[Peroral anticoagulant therapy--are the TT-values reliable?]. / Peroral antikoagulasjonsbehandling--er TT-verdiene til å stole på?

As part of the Norwegian Medical Association's quality assurance programme for the primary health care sector we have investigated the lasting quality of the specimens drawn for determination of Thrombotest. Blood drawn into siliconated glass tubes resulted in varying Thrombotest values, depending on the time of analysis after specimen collection. Reliable Thrombotest values are needed to be able to administer the correct dosage of warfarin. Thrombotest analysis should therefore be performed within two hours, or after 48 hours of specimen collection.

[Measurement of ejection fraction after acute myocardial infarction. A comparison of measurements by means of radionuclide technique one week and 8 weeks after the infarction]. / Gjentatt måling av ejeksjonsfraksjon etter akutt hjerteinfarkt. Sammenlikning av måling med nukleaermedisinsk teknikk 1. og 8. uke.

Left ventricular ejection fraction was measured in 54 patients by means of radionuclide technique at one week after, and again at eight after acute myocardial infarction that had been treated with streptokinase. In 17 patients (31%) ejection fraction increased and in 15 patients (28%) it decreased > or = 5 ejection fraction units. In 22 patients (41%) ejection fraction remained unchanged. No obvious difference were found between the three groups as regards infarct localization, infarction size (enzyme activity), or level of first ejection fraction measurement. There was a statistically significant (p < 0.05) longer delay from start of chest pain until treatment was started among the patients with increased ejection fraction than among the patients with decreased ejection fraction.

Do X-ray determined cardiac volume and signs of congestive heart failure provide additional prognostic information after myocardial infarction if the left ventricular ejection fraction is known?

Cardiac volume (CV) was measured and indices of pulmonary congestion (PCG) were judged from routine chest films taken post myocardial infarction (AMI) in a consecutive series of 477 patients (340 first and 137 recurrent AMIs). Cardiac volume (CV) and signs of PCG were compared to left ventricular ejection fraction (LVEF), measured with isotope technique, and the prognostic value of all the parameters was assessed after 1 and 5 years. The accuracy of CV and PCG in predicting impaired LVEF was low (62% and 50% respectively). Although specificity is suboptimal, however, these parameters provided valuable prognostic information. For example, patients with signs of PCG had a very high 1 and 5 years' mortality, and two-thirds of those who died during the first year of observation had enlarged CV. The independent value of LVEF determination was mainly observed in re-AMI patients. A more restricted use of this expensive procedure may therefore be recommended.

Computed tomography and scintigraphy in the diagnosis of splenic injury.

In a prospective study of 48 patients suspected to have splenic injury, the diagnostic value of computed tomography (CT) and scintigraphy was investigated. Both methods showed high sensitivity, demonstrating 27 of 28 ruptures. The specificity was 100% for CT and 80% for scintigraphy, since the latter method gave four false-positive diagnoses with regard to rupture and bleeding. Scintigraphy, however, has advantages over CT in children and noncooperative adults and is highly suitable in local trauma to the left lower thorax. CT is preferable in cases with possible trauma to multiple organs, such as commonly occurs in traffic accidents, and also provides a rough estimate of the extent of bleeding.

Scintigraphic follow-up of splenic rupture.

Scintigraphic and clinical follow-up were performed one to six years after splenic rupture in 49 patients. Splenosis was found in 11 of 12 patients subjected to splenectomy. In six patients subjected to splenic repair, and in 31 patients managed nonoperatively, the scan was normal or almost normal. Scintigraphy is a useful tool in follow-up of patients with splenic injuries. Splenosis is common after splenectomy only for trauma; and pseudocyst development must be very rare in patients managed nonoperatively for splenic rupture.

Ligation of the left renal vein.

In abdominal aortic reconstruction it is sometimes necessary to ligate and divide the left renal vein in order to avoid injury to this vessel and to secure better access to the aorta and/or the renal arteries. The procedure was utilized in 11 such patients, who were followed up clinically and with renography. No untoward sequelae were found, and it is concluded that the procedure as a rule may safely be performed.

Systolic time intervals and ejection fraction in assessing left ventricular performance following acute myocardial infarction. Comparison of systolic time intervals and equilibrium radionuclide ventriculography.

Left ventricular performance in 54 patients with acute myocardial infarction was studied by means of systolic time intervals (STI) and ejection fraction (EF) determined using radionuclide technique. The data were correlated to clinical parameters of left ventricular heart failure and size of infarction. Thirty-seven patients were studied in the convalescent period with repeated registrations at 6, 10 and 24 weeks. Patients with left ventricular heart failure had markedly depressed EF, significantly different from EF in the non-heart failure group. STI did not show any difference. A strong correlation between infarct size and EF could be demonstrated. STI discriminated significantly transmural from non-transmural infarctions, and presented significant differences between those with normal EF (greater than 50%) and patients with EF below 35%. No significant changes could be found in left ventricular performance during the convalescent period, except for an increase in corrected preejection period (PEPc) probably due to drugs. The correlation between EF and STI was poor, the highest correlation coefficient being 0.55 between EF and the ratio PEP/LVET.

Organ survey through digitized imaging: value in detection of a splenic rupture.

The rapidly updated display of scintigraphic images processed by a computer system and used for positioning is of high quality and may be used to do a quick survey of an organ. The value of this in a preliminary investigation is illustrated by a case of a patient with a splenic rupture. The information obtained through the preliminary survey contributed significantly to the correct diagnosis. Diagnostic reliability may be improved by inclusion of this procedure in scintigraphic investigations, especially in emergency situations.

Combined scintigraphy of liver, spleen, and lung in the diagnosis of subphrenic abscess.

Two hundred and fifty-six patients have, during the past 5 years, been examined by combined liver, spleen, and lung radionuclide imaging. The reason for this investigation was to identify or rule out subphrenic abscess, which is a rare but feared complication of abdominal surgery. Primary subphrenic abscess may also be seen, and in such cases the diagnosis is extremely difficult. Subphrenic abscess was demonstrated by radionuclide imaging in 17 patients, and all of these were later confirmed by surgery. In this study there was one false-positive and one false-negative result. During this period other pathological conditions involving lung and liver and with symptoms similar to subphrenic abscess have also been demonstrated by this technique, such as lung embolism and liver abscess.