RESUMEN
This paper introduces a novel data-driven approximation method for the Koopman operator, called the RC-HAVOK algorithm. The RC-HAVOK algorithm combines Reservoir Computing (RC) and the Hankel Alternative View of Koopman (HAVOK) to reduce the size of the linear Koopman operator with a lower error rate. The accuracy and feasibility of the RC-HAVOK algorithm are assessed on Lorenz-like systems and dynamical systems with various nonlinearities, including the quadratic and cubic nonlinearities, hyperbolic tangent function, and piece-wise linear function. Implementation results reveal that the proposed model outperforms a range of other data-driven model identification algorithms, particularly when applied to commonly used Lorenz time series data.
RESUMEN
The gamma probe is a commonly used detector for localizing sentinel lymph nodes after the injection of radiopharmaceuticals. In recent years, studies have focused on improving the features of gamma probes to achieve more consistent localization of the radiotracer uptake. As part of this effort, a novel gamma probe prototype based on an active shielding was developed, and its characteristics, including sensitivity, resolution and shielding effectiveness, were determined. The prototype integrates trapezoidal-shaped bismuth germanate (BGO) array coupled with a silicon photomultiplier (SiPM) array, accompanied by dedicated electronics and software for stand alone usage. We conducted a thorough characterization, validating experimental observations through Monte Carlo simulations using the GEANT4 simulation package. In scattering environment, with a probe-source distance of 30 mm, the experimental results show that the detector sensitivity is 120 ± 5 cps/MBq, and the spatial and angular resolutions, in terms of full width at half maximum (FWHM), are 44.8 ± 1.3 mm and 87.3 ± 1 . 5 ∘ , respectively. The shielding effectiveness of the probe was determined to be greater than 95 % . The prototype with active shielding was found to have comparable performance to conventional gamma probes.
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OBJECTIVE: In this study, we aimed to investigate the most appropriate education method for patients to use their inhaler devices with the proper technique. PATIENTS AND METHODS: The study had a cross-sectional, multicenter design. 525 consecutive patients who had never used an inhaler therapy before were included in the study. Seven different types of inhalers were evaluated. 75 patients were included for each device type. For each device type, 25 patients were trained by their own physicians who personally demonstrated the use of the device [verbal education with physical demonstration (VEWPD)], 25 were given multimedia-assisted training (MAT), and 25 received both types of training together (first VEWPD followed by MAT). After the patients were trained, inhaler medications were used under the supervision of a physician. Correct use of the inhaler devices and perceptions of convenience were scored. RESULTS: For Ellipta inhaler device and Levered Diskus inhaler device, the proportion of patients using their devices properly was significantly higher in patients who were instructed with both of the methods together compared to other education groups (p = 0.011, p = 0.015). The effects of different types of training on learning in Sanohaler, Diskus inhaler, and Pressurized metered dose inhaler devices were the same. CONCLUSIONS: We could not come to a conclusion that multimedia training was more beneficial than other training. As an unexpected result, in almost all of the devices, patients who received multimedia training in combination with verbal training did not develop better learning despite being shown the use of the device twice (except Ellipta inhaler, and Levered Diskus inhaler device).
Asunto(s)
Multimedia , Nebulizadores y Vaporizadores , Humanos , Estudios Transversales , Inhaladores de Dosis Medida , Administración por InhalaciónRESUMEN
BACKGROUND: Fournier's Gangrene (FG) is the necrotizing fasciitis of the perineal region. AIMS: To compare the effectiveness of debridement alone and debridement with vacuum-assisted closure in the treatment of Fournier's gangrene. METHODS: Twenty-two patients operated for FG were analyzed retrospectively. Debridement-only and debridement + VAC treatment groups were compared in terms of age, gender, predisposing factors, comorbid diseases, intensive care unit and hospital stay durations, laboratory results, septic shock, treatment methods, Fournier' gangrene severity index (FGSI) and mortality. RESULTS: The M/F ratio was 13/9. There were 10 and 12 patients in debridement-only and debridement + VAC groups, respectively. Ten patients (45.5%) were admitted to intensive care unit, 8 (36.4%) needed colostomy and 7 (31.9%) developed septic shock, respectively. The mortality rate was 27.3%. There was no significant difference in terms of age, gender, laboratory parameters, number of debridement, length of stay in intensive care unit and hospital, shock duration, and mortality (P > 0.05). The FGSI scores also did not show any difference between the groups which showed that the severity of the disease in both groups are similar. CONCLUSION: The VAC treatment was found not to provide a statistically significant benefit on mortality. Early and adequate debridement and antibiotic are still the most important factors in the treatment of FG and to reduce mortality.
