Pam Harrison

TORONTO — A large proportion of patients with hypertension and type 2 diabetes also have silent coronary artery disease, according to myocardial perfusion imaging studies presented at the annual meeting of the Society of Nuclear Medicine.

Christien Côté, M.D., and colleagues carried out a prospective study to identify both the prevalence and severity of silent ischemia in 595 hypertensive patients with and without type 2 diabetes. “We also wanted to establish to what extent type 2 diabetes modified the prevalence and severity of silent CAD in hypertensive patients and we wanted to assess the predictive value of risk factors for silent CAD,” said Dr. Côté, professor of medicine at Laval University, Quebec City.

Study subjects were 45 years of age and older and had either essential hypertension alone (363) or coexisting diabetes (232). None had a history of typical angina, and there were no differences in age, sex, or duration of hypertension between the two groups.

Unlike previous studies, patients were selected for dipyridamole stress testing according to American Diabetes Association guidelines for coronary investigation, observed Dr. Côté.

All patients underwent dipyridamole stress

Investigators also assessed the predictive value of risk factors on the prevalence of silent CAD. In the hypertensive population, they found that only dyspnea was predictive of silent CAD, while both dyspnea and proteinuria were predictive of the same ischemic defect in the hypertensive diabetic population.

Previous studies suggested that the prevalence of silent ischemia in hypertensive diabetic patients varied from about 15% to over 50%. The high prevalence of silent ischemia in hypertensive diabetic patients found in this study is of concern, as asymptomatic patients are unlikely to seek medical attention and, as a result, cardiovascular disease events are less likely to be prevented.

CAD is the leading cause of morbidity and mortality in hypertensive patients, and the coexistence of hypertension and type 2 diabetes further increases this risk, Dr. Côté said.

TORONTO — A large proportion of patients with hypertension and type 2 diabetes also have silent coronary artery disease, according to myocardial perfusion imaging studies presented at the annual meeting of the Society of Nuclear Medicine.

Christien Côté, M.D., and colleagues carried out a prospective study to identify both the prevalence and severity of silent ischemia in 595 hypertensive patients with and without type 2 diabetes. “We also wanted to establish to what extent type 2 diabetes modified the prevalence and severity of silent CAD in hypertensive patients and we wanted to assess the predictive value of risk factors for silent CAD,” said Dr. Côté, professor of medicine at Laval University, Quebec City.

Study subjects were 45 years of age and older and had either essential hypertension alone (363) or coexisting diabetes (232). None had a history of typical angina, and there were no differences in age, sex, or duration of hypertension between the two groups.

Unlike previous studies, patients were selected for dipyridamole stress testing according to American Diabetes Association guidelines for coronary investigation, observed Dr. Côté.

All patients underwent dipyridamole stress

Investigators also assessed the predictive value of risk factors on the prevalence of silent CAD. In the hypertensive population, they found that only dyspnea was predictive of silent CAD, while both dyspnea and proteinuria were predictive of the same ischemic defect in the hypertensive diabetic population.

Previous studies suggested that the prevalence of silent ischemia in hypertensive diabetic patients varied from about 15% to over 50%. The high prevalence of silent ischemia in hypertensive diabetic patients found in this study is of concern, as asymptomatic patients are unlikely to seek medical attention and, as a result, cardiovascular disease events are less likely to be prevented.

CAD is the leading cause of morbidity and mortality in hypertensive patients, and the coexistence of hypertension and type 2 diabetes further increases this risk, Dr. Côté said.

TORONTO — A large proportion of patients with hypertension and type 2 diabetes also have silent coronary artery disease, according to myocardial perfusion imaging studies presented at the annual meeting of the Society of Nuclear Medicine.

Christien Côté, M.D., and colleagues carried out a prospective study to identify both the prevalence and severity of silent ischemia in 595 hypertensive patients with and without type 2 diabetes. “We also wanted to establish to what extent type 2 diabetes modified the prevalence and severity of silent CAD in hypertensive patients and we wanted to assess the predictive value of risk factors for silent CAD,” said Dr. Côté, professor of medicine at Laval University, Quebec City.

