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Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 2003; 107: 664666 Nieman K, Rensing BJ, van Geuns RJ, et al. Usefulness of multislice computed tomography for detecting obstructive coronary artery disease. J Cardiol 2002; 89: 913918 Kopp AF, Schroeder S, Kuettner A, et al. Non-invasive coronary angiography with high resolution multidetector-row computed tomography: results in 102 patients. Eur Heart J 2002; 23: 17141725 Amoroso G, Battolla L, Gemignani C, et al. Myocardial bridging on left anterior descending coronary artery evaluated by multidetector computed tomography. Int J Cardiol 2004; 95: 335337 Kantarci M, Duran C, Durur I, et al. Multidetector CT evaluation of the coronary arteries: techniques, anatomy and variations. Bulletin of Computed Tomography 2004; 2: 9098 Vogl TJ, Abolmaali ND, Diebold T, et al. Techniques for the detection of coronary atherosclerosis: multi-detector row CT coronary angiography. Radiology 2002; 223: 212220 Smith SC, Taber MT, Robiolio PA, Lasala JM. Acute myocardial infarction caused by a myocardial bridge treated with intracoronary stenting. Cathet Cardiovasc Diagn 1997; 42: 209212 Schwarz ER, Klues HG, vom Dahl J, Klein I, Krebs W, Hanrath P. Functional, angiographic and intracoronary Doppler flow characteristics in symptomatic patients with myocardial bridging: effect of shortterm intravenous beta-blocker medication. J Coll Cardiol 1996; 27: 16371645 Morales AR, Romanelli R, Tate LG, et al. Intramural LAD: significance of depth of the muscular tunnel. Hum Pathol 1993; 24: 693701 Noble J, Bourassa MG, Petitclerc R, et al. Myocardial bridging and milking effect of the left anterior descending coronary artery: normal variant or obstruction? J Cardiol 1976; 37: 993999 Hort W. Anatomie und Pathologie der Koronararterien. B. Muskelbrcken der Koronararterien. In: Hort W. Pathologie des Endokards, der Koronararterien und des Myokards. Berlin, Germany: Springer-Verlag, 2000: 220231 19. Arnau Vives MA, Martinez Dolz LV, Almenar Bonet L, Lalaguna LA, Ten Morro F, Palencia Perez M. Myocardial bridging as a cause of acute ischemia: description of a case and review of the literature [in Spanish]. Rev Esp Cardiol 1999; 52: 441444 Yano K, Yoshino H, Taniuchi M, et al. Myocardial bridging of the LAD in acute inferior wall myocardial infarction. Clin Cardiol 2001; 24: 202208 Mohlenkamp S, Hort W, Ge J, Erbel R. Update in myocardial bridging. Circulation 2002; 106: 26162622 Dominguez B, Valderrama V, Arrocha R, Lombana B. Myocardial bridging as a cause of coronary insufficiency [in Spanish]. Rev Med Panama 1992; 17: 2835 Klues HG, Schwarz ER, vom Dahl J, et al. Disturbed intracoronary hemodynamics in myocardial bridging: early normalization by intracoronary stent placement. Circulation 1997; 96: 29052913 Flynn MS, Kern MJ, Aguirre FV, Bach RG, Caracciolo EA, Donohue TJ. Intramyocardial muscle bridging of the coronary artery: an examination of a diastolic "spike and dome" pattern of coronary flow velocity. Cathet Cardiovasc Diagn 1994; 32: 3639 Gurewitch J, Gotsman MS, Rozenman Y. Right ventricular myocardial bridge in a patient with pulmonary hypertension: a case report. Angiology 1999; 50: 345347 Woldow AB, Goldstein S, Yazdanfar S. Angiographic evidence of right coronary bridging. Cathet Cardiovasc Diagn 1994; 32: 351353 Munakata K, Sato N, Sasaki Y, et al. Two cases of variant form angina pectoris associated with myocardial bridge: a possible relationship among coronary vasospasm, atherosclerosis and myocardial bridge. Jpn Circ J 1992; 56: 12481252. References Medical Devices Agency 2001 ; MDA SN2001 19 ; Safe Use and Disposal of Sharps The Epic Project Development National Evidence-based Guidelines for Preventing Health Care Associated Infections. Journal of Hospital Infection 2001 ; 47: S35-S37 supplement, for example, nabumetone dose.
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Perioperative urinary flow, in particular, does not appear to correlate with renal outcome 9 ; . Likewise, mannitol has had protective properties in experimental models, but studies in adult cardiac surgery patients have been unable to replicate the animal findings. The discrepancies between the animal and clinical data may reflect a true lack of efficacy in renal protection or, because of shortcomings in sample size or choice of indicator of renal function 10 ; , an inability to detect an actual improvement in renal performance. Most investigations have focused on diuresis 6 8, 11 ; or glomerular function, as measured by serum creatinine or creatinine clearance 8, 11 ; , to evaluate renal performance in patients undergoing cardiac surgery. However, urinary output, serum creatinine levels, and creatinine clearances are insensitive monitors of renal function 9, 12 ; . Consequently, unless the anticipated change in glomerular function is substantial, detection would require such a large sample size that multicenter trials would be required 10 ; . Tubular excretion of low-molecular-weight proteins has been proposed as a more sensitive marker of renal injury 10, 13, 14 ; . One such marker is 2-microglobulin 2M ; , an 11, 800-Da protein that is expressed on the surface of all nucleated cells as part of the major histocompatibility complex. It is 95% filtered by the glomerulus and 99.9% reabsorbed in the proximal tubule. A decrease in tubular reabsorption and an increase in urinary excretion of 2M accompany even minimal changes in proximal tubular function. 2M excretion has a sensitivity of 84.6% and a specificity of 100% as a marker for tubular lesions 15 ; . It has been extensively used in the diagnosis and monitoring of chronic disease processes, in the acute onset of clinical renal dysfunction, in detecting renal changes after therapeutic protocols, and in acute experimental clinical protocols. Furthermore, it has been established by biopsy that 2M excretion rate correlates with clinically important renal tubular damage 16, 17 ; and can track changes in tubular pathophysiology 16, 18, 19 ; . Finally, 2M excretion rate has been included in an international database as a useful screening tool for nephrotoxic exposure 20 ; . The purpose of this study was to assess the effects of mannitol and DA, the two drugs used most often as renal protective adjuncts in CPB, on renal tubular function as measured by changes in 2M excretion!

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