Erythromycin effect in delayed gastric emptying time due to diabetic gastroparesis / 대한내과학회지

No abstract available.

Usefulness of SPECT Thallium-201 Exercise Myocardial Perfusion Scan in Coronary Artery Disease

To evaluate the usefullness of SPECT thallium-201 exercise myocardial perfusion scan in coronary artery disease, polar maps processing SPECT images were compared to the exercise treadmill test and the findings of coronary angiographies in 12 normal subjects and 27 patients with the coronary artery disease. The following results were obtained : 1) Sensitivity and specificity of thallium-201 exercise myocardial perfusion scan was 96% and 83%, higher than that of exercise treadmill test(81% abd 61%). 2) In the branches of coronry artery, the sensitivity, specificity and positive predicitive values were 82%, 88%, 90% in left anterior descending artery, 33%, 88%, 57% in left circumflex artery and 69%, 81%, 90% 64% in right coronary artery. 3) The good correlation was observed between the degree of perfusion defect in polar map of thallium-201 myocardial scan in stress and 'myocardial ischemic score' predicted in coronary angiography(p<0.001). Also the degree of reversible perfusion defect had significant correlation with the durtion of exercise. 4) The pulmonary to myocardial ratio of thallium-201 uptake in coronary artery disease group higher than that of angina group. And the perfusion defect with stress and double product at maximal exercise had strongest assocition with the pulmonary to myocardial ratio of thallium-201 uptake by stepwise multiple linear regression. In conclusion, SPECT thallium-201 exercise myocardial perfusion scan is superior to the exercise treadmill test in diagnosing the coronary artery disese and is useful for predicting the sites and degree of coronary arterial stenosis. Also the pulmonary to myocardial ratio of thallium-201 uptake is thought to be good new test index in evaluating the left ventricular function of patients with coronary artery disease.

Assessment of Ventricular Function and Phase Abnormality by Gated Blood Pool Scan in Dilated Cardiomyopathy

Gated blood pool scan(GBPS) may be used for evaluating patients with dilated cardiomyopathy(DCM) where it can assist in the diagnosis, and evaluation of severity, disease progression or therapeutic efficacy. In addition to the routine parameters that have been available by GBPS, relatively simple mathematical manipulations of the equilibrium time activity curve can derive parameters relating to the degree and sequence of ventricular emptying. This first harmonic phase analysis may enable quantitative and more specific measurements of wall motion abnormalities in DCM and may thus be useful for more accurate assessments in these patients. Thus, in an attempt to evaluate the findings of phase analysis in DCM and to determine their possible usefulness in this entity, we measured parameters of phase analysis from the resting GBPS of 25 DCM patients and 11 normal controls, and compared these with other parameters of ventricular function from GBPS or echocardiography. Parameters of the systolic as well as diastolic function were markedly depressed for both left and right ventricles (all p<0.001), and echocardiographic LV systolic diameter was increased in all patients. Phase analsis showed the mean and standard deviation of phase angle(Mph & SDph) of both ventricles to be singificantly greater, and the mean amplitude smaller in DCM patients compared to controls(p<0.01). SDph appeared to be a sensitive parameter(LV 100%, RV 92%), and LV SDph showed significant correlations with other GBPS parmeters such as LV ejection fraction(LVEF) and LV peak ejection rate(LVPER) (r=-0.85 and 0.75, respectively) (all p<0.001), and with LV systolic diameter (r=0.78, p<0.001). Also, LV mean amplitude correlated well with LVEF (r=0.79, p<0.001). Thus, phase analysis of GBPS was able to show and quantify significant asynchronity in contraction of both ventricles in DCM, and these parameters may by useful in evaluating ventricular performance in these patients.

Evaluation of Residual Myocardial Ischemia in the Infarct Zone by Dipyridamole Stress SPECT 99mTc-MIBI Myocardial Scan

In the recovery phase of acute myocardial infarction, residual ischemia is an important predictor of future cardiac event. To quantitatively evaluate the residual ischemia in the infarct zone and to see whether it can be predicted by particular coronary angiographic characteristics, dipyridamole stress SPECT 99mTc-MIBI myocardial scan was used in 31 patients with uncomplicated acute myocardial infarction. Quantitative assessment of residual ischemia in the infarct zone was made by the ratio of reversible defect in the polar display of SPECT MIBI scan to the total polar map area. Residual ischemia in the infarct zone in these patients does not correlate with patency, collateral circulation or jeopardy score of the infarct related artery. PTCA was performed in 7 patients with significant reversible defect and suitable anatomical lesion to evaluate the reversibility by revascularization. Following the PTCA mean reversible defect decreased significantly from 10.1+/-2.2% to 1.3+/-1.3%(P<0.05). In 10 patients with multivessel disease, 7(54%) out of 13 remote sites showed significant reversible defect showing limited usefulness in the detection of concomitant remote lesion in multivessel disease. Thus dipyridamole stress 99m Tc-MIBI myocardial scan is useful in the evaluation of residual ischemia in the infarct zone, and helpful in the decision making and assessing the result of revascularization.