Myocardial scintigraphy using 99m-technetium pyrophosphate in the diagnosis of acute myocardial infarct. Comparison of planar and tomographic imaging

The aim of the study was to compare the effectiveness of planar and single photon emission computed tomography (SPECT) imaging with 99mTc-pyrophosphate in the verification of acute myocardial infarction. The study was performed on 39 patients (26 males, 13 females) aged between 41-76 years (mean 61 +/- 9) admitted to CCU for acute myocardial infarction. Patients underwent planar and SPECT imaging using a double-head-camera with a 360 degrees rotation arc within 6 days of admission. Planar images were obtained in three standard projections (anterior, LAO 45 degrees, LAO 75 degrees) with acquisitions of 500000 counts each. To obtain SPECT images ninety projections, each lasting 20 seconds, were taken; subsequently images reconstruction was performed using an iterative algorithm. Positive planar images were found in 21 out of 39 patients; SPECT images were positive in 33 patients. In "Q wave" myocardial infarctions planar images were positive in 13 out of 15 patients, whereas SPECT images were positive in all subjects; in "non-Q wave" myocardial infarctions planar images were positive in 6 out of 22 patients whereas SPECT images were positive in 16 patients (p less than 0.005); in 2 patients with left bundle branch block both planar and SPECT images were positive. A bidimensional echocardiogram was carried out on 38 patients: an alteration of left ventricular regional wall motion was present in 30 subjects; in one patient diffuse hypokinesia was present.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinico-developmental aspects in 44 cases of polymyositis/dermatomyositis

A retrospective study, paying particular attention to the clinical and evolutive aspects of the disease, was performed on 44 subjects affected by polymyositis/dermatomyositis (PM/DM) and hospitalized at the Institute of Medical Clinics of the 1st School of Medicine of Naples University. On the basis of the different clinical pictures, the cases were classified into the following groups: primary PM (4); primary DM (19); DM/PM associated with malignancy (6); childhood DM/PM (3); PM/DM associated with connective tissue disorders (12). Diagnosis was established in terms of the following criteria: a) symmetrical and mostly proximal bilateral muscle weakness (100%); b) elevation of serum enzymes (86.3%); c) electromyographic findings of myopathy sometimes with fibrillation potentials, increased insertional irritability and pseudo-myotonic discharges (93.1%); d) muscle biopsy changes compatible with a clinical form of polymyositis (83.3% out of 30 cases); e) dermatological manifestations including particularly pink or lilac edema-erythema over the periorbital areas, wine-red maculae, Gottron's sign, "poikiloderma vasculare atrophicans", telangiectasias and skin vasculitis (86.3%). An involvement of the extraneural apparatus and organs was present in 40 patients; the most damaged was the osteoarticular apparatus, followed by esophagus, lung, heart and kidney; such pathology was rarely present in the childhood form. A follow-up of the disease has been performed in 36 cases and the therapy consisted fundamentally of high dose corticosteroids (mostly prednisone), associated, in a minority of cases, with methotrexate. A clinical improvement was observed in most cases and a remission of the disease in part of the latter. However, a worsening of the illness was noticed only in the patients suffering from PM/DM associated with malignancy, and mortality rate was 11.1% in all.     

99mTc-labelling of leucocytes with 99mTc-DPO: a complex developed for myocardial imaging

The lipophilic ^99mTc-DPO complex, developed as a myocardial imaging radiopharmaceutical, was used to label leucocytes. After an incubation of 0.1 ml ^99mTc-DPO (8 g DMPE*2HCl) with mixed leucocytes in plasma, the labelling efficiency was over 70%. During incubation in 5 ml plasma, a loss of activity was found between 20% (1 h) and 35% (3 h) caused by elution. Disturbances of cell viability could not be found with the help of the chemiluminescence test. The in vivo recovery was determined in three dogs and was 45%–50% (0.5 h), 30%–36% (1 h), and 18%–24% (3 h). Autologous ^99mTc-DPO-leucocytes were used on seven patients with suspected osteomyelitis, there were four true negative and three true positive results. The target/nontarget ratio determined by ROI in the positive cases was 1.8 to 2.5 at 3 h after injection.     

Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy

A comparison was made of the effects of continuous epidural analgesia with bupivacaine and intermittent epidural morphine on bowel function after abdominal hysterectomy. The duration of postoperative ileus was assessed as the time from the end of operation to the first postoperative passage of flatus and feces. Twenty-two patients were randomly allocated to two equal groups. An "epidural morphine" group received general anesthesia and epidural morphine for postoperative pain relief, and an "epidural bupivacaine" group was given combined general anesthesia and epidural anesthesia with 0.5% bupivacaine intraoperatively and epidural analgesia with 0.25% bupivacaine postoperatively. Epidural morphine or bupivacaine was given for 42 h postoperatively. Pain intensity (visual analog scale) was low in both groups, but lower (P less than 0.05) in the epidural bupivacaine group. The time to first passage of flatus was 22 +/- 16 h in the epidural bupivacaine group and 56 +/- 22 h in the epidural morphine group (P less than 0.001). The time to first postoperative passage of feces was shorter (P less than 0.05) in the former than in the latter 57 +/- 44 h vs 92 +/- 22 h). The patients of the epidural bupivacaine group started intake of oral fluids earlier (P less than 0.01) and to a greater extent (P less than 0.05) than those in the epidural morphine group. It is concluded that the duration of postoperative ileus after hysterectomy is shorter when epidural bupivacaine is given for postoperative pain relief than when this is achieved by epidural morphine.     

Physiological, social and motivational characteristics of fitness center clients

Physiological, social and motivational characteristics of attendants to a fitness club. Little is known on the epidemiology of exercisers not engaging into competitive sports events, such as those attending fitness clubs. We investigated 85 regular attendants to a fitness club in Zurich, Switzerland: 44 men and 41 women, with a mean age of 35 (+/- 10) years. All subjects carried out the club-based fitness-test and answered additional questions on sports activity, lifestyle, and their motives to exercise. As anticipated, fitness club attendants smoked less and were more active and more educated than the general population. Among fitness club attendants themselves, known and plausible interrelationships between endurance capacity, body fat content, and habitual exercise could be confirmed as highly significant. Body fat content, as estimated from bioimpedance measurement, was more closely related to important dependent variables than the body mass index, for example to female endurance capacity (r = -0.33 vs. -0.03), or to age in men (r = 0.48 vs. 0.22). Unexpectedly, social factors were only poor predictors of differences in fitness and exercise levels within the study sample. Compared with joggers, fitness club attendants seemed to be motivated relatively more by targets of health promotion, e.g. weight control, and less motivated by "intrinsic" joy and fun with sports activity itself. Further studies will have to demonstrate whether fitness clubs are actually able to promote "lifetime exercise".     

The effect of volleyball playing on the knee extensor mechanism

The knee extensor mechanism was examined in 32 male competitive volleyball players (Group V) and in a control group of 49 young adult males (Group C) to evaluate the effects of previous jumping activity on the knee extensor mechanism. Several variables were recorded by means of a structured questionnaire, and by clinical and radiographic examination. The amount of physical activity from the age of 7 years onward was significantly greater in Group V than in Group C. The incidence of anterior knee pain during the year preceding the examination was higher in Group V (31%) than in Group C (6%; P less than 0.01). The most common reason for anterior knee pain in Group V was so-called "jumper's knee." No significant difference between the groups was found in the incidence of clinical symptoms and signs of patellar chondromalacia. There were radiologically detectable soft tissue calcifications at the upper or lower pole of the patella or anterior to the patella in 38% of the subjects in Group V, but no such calcifications were seen in Group C (P less than 0.001). However, persistent symptoms did not correlate with the calcifications. Group V subjects had a slight but significant trend to patella alta when compared to Group C (P less than 0.05) according to the Blackburne and Peel index.     

Surgical indications status in ileus using a simple clinical index

Based on a retrospective analysis of a group of patients with ileus disease in regard of the indication for operative intervention an "ileus index" was created which is derived from simple clinical and radiological findings and laboratory data. Prospective evaluation of this index showed its effectiveness in separating patients who had to undergo an emergency operation from those who could be operated electively after preceding diagnostic procedures or could be treated conservatively.     

