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  • 1
    Electronic Resource
    Electronic Resource
    Comparative study of rest technetium-99m sestamibi SPET and low-dose dobutamine stress echocardiography for the early assessment of myocardial viability after acute myocardial infarction: importance of the severity of the infarct-related stenosis (1996)
    Springer
    European journal of nuclear medicine 23 (1996), S. 748-755 
    Details
    ISSN: 1619-7089
    Keywords: Myocardial infarction ; Technetium-99m sestamibi ; Dobutamine stress echocardiography ; Coronary anatomy ; Viability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Rest technetium-99m sestamibi single-photon emission tomography (SPET) has been shown to under-estimate viability in some patients with chronic ischaemic myocardial dysfunction. The present study was designed to appraise the value of99mTc-sestamibi as a viability tracer in patients with a recent myocardial infarction and to determine factors that might influence its accuracy in assessing infarct size. Therefore, rest99mTc-sestamibi SPET, low-dose dobutamines stress echocardiography and quantitative coronary angiography were performed in 51 patients with a recent myocardial infarction. Perfusion activity and regional wall motion were scored semi-quantitatively using the same segmental division of the left ventricle. Assessment of99mTc-sestamibi uptake as a marker of viability was performed by comparing a binary uptake score (viable=〉50% vs necrotic =≤50% of the maximal tracer activity) with a binary wall motion classification during low-dose dobutamine infusion (viable=normal/hypokinetic vs necrotic=akinetic/dyskinetic). Infarct size, expressed as the number of segments with evidence of necrotic tissue, was significantly greater in the scintigraphic study than in the echocardiographic study (2.8±1.5 vs 2.2±1.3,P=0.006). This overestimation of infarct size by99mTc-sestamibi was present only in patients with a severe infarct-related stenosis (% diameter stenosis ≽65%–100%) and particularly those with “late” reperfusion therapy (time delay ≽180 min). In patients without a severe infarct-related stenosis,99mTc-sestamibi was able to accurately distinguish viable from necrotic segments. Thus, rest99mTc-sestamibi scintigraphy early after acute myocardial infarction may underestimate residual viability within the infarct region, particularly in patients with low flow state coronary anatomy, as a result of a severe infarct-related stenosis and/or late reperfusion therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00843702
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  • 2
    Electronic Resource
    Electronic Resource
    Adenosine technetium-99m sestamibi single-photon emission tomography for the assessment of jeopardized myocardium early after acute myocardial infarction (1997)
    Springer
    European journal of nuclear medicine 24 (1997), S. 1121-1127 
    Details
    ISSN: 1619-7089
    Keywords: Jeopardized myocardium ; Adenosine ; Technetium-99m sestamibi ; Stenosis severity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study investigated the value of technetium-99m sestarnibi scintigraphy in identifying patients at risk for post-infarct ischaemia (=jeopardized myocardium), especially within the reperfused infarct region. In 51 patients with a recent (〈I month) myocardial infarction, adenosine99mTc-sestamibi single-photon emission tomography (SPET) and dobutamine stress echocardiography (DSE) were performed and correlated with the presence of significant coronary artery stenosis [% diameter stenosis (DS) 〉50%] on quantitative coronary angiography. Regional perfusion activity was analysed semiquantitatively (score 0–4) on a 13-segment left ventricular model. DSE was used for the estimation of the infarct size (low-dose DSE) and for concomitant evaluation of ischaemia (high-dose DSE). A reversible perfusion defect within the infarct region was observed in 20 of the 37 patients with a significant infarct-related lesion (sensitivity of 54%) and only in one patient without a significant infarct-related lesion (specificity of 93%). Further analysis revealed that the scintigraphic assessment of jeopardized myocardium was fairly good in patients with a moderate (DS 51%–64%) infarct-related stenosis but was inadequate in patients with a severe (DS≥65%) infarct-related stenosis (sensitivity of 80% vs 36%,P〈0.01), while the echocardiographic detection of ischaemia was not influenced by stenosis severity (sensitivity of 73% in both subgroups). This scintigraphic under-estimation of jeopardized myocardium was mainly related to a