved patient survival.

Adult↗

PubMed2000

Impact of colony-stimulating factor therapy on clinical outcome and frequency rate of nosocomial infections in intensive care unit neutropenic patients.

OBJECTIVES: To determine whether the use of recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim) reduces the mortality rate and the frequency rate of nosocomial infections in neutropenic patients requiring intensive care unit (ICU) admission. DESIGN: Retrospective consecutive case series analysis. SETTING: Medical ICU of a teaching hospital. PATIENTS: We compared two groups of patients, according to whether or not they received G-CSF. In the ICU, 28 leukopenic patients received filgrastim (5 microg of body weight per day intravenously). In all these patients, G-CSF was continued until recovery from leukopenia, defined as a leukocyte count >1,000/mm3. A total of 33 ICU leukopenic patients did not receive G-CSF. End points included leukocyte count, bone marrow recovery, frequency of ICU nosocomial infections (pneumonia, urinary tract, and catheter-related infections), and mortality rate. MEASUREMENTS AND MAIN RESULTS: There were no differences in number of patients who recovered from leukopenia or in whom blood leukocyte count increased. Nosocomial infections occurred in the same percentage in both groups. The percentage of patients who died was identical in both groups. The percentage of patients with and without filgrastim therapy who recovered from leukopenia but died, was 86% and 78%, respectively. CONCLUSION: In the ICU, clinical outcome of neutropenic patients was not changed by G-CSF therapy. It is possible that G-CSF therapy may not be helpful in improving the ICU clinical outcome of neutropenic patients. Additional controlled studies designed to address this question are warranted.

Adult↗

PubMed2000

Noninvasive continuous positive airway pressure in neutropenic patients with acute respiratory failure requiring intensive care unit admission.

OBJECTIVE: To evaluate the tolerance and the efficacy of noninvasive continuous positive airway pressure (CPAP) in severe acute respiratory failure occurring in intensive care unit (ICU) neutropenic patients with hematologic malignancies, and to establish predictive variables of efficacy of this method. DESIGN: Prospective study over a 5-yr period. SETTING: Hematologic and medical intensive care unit of a teaching hospital. METHODS: Among 129 neutropenic patients admitted to the ICU, 64 patients presented with febrile acute hypoxemic normocapnic respiratory failure (PaO2/FIO2 ratio <200) and were enrolled. In addition to standard therapy, patients received CPAP with a facial mask. The initial settings of the CPAP were 6 cm H2O positive end-expiratory pressure and FIO2 0.8 (80%). Physiologic measurements were performed at the end of 45 mins of ventilation with first adjustments. CPAP was used with a sequential mode (45 mins/3 hrs). CPAP was efficient if intubation was avoided. RESULTS: The setting of CPAP, after adjustments, was as follows: positive end-expiratory pressure 7 +/- 1 cm H2O and FIO2 0.7 +/- 0.1 (70% +/- 10%). For the 64 patients, CPAP was administered for a total of 6 +/- 2 hrs during the first 24 hrs. The mean duration of CPAP was 7 +/- 3 days. A reduction in respiratory rate to less than 25 breaths/min was achieved in 53% of patients. PaO2/FIO2 ratio increased from 128 +/- 32 to 218 +/- 28. CPAP was successful in avoiding endotracheal intubation in 16/64 patients. A total of 16 responders and four nonresponders survived. Hepatic failure was a criterion indicating the failure of CPAP: 1/16 vs. 26/48 (p = .001). In multivariate analysis, two variables were predictive of failure of CPAP: Simplified Acute Physiology Score II (58 +/- 14 vs. 41 +/- 11) and a hepatic failure at the entry into the study. CONCLUSION: CPAP was efficient in 25% of cases. All the responders survived. This noninvasive method was used as a way to avoid mechanical ventilation, which is well correlated with a poor prognosis in neutropenic ICU patients. Further controlled studies are needed to confirm the efficacy of noninvasive CPAP and to evaluate the most appropriate selection of immunocompromised patients.

Adult↗

PubMed2000

Longitudinal studies in the epidemiology of vesicular stomatitis on Costa Rican dairy farms.

Twenty-three Costa Rican dairy herds from an vesicular stomatitis (VS) endemic area were under an active surveillance between April 1997 and March 1999. Ninety-two confirmed cases of VS New Jersey were found. Factors associated with clinical cases of VS virus New Jersey were: Parity (animals of parity 4 or 5 were 5.3 times more likely to present a clinical case than animals of parity 3 and lower; on the other hand, animals of parity 6 and higher showed an odds 4.6 times greater than animals of parity 3 and lower.) Ecological life zone (animals in premountain moist forest were 7.4 times more likely to present clinical cases than animals in lower mountain rain forest). Factors associated with seropositivity at the time of birth were farm and breed (Jersey calves had an odds 14.7 times greater than Holstein calves). Seroconversion, defined as the first twofold increase in the titers of the blood, was associated with farm and showed four peaks during the study period, September (wet season) 1997, February (dry season) 1998, September 1998, and February 1999. Finally, time to event analysis showed difference between farms and age, older animals showed the first seroconversion earlier than younger animals.