Study subjects were 45 years of age and older and had either essential hypertension alone (363) or coexisting diabetes (232). None had a history of typical angina, and there were no differences in age, sex, or duration of hypertension between the two groups.

Unlike previous studies, patients were selected for dipyridamole stress testing according to American Diabetes Association guidelines for coronary investigation, observed Dr. Côté.

All patients underwent dipyridamole stress

Investigators also assessed the predictive value of risk factors on the prevalence of silent CAD. In the hypertensive population, they found that only dyspnea was predictive of silent CAD, while both dyspnea and proteinuria were predictive of the same ischemic defect in the hypertensive diabetic population.

Previous studies suggested that the prevalence of silent ischemia in hypertensive diabetic patients varied from about 15% to over 50%. The high prevalence of silent ischemia in hypertensive diabetic patients found in this study is of concern, as asymptomatic patients are unlikely to seek medical attention and, as a result, cardiovascular disease events are less likely to be prevented.

CAD is the leading cause of morbidity and mortality in hypertensive patients, and the coexistence of hypertension and type 2 diabetes further increases this risk, Dr. Côté said.

TORONTO — The risk of provoking thyroid storm with administration of radioactive iodine appears to be vanishingly small even in cases of severe thyrotoxicosis, Vani Vijayakumar, M.D., said at the annual meeting of the Society of Nuclear Medicine.

Patients undergoing such treatment therefore do not need to be placed on thiouracil drugs first, provided that they receive concomitant β-blocker therapy and good counseling, added Dr. Vijayakumar of the nuclear medicine section at the University of Texas Medical Branch, Galveston.

In a retrospective study, Dr. Vijayakumar and her colleagues identified 122 patients who were treated for severe thyrotoxicosis between August 2003 and December 2004. Patients were judged to have severe hyperthyroidism when there were marked signs and symptoms of thyrotoxicosis, suppressed levels of TSH, and markedly elevated levels of free T4 or free T3.

The diagnosis of severe thyrotoxicosis also required radioactive iodine (I-131) uptake exceeding 30% at 4 or 24 hours after administration of I-131. Of the 122 patients identified with severe thyrotoxicosis, the diagnosis of Graves' disease predominated. For the group overall, TSH levels were between 0.01 and 0.06 mIU/L.

Most of the patients were females between ages 15 and 64 years, and the range of radioactive iodine uptake was between 31% and 92%. All patients were treated with 10–20 mCi of I-131 and were evaluated for any evidence of thyroid storm.

“Ninety-two patients had one radioactive iodine treatment, 21 patients had two radioactive treatments, and only a few had three treatments,” Dr. Vijayakumar reported. Eight patients received no radioactive iodine treatment at all. Four patients were thyrotoxic and were placed on propylthiouracil (PTU); three patients were already on PTU and did not receive I-131.

Most patients were placed on β-blocker drugs at the time of initial I-131 therapy, and those drugs were continued for at least 2 months. Patients were educated about the signs and symptoms of thyroid storm before receiving I-131 treatment, Dr. Vijayakumar said.

At first follow-up 2 months later, “none of these patients had any symptoms of thyroid storm,” Dr. Vijayakumar said. In a subset of 39 high-risk patients—defined as having I-131 uptakes in excess of 70%, marked signs and symptoms of hyperthyroidism, and markedly elevated free T4 or free T3 levels—I-131 treatment was well tolerated, and led to “marked clinical improvement.” Again, none of these high-risk patients had any sign of thyroid storm.

“Thyroid storm after radioactive iodine is extremely rare,” Dr. Vijayakumar concluded. “Hence, it is safe to treat these hyperthyroid patients in thyrotoxicosis with radioactive iodine, [although] simultaneous β-blockers are necessary, and patient education is also important. With all these measures in place, 4–6 weeks of prior medical treatment [with PTU] may not be necessary.”

Thyroid storm, an acute, life-threatening thyroid hormone-induced hypermetabolic state that can occur in patients with thyrotoxicosis, is usually precipitated by stress such as surgery or infection.

Although thyroid storm is rare—occurring in 1%–2% of hyperthyroid patients—mortality approaches 20% if the condition goes unrecognized and untreated. Features of thyroid storm include a high fever, flushing, sweating, tachycardia, agitation, and delirium. The diagnosis of thyroid storm is largely clinical as thyroid function tests cannot differentiate between thyroid storm and thyrotoxicosis.

