Referral practice, reporting standards, and the impact of dopamine transporter scans done in a tertiary hospital.

AIMS: We studied the referral practice, reporting standards, and the impact of 123 ioflupane single photon emission computed tomogram dopamine transporters (DAT-SPECT) scans conducted for the diagnosis and clinical management of patients. SETTINGS AND DESIGNS: The present study was a retrospective, non-interventional study. MATERIALS AND METHODS: We assessed the DAT scan referral and the official reports available from the Nuclear Medicine Department of the Mater Misericordiae University Hospital over 1 year (2013). We also assessed the impact of the DAT scan result on the management of patients by analyzing patient records. The European Association of Nuclear Medicine Neuroimaging (EANM) 2010 and the Federal Drug Administration (FDA) 2012 guidelines were taken as the standard against which the quality of our DAT scans reporting was assessed. STATISTICAL METHODS: Microsoft Excel 2010 and graphpad software were used for statistical analysis. RESULTS: Twenty five (56.2%) out of a total of 48 DAT scans were performed to confirm early Parkinson's disease, 5 (8.9%) were done to exclude drug-induced parkinsonism, and 8 (14.3%) to distinguish essential tremor from parkinsonism; 2 scans were performed to distinguish Lewy body diseases from Alzheimer's dementia, and 4 indications were outside the recommended guidelines. Twelve out of the 26 (46%) abnormal scans had bilateral abnormalities. Twenty one out of the 25 DAT scans proved the clinical diagnosis of degenerative parkinsonism to be correct. CONCLUSION: The overall compliance of the DAT imaging with the existing standard guidelines was good. DAT scan can be very useful in clinical practice because it influences the clinical diagnosis and management in 23% of the patients.

Diagnosis and treatment of effusive-constrictive pericarditis: a case report.

BACKGROUND: Effusive-constrictive pericarditis (ECP) is a rare syndrome involving pericardial effusion and concomitant constrictive pericarditis. The hallmark is a persistently elevated right atrial pressure of >10 mmHg or reduction of less than 50% from baseline despite pericardiocentesis. Aetiologies include radiation, infection, malignancy, and autoimmune disease. CASE SUMMARY: A 71-year-old man with a history of atrial fibrillation, obesity, hypertension, obstructive sleep apnoea, managed with continuous positive airway pressure presented with acute pericarditis complicated by pericardial effusion leading to cardiac tamponade. He was diagnosed with ECP after pericardiocentesis and was managed surgically with a pericardial window. DISCUSSION: Early detected cases of ECP can be managed by medical therapy. Therapeutic interventions include pericardiocentesis, balloon pericardiostomy, and pericardiectomy. This report describes a case of new-onset congestive heart failure secondary to ECP.

The effect of an active arm action on heart rate and predicted VO(2max) during the Chester step test.

This study examined whether the predictive outcomes of the Chester step test (CST) would be influenced by arm dynamics. Participants completed the CST on two separate occasions, once using active arms and once using passive arms. Results revealed that when compared to the passive arm protocol, the use of active arms led to a mean increase in heart rate of approximately 7 beats per minute across all of the incremental stages. However, this increase had little impact upon predicted VO(2max). Consequently, these results indicate that when performing the CST, participants are able to adopt an arm action that is compatible with personal preference.