Pain management in the emergency department.
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Biomedical subjects
Publications and source records attributed to J Gutman.
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The value of right ventricular thallium-201 analysis in detecting proximal right coronary artery stenosis in exercise myocardial scintigraphy was analyzed in 52 patients, 27 with and 25 without proximal right coronary artery stenosis. For the detection of proximal right coronary artery stenosis, the sensitivity and specificity of thallium scintigraphic analysis were 59 and 88% for a right ventricular abnormality, 67 and 68% for a left ventricular inferior wall abnormality, and 93 and 56% for an abnormality of either. When both right and left ventricular thallium images were abnormal, all 9 patients had proximal right coronary artery stenoses, and when both were normal, 26 of 28 patients had a normal proximal right coronary artery. The sensitivity and specificity of blood pool scintigraphic variables during exercise (right ventricular ejection fraction and left ventricular inferior wall motion) were not significantly different for detection of proximal right coronary artery stenosis. Thus, the additional analysis of the right ventricle on thallium-201 stress scintigrams can improve the detection of proximal right coronary artery stenosis. When both right ventricular and left ventricular thallium scintigrams are abnormal (or normal), the ability to predict the presence (or absence) of proximal right coronary artery stenosis is very high.
To obtain normal values for left atrial function noninvasively, volumes of the left atrium and ventricle were calculated in 52 volunteers by 2-dimensional echocardiography. A light pen digitizing and computation system, controlled by a microprocessor, was used to outline the left atrium and ventricle in orthogonal apical views. Then, to calculate end-systolic and end-diastolic atrial and ventricular volumes, a modified Simpson's rule formula was used. End-systolic left atrial volume (mean +/- standard deviation) was 37 +/- 11.7 ml or 21 +/- 6.6 ml/m2. The change in left atrial volume from end-systole to end-diastole was 24 +/- 7.6 ml or 13.5 +/- 4.3 ml/m2, which represented 37 +/- 12.9% of left ventricular stroke volume. The mean fractional emptying of the left atrium was 65 +/- 8.9% and the conduit volume was 41 +/- 14.0 ml or 23 +/- 7.9 ml/m2. These values are similar to those reported in studies in which left atrial function was calculated from contrast angiography.
The relationship between the severity of coronary artery stenosis and the time to completed redistribution of thallium 201 (TI-201) defects following maximal exercise was investigated in 59 patients undergoing stress-redistribution TI-201 scintigraphy, coronary angiography, and contrast ventriculography. Multiple view TI-201 scintigrams were obtained, beginning 6 minutes (immediately post stress), less than 1 hour (early), 3 to 5 hours (average), and 18 to 24 hours (late) following intravenous TI-201 injection at peak exercise. Angiographic lesions were grouped into five levels of severity by percent stenosis. In the 107 defects which were seen on the immediate post stress images, early redistribution was noted in 15 (14%) and late redistribution was found in 23 (21%). In addition, there was a correlation (r = 0.56) between the time to completed redistribution and the severity of the coronary artery stenosis (p = 0.001). In comparison to defects with early and average redistribution, the segments contralateral to those with defects showing late redistribution more often had a critical stenosis supplying that segment. The frequency of myocardial infarction on ECG and the number of segments with akinetic and dyskinetic wall motion were less in defects undergoing late rather than no redistribution. Thus the time to completed TI-201 redistribution following stress appears to be related to the severity of stenosis in the coronary artery supplying the defect. Also, late redistribution is associated with the presence and early redistribution with the absence of a significant stenosis in the coronary artery to the contralateral segment.
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Almost all (93 per cent of 150) of the physicians surveyed reported frequent exposure to mass media, and almost two-thirds (60 per cent) state that this exposure included health items. Over half replied that at least one mass media source was useful to them as a source of health information. And, one physician in five (21 per cent) indicated that mass media could influence his attitude about health. The success of the dietitian in the health care setting depends to a large extent on the physician's support. In view of the influence of the mass media on physicians, as reported in this survey, the recommendation is made that dietitians give more attention to this avenue of improving their image with the medical profession.
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