Scientific echosounder data provide a predator's view of Antarctic krill (Euphausia superba).

Raw acoustic data were collected in East Antarctica from the RSV Aurora Australis during two surveys: the Krill Availability, Community Trophodynamics and AMISOR Surveys (KACTAS) and the Krill Acoustics and Oceanography Survey (KAOS) in the East Antarctic (centre coordinate 66.5° S, 63° E). The KACTAS survey was conducted between 14th to 21st January and 2001, and the KAOS survey was conducted between 16 January and 1 February 2003. We examine the Antarctic krill (Euphausia superba) component of these surveys and provide scientific echosounder (EK500 and EK60) data collected at 38, 120 and 200 kHz, cold water (-1 °C) echosounder calibration parameters and accompanying krill length frequency distributions obtained from trawl data. We processed the acoustic data to apply calibration values and remove noise. The processed data were used to isolate echoes arising from swarms of krill and to estimate metrics for each krill swarm, including internal density and individual swarm biomass. The krill swarm data provide insights to a predators' views of krill distribution and density.

The characteristics of krill swarms in relation to aggregating Antarctic blue whales.

We model the presence of rare Antarctic blue whales (Balaenoptera musculus intermedia) in relation to the swarm characteristics of their main prey species, Antarctic krill (Euphausia superba). A combination of visual observations and recent advances in passive acoustic technology were used to locate Antarctic blue whales, whilst simultaneously using active underwater acoustics to characterise the distribution, size, depth, composition and density of krill swarms. Krill swarm characteristics and blue whale presence were examined at a range of spatiotemporal scales to investigate sub meso-scale (i.e., <100 km) foraging behaviour. Results suggest that at all scales, Antarctic blue whales are more likely to be detected within the vicinity of krill swarms with a higher density of krill, those found shallower in the water column, and those of greater vertical height. These findings support hypotheses that as lunge-feeders of extreme size, Antarctic blue whales target shallow, dense krill swarms to maximise their energy intake. As both Antarctic krill and blue whales play a key role in the Southern Ocean ecosystem, the nature of their predator-prey dynamics is an important consideration, not only for the recovery of this endangered species in a changing environment, but for the future management of Antarctic krill fisheries.

A prospective observational study of maternal oxygenation during remifentanil patient-controlled analgesia use in labour.

Numerous studies of remifentanil patient-controlled analgesia during labour have shown high levels of maternal satisfaction, but concerns remain, especially over the side-effects of sedation and respiratory depression. We conducted a prospective observational study of maternal oxygen desaturation during remifentanil patient-controlled analgesia. Pulse oximetry values were recorded every eight s and later downloaded for analysis. A desaturation episode was defined as oxygen saturation < 90%. We collected 148 h of data in 61 women, during which we observed 176 desaturation episodes. These episodes occurred in 43 (70%) women. The median (IQR [range]) of the lowest saturation during each episode was 87 (85-89 [68-89])% with duration 16 (8-24 [8-104]) s. Supplementary oxygen reduced the time per hour spent with saturation < 90%, but not the depth or duration of individual episodes. Desaturation episodes were twice as common during the second stage of labour as compared with the first stage. Prior opioid administration, bolus size and use of nitrous oxide during patient-controlled analgesia use were not found to influence frequency, depth or duration of desaturation episodes. Although these findings suggest desaturation occurs more frequently during remifentanil patient-controlled analgesia than previously reported, the results are comparable with earlier oximetry studies of women who received nitrous oxide and pethidine during labour.

Comparison of microbial community assays for the assessment of stream biofilm ecology.