severely impaired myocardial perfusion under baseline conditions, as was evidenced by a significantly more severe rest perfusion score in the infarct region in patients with a severe stenosis as compared to those with a moderate stenosis (average score: 1.5±0.7 vs 2.1±0.6,P〈0.01), while infarct size on echocardiography was similar for both subgroups. It may be concluded that early after an acute myocardial infarction, adenosine99mTc-sestamibi SPET may underestimate reperfused but still jeopardized myocardium, particularly in patients with a severe infarct-related stenosis. In these patients the evaluation of the ischaemic burden on rest-stress scintigraphy is hampered by the presence of a severely impaired myocardial perfusion in resting conditions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01254243
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  • 3
    Electronic Resource
    Electronic Resource
    Adenosine technetium-99m sestamibi single-photon emission tomography for the assessment of jeopardized myocardium early after acute myocardial infarction (1997)
    Springer
    European journal of nuclear medicine 24 (1997), S. 1121-1127 
    Details
    ISSN: 1619-7089
    Keywords: Key words: Jeopardized myocardium ; Adenosine ; Technetium-99m sestamibi ; Stenosis severity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. This study investigated the value of technetium-99m sestamibi scintigraphy in identifying patients at risk for post-infarct ischaemia (=jeopardized myocardium), especially within the reperfused infarct region. In 51 patients with a recent (〈1 month) myocardial infarction, adenosine 99mTc-sestamibi single-photon emission tomography (SPET) and dobutamine stress echocardiography (DSE) were performed and correlated with the presence of significant coronary artery stenosis [% diameter stenosis (DS) 〉50%] on quantitative coronary angiography. Regional perfusion activity was analysed semi-quantitatively (score 0–4) on a 13-segment left ventricular model. DSE was used for the estimation of the infarct size (low-dose DSE) and for concomitant evaluation of ischaemia (high-dose DSE). A reversible perfusion defect within the infarct region was observed in 20 of the 37 patients with a significant infarct-related lesion (sensitivity of 54%) and only in one patient without a significant infarct-related lesion (specificity of 93%). Further analysis revealed that the scintigraphic assessment of jeopardized myocardium was fairly good in patients with a moderate (DS 51%–64%) infarct-related stenosis but was inadequate in patients with a severe (DS≥65%) infarct-related stenosis (sensitivity of 80% vs 36%, P〈0.01), while the echocardiographic detection of ischaemia was not influenced by stenosis severity (sensitivity of 73% in both subgroups). This scintigraphic underestimation of jeopardized myocardium was mainly related to a severely impaired myocardial perfusion under baseline conditions, as was evidenced by a significantly more severe rest perfusion score in the infarct region in patients with a severe stenosis as compared to those with a moderate stenosis (average score: 1.5±0.7 vs 2.1±0.6, P〈0.01), while infarct size on echocardiography was similar for both subgroups. It may be concluded that early after an acute myocardial infarction, adenosine 99mTc-sestamibi SPET may underestimate reperfused but still jeopardized myocardium, particularly in patients with a severe infarct-related stenosis. In these patients the evaluation of the ischaemic burden on rest-stress scintigraphy is hampered by the presence of a severely impaired myocardial perfusion in resting conditions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01254243
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  • 4
    Electronic Resource
    Electronic Resource
    Recall and selection bias in reporting past alcohol consumption among breast cancer cases (1993)
    Springer
    Cancer causes & control 4 (1993), S. 441-448 
    Details
    ISSN: 1573-7225
