Measurement of glomerular filtration rate in ICU patients using 99mTc-DTPA and inulin.

Improved and reliable methods for assessing glomerular filtration rate (GFR) in intensive care patients are needed in light of known deficiencies using creatinine clearance. We compared simultaneous two-hour clearances of inulin (CIn), creatinine (CCr), and 99mTc-diethylenetriaminepentaacetic acid (CDTPA) in 18 medical or surgical intensive care patients (range, 49 to 92 years old) with blood urea nitrogen (BUN) levels greater than 17.9 mmol/liter (0.5 mg/ml), serum creatinine levels greater than 150 mumol/liter (0.02 mg/ml), or estimated Cockcroft clearance less than 60 ml/min. Patients had severe renal dysfunction with average GFR of 35 ml/min (range, 2 to 69 ml/min). CDTPA and CCr correlated significantly with CIn, although CDTPA tended to provide a closer approximation. Cockcroft clearance (32 +/- 4 ml/min) was grossly similar to CDTPA and CIn and correlated significantly, especially when weight was calculated using actual as opposed to ideal body weight. In a subset of 13 patients with CIn less than 30 ml/min, only CDTPA was significantly correlated with CIn. In patients in the intensive care unit, CDTPA provides a rapid, accurate, and inexpensive clinical assessment of GFR, even at very low GFRs.

Pharmacy practice in the United States Army.

The current status of pharmaceutical services in the United States Army Medical Department is described. The mission of the Army Medical Department is to ensure the health of the soldier during times of peace and war. Of the 225 commissioned pharmacy officers currently on active duty, 156 are assigned to U.S. Army medical centers and community hospitals in the United States, and 29 are stationed at hospitals in Europe, Korea, Panama, and Japan. Army pharmacy officers are supported by 879 Army-trained pharmacy technicians and 319 civilian pharmacists employed by the Army. Army Medical Department hospital pharmacies provide inpatient and ambulatory-care services as well as specialized nuclear pharmacy, oncology, investigational drug, and materials development services. Pharmacy officers assigned to the Pharmacy Branch of the U.S. Army Academy of Health Sciences conduct 17-week technician training programs six times a year and provide other pharmacy courses and continuing education programs. The U.S. Army Allergen Extract Laboratory dispenses diagnostic and immunotherapy agents by mail in response to prescriptions submitted by military allergy clinics. Pharmacy officers may be deployed with field hospitals during times of combat or for extended training exercises in places such as Egypt, Grenada, and Honduras. Pharmacy officers may also be assigned to three- or four-year tours of duty in Army hospitals located in Europe. In the future, the emphasis of Army pharmacy practice will be on the expansion of clinical pharmaceutical services and the development of advanced interactive communication systems, quality assurance programs, and peer-review programs.

Value of selective spleen scintigraphy when liver/spleen image shows equivocal spleen defects: concise communication.

A retrospective review was performed to determine the utility of selective spleen scintigraphy (SSS) in the evaluation of equivocal defects on liver/spleen (LS) image. Six of seven questionable features on LS image were classified on SSS to be definite defects in three, and normal in three. Three of seven patients had defects on SSS that were not seen on LS image. The inability of the LS image to exclude or delineate an abnormality in the spleen was attributed to an overlying left lobe of the liver in five, and to technique in one. The SSS is a valuable diagnostic tool in the further evaluation of equivocal spleen defects on LS image, and SSS may demonstrate abnormalities not demonstrated on LS image.

Radioiodine volatilization from reformulated sodium iodide I-131 oral solution.

By changing the pH and adding buffers, antioxidants, and stabilizers to a sodium iodide (I-131) oral solution, a reduced radioiodine volatilization was claimed by a commercial supplier of radiopharmaceuticals. This study compares the airborne radioactivity volatilized from the reformulated sodium iodide solution with that which became airborne from a previous formulation. Air samples were obtained from the fume hood's exhaust stack during initial venting, and from the breathing zones of physicians and technologists administering the solution to the patient. Analysis of the air samples indicates significant reduction in the airborne radioiodine following initial venting of the solution vial and during patient administration. Additionally, there has been a decline in the I-131 thyroid burdens for occupationally exposed personnel handling the reformulated sodium iodide solutions.