Asunto(s)
Gangrena de Fournier , Terapia de Presión Negativa para Heridas , Antibacterianos/uso terapéutico , Desbridamiento , Gangrena de Fournier/cirugía , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND: Induction therapy is mostly recommended for deceased-donor transplantation, whereas it has some controversies in live-donor transplantation. In this study, we described the outcomes of live-donor renal transplant recipients who received ATG-Fresenius (ATG-F) induction. METHODS: Live-donor transplantations in patients over 18 years old with ATG-F induction between 2009 and 2015 were included. All patients received quadruple immunosuppression, one of which was ATG-F induction. Biopsies after the artery anastomosis (zero hour) and protocol biopsies at the 6th month and at the 1st first year were obtained. Acute graft dysfunction was defined as a 20% to 25% increase in creatinine level from baseline. All acute rejection episodes were biopsy-confirmed. All episodes were initially treated with intravenous methyl prednisolone (MP) or ATG-F if resistant to MP. Four hundred twenty-two patients with live-donor transplantation were evaluated. The mean age was 40 ± 13 (18-73) years. The mean panel-reactive antibody levels were 42% ± 30% and 45% ± 30% for class I and II, respectively. RESULTS: The mean mismatch number for living unrelated donors (n = 112) was 4.6 ± 1.0. Acute rejection rate was 29.1% (123 patients) within the first year. The mean cumulative ATG-F doses for per patient and per kilogram were 344 ± 217 mg and 5.1 ± 2.7 mg, respectively. Patient survival rates were 98.3% and 96.7% for 12 months and 60 months, respectively. Death-censored graft survival rates were 97.6% and 92.1% for 12 months and 60 months, respectively. CONCLUSIONS: ATG-F induction provided excellent graft and patient survival rates without any significantly increased side effects. Increasing sensitized patient numbers, more unrelated donors, increasing re-transplantation numbers, and more desensitization protocols make ATG-F more favorable in an induction regimen.
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Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Inmunosupresores/uso terapéutico , Trasplante de Riñón/métodos , Adulto , Femenino , Humanos , Terapia de Inmunosupresión/métodos , Trasplante de Riñón/efectos adversos , Donadores Vivos , Masculino , Persona de Mediana EdadRESUMEN
Background and Objective: Specific allergen immunotherapy is the only treatment modality that might change the natural course of allergic diseases in childhood. We sought to prospectively compare the long-term clinical and immunological effects of sublingual (SLIT) and subcutaneous (SCIT) immunotherapy compared with pharmacotherapy alone. Methods: In this single-center, prospective randomized controlled trial, 48 children with mild persistent asthma with/without rhinitis, monosensitized to house dust mites (HDMs) were followed for 3 years. At baseline and years 1 and 3 of follow-up, patients were evaluated and compared for total rhinitis (TRSS) and asthma (TASS) symptom scores, total symptom scores (TSS), total medication scores (TMS), safety profiles, skin-nasal-bronchial reactivity, and immunological parameters. Results: A significant reduction was observed in TASS for both HDM-SCIT and HDM-SLIT at year 3 of treatment compared with baseline and controls (P<.05 for both), with significant improvement in rhinitis symptoms for both groups compared with controls (P=.01 for both). TSS decreased significantly in both HDM-SCIT and HDM-SLIT at year 3 compared with baseline (P=.007 and P=.04, respectively) and controls (P<.01 for both). A significant reduction in TMS was observed in HDM-SCIT and HDM-SLIT compared with baseline and controls (P=.01 in all cases), with a reduction in skin reactivity to HDM (P<.05). Finally, a significant increase in allergen specific IgG4 was observed in the SCIT group at year 3 compared with baseline, the SLIT group, and controls (P<.001 in all cases). Conclusions: HDM-sensitized asthmatic children treated for at least 3 years with either SCIT or SLIT showed sustained clinical improvement (AU)