We investigated a range of microbiological community assays performed on scrapes of biofilms formed on artificial diffusing substrates deployed in 8 streams in eastern Scotland, with a view to using them to characterize ecological response to stream water quality. The assays considered were: Multiplex Terminal Restriction Fragment Length Polymorphism or M-TRFLP (a molecular method), Phospholipid Fatty Acid or PLFA analysis (a biochemical method) and MICRORESP™ (a physiological method) alongside TDI, diatom species, and chlorophyll a content. Four of the streams were classified as of excellent status (3-6µg/L Soluble Reactive Phosphorus (SRP)) with respect to soluble P content under the EU Water Framework Directive and four were of borderline good/moderate or moderate status (43-577µg/L SRP). At each site, 3 replicates of 3 solute diffusion treatments were deployed in a Latin square design. Solute diffusion treatments were: KCl (as a control solute), N and P (to investigate the effect of nutrient enrichment), or the herbicide isoproturon (as a "high impact" control, which aimed to affect biofilm growth in a way detectable by all assays). Biofilms were sampled after 4weeks deployment in a low flow period of early summer 2006. The chlorophyll a content of biofilms after 4weeks was 2.0±0.29mg/m(2) (mean±se). Dry matter content was 16.0±13.1g/m(2). The M-TRFLP was successfully used for generating community profiles of cyanobacteria, algae and bacteria and was much faster than diatom identification. The PFLA and TDI were successful after an increase in the sample size, due to low counts. The MICRORESP(™) assays were often below or near detection limit. We estimated the per-sample times for the successful assays as follows: M-TRFLP: 20min, PLFA 40min, TDI 90min. Using MANOVA on the first 5 principal co-ordinates, all the assays except MICRORESP(™) showed significant differences between sites, but none of the assays showed a significant effect of either initial stream trophic status (as classified by the EU Water Framework Directive using chemical standards for soluble P), or of the diffusing solute treatment. Multiple Procrustes analysis on the ordination results showed that the diatom and M-TRFLP data sets hold distinct, though as yet unexplored, information about the ecological factors affecting stream biofilms. The diatom data were subjected to principal components analysis, to identify which taxa were more strongly influenced by site variables, trophic status or treatment effects. These were Acnanthes lanceolata, A. minutissimma, Nitzchia spp., Coccineis spp. and Navicula spp. Further experimentation and data analysis on a larger number of sites, to identify specific M-TRFLP bands that could be used as indicators linked to specific taxa, are desirable. Results highlight the need for a multifactorial approach to understanding controls on stream ecology.

Long-term trends in hydro-climatology of a major Scottish mountain river.

The River Dee, in North East Scotland, is a mountainous river strongly influenced by patterns of snow accumulation and melt from the Cairngorm Mountains. Analysis of this river's flow record from 1929-2004, the longest in Scotland, supports anecdotal evidence that river extreme flows are increasing. There was no detectable change in the overall annual flow patterns. However, an analysis of seasonal data suggested a shift towards increased flows in spring (March-May) and decreased flows in summer (June-August) over the 75 years of the record. Flows in spring exceeded 29 m(3) s(-1) for 50% of the time over the earliest part of the record (1930 to 1954), whereas in the last 25 years of the record (1979 to 2004) 50% of the flows exceeded 35 m(3) s(-1). Precipitation is increasing in the spring and decreasing in July and August. If these trends continue they have important implications for water management in the Dee, with a potential increase in flood risk in spring and the increased possibility of drought in summer. Combined with this increase in flows the river appears to be more responsive to precipitation events in the catchment. In large heterogeneous catchments with a marginal alpine/high latitude climate it is difficult to assess the amount of precipitation falling as snow and its relative accumulation and ablation dynamics on daily to seasonal time scales. Changes in the temporal pattern of coherence between flow and precipitation are thought to be linked to changing snow patterns in the upland part of the catchment. A decreased amount of precipitation occurring as snow has led to higher coherence. We also show that in responsive systems it is important to record river flows at an hourly rather than daily time step in order to characterise peak flow events.

Seminal oxidative stress in patients with chronic prostatitis.

Prostatitis has been associated with abnormal semen parameters and may be the cause of infertility in some patients. Sperm antibodies and impaired sperm motility have been observed in the semen of patients with prostatitis. More recently, seminal oxidative stress has been detected in patients with prostatitis or accessory gland infection. Oxidative stress is the result of elevated Reactive Oxygen Species (ROS) or depressed Total Anti-oxidant Capacity, or both. Granulocytes, in prostatic fluid may be responsible for the generation of ROS, which are known to impair sperm function. Abnormal levels of ROS, however, have also been detected in the absence of leucocytospermia. Several investigators have observed significant oxidative stress in the semen or prostatic fluid from patients with bacterial and abacterial forms of prostatitis, comparable with levels reported in men with recognized infertility. Whether prostatitis is a risk factor for infertility or not, remains controversial. Therefore, the role of seminal oxidative stress as either the result of prostatic inflammation or the cause of infertility is likewise debatable, but plausible. We summarize the results of our studies, as well as those of others who are dedicated to the research of prostatitis, and its potential effects on semen quality.

The four categories of prostatitis: a practical approach to treatment.

