Risk Factors for 30-day Hospital Readmissions After Peripheral Vascular Interventions in Peripheral Artery Disease Patients at the US-Mexico Border.

Peripheral artery disease (PAD) is associated with high rates of readmission following endovascular interventions and contributes to a significant hospital readmission burden. Quality metrics like hospital readmissions affect hospital performance, but must adjust to local trends. Our primary goal was to evaluate risk factors and readmission rates post-percutaneous peripheral intervention in a US-Mexico border city, at a single tertiary university hospital. We performed a retrospective review of patients with PAD undergoing first time peripheral intervention from July 2015 to June 2020. Among 212 patients, 58% were readmitted with median 235-day follow-up (inter-quartile range (IQR) 42-924); 35.3% of readmissions occurred within 30 days, and 30.2% of those were within 7 days. Median time to readmission was 62 days. Active smokers had 84% higher risk of readmission (hazard ratio (HR) 1.84, 95% CI 1.23-2.74, P < .01). Other significant factors noted were insurance status-Medicaid or uninsured (HR 1.94, 95% CI 1.22-3.09), prior amputation (HR 1.69, 95% CI 1.13-2.54), heart failure, both preserved (HR 4.35, 95% CI 2.07-9.16) and reduced ejection fraction (HR 1.88, 95% CI 1.14-3.10). Below the knee, interventions were less likely to be readmitted (adjusted HR .64, 95% CI 0.42-.96). Readmission rates were unrelated to medication adherence.

Foliar application of triacontanol ameliorates heat stress through regulation of the antioxidant defense system and improves yield of eggplant / Title in the second language of the article: Amelioration of heat stress in egg plant through application of tricontanol

Abstract Transplanting time and genotype contribute to improving crop yield and quality of eggplant (Solanum melongena L.). A field experiment was conducted to investigate the impact of foliar applied of triacontanol (TRIA) and eggplant genotypes 25919, Nirala, 28389 and Pak-10927,transplanted on 1 March,15 March, and 1 April on exposure to high air temperature conditions. The experiment was performed according to Randomized Complete Block Design and the data was analyzed by using Tuckey,s test . The TRIA was applied at 10µM at flowering stage; distilled water was used as the control. Rate of photosynthesis and transpiration, stomatal conductance, water use efficiency, and effects on antioxidative enzymes (superoxide dismutase, catalase and peroxidase) were evaluated. The 10µM TRIA increased photosynthesis rate and water use efficiency and yield was improved in all genotypes transplanted at the different dates. Foliar application of 10µM TRIA increased antioxidative enzyme activities (SOD, POD & CAT) and improved physiological as well as biochemical attributes of eggplant genotypes exposed to high heat conditions. Highest activity of dismutase enzyme 5.41mg/1g FW was recorded in Nirala genotype in second transplantation. Whereas, lowest was noted in PAK-10927 (2.30mg/g FW). Maximum fruit yield was found in accession 25919 (1.725kg per plant) at 1st transplantation with Triacontanol, whereas accession PAK-10927 gave the lowest yield (0.285 kg per plant) at control treatment on 3rd transplantation. Genotype, transplanting date and application of TRIA improved growth, yield and quality attributes under of heat stress in eggplant.

