Is coronary angiography necessary for vascular surgery patients who have positive results of dipyridamole thallium scans?

PURPOSE: Because dipyridamole thallium (DT) scanning is a useful predictor of perioperative cardiac events, a positive results of a DT scan is frequently the basis for performing more invasive cardiac evaluation and for consideration for performing coronary revascularization procedures before performing peripheral vascular surgery. The rationale for this approach has been that the treatment of anatomically significant coronary artery disease would lower the risk of performing a subsequent vascular operation. However, the benefit of performing aggressive diagnostic and therapeutic cardiac procedures in such patients remains unproved. To examine this issue, data from patients who underwent coronary angiography because of thallium redistribution were compared with data from matched control subjects who underwent peripheral vascular operations without further cardiac evaluation. METHODS: The medical records of 70 consecutive patients who underwent coronary angiography because of the presence of two or more segments of redistribution on DT scan were reviewed and compared with 70 other patients matched with respect to age, gender, peripheral vascular operation, and number of segments of redistribution on DT scan who did not undergo additional cardiac evaluation. RESULTS: DT scans were performed on 934 preoperative peripheral vascular surgery patients to help in the assessment of operative risk. Ischemic responses, defined as two or more segments of redistribution, were observed in 297. Of these, 70 underwent cardiac catheterization and 25 underwent coronary revascularization procedures. Adverse outcomes affected 46% of the coronary angiography group and 44% of the control group (p = NS). Patients who underwent coronary angiography and were considered for myocardial revascularization had fewer cardiac events with a subsequent vascular operation than did the control subjects. However, any possible benefit from invasive cardiac evaluation was offset by the three deaths and two myocardial infarctions (MIs) that complicated the cardiac evaluation. There was no significant difference between the angiography group and the matched control subjects with respect to perioperative nonfatal MI (13% vs 9%), fatal MI (4% vs 3%), late nonfatal MI (16% vs 19%), or late cardiac death (10% vs 13%). In long-term follow-up, MIs occurred later in patients who underwent coronary angiography than the control subjects (p = 0.049), but this difference was not associated with an improvement in the overall survival rate. CONCLUSIONS: The risks of extended cardiac evaluation and treatment did not produce any improvement in either the perioperative or the long-term survival rate. For most vascular surgery patients who have a positive result of a DT scan, coronary angiography does not provide any additional useful information.     

Variation in Malting Quality and Heat Resistance in the Malting Barley Variety “Alexis”

In earlier studies concerning vigour, where subsamples are heat‐treated before germination there was found heat‐sensitive as well as heat‐resistant barley samples. The vigour model developed by Ellis and Roberts and further developed at Carlsberg, could only describe the heat‐sensitive barleys. Seventeen samples of the “Alexis” variety grown widely in Europe were collected from the EBC trials in 1994 in order to see if heat resistance in barley was influenced by different growing conditions. We found both heat‐sensitive samples following the vigour model as well as pronounced heat‐resistant samples, but these were not divided according to growing conditions. The germination curves dependent on heat treatment and germination time were evaluated by Principal Component Analysis (PCA). Heat‐resistant barley samples could be differentiated from heat‐sensitive samples already after ½ h of heat treatment at 68°C (12% moisture) and after 3 days of germination. The barley samples were analysed with regard to malting quality. The PCA evaluation of the data divided the samples according to growing location, mainly due to differences in protein and β‐glucan. However, the malting analyses could not describe the differences in heat resistance and sensitivity of the barleys. The biochemical background of the heat resistance found is discussed on the basis of literature. Our findings should give an experimental basis for exploiting a biochemical principle for heat resistance, which is formed during grain filling and consumed during storage and germination.     

Invasive angiology in acute arterial pathology in a critically ill newborn infant

Four patients who complained of symptoms and signs compatible with biliary tract disease and in whom the diagnosis of gallbladder (three cases) and common bile duct ascariasis (one case) was made sonographically are reported. In two patients with gallbladder ascariasis, cholecystectomy corroborated the presence of the round-worms, and was curative. The third patient was a pregnant woman (32nd gestational week) who took piperazine citrate, and a second sonogram performed 29 days later was completely normal. The fourth patient with common bile duct ascariasis underwent choledochotomy with extraction of one ascaris lumbricoides from the common duct, and a T tube was left in place for 15 days. All patients received antiparasitics and had a favorable outcome. Ultrasonography is an important noninvasive diagnostic procedure in the work-up of these patients, who usually describe a clinical picture suggesting gallstone disease: this is especially true in the presence of pregnancy.     

Bayesian multichannel image restoration using compound Gauss-Markov random fields

We develop a multichannel image restoration algorithm using compound Gauss-Markov random fields (CGMRF) models. The line process in the CGMRF allows the channels to share important information regarding the objects present in the scene. In order to estimate the underlying multichannel image, two new iterative algorithms are presented and their convergence is established. They can be considered as extensions of the classical simulated annealing and iterative conditional methods. Experimental results with color images demonstrate the effectiveness of the proposed approaches.