Numerical modeling of a MHD non-linear radiative Maxwell nano fluid with activation energy.

The present research explores linear as well as nonlinear radiation patterns based on the MHD non-Newtonian (Maxwell) nanofluid flow having Arrhenius activation energy. This study's core focus is MHD properties in non-Newtonian fluid dynamics and boundary layer phenomena analysis. It initiates with time-dependent equations, employing boundary layer approximations. Extensive numerical computations, executed with custom Compact Visual Fortran code and the EFD method, provide profound insights into non-Newtonian fluid behavior, revealing intricate force interactions and fluid patterns. To check the stability of the solution, a convergence and stability analysis is performed. With the values of ΔY = 0.25, Δτ = 0.0005, and ΔX = 0.20; it is found that the model convergence occurs to the Lewis number, Le > 0.016 as well as the Prandtl number, Pr > 0.08. In this context, investigating non-dimensional results that depend on multiple physical factors. Explanation and visual representations of the effects of different physical characteristics and their resultant temperatures, concentrations, and velocity profiles are provided. As a result of the illustrations, the skin friction coefficient and Sherwood number, which are calculated, as well as Nusselt values, have all come up in discussion. Additionally, detailed representations of isothermal lines and streamlines are implemented, and it is pointed out that the development of these features occurs at the same time as Brownian motion. Furthermore, the temperature field for Maxwell fluid is modified due to the impression of chemical reaction as well as the Dufour number (Kr and Du). Our research demonstrates the superior performance of non-Newtonian solutions, notably in cases involving activation energy and nonlinear radiation. This paradigm shift carries significant implications. In another context, the interplay between Maxwell fluid and nonlinear radiation is notably affected by activation energy, offering promising applications in fields like medicine and industry, particularly in groundbreaking cancer treatment approaches.

Evaluation of antioxidant properties of nanoencapsulated sage (Salvia officinalis L.) extract in biopolymer coating based on whey protein isolate and Qodumeh Shahri (Lepidium perfoliatum) seed gum to increase the oxidative stability of sunflower oil.

Sage leaf extract (SLE) is considered an excellent source of bioactive compounds mainly because of its high content of phenolics, widely known as natural antioxidants. This study aimed to compare the performance of free/encapsulated SLE by different coatings in protecting sunflower oil against oxidative deterioration. The coating materials were whey protein isolate and qodumeh seed gum at different ratios (1:0, 1:1, and 0:1). Each nanocapsule was analyzed for particle size, zeta potential, encapsulation efficiency, phenolics release, and SEM images. The total phenolic compounds of SLE were 31.12 mg GA/g. The antioxidant activity of SLE was increased in both DPPH and FRAP assays by increasing extract concentration from 50 to 250 ppm. All nanoparticles exhibited nanometric size, negative zeta potential, encapsulation efficiency higher than 60%, and gradual release during storage. The oxidative stability of sunflower oil with or without the incorporation of 250 ppm of free/encapsulated SLE was evaluated during 24 days of storage at 60°C. Peroxide value (PV), thiobarbituric acid value (TBA), oxidative stability index (OSI), color index (CI), and conjugated dienes (CD) were determined. COPM nanoparticles showed the lowest PV, TBA, CI, and CD but both SGUM and WHEY were more effective in delaying oil oxidation than TBHQ and free extract. Higher OSI was observed in oil-containing nanoparticles with composite coating. Results obtained reinforce the use of whey protein isolate and qodumeh seed gum as a coating for encapsulating SLE to increase the shelf life of sunflower oil as a natural antioxidant.

Evaluation of Short Term Outcome of Stapled Transanal Rectal Resection (STARR) for ODS (Obstructed Defecation Syndrome) by Comparing Pre and Post-operative ODS Score.

