A Dangerous Relationship: A Case of Imported Plasmodium falciparum and Salmonella Typhi Coinfection.

Malaria is a parasitic disease transmitted by the bite of female Anopheles mosquitoes. Although domestic malaria case notification in our country is not seen in World Health Organization records, cases originating from abroad are detected. Travelers to countries where malaria is endemic can become infected with the parasite. In our country, an average of 200-250 cases of malaria originating from abroad are reported every year. Approximately 75% of malaria cases of foreign origin detected in our country are P. falciparum malaria. Malaria and salmonellosis are infections especially seen in developing countries. Although malaria-Salmonella coinfection is rare, early diagnosis and treatment are important in terms of its high mortality rate. Preliminary information and initiation of chemoprophylaxis in travels to regions where the disease is endemic remain important in transmission. In this presentation, a case was examined following a business trip to Africa without any chemoprophylaxis, who applied to a local hospital upon symptoms and was diagnosed with P. falciparum and Salmonella Typhi coinfection but given incomplete treatment. After returning to our country, the patient applying to us with complaints of high fever, chills, nausea, diarrhea and abdominal pain and was discharged with ful recovery.

Effects of methylphenidate on femoral bone growth in male rats.

The use of Methylphenidate (MP) can have adverse effects on bone growth and mineralization. This study aimed to investigate the underlying pathophysiology of MP-induced skeletal deficits in growing rats using stereological and immunohistochemical methods. Male rats, aged 4 weeks, were orally treated with MP through an 8-h/day water drinking protocol. The rats (n=30) were randomly divided into three groups: MP-High Dose (30/60 mg/kg/day MP), MP-Low Dose (4/10 mg/kg/day MP), and control (water only). After 13 weeks, the femoral bones were assessed using calliper measurements, dual-energy X-ray absorptiometry, and biomechanical evaluation. The total femur volume, cartilage volume, growth zone volume, and volume fractions were determined using the Cavalieri method. Immunohistochemical analyses were conducted using alkaline phosphatase and anti-calpain antibody staining. Rats exposed to MP exhibited significant reductions in weight gain, femoral growth, bone mineralization, and biomechanical integrity compared to the control group. The total femoral volume of MP-treated rats was significantly lower than that of the control group. The MP-High Dose group showed significantly higher ratios of total cartilage volume/total femoral volume and total growth zone volume/total femoral volume than the other groups. Immunohistochemical evaluation of the growth plate revealed reduced osteoblastic activity and decreased intracellular calcium deposition with chronic MP exposure. The possible mechanism of MP-induced skeletal growth retardation may involve the inhibition of intracellular calcium deposition in chondrocytes of the hypertrophic zone in the growth plate. In this way, MP may hinder the differentiation of cartilage tissue from bone tissue, resulting in reduced bone growth and mineralization.

Can Ratio of Neutrophil-to-Lymphocyte Count and Erythrocyte Sedimentation Rate in Diabetic Foot Infecti on Predict Osteomyelitis and/or Amputation?

The aim of this study was to search for any relations between the neutrophil-to-lymphocyte ratio (NLR) and the development of osteomyelitis and the need for amputation in patients with diabetic foot infection (DFI). All data included DFI patients who were hospitalized in our Infectious Diseases Clinic between 2012 and 2015 and who were classified according to International Classification Disease Code System. 75 patients were analyzed in the study. The DFI patients were stratified into 3 groups of whom had amputation procedure, whom had only debridement/drainage procedure and whom had any surgery procedure. Sidac post hoc analysis was used to perform the effects of NLR, C-reactive protein, erythrocyte sedimentation rate and glycosylated hemoglobin on the surgery procedure status. The DFI patients were also stratified into two another separate group for another analysis to search for the effect of NLR values on the development of osteomyelitis. The mean value of NLR in the amputated patients' group (15.7±10.3 was significantly higher than those with debridement procedure (9.9±5.6) and those without any surgery (6.0±2.8) (P=0.001). NLR values were also found significantly higher in patients with osteomyelitis in the second analysis (P=0.004). In this study, the NLR was found to have a predictive value on the development of osteomyelitis and on the progression to amputation in patients with DFI.

Diagnostic value of additional 18F-FDG PET/CT imaging using a vaginal catheter in patients with paravaginal malignant lesions.