Antecedentes: La inmunoterapia con alérgenos es el único tratamiento que podría cambiar el curso natural evolutivo de las enfermedades alérgicas en la infancia. Nuestro objetivo era comparar, de manera prospectiva, la eficacia a largo plazo de la inmunoterapia sublingual (SLIT) y subcutánea (SCIT), con el tratamiento exclusivo con farmacoterapia convencional. Métodos:En este ensayo clínico, prospectivo de tres años de duración, realizado en un solo centro y aleatorizado, se incluyeron 48 niños con asma leve persistente, con o sin rinitis asociada, monosensibilizados a los ácaros del polvo (HDM). Los pacientes fueron evaluados al inicio, al año y a los tres años de tratamiento, comparándose los cambios en la puntuación de síntomas nasales (TRSS), bronquiales (TASS), puntuación total de síntomas (TSS) y consumo de medicación (TMS), perfil de seguridad, reactividad frente al alérgeno cutánea, nasal y bronquial y diversos parámetros inmunológicos. Resultados: Se observó una reducción significativa del TASS tanto para el grupo HDM-SCIT como HDM-SLIT al final del tercer año de tratamiento, tanto cuando se comparaba con la situación basal como con los cambios observados en el grupo control (p<0.05, respectivamente). El TRSS también mejoró significativamente en ambos grupos HDM-SCIT y HDM-SLIT en el tercer año de tratamiento, cuando los cambios se compararon con los observados en el grupo control (p=0,01, en ambos). El TSS y el TMS disminuyeron también significativamente en ambos grupos HDM-SCIT y HDM-SLIT en el tercer año, comparado con la situación basal (p=0,007, p=0,04/ p=0,01, p=0,01 respectivamente) y con el grupo control (p<0,01,p<0,01/ p=0,01, p=0,01, respectivamente). Tras tres años de tratamiento la reactividad cutánea frente a los alérgenos de los ácaros disminuyó significativamente (p<0,05). Los niveles de IgG4 específica frente a ácaros se incrementaron en el grupo SCIT-HDM, comparados con la situación basal y con los cambios observados en el grupo SLIT-HDM y control (p<0,001, respectivamente). Conclusiones: El tratamiento durante tres años con inmunoterapia específica tanto SCIT como SLIT se acompañó de una eficacia clínica sostenida, en este grupo de niños asmáticos sensibilizados a los ácaros del polvo. Ambas rutas de administración de la inmunoterapia parecen tener mecanismos de acción similares (AU)
Asunto(s)
Niño , Femenino , Humanos , Masculino , Inmunoterapia Sublingual/métodos , Inmunoterapia Sublingual , Inmunoterapia/métodos , Inmunoterapia/normas , Desensibilización Inmunológica/métodos , Asma/inmunología , Asma/terapia , Rinitis/inmunología , Rinitis/terapia , Absorción Subcutánea , Estudios Prospectivos , Infestaciones por Ácaros/tratamiento farmacológico , Ácaros , Ácaros/inmunología , Pruebas Cutáneas/métodos , Inmunoadhesinas CD4/inmunologíaRESUMEN
BACKGROUND AND OBJECTIVE: Specific allergen immunotherapy is the only treatment modality that might change the natural course of allergic diseases in childhood. We sought to prospectively compare the long-term clinical and immunological effects of sublingual (SLIT) and subcutaneous (SCIT) immunotherapy compared with pharmacotherapy alone. METHODS: In this single-center, prospective randomized controlled trial, 48 children with mild persistent asthma with/without rhinitis, monosensitized to house dust mites (HDMs) were followed for 3 years. At baseline and years 1 and 3 of follow-up, patients were evaluated and compared for total rhinitis (TRSS) and asthma (TASS) symptom scores, total symptom scores (TSS), total medication scores (TMS), safety profiles, skin-nasal-bronchial reactivity, and immunological parameters. RESULTS: A significant reduction was observed in TASS for both HDM-SCIT and HDM-SLIT at year 3 of treatment compared with baseline and controls (P<.05 for both), with significant improvement in rhinitis symptoms for both groups compared with controls (P=.01 for both). TSS decreased significantly in both HDM-SCIT and HDM-SLIT at year 3 compared with baseline (P=.007 and P=.04, respectively) and controls (P<.01 for both). A significant reduction in TMS was observed in HDM-SCIT and HDM-SLIT compared with baseline and controls (P=.01 in all cases), with a reduction in skin reactivity to HDM (P<.05). Finally, a significant increase in allergen specific IgG4 was observed in the SCIT group at year 3 compared with baseline, the SLIT group, and controls (P<.001 in all cases). CONCLUSIONS: HDM-sensitized asthmatic children treated for at least 3 years with either SCIT or SLIT showed sustained clinical improvement.