    Keywords: Alcohol ; bias ; breast neoplasms ; case-control studies ; prospective studies ; questionnaires ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Recall and selection bias are well-recognized potential problems in case-control studies of alcohol and cancer, but few analyses have attempted to assess the direction and the magnitude of these potential biases. We thus examined alcohol consumption in relation to risk of breast cancer using dietary questionnaires administered both before and after the diagnosis of breast cancer in the Nurses' Health Study (United States). Among cohort members who completed a dietary questionnaire in 1986 and who were free of cancer, 616 were diagnosed with breast cancer during follow-up to December 1989. These cases and 1,277 controls (a random sample of cohort members who did not develop cancer up to 1990) then were sent another questionnaire inquiring about their diet in 1985. Four hundred and ninety-four cases (80.2 percent) and 999 controls (78.2 percent) responded to the second questionnaire. The analysis based on the prospective (1986) questionnaire demonstrated an elevated risk of breast cancer among women who drank 30 or more g of alcohol daily (about two drinks) relative to nondrinkers (odds ratio [OR]=1.55, 95 percent confidence interval [CI]=1.01–2.39). The analysis based on the retrospective questionnaire also indicated a similar but slightly attenuated elevation of risk of breast cancer among women who drank at least 30 g daily (OR=1.42, CI=0.85–2.40). In these data, bias due to selection and recall had only minor effects on reported intake of alcohol consumption.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00050863
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  • 5
    Electronic Resource
    Electronic Resource
    Glycosylated hemoglobin and risk of colorectal cancer and adenoma (United States) (1999)
    Springer
    Cancer causes & control 10 (1999), S. 379-386 
    Details
    ISSN: 1573-7225
    Keywords: colorectal neoplasms ; glycosylated ; hemoglobin A ; United States ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: The consistently observed epidemiologic associations of obesity and physical activity with colorectal cancer and precursor adenoma risk suggest that insulin and glucose control may be contributory. We evaluated the association of glycosylated hemoglobin (HbA1c), a clinical indicator of average glycemia over the previous 2 months, and possibly, indirectly, a marker of average blood insulin level, with colorectal carcinogenesis. Methods: Among women in the Nurses' Health Study, who provided blood in 1989–90 and were diagnosed subsequently in 1989–94, we included 79 colorectal cancer cases and 156 matched controls, and 201 distal colorectal adenoma cases and 201 matched controls. HbA1c concentrations in red blood cells were determined blindly by turbidometric immunoinhibition. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from conditional logistic regression models. Results: HbA1c level did not significantly differ between colorectal cancer cases (median 5.5%) and controls (5.5%, p = 0.5), although a small difference between adenoma cases (5.6%) and controls (5.5%, p = 0.06) was noted. Compared to the lowest tertile of HbA1c (median 5.2%), women in the middle (median 5.5%, OR = 1.2, CI = 0.6–2.5) and upper (5.8%, OR = 1.2, CI = 0.6–2.7) tertiles were not at an increased risk for colorectal cancer. A modestly elevated risk of distal colorectal adenoma in the upper (median 5.8%, OR = 1.4, CI = 0.9–2.3) versus lower (median 5.3%) tertile could not be excluded. These associations were not appreciably altered after adjusting for known and suspected colorectal cancer risk factors. Conclusion: Over the range of levels observed in this relatively small sample of middle-aged women, prediagnostic HbA1c does not clearly predict colorectal cancer and adenoma risk.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008953611657
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  • 6
    Electronic Resource
    Electronic Resource
    Reproductive factors and family history of breast cancer in relation to plasma estrogen and prolactin levels in postmenopausal women in the Nurses' Health Study (United States) (1995)
    Springer
    Cancer causes & control 6 (1995), S. 217-224 
    Details
    ISSN: 1573-7225
    Keywords: Breast cancer ; endogenous hormones ; family history ; postmenopausal women ; reproductive factors ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Parity, age at first birth, age at menarche, and a family history of breast cancer have each been associated consistently with breast cancer risk. Whether this increase in risk is mediated, at least in part, through changes in endogenous hormone levels is unclear. We conducted a cross-sectional study of the relationships between these factors and plasma hormone levels in 216 healthy postmenopausal women in the Nurses' Health Study (United States). The hormones evaluated were estradiol, percent and total free estradiol, percent and total bioavailable estradiol, estrone, estrone sulfate, and prolactin. After controlling for age, body mass index (weight/height2), and alcohol use, we observed inverse associations between estrone sulfate and parity (r=−0.15, P=0.03) and between percent bioavailable estradiol and age at first birth (r=−0.17, P=0.02). Although women with a family history of breast cancer tended to have higher estrogen levels compared with women without such history, the differences were not statistically significant. Age at menarche was not related significantly to any of the hormones. These data provide some additional evidence that the inverse relationship observed between parity and breast cancer risk may be mediated, at least in part, through decreased estrogen levels. Our data do not support a substantial influence of either family history of breast cancer or age at menarche on postmenopausal estrogen or prolactin levels.