TORONTO — The risk of provoking thyroid storm with administration of radioactive iodine appears to be vanishingly small even in cases of severe thyrotoxicosis, Vani Vijayakumar, M.D., said at the annual meeting of the Society of Nuclear Medicine.

Patients undergoing such treatment therefore do not need to be placed on thiouracil drugs first, provided that they receive concomitant β-blocker therapy and good counseling, added Dr. Vijayakumar of the nuclear medicine section at the University of Texas Medical Branch, Galveston.

In a retrospective study, Dr. Vijayakumar and her colleagues identified 122 patients who were treated for severe thyrotoxicosis between August 2003 and December 2004. Patients were judged to have severe hyperthyroidism when there were marked signs and symptoms of thyrotoxicosis, suppressed levels of TSH, and markedly elevated levels of free T4 or free T3.

The diagnosis of severe thyrotoxicosis also required radioactive iodine (I-131) uptake exceeding 30% at 4 or 24 hours after administration of I-131. Of the 122 patients identified with severe thyrotoxicosis, the diagnosis of Graves' disease predominated. For the group overall, TSH levels were between 0.01 and 0.06 mIU/L.

Most of the patients were females between ages 15 and 64 years, and the range of radioactive iodine uptake was between 31% and 92%. All patients were treated with 10–20 mCi of I-131 and were evaluated for any evidence of thyroid storm.

“Ninety-two patients had one radioactive iodine treatment, 21 patients had two radioactive treatments, and only a few had three treatments,” Dr. Vijayakumar reported. Eight patients received no radioactive iodine treatment at all. Four patients were thyrotoxic and were placed on propylthiouracil (PTU); three patients were already on PTU and did not receive I-131.

Most patients were placed on β-blocker drugs at the time of initial I-131 therapy, and those drugs were continued for at least 2 months. Patients were educated about the signs and symptoms of thyroid storm before receiving I-131 treatment, Dr. Vijayakumar said.

At first follow-up 2 months later, “none of these patients had any symptoms of thyroid storm,” Dr. Vijayakumar said. In a subset of 39 high-risk patients—defined as having I-131 uptakes in excess of 70%, marked signs and symptoms of hyperthyroidism, and markedly elevated free T4 or free T3 levels—I-131 treatment was well tolerated, and led to “marked clinical improvement.” Again, none of these high-risk patients had any sign of thyroid storm.

“Thyroid storm after radioactive iodine is extremely rare,” Dr. Vijayakumar concluded. “Hence, it is safe to treat these hyperthyroid patients in thyrotoxicosis with radioactive iodine, [although] simultaneous β-blockers are necessary, and patient education is also important. With all these measures in place, 4–6 weeks of prior medical treatment [with PTU] may not be necessary.”

Thyroid storm, an acute, life-threatening thyroid hormone-induced hypermetabolic state that can occur in patients with thyrotoxicosis, is usually precipitated by stress such as surgery or infection.

Although thyroid storm is rare—occurring in 1%–2% of hyperthyroid patients—mortality approaches 20% if the condition goes unrecognized and untreated. Features of thyroid storm include a high fever, flushing, sweating, tachycardia, agitation, and delirium. The diagnosis of thyroid storm is largely clinical as thyroid function tests cannot differentiate between thyroid storm and thyrotoxicosis.

TORONTO — The risk of provoking thyroid storm with administration of radioactive iodine appears to be vanishingly small even in cases of severe thyrotoxicosis, Vani Vijayakumar, M.D., said at the annual meeting of the Society of Nuclear Medicine.

Patients undergoing such treatment therefore do not need to be placed on thiouracil drugs first, provided that they receive concomitant β-blocker therapy and good counseling, added Dr. Vijayakumar of the nuclear medicine section at the University of Texas Medical Branch, Galveston.

In a retrospective study, Dr. Vijayakumar and her colleagues identified 122 patients who were treated for severe thyrotoxicosis between August 2003 and December 2004. Patients were judged to have severe hyperthyroidism when there were marked signs and symptoms of thyrotoxicosis, suppressed levels of TSH, and markedly elevated levels of free T4 or free T3.