Obstructed defecation syndrome (ODS) is a common anorectal problem and it can be corrected by various surgical approaches but most of these have high recurrence and complication rates. Antonio Longo introduced Stapled transanal rectal resection (STARR) in 2003 as a minimally invasive transanal operation for correction ODS associated with rectocele and or rectal intussusception. This study was designed to assess the short term outcome of Stapled Transanal Rectal Resection (STARR) as a surgical treatment of Obstructed Defecation Syndrome (ODS). This is a quasi experimental study which was carried out in the department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from May 2016 to June 2017. Seventeen (17) patients were included in the study. Patients with obstructed defecation syndrome and rectocele and or rectal intussusception admitted in the department of Colorectal Surgery were enrolled in the study as per inclusion and exclusion criteria. History, clinical examination, Proctoscopy, Colonoscopy and MR Defecography was done for evaluation of the patients. During evaluation preoperative Longo's ODS score of every patient also determined and compared with postoperative ODS score. The patient was followed up regularly at one, three and six months after each operation. The ODS score in 82.35% patients improved significantly. The postoperative score was high (13-15) only in 02(11.8%) patients probably due to presence of physiological factors. Post-operative defecatory urgency was developed in only 02(11.76%) patients. Major postoperative complication like hemorrhage or rectovaginal fistula did not develop in any patient. STARR is an effective, less invasive and simple procedure for the treatment of ODS with rectocele and/or rectal intussusception without major morbidity but other physiological causes of ODS should exclude preoperatively because its presence makes the surgical intervention fruitless.

External versus Endoscopic Dacryocystorhinostomy for Primary Acquired Nasolacrimal Duct Obstruction.

PURPOSE: The purpose of the study is to compare the surgical outcomes and success rates of external dacryocystorhinostomy (EX-DCR) versus endoscopic endonasal DCR (EN-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). METHODS: This retrospective nonrandomized study was conducted at Farabi Eye Hospital and Noor Eye Hospital, Iran. A review of electronic medical records of all patients with PANDO who underwent EX-DCR or EN-DCR between January 2016 and 2018 was carried out. RESULTS: A total of 803 patients underwent surgery, of which 618 patients (77%) were managed by EX-DCR and 185 patients (23%) by EN-DCR. The majority of cases (62%) were female. The mean age of the patients in EX-DCR and EN-DCR groups was 40.8 ± 14.2 and 34.3 ± 9.2 years, respectively. EX-DCR resulted in significantly less amount of pain compared to EN-DCR (P < 0.05). The success rate of surgery among EX-DCR and EN-DCR groups was 92.4% and 91.1%, respectively, and did not show statistically significant difference. A higher incidence of intraoperative hemorrhage requiring intervention was noted in the EN-DCR group (16.7% vs. 4.5%). Postoperative patient's satisfaction with EN-DCR and EX-DCR was 73% and 82%, respectively. CONCLUSION: Both EX-DXR and endoscopic DCR surgeries have high success rates and low incidence of failure. The choice of DCR technique should be based on the experience of the surgeon and patient's lacrimal and nasal anatomy and preferences.

Role of Intraperitoneal Normal Saline Instillation in Relieving Post-operative Pain Following Laparoscopic Cholecystectomy: A Quasi Experimental Study.

Laparoscopic cholecystectomy has rapidly become the procedure of choice for the treatment of calculus cholecystitis for having clear advantage over open method in reducing surgical morbidity, postoperative pain and complication. But still patients undergoing laparoscopic cholecystectomy complain of considerable pain especially on first post-operative day necessitating use of better methods for postoperative analgesia. This quasi experimental study was done in Surgery Unit III, Mymensingh Medical College Hospital from July 2016 to June 2017 to assess the role of intraperitoneal normal saline instillation following laparoscopic cholecystectomy in relieving postoperative pain. In this study total 200 patients of calculus cholecystitis were enrolled according to inclusion and exclusion criteria and assigned equally into two groups by non-equivalent control group design. Both the control group and experimental group were managed according to the standard protocol and operated in routine operation theater. The experimental group (n=100) was additionally instilled with 25-30ml/kg body weight of normal saline at 37°C at the gallbladder bed and subdiaphragmatic space at the end of surgery and all the data were recorded in individual case record form. Among the sample most of the patients were between 25-60 years of ages with the peak age being between 43-51 years. Eighty one percent (81%) of the total patients were female with male female ratio being 1:5.25 in Control group and 1:3.54 in Experimental group. The VAS scores for visceral pain in experimental group were significantly less than that of control group at 6 hours (p<0.001), 12 hours (p<0.001), 24 hours (p<0.001) and 48 hours (p=0.026). The VAS scores for shoulder tip pain in experimental group were also significantly less than that of control group at 6 hours (p<0.001), 12 hours (p<0.018) and 24 hours (p=0.004). The administration of analgesics was also significantly less in the experimental group than in control group at 6 hours (p<0.001), 12 hours (p<0.001), 24 hours (p=0.313) and 48 hours (p=0.297) with no significant differences at 72 hours. The mean hospital stay in this study was 2.2±0.7 days in the control group and 2.1±0.8 days in the experimental group showing no significant difference (p>0.05). Intraperitoneal normal saline instillation following laparoscopic cholecystectomy may be an eminent choice for reducing postoperative pain improving patient's experience.