BACKGROUND: In routine noncontrast-enhanced PET/computed tomography (CT) studies, the female pelvis is one of the most challenging anatomical regions to interpret. In surgically treated patients, it may be more difficult to determine the accurate location of paravaginal hypermetabolic lesions. In this study, the aim was to investigate the contribution of additional PET/CT imaging using a vaginal catheter in patients with pelvic malignant disease. METHODS: Forty-seven patients with pelvic malignancies were enrolled in this study. Following routine whole-body fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT scanning, an additional pelvic scan was obtained after placement of a plastic catheter in the vaginal lumen (v-catheter). All suspected foci in vaginal and paravaginal areas were evaluated for both studies. The contribution of additional v-catheter imaging was determined visually by five experienced interpreters. RESULTS: Pathological F-FDG uptake in various vaginal and/or paravaginal locations was detected in 24 of 47 patients after conventional PET/CT imaging. In 10 of these 24 patients, anatomic relations within the uptake area could not be confidently described and v-catheter imaging provided a significant contribution in all 10 cases. In seven of these 10 sites examined, pathological F-FDG uptake was safely ruled out and three sites were confirmed to be malignant. In total, the final interpretation in 13 of 24 patients (54%) was modified by additional v-catheter imaging. The contribution rate of catheter imaging was 89% in treated patients and 33% in untreated patients with vaginal and/or paravaginal lesions on initial scans. CONCLUSIONS: Additional v-catheter imaging of pelvis may be of diagnostic value in the accurate anatomical definition of hypermetabolic lesions in the vaginal/paravaginal area on noncontrasted PET/CT studies.

Early Response to Everolimus Therapy Detected on 68Ga-DOTATATE PET/CT in a Patient With Pancreatic Neuroendocrine Tumor.

Everolimus is a mammalian target of rapamycin inhibitor that has been recently approved for the treatment of patients with advanced progressive pancreatic neuroendocrine tumor. Here, we present a case in which an early therapy response to everolimus was effectively demonstrated by Ga-DOTATATE PET/CT.

Evaluation of febrile neutropenic episodes in adult patients with solid tumors.

The clinical use of cytotoxic chemotherapeutic agents has increased survival in cancer patients. However, treatment-associated bone marrow suppression and neutropenia often render patients prone to life-threatening infections. The aim of this study was to evaluate episodes of febrile neutropenia (FN) in patients with solid tumors, and identify the microorganisms and the factors affecting mortality. A total of 100 primary febrile attacks in cancer patients who were followed up at the Department of Oncology of the Akdeniz University Medical Faculty Hospital between January, 2011 and May, 2012, were retrospectively investigated. FN attacks were classified in three groups as follows: Fever of unknown origin, clinically documented infections and microbiologically documented infections. We found that prolonged neutropenia, Multinational Association for Supportive Care in Cancer (MASCC) score <21 and the presence of metastasis increased mortality. We also compared the three groups of infection categories according to mortality rate, but did not observe any significant differences among these groups. Patients with malignancies should be assessed individually during the FN episodes. It is crucial to keep possible infectious pathogens in mind and evaluate the MASCC score, neutropenia duration and metastatic status of the patients, and start empirical antibiotic therapy immediately.

Current radiological techniques used to evaluate unilateral partial ureteral obstruction: an experimental rabbit study.

AIM: The aim of this study was to evaluate functional and prognostic benefits of Doppler ultrasonography (DU), diuretic renal scintigraphy (DRS), and magnetic resonance urography (MRU) during diagnosis and follow-up of ureteropelvic junction obstruction (UPJO) and to examine apoptosis rates caused by UPJO in an experimental rabbit model. METHOD: Twenty-four rabbits were divided randomly into two groups. The left kidneys of 15 rabbits from the first group underwent Ulm-Miller surgery to create UPJO, whereas the left kidneys of nine rabbits from the second group underwent sham surgery. A pressure flow study (Whitaker's test) was done during postoperative week 6. Based on the Whitaker test, the DU, DRS, and MRU findings were compared. The number of apoptotic renal cells was counted after death. RESULT: The Whitaker test run during postoperative week 6 revealed obstructions in 15 rabbits from group 1; the nine rabbits of the sham group had no obstructions. Sensitivity and specificity of DRS were 93.3 and 88.8 %, respectively, and those of MRU were 93.3 and 88.8 %, respectively. The postoperative mean RI values were significantly higher than the preoperative values, associated with sensitivity of 86.6 % and specificity of 77.5 % for detecting UPJO. DRS, MRU, and RI could not predict UPJO in one (8 %), one (8 %), and two (16 %) kidneys, respectively. Likelihood ratio (LR) was 8.4 for MRU and scintigraphy, while for RI, LR was 3.9. Pathology specimens revealed that all kidneys with UPJO underwent apoptosis, and the number of apoptotic cells was significantly higher on the UPJO-created side than on the contralateral and in the sham group (p < 0.05). No test predicted all apoptosis related to UPJO. CONCLUSION: The RI, DRS, and DMRU results correlated with the pressure flow results for detecting UPJO. No single radiological technique predicted all initial UPJO-created kidneys that concluded with apoptosis. Further studies are required to seek with better methods for diagnosing an obstruction or to define a combination of radiological techniques aiding in the management decision.