The diagnosis of severe thyrotoxicosis also required radioactive iodine (I-131) uptake exceeding 30% at 4 or 24 hours after administration of I-131. Of the 122 patients identified with severe thyrotoxicosis, the diagnosis of Graves' disease predominated. For the group overall, TSH levels were between 0.01 and 0.06 mIU/L.

Most of the patients were females between ages 15 and 64 years, and the range of radioactive iodine uptake was between 31% and 92%. All patients were treated with 10–20 mCi of I-131 and were evaluated for any evidence of thyroid storm.

“Ninety-two patients had one radioactive iodine treatment, 21 patients had two radioactive treatments, and only a few had three treatments,” Dr. Vijayakumar reported. Eight patients received no radioactive iodine treatment at all. Four patients were thyrotoxic and were placed on propylthiouracil (PTU); three patients were already on PTU and did not receive I-131.

Most patients were placed on β-blocker drugs at the time of initial I-131 therapy, and those drugs were continued for at least 2 months. Patients were educated about the signs and symptoms of thyroid storm before receiving I-131 treatment, Dr. Vijayakumar said.

At first follow-up 2 months later, “none of these patients had any symptoms of thyroid storm,” Dr. Vijayakumar said. In a subset of 39 high-risk patients—defined as having I-131 uptakes in excess of 70%, marked signs and symptoms of hyperthyroidism, and markedly elevated free T4 or free T3 levels—I-131 treatment was well tolerated, and led to “marked clinical improvement.” Again, none of these high-risk patients had any sign of thyroid storm.

“Thyroid storm after radioactive iodine is extremely rare,” Dr. Vijayakumar concluded. “Hence, it is safe to treat these hyperthyroid patients in thyrotoxicosis with radioactive iodine, [although] simultaneous β-blockers are necessary, and patient education is also important. With all these measures in place, 4–6 weeks of prior medical treatment [with PTU] may not be necessary.”

Thyroid storm, an acute, life-threatening thyroid hormone-induced hypermetabolic state that can occur in patients with thyrotoxicosis, is usually precipitated by stress such as surgery or infection.

Although thyroid storm is rare—occurring in 1%–2% of hyperthyroid patients—mortality approaches 20% if the condition goes unrecognized and untreated. Features of thyroid storm include a high fever, flushing, sweating, tachycardia, agitation, and delirium. The diagnosis of thyroid storm is largely clinical as thyroid function tests cannot differentiate between thyroid storm and thyrotoxicosis.

TORONTO — Positron emission tomography using

Dr. Oyen, professor of nuclear medicine at Radboud University Nijmegen (Netherlands) Medical Centre, and colleagues assessed the value of FDG-PET in helping detect infectious lesions that may have spread to other sites in patients with bacteremia or fungemia—what they term “secondary metastatic infection.” Prior to undergoing FDG-PET, each patient had undergone a mean of four conventional diagnostic procedures, including blood work, ultrasound studies, and CT scans.

The retrospective review included 40 FDG-PET scans performed at the center between October 1998 and September 2004. A total of 41 FDG-PET scans were performed in 39 patients, but 1 scan was excluded because the patient's claustrophobia led to an incomplete scan. The scans were ordered by referring physicians because patients had persistent fever despite an adequate course of antibiotics, and therefore were suspected of harboring a secondary metastatic infection. Blood cultures confirmed that about 60% of the episodes resulted from gram-positive bacteria, whereas about 18% resulted from gram-negative bacteria and about 20% resulted from Candida species. The source of infection was polymicrobial in the remaining episodes.

Of the group, “30% had abnormalities on previous diagnostic techniques, but physicians were not satisfied with the conventional diagnoses, and these abnormalities were confirmed by FDG-PET,” Dr. Oyen said in an interview.

Overall, 45% of the 40 scans provided clinically relevant, new information. FDG-PET confirmed already diagnosed abnormalities in another 30% of the scans, yielding a positive predictive value of 91%. No patient developed infectious complications when the FDG-PET was negative, yielding a negative predictive value of 100% in this small series of patients.