To diagnose prostatitis correctly and select appropriate therapy, one should use the Meares-Stamey technique for culturing urine and prostatic secretions and apply the classification system for prostatitis devised by the National Institutes of Health. The continuing search for an effective therapy for the most common type, chronic abacterial prostatitis, has led to adoption of treatments from other specialties and reevaluation of standard treatments.

Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate specific antigen.

PURPOSE: Although prostatitis may cause elevated prostate specific antigen (PSA), asymptomatic patients are not routinely screened for this diagnosis before transrectal biopsy is performed to rule out cancer. Many negative biopsies reveal evidence of prostatitis classified as National Institutes of Health (NIH) category IV prostatitis or asymptomatic inflammation. To our knowledge this report represents the initial study of the incidence of NIH category IV prostatitis in men before biopsy and its clinical significance. MATERIALS AND METHODS: From 1996 to 1998 asymptomatic men with elevated PSA levels were evaluated for laboratory signs of prostatitis. Patients with expressed prostatic secretions or post-prostate massage urine (voiding bottle 3 [VB3]) positive for greater than 20 and greater than 10 white blood cells per high power field, respectively, received antibiotics for 4 weeks and were reevaluated after 6 to 8 weeks. Men without these clinical signs promptly underwent biopsy. Those with acute urinary tract infection and PSA greater than 30 ng./ml., without a rectum or who refused biopsy were excluded from study. RESULTS: Of the 187 study patients 122 were evaluable with a mean PSA of 9.35 ng./ml., including 51 (42%) with laboratory signs of prostatitis. After treatment PSA was normal in 22 cases and remained elevated in 29, including 9 in which biopsy revealed cancer. The change or improvement in PSA was significantly greater in men with benign results than in those with prostate cancer (-21.32 versus -1.33%, p = 0.001). In the cohort with negative expressed prostatic secretion and VB3 results transrectal ultrasound guided biopsy was done promptly. Screening decreased the number of biopsies by 18% (22 of 122 cases). The positive predictive value of PSA for detecting biopsy proved cancer improved with screening for prostatitis (45 of 122 cases or 37% versus 36 of 71 or 51%). Long-term followup revealed continued normal or stable PSA in the prostatitis cohort. CONCLUSIONS: Screening for NIH category IV prostatitis should be considered in men with elevated PSA. Although patients may be asymptomatic, anxiety caused by prostate cancer and diagnostic procedures contributes to the clinical significance of this disorder.

Seminal oxidative stress in patients with chronic prostatitis.

OBJECTIVES: An association between prostatitis and male infertility has been suspected, yet is poorly understood. Prostatitis is often associated with granulocytes in the prostatic fluid that generate reactive oxygen species (ROS), known to impair male fertility. We compared ROS, the total antioxidant capacity (TAC), and a novel index of oxidative stress (ROS-TAC score) in patients with chronic prostatitis and in healthy controls. METHODS: Semen specimens from 36 men with chronic prostatitis (National Institutes of Health category IIIa), 8 men with prostatodynia (National Institutes of Health category IIIb), and 19 controls attending our urologic clinic were examined according to the World Health Organization criteria. Leukocytospermia was measured by the Endtz test (myeloperoxidase assay). ROS and TAC production was measured by chemiluminescence assay. A composite ROS-TAC score was also calculated in patients and controls. RESULTS: The sperm concentration, percentage of motility, and morphology among the groups did not differ. The mean +/- standard error log-transformed ROS level was significantly higher in patients with leukocytospermia (3.2 +/- 0.6) than in patients without leukocytospermia (1.8 +/- 0.2; P = 0.04) and controls (1.3 +/- 0.3, P = 0.01). TAC was significantly lower in patients with or without leukocytospermia (859.69 +/- 193.0 and 914.9 +/- 65.2, respectively) than in controls (1653.98 +/- 93.6, P = 0.001). The mean ROS-TAC score of controls (50.0 +/- 4.1) was significantly higher than those of patients with chronic prostatitis and leukocytospermia (8.2 +/- 9.2) and those without leukocytospermia (34.2 +/- 2.9; P <0.001). CONCLUSIONS: Men with chronic prostatitis or prostatodynia have seminal oxidative stress, irrespective of their leukocytospermia status. These observations may help shed light on the long-standing controversy surrounding prostatitis and infertility.

Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia.