CSF hydrothorax: neither migration of peritoneal catheter into the chest nor ascites. Case report and review of the literature.

INTRODUCTION: Complications of ventriculoperitoneal (V/P) shunt surgery are generally due to infection, or mechanical or dynamic dysfunction. Thoracic complications like cerebrospinal fluid (CSF) hydrothorax are rarely seen. PATIENT AND METHODS: We present a CSF hydrothorax patient as a rare complication of V/P shunt surgery and review of the literature. The patient was a 7-month-old girl who had V/P shunt surgery for hydrocephalus. Six months after surgery, she was admitted to hospital with the complaint of cough. As the chest X-ray revealed hydrothorax, a chest tube was inserted. Although her shunt tip was in the abdominal cavity in shuntograms, positive beta-2 transferrin in liquid sample and Tc 99m cisternography proved that it was CSF. After we replaced her V/P shunt with a ventriculoatrial shunt, the liquid coming from the chest tube progressively diminished and disappeared, and her chest tube was removed. RESULTS: There are 36 CSF hydrothorax cases, including the present case, in the literature. There is peritoneal catheter migration into the chest in 22 of them (61.1 %). Half of the remaining 14 cases (38.9 %) without catheter migration have also CSF ascites. But, in the other half (seven cases), there is neither catheter migration nor CSF ascites as in the present case. CONCLUSION: CSF hydrothorax following V/P shunt surgery is a very rare complication that may cause serious respiratory distress. It is important to keep in mind that peritoneal catheter migration into the chest may or may not occur. Even ascites may not accompany CSF hydrothorax in a patient without peritoneal catheter migration.

Acute renal failure with acyclovir treatment in a child with leukemia.

Acyclovir is an effective, frequently used antiviral agent. Adverse effects of this drug are well known and are especially seen with high doses and/or dehydration. In this article, we report a 6-year-old boy with leukemia with nonoliguric acute renal failure in normal hydration status after using acyclovir treatment. He had no preexisting renal impairment, and there were no additional symptoms. Dimercaptosuccinic acid radionucleid scyntigraphy and other laboratory findings revealed impairment of proximal tubule function, in addition to distal tubule. We emphasize that renal functions should be monitored carefully during treatment with acyclovir, and asymptomatic nephrotoxicity must be kept in mind.

Comparison of primary and secondary lower-extremity lymphedema treated with supermicrosurgical lymphaticovenous anastomosis and lymphaticovenous implantation.

Although some authors previously stated that microlymphatic surgery does not have application to primary lymphedema, opposite views are reported based on the observations that the lymphatics were not hypoplastic in majority of these patients and microlymphatic surgery yielded significant improvement. The aim of this study was to compare the intraoperative findings and outcomes of primary and secondary lower-extremity lymphedema cases treated with lymphaticovenous shunts. Between December 2006 and April 2009, microlymphatic surgery was performed in 80 lower extremities with primary and 21 with secondary lymphedema. These two groups of extremities are compared according to the morphology of the lymphatic vessels and possibility of precise anastomoses, their response to the treatment, and final outcomes based on volumetric measurements during the follow-up period. The morphology of the lymphatics in secondary lymphedema was more consistent, and at least one collector larger than 0.3 mm was available for anastomosis in 20 of 21 extremities. In the primary lymphedema group, the lymphatics were smaller than 0.3 mm in 13 of 80 extremities. It was, therefore, possible to perform supermicrosurgical lymphaticovenous anastomosis in 84% of extremities with primary lymphedema and 95% of extremities with secondary lymphedema. Reduction of the edema occurred earlier in the secondary lymphedema group, but the mean reduction in the edema volume was comparable between the two groups. Microlymphatic surgery, although more effective and offered as the treatment of choice for secondary lymphedema, would also be a valuable and relevant treatment of primary lymphedema.

Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema.

Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow-up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients.

The role of coughing as a gastroesophageal-reflux provoking maneuver: the scintigraphical evaluation.