Resumo O tempo de transplante e o genótipo contribuem para melhorar a produtividade e a qualidade da cultura da berinjela (Solanum melongena L.). Um experimento de campo foi conduzido para investigar o impacto da aplicação foliar de triacontanol (TRIA) e genótipos de berinjela 25919, Nirala, 28389 e Pak-10927, transplantados em 1 de março, 15 de março e 1 de abril de exposição a condições de alta temperatura do ar. O experimento foi realizado de acordo com o Randomized Complete Block Design e os dados foram analisados pelo teste de Tuckey. O TRIA foi aplicado a 10 µM na fase de floração; água destilada foi utilizada como controle. Taxa de fotossíntese e transpiração, condutância estomática, eficiência do uso da água e efeitos sobre as enzimas antioxidantes (superóxido dismutase, catalase e peroxidase) foram avaliados. O TRIA 10 µM aumentou a taxa de fotossíntese e a eficiência do uso da água e o rendimento foi melhorado em todos os genótipos transplantados nas diferentes datas. A aplicação foliar de TRIA 10µM aumentou as atividades das enzimas antioxidantes (SOD, POD e CAT) e melhorou os atributos fisiológicos e bioquímicos de genótipos de berinjela expostos a condições de alto calor. A atividade mais elevada da enzima dismutase 5,41mg / 1g FW foi registrada no genótipo Nirala no segundo transplante. Considerando que o mais baixo foi observado em PAK-10927 (2,30 mg / g FW). A produtividade máxima de frutos foi encontrada no acesso 25919 (1,725 ​​kg por planta) no 1º transplante com Triacontanol, enquanto o acesso PAK-10927 deu a menor produção (0,285 kg por planta) no tratamento de controle no 3º transplante. Genótipo, data de transplante e aplicação de TRIA, melhoramento do crescimento, rendimento e atributos de qualidade sob estresse térmico em berinjela.

Foliar application of triacontanol ameliorates heat stress through regulation of the antioxidant defense system and improves yield of eggplant

Abstract Transplanting time and genotype contribute to improving crop yield and quality of eggplant (Solanum melongena L.). A field experiment was conducted to investigate the impact of foliar applied of triacontanol (TRIA) and eggplant genotypes 25919, Nirala, 28389 and Pak-10927,transplanted on 1 March,15 March, and 1 April on exposure to high air temperature conditions. The experiment was performed according to Randomized Complete Block Design and the data was analyzed by using Tuckey,s test . The TRIA was applied at 10µM at flowering stage; distilled water was used as the control. Rate of photosynthesis and transpiration, stomatal conductance, water use efficiency, and effects on antioxidative enzymes (superoxide dismutase, catalase and peroxidase) were evaluated. The 10µM TRIA increased photosynthesis rate and water use efficiency and yield was improved in all genotypes transplanted at the different dates. Foliar application of 10µM TRIA increased antioxidative enzyme activities (SOD, POD & CAT) and improved physiological as well as biochemical attributes of eggplant genotypes exposed to high heat conditions. Highest activity of dismutase enzyme 5.41mg/1g FW was recorded in Nirala genotype in second transplantation. Whereas, lowest was noted in PAK-10927 (2.30mg/g FW). Maximum fruit yield was found in accession 25919 (1.725kg per plant) at 1st transplantation with Triacontanol, whereas accession PAK-10927 gave the lowest yield (0.285 kg per plant) at control treatment on 3rd transplantation. Genotype, transplanting date and application of TRIA improved growth, yield and quality attributes under of heat stress in eggplant.

Resumo O tempo de transplante e o genótipo contribuem para melhorar a produtividade e a qualidade da cultura da berinjela (Solanum melongena L.). Um experimento de campo foi conduzido para investigar o impacto da aplicação foliar de triacontanol (TRIA) e genótipos de berinjela 25919, Nirala, 28389 e Pak-10927, transplantados em 1 de março, 15 de março e 1 de abril de exposição a condições de alta temperatura do ar. O experimento foi realizado de acordo com o Randomized Complete Block Design e os dados foram analisados pelo teste de Tuckey. O TRIA foi aplicado a 10 µM na fase de floração; água destilada foi utilizada como controle. Taxa de fotossíntese e transpiração, condutância estomática, eficiência do uso da água e efeitos sobre as enzimas antioxidantes (superóxido dismutase, catalase e peroxidase) foram avaliados. O TRIA 10 µM aumentou a taxa de fotossíntese e a eficiência do uso da água e o rendimento foi melhorado em todos os genótipos transplantados nas diferentes datas. A aplicação foliar de TRIA 10µM aumentou as atividades das enzimas antioxidantes (SOD, POD e CAT) e melhorou os atributos fisiológicos e bioquímicos de genótipos de berinjela expostos a condições de alto calor. A atividade mais elevada da enzima dismutase 5,41mg / 1g FW foi registrada no genótipo Nirala no segundo transplante. Considerando que o mais baixo foi observado em PAK-10927 (2,30 mg / g FW). A produtividade máxima de frutos foi encontrada no acesso 25919 (1,725 kg por planta) no 1º transplante com Triacontanol, enquanto o acesso PAK-10927 deu a menor produção (0,285 kg por planta) no tratamento de controle no 3º transplante. Genótipo, data de transplante e aplicação de TRIA, melhoramento do crescimento, rendimento e atributos de qualidade sob estresse térmico em berinjela.