Outcome of Management of Liver Abscess by Surgical Approach in a Tertiary Care Hospital.

Liver abscess is a serious, life threatening condition. A recent development in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The purpose of this study is to search for the clinical presentations and surgical outcomes of liver abscess in our country. The markers of the outcome are mortality, duration of hospital stay and complications such as wound infection, residual disease following surgery, biliary leakage, intra abdominal abscess formation. This observational cross sectional study was conducted in Mymensingh Medical College & Hospital (MMCH), Bangladesh for 12 months from 1st January 2017 to 31st December 2017. Total 25 patients presenting with the features of liver abscess were included in this study by convenient and purposive sampling according to the inclusion and exclusion criteria. Surgical principles of liver abscess management were applied and outcomes were observed. The patients were diagnosed on the basis of clinical feature, findings of abdominal ultrasound and occasionally by doing CT scan. Most of the patients (28%) were in the age group of 51-60 years. Regarding sex distribution majority of the patients (64%) was male. Most of patients presented with fever (92%), anorexia and vomiting (32%), upper abdominal pain (84%). Hepatomegaly and reactive pleural effusion are the important findings present in 9(36%) and 8(32%) patients respectively. Size of the liver abscess was more than 5cm in 72% patients. Among the patients right lobe was predominantly involved. It was found during laparotomy that 4 patients (16%) had spontaneous rupture of abscess into peritoneal cavity. One (4%) patient developed biliary leakage after surgical drainage. No intra abdominal abscess or residual diseases was observed after surgery. Among the patients 24% developed wound infection. The overall mortality rate was 12%. The median length of hospital stay was 8 days (range: 1-15 days). Outcome of surgical drainage of liver abscess in tertiary care hospital of our country shows satisfactory result. So, patients with large multiple liver abscess, septic shock, failures of percutaneous drainage should be treated by early open surgical intervention.

Effectiveness of Pressurized Normal Saline Irrigation of Subcutaneous Tissue Following Appendicectomy in Decreasing Wound Infection: A Quasi Experimental Study.

Acute appendicitis is the commonest cause of acute abdomen necessitating surgical intervention and wound infection is the most frequently encountered complication following appendicectomy. To assess the effectiveness of pressurized normal saline irrigation of subcutaneous tissue following appendicectomy in decreasing wound infection this quasi experimental study was done in Surgery Unit III, Mymensingh Medical College Hospital from January 2018 to December 2018. In this study total 200 patients of acute appendicitis were enrolled according to inclusion and exclusion criteria and assigned equally into two groups by non-equivalent control group design. In control group all the standard protocol of wound closure following appendicectomy was followed and in experimental group along with the standard protocol the subcutaneous tissue was irrigated by pressure with normal saline and all the data were recorded in individual case record form. Among the sample most of the patients were between 10-19 years of ages and the male female ratio was 1.38:1. In control group 30% patients developed wound infection while 12% patients developed wound infection in experimental group with a P value of 0.027. Mean hospital stay of experimental group was less than the control group (P value less than 0.05). Overall postoperative outcome in context of wound infection and hospital stay is better following pressurized normal saline irrigation of subcutaneous tissue during closure.

Efficacy of Intra-peritoneal Tramadol Instillation for Postoperative Pain Management after Laparoscopic Cholecystectomy.

