Metabolic cardiac imaging in severe coronary disease: assessment of viability with iodine-123-iodophenylpentadecanoic acid and multicrystal gamma camera, and correlation with biopsy.

Fifteen patients with coronary disease and resting left ventricular ejection fractions of less than or equal to 0.35 underwent resting metabolic cardiac imaging utilizing 1 mCi [123I]iodophenylpentadecanoic acid (IPPA) intravenously and a multicrystal gamma camera. Parametric images of regional rates of IPPA clearance and accumulation were generated. Forty-two vascular territories (22 infarcted) were evaluated by metabolic imaging as well as transmural myocardial biopsy. Despite resting akinesis or dyskinesis in 20/22 (91%) infarcted territories, 16/22 (73%) of these territories were metabolically viable. Transmural myocardial biopsies in all patients (43 sites, 42 vascular territories) during coronary bypass surgery confirmed IPPA results in 39/43 patients (91%). When compared to biopsy, scan sensitivity for viability was 33/36 (92%) with a specificity of 6/7 (86%). Eighty percent of bypassed, infarcted but IPPA viable segments demonstrated improved regional systolic wall motion postoperatively as assessed by exercise radionuclide angiography. We conclude resting IPPA imaging identifies viable myocardium, thereby providing a safe, cost-effective technique for myocardial viability assessment.

Exercise-induced Wall Motion Abnormalities and Resting Left Ventricular Dysfunction in the Morbidly Obese as Assessed by Radionuclide Ventriculography.

Rest and exercise first pass radionuclide ventriculograms were obtained in 62 morbidly obese subjects (56 women, six men, mean age 38 years, mean weight 269.2 +/- 46.0 lb, mean height 65.2 +/- 3.1 in., mean Body Mass Index 44.5 +/- 6.2 kg/m(2), mean excess body weight 134.1 +/- 41.1 lb) scheduled for vertical banded gastroplasty. Fifty-six percent demonstrated exercise-induced wall motion abnormalities mimicking coronary disease, compared to 12% of controls (p = 0.03). No subject with exercise-induced abnormalities had coronary disease at cardiac catheterization although only those with an anginal chest pain history underwent angiography. Twenty-six percent demonstrated resting left ventricular systolic dysfunction as manifested by a reduced resting left ventricular ejection fraction ( <0.50). Thirty-one percent of these patients demonstrated exercise-induced abnormalities, versus 65% of morbidly obese subjects with normal resting ejection fractions (p = 0.04). Obesity-induced left ventricular hypertrophy with associated reduced coronary vasodilator reserve could explain the abnormalities. Six month post-gastroplasty follow-up radionuclide ventriculograms show group normalization of the resting left ventricular ejection fraction in those with preoperative dysfunction, possibly due to left ventricular unloading with some regression of hypertrophy.

Functional cardiac imaging in coronary disease: increased sensitivity of first-pass radionuclide angiography utilizing sequential regional left ventricular early diastolic filling rate images.

In 127 patients, 113 with greater than or equal to 50% coronary artery stenosis (CAD), 14 with normal coronaries, cardiac catheterization and first-pass radionuclide angiography (RNA) utilizing left ventricular (LV) regional ejection fraction, first half systolic LV regional mean transit time and ejection rate images were performed. Additionally, the incremental value of a new technique, sequential regional LV filling rate images focusing on the first third of diastole, was established. Diastolic imaging improved RNA sensitivity from 88% (100/113) to 96% (109/113). Single vessel disease sensitivity increased from 77% (23/30) to 90% (27/30), whereas multivessel disease RNA positivity changed from 93% (77/83) to 99% (82/83). LAD system (LAD/D) sensitivity improved by 24% to 94% (79/84); RCA system (RCA/PDA) sensitivity increased 17% to 84% (59/70); circumflex system (CFX/OM) sensitivity was 83% (67/81), an improvement of 5%. Specificity was well maintained despite the increased sensitivity, as 86% (12/14) of patients with normal coronaries were normal by RNA. Furthermore, in the 113 CAD patients, 81% (84/104) of the vessels with insignificant or no stenosis were normal by RNA. We conclude sequential regional LV diastolic filling images substantially increase RNA sensitivity for CAD, while specificity is satisfactorily maintained.

