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Claimed that "there is evidence" of a correlation between reduced serotonin activity and aggressive behavior. They hypothesized that by measuring the boys' biochemical responses to fenfluramine they would be able to replicate earlier findings and find a predictive biological marker predisposing the children to violence. The published report indicates that the children were required to follow a special diet for four days, to fast for 18 hours before they were to swallow fenfluramine "challenge" ; , and they were to have an intravenous catheter inserted in their arm, which would remain for more than five hours, during which time blood would be drawn. The investigators justified the risks and discomfort that the children would bear, by stating: "Research on the relationship between adverse rearing and serotonin may enhance understandings of the association between serotonin and aggression across development." [p. 841]. [Emphasis added] Parents were paid $125 and the children received $25 dollar gift certificates to Toys 'R Us.279 This experiment encapsulates many of the flaws in the current human research review, approval and oversight system, by demonstrating institutional failings. First, although federal regulations prohibit the use of children in research involving "greater than minimal risks" if there is no potential benefit for them, 51 four prominent institutional review boards approved this speculative, nontherapeutic experiment. The members of those review boards saw nothing wrong with an experiment that would expose children to greater than minimal risks, discomfort, trauma, and label them as "predisposed to violence." Nor did they appreciate the potential harm that may be caused the children from being labeled henceforth with a psychiatric diagnosis linked to aggression.280 Second, fenfluramine carries far greater risks than "minimal risk"-it carries the risk of neurotoxicity, 281 and it was later learned, the risk of heart valve damage. As early as December 15, 1993, neuroscientists had warned the FDA not to approve fenfluramine or its combination form, fen-phen trade name: Redux ; .282 They pointed out that, "Redux had been shown to cause brain damage in animals and might do the same in humans by eroding the body's supply of serotonin." In 1996, Dr. Muldoon and investigators at the University of Pittsburgh reported that a single dose of fenfluramine had caused adverse side effects in 90% of the normal human subjects who reported fatigue, headache, lightheadedness, and difficulty in concentrating.283 In September, 1997, the drug was recalled after FDA had received at least 100 reports of heart valve damage and news of a much higher than expected percentage of abnormal cardiograms. In its withdrawal announcement FDA stated: "Approximately 30% of the patients that were evaluated had abnormal echocardiograms, even though they had no symptoms. This is a much higher than expected percentage of abnormal test results."284 Third, the children did not display any aggressive behavior at the time they were recruited for the experiment. The children could not, therefore, be regarded as having a condition that could be helped by the study, for instance, ultram recreational. 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ICD9 CM A ; is being used throughout the hospital system in Australia and many other countries. Some primary care software relies on selected sub-groups of its available codes. It is available through the National Coding Centre. Read Clinical Codes are being used throughout general practice in the UK and are being trialed in New Zealand in both primary and secondary care. About 15 practices in Australia use them, most having adopted them as part of the Demonstration Practice Trials, funded by the Commonwealth Department of Human Services and Health. However, since the trials are finished these practices will now require a license for Read which can be obtained from their UK distributor, Computer Aided Medical Services. Return to Instructions.

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S. Achenbach 1 , M. Ferencik 2 , D. Ropers 1 , S. Abbara 2 , R. Cury 2 , K. Nieman 2 , U. Hoffmann 2 , W.G. Daniel 1 . 1 University of Erlangen, Medizinische Klinik II, Erlangen, Germany; 2 Massachusetts General Hospital, Department of Radiology, Boston, United States of America Multi-detector CT MDCT ; permits detection of coronary stenoses. We compared the accuracy of 2- and 3-dimensional postprocessing methods for the detection of coronary stenoses. MDCT data sets 16x0.75 mm collimation, 375 ms rotation, 80-90 ml contrast agent i.v. at 5 ml patients mean age: 56 years, mean heart rate: 61 min ; with artifact-free visualization of all coronary arteries were selected. 5 independent investigators evaluated the MDCT data concerning the presence of stenoses 50% diameter reduction, using either exclusively axial images 1mm thickness, "axial" ; , free oblique multiplanar reconstructions 1mm thickness, "oblique MPR" ; , free oblique sliding thin slab maximum intensity projections 5 mm thickness, STS-MIP ; , pre-rendered curved multiplanar reconstructions curved MPR ; , prerendered curved maximum intensity projections 3mm thickness, curved MIP ; , or pre-rendered 3-dimensional volume rendering technique reconstructions VRT ; . All investigators were blinded to angiographic data and MDCT evaluation results were compared to the results of invasive coronary angiography performed the following day. All analyses were performed on a per-artery basis 4 arteries per patient: left main, left anterior descending, left circumflex, and right coronary artery ; . Axial images and oblique MPR had the highest rates of evaluable arteries and accuracies for stenosis detection see table ; . The rate of accurately classified arteries counting unevaluable arteries as not accurately classified ; was signifiTable 1 Axial Oblique MPR STS-MIP Curved MPR Curved MIP 3-D VRT Evaluable Sensitivity Specificity Neg. pred. value Pos. pred. value Accurately classified arteries 99% 91% 88, for instance, ultram and pregnancy.
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