Gall stone disease is one of the most common conditions encountered in general surgical practices in adult population. The gold standard treatment for symptomatic gall stone disease is laparoscopic cholecystectomy. It results in less post-operative pain as compared to open cholecystectomy but post-operative pain may be mild, moderate or even severe in some patients. This Randomized control trail was conducted to In-patient department of Surgery, Mymensingh Medical College & Hospital (MMCH), Mymensingh, Bangladesh from April 2018 to September 2018. It was undertaken to evaluate the analgesic effect of intra-peritoneal tramadol instillation in patients undergoing laparoscopic cholecystectomy. Total 70 patients with symptomatic gallstone disease undergoing laparoscopic cholecystectomy were randomized equally in two groups. Then patients were selected in according to the inclusion and exclusion criteria. In first group (Group A), patients were received intra-peritoneal tramadol 100mg (diluted in 20.0ml distilled water). Sprayed 10.0ml diluted tramadol into the sub diaphragmatic area, 5.0ml into the area of gall bladder bed and 5.0ml into the space between the liver and kidney under direct vision just before removal of trocars. In second group (Group B) the conventional operative procedure was followed. Postoperatively, patient was extubated and shifted to recovery room. Data recorded and analyzed, such as post-operative pain score at 1, 4, 8, and 24 hour; cumulative 1, 8 and 24 hour analgesic consumption. In addition that postoperative hospital period monitoring of heart rate, blood pressure, respiratory rate, temperature at 0, 4, 8, 24 hours was also analyzed. Intensity of pain was assessed by Visual Analogue Scale (VAS) scoring system. Patients showed a VAS ≥3 or patients who requested for analgesia was administrated a supplemental dose of analgesic. In the present study the mean pain scores in Group A were found to be low at1hourpost-operative was 0.60±0.56 and there was a gradual increase in score in respect of time interval with peak of 2.07±0.91 at 24 hours. Whereas, in Group B the mean pain scores immediate post-operative period were at its peak was, 2.50±0.82 which decreased to 1.30±0.84 at 1 hour and further there was rise at 4 hours (2.10±0.71) and 24 hours (2.33±0.0.71). But at any point of time the mean VAS remained significantly low (p<0.050) in patients with Group A compared to Group B except at 1st 24 hours (p=0.210). Intra-peritoneal instillation of tramadol for postoperative pain control in laparoscopic cholecystectomy has beneficial effect in terms of postoperative pain relief following laparoscopic cholecystectomy.

Mesenteric Fibromatosis: A Case Report.

Fibromatosis of mesentery is a very rare disease and only a few cases have been reported. Here we report a case of 40 year old man admitted on 16 October, 2017 in the Department of Surgery (Unit-3) of Mymensingh Medical College Hospital with history of recurrent abdominal pain and progressively enlarging intra-abdominal lump for 2 years. Out of different diagnostic dilemmas, finally we came to the conclusion of its being a mass lesion primarily arising from the mesentery and involving the adjoining gut according to the report of CT abdomen. Laparotomy was performed and a lump measuring about 18 cm × 20 cm arising from mesentery was found, in which distal part of jejunum and proximal part of ileum were embedded. The mass was excised with incorporated gut loops and histopathology report revealed fibromatosis of mesentery.

Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital.

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Early Outcome of Primary Repair in Colonic Injury.

The management of the colon injury remains controversial in spite of a number of divergent reports during the past decade. Previously surgeons were reluctant to do primary anastomosis but now-a-days they are doing primary repair with good results. The present study is designed to see the early outcomes of primary repair in colonic injury. This prospective observational study performed at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2013 to June 2013 with allocation of 50 patients with colonic injury who underwent laparotomy with primary repair of that injury in the department of Casualty Surgery. A primary repair was performed after freshening the edges or by resection and primary anastomosis with 3.0 round-body Vicryl by single layer extra mucosal interrupted suture. Data processed using software SPSS version 16.0. For all analytical results a p value <0.05 was considered significant. In this study the commonest site of injury were transvers colon and sigmoid colon 38.0% in each. Out of 50 respondents, 5(10.0%) developed burst abdomen, 1(2.0%) developed entero-cutaneous fistula with none had paralytic ileus or septicaemia or pelvic collection. No mortality observed. This study showed that the increasing in colon injury scale (CIS) score culminate into increasing rate of postoperative complication & post operative complications were more at left colon (24%). On basis of our findings, we recommend the primary repair is a safe and effective surgical technique for addressing the large gut injury. Unnecessary proximal diversions should be avoided. According to our experience, we believe that the policy of primary repair of colon injuries can be applied more liberally in majority of patients with high success rate.

