By C. Nafalem. Midwestern Baptist College. 2018.

First discount lasuna 60 caps with visa cholesterol test fasting australia, we have to believe it and envision it; the science and know- how are there generic lasuna 60 caps otc cholesterol medication debate. Please don’t misinterpret my focus on type 2 diabetes by think- ing that I am not concerned about the tragedy of type 1 diabetes, which is more prevalent in children, because it deeply saddens me. Type 1 diabetes is less prevalent than type 2 diabetes, and once it occurs it is not reversible. It accounts for 5 to 15 percent of the total diabetics, depending on what population you study. Most importantly, the plant-based approach mentioned previously that can dramatically prevent and even reverse type 2 diabetes, helps protect against the consequences of lifelong high blood sugar and insulin levels, such as eye, kidney, nerve, and cardiovascular damage. While researching new ways to create insulin in the body are important, studying why type 1 diabetes occurs in the first place is equally if not more important. Three areas that I would like to see studied urgently are as follows: • The role of vitamin D deficiency during pregnancy, lactation, and early childhood, setting the stage for an autoimmune or infectious insult that might damage the pancreas in the first place, leading to lack of insulin production. Take vitamin D during pregnancy and start it immediately after birth in the child; avoid cow’s milk products in childhood; and possibly supplement with - 45 - staying healthy in the fast lane probiotics during pregnancy, lactation, and throughout childhood. Finding out how to prevent type 1 diabetes by modulation of envi- ronmental and dietary factors is critically important and should be a major research focus in diabetic industries and by public health institutions. That means that we can easily and effectively reduce our risk of cardiovascular disease by:35 • engaging in regular physical activity,36 • avoiding tobacco use and secondhand smoke,37 • choosing a diet rich in fruit and vegetables, and avoiding foods that are high in fat, sugar, refined carbohydrates, and salt, and38 • maintaining an ideal body weight. To profoundly reduce the risk of heart disease, I believe we have to emphasize a dramatic reduction (preferably elimination) in animal-based foods, which includes total meats and dairy products, and encourage the con- sumption of only whole-grain products when grains are consumed. We also need to eliminate added fats, oils, and sugars by eating whole foods only. And of course, eat lots more vegetables, fruit and beans, and small amounts of raw nuts or seeds. Heart disease reversal by aggressive diet and lifestyle change was shown over thirty years ago by the late Nathan Pritikin and fifty years ago by California cardiologist Dr. Dean Ornish’s Program For Reversing Heart Disease,43 has also shown that a very low-fat, unrefined, mainly plant-based diet, with exercise and stress management, can reverse heart disease. Ornish’s work really put the whole concept of a diet and life- style approach to reversing heart disease on the road to legitimacy with his published work in the Lancet. The China Project, one of the most comprehensive databases on the multiple causes of disease ever compiled, was initiated in 1983, and the book The China Study (2006), with key investigator and co-author T. Colin Campbell, PhD from Cornell University, showed virtually no heart disease in parts of rural China where cholesterol levels ranged from 90 to 170 mg/dl (average 125 to 130), and the diets of these individuals were predominantly plant-based. Castelli said the following when asked if he couldn’t use drugs, but he could get the average American to go on the diet of his choice to reverse heart disease, “I would do it (diet) and it would work better than the drugs. Castelli commented on two past diet trials that showed reversal of heart disease, the St. Now if I would have put everyone on a veg- etarian diet and drive their numbers down by diet, we would get rid of all the atherosclerosis in America. I therefore decided it would be more appropriate to look at the leading killer of women and men in Western civilization, which is cardiovascular disease and heart attacks because in this global research it was very apparent that there were many cul- tures where heart disease and heart attacks were virtually non- existent. I mean, even today if you’re a cardiac surgeon and you go to rural China or the Papua Highlands in New Guinea, or if you go to central Africa or the Tarahumara Indians in northern Mex- ico, forget it. You’d better plan on selling pencils because you’re not going to find cardiovascular disease there, and it’s largely be- cause of that plant-based nutrition, and that’s what made me feel - 48 - the good news: chronic disease is preventable and