PURPOSE: Ureaplasma urealyticum is a commensal of the lower genitourinary tract of many sexually active adults. The organism is more common in partners of infertile than fertile marriages. We conducted a prospective study at our tertiary care center to confirm a possible association between U. urealyticum and abnormal sperm function parameters. MATERIALS AND METHODS: A total of 50 consecutive male patients seeking general urology consultation for lower urinary tract symptoms characteristic of chronic prostatitis were evaluated. Urine and semen localization cultures were performed with additional semen cultures for U. urealyticum, Chlamydia trachomatis and Mycoplasma hominis. Specimens from 21 healthy men were used as controls. Specimens were analyzed by a computer assisted semen analyzer, and verified manually for concentration, percent motility and morphology. Leukocytospermia was measured by the Endtz test. Semen specimens were also analyzed for reactive oxygen species (ROS), acrosome reaction and mannose binding assay. RESULTS: Of the patients 17 had positive U. urealyticum cultures and the other cultures were negative. Patients with U. urealyticum had significantly higher ROS levels (log [ROS + 1] = 2.52 +/- 0.25) than those without U. urealyticum (1.49 +/- 0.20, p = 0.002) or controls (1.31 +/- 0.19, p = 0.002). Leukocytospermia was detected in only 1 of the 17 (6%) positive specimens and 4 (12%) negative specimens. CONCLUSIONS: Seminal ROS levels are elevated among patients with U. urealyticum. ROS induces lipid peroxidation, which reduces membrane fluidity and sperm fertilization capability, and may be the mechanism by which U. urealyticum impairs sperm function. Absence of leukocytospermia does not exclude U. urealyticum.

Association of chronic urinary symptoms in women and Ureaplasma urealyticum.

UNLABELLED: OBJECTIVES. To determine the incidence of Ureaplasma urealyticum in women experiencing chronic urinary symptoms and to determine whether antibiotic therapy targeting these organisms is effective. METHODS: Forty-eight consecutive women referred to our academic medical center for chronic voiding symptoms and possible interstitial cystitis underwent urologic evaluation, including culture screening for U. urealyticum and Mycoplasma hominis. Patients with positive cultures were treated with a 1-g dose of azithromycin; persistent infection was treated with 7 days of doxycycline, ofloxacin, or erythromycin. Patients reported symptom severity (0, mild; 3, severe) and voiding frequency before and 6 months after treatment. RESULTS: Positive cultures were obtained in 23 (48%) of 48 patients; 22 had U. urealyticum and 1 had M. hominis. All had negative cultures after treatment. The mean symptom severity score improved with treatment (2.2 to 0.7, P <0.001), and the mean urinary frequency decreased (9.2 daily to 6.8 daily, P <0.001). Two of the 23 patients experienced no improvement; one had detrusor instability and the other had medically related urinary frequency. Of the 25 patients with negative cultures, interstitial cystitis was established in only 9 (19% of the total sample). CONCLUSIONS: Although often overlooked or improperly treated, U. urealyticum and M. hominis infections may account for a large proportion of unexplained chronic voiding symptoms. Culture and treatment should be considered before pursuing more costly and invasive tests.

Pelvic floor physical therapy for patients with prostatitis.

The most common form of prostatitis is National Institutes of Health category III, also known as chronic abacterial prostatitis/chronic pelvic pain syndrome. The search for effective and durable therapy for this condition remains frustrating for both patients and physicians. A new approach incorporating a neurobahavioral and musculoskeletal perspective is emerging as a means of diagnosing and treating affected patients. Adopting methods from gynecology, colorectal surgery, and physical therapy has had promising effects in men diagnosed with chronic prostatitis.

NMP22: a sensitive, cost-effective test in patients at risk for bladder cancer.

BACKGROUND: This study was designed to determine the clinical utility of NMP22 as a urinary marker for the early detection of transitional cell carcinoma (TCC) of the bladder in patients with hematuria or other indications for risk of malignancy. Its utility will be measured by sensitivity and specificity estimates as compared to cystoscopy. Since urine cytology is normally collected in this population of patients, it will also be analyzed and compared to cystoscopy. MATERIALS AND METHODS: Each patient submitted a single voided urine which was stabilized with the NMP22 urine collection kit or preserved in the appropriate cytology medium for cytopathologic testing. All patients provided the urine samples before cystoscopic exam. Of the 146 patients, there were 43 patients with microscopic hematuria and 13 with gross hematuria. Other indications for cystoscopy included unexplained or medically refractory voiding. There were 8 patients with biopsy confirmed bladder cancer and 138 patients with benign conditions of the bladder. RESULTS: The median NMP22 value for the bladder cancer malignancies was 27.8 U/mL (95% Confidence interval: 10.5-32.1 U/mL). The median NMP22 value for the benign conditions of the bladder was 3.25 U/mL (95% Confidence interval: 2.5-3.8 U/mL). The urinary NMP22 values from the bladder cancer group was statistically different (p < .000001 Mann-Whitney U test) than the NMP22 values in the benign conditions group. Using a reference value of 10.0 U/mL, the sensitivity of NMP22 was 100% with a specificity of 90%, while cytology had a sensitivity of 25% and a specificity of 100%. Due to its high negative predictive value, using NMP22 alone could have eliminated 124 cystoscopies with total savings ranging from $24,824 to $63,264 depending on the type of insurance carrier. CONCLUSIONS: This study indicates that urinary NMP22 is a useful, cost-effective marker for the early detection of bladder cancer.