A Comparative Study between FNAC and Histopathology in Diagnosis of Breast Lump.

Worldwide a large number of patients have been suffering from breast lump and this trend is gradually increasing. It is difficult to determine whether a lump is benign or malignant from clinical assessment. Thus the need for microscopic tissue analysis arises. This study was designed to determine the value of fine needle aspiration cytology in the diagnosis of breast lumps and to compare the result of FNAC with histopathological diagnosis to assess its accuracy. A prospective study in the period of January 2009 to December 2010 was done. One hundred and ten (110) patients who came to the Department of Surgery in Mymensingh Medical College Hospital, Bangladesh in two years for their palpable breast masses were chosen for the study. There were 70(63.63%) benign, 33(30.00%) malignant and 07(6.36%) suspicious smears in FNAC. Inadequate samples were repeated. The number of repeats increased the diagnostic accuracy of aspirates which is statistically significant when compared with histopathology. In histopathology Invasive ductal carcinoma was the most commonly reported lesion with maximum incidence in the 4th, 5th, and 6th decades followed by invasive lobular carcinoma and other malignant lesions. FNAC serves as a rapid, economical and reliable tool for the diagnosis of palpable breast lesions and its reliability is influenced by the skillness of the aspirator. So physician should use this tool with clinical experience.

Single layer gastro-intestinal anastomosis in gastric cancer surgery.

Gastrojejunostomy is one of the most important procedures in gastric cancer surgery. Anastomosis between different parts of the stomach and the intestine is a basic technical component in all gastrointestinal procedure. This study evaluated complications of gastrojejunostomy in gastric cancer surgery with two methods: single-layer and double-layer anastomosis. This study was carried out in the Department of Surgery in Mymensingh Medical College Hospital from January 1st 2010 to June 30th 2012. Fifty patients with carcinoma stomach who needed gastrojejunostomy were included in this study. These patients with average age of 43.22 years were divided in two groups (25 in each group); single-layer and double-layer anastomosis. In single-layer anastomosis gastrojejunostomy was performed in interrupted method with absorbable suture (3/0 vicryl). Double-layer anastomosis was carried out with continuous suture (2/0 silk, 2/0 catgut). Possible post-operative complications like anastomotic leakage, pelvic abscess, abdominal sepsis, anastomotic stenosis and wound infection were evaluated. In the single-layer group, 2 patient (4%) developed anastomotic leakage, wound infection and only 1 patient (2%) developed abdominal sepsis, pelvic abscess and anastomotic bleeding. No patient developed anastomotic stricture. In double-layer group, no patient developed anastomotic leakage but wound infection only in 1 patient (2%). Gastrojejunostomy with single-layer hand-sewn suture technique is safe without serious complications in comparison to double-layer suture technique. More-over operation time is less and cost is less in single-layer method.

Anatomical and congenital anomalies of extra hepatic biliary system encountered during cholecystectomy.

Anomalous biliary anatomy is frequently encountered by surgeons during cholecystectomy. Importance of its recognition lies in avoiding serious biliary injuries. This study was carried out to assess the frequency of anatomical and congenital anomalies of extrahepatic biliary system in patients undergoing cholecystectomy. This is an observational study performed in the Department of Surgery, Combined Military Hospital (CMH) Momenshahi, CMH Ghatail and Mymensingh Medical College Hospital for a period of five years from June 2007 to June 2012. Two hundred and fifty diagnosed patients of cholelithiasis undergoing routine cholecystectomy were assessed for anatomical and congenital anomalies of extra hepatic biliary system as well as vascular anomalies. Structures mainly assessed for anomalies were gall bladder, cystic duct, supraduodenal part of Common Bile Duct (CBD), cystic artery and hepatic artery which are routinely handled during cholecystectomy. However, assessment of variations and anomalies, of hepatic ducts, portal vein, retroduodenal and pancreatic parts of CBD were not done due to possibility of iatrogenic injuries. Two hundred and fifty cases of cholelithiasis comprising 216(86.4%) females and 34(13.6%) males with mean age of 39.15 years were included in the study. Clinical presentation includes mainly pain in right hypochondrium (74.8%), pain in right hypochondrium and epigastrium (18.8%) and pain in epigastrium alone (7.6%). Laparoscopic cholecystectomy was done in 157 patients and 93 patients were treated by open procedure including conversion cases. Operative findings revealed variations in 38 cases (15.2%) mainly involving cystic artery (8%), cystic duct (4.4%) and gall bladder (1.6%). Postoperative complications includes bleeding 3.6%, biliary leak from drain 1.6% and CBD injury 0.8% giving rise to 0.8% morbidity, however, no mortality was seen in this series. Anatomical and congenital anomalies of biliary tree, are not common but may be significant during surgery as failure to recognize them leads to iatrogenic injuries and can increase morbidity and mortality.