Foliar application of triacontanol ameliorates heat stress through regulation of the antioxidant defense system and improves yield of eggplant.

Transplanting time and genotype contribute to improving crop yield and quality of eggplant (Solanum melongena L.). A field experiment was conducted to investigate the impact of foliar applied of triacontanol (TRIA) and eggplant genotypes 25919, Nirala, 28389 and Pak-10927,transplanted on 1 March,15 March, and 1 April on exposure to high air temperature conditions. The experiment was performed according to Randomized Complete Block Design and the data was analyzed by using Tuckey,s test . The TRIA was applied at 10µM at flowering stage; distilled water was used as the control. Rate of photosynthesis and transpiration, stomatal conductance, water use efficiency, and effects on antioxidative enzymes (superoxide dismutase, catalase and peroxidase) were evaluated. The 10µM TRIA increased photosynthesis rate and water use efficiency and yield was improved in all genotypes transplanted at the different dates. Foliar application of 10µM TRIA increased antioxidative enzyme activities (SOD, POD & CAT) and improved physiological as well as biochemical attributes of eggplant genotypes exposed to high heat conditions. Highest activity of dismutase enzyme 5.41mg/1g FW was recorded in Nirala genotype in second transplantation. Whereas, lowest was noted in PAK-10927 (2.30mg/g FW). Maximum fruit yield was found in accession 25919 (1.725kg per plant) at 1st transplantation with Triacontanol, whereas accession PAK-10927 gave the lowest yield (0.285 kg per plant) at control treatment on 3rd transplantation. Genotype, transplanting date and application of TRIA improved growth, yield and quality attributes under of heat stress in eggplant.

Single photon emission computerized tomography in the evaluation of the osteoblastic activities of a new bone regeneration technique: analysis of 12 mandibular sites in six experimental pigs / La tomografía computarizada por emisión de fotón único en la evaluación de las actividades osteoblásticas de una nueva técnica de regeneración ósea: análisis de 12 sitios mandibulares en seis cerdos experimentales

OBJECTIVES: To utilize single photon emission computerized tomography performed in sequence to determine the osseo-integrating capabilities and osteoblastic activities of a new bone regeneration technique called the membrane - sandwich technique (Ogunsalu sandwich bone regenerating technique) and to compare the quality and quantity of bone formed by this bone regeneration unit to bone regeneration obtained by using the same particulate bone grafting material covered with interceed® (another type of bio-resorbable membrane). DESIGN AND METHOD: Single photon emission computerized tomography bone imaging was performed in sequence on the mandible of a total of 6 pigs on both the right and left side (total of 12 sites) at two and a half hours following the injection of technetium 99m methylene diphosphate. Imaging was performed using a Siemen Orbitar II gamma camera. The projection data was acquired in a 128 x 128 matrix over 180 arc and SPECT reconstruction was performed using a filtered back projector method with a Shepp-Logan Hanning filter and a cut-off frequency of 0.4. The surgical defect on one side of the jaw was treated with the sandwich unit with Bio-oss particulate bone within it, while the other side contained the same quantity of Bio-oss as in the left side but just covered with interceed® membrane. The osteoblastic uptake on the side with the classical sandwich was compared to the side with the particulate bone covered with interceed® membrane for dynamic physiological activities. The average activity for both sides was calculated and compared. RESULT: For all the 12 sites, osteoblastic activities were recorded and indicated that vascularized bone was formed at all the experimental sites. Autogenous bone graft was confirmed to be superior to xenograft using this sandwich technique. Furthermore, the osteoblastic activities on the sandwich side were seen to be more when compared with the control side (Interceed® side). CONCLUSION: The Ogunsalu sandwich bone regeneration technique has been successfully evaluated with SPECT which shows osteoblastic activity with formation of vascularized bone which integrates with the surrounding bone.