Patient characteristics associated with vasectomy reversal.

PURPOSE: More than 30 million couples throughout the world are using vasectomy as a method of birth control. It is estimated that up to 6% of men who undergo voluntary sterilization will eventually request reversal, despite the high cost and relatively low success rate of the procedure. We identified characteristics that predict which vasectomy patients may request reversal. We also examined the cost and effectiveness of pre-vasectomy sperm cryopreservation followed by intrauterine insemination as an alternative method of achieving pregnancy. MATERIALS AND METHODS: We reviewed medical charts of 365 patients who underwent vasectomy and 290 who underwent vasectomy reversal between 1990 and 1997. Data were collected on patient age at the time of vasectomy, religion, occupation, wife employment status, number of marriages, number of children, reason for reversal, and number of years between vasectomy and reversal. Based on previously reported values, pregnancy rates and cost per successful pregnancy were estimated for vasectomy reversal surgery, and compared with a calculated cost per pregnancy for sperm cryopreservation and intrauterine insemination. RESULTS: Patient factors significantly associated with increased vasectomy reversal included younger age at time of vasectomy (p < 0.001) and a wife who worked outside the home (p < 0.001). Vasectomy reversal occurred 12.5 times more often (95% confidence interval [CI] 7.6 to 20.7) in men who underwent vasectomy in their 20s than in men who were older. Men whose wives were not employed requested reversal 0.48 times as often (95% CI 0.33 to 0.71) as those whose wives worked. Men who were younger at vasectomy tended to wait longer before reversal (median 10 years) than other patients (p < 0.001). At 10 years our calculated pregnancy rates and cost per pregnancy were 44% and $12,727 for vasectomy reversal, and 41% and $9,512 for intrauterine insemination with banked sperm (3 attempts). CONCLUSIONS: Patients who requested vasectomy reversal most often chose voluntary sterilization at a younger age. We believe that younger men should be given better pre-vasectomy counseling. However, the success rate and cost-effectiveness of sperm cryopreservation before vasectomy, with subsequent intrauterine insemination, may make this nonsurgical alternative desirable for younger couples who choose vasectomy even when properly informed about reversal rates.

Developing a patient self-medication program for the rehabilitation setting.

Self-medication, the ability of the patient to administer his or her own medication, can be useful in the rehabilitation setting in reducing the incidence of polypharmacy, medication abuse, and inappropriate medication usage. However, a patient self-medication program also introduces a variety of issues, such as defining each team member's responsibilities and outlining the steps of the program. These issues may impede the development and implementation of the program. A review of the rehabilitation literature yields little information about program development in the rehabilitation setting or about dealing with such issues. The purpose of this article is to describe the need for a self-medication program in the rehabilitation setting, the development of one such program, and ways to overcome some of the problems that cause such programs to falter.

Scintigraphic diagnosis of peritoneo-pleural communication in the absence of ascites.

Pleural effusion in the presence of cirrhosis and ascites is well recognized. Peritoneal fluid is thought to enter the pleural cavity either because of overloaded lymphatics or a structural defect between the peritoneal and chest cavities. Pleural effusion rarely occurs in the absence of demonstrable ascites. This report describes the scintigraphic diagnosis of peritoneo-pleural communication in a patient with cryptogenic cirrhosis and pleural effusion without ascites.

Pheochromocytoma in a pregnant patient.

