Simultaneous measurement of left ventricular function and myocardial perfusion during a single exercise test: dual isotope imaging with gold-195 m and thallium-201

The state of left ventricular function and myocardial perfusionare important determinants of prognosis in patients with coronaryartery disease and information on both can be valuable for planningindividual patient management. We have studied the feasibilityof simultaneous measurement of left ventricular ejection fractionwith ultra short-lived gold-195 m (half life 30.5 seconds) andmyocardial perfusion with thallium-201, at rest and after exercisewith a single-crystal gamma camera. The results with first-passradionuclide angiocardiography (RNA) using gold-195 m at restwere reproducible and agreed closely with the results obtainedusing technetium-99 m equilibrium radionuclide angiocardiography(r = 0.93). Ejection fraction by firstpass gold-195 m RNA duringsemi-supine ergometric exercise decreased by >5% in 13 outof 18patients with coronary artery disease and stable angina.Simultaneous myocardial imaging with thallium-201 was abnormalin all patients. The change in regional wall motion abnormalityscore during exercise correlated with the change in myocardialperfusion (r = 0.71, P<0.01) and with the change in globalleft ventricular ejection fraction (r = 0.77, P<0.001). Thewidely differing energy levels and half-lives of gold-195 mand thallium-201 made it possible to separate clearly the imagesdue to each radionuclide. This study has demonstrated the feasibilityof simultaneous or sequential assessment of left ventricularfunction and myocardial perfusion during a single exercise test,a technique which can offer advantages in clinical evaluationof patients with coronary artery disease.     

EVALUATION OF HOSPITAL ACQUIRED PSEUDOMONAS INFECTION IN PARAPLEGIC AND ORTHOPAEDIC CASES

One hundred isolates of Pseudomonas aeruginosa from patients of the spinal cord injury and orthopaedic centre were evaluated on the basis of 2 laboratory assays; antibiotic sensitivity and pyocin typing. Antibiotic drug resistance was found in 54 per cent of the isolates. The urinary tract, pressure sores and wound swabs were the most common clinical specimens. Spinal cord injury patients showed a high rate of nosocomial colonisation. Ceftazidime, amikacin, norflox and ciprofloxacin were the most active antimicrobial agents. Gentamicin, carbenicillin and tobramycin showed high resistance. Pyocin typing with 22 strains did yield information to establish a clinico – epidemiological relationship.KEYWORDS: Antibiotic sensitivity, Pyocin typing, Pseudomonas     

A case of refractory adult‐onset Still’s disease treated with anakinra

Adult‐onset Still’s disease (AOSD) often presents both a diagnostic and a therapeutic challenge. We report a 40‐year‐old Chinese woman, in whom multiple adjustments of drug combinations were required before successful control of the patient’s disabling symptoms. The patient failed multiple therapies including non‐steroidal anti‐inflammatory drugs, glucocorticoid, methotrexate (MTX), cyclosporine, leflunomide and infliximab. Treatment was complicated by hyperglycemia, glucocorticoid‐induced osteoporosis, worsening hypertension and vaginal candidiasis. She suffered recurrent hospitalisation for active disease, developed carpal joint erosions and lost her employment over the course of 1 year. In view of refractoriness to multiple conventional therapies, anakinra was initiated in combination with MTX with a rapid and sustained improvement in clinical and laboratory parameters over 12 months. However, radiographic damage ensued despite aggressive therapies.     

A SIMPLE COLD STAINING METHOD FOR ACID FAST BACILLI

Sputum from 105 cases of pulmonary tuberculosis were studied. Direct and post concentration smears were stained by Ziehl – Neelsen (ZN) and cold staining methods. The cold staining method is simple, because it eliminates heatingof stain. For direct smear, the correlations of cold staining procedure with conventional ZN method was 93% and for post concentration smear it was 100%.KEY WORDS: Acid fast bacilli, Mycobacterial cold staining