OBJETIVOS: Utilizar la tomografía computarizada por emisión de fotón único (TCEFU) realizada en secuencia, a fin de determinar la capacidad óseo-integradora y las actividades osteoblásticas de una nueva técnica de regeneración del hueso, denominada técnica de membrana-sándwich, y comparar la calidad y cantidad de hueso formado por esta unidad de regeneración ósea con la regeneración ósea obtenida mediante el mismo material de injerto de hueso particulado cubierto con interceed® (otro tipo de membrana bioreabsorbible). DISEÑO Y MÉTODO: Mediante TCEFU, se realizó un estudio de imágenes óseas en secuencia, de la mandíbula de un total de 6 cerdos, a los lados izquierdo y derecho (un total de 12 sitios) a las dos horas y media, luego de una inyección de difosfato de metileno marcado con tecnecio 99 m. El examen de imágenes fue realizado usando una cámara gamma Siemens Orbiter tipo II. Los datos de la proyección fueron adquiridos en una matriz de 128 x 128 sobre un arco de 180 y la reconstrucción con TCEFU se realizó usando un método de retroproyección filtrada, con un filtro Shepp-Logan-Hanning y una frecuencia de corte de 0.4. El defecto quirúrgico en un lado de la mandíbula fue tratado con la unidad de sándwich con hueso particulado bio-oss dentro, mientras que el otro lado contenía la misma cantidad de Bio-oss del lado izquierdo, pero cubierto con una membrana de interceed®. La respuesta osteoblástica en el lado con el sándwich clásico fue comparada con el lado del hueso particulado cubierto con la membrana de interceed® en cuanto a actividades fisiológicas dinámicas. La actividad promedio de ambos lados fue calculada y comparada. RESULTADO: En los 12 sitios, las actividades osteoblásticas fueron registradas de forma indicando que se formó hueso vascularizado en todos los sitios experimentales. Se confirmó que el injerto óseo autógeno es superior al xenoinjerto que usa esta técnica de sándwich. Además, se observó que las actividades osteoblásticas en el lado del sándwich eran más en comparación con el lado control (lado del interceed®). CONCLUSIÓN: La técnica de Ogunsalu para la regeneración ósea por "sándwich" o membrana inter-posicional, ha sido exitosamente evaluada mediante TCEFU, concluyéndose que la misma consiste en la actividad osteoblástica con formación de hueso vascularizado que se integra al hueso circundante.

Single photon emission computerized tomography and histological evaluation in the validation of a new technique for closure of oro-antral communication: an experimental study in pigs / Tomografía computarizada mediante emisión de fotones simples y evaluación histológica en la validación de una nueva técnica para el cierre de la comunicación oroantral: un estudio experimental en cerdos

Various bone regeneration techniques have evolved recently but controversies regarding vascularization and integration of such bone grafting techniques have led occasionally to animal experiment to validate such techniques. The objective of this study was to evaluate the evidence of vascularization and osseo-integration of a new bone regeneration technique utilized for the closure of oro-antral communication (OAC) by an experimental model in which Single Photon Emission computerized Tomography and histological studies were conducted in pigs. We conclude that the sandwich technique used for the closure of OAC results in a vascularized new bone formation which eventually osseo-integrate with the surrounding bone. Also, this experimental study confirmed that autogeneous bone graft was superior to xenografts when used within the sandwich unit.

