Reproducibility of Adenosine Tc-99m sestaMIBI SPECT for the Diagnosis of Coronary Artery Disease / 대한핵의학회잡지

PURPOSE: Adenosine myocardial perfusion SPECT has proven to be useful in the detection of coronary artery disease, in the follow up the success of various therapeutic regimens and in assessing the prognosis of coronary artery disease. The purpose of this study is to define the reproducibility of myocardial perfusion SPECT using adenosine stress testing between two consecutive Tc-99m sestaMIBI (MIBI) SPECT studies in the same subjects. METHODS: Thirty patients suspected of coronary artery disease in stable condition underwent sequential Tc-99m MIBI SPECT studies using intravenous adenosine. Gamma camera, acquisition and processing protocols used for the two tests were identical and no invasive procedures were performed between two tests. Mean interval between two tests were 4.1 days (range: 2-11 days). The left ventricular wall was divided into 18 segments and the degree of myocardial tracer uptake was graded with four-point scoring system by visual analysis. Images were interpretated by two independent nuclear medicine physicians and consensus was taken for final decision, if segmental score was not agreeable. RESULTS: Hemodynamic responses to adenosine were not different between two consecutive studies. There were no serious side effects to stop infusion of adenosine and side effects profile was not different. When myocardial uptake was divided into normal and abnormal uptake, 481 of 540 segments were concordant (agreement rate 89%, Kappa index 0.74). With four-grade scoring system, exact agreement was 81.3% (439 of 540 segments, tau b=0.73). One and two-grade differences were observed in 97 segments (18%) and 4 segments (0.7%) respectively, but three-grade difference was not observed in any segment. Extent and severity scores were not different between two studies. The extent and severity scores of the perfusion defect revealed excellent positive correlation between two test (r value for percentage extent and severity score is 0.982 and 0.965, p< 0.001) CONCLUSION: Hemodynamic responses and side effects profile were not different between two consecutive adenosine stress tests in the same subjects. Adenosine Tc-99m sestaMIBI SPECT is highly reproducible, and could be used to assess temporal changes in myocardial perfusion in individual patients.

A Case of Formation of Interbronchial Fistula Complicated by Long-standing Bronchial Foreign Body / 결핵

In healthy adults, diagnosis of aspiration of foreign body into tracheobronchial tree is not difficult because various symptoms such as dyspnea, coughing, or cyanosis develop when foreign b~y is aspirated into tracheobronchial tree. But unless a clear history of an aspiration event can be obtained diagnosis will be delayed. Early complications of tracheobronchial foreign body aspiration include asphyxia, cardiac arrest, dyspnea, laryngeal edema, and cyanosis. Late complications include pneumonia, lung abscess, bronchiectasis, hemoptysis, bronchial stenosis, arid polyp. Treatment is removal of foreign body by operation or bronchoscopy. Currently, flexible bronchoscopy is preferred in adults than rigid bronchoscopy. A 36-year-old male visited to Dongkang hospital due to productive coughing and dyspnea On auscultation, focal inspiratory wheezing was heard. On chest PA, mild emphysematous change was seen. Flexible bronchoscopy was done. Bronchoscopically, mucoid impaction, surrounding inflammation, foreign body lodged in the right lower lobe bronchus, and interbronchial fistula(between right middle and lower lobe bronchus) were seen Foreign body(2.4 x 1.3cm sized antacid package) was removed by flexible bronchoscopy. Later, history of aspiration of a piece of antacid package was found. We report a case of recurrent bronchitis with interbronchial fistula as a result of occult aspiration of foreign body with review of the literatures.

Total Hip Arthroplasty in Hemophilic Arthritis: A Case Report / 대한정형외과학회잡지

Total hip arthroplasty was performed on a 32 year old man with hemophilia A. A series of complications were encountered; namely, femoral shaft fracture during arthroplasty, hemolytic anemia, Factor VII inhibition, pseudotumor formation and wound dehiscence and sepsis as a result of shortage of cryoprecipitate supply, and general debilitation and septicemia from fhe use of immunosuppressive agents, finally leading to death 67 days after operation. Initially, 399 bottles of cryoprecipitate (each containing approximately 100 units of Factor VII) were anticipated. In practice, however, a total of 660 bottles and packs had been consumed on the patient when the supply was exhausted. Total hip arthroplasty can be carried out on hemophilia patients, provided that the planning be impeccable and the supply of antihemophilic factor virtually unlimited.