Excisional techniques for endometriosis with the CO2 laser laparoscope.

Laparoscopic excisional techniques, used for endometriosis on 319 of 495 patients during the years 1982-1986 at Baptist Memorial Hospital, Memphis, significantly increased the percentage of confirmation per patient. That percentage for all patients rose from 8 in 1982 to 97 in 1986. A significant increase occurred also in confirmation for patients with specimens submitted--from 62% in 1982 to 97% in 1986. At the same time, tissue confirmation also increased the documentation of the appearance of endometriosis. Pink, red, white, black and clear lesions were proven to be endometriosis. In addition, psammoma bodies, hemangiomas, old suture material, hemorrhages around old suture material, carcinoma and ectopic pregnancy, all of which had some characteristics of endometriosis, were shown not to be that disease. There were no complications related to the excisional techniques.

[Narcolepsy and sudden onset of REM periods after nocturnal awakenings]. / Narcolepsia e início súbito de períodos REM após despertares noturnos.

The objective of this study was to evaluate polysomnographic data, and especially the sudden onset of REM periods that occur after spontaneous awakenings during the night as characteristics of narcolepsy. We evaluated 148 consecutive patients with excessive daytime somnolence, except for those with sleep apnea. After clinical evaluation, all-night polysomnographic recording and multiple sleep latency test, 55 were diagnosed as narcoleptics and 93 were grouped as non-narcoleptics. The mean age of narcoleptics was 42.9 +/- 14.4 years old and the non-narcoleptics were 40.3 +/- 13.5 years old. Polysomnographic variables were compared between both samples using unpaired t test. Non-significant differences were found for: sex; total time in bed; total sleep time; time in stages 3, 4 and REM; number of arousals (less than 30 sec); number of body movements; REM density. The following significant differences were found: number of sleep onset REM periods during the night was higher for narcoleptics (p less than 0.001); total sleep time was lower for narcoleptics (p = 0.02); sleep latency was shorter for narcoleptics (p less than 0.001); REM latency to stage 1 was shorter for narcoleptics (p less than 0.001); time in stage 1 was higher for narcoleptics (p less than 0.001); time in stage 2 was lower for narcoleptics (p less than 0.001); number of full awakenings (greater than 30 sec) was higher for narcoleptics (p less than 0.001); number of awakenings longer than 5 minutes was higher for narcoleptics (p = 0.002). In conclusion, there were marked differences in the sleep architecture between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Demographic, situational, and scholastic factors in medical school attrition.

In an investigation of withdrawals and delays among students enrolled at the University of Tennessee College of Medicine over a four-year period, we found significantly higher rates of attrition among minority than nonminority students and among female than male enrollees. There were, however, no significant sex-related differences in the nature of delays (ie, voluntary versus involuntary) or in the timing of their occurrence within the curriculum (preclinical versus clinical). Academic problems were cited for most of the students who were required to delay or withdraw, while voluntary attrition was related to family, psychologic, and career-choice problems. When compared with successful matched control students, the study group of all delays and withdrawals had significantly higher scores on the verbal and general knowledge MCAT subtests, while the subgroup of involuntary delays had significantly lower science MCAT scores than their controls. In addition, significantly more of the successful controls had attended a superior private liberal arts college, had an undergraduate science major, and came from professional families. We suggest that these findings indicate the need for substantial revision in curricula and selection processes if we are to achieve the goal of producing well rounded physicians who are an ethnically and socioeconomically representative group.

Update on the analysis of the need for pediatric surgeons in the United States.

An updated version of the 1975 analysis of pediatric surgical manpower needs in the United States by regional questionnaire analysis indicates that pediatric surgeons and capable hospital facilities are unusually well-distributed and that the estimated need is close to the present number practicing. Pediatric surgery grew by a factor of over 30% relative to population over the last five years, but this growth rate would be excessive if it continued. The growth included not only graduates from approved training programs but also from nonapproved training programs and from immigration. Limitations should probably be placed on the latter two sources of entry into the practice system. A computer analysis was made to project numbers of pediatric surgeons per unit population until the year 2010 with differing levels of trainee output. The study indicates that 15-17 individuals entering the system from all sources are sufficient to allow for modest continued growth of the specialty if current population trends continue.