Exercise tolerance test [ETT] or myocardial perfusion scan [MPS] -what to choose in patients of ischaemic heart disease [IHD]?

To evaluate the validity of exercise tolerance test [ETT] with treadmill exercise in the diagnosis and follow-up of ischaemic heart disease [IHD], taking myocardial perfusion scan [MPS] as standard. Retrospective, validation study. Nuclear Medical Centre [NMC] Armed Forces Institute of Pathology [AFIP], Rawalpindi, Pakistan, from 1 January to 31 December 2009. One hundred and nineteen patients [88 males, 31 females], referred for MPS; were selected through non-probability, consecutive sampling. Patients of all ages and gender, fit to undertake treadmill exercise, were included. Patients with contraindications to ETT, like unstable angina, conduction abnormalities, etc., or those who had taken a beta blocker within the preceding 24 hours, were excluded. ETT through treadmill exercise was done, followed by MPS with single photon emission computed tomography [SPECT] technique, using Thallium-201 or Technetium-99 m 2-methoxy-isobutyl-isonitrile [MIBI]. ETT was interpreted as positive or negative for ischaemia, with borderline changes considered positive. MPS was interpreted as positive or negative for ischaemia. Validity of ETT was evaluated in terms of sensitivity [Sn], specificity [Sp], and positive and negative predictive value [PPV and NPV], taking MPS as standard. Sensitivity of ETT was found to be 77.5% and specificity was 43.6%. PPV was 73.8% and NPV was 48.6%. Out of a total [n] of 119 patients, true positive [TP] cases were 62, true negative [TN] 17, false positive [FP] 22 and false negative [FN] 18. ETT is an acceptably sensitive but non-specific test for evaluating myocardial ischaemia, with adequate PPV but low NPV, when validating it against MPS. Replacing the MPS with ETT, in the diagnosis and follow-up of IHD, is thus, not prudent. ETT can be useful as a screening test

Doppler ultrasound for assessment of pulsatility index variation of middle cerebral artery in intrauterine growth retardation

To assess variation of pulsatility index of middle cerebral artery [MCA-PI] in intrauterine growth retardation [IUGR]. Descriptive study. Hospital Lahore, from March 2006 to September 2006. A total 100 patients with IUGR in third trimester were selected. Ultrasound estimation of fetal weight [using fetal biometry] below 10[th] percentile for that gestational age was labeled as IUGR. MCA-PI value of less than 0.751 was labeled as abnormal. Abnormal values of PI-MCA were found in 79% of IUGR cases while 21% had normal values. PI-MCA is a sensitive modality of assessing IUGR

Frequency of DVT after total knee replacement in Pakistani population by employing color duplex scan

To determine the frequency of Deep Vein Thrombosis [DVT] by Color Duplex Scanning [CDS] after total knee replacement [TKR] in Pakistani population. Interventional study. Department of Orthopaedic Surgery, Combined Military Hospital Lahore, from 1st Sep 2007 to 1st Sep 2008. Thirty five patients, both male and female, age 50 to 80 years, ASA physical status II and III scheduled for total knee replacement [TKR] were subjected to preoperative and postoperative color Doppler to determine the presence of asymptomatic DVT in both legs. None of the patients were administered anticoagulant. DVT was not detected in any case after TKR. One patient developed nonfatal pulmonary embolism on 10th postoperative day. CDS did not pick DVT in this patient. CDS is a useful investigation tool to determine the presence of DVT in total knee replacements surgery. In the West all patients undergoing TKR are administered anticoagulant therapy. This practice is however, not universally accepted in Pakistan. Few studies conducted in Pakistan are equivocal. Present study was done to detect asymptomatic DVT in our patients after TKR. Our study does not show any evidence of DVT as picked up by CDS. The difference could be due to racial factor or the sample size was too small or the yield of CDS may not be very high

Cholescintigraphy of children with prolonged neonatal jaundice

To find the cause of neonatal jaundice in patients of up to 1 year of age, referred to Nuclear Medical Centre, AFIP Rawalpindi. Patients of jaundice up to 1 year of age referred by paediatricians from Military Hospitals were subjected to radionuclide cholescintigraphy at Nuclear Medical Centre, AFIP, Rawalpindi. The pattern noted was that 41% cases were scintigraphically positive for biliary atresia, 37% cases were found to be negative for it. Sixteen percent of the cases showed scintigraphic evidence of parenchymal liver disease and the possibility of biliary atresia could not be completely ruled out in these patients. Interestingly 6% of the cases were noted to be inconclusive though they were suffering from jaundice. The female to male ratio were 1:1.5, 1:6, and 1:1.6 for biliary atresia, negative for biliary atresia and parenchymal liver disease respectively. The cause of neonatal jaundice in most cases was biliary atresia and the frequency in males was higher as compared to female patients