A giant Condyloma accuminata.

Condyloma accuminata is not a rare disease in our country. But such a giant Condyloma accuminata is very uncommon case that we reported here. It is a type of venereal wart that commonly grows in genital region, caused by the HPV (Human papilloma virus). It is considered one of the most common sexually transmitted disease in western countries. The patient presented with cauliflower like fungating growth over the genitalia for 15 years with pain and burning sensation over the lesion for 1 month. Patient had multiple sexual partners for about 20 years. Clinically the patient was diagnosed as Condyloma accuminata. The wart was excised under spinal anesthesia and confirmed by histopathology.

Usefulness of preoperative stress perfusion imaging in predicting prognosis after liver transplantation.

The role of preoperative stress single-photon emission computed tomographic (SPECT) imaging in patients with end-stage liver disease who underwent liver transplantation is not well established. We reviewed medical records of patients who had liver transplantation at our institution between January 1998 and November 2001. During this time, 339 patients (213 men, aged 51 +/- 11 years) underwent liver transplantation. Of these, 87 patients had preoperative stress SPECT imaging. Diabetes mellitus (30% vs 11%), hypertension (26% vs 12%), and coronary artery disease (15% vs 7%) were more prevalent in those with than without SPECT (p <0.01 each). The stress SPECT perfusion images were normal in 78 patients (91%) and the left ventricular ejection fraction was 72 +/- 10%. SPECT images revealed ascites in 66% and splenomegaly in 83% of patients. There were 35 total deaths (10%) and 5 nonfatal myocardial infarctions over a mean follow-up of 21 +/- 13 months. Most deaths (32 of 35) were noncardiac and sepsis was the most common cause of death. A normal SPECT study had a 99% negative predictive value for perioperative cardiac events. Kaplan-Meier survival curves showed an 87% 2-year cumulative survival rate in the total group. Thus, in patients undergoing liver transplantation, 2-year survival depends on early noncardiac events. A normal stress SPECT study identified patients at a very low risk for early and late cardiac events despite a higher risk profile. SPECT images also revealed unique findings, such as ascites and splenomegaly, which could produce image artifacts and may interfere with accurate image interpretation.

Adenosine myocardial perfusion single photon emission computed tomographic stress testing 24-72 h after uncomplicated myocardial infarction.

Safety of performing adenosine myocardial perfusion stress testing as early as 24 h after acute uncomplicated myocardial infarction is not known. We evaluated 31(14 females and 17 males, average age 72, range 46-89 years) consecutive patients with uncomplicated myocardial infarction, who underwent adenosine myocardial perfusion stress imaging, 24-72 h after infarction for risk stratification. Adenosine was infused at a rate of 140 microg/kg/min for 6 min. Twenty patients were presented with non-ST-elevation myocardial infarction. Eleven patients were admitted with acute ST-elevation myocardial infarction. Patients were monitored for signs of complication during and immediately after the stress test. The average time from admission to performance of stress tests was 51 +/- 19 h, ranging from the minimum of 24 h to maximum 72 h. No complications related to adenosine infusion were detected. In conclusion, our data suggest that a further large study of early adenosine myocardial perfusion SPECT imaging may be safe in a carefully selected group of patients after uncomplicated myocardial infarction.