Scintigraphic diagnosis of tricuspid regurgitation

The authors describe a simple technique for diagnosis of tricuspid regurgitation. Red blood cells were labeled in vivo with 99mTc and 22 patients were studied with ECG-gated blood-pool imaging of the liver. A single region of interest was manually drawn around the liver and a time-activity curve obtained. The per cent change in liver counts during the cardiac cycle was found to be significantly higher in the 12 patients with tricuspid regurgitation (Group I) (mean, 4.04 +/- 1.6%; range, 1.3-21.4%) compared with the 10 controls (Group II) (mean, 0.35 +/- 0.16%; range, 0.013-1.3%) (p less than 0.05). Using a 1% change in liver counts as the criterion of a positive study, all 12 cases in Group I were diagnosed correctly, but there was one false positive in Group II; thus the sensitivity was 100% and the specificity 90%.     

The role of complex investigation of the surgeons' activities in the assessment of effectiveness and quality of medical service

The introduction of computerization, personal computers in particular, in the system of management of medical institutions has greatly widened the possibilities of processing the routine information, and automated calculation of the cost price of treatment. The cost price of treatment of 1654 patients of a surgical unit was analyzed. In 1180 patients treated by 3 doctors the cost price of treatment was assessed with special reference to the rating, complexity of the hospital supply of the case, load, integral coefficient of the quality. The complex method of the assessment of the hospital surgeon's work allows to determine ways of economical effectiveness in treatment of patients.     

Time-dependent effects of antihypertensive agents and chronocorrecting action of melatonin in patients with arterial hypertension

The chronopharmacodynamics of angiotension-converting enzyme (ACE) inhibitors, such as ramipril (R), enalapril (E), acetene (A), caposide-50 (C-50) and the effect of the epiphyseal neurohormone melatonin used alone and in combination with cozaar (Co) and cintome (Ci) in the randomized groups including 124 patients with arterial hypertension (AH). The ACE inhibitors were given in the morning, afternoon, and evening. Co and Ci were used in the morning. Melatonin was given at 10.00 p.m. 10-14 days before and after therapy, 24-hour monitoring (Astracard, Russia) and echocardiography (Toshiba, Japan) were performed. Analyzing the findings indicated the time-dependent hemodynamic effects of R, E, and C-50. Ci, A, and Co were found to have antihypertensive and vasodilatory effects without normalizing the chronostructure of circadian rhythms of major hemodynamic parameters. By producing antihypertensive and vasodilatory effects, melatonin leads to the recovery of circadian hemodynamic organization when used alone and in combination with Co, Ci, and ACE inhibitors.     

Relationship between the chest radiograph, regional lung function studies, exercise tolerance, and clinical condition in cystic fibrosis

This study evaluated the accuracy of the interpretation of the chest film in delineating localised abnormalities of ventilation and perfusion, as well as the overall severity of airways obstruction, exercise tolerance, and clinical condition in children with cystic fibrosis. Radiographic findings in various regions of the chest film were compared with the functional values obtained with regional lung function tests which evaluated the arrival and disappearance of boluses of radioactive nitrogen given by inhalation and infusion. While the more severely affected areas on the chest radiograph were found to correlate with similar regions on the lung function tests, as did overall scores, errors occurred in some cases if the x-ray film alone was used as a judge of regional physiological derangement. In addition the degree of airways obstruction, the exercise tolerance on a cycle ergometer, and clinical grading, each correlated significantly with the radiographic score. We conclude that the chest radiograph is a good indicator of the overall severity of the lung disease and that it correlates well with exercise tolerance and clinical condition in cystic fibrosis.     

Hepatic scintigraphy in management of infants and children with liver disease

Scintiscans of liver and spleen using technetium 99m sulphur colloid in 15 infants with extrahepatic biliary atresia and 11 infants with severe obstructive jaundice (7 with genetic deficiency of alpha 1-antitrypsin) showed similar hepatic size, pattern of isotope uptake, and splenic abnormality with no distinguishing features. In 37 older children with a variety of liver disorders, the scan was invaluable in showing filling defects in five instances. Selenomethionine was taken up not only by the two filling defects due to hepatoblastoma but also in a haemangioendothelioma. In the remaining patiens liver scanning confirmed hepatic abnormality and the necessity for more specific invasive diagnostic investigations.     

Cardiac Tamponade,Sever Hypothyroidism and Acute Respiratory Distress Syndrome (ARDS) with COVID-19 Infection

A 21-years-old with Down syndrome presented with respiratory distress. Initial investigations revealed a cardiac tamponade. On further evaluation, he had positive coronavirus disease-2019 (COVID-19), severe chest infection and severe hypothyroidism. He responded well to urgent pericardiocentesis, levothyroxine, hydrocortisone and tocilizumab.