Biomedical subjects
Publications and source records attributed to B Delaloye.
We present the case of a 56-year-old woman with proven dermatomyositis associated with an adenocarcinoma of the gallbladder. The association of dermatomyositis-polymyositis and cancer has been known for many years but is still controverted. The search for a malignancy in a patient with DM-PM should not be systematic but guided by abnormal history, physical examination and laboratory results.
The advent of new diagnostic procedures such as petrosal venous sampling and CRF testing has improved the possibilities of precise location of the site of hormonal overproduction in Cushing's syndrome. We report on a case of ectopic ACTH-dependent Cushing's syndrome in which the use of such techniques helped to locate the tumor. A 45-year-old woman with definite ACTH-dependent Cushing's syndrome was referred to our clinic for evaluation. ACTH, cortisol and urinary 17OHCS failed to suppress on high dose dexamethasone oral administration. Computerized tomography showed bilateral adrenal hyperplasia and an empty sella turcica. ACTH and cortisol did not increase after CRF administration. Staged caval system catheterism via both femoral veins up to the inferior petrosal sinuses, including after CRF administration, demonstrated no ACTH gradient between staged samples and simultaneous peripheral venous blood. This suggested a tumor drained by the portal system. An abdominal ultrasonography demonstrated a pancreatic mass, that was surgically excised and appeared as a benign islet cell tumor. Portal vein ACTH promptly decreased after tumor excision and postoperative peripheral cortisol and ACTH were normal. On immunostaining the tumor cells proved to be positive for ACTH.
Fifty-seven patients with suspected CEA-producing tumors were studied prospectively by radioimmunoscintigraphy (RIS) using a 123I-labeled anti-CEA monoclonal antibody (MAb) (essentially the F(ab')2 or Fab fragments) and emission computed tomography (ECT). Results of RIS were compared to those of a comprehensive diagnostic study. Final diagnosis was based on surgery, biopsy and autopsy (n = 39) or follow-up findings (n = 18). Three groups of patients were defined: Group A with suspected primary tumors (n = 11), Group B with probable (n = 19) and Group C with questionable (n = 27) tumor relapse. Eighty-eight per cent, 93% and 71% of the anatomic regions studied were correctly identified as being involved, and 97%, 97%, and 87% as being free from tumor in Groups A, B, and C, respectively. In the 27 patients from Group C with no definite diagnosis of relapse, and in whom diagnosis was most difficult, 38 tumor sites were involved. Of these, 21 were detected by both prospective RIS and repeated comprehensive study, six by RIS only and seven by conventional methods only. Four sites remained undetected by both approaches. Ten of the 21 lesions were detected by RIS more than 1 mo earlier than by any other method. Among the seven tumor sites detected by other diagnostic modalities only, three were identified at the time of RIS and four became positive more than 6 mo later. Overall diagnosis was entirely correct in 30, partially correct in 16 and incorrect in six patients studied. RIS with ECT and 123I-labeled anti-CEA MAb allows early detection of recurrence or metastasis of colorectal cancer. It thus contributes to reduced delay between diagnosis and treatment.
Explore the source record for details and available documents.
In 2 patients with infarction in the territory of the right anterior choroidal artery, hemiparesis, hemihypesthesia (in 1), and hemianopia or superior quadrantanopia were associated with severe multimodal hemineglect, without anosognosia, disorientation, or asomatognosia. Single-photon emission tomography showed that marked hypoperfusion was not limited to the right posterior capsular region, but also involved the overlying parietal cortex, and to a lesser extent the frontal cortex. At autopsy in 1 patient, the infarct was nearly limited to the deep white matter of the temporal isthmus and the retrolenticular part of the internal capsule; only minute lesions were present in the globus pallidus, body of caudate, and amygdala. These findings are consistent with a disconnection phenomenon as the basis for subcortical neglect with ipsilateral deactivation of the parietofrontal cortex.