BACKGROUND: Attempts have been made to improve the positivity of the radionuclide detection of gastroesophageal reflux (GER). The aim of this study was to examine the possible contribution of coughing as a provoking maneuver in GER scintigraphy. METHODS: One hundred and twenty-five patients (mean age: 9.2+/-3.2 years) who had a clinical probability of having GER and were fully able to cooperate for coughing on command were included in the study. The patients were asked to cough gently four to six times per minute in the 2nd, 4th, and 6th 10-min periods within a 60-min total study time. The presence and number of GER episodes were noted for each period in all patients. RESULTS: Sixty-one of 125 patients (48.8%) showed no scintigraphic finding of GER and were interpreted as normal. In the remaining 64 patients (51.2%), GER was observed and these patients were interpreted as abnormal (GER+). Among patients with abnormal results, 25 (39%) presented GER episodes only during the coughing intervals of the study. In 33 (51.6%) patients, the reflux was seen both at coughing and noncoughing periods. In only six patients (9.4%) with GER in noncoughing periods, coughing did not provoke any reflux episodes. No overall correlation between cough-provoked frequency of reflux, number of GER episodes, and symptom severity was found in 64 GER+ patients (P>0.5); but in the subgroup of patients presenting GER episodes only during the coughing intervals, 60% (15 of 25), presented GER episodes only in one of the three cough-provoked intervals and also had the lowest symptom severity scores. CONCLUSION: The results of our study showed that 39% (25 of 64) of the observed GER findings were achieved exclusively by means of cough provocation.

Orbital drainage of different sizes of colloids in rabbits: a dynamic scintigraphic study.

PURPOSE: To investigate the drainage patterns of radiolabeled colloids of different sizes injected into the orbital cavity in an animal model. METHODS: Twenty-one orbits of 11 rabbits were included in the study. In group 1, human serum macroaggregates with particle sizes of 10 to 100 microm, labeled with 10 mL of 1480 MBq (40 mCi) technetium pertechnetate Tc 99m (99mTc), were used. In group 2, human serum albumin colloidal particles with particle sizes of 50 to 80 nm, labeled with 5 mL of 740 MBq (20 mCi) 99mTc, were used. In group 3, colloidal tin with particle sizes of 300 to 600 nm, labeled with 9 mL of 1665 MBq (45 mCi) 99mTc, were used. The dynamic acquisition of liver for 10 minutes (120 frames for 5 seconds) in a 128 x 128 matrix was acquired immediately after intraorbital injection and at the end of the second hour. RESULTS: The liver in groups 2 and 3 and the lung in group 1 were visualized in 10 seconds or less in six, five, and four rabbits, respectively. The injected activity persisted in the orbits in varying percentages in all rabbits at the end of acquisition. CONCLUSIONS: Intraorbital injections have a great potential for systemic absorption and should not be considered as local pharmaceutical administration.

Effect of types of resection and manipulation on trocar site contamination after laparoscopic colectomy: An experimental study in rats with intraluminal radiotracer application.

BACKGROUND: The etiology and incidence of port-site metastases after laparoscopic surgery for colorectal cancer remain unknown. The purpose of this experimental study was to detect and quantify the amount of contamination at the port-site by means of a method utilizing radiolabelled colloid particles following extra- or intracorporeal laporoscopic resection of cecum. METHODS: Prior to experimental surgery, we obtained a high concentration of luminal colonic radiotracer activity by per anum application of sulphur colloid molecules labelled with Tc-99m pertechnetate. In three main groups of rats, we either resected a portion of cecum extracorporeally or intracorporeally, or did no resection. Each main group was further divided into two subgroups, in which the manipulations were either autraumatic or traumatic. We excised trocar sites as 2 cm doughnuts after completion of the surgical procedure. We used gamma camera imaging to quantify the amount of radioactive contamination at trocar sites. The background corrected trocar site activity for each rat was calculated. Activities exceeding the maximum background activity were accepted as trocar site contamination. RESULTS: We detected an overall incidence of contamination in 44% of rats. This rate were 71% and 17% in traumatic and atraumatic subgroups. The resection itself increased the rate and intensity of contamination, as well (p = 0.04). The most intensive contamination was detected in the intracorporeal resection with traumatic manipulation subgroup (p = 0.0007). CONCLUSIONS: Both the presence of resection and manipulative trauma seemed to be increasing the rate and intensity of the radioactive activity at the trocar site. When traumatic manipulatiun was exercised, the contamination was so intense that the type of resection did not differ. We concluded that our scintigraphic method would be useful in the intraoperative detection of port site contamination by the tumor cells, and that surgeons would take some preventive measures to prevent future port-site metastases.