reversible that if we could get people to eat to save their hearts they would actually then be saving themselves from cancer as well, and I still think that’s true. Esselstyn, Ornish, Fleming, and Rip Esselstyn), if applied with diligence, will stop the progression of and reverse heart disease in many people. Heart disease, the world’s number one killer, can be relegated to a “toothless paper tiger,” as Dr. You might be wondering why I am taking so much time on type 2 diabetes and heart disease treatment by diet and lifestyle and using the word “reversible. The same diet will greatly - 49 - staying healthy in the fast lane reduce the incidence of both. With this will come the dramatic reduction of all chronic diseases and a new, sustainable era in healthcare where low-cost lifestyle changes are the most powerful medicines, and we are free of the self-inflicted shackles of healthcare reform, insurance companies, and pharma- ceutical and hospital expenses. Read the books and listen to the interviews and references I share if you don’t believe me. If you don’t want to edu- cate yourself, just do the 9 Simple Steps to Optimal Health strictly for three to six months and see what happens! Chronic Disease Prevention and our Children In order to adequately address the systemic health risks that threaten our children, parents must make a commitment to live and eat differently. Parents must create a lifestyle for the whole family that is centered predominantly on unrefined, nutrient-rich, and less calorie-dense whole plant foods and minimal amounts of processed and animal foods. Furthermore, we need to become engaged with our schools in order to ensure that they are providing healthy, whole foods (vegetables, fruit, whole grains, beans, nuts, seeds), especially whole-grain products, on their premises.

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Worse outcome was associated with increased expression of genes associated with mesenchymal differentiation and angiogenesis buy 60 caps lasuna amex cholesterol total test. Multivariate analysis confirmed that the 9-gene set was an independent predictor of outcome after adjust- ing for clinical factors and methylation of the methyl-guanine methyltransferase promoter discount 60caps lasuna diet chart cholesterol patients. Personalized Chemotherapy of Brain Tumors Although ~26 % of patients treated with temozolomide survive >2 years, it is diffi- cult to predict who would respond to therapy. Simulating Chemotherapeutic Schemes for Individualization A novel patient individualized, spatiotemporal Monte Carlo simulation model of tumor response to chemotherapeutic schemes in vivo has been described (Stamatakos et al. A mesh is super- imposed upon the anatomical region of interest and within each geometrical cell of the mesh the most prominent biological “laws” (cell cycling, apoptosis, etc. A good qualitative agreement of the model’s predictions with clinical experience supports the applicability of the approach to chemotherapy optimization. During their low-grade period, these tumors exhibit systematically a spontaneous and continuous radiological Universal Free E-Book Store 288 10 Personalized Therapy of Cancer growth, whatever their histological subtypes. It depends on intrinsic factors (1p19q codeletion status, P53 over- expression status) and can be modified by extrinsic factors such as pregnancy. Because response to chemotherapy varies and the adverse effects may outweigh benefits in pathological types of tumors that do not respond to chemotherapy, there is thus an urgent need for refined diagnostic markers to improve glioma classification and predicting their chemosensitivity. A significant finding of this trial was that tumors lacking 1p and 19q alleles are less aggressive or more responsive or both (Cairncross et al. The specific chromosomal change in oligodendroglial brain tumors is thus associated with a very good prognosis and may also identify patients who would benefit from chemotherapy treatment in addition to radiotherapy at diagnosis for long-term tumor control. The findings could change the future of how brain cancers are diagnosed and treatments are personalized based on genetic make-up of the tumor. Testing for chromosomal deletions should be a mandatory part now of the management of patients with these tumors. Universal Free E-Book Store Personalized Management of Cancers of Various Organs 289 Clinical implementation of these results is expected to greatly improve routine glioma diagnostics and will enable a patient specific therapeutic approach. Protocols will be established that are able to distinguish chemosensitive and chemoresistant tumors, and implementation of these protocols in routine diag- nosis will enable tailored chemotherapy for individual glioma patients, thereby avoiding unnecessary harmful side effects and improving their quality of