Pheochromocytoma accounts for only 0.1% of hypertension found in adults between 40 and 70 years of age. Although it is extremely rare in pregnancy, if it occurs and is unrecognized in pregnant women, pheochromocytoma can have catastrophic effects. For instance, maternal fatal hypertension can be precipitated by anesthesia, vaginal delivery, uterine contractions, or even vigorous fetal movements. Fetal growth retardation is often seen secondary to decreases in uteroplacental perfusion. Fetal hypoxia or death can also occur with maternal episodes of headache, palpitations, and diaphoresis related to tumor secretions. Because many of the signs and symptoms of pheochromocytoma are similar to more frequently encountered hypertensive syndromes related to pregnancy, the diagnosis of pheochromocytoma can be easily overlooked. The case report presented here illustrates the difficulties associated with the diagnosis of pheochromocytoma in a pregnant patient, highlights problems encountered by patients with the tumor, and reviews diagnostic and treatment approaches.

MR assessment of pituitary gland morphology in healthy volunteers: age- and gender-related differences.

PURPOSE AND METHODS: High-field MR images at 1.5 T were used to characterize the effects of age and gender on pituitary size and shape in a sample of 71 adult volunteers (40 females), aged 21 to 82 years. FINDINGS: For all subjects, age was inversely correlated with pituitary height (r = -.43, P less than .0002) and cross-sectional area (r = -.35, P less than .0028). Age-specific gender differences were also present in pituitary height and area. A convex upper pituitary margin was more common in females (P = .002) and younger subjects (P = .009). CONCLUSIONS: This study confirms that aging is accompanied by gender-specific changes in pituitary size and shape, and provides normative data that may facilitate evaluation of the pituitary gland in neuroendocrine disorders.

Comparison of bicycle and treadmill radionuclide angiocardiography.

The purpose of this study was to test motion-correction algorithms for initial-transit radionuclide angiocardiograms acquired at rest and during bicycle and treadmill exercise. Treadmill data was spatially reoriented by computer software designed to eliminate motion of a 125I point source simultaneously recorded at a lower energy window. A second algorithm based on left ventricular centroid counts further corrected for motion on all studies. Exercise left ventricular ejection fraction was higher on the treadmill (0.68 +/- 0.07) compared to the bicycle (0.64 +/- 0.08) (p less than 0.0001, r = 0.88). Treadmill exercise also resulted in larger end-diastolic volumes (180 +/- 30 versus 157 +/- 36, p less than 0.0001), stroke volumes (124 +/- 28 versus 101 +/- 29, p less than 0.0001) and cardiac outputs (19.9 +/- 4.6 versus 15.9 +/- 5.0, p less than 0.0001). Similar variances for these hemodynamic measurements suggest that the mean differences observed were physiologic and that error from body motion was effectively corrected by this approach. We conclude that the measurement of left ventricular function during treadmill exercise, when combined with these techniques for correcting motion, is a reasonable alternative to conventional bicycle exercise.

Combined exercise radionuclide angiocardiography and single photon emission computed tomography perfusion studies for assessment of coronary artery disease.

Although there is widespread use of exercise thallium 201 scintigraphy and radionuclide angiocardiography in patients with coronary artery disease (CAD), little is known about the independence, concordance, or relative importance of these studies in the diagnosis, prognosis, and assessment of the outcome of therapy. The use of both tests in the same patient has been impractical because of the logistic considerations imposed by two exercise tests on separate days, and excessive radiation exposure. New technetium 99m-labeled radiopharmaceuticals with high myocardial extraction now permit the simultaneous assessment of myocardial perfusion (single photon emission computed tomography [SPECT]) and ventricular function (radionuclide angiocardiography [RNA]) during treadmill exercise (exercise tolerance test [ETT]). The ability to perform all three tests during a single exercise session offers a very attractive technique to evaluate patients with CAD. The investigators studied 86 patients with chronic CAD using the same-day perfusion and function protocol combined with treadmill exercise. The results demonstrate good concordance between myocardial perfusion and ventricular function as indicated by a significant correlation between tomographic perfusion defect size and ejection fraction (P less than .0001, R = 0.75 at rest and P less than .0001, R = 0.76 during exercise). Stepwise logistic regression was used to model ETT, RNA, and SPECT variables against the presence of one or more 60% stenoses by quantitative angiography, an end point present in 47 patients. Univariable analysis showed all three tests (ETT, RNA, and SPECT) to be significant predictors of the end points (lambda 2 = 5.1, P less than .05; lambda 2 = 12.5, P less than .001; and lambda 2 = 16.1, P less than .001, respectively). Multivariable analysis demonstrated that SPECT provided more diagnostic information than ETT and RNA (Lambda 2 = 16.1, P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)