Pharmacologic stress imaging

Article Abstract:

If cardiac patients are unable to perform an exercise stress test, several chemicals are available for mimicking the effects of stress upon the heart during thallium imaging or positron emission tomography for evaluating the cardiovascular system. Reasons for avoiding exercise are recent heart attack, arthritis or other physically limiting condition, or being severely out of condition. Dipyridamole and adenosine are used in scintigraphy (photographic imaging of organ or tissue function by measuring the uptake of radioactive material), while dobutamine is used with two-dimensional echocardiography (ultrasound). At this time, intravenous adenosine has not been approved for by the Food and Drug Administration for use in imaging. Stress imaging is used to detect coronary artery disease (CAD) and to determine the risk of heart attack or other event. This article summarizes the physiologic effects of dipyridamole in perfusion (blood circulation) imaging and the protocol. Dipyridamole is comparable to exercise testing in the detection of CAD, and it can also differentiate between reduced circulation (ischemia) and scarring. It is useful for risk stratification, assigning a prognosis, and detection of reblockage of an artery that had been opened up by coronary angioplasty, or insertion of a catheter. Dipyridamole has a number of side effects. Major side effects occur in fewer than one percent of patients, but may include fatal or nonfatal heart attack, especially in patients with unstable angina. One in 20 will experience chest pain, and headache or dizziness each occurs in one out of nine. Nausea and low blood pressure each occur in about 1 in 25. Aminophylline, a bronchodilator, is required by 15 to 20 percent of the patients, and is almost always completely effective. Dipyridamole and dobutamine echocardiography are described, and dobutamine is regarded as the more effective chemical for imaging modalities such as echocardiography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Dipyridamole, Adenosine, Heart function tests, Dobutamine

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Ultrasonography of acute abdominal pain in children

Article Abstract:

Abdominal pain is frequent among children. No specific cause in found in about one third of the cases, while medical conditions or surgical emergencies account for the rest. Appendicitis is the most frequent cause of surgical emergencies to treat abdominal pain. X-rays, the usual diagnostic technique, may not detect disorders in up to half of patients with abdominal pain. Barium enema is also less than ideal for diagnosis of appendicitis. New techniques in ultrasonographic imaging have made the diagnosis of appendicitis easier in both adults and children. It also helps in ruling out appendicitis and providing other diagnoses among patients with abdominal pain. One hundred eighty-two pediatric patients with abdominal pain underwent ultrasound to diagnose appendicitis or to detect other causes of the pain. Ultrasonography provided correct diagnoses 68 percent of the time overall, and correctly diagnosed appendicitis in 82 percent of the children who had it. Ultrasound did not indicate appendicitis in any cases where it was not present. The results of similar studies of the diagnostic usefulness of ultrasound imaging in the presence of abdominal pain are reviewed. Based on the findings of this study and others, it is concluded that ultrasonography should be used to evaluate children with suspected appendicitis, as well as to evaluate other causes of abdominal pain. In roughly half the cases of abdominal pain in children, the cause will remain unknown. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrasound imaging, Diagnosis, Causes of, Appendicitis, Abdominal pain in children, Pediatric abdominal pain

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