Asunto(s)
Antiasmáticos/uso terapéutico , Asma/terapia , Pyroglyphidae/inmunología , Rinitis Alérgica/terapia , Inmunoterapia Sublingual/métodos , Animales , Antígenos Dermatofagoides/inmunología , Proteínas de Artrópodos/inmunología , Asma/complicaciones , Asma/inmunología , Niño , Cisteína Endopeptidasas/inmunología , Desensibilización Inmunológica/métodos , Femenino , Volumen Espiratorio Forzado , Humanos , Hipersensibilidad/complicaciones , Hipersensibilidad/inmunología , Hipersensibilidad/terapia , Inmunoglobulina E/inmunología , Inmunoglobulina G/inmunología , Inyecciones Subcutáneas , Interferón gamma/inmunología , Interleucina-10/inmunología , Interleucina-5/inmunología , Leucocitos Mononucleares/inmunología , Estudios Longitudinales , Masculino , Rinitis Alérgica/complicaciones , Rinitis Alérgica/inmunología , Resultado del TratamientoRESUMEN
Objetivo. El corazón es uno de los órganos afectados por la anemia de células falciforme (SCA). El objetivo de este estudio prospectivo es evaluar la perfusión miocárdica y la función del ventrículo izquierdo (LV) en niños con SCA por la gammagrafía de perfusión miocárdica (G-MPS) y comparar los resultados con los hallazgos ecocardiográficos. Métodos. Se evaluaron cuarenta y tres pacientes con SCA mediante estudios de G-MPS y ecocardiografía. La perfusión miocárdica y la función ventricular con la valoración de la motilidad y del engrosamiento se analizaron tanto de forma visual como cuantitativa. Se calcularon el EDV, ESV, EF, y el índice pulmón /corazón (L/H). Resultados. Ninguno de los pacientes presentó deterioro de la perfusión post-estrés en el G-MPS. Se observó dilatación del LV en 15 pacientes, que también estuvo presente en el ecocardio. Los valores de EF se encontraban dentro de los límites normales. La correlación entre los valores de EF, mediante ambos métodos no fueron estadísticamente significativas. Sin embargo la dilatación del ventrículo izquierdo detectados por ambos métodos y los valores de EDV-ESV en la G-MPS se correlacionaron con los diámetros sistólico y diastólico final calculados por la ecocardiografía (p<0,05). La ecocardiografía en modo-M mostró mayor índice de rendimiento miocárdico (LV-MPI) en pacientes con dilatación del LV. También hubo una relación significativa entre la dilatación del ventrículo izquierdo y la frecuencia de transfusiones sanguíneas (> 5/año) y el síndrome torácico agudo (p <0,05). Conclusión. El deterioro de la perfusión miocárdica en los niños con SCA no se observa con frecuencia. Debe considerarse el realizar la gammagrafía sólo en pacientes con síntomas cardíacos. Puesto que los valores de EF de los niños con SCA no se deterioran en las primeras etapas, el LV-MPI y la dilatación del ventrículo izquierdo deberían considerarse como un parámetro significativo(AU)
Objectives. The heart is one of the organs affected by sickle cell anemia (SCA). This prospective study has aimed to evaluate myocardial perfusion and left ventricle (LV) function in children with SCA by gated myocardial perfusion scintigraphy (G-MPS) and to compare the results with echocardiographic parameters. Methods. Forty-three patients with SCA were evaluated by G-MPS and echocardiography. Myocardial perfusion and motion with thickening function were analyzed both visually and quantitatively. End-diastolic (EDV), end-systolic volumes (ESV), ejection fraction (EF), lung-to-heart (L/H) ratio were also calculated. Results. None of the patients showed stress perfusion impairment in G-MPS. LV dilatation in 15 patients was observed both by G-MPS and echocardiography. EF values were within normal limits. Correlation between EF values calculated by two methods was not statistically significant. However, LV dilatation detected by both methods and EDV-ESV values in G-MPS were correlated to end-diastolic and end-systolic diameters calculated in echocardiography (p<0.05). M-Mode echocardiography revealed higher myocardial performance index (LV-MPI) in patients with LV dilatation. There was also a significant relationship between LV dilatation and frequent blood transfusions (>5/years) and acute chest syndrome (p<0.05). Conclusion. Myocardial perfusion impairment in children with SCA is not frequently observed. Thus, performing the scintigraphy only in patients with cardiac symptoms should be considered. Since EF values of the children with SCA are not deteriorated in early stages, LV-MPI and LV dilatation should be considered as a significant parameter other than EF or perfusion data(AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Imagen de Perfusión Miocárdica/métodos , Imagen de Perfusión Miocárdica , Ecocardiografía/métodos , Ecocardiografía , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/diagnóstico , Anemia de Células Falciformes/fisiopatología , Anemia de Células Falciformes , Estudios ProspectivosRESUMEN
