Evaluation of different methods of enhanced elimination in phenobarbital overdose

Twenty-seven patients with phenobarbital overdose were treated by multipledoses of oral activated charcoal [n = 9], urinary alkalinization [n = 9] and acombined use of both modalities [n = 0]. Blood samples were taken from eachpatients at the time of admission [time 0], then at 6, 12, 24, 36 and 48 hourspost admission for the estimation of plasma phenobarbital concentrations. Half life, total body clearance and elimination rate constant of all patientswere calculated. It was found that multiple-dose activated charcoal [MDAC]and combined use of both MDAC and urinary alkalinization resulted in asignificant statistical reduction of phenobarbital half life and an increasein its total body clearance and elimination rate constant, when either of themwas compared with urinary alkalinization alone. MDAC alone was the mosteffective method for enhancing phenobarbital elimination in overdosedpatients, even more than the combined therapy, although there was nosignificant difference between them

Evaluation of coronary artery disease using locally prepared myocardial perfusion agent 99m Tc-MIBI

Technitium [[99m]Tc] labeled isonitrile complexes are recently introduced agents for imaging myocardial perfusion and viability. This study presents the first clinical experience with a locally prepared agent[99m]Tc methoxyisobutylisonitrile [MIBI]. Sixteen randomly selected cases [M:F 14:2, mean age 48 years] were included; clinically 4 patients were asymptomatic, 6 had history of Ml while remaining 6 had angina with no previous incidence of Ml. Separate injections were given for rest and stress studies either on the same day [9 cases] or on separate days [7 cases]. All patients were stressed according to the Modified Bruce Protocol and [99m]Tc MIBI was injected at peak stress. Early blood pool and delayed static images showed reasonably good localization of MIBI in the viable myocardium and image quality was also comparable to what has been reported in literature. Scans were negative for any perfusion abnormality in 6 cases, positive for single vessel disease in 6 and for two vessels disease in 4 patients. We conclude that the locally prepared[99m]Tc MIBI has optimal sensitivity and pharmacokinetic properties for myocardial imaging and detection of CAD. Moreover the local preparation would also entail considerable foreign exchange saving