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00051793
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  • 7
    Electronic Resource
    Electronic Resource
    A prospective study of body mass, height, and smoking on the risk of colorectal cancer in women (1991)
    Springer
    Cancer causes & control 2 (1991), S. 117-124 
    Details
    ISSN: 1573-7225
    Keywords: body height ; body weight ; colorectal neoplasms ; smoking ; United States ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Female registered nurses in the United States who responded to a questionnaire in 1976 that inquired about height, weight, and smoking history were followed for the development of colon or rectal cancers through May of 1984. Among the 118,404 respondents free of cancer in 1976, 191 colon cancers and 49 rectal cancers were observed during 916,170 person-years of follow-up. After omitting cases diagnosed within two years of weight report, we found little overall relation of body mass (Quetelet's) index to colon cancer risk; however there was a suggestion of elevated risk for the heaviest category of body mass index (≥29 kg/m2, relative risk (RR)=1.5; 95 percent confidence interval = 0.8–2.7) relative to the lowest category (〈21 kg/m2). Self-reported body mass index from adolescence had a slightly more pronounced, although not significant, association with risk of colon cancer. Increasing height was significantly associated with colon cancer (RR=1.6, 95 percent confidence interval = 1.1–2.5 for the tallest category [≥168 cm] vs the shortest [〈160 cm], trend P=0.04). Measures of current or past smoking failed to demonstrate any consistent relationship with colon cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00053131
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  • 8
    Electronic Resource
    Electronic Resource
    A prospective study of oral contraceptive use and risk of breast cancer (Nurses' Health Study, United States) (1997)
    Springer
    Cancer causes & control 8 (1997), S. 65-72 
    Details
    ISSN: 1573-7225
    Keywords: Breast cancer ; oral contraceptives ; United States ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Results of previous epidemiologic studies have provided reassurance that there is little, if any, increase in risk of breast cancer with oral contraceptive (OC) use in general. However, in several studies, an increased risk of breast cancer has been observed in two subgroups, young women who used OCs for extended durations and in women who used OCs prior to a first-term pregnancy. We evaluated these relationships using data from the ongoing Nurses' Health Study cohort (United States). We documented 3,383 cases of breast cancer from 1976 to 1992 among 1.6 million person-years of follow-up. We observed no overall relationship between duration of OC use and breast cancer risk, even among women who reported using OCs for 10 or more years (multivariate relative risk [RR]=1.11, 95 percent confidence interval [CI]=0.94-1.32). Among women less than 45 years of age, the multivariate RR for using OCs for 10 or more years was 1.07 (CI=0.70-1.65) compared with never-users. The risk associated with five or more years of OC use prior to a first full-term pregnancy compared with never-use was 0.96 (CI=0.65-1.43). Among women less than 45 years of age, we observed no evidence of an increased risk with OC use before a first full-term pregnancy (use for five or more years: RR=0.57, CI=0.24-1.31). Because of the age distribution of our cohort, we were unable to evaluate these relationships among women less than 40 years of age. Our study provides considerable evidence that long-term past OC use, either overall or prior to a first full-term pregnancy, does not result in any appreciable increase in breast cancer risk in women over 40 years of age.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1018435205695
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