Hallazgos inesperados en la gammagrafía ósea, tales como la captación asimétrica en las extremidades, pueden causar confusión en el diagnóstico. Los autores describen tres casos de inyección intraarterial accidental de 99mTc-metilenedifosfonato (99mTc-MDP) en la región antecubital, discutiendo el origen de los hallazgos y su diagnóstico diferencial(AU)
Unexpected findings on bone scintigraphy such as asymmetrical uptake in extremities may cause confusion for the diagnosis. The authors describe three cases of accidental intraarterial injection of Tc-99m methylene diphosphonate (99mTc-MDP) on the antecubital region and discuss the findings and differential diagnosis(AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Extremidad Superior/patología , Extremidad Superior , Exametazima de Tecnecio Tc 99m , Inyecciones Intraarteriales/métodos , Inyecciones Intraarteriales , Infusiones Intraarteriales/instrumentación , Infusiones Intraarteriales/métodos , Infusiones Intraarteriales/tendencias , Infusiones Intraarteriales , Medicina Nuclear/métodosRESUMEN
Objetivo. La espondilitis anquilosante (AS) es una enfermedad inflamatoria crónica con inflamación importante en las articulaciones y los órganos extraarticulares. Los pacientes con AS tienen aproximadamente dos veces más riesgo de mortalidad que la población normal. Una de las razones de este aumento en mortalidad, es el aumento del riesgo cardiovascular. Este estudio se planificó para evaluar la perfusión miocárdica y función ventricular izquierda con 99mTc-MIBI perfusión miocárdica sincronizada computarizada por emisión de foton único (SPECT). Material y métodos. El grupo de estudio consistió en 28 pacientes con AS (19 hombres y 9 mujeres), y la edad media de 39,46±10,98 años. Todos los pacientes fueron sometidos a 99mTc-MIBI SPECT de perfusión miocárdica sincronizada con el protocolo del mismo día. Resultados. Hemos detectado varios factores de riesgo como el hábito de fumar en 12, antecedentes familiares de enfermedad cardiovascular en 12, la hipertensión arterial en 3, la hiperlipidemia en 9 pacientes. Hemos llevado a cabo la perfusión miocárdica SPECT para cada paciente, el patrón de perfusión normal siendo en las imágenes SPECT. De los 28 pacientes, ocho pacientes tuvieron una perfusión normal, pero anomalías en el movimiento de la pared. Conclusión. Hemos detectado que la perfusión miocárdica se preserva en los pacientes con AS. Sin embargo, se observa anormalias en el movimiento de la pared venticular izquierda. Llegamos a la conclusión que la espondilitis anquilosante pueda ser asociados con la disfunción microvascular y la gammagrafía de perfusión miocárdica sincronizada podría ser útil en pacientes con EA para la evaluación de la función del ventrículo izquierdo, aún si existe una baja puntuación en el índice de actividad de la enfermedad espondilitis anquilosante (BASDAI) y menor duración de la enfermedad(AU)
Background. Ankylosing spondilitis (AS) is a chronic inflammatory disease with prominent inflammation in joints and extraarticular organs. AS patients have approximately two times more risk of mortality than the normal population. One reason for this increase in mortality is increased cardiovascular risk. In this study, we have aimed to evaluate myocardial perfusion and left ventricular function using 99mTc-MIBI gated myocardial perfusion single photon emission computed tomography (SPECT). Material and methods. The study group consisted of 28 AS patients (19 men, 9 women), and mean age 39.46±10.98 years. All patients underwent 99mTc-MIBI gated myocardial perfusion SPECT with the same day protocol. Results. We detected various risk