Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Thirty patients with clinical signs of infective endocarditis and pathologic echocardiographic findings indicating vegetations underwent scanning with In-111 or Tc-99m hexamethylpropylene amineoxime (HMPAO) labeled granulocytes. Blood cultures were positive in 60% of the patients. The other cases were negative as a result of antibiotic pretreatment. The results of scintigraphy were correlated with the subsequent clinical course, and in 20 cases with data obtained by histologic examination of the valves. With regard to the degree of the inflammatory process, the nuclear medical procedure provided the following results: true-positive in 6 cases, false-positive in 1 case, true-negative in 19 cases, and false-negative in 3 cases. In this study, positive granulocyte scans correlate with high activity of the inflammatory process and predict a poor prognosis for the patients concerned.

Thirty patients with clinically suspected infective endocarditis were scanned with Indium-111- or Tc-99m-HMPAO-labeled granulocytes. The scans were correlated with the clinical course, and in 20 cases with the results from histologic examination of the valves. In six cases the scintigraphic examination gave correct positive results, in three cases false negative, in one case a false positive, and in 20 cases correct negative results. If we limit the analysis to only the histologically proven cases, our data suggest a specificity of the method of 86 % and a sensitivity of about 67 %.

Thirty patients with clinically suspected infective endocarditis were scanned with Indium-111- or Tc-99m-HM-PAO-labeled granulocytes. The scans were correlated with the clinical course, and in 20 cases with the results from histologic examination of the valves. In six cases the scintigraphic examination gave correct positive results, in three cases false negative, in one case a false positive, and in 20 cases correct negative results. If we limit the analysis to only the histologically proven cases, our data suggest a specificity of the method of 86% and a sensitivity of about 67%.

A new accelerometer‐based adaptive rate pacemaker (OEXCELVRTM) was evaluated to investigate its behavior at nominal settings during treadmill exercise testing and postural changes. Eight patients with sinus rhythm were selected to compare intrinsic heart rate to sensor mediated rate. Throughout exercise treadmill testing, changes in the sensor mediated rate closely paralleled actual physiological changes. The Pearson product moment correlation of pacing rate with sinus frequency, calculated for all patients, was r = 0.82 (P = 0.001). Change in the patient's physical position resulted in immediate change in sensor rate, which corresponded appropriately to the type of position change and activity level. Average (± SD) pacing rate was 62.4 ± 2.7 beats/min supine; 67 ± 3.8 beats/min sitting; 69.8 ± 6.4 beats/min standing; 81.6 ± 8.7 beats/min slow walking; and 96.8 ± 1.3 beats/min fast walking. After 4 minutes of recovery, the average pacing rate dropped to 65 ± 3 beats/min. The interaction between the accelerameter and the pulse generator at nominal settings was accurate and infrequently required the use of its many programming options. The accelerometer sensor and pulse generator algorithm in this device during postural change and exercise resulted in physiological‐like changes in sensor mediated heart rate.

The lipophilic 99mTc-HMPAO complex can be used for labelling platelets as well as granulocytes. Platelets were isolated according to standard isolation procedures for the evaluation of the optimal labelling parameters. The labelling efficiency (%) depends on incubation temperature (22° C: 40%; 37° C: 50%), incubation time (3 min: 20%, 25 min: 55%) and the incubation medium (plasma: 40%; saline 50%). The 60 min 99mTc elution, out of the platelets ranged around 8%. The platelet recovery used as a quality control parameter is around 25%±4% and is stable for at least 240 min. The high elution rate out of the platelets leads to renal excretion of the label and hence to significant kidney and bladder activity. Intestinal excretion of the label can also be frequently demonstrated. Fresh thrombotic lesions can normally be detected 4 h after reinjection of the labelled platelets, and in some patients as early as 1 h after reinjection. In conclusion, 99mTc-HMPAO seems to be a promising platelet label for imaging thrombotic lesions but not for platelet survival studies, because of the short physical half life of 99mTc.

The effects of 5 and 10 mg bisoprolol once daily for 7 days on exercise ECG, myocardial perfusion and left ventricular function in 25 patients with stable coronary heart disease have been assessed in a double-blind, randomized, parallel group trial design.

Twenty-five patients were examined in vivo with 99mTc labelled monoclonal antibodies; 15 with suspected infections with an antigranulocyte antibody (BW 250/183), 10 with suspected recurrence of a colorectal carcinoma with an anti CEA antibody (BW 431/26). Both antibodies were IgG1 isotypes. In the patients with suspected infections no change of the peripheral leukocyte count could be observed after the antibody injection (1 mg, n=9; 0.5 mg, n=1; 0.25 mg, n=6). In 2 patients examined with the anti CEA antibody (2 mg), a significant decrease of the peripheral leukocyte count could be observed. The recovery rate of the 99mTc antibody labelled granulocytes was calculated to be about 10%. The increase of the antibody-antigen binding was calculated to be 0.2%/min. In vivo the organ distribution curves demonstrated an increase of 99mTc activity over spleen and bone marrow of 1.1%/min, which was interpreted as antigen-antibody reactivity. The organ distribution curves of the anti granulocyte antibody over spleen and bone marrow showed typical binding characteristics to the local granulocyte epitopes. The curves over other organs showed a simple perfusion pattern. The curves of the anti CEA antibody showed a perfusion pattern over all the examined organs. A sham dialysis model in one patient with renal insufficiency undergoing regular dialysis treatment demonstrated the viability of 99mTc antibody labelled granulocytes in vivo. The kinetic patterns of the 99mTc antibody in patients with Crohn's disease were interpreted as CEA binding of the antibody in the bowel wall.

The lipophilic 99Tcm hexamethylpropyleneamineoxime (HMPAO) complex can be used for labelling platelets as well as granulocytes. For the evaluation of optimal labelling parameters, platelets were isolated according to standard isolation procedures. The labelling efficiency (%) depends on incubation temperature (22 degrees C: 40%; 37 degrees C: 50%), incubation time (3 min: 20%; 25 min: 55%) and the incubation medium (plasma: 40%; saline: 50%). The 60 min 99Tcm elution from the platelets is around 8%. The platelet recovery, used as a quality parameter, is around 25 +/- 4% and is stable for at least 240 min. The high elution rate from the platelets leads to renal excretion of the label and so to significant kidney and bladder activity. Intestinal excretion of the label can also be frequently demonstrated. Fresh thrombotic lesions can usually be detected 4 h after reinjection of the labelled platelets, and in some patients as early as 1 h after reinjection of the platelets. In conclusion, 99Tcm HMPAO seems to be a promising platelet label for imaging thrombotic lesions but not for platelet-survival studies because of the short physical half-life of 99Tcm.