life. Personalized Therapy of Neuroblastomas Neuroblastoma usually arises in the tissues of the adrenal glands but is also seen in the nerve tissues of the neck, chest, abdomen and pelvis. It responds to chemother- apy with topotecan, which interacts with a critical enzyme in the body called topoi- somerase. The aim is to get the right dosage of topotecan for a good antitumor effect and to minimize toxicity. The aim of the initial treatment with the drug is to quickly reduce the size of the tumor that must be surgically removed. Reducing tumor size with topotecan and surgery also reduces the risk that the cancer will develop resistance to standard chemotherapy drugs that are administered afterward. The scientists are now working on a method where they could tell pediatric oncologists that they could adjust the topotecan dosage according to patient characteristics to get a better antitumor effect and not even need to check blood levels. Universal Free E-Book Store 290 10 Personalized Therapy of Cancer Personalized Therapy of Medulloblastomas Medulloblastoma is a malignant tumor of the cerebellum usually diagnosed in chil- dren at the median age of 5 years, but it may occur in young adults. Treatment is surgery followed by radiation therapy and chemotherapy, which have serious short- term and long-term adverse effects. Patients with recurrence after primary therapy have a particularly poor prognosis. The hedgehog pathway, an embryonic signaling cascade that regulates stem-cell and progenitor-cell differentiation, is involved in the pathogenesis as medulloblastoma arises from these cells. It was used successfully in a patient with advanced medulloblastoma that had been refractory to multiple prior therapies (Rudin et al. Identifying the mechanisms of acquired resistance to selective hedgehog pathway inhibitors in patients with medulloblastoma will be of particular interest in future studies. The development of a diagnostic biomarker for hedgehog pathway activa- tion has been challenging because alteration of many pathway components may result in an activated phenotype. A gene-expression signature, which appears to correlate with hedgehog pathway activation in medulloblastoma, showed specific pathway activation in this patient’s tumor. Testing this and other potential strategies for identifying biomarkers will be important components of future clinical trials of hedgehog pathway inhibitors. Even benign tumors require surgery if they affect the surrounding brain tissue and disrupt neurological functions. Genomic analysis has shown that the entire genetic landscape of meningiomas can be explained by abnormalities in just 5 genes. Meningiomas with these mutations are found in the skull base and are unlikely to become malignant. It can induce stem cell formation, even in cells that have fully dif- ferentiated into a specific tissue type.

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These are order 60 caps lasuna overnight delivery what cholesterol medication is safest, Aristotle says order lasuna 60 caps on-line cholesterol score breakdown, the most important functions living be- ings can realise or experience qua living beings, and it is for the purpose of these functions that the bodily structures such as described in History of Animals and Parts of Animals (and in the lost work On Plants) exist. The Parva naturalia are closely linked to Aristotle’s work On the Soul, and the psycho-physiological explanation of dreams which Aristotle expounds in On Dreams (and which, in the enumeration listed above, is subordinated to and included in the discussion of sleeping and waking) heavily draws upon Aristotle’s general theory of the soul, especially his views on sense- perception, ‘imagination’ (phantasia), and on the so-called ‘central sense faculty’ (kurion aistheterion¯ ¯ ). This context of the study of nature should make clear from the outset that the interest taken by Aristotle in dreams is neither epistemological nor practical, hermeneutic or therapeutic – as it is, for example, in the Hippocratic work On Regimen quoted above, of which Aristotle was aware. Against this background, the questions Aristotle is pursuing in the three works in question make perfect sense. Thus in the preface to On Sleep and Waking (453 b 11–24), which in a way serves as an introduction to all three of the treatises, he says that he is going to consider whether sleeping and waking are ‘peculiar to the soul’ or ‘common to soul and body’, and, if common to both, what parts of soul and body are involved; whether sleep occurs in all living beings or only in some; and through what cause (aitia) it occurs. But this question is not explicitly raised, and his relevant remarks are scattered, nuanced and complicated, so that an answer unfolds only gradually through the continuous discussion in the three works; and it is not free from apparent