factors including smoking habits in 12, family history of cardiovascular disease in 12, hypertension in 3, hyperlipidemia in 9 patients. We performed a myocardial perfusion SPECT for each patient and found normal perfusion pattern in SPECT images. Out of 28 patients, eight patients had normal perfusion but wall motion abnormalities. Conclusion. We detected that myocardial perfusion is preserved in the patients with AS. However, left ventricular wall motion abnormalities are seen. We concluded that ankylosing spondylitis may be associated with microvascular dysfunction and gated myocardial perfusion scintigraphy could be valuable in AS patients for the evaluation of LV function even if the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score are low and the disease duration shorter(AU)
Asunto(s)
Humanos , Masculino , Femenino , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca/métodos , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Imagen de Perfusión Miocárdica/métodos , Función Ventricular/efectos de la radiación , /efectos de la radiación , /tendenciasRESUMEN
Los autores describen un patrón poco frecuente al observar captación de 99mTc-MDP a nivel de tejidos blandos en la gammagrafía ósea (GO) realizada a dos pacientes con diagnóstico de Linfoma no Hodgkin. Los dos pacientes tenían masas abdominales y la GO revelo captación del trazador en la región abdominal. Se discuten los posibles mecanismos de captación de los trazadores óseos en los tejidos blandos(AU)
The authors describe a rare pattern of soft tissue uptake observed in a 99mTc-MDP bone scintigraphy of two patients with the diagnosis of non-Hodgkin's lymphoma. Both patients had abdominal masses and bone scintigraphy revealed unusual 99mTc-MDP uptake in the abdominal region. The possible mechanisms of soft tissue uptake of bone seeking agents are discussed(AU)
Asunto(s)
Humanos , Masculino , Femenino , Pentetato de Tecnecio Tc 99m , Tecnecio , Linfoma no Hodgkin/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico , Linfoma no Hodgkin , Trazadores RadiactivosAsunto(s)
Circulación Colateral , Eritrocitos , Hemorragia Gastrointestinal/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Venas Umbilicales/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/patología , Vena Ilíaca/patología , Hallazgos Incidentales , Hepatopatías Alcohólicas/complicaciones , Hepatopatías Alcohólicas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Vena Porta/patología , Cintigrafía , Radiofármacos , Tecnecio , Venas Umbilicales/patologíaRESUMEN
OBJECTIVES: The heart is one of the organs affected by sickle cell anemia (SCA). This prospective study has aimed to evaluate myocardial perfusion and left ventricle (LV) function in children with SCA by gated myocardial perfusion scintigraphy (G-MPS) and to compare the results with echocardiographic parameters. METHODS: Forty-three patients with SCA were evaluated by G-MPS and echocardiography. Myocardial perfusion and motion with thickening function were analyzed both visually and quantitatively. End-diastolic (EDV), end-systolic volumes (ESV), ejection fraction (EF), lung-to-heart (L/H) ratio were also calculated. RESULTS: None of the patients showed stress perfusion impairment in G-MPS. LV dilatation in 15 patients was observed both by G-MPS and echocardiography. EF values were within normal limits. Correlation between EF values calculated by two methods was not statistically significant. However, LV dilatation detected by both methods and EDV-ESV values in G-MPS were correlated to end-diastolic and end-systolic diameters calculated in echocardiography (p<0.05). M-Mode echocardiography revealed higher myocardial performance index (LV-MPI) in patients with LV dilatation. There was also a significant relationship between LV dilatation and frequent blood transfusions (>5/years) and acute chest syndrome (p<0.05). CONCLUSION: Myocardial perfusion impairment in children with SCA is not frequently observed. Thus, performing the scintigraphy only in patients with cardiac symptoms should be considered. Since EF values of the children with SCA are not deteriorated in early stages, LV-MPI and LV dilatation should be considered as a significant parameter other than EF or perfusion data.