Varias técnicas de regeneración de huesos han sido desarrolladas recientemente, pero las controversias con respecto a la vascularización e integración de tales técnicas de injerto de hueso han llevado de vez en cuando a la experimentación con animales, a fin de validar estas técnicas. El objetivo de este estudio fue evaluar la evidencia de vascularización e integración ósea de una nueva técnica de regeneración de hueso utilizada para el cierre de la comunicación oro-antral (COA), mediante un modelo experimental en el que se practicó la tomografía computarizada mediante emisión de fotones simples y se realizaron estudios histológicos en cerdos. Concluimos que la técnica de sándwich usada para el cierre de COA da lugar a una formación ósea vascularizada que acaba produciendo una oseointegración con el hueso circundante. Asimismo, este estudio experimental confirmó que el injerto óseo antólogo es superior a los xenoinjertos cuando se usa dentro de la unidad de sándwich.

Single photon emission computerized tomography and histological evaluation in the validation of a new technique for closure of oro-antral communication: an experimental study in pigs.

Various bone regeneration techniques have evolved recently but controversies regarding vascularization and integration of such bone grafting techniques have led occasionally to animal experiment to validate such techniques. The objective of this study was to evaluate the evidence of vascularization and osseo-integration of a new bone regeneration technique utilized for the closure of oro-antral communication (OAC) by an experimental model in which Single Photon Emission computerized Tomography and histological studies were conducted in pigs. We conclude that the sandwich technique used for the closure of OAC results in a vascularized new bone formation which eventually osseo-integrate with the surrounding bone. Also, this experimental study confirmed that autogeneous bone graft was superior to xenografts when used within the sandwich unit.

Single photon emission computerized tomography in the evaluation of the osteoblastic activities of a new bone regeneration technique: analysis of 12 mandibular sites in six experimental pigs.

OBJECTIVES: To utilize single photon emission computerized tomography performed in sequence to determine the osseo-integrating capabilities and osteoblastic activities of a new bone regeneration technique called the membrane--sandwich technique (Ogunsalu sandwich bone regenerating technique) and to compare the quality and quantity of bone formed by this bone regeneration unit to bone regeneration obtained by using the same particulate bone grafting material covered with interceed (another type of bio-resorbable membrane). DESIGN AND METHOD: Single photon emission computerized tomography bone imaging was performed in sequence on the mandible of a total of 6 pigs on both the right and left side (total of 12 sites) at two and a half hours following the injection of technetium 99m methylene diphosphate. Imaging was performed using a Siemen Orbitar II gamma camera. The projection data was acquired in a 128 x 128 matrix over 180 arc and SPECT reconstruction was performed using a filtered back projector method with a Shepp-Logan Hanning filter and a cut-off frequency of 0.4. The surgical defect on one side of the jaw was treated with the sandwich unit with Bio-oss particulate bone within it, while the other side contained the same quantity of Bio-oss as in the left side but just covered with interceed membrane. The osteoblastic uptake on the side with the classical sandwich was compared to the side with the particulate bone covered with interceed membrane for dynamic physiological activities. The average activity for both sides was calculated and compared. RESULT: For all the 12 sites, osteoblastic activities were recorded and indicated that vascularized bone was formed at all the experimental sites. Autogenous bone graft was confirmed to be superior to xenograft using this sandwich technique. Furthermore, the osteoblastic activities on the sandwich side were seen to be more when compared with the control side (Interceed side). CONCLUSION: The Ogunsalu sandwich bone regeneration technique has been successfully evaluated with SPECT which shows osteoblastic activity with formation of vascularized bone which integrates with the surrounding bone.

Lymphoscintigraphic evaluation of chronic lower limb oedema.

Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), venography, lymphoscinti-graphy (LS) and contrast lymphography are frequently utilized in the evaluation of lower limb oedema but no clinical data from the Caribbean have been published on the role of LS despite its well-recognized clinical application. The successful clinical application of CT, colour doppler sonography and MRI in differentiating the various causes of lower limb oedema is well understood. Lymphoscintigraphy has found less acceptability especially in the Caribbean where nuclear imaging techniques are only now currently being developed. This paper describes the initial experience with this technique in 15 patients over a five-year period and discusses its value when lower limb lymphoedema is suspected. Scintigrams were analyzed for visualization of lymph vessels and lymph nodes, dilatation of lymphatic vessels, collaterals and dermal back flow. Lymphoscintigrams were classified as normal (n = 5) or consistent with lymphoedema (n = 10). Failure to visualize lymphatic vessels occurred in two cases of suspected primary lymphoedema. In the remaining eight cases of secondary lymphoedema, a positive study based on altered lymphatic flow and anatomy was recorded. An alternative explanation was offered in three out of five cases in which a normal lymphoscintigram was obtained.

Lymphoscintigraphic evaluation of chronic lower limb oedema

Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), venography, lymphoscinti-graphy (LS) and contrast lymphography are frequently utilized in the evaluation of lower limb oedema but no clinical data from the Caribbean have been published on the role of LS despite its well-recognized clinical application. The successful clinical application of CT, colour doppler sonography and MRI in differentiating the various causes of lower limb oedema is well understood. Lymphoscintigraphy has found less acceptability especially in the Caribbean where nuclear imaging techniques are only now currently being developed. This paper describes the initial experience with this technique in 15 patients over a five-year period and discusses its value when lower limb lymphoedema is suspected. Scintigrams were analyzed for visualization of lymph vessels and lymph nodes, dilatation of lymphatic vessels, collaterals and dermal back flow. Lymphoscintigrams were classified as normal (n = 5) or consistent with lymphoedema (n = 10). Failure to visualize lymphatic vessels occurred in two cases of suspected primary lymphoedema. In the remaining eight cases of secondary lymphoedema, a positive study based on altered lymphatic flow and anatomy was recorded. An alternative explanation was offered in three out of five cases in which a normal lymphoscintigram was obtained

Value of routine long bone radiographs in management of babies with a positive VDRL at the Mount Hope Women's Hospital

This retrospective study examined the records of 44 mothers and 44 babies with a positive blood VDRL test and/or who showed symptoms of congenital syphilis at the Mount Hope Women's Hospital (MHWH), Trinidad, between June 1, 1996 and September 30, 1998. Long bone radiographs of 40/44 (91) babies were assessed independently by two radiologists for signs of congenital syphilis and the data were analysed using frequency tables. Of the 44 mothers in the study, 34 (77) were VDRL positive and the rest were either negative or unknown. Maternal age ranged from 14 to 39 years and most (92) had antenatal care. Fourteen of the 34 (41) VDRL positive mothers received treatment antenatally. All mothers were asymptomatic and none had any clinical features of syphilis. In 35/44 babies, the VDRL test was positive and in nine, the test was either negative or unknown. Twenty-six of the babies had signs suggestive of congenital syphilis and in 12, (46) long bone radiographs revealed changes compatible with the diagnosis of congenital syphilis. Radiographic abnormalities were present only in infants with VDRL titres > 1:8

Value of routine long bone radiographs in management of babies with a positive VDRL at the Mount Hope Women's Hospital.

This retrospective study examined the records of 44 mothers and 44 babies with a positive blood VDRL test and/or who showed symptoms of congenital syphilis at the Mount Hope Women's Hospital (MHWH), Trinidad, between June 1, 1996 and September 30, 1998. Long bone radiographs of 40/44 (91%) babies were assessed independently by two radiologists for signs of congenital syphilis and the data were analysed using frequency tables. Of the 44 mothers in the study, 34 (77%) were VDRL positive and the rest were either negative or unknown. Maternal age ranged from 14 to 39 years and most (92%) had antenatal care. Fourteen of the 34 (41%) VDRL positive mothers received treatment antenatally. All mothers were asymptomatic and none had any clinical features of syphilis. In 35/44 babies, the VDRL test was positive and in nine, the test was either negative or unknown. Twenty-six of the babies had signs suggestive of congenital syphilis and in 12, (46%) long bone radiographs revealed changes compatible with the diagnosis of congenital syphilis. Radiographic abnormalities were present only in infants with VDRL titres > 1:8.