The high diagnostic accuracy of FDG-PET in this series may not apply to lower-risk patients whose bacteremia or fungemia is less likely to have spread. Nevertheless, FDG-PET appears to be a “valuable imaging technique” for high-risk patients, he noted.

The researchers are planning a prospective study to test whether FDG-PET is useful in lower-risk patients with bacterial or fungal infections in the blood.

TORONTO — Positron emission tomography using

Dr. Oyen, professor of nuclear medicine at Radboud University Nijmegen (Netherlands) Medical Centre, and colleagues assessed the value of FDG-PET in helping detect infectious lesions that may have spread to other sites in patients with bacteremia or fungemia—what they term “secondary metastatic infection.” Prior to undergoing FDG-PET, each patient had undergone a mean of four conventional diagnostic procedures, including blood work, ultrasound studies, and CT scans.

The retrospective review included 40 FDG-PET scans performed at the center between October 1998 and September 2004. A total of 41 FDG-PET scans were performed in 39 patients, but 1 scan was excluded because the patient's claustrophobia led to an incomplete scan. The scans were ordered by referring physicians because patients had persistent fever despite an adequate course of antibiotics, and therefore were suspected of harboring a secondary metastatic infection. Blood cultures confirmed that about 60% of the episodes resulted from gram-positive bacteria, whereas about 18% resulted from gram-negative bacteria and about 20% resulted from Candida species. The source of infection was polymicrobial in the remaining episodes.

Of the group, “30% had abnormalities on previous diagnostic techniques, but physicians were not satisfied with the conventional diagnoses, and these abnormalities were confirmed by FDG-PET,” Dr. Oyen said in an interview.

Overall, 45% of the 40 scans provided clinically relevant, new information. FDG-PET confirmed already diagnosed abnormalities in another 30% of the scans, yielding a positive predictive value of 91%. No patient developed infectious complications when the FDG-PET was negative, yielding a negative predictive value of 100% in this small series of patients.

The high diagnostic accuracy of FDG-PET in this series may not apply to lower-risk patients whose bacteremia or fungemia is less likely to have spread. Nevertheless, FDG-PET appears to be a “valuable imaging technique” for high-risk patients, he noted.

The researchers are planning a prospective study to test whether FDG-PET is useful in lower-risk patients with bacterial or fungal infections in the blood.

TORONTO — Positron emission tomography using

Dr. Oyen, professor of nuclear medicine at Radboud University Nijmegen (Netherlands) Medical Centre, and colleagues assessed the value of FDG-PET in helping detect infectious lesions that may have spread to other sites in patients with bacteremia or fungemia—what they term “secondary metastatic infection.” Prior to undergoing FDG-PET, each patient had undergone a mean of four conventional diagnostic procedures, including blood work, ultrasound studies, and CT scans.

The retrospective review included 40 FDG-PET scans performed at the center between October 1998 and September 2004. A total of 41 FDG-PET scans were performed in 39 patients, but 1 scan was excluded because the patient's claustrophobia led to an incomplete scan. The scans were ordered by referring physicians because patients had persistent fever despite an adequate course of antibiotics, and therefore were suspected of harboring a secondary metastatic infection. Blood cultures confirmed that about 60% of the episodes resulted from gram-positive bacteria, whereas about 18% resulted from gram-negative bacteria and about 20% resulted from Candida species. The source of infection was polymicrobial in the remaining episodes.

Of the group, “30% had abnormalities on previous diagnostic techniques, but physicians were not satisfied with the conventional diagnoses, and these abnormalities were confirmed by FDG-PET,” Dr. Oyen said in an interview.

Overall, 45% of the 40 scans provided clinically relevant, new information. FDG-PET confirmed already diagnosed abnormalities in another 30% of the scans, yielding a positive predictive value of 91%. No patient developed infectious complications when the FDG-PET was negative, yielding a negative predictive value of 100% in this small series of patients.

The high diagnostic accuracy of FDG-PET in this series may not apply to lower-risk patients whose bacteremia or fungemia is less likely to have spread. Nevertheless, FDG-PET appears to be a “valuable imaging technique” for high-risk patients, he noted.

The researchers are planning a prospective study to test whether FDG-PET is useful in lower-risk patients with bacterial or fungal infections in the blood.