Diffuse and focal nesidioblastosis. A clinicopathological study of 24 patients with persistent neonatal hyperinsulinemic hypoglycemia

The morphological abnormalities of the endocrine pancreas that underlie persistent neonatal hyperinsulinemic hypoglycemia (PNHH) and are included under the heading "nesidioblastosis" appear to be heterogeneous. We studied pancreatic specimens of 24 patients by light microscopy and immunocytochemistry in order to classify the changes of the endocrine pancreas and relate them to the therapy applied. Two main forms of nesidioblastosis were recognized: a focal and a diffuse type. Both types occurred with equal frequency. Focal nesidioblastosis was characterized by nodular hyperplasia of islet-like cell clusters, including ductuloinsular complexes and hypertrophied insulin cells with giant nuclei. In nine patients, this lesion was unifocal (including an adenoma-like nodule), while two patients each had two separate foci, and one patient had at least three foci. Diffuse nesidioblastosis involved the entire pancreas; it was distinguished by irregularly sized islets and ductulo-insular complexes, both of which contained distinctly hypertrophied insulin cells. Three pancreases lacked these diagnostic features and thus posed difficult diagnostic problems. From the follow-up data, we conclude that partial pancreatectomy with excision of the diseased focus is the treatment of choice for most patients with focal nesidioblastosis whereas diffuse nesidioblastosis requires near-total pancreatectomy. In two patients who had multifocal and diffuse nesidioblastosis and were treated at the age of 6 and 8 years, respectively, the changes of the endocrine pancreas were comparable with those of the young age group and failed to reveal any signs of maturation.     

Cellulosic versus Synthetic Membranes: A Reasonable Comparison?

Of the two main classes of dialysis membranes, cellulosic and synthetic, the former represents the standard membrane used in dialysis therapy. The disputed properties of cellulosic membranes related to biocompatibility have inspired a number of authors to compare these two membrane classes from a variety of perspectives. However, such a strict categorization as "synthetic" or "cellulosic" is of doubtful value from the point of view of polymer chemistry. Here, biocompatibility and performance properties of these two membrane classes are compared with the aim of investigating the validity of this categorization. The biocompatibility parameters studied are complement and leukocyte activation together with activation of the coagulation cascade. Analysis of a variety of both cellulosic and synthetic membranes with different degrees of biocompatibility showed that biocompatibility can be achieved by both classes of membranes and is, therefore, not a particular property of one class only. Furthermore, performance and beta 2-microglobulin removal properties of the two classes of membranes do not particularly favor one of these classes. Therefore, differences between cellulosic and synthetic membranes are not manifested in parameters like biocompatibility, hydraulic permeability, and overall performance.     

The significance of adult hematuria: 1,000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis

Between March 1976 and June 1985, 1,000 consecutive adults with asymptomatic gross or microscopic hematuria in the absence of proteinuria were evaluated urologically. Lesions that could account for the hematuria were detected in 88.3 per cent of the patients. Life-threatening lesions were diagnosed in 9.1 per cent of the patients, while lesions requiring at least observation were present in 22.8 per cent. The incidence of life-threatening lesions increased with age, with a sharp increase after age 50 years. Life-threatening lesions were more common in men (13.6 per cent) than in women (4.9 per cent). In general, as the degree of hematuria increased so did the yield of life-threatening lesions; however, there was no "safe" lower limit of hematuria. Of the patients with life-threatening lesions 18.6 per cent had at least 1 urinalysis with less than 3 red blood cells per high power field within 6 months of the diagnosis. The direct medical cost of a hematuria evaluation was $777. The difference in direct medical costs to diagnose and treat localized versus metastatic genitourinary cancer was $48,070 in 3 matched pairs of patients. In this study group 77 of 84 patients (92 per cent) diagnosed with genitourinary cancer had localized disease. A hematuria evaluation was cost-effective for all groups studied. A literature-based estimate of the life-threatening risks of diagnostic studies applied to the study data resulted in a 1.1 per cent life-threatening risk per hematuria evaluation. For all categories studied, except for women less than 40 years old with microscopic hematuria, the risk of a hematuria evaluation was less than the incidence of life-threatening lesions discovered as a result of the evaluation. Asymptomatic hematuria, whether gross or microscopic, is a significant finding and warrants evaluation from a risk-benefit and cost-effectiveness standpoint.