The role of labelled red blood cell scintigraphy in the detection of acute gastrointestinal bleeding

This paper describes the experience with 99m Technetium labelled red blood cell (99mTc RBC) scintigraphy in twenty-two patients presenting with acute gastrointestinal (GI) tract bleeding. Studies were positive in thirteen cases--eight from the lower GI tract and five from the upper. The data from surgical intervention were available in ten cases. Scintigraphy cannot diagnose the cause of GI bleeding, as it is a nonspecific study. Its usefulness lies in its ability to accurately diagnose the bleeding site, as was shown in this study where there was good surgical correlation. The simplicity, reproducibility and reliability of the technique, particularly when bleeding rates are low and intermittent, make it, in our view, the first line of investigation in any patient with suspected bleeding from the colon or upper GI tract if endoscopic evaluation is not possible in the latter. Its current under-utilisation in the Caribbean may be a reflection of the lack of nuclear imaging facilities.

The role of labelled red blood cell scintigraphy in the detection of acute gastrointestinal bleeding.

This paper describes the experience with 99m Technetium labelled red blood cell (99mTc RBC) scintigraphy in twenty-two patients presenting with acute gastrointestinal (GI) tract bleeding. Studies were positive in thirteen cases--eight from the lower GI tract and five from the upper. The data from surgical intervention were available in ten cases. Scintigraphy cannot diagnose the cause of GI bleeding, as it is a nonspecific study. Its usefulness lies in its ability to accurately diagnose the bleeding site, as was shown in this study where there was good surgical correlation. The simplicity, reproducibility and reliability of the technique, particularly when bleeding rates are low and intermittent, make it, in our view, the first line of investigation in any patient with suspected bleeding from the colon or upper GI tract if endoscopic evaluation is not possible in the latter. Its current under-utilisation in the Caribbean may be a reflection of the lack of nuclear imaging facilities.

Myocardial perfusion scintigraphy using Tc99m labelled compounds: correlations with coronary angiography.

The increasing incidence of ischaemic heart disease with high mortality rate and the recent introduction of Tc99m labelled myocardial perfusion imaging agents, along with the advent of a Coronary Angiography programme in Trinidad and Tobago, prompted the comparison of the sensitivity and specificity of myocardial perfusion scintigraphy (MPS) with coronary angiography (CA). Using a standard one-day code-differential imaging protocol Single Photon Emission Computed Tomography (SPECT), images of the left ventricular myocardium of 30 patients were obtained at rest and following exercise: These images were analyzed for perfusion defects to assess each of the three main coronary arteries; the left anterior descending artery (LAD), the right coronary artery (RCA) and the left circumflex artery (LCx). The data were then correlated with the angiographic findings. MPS yielded an overall sensitivity of 97.5% and a specificity of 83.6% when compared to CA. Discordant data were obtained in the analysis of nine vascular territories with scintigraphy producing eight false positives and one false negative. The false positive cases were seen in two males and four females. Of the males, one was discovered to have intramyocardial tunnelling of the LAD artery and the other demonstrated differential perfusion between the LAD and LCx arteries. Of the females, one was classified as having Syndrome X and another demonstrated differential perfusion between the LAD and LCx arteries; the other two cases were attributed to breast attenuation. The one false negative was obtained in a patient who demonstrated good collateral circulation on angiography. MPS thus compares very well with CA in assessing the three main myocardial vascular territories.

Abdominal air: the radiologist's enemy and friend

Two cases are presented which illustrate the radiological drawbacks and advantages of air when it is present either around or within an organ of clinical interest. The physical principles underlying this anomaly are briefly discussed, particularly in relation to plain film radiology and ultrasonic imaging. The importance of recognising this phenomenon and the diagnostic difficulties which may arise stressed