Sixteen European countries participated in this WHO-IAEA intercomparison for which transmission CAP (College of American Pathologists) thyroid and IAEA-WHO liver phantoms were used. A total of 257 laboratories submitted 428 image evaluation reports. Overall results showed differences in performance between the various countries but similarities in performance for two gamma camera subgroups defined by year of manufacture, before and after 1980. A unique review of current European liver imaging practice is presented in terms of technical parameters, imaging conditions and evaluation procedures, and quality control procedures. The WHO-IAEA intercomparison demonstrated the need to establish new, or to improve the existing, quality control programmes in certain countries. However, the large number of participating laboratories, 257 compared with 70 in the previous WHO study, (Volodin et al. 1985), shows that these international studies are serving a useful purpose in promoting quality control in nuclear medicine imaging laboratories.
F(ab')2-fragments of the anti-melanoma monoclonal antibody MeI-14 were labelled with 123I for external scanning and with 125I for tissue measurement of radioactivity and injected intravenously into patients scheduled for surgical resection of a glioma. The paired-label study was performed by injecting simultaneously 131I-labelled control (F(ab')2-fragments. The patients were scanned by computerised tomoscintigraphy. After surgery, the activities of 125I and 131I were counted in tumour and normal tissues. The results indicate that there was a low but definite uptake of the antibody in the tumour due to its specificity. The external detection was difficult because of accumulation of antibody fragments in the skull.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The effect of a synthetic atrial natriuretic peptide (atriopeptin III) on blood pressure, heart rate, and hematocrit was investigated in conscious, nephrectomized (n = 6), and sham-operated (n = 6) rats. Atriopeptin III infusion (1 microgram/min iv for 30 min) decreased mean blood pressure to a similar extent in nephrectomized [from 122 +/- 5 to 108 +/- 3 (SE) mmHg; P less than 0.01] and in sham-operated rats (from 124 +/- 4 to 103 +/- 2 mmHg; P less than 0.01), whereas it had no significant effect on heart rate. Hematocrit rose similarly in nephrectomized (from 45 +/- 1 to 49 +/- 1%; P less than 0.01) and in sham-operated rats (from 46 +/- 1 to 50 +/- 1%; P less than 0.001). Infusion of the vehicle of atriopeptin III to nephrectomized rats (n = 7) did not change any of these parameters. Plasma volume and red cell mass of nephrectomized rats infused with atriopeptin III was measured by use of radiolabeled albumin and erythrocytes, respectively. A plasma volume contraction of approximately 10% (P less than 0.01) was observed, whereas red cell mass did not change. In an additional group of nephrectomized rats (n = 6), Na nitroprusside was infused intravenously at a rate of 2 micrograms/min for 30 min. Na nitroprusside reduced mean blood pressure from 127 +/- 4 to 106 +/- 3 mmHg (P less than 0.001), but hematocrit remained unchanged (46 +/- 1% before vs. 45 +/- 1% after infusion). In four anesthetized rats with both kidneys and the spleen removed atriopeptin III still raised the hematocrit.(ABSTRACT TRUNCATED AT 250 WORDS)
This clinical study was based on experimental results obtained in nude mice grafted with human colon carcinoma, showing that injected 131I-labeled F(ab')2 and Fab fragments from high affinity anti-carcinoembryonic antigen (CEA) monoclonal antibodies (MAb) gave markedly higher ratios of tumor to normal tissue localization than intact MAb. 31 patients with known colorectal carcinoma, including 10 primary tumors, 13 local tumor recurrences, and 21 metastatic involvements, were injected with 123I-labeled F(ab')2 (n = 14) or Fab (n = 17) fragments from MAb anti-CEA. The patients were examined by emission-computerized tomography (ECT) at 6, 24, and sometimes 48 h after injection using a rotating dual head scintillation camera. All 23 primary tumors and local recurrences except one were clearly visualized on at least two sections of different tomographic planes. Interestingly, nine of these patients had almost normal circulating CEA levels, and three of the visualized tumors weighed only 3-5 g. Among 19 known metastatic tumor involvements, 14 were correctly localized by ECT. Two additional liver and several bone metastases were discovered by immunoscintigraphy. Altogether, 86% of the tumor sites were detected, 82% with F(ab')2 and 89% with Fab fragments. The contrast of the tumor images obtained with Fab fragments suggests that this improved method of immunoscintigraphy has the potential to detect early tumor recurrences and thus to increase the survival of patients. The results of this retrospective study, however, should be confirmed in a prospective study before this method can be recommended for the routine diagnosis of cancer.