Periodontal & systemic bone changes in rats with experimental lathyrism.

BACKGROUND & OBJECTIVE: It is not clear how lathyrism affects the systemic bone metabolism. We therefore undertook a study to observe periodontal and systemic bone changes by performing radiological, metabolic, and bone densitometric evaluations in rats with experimental lathyrism. METHODS: A total of 30 rats were used. Experimental lathyrism was induced by once daily subcutaneous administration of beta-aminopropionitrile (beta-APN), at a dose of 5 mg beta-APN/0.4 ml per 100 g of body weight for 40 days. After 40 days, vertebral bone mineral density was analyzed by means of dual energy X-ray absorbtiometry in both groups. Blood was drawn by cardiac puncture and the animals were decapitated. Serum calcium levels were measured. Right mandibles were removed and radiographs were obtained. Alveolar bone level was determined in the radiographs. RESULTS: In all lathyritic rats, alveolar bone level was pathologically decreased with visible resorption. Vertebral bone mineral density values of lathyritic rats did not differ significantly from those of the control group. Compared to controls, there was a statistically significant decrease in serum calcium levels in the lathyritic group (P<0.001). INTERPRETATION & CONCLUSION: Significant alveolar bone resorption without alterations in vertebral bone mineral density indicated that lathyrogen administration for 40 days presumably has not caused systemic demineralization. This model could be used for studying the role of local and systemic agents on periodontal alveolar bone resorption.

Frontal functions in young patients with essential tremor: a case comparison study.

Essential tremor (ET) is classified as a pure motor system disease. It has been previously reported that impairments in cognitive functions can be associated with ET. The authors assessed cognitive functions in a relatively young patient group with ET and comparison subjects. Correlations between tremor severity and regional cerebral blood flow (rCBF) and neuropsychological test performances of ET patients and comparison subjects were investigated. Sixteen patients with ET and 16 comparison subjects were assessed by a comprehensive neuropsychological test battery designed to assess global attention, language, memory, visuospatial functions, and executive functions. In 11 of 16 patients and in nine of 16 comparison subjects, rCBF was measured by technetium-99m-hexamethyl propylene amine oxime single photon emission computed tomography (technetium-99m-HMPAO SPECT). The tremor severity was quantified using the Clinical Rating Scale for Tremor (CRST). Findings revealed that ET patients differed significantly from comparison subjects on tests assessing visuospatial functions and verbal memory, whereas differences in other tests did not reach statistical significance. There was no significant difference between the rCBF of ET patients and comparison subjects. There were statistically significant inverse correlations between tremor severity and executive functions. Tremor severity was inversely correlated with bilateral frontal blood flow by technetium-99m-HMPAO SPECT. Conclusions suggest that the subclinical cognitive deficits characterized by visuospatial and verbal memory impairments and executive dysfunction may be a clinical feature of ET, and the cerebello-thalamo-frontal network may play a role in the pathophysiology of this disorder.

The evaluation of microleakage and bond strength of a silicone-based resilient liner following denture base surface pretreatment.

STATEMENT OF PROBLEM: The failure of adhesion between a silicone-based resilient liner and a denture base is a significant clinical problem. PURPOSE: The purpose of this study was to examine the effects of denture base resin surface pretreatments with different chemical etchants preceding the silicone-based resilient liner application on microleakage and bond strength. The initial effects of chemical etchants on the denture base resin in terms of microstructural changes and flexural strength were also examined. MATERIAL AND METHODS: Forty-two polymethyl methacrylate (PMMA) denture base resin (Meliodent) specimens consisting of 2 plates measuring 30 x 30 x 2 mm were prepared and divided into 7 groups (n = 6). Specimen groups were treated by immersion in acetone for 30 (A30) or 45 (A45) seconds, methyl methacrylate monomer for 180 (M180) seconds, and methylene chloride for 5 (MC5), 15 (MC15) or 30 (MC30) seconds. Group C had no surface treatment and served as the control. Subsequently, an adhesive (Mollosil) and a silicone-based resilient denture liner (Mollosil) were applied to the treated surfaces, and all specimens were immersed in the radiotracer solution (thalium-201 chloride) for 24 hours. Tracer activity (x-ray counts), as a parameter of microleakage, was measured using a gamma camera. For bond-strength measurement, 84 rectangular PMMA specimens (10 x 10 x 40 mm) were surface-smoothed for bonding and treated with the different chemical etchants using the same previously described group configurations. The adhesive and the silicone-based denture liner were applied to the treated surfaces. Tensile bond-strength (MPa) was measured in a universal testing machine. Flexural strength measurement was performed with 49 PMMA specimens (65 x 10 x 3.3 mm according to ISO standard 1567) in 7 groups (n = 7), with 1 flat surface of each treated with 1 of the chemical etchants preceding adhesive application. The flexural strength (MPa) was measured using a 3-point bending test in a universal testing machine. The data were analyzed by 1-way analysis of variance and the Tukey HSD test (alpha = .05). RESULTS: Significant differences were found between the groups in terms of microleakage (P < .0001). The lowest microleakage was observed in group M180 (30,000 x-ray counts) and the highest in the control group (44,000 x-ray counts). The mean bond strength to PMMA resin ranged from 1.44 to 2.22 MPa. All treated specimens showed significantly higher bond strength than controls (P < .01). The flexural strength values all significantly differed (P < .05). All experimental specimens that had chemical surface treatments showed lower flexural strength than controls (P < .05). CONCLUSION: Treating the denture base resin surface with chemical etchants increased the bond strength of silicone-based resilient denture liner to denture base and decreased the microleakage between the 2 materials. Considering the results of both tests together, the use of methyl methacrylate monomer for 180 seconds was found to be the most effective chemical treatment.

