BACKGROUND: With multihead gamma cameras both 180- and 360-degree acquisitions of myocardial perfusion are feasible. However, with 99mTC-labeled sestamibi (99mTC-sestamibi) the optimal clinically relevant demonstration of the superiority of 180- versus 360-degree data acquisition has not been performed. METHODS: Seventy-two consecutive patients undergoing 99mTC-sestamibi imaging at rest and stress who had coronary angiography performed within 3 months were enrolled. The results of blinded interpretation of 13 segments per patient for the 180- and 360-degree data were compared for interobserver variability. Sensitivity and specificity of defect localization in the left anterior descending, right coronary, and left circumflex territories for detection of 50% or greater or 70% or greater stenoses by coronary angiography were compared. RESULTS: There was significant segmental agreement of the stress perfusion images between observers for 180-degree (Kappa = 0.63) and 360-degree data (Kappa = 0.58), but the agreement was significantly higher for 180-degree data (p < 0.05). Overall sensitivity for the detection of coronary artery disease as a 50% or greater stenosis in 62 patients was 79% with 180-degree acquisition and 77% with 360-degree acquisition. The specificity for absence of coronary artery disease in 10 patients was also similar at 70% and 80%, respectively. There was no overall difference in detection of individual stenoses with a sensitivity of 54% with 180-degree acquisition and 50% with 360-degree acquisition. Specificity was also similar at 78% and 81%, respectively. CONCLUSION: There is no difference in clinically relevant detection of overall coronary artery disease or individual stenoses using 180- or 360-degree acquisition of 99mTC-sestamibi myocardial perfusion images. However, 180-degree acquisition has superior interobserver reproducibility.

Coronary Angiography↗

PubMedDate not supplied

Prognostic value of dipyridamole SPECT imaging in low-risk patients after myocardial infarction.

BACKGROUND: The prognostic value of perfusion imaging was assessed in low-risk patients after myocardial infarction (MI) and compared with clinical and angiographic variables. METHODS AND RESULTS: Rest thallium and dipyridamole technetium 99m sestamibi single photon emission computed tomography imaging was performed in 203 (91%) low-risk patients 3 to 21 days after MI who were enrolled in a trial of low-dose warfarin sodium and aspirin. Patients were considered low risk with planned nonintervention, on the basis of an uncomplicated course after MI, negative submaximal stress electrocardiography, and the absence of significant angiographic disease requiring revascularization. During a minimum follow-up of 12 months, 69 patients (34%) had clinical events: 1 cardiac death, 7 MIs, 26 admissions for unstable angina, 18 coronary bypass grafting, and 17 angioplasty. Univariate analysis identified the extent of significant angiographic stenoses (> or =70%) and the extent of scintigraphic defect as predictive of future events. On multivariate analysis, the presence of any scintigraphic reversibility had the strongest correlation with clinical events, with better predictive value than angiographic multivessel stenoses (P =.0006 vs P =.003). CONCLUSIONS: In the low-risk population after MI, scintigraphic reversibility remains a strong predictor of cardiac events, with greater prognostic value than angiographic data. The extent of scintigraphic reversibility was directly correlated with clinical events. Therefore scintigraphic imaging remains clinically relevant for risk stratification in the current low-risk population after MI.

Adult↗

PubMedDate not supplied

Care of a patient with breathing difficulties.

Use of the Roper model of nursing care enabled the patient's physical, social and psychological needs to be met. Identification of actual and potential problems in each activity of daily living enabled goals to be set and care plans to be implemented to alleviate the problems. It is important that nursing care addresses not only the physical side of nursing, but also the psychological needs of the patient and the patient's family. By identifying the patient's fears in each activity of daily living, we could offer practical help and reassurance which greatly facilitated her return to independent living.

Aged↗

PubMedDate not supplied

Disposition of cefixime in the pregnant and lactating rat. Transfer to the fetus and nursing pup.

The disposition of cefixime, a potent, third generation, orally active cephalosporin, was characterized in the pregnant and lactating rat. After a single iv dose of 17.8 mg/kg 14C-cefixime to day 18 pregnant rats, the half-life for elimination of radioactivity from both maternal serum and placentas was 6.9 hr. Elimination from fetal plasma and tissues was somewhat longer, 12.5 and 13.7 hr, respectively. However, comparison of areas under the curve indicated that exposure of the fetuses to cefixime was far less than that of placentas. Whole body autoradiography showed the greatest radioactivity in maternal liver, kidney, and intestines. In the lactating rat, steady state plasma concentrations of 14C-cefixime were achieved by continuous ip infusion of 2.54 mg/kg/day via Alza osmotic Mini-pumps from days 10 to 14 postpartum. Plasma concentrations of radioactivity in the dams were, on the average, 70 times greater than in their nursing pups throughout the study. After 102 hr of drug infusion, total radioactivity in the body of the pups, including the stomach and intestinal contents, was 1% of the 14C-cefixime estimated to be in the mother's body at steady state. Overall, these data indicate that exposure of the developing rat fetus and nursing pup to cefixime after maternal drug administration is quantitatively small.

Animals↗