contradictions. In On Sleep and Waking, Aristotle begins by defining sleep negatively as the inability of the sense faculty to be activated (adunamia tou energein, 454 b 5, 458 a 29). Sleep is said to be a ‘fetter and immobilisation’ (desmos kai akinesia¯ , 454 b 10) an ‘inac- tivity’ (argia) or ‘incapacitation’ (adunamia) of the sensitive faculty (455 b 3ff. It is a state in which the vegetative part of the soul gains the upper hand (455 a 1–2), and it is caused by various physiological processes that are connected with the digestion of food (such as heating, cooling, evapo- ration of food, and sifting of the blood). Whether these physiological processes also affect the ability to think and the operations of the intellectual part of the soul, is a question which Aristotle does not address explicitly. Strictly speaking, since Aristotle’s supreme intellectual faculty, the nous, is said to be incorporeal and not to require simultaneous perception in order to be active,20 there is, at least in principle, no reason why we should not be able to think while being asleep. Aristotle’s negative definition of sleep does not, however, imply a negative evaluation of this ‘affection’ (pathos). Sleep is a good thing and serves a purpose, for it provides rest (anapausis) to the sense-organs, which would otherwise become overstretched, since they are unable to be active without interruption (454 a 27, 455 b 18ff. Here, again, one may note a difference compared with thinking; for one of the differences between perception and thinking, according to Aristotle, is that perception cannot go on forever, indeed if we overstretch our sense-organs, we damage them; thinking, on 19 For a discussion of Aristotle’s physiological explanation of sleep see Wiesner (1978). Aristotle on sleep and dreams 177 the other hand, does not know fatigue and the harder we exercise our intellectual faculty, the better it functions. Sleep, he argues in chapter 1 of On Sleep and Waking, is the opposite of waking; and since waking consists in the exercise of the sensitive faculty, sleep must be the inactivity of this faculty. In fact, sleep is nothing but a state of what Aristotle elsewhere calls ‘first entelechy’,23 a state of having a faculty without using it, which may be beneficial in order to provide rest to the bodily parts involved in its exercise. Furthermore, Aristotle is characteristically keen to specify that sleep is a particular kind of incapacitation of the sense faculty as distinct from other kinds of incapacitation, such as faint and epileptic seizure (456 b 9–16). He also applies his explanatory model of the four causes (which he reminds us of in 455 b 14–16) to the phenomenon of sleep, listing its formal, final, material and efficient causes, and leading up to two com- plementary definitions stating the material and the formal cause of sleep: the upward movement of the solid part of nutriment caused by innate heat, and its subsequent condensation and return to the primary sense organ. And the definition of sleep is that it is a seizure of the primary sense organ which prevents it from being activated, and which is necessary for the preservation of the living being; for a living being cannot continue to exist without the presence of those things that contribute to its perfection; and rest (anapausis) secures preservation (soteria¯ ¯ ). It is true that, in the course of his argument, Aristotle occasionally refers to empirical observations, or at least he makes a number of empirical claims, which can be listed as follows: 1. Nutrition and growth are more active in sleep than in the waking state (455 a 1–2). Some people move and perform various activities in sleep, and some of these people remember their dreams, though they fail to remember the ‘waking’ acts they perform in sleep (456 a 25). Words are spoken by people who are in a state of trance and seemingly dead (456 b 16). People with inconspicuous veins, dwarfish people, and people with big heads are inclined to much sleep (457 a 20). People with marked veins do not sleep much; nor do melancholics, who in spite of eating much remain slight (457 a 26). Yet while some of these claims are interesting as testifying either to Aristotle’s own observational capacities or to his considerable knowledge of medico- physiological views on sleeping, as a whole they can hardly be regarded as impressive for their wide range or systematicity; and in the argument, most of these empirical claims have at best only a marginal relevance to the topic of sleep. They are mentioned only in passing, and none are presented by Aristotle as guiding the investigation inductively to a general theory or as playing a decisive role in settling potentially controversial issues. Nor does Aristotle explain how observations that seem to be in conflict with the theoretical views he has expounded can nevertheless be