Myocardial perfusion defects with near-to-absent count reduction: a comparison of gated SPECT to radionuclide ventriculography in the determination of left ventricular function.

OBJECTIVE: The main aim of the study was, to estimate the impact of perfusion defects including significantly depleted areas of varying size on gated perfusion SPECT (GPS) determined ejection fraction (EF) measurements in comparison to radionuclide ventriculography (RVG). A secondary objective was the evaluation of the GPS-RVG agreement of EF in patients with normal and deteriorated left ventricular function, separately. METHODS: Fifty-nine patients having perfusion defects including at least one segment with no visible tracer uptake in rest myocardial GPS related to myocardial infarction (older than 15 days) were studied. Myocardial perfusion was visually analyzed using a 17 segment-model, on a five-point (0-4) grading system in which Grade-4 (0-9% maximal uptake) represents cold defects. The patients with >or=4 adjacent, with 2-3 adjacent and with 1 single cold segments were named as Group1(GR1), Group2(GR2) and Group3(GR3), respectively. Secondly, the patients were re-grouped according to RVG-EF values. (Group A: patients with EF<50%; Group B: patients with EF>or=50%). In each group, the GPS-EFs were compared with RVG performed within one week and also the variations of GPS-RVG EF differences among the groups were statistically analyzed. RESULTS: In overall (r=0.86) and in each subgroup, EFs obtained by GPS were well correlated with RVG. However, in overall (difference mean EF% [dEF%]=4.6+/-6.7, p<0.001) as well as in subgroup evaluation, GPS significantly (p<0.005) underestimated EF. There was no statistically significant difference in GPS-RVG EF variations between GR1, GR2 and GR3 (p>0.05). The RVG-mean differences and RVG-correlation coefficients calculated for GR1,GR2 and GR3 were dEF%=3.1+/-4.6, r=0.85; dEF%=3.7+/-6.03, r=0.80 and dEF%=6.2+/-8.03, r=0.79, respectively. Mean dEF% was statistically higher in group-B than group-A (mean difference of dEF%=4,2, p<0.05). In group-A, GPS-EF values were better agreed with RVG (dEF%=3.34, r=0.75) than in group-B (dEF%=7.52, r=0.53). CONCLUSION: The stability of the calculation algorithm of QGS in EF calculation of patients with large depleted infarct areas could be confirmed. The agreement of GPS determined EF is higher in patients having myocardial integrity loss and left ventricular dysfunction.

Apical hypertrophic cardiomyopathy: a case of slow flow in lad and malign ventricular arrhythmia.

The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of epicardial coronary artery disease. Patients often present with acute coronary syndrome. Histopathologic studies have revealed the existence of fibromuscular hyperplasia and myofibrilar hypertrophy. Apical hypertrophic cardiomyopathy is a benign progressive form of hypertrophic cardiomyopathy, that is rarely observed in western communities. It remains commonly asymptomatic until advanced ages. Syncope, arrhythmia or sudden death may be the first symptom. We report a case of slow coronary arterial flow in a 71-year-old male patient with apical hypertrophic cardiomyopathy who experienced chest pain and sudden cardiac arrest due to ventricular arrhythmia.