Age Distribution↗

PubMed2000

Renal vascular reactivity to P(2)-purinoceptor activation in spontaneously hypertensive rats.

This study was performed to determine the possible contribution of an imbalance between P(2X) (vasoconstriction) and P(2Y) (vasodilation)-purinergic reactivity to the increased vascular resistance of spontaneously hypertensive rats (SHR). The vasoactive responses to alpha,beta-methylene ATP and 2-methylthio ATP specific agonists, respectively, for P(2X) and P(2Y) purinergic receptors were characterized in isolated perfused kidneys from Wistar Kyoto (WKY) and SHR. To analyze P(2X)- and P(2Y)-purinergic reactivity we used phenylephrine and barium chloride, or acethylcholine (ACh) and sodium nitroprusside (NP) as reference compounds, respectively. The renal vasculature from SHR showed markedly enhanced reactivity to alpha,beta-methylene ATP, phenylephrine and barium chloride. The dose-response curves were characterized by a similar threshold, with a greater maximal response. There were no significant differences in the dose-response curves or in maximal vasodilation to 2-methylthio ATP, ACh or NP when both groups were compared, except at the dose of 10(-6) g/g kidney weight of NP in which the SHR group showed an increased responsiveness. The results indicate that the increased responsiveness of kidneys from SHR to alpha,beta-methylene ATP may be due to nonspecific functional changes in the renal vasculature rather than to a specific alteration in the activity of renal P(2X)-purinoceptors. Our results also indicate that P(2Y)-purinergic reactivity, nitric oxide-induced vasodilation and the cGMP-dependent mechanisms of vasodilation are well preserved in SHR.

Adenosine Triphosphate↗

PubMed2000

Interaction between nitric oxide and mineralocorticoids in the long-term control of blood pressure.

We analyzed the effects of a possible interaction between nitric oxide deficiency and mineralocorticoids on the long-term control of blood pressure and renal and endocrine variables. Six groups of uninephrectomized male Wistar rats were used: control animals and rats that received (1) N(G)-nitro-L-arginine methyl ester (L-NAME) subpressor (0.5 mg/100 mL drinking fluid), (2) L-NAME pressor (35 mg/100 mL drinking fluid), (3) deoxycorticosterone acetate (DOCA; 12. 5 mg/wk per rat), (4) DOCA plus L-NAME subpressor, or (5) L-NAME pressor plus DOCA. For all groups, the drinking fluid was tap water or 1% NaCl solution. We measured the time course of tail systolic blood pressure (SBP) and body weight for 3 weeks in all rats. At the end of the experimental period, we measured mean arterial pressure (direct recording) and endocrine and renal variables. Tail SBP rose significantly in the DOCA plus L-NAME subpressor-treated group but remained at normotensive levels in the DOCA-treated group. The addition of L-NAME to the subpressor dose accelerated the blood pressure increase in DOCA-salt hypertensive rats. The simultaneous administration of DOCA and L-NAME increased blood pressure and mortality rates in rats that drank water or saline compared with the rats treated with L-NAME alone. The subpressor dose of L-NAME did not increase blood pressure in saline-drinking rats. We conclude that impaired NO synthesis results in increased sensitivity to the pressor effect of mineralocorticoids in the presence or absence of an increased saline intake. Hence, nitric oxide contributes to the adaptative response to mineralocorticoid excess, perhaps through the facilitation of natriuresis and, thus, control of blood pressure.

Animals↗

PubMed2000

Rotation and restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria.

To test the hypothesis that a new program of antibiotic strategy control can minimize the incidence of ventilator-associated pneumonia (VAP) caused by potentially antibiotic-resistant microorganisms, we performed a prospective before-after study in 3, 455 patients admitted to a single intensive care unit over a 4-yr period. Regarding the bacterial ecology and the increasing antimicrobial resistance in our medical intensive care unit (MICU), we decided to vary our choice of empiric and therapeutic antibiotic treatment, with a supervised rotation, and a restricted use of ceftazidime and ciprofloxacin, which were widely prescribed before this scheduled change. For all patients, VAP was diagnosed based on the results of quantitative culture of bronchoalveolar lavage specimens (>/= 10(4) cfu/ml). We studied 1,044 and 1,022 patients requiring more than 48 h of mechanical ventilation (MV), respectively, in the before-period (2 yr: 1995-1996) and the after-period (2 yr: 1997-1998). We observed a decrease from 231 consecutive episodes of VAP in the before-period to 161 episodes of VAP in the after-period (p < 0.01), particularly for VAP occurring before 7 d of MV. The total number of potentially antibiotic-resistant gram-negative bacilli responsible for VAP such as Pseudomonas aeruginosa, Burkholderia cepacia, Steno-trophomonas maltophilia, and Acinetobacter baumanii decreased from 140 to 79 isolated bacilli. The susceptibilities of these bacteria to the antibiotics regimen increased significantly, especially for P. aeruginosa and B. cepacia. The percentage of methicillin-sensitive Staphylococcus aureus increased significantly from 40% to 60% of S. aureus responsible for VAP. These results suggest that a new strategy of antibiotics use could be an efficient means to reduce the incidence of VAP caused by antibiotic-resistant bacteria. Nevertheless, further studies are needed to validate these data.