A 58 year old hypertensive man suffered an acute right-sided hemiataxia associated with painful hypoesthesia. CT showed an infarct in the territory of the left anterior choroidal artery. The sensory defect involved all the elementary modes, but predominated on pain sensation. The ataxia suggested a cerebellar type of dysfunction, with hypermetria, intentional tremor, dysdiadochokinesia and a positive rebound phenomenon. There was no hemiparesis, no hemianopia, no neuropsychological dysfunction and no oculomotor abnormality. Hemiataxia with hemisensory defect has not been reported in stroke, and it constitutes a new clinical form of lacunar syndrome. The hemiataxia may be related to the finding on single-photon emission computed tomography (SPECT) using 123 I-amphetamine of a crossed cerebellar diaschisis, which may suggest a transneuronal deactivation. This metabolic depression may have been due to involvement of the temporo-parieto-pontine bundle of Türck in the retro and sub-lenticular portion of the internal capsule. The finding of a normal cortical blood flow may explain why no neuropsychological impairment was present, because of the absence of functional deactivation of the cortex by the underlying deep infarct.
Although the relationship between chronic bronchopathies and gastro-esophageal reflux is known, the existence and role of nocturnal broncho-aspiration is controversial. 32 patients with chronic bronchopathy and 13 controls without digestive or respiratory symptoms were studied. Nocturnal broncho-aspiration was diagnosed by the demonstration of vegetable fibers in the morning expectorate and by the presence of radioactive pulmonary foci 15 hours following an isotopic meal. Vegetable fibers were found with equal frequency in both groups. On the other hand, positive pulmonary scintigraphy, reflecting nocturnal broncho-aspiration, was observed in 24 of the 32 patients (75%) and only in 2 of the 13 controls (15%) (p less than 0.001). Thus, broncho-aspiration is a frequent occurrence in chronic bronchopathies.
99mTc-Hydroxymethylene diphosphonate (HMDP) was compared to 99mTc-methylene diphosphonate (MDP) with respect to image quality, lesion detectability, and the uptake ratios of normal bone to soft tissue (B/S), metastatic bone to soft tissue (M/S) and bone metastases to normal bone (M/B) at 2 and 3 h after injection in the same subjects. Thirty-three patients with bone metastases were examined in six nuclear-medicine departments, with each center using its usual bone-scanning protocol which was identical for both compounds in the same patient. The uptake of 99mTc-HMDP in normal bone (B/S) was significantly higher than that of MDP at 2 and 3 h, but there were no significant differences between the two compounds with regard to the M/S or M/B ratios. The M/B of HMDP at 2 h was not significantly different from that of MDP at 3 h, the latter showing a significantly higher B/S and M/S ratio. All lesions were detected with both compounds, even at 2 h. The image quality was rated as follows (in decreasing order): HMDP (3 h), MDP (3 h), HMDP (2 h), and MDP (2 h). HMDP was shown to be a useful bone-imaging agent, especially when shorter intervals between injection and recording are required.
Twelve countries participated in the WHO intercomparison for which transmission CAP (College of American Pathologists) brain and CAP liver phantoms and emission London liver phantoms were used. A total of 157 imaging devices were tested. Overall results from the phantoms revealed a wide range of targets detected. For the CAP-phantoms target detectability dropped below 50% for target sizes less than 9 mm and below 60% for target contrast less than 0.84:1. On average one false positive and six false negative results were reported using CAP-brain phantoms and one false positive and one false negative result using CAP-liver phantoms. For the London liver phantoms containing the tissue equivalent rubber abdominal simulation the target of 1 cm was never visualised. Two targets in this phantom (2 cm and 2.5 cm) were correctly identified in 34% of studies and one of these targets in 52% of studies. Equivocal and false positive results were reported in 42%. The WHO inter-comparison demonstrated the need to establish new, or to improve the existing, quality control programmes.
Explore the source record for details and available documents.