accommodated within that theory. Thus, in spite of his definition of sleep as the absence of sensation, Aristotle on several occasions acknowledges that various things may occur to us while we are in a state of sleep. This is obviously relevant for the discussion of dreams and divination in sleep that follows after On Sleep and Waking; but already in On Sleep and Waking we find certain anticipations of this idea, for example in 456 a 25–9, where he acknowledges that people may perform waking acts while asleep on the basis of an ‘image or sensation’ (nos. And on two occasions, the wording of On Sleep and Waking seems to open the door to sensations of some kind experienced in sleep: ‘Activity of sense perception in the strict and unqualified sense (kurios¯ kai haplos¯ ) is impossible while asleep’ (454 b 13–14), and ‘we have said that sleep is in some way (tropon tina) the immobilisation of sense perception’ (454 b 26). These specifications suggest that more may be at stake than just an unqualified absence of sensation. Yet how the phenomena Aristotle on sleep and dreams 179 referred to are to be explained within the overall theory, he does not make clear. This absence of a teleological explanation of dreams is significant, and I shall come back to it at the end of this chapter. In On Dreams,asinOn Sleep and Waking, Aristotle again begins by stating rather bluntly that dreams cannot be an activity of the sense faculty, since there is no sense-perception in sleep (458 b 5–10). However, in the course of the argument he recognises that the fact that sense-perception cannot be activated (energein) does not mean that it is incapable of being ‘affected’ (paschein): rì oÔn t¼ m•n mŸ ¾rŽn mhd•n ˆlhq”v, t¼ d• mhd•n p†scein tŸn a­sqhsin oÉk ˆlhq”v, ˆllì –nd”cetai kaª tŸn Àyin p†scein ti kaª t‡v Šllav a«sqžseiv, ™kaston d• toÅtwn ãsper –grhgor»tov prosb†llei m”n pwv t¦€ a«sqžsei, oÉc oÌtw d• ãsper –grhgor»tová kaª Âte m•n ¡ d»xa l”gei Âti yeÓdov, ãsper –grhgor»sin, Âte d• kat”cetai kaª ˆkolouqe± tä€ fant†smati.

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Nine genes were of special relevance to clinicians dealing with deafness in identified within this critical region and sequencing of the context of developmental delay buy cheap lasuna 60caps line cholesterol in foods guide. Consequently the emerging data confirm that motor delay and hypotonia (90% ) buy lasuna 60 caps visa xymogen cholesterol, moderate to severe Newly emerging concepts in syndromology relevant to audiology 43 mental retardation (90% ), pointed chin (80%), seizures to hearing abnormalities. These have been characterised as high (70% ), clinodactyly and/or short fifth finger (60% ), ear frequency bilateral sensorineural hearing loss in 8 of 18 cases in asymmetry (55% ), low-set ears (55% ), hearing deficits one report, a further two cases having conductive loss charac- (55% ), and other variable features, including congenital terised as severe degree (15). Some have com- enced dysmorphologists will often recognise children with mented on a horizontality of the eyebrows, which they find this syndrome clinically, despite a normal karyotype report, and clinically valuable in alerting them to this syndromic diagnosis discussion with cytogeneticist colleagues will often lead to reeval- but that is inconstant, as any examination of published uation of the original chromosome report and the identification photographs shows. Note especially the horizontality of the eyebrows, which is a good clinical sign but not universal. Laryngotracheobronchoscopy showed multiple haemorrhagic regions in the trachea and main bronchi, consistent with acute respiratory arrest. A genetics referral led to some new points being established—specifically there was no facial dysmorphism, but the developmental history was suggestive of slight parental concern in that milestones were not being achieved at the same rate as had occurred in the older siblings. Subsequently this child developed severe palatal insuffi- ciency, with little evidence of gag reflex on video fluoroscopy (Fig. Follow- ing fundoplication, airway function improved greatly and even- comprising developmental delay, hypertelorism, often cleft tually it was possible to reinstigate oral feeding. Oropharyngeal palate and palatal dysfunction, low-set ears, poor growth, and hypotonia and palatal dysfunction are a well-established feature abnormal fifth finger nails has been known for many years (16). However, the deletion procedures, it ought to be worth clinically examining the nails can be subtle cytogenetically, and, the patient’s clinical condi- for tail of the nail sign and reviewing the chromosomes for tion being mild, be missed. Such a case arose in this author’s evidence of 4q-abnormality, which can be familial and own practice recently. Having established a deletion of chromosome 2q22–23 in one of these