Aged↗

PubMed2000

Temporal and spatial variation of phlebotomine (Diptera: Psychodidae) community diversity in a cutaneous leishmaniasis endemic area of Costa Rica.

Phlebotomine sand fly species composition and diversity were studied in Acosta, an area of Costa Rica endemic for cutaneous leishmaniasis. Two CDC miniature light traps per house were set overnight in 72 houses distributed in 6 localities, once a month, during the rainy seasons of 1994 and 1995. Of the 22 species collected, the most common were Lutzomyia serrana (Damasceno & Arouck), L. youngi Feliciangelli & Murillo, L. ylephiletor (Fairchild & Hertig), L. shannoni (Dyar), L. cruciata (Coquillett), L. gomezi (Nitzulescu), L. sanguinaria (Fairchild & Hertig), and Warileya rotundipennis (Fairchild & Hertig). The Czekanowsky index and the Sorensen index as modified by Bray and Curtis to consider abundance were used to compare species composition and beta-diversity. Comparisons were made among localities within years, between years, and localities each year. The data strongly indicated that phlebotomine species composition is more stable than diversity or abundance.

Animals↗

PubMed2000

Studies on the in vitro phototoxicity of the antidiabetes drug glipizide.

The phototoxic antidiabetes drug glipizide (1) is photolabile under aerobic conditions and UV-B light. Irradiation of a phosphate-buffered solution of 1 under oxygen atmosphere produces 4 photoproducts as well as singlet oxygen, which was detected by trapping it with 2,5-dimethylfuran and by the histidine test. The photochemistry of 1 involves cleavage of the sulfonamine and the sulfonamine-R bonds. Red blood cell lysis, photosensitized by glipizide and the products of its aerobic photolysis were demonstrated. The photohemolysis rate was lower for 1 than for its photoproducts. Inhibition of this process on addition of 1, 4-diazabicyclo[2.2.2]octane (DABCO), reduced glutathione (GSH), Vitamin C, sodium azide, superoxide dismutase, and a-tocopherol confirmed the possibility of singlet oxygen, superoxide ion and free radicals participation. Furthermore, in a lipid-photoperoxidation test with linoleic acid the in vitro phototoxicity of glipizide was also verified. A low decreasing cell viability of lymphocytes and neutrophils was observed.

Cell Survival↗

PubMed2000

[Reactive hemaphagocytic syndrome in a patient with midline NK-cell lymphoma].

Different etiologies have been shown to underly lethal midline granuloma. Evidence of natural killer cell lymphoma is obtained by immunolabeling and molecular biology studies. The tumor has a characteristic immunophenotype and genotype. This clinicopathological entity is highly associated with Epstein-Barr virus (EBV). We present the case of a patient with EBV associated with nasal-type natural-killer cell lymphoma and a coexisting hemophagocytic syndrome.

Adult↗

PubMed2000

[Improved left ventricular endocardial detection by a first generation contrast agent. Effect of dose].

The study of global and segmental left ventricular function forms part of every echocardiographic examination. However, this is only possible when the endocardial borders are well identified. The authors report the results of a study with Albunex, a first generation contrast agent used by intravenous injection. The object of this study was to assess the efficacy of Albunex in improving left ventricular endocardial detection compared with standard transthoracic echocardiography (TTE) and the dose-effect relationship. Forty-one patients were included prospectively at two cardiological hospital centres between 1995 and 1997, before the development of second harmonic imaging. Two patients were excluded from the study. Each patient underwent transthoracic echocardiography in the fundamental mode with an apical four-chamber view. The following procedure was adopted: 1) standard examination, 2) low dose Albunex (0.1 mg/Kg) injected via a peripheral vein, 3) high dose Albunex (0.2 mg/Kg) injected via a peripheral vein, 4) low dose Albunex injected via a central vein, 5) high dose Albunex injected via a central vein. The analysis of results was performed by two independent observers and showed that Albunex improved endocardial detection (p < 0.005); this detection was significantly better with high doses of Albunex and with central vein injection (p < 0.005); the septal border was better visualised than the lateral wall endocardium (p < 0.005) but the improvement in endocardial detection was greater for the lateral wall (p < 0.005). No complications were observed during the procedure. The authors conclude that Albunex improves left ventricular endocardial detection. This benefit is mainly due to improved lateral wall detection, and increases with higher doses of the contrast agent.

Adult↗