Asunto(s)
Anemia de Células Falciformes/fisiopatología , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca/métodos , Imagen de Perfusión Miocárdica/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Adolescente , Anemia de Células Falciformes/tratamiento farmacológico , Benzoatos/uso terapéutico , Terapia por Quelación , Niño , Deferasirox , Dilatación Patológica/diagnóstico por imagen , Dipiridamol , Ecocardiografía de Estrés , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hidroxiurea/uso terapéutico , Quelantes del Hierro/uso terapéutico , Sobrecarga de Hierro/inducido químicamente , Sobrecarga de Hierro/tratamiento farmacológico , Masculino , Estudios Prospectivos , Volumen Sistólico , Reacción a la Transfusión , Triazoles/uso terapéutico , Vasodilatadores , Disfunción Ventricular Izquierda/etiologíaRESUMEN
BACKGROUND: Ankylosing spondilitis (AS) is a chronic inflammatory disease with prominent inflammation in joints and extraarticular organs. AS patients have approximately two times more risk of mortality than the normal population. One reason for this increase in mortality is increased cardiovascular risk. In this study, we have aimed to evaluate myocardial perfusion and left ventricular function using (99m)Tc-MIBI gated myocardial perfusion single photon emission computed tomography (SPECT). MATERIAL AND METHODS: The study group consisted of 28 AS patients (19 men, 9 women), and mean age 39.46±10.98 years. All patients underwent (99m)Tc-MIBI gated myocardial perfusion SPECT with the same day protocol. RESULTS: We detected various risk factors including smoking habits in 12, family history of cardiovascular disease in 12, hypertension in 3, hyperlipidemia in 9 patients. We performed a myocardial perfusion SPECT for each patient and found normal perfusion pattern in SPECT images. Out of 28 patients, eight patients had normal perfusion but wall motion abnormalities. CONCLUSION: We detected that myocardial perfusion is preserved in the patients with AS. However, left ventricular wall motion abnormalities are seen. We concluded that ankylosing spondylitis may be associated with microvascular dysfunction and gated myocardial perfusion scintigraphy could be valuable in AS patients for the evaluation of LV function even if the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score are low and the disease duration shorter.
Asunto(s)
Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca/métodos , Imagen de Perfusión Miocárdica/métodos , Espondilitis Anquilosante/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Adulto , Comorbilidad , Prueba de Esfuerzo , Femenino , Pruebas de Función Cardíaca , Humanos , Hiperlipidemias/epidemiología , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Movimiento (Física) , Sobrepeso/epidemiología , Radiofármacos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Método Simple Ciego , Fumar/epidemiología , Espondilitis Anquilosante/epidemiología , Tecnecio Tc 99m Sestamibi , Disfunción Ventricular Izquierda/epidemiología , Adulto JovenRESUMEN
Unexpected findings on bone scintigraphy such as asymmetrical uptake in extremities may cause confusion for the diagnosis. The authors describe three cases of accidental intraarterial injection of Tc-(99m) methylene diphosphonate ((99m)Tc-MDP) on the antecubital region and discuss the findings and differential diagnosis.
Asunto(s)
Inyecciones Intraarteriales/efectos adversos , Radiofármacos/administración & dosificación , Radio (Anatomía)/diagnóstico por imagen , Medronato de Tecnecio Tc 99m/administración & dosificación , Cúbito/diagnóstico por imagen , Imagen de Cuerpo Entero , Anciano de 80 o más Años , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Diagnóstico Diferencial , Reacciones Falso Positivas , Femenino , Falanges de los Dedos de la Mano/diagnóstico por imagen , Humanos , Inyecciones Intravenosas , Masculino , Huesos del Metacarpo/diagnóstico por imagen , Persona de Mediana Edad , Cintigrafía , Radiofármacos/farmacocinética , Medronato de Tecnecio Tc 99m/farmacocinética , Vértebras Torácicas/diagnóstico por imagenRESUMEN
The authors describe a rare pattern of soft tissue uptake observed in a (99m)Tc-MDP bone scintigraphy of two patients with the diagnosis of non-Hodgkin's lymphoma. Both patients had abdominal masses and bone scintigraphy revealed unusual (99m)Tc-MDP uptake in the abdominal region. The possible mechanisms of soft tissue uptake of bone seeking agents are discussed.