patients, the authors then proceeded to review the litera- ture of clinical data from published cases with visible deletions in this region of chromosome 2q and felt there were strong facial resemblances between the features on the six cases under report and the case previously identified by Lurie et al. This phenomenon exemplifies the important learning process, which dysmorphologists often com- ment upon and call “getting your eye in”—essentially a learning period during which one recognises the phenotype and, having so done, recognises the pattern in future consultations with other patients. This learning stage is an important process in the emer- gence of any new dysmorphic syndrome. It also follows that if the original authors identified five patients within a few months that the syndrome must be a relatively common problem and these cases were unlikely to be unique cases. Subsequent events have shown that such is indeed the correct conclusion—a review by the original authors in 2003 recorded 45 cases from several continents (20). Commenting on the configuration of the ear lobes, which they described “as like orecchiette pasta or red blood corpuscles in shape, is a consistent and easily recognised feature. Perhaps it is not so much the clinical sign itself, which is new—indeed it is likely that this condition has always existed, new, as the recognition of that sign as a marker for a specific but the relevance of the clinical signs and their specific causal genetic disease or syndrome. Most cases of this malforma- Wilson syndrome, after the pair of principal observers, Drs. David tion arise as isolated clinical findings and many patients are Mowat and Meredith Wilson. Most cases arise as new events in the family and, if tion, microcephaly, short stature, and, in four of the six, neonatal taken, the family history is unremarkable. Severe constipation was present in all which is frequently not sought, is the history of the pregnancy, 46 Genetics and hearing impairment Figure 3. As with the ear abnormalities in 2q deletion syndrome, choanal atresia related to the ingestion of carbimazole during pregnancy has long existed but the association has been over- looked by failure to take the history of the pregnancy. Often the diagnostic significance of a specific clinical sign can be obscured by lack of reports or failure to observe the sign in cases with the condition. It certainly seems that this and, in particular, a history of maternal medication. In fact, observation is true in respect of Keipert syndrome, in which a trickle of cases since Greenberg first observed choanal atresia condition deafness is associated with broad thumbs and halluces in the offspring of a woman exposed to carbimazole in preg- (Fig. Only a handful of reports have recognised this rare nancy (21) have supported a likely causal effect for choanal diagnosis, but the author is aware of at least three further cases, which have been brought to his attention following a report of a classical case (24). Apart from the broad thumbs, there was general reduction in the terminal phalanges on radiology with a large thumb epiphysis (Fig. It is likely that there are many other cases of this syndrome currently unrecognised for want of clinical examination. Molecular genetics of known syndromes informs clinical classification and explains some previous contradictions Antley–Bixler syndrome Antley–Bixler syndrome is a condition derived from the epony- mous 1975 report of a patient with craniosynostosis, radiohumeral synostosis and femoral bowing (25). Over 30 sub- sequent cases have been described, sometimes as single events, often as sibships. Genital abnormality is an inconstant element of the therapeutic advantages of fluconazole is the improved speci- the condition. However, the syndrome is very difficult to ficity it shows for the fungal cytochrome P450 enzyme complex, distinguish from two other clinical disorders: Pfeiffer syndrome the embryopathy is likely to reflect relative adrenal insuffi- with large joint synostosis, in which the genital malformations ciency in infants who develop features of the embryopathy in are absent, and fluconazole embryopathy. Thus clinical observations, in this instance the led one group of authors to pursue this line of enquiry further. If we look at Pendred syndrome, the has been developed further and mutations in cytochrome P450 classical diagnostic triad of deafness, goitre, and a positive per- oxidoreductase identified in children with disordered steroido- chlorate discharge test have been shown to be relatively poor genesis, ambiguous genitalia, and Antley–Bixler syndrome, this identifiers of affected individuals. Not only has the molecular genetics resolved the clinical practice, the use of the perchlorate discharge test has differences between the overlapping clinical phenotypes but it largely been supplanted.

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In G3 best lasuna 60caps cholesterol eggs per day, with more advanced myocardial perfusion pathology buy 60caps lasuna with visa cholesterol levels ratio canada, the correlation was highly significant in the categories of fixed and total defects, while no statistically signifi­ cant correlation in the reversible defect category was found. Such a situation creates a great need for cardiology, including the development of diagnostic tools useful for detection of the disease, assessment of its progression and follow-up in the course of therapy. Contemporary nuclear medicine provides reliable, reproducible and non-invasive methods of this type. Myocardial perfusion scintigraphy has, since the introduction of 201T1C1, become the most commonly performed procedure in nuclear cardiology [1]. In particular, double stage stress/rest perfusion imaging provides detailed information about localization and the extent of the area involved in a pathological process, making it possible to distinguish between post-infarct scar and hypoperfused but still viable myocardium. These patients may gain remarkable benefits from suitable therapeutic interventions. To avoid the substantial radiophysical limitations of 201T1C1, as well as logistical problems with its production and delivery (particularly important for developing countries), isonitrile complexes labelled with 99Tcm were introduced [3-5]. Nuclear cardiology also provides a non-invasive and reproducible technique for the assessment of the haemodynamic function of the heart chambers, such as radi­ onuclide ventriculography [6, 7]. In a time interval not exceeding two weeks, a gated blood pool study under rest conditions was performed as well. All the scintigraphic data were acquired with the use of a Picker Dyna 5 gamma camera connected to a Siemens MaxDelta computer system. Prior to stress myocardial perfusion scintigraphy, the patients were subjected to a symptom limited bicycle ergometer exercise to reach at least 85 % of the age-predicted maximal heart rate. Within this range, 30 equidistant image frames in a step-and-shoot mode were registered with a time duration of 50 s/frame. During the rest study, the acquisition conditions and dose of the tracer were the same. The value of the reversible defect was calculated as the difference between the total defect and fixed defect [14-16]. For the whole study, 6 000 000 counts were collected, which was equal usually to about 500 heart cycles. In the data acquisition procedure, division of a single heart cycle into 26 frames was carried out. Prior to every radionuclide investigation, the patient’s written consent was obtained. The first group (Gl) comprised 20 patients with no perfusion defects both at rest and during stress in visual assessment. In a quantitative evalua­ tion, the perfusion parameters were within the range of normal values [17]. The third group was composed of 133 patients with perfusion defects present at rest (see Table I). The total perfusion defect presented significant differences between individual groups of patients under study. This defect, observed in G3, was significantly greater than the corresponding values for G2 and G1. In the quantitative evaluation of the rest study, the numerical values of the myocardial perfusion in G1 and G2 were within the range of normal values. On the other hand, in G3 these values exceeded markedly the normal values and were significantly greater than in G1 or G2. All the groups differed significantly in the category of the reversible defect, which was the largest in G2. On the other hand, in the most numerous group G3, with more advanced myocardial perfusion pathology, the correlation was highly significant (p < 0. Such coefficient values in posterolateral and inferior wall regions were slightly lower, but still statistically significant. Visual analysis of perfusion images and bullseye and 2-D echo wall motion were compared, evaluating changes only in revascularized segments. Five myocardial segments and bullseye quantitative parameters were observed according to 2-D echo results: (a) reduction in total perfusion defect size; and (b) reduction in global defect severity. The results were: (1) the global segmental concordance between perfusion and wall motion was 66% (к: 0. Discordant segments were read as improvement only in the perfusion scan in 20% and only in wall motion in 14%. The conclusion is: quantitative gated perfusion data are helpful in the evaluation of coronary revascularization. Acute myocardial infarction is the major complication, and coronary revas­ cularization is the final therapy in order to recover adequate flow to myocardial walls. On the other hand, it is well known that angioplasty has a high incidence of restenosis (30-50% at six months). Soon after the procedure, during the first months, motion recovery is not always observed parallel to perfusion improve­ ment or with metabolic function. The recovery of myocardium at risk with revascularization could be evaluated through radionuclide, echographic or even metabolic studies pre- and post­ procedure.

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