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Biomedical subjects

D Fink-Bennett

Publications and source records attributed to D Fink-Bennett.

At least 37 records · Page 2Linked to original sources
PubMed1991

Cholecystokinin cholescintigraphy: detection of abnormal gallbladder motor function in patients with chronic acalculous gallbladder disease.

CCK cholescintigrams were performed in 374 patients with recurrent postprandial right upper quadrant pain, biliary colic, and a normal gallbladder sonogram and/or cholecystogram. The results of these examinations were correlated with the patients' final medical/surgical diagnoses. Twenty-seven patients recruited as control volunteers without objective clinical evidence of biliary disease also underwent CCK cholescintigraphy to determine if the degree of gallbladder contraction post-CCK differs in symptomatic versus asymptomatic subjects. Decreased gallbladder motor function was identified (maximal gallbladder ejection fraction response to CCK less than 35%) in 94% of patients with histopathologically confirmed chronic acalculous cholecystitis or the cystic duct syndrome and in 88% of patients clinically believed to have chronic acalculous biliary disease. Decreased gallbladder motor function does not distinguish symptomatic from asymptomatic gallbladder disease.

Cholecystokinin↗
PubMed1991

Indium-111-leukocyte imaging in acute cholecystitis.

Eleven patients with suspected acute cholecystitis underwent sequential 99mTc-iminodiacetic derivative (IDA) and 111In-white blood cell (WBC) imaging to determine if 111In-WBCs accumulate within an acutely inflamed hemorrhagic gallbladder wall and, thus, could be employed as a reasonable alternative to 99mTc-IDA scintigraphy in detecting acute cholecystitis. Seven patients had surgically confirmed acute cholecystitis. Of these cases, five had a true-positive 99mTc-IDA and 111In-WBC, one an indeterminate 111In-WBC and true-positive 99mTc-IDA, and one a true-positive 111In-WBC and false-negative 99mTc-IDA scan. The remaining four patients did not have acute cholecystitis. All visualized their gallbladder within 1 hr after 99mTc-IDA administration and none had 111In-WBC gallbladder wall uptake. Both 111In-WBC and 99mTc-IDA scintigraphy accurately detected acute cholecystitis: hepatobiliary scintigraphy demonstrated a cystic duct obstruction and 111In-WBC imaging detected the inflammatory infiltrate within the gallbladder wall. The sensitivity and specificity of each was 86% and 100%, respectively.

Acute Disease↗
PubMed1991

Morphine-augmented cholescintigraphy: its efficacy in detecting acute cholecystitis.

Cholescintigrams were performed in 158 patients suspected of having acute cholecystitis after administration of 185 Mbq (5 mCi) of 99mTc-mebrofenin or disofenin. Morphine sulfate, 0.04 mg/kg was given intravenously if there was nonvisualization of the gallbladder at 40-60 min provided that radiotracer was seen within the small bowel. Acute cholecystitis was deemed present if there was nonvisualization of the gallbladder 30 min post-morphine administration; no cystic duct obstruction was present if the gallbladder was demonstrated pre- or post-morphine administration. A final diagnosis was estimated in 51 postoperative patients histologically, the remainder having their final diagnosis gleaned from their medical records. The sensitivity, specificity, positive and negative predictive value of morphine-augmented cholescintigraphy in detecting acute cholecystitis was 94.6, 99.1, 97.2, and 98.3%, respectively. These findings indicate that morphine-augmented cholescintigraphy detects acute cholecystitis with as high a degree of accuracy as conventional hepatobiliary scintigraphy, yet requires only 1.5 hr to establish the diagnosis.

Acute Disease↗
PubMed1990

Sequential technetium-99m sulfur colloid/indium-111 white blood cell imaging in macroglobulinemia of Waldenstrom.

Technetium-99m sulfur colloid (SC) and indium-111 labeled leukocyte (In-111 WBC) scintigraphy was performed on a 77-year-old female patient to rule out a left periprosthetic infection. Anterior Tc-99m SC and In-111 WBC images of the pelvis and femurs revealed no abnormal deposition of radiotracer about the Austin-Moore prosthesis. Absent radiotracer uptake, however, was demonstrated within the left hemipelvis. A left iliac bone marrow aspirate and biopsy revealed a lymphoplasmacytic infiltrate consistent with Waldenstrom's macroglobulinemia.

Aged↗
PubMed1990

Contemporary techniques for the radioisotopic evaluation of the dilated urinary tract.

Regardless of one's approach to the evaluation of hydronephrosis, nuclear imaging should be part of every child's evaluation, as it is the only imaging modality capable of providing significant renal function information. The studies can easily be performed on an outpatient basis without sedation. Diuretic renal scintigraphy is deceptively simple to perform, and commitment to detail is exceedingly important if the results are to be valid. Radioisotope transit time may also be helpful, although its calculation is technically difficult. Determination of the function of the kidneys individually is possible by several methods.

Child↗
PubMed1989

Detection of heterotopic gastric mucosa in the upper esophagus with 99mTc-pertechnetate scintigraphy.

Five patients with patches of gastric fundal type columnar epithelium in the proximal esophagus at the level of the upper esophageal sphincter diagnosed by upper endoscopy underwent 99mTc-pertechnetate scintigraphy (TcO4-). In all instances, the patches contained both chief cells and mucus-secreting cells. One patient had dysphagia localized to the area of columnar epithelium. Two cases of heterotopic gastric mucosa in the upper esophagus (HGM-UE) were demonstrated by TcO4-. In both, thyroid uptake was absent due to complete suppression of thyroid function by thyroid hormone supplements. TcO4- accumulated in thyroid glands of the other three patients, causing overlapping activity between the thyroid gland and HGM-UE. TcO4- scintigraphy is suitable for the detection of HGM-UE only in those patients who have had a total thyroidectomy or are on suppressive thyroid therapy.

Adolescent↗
PubMed1989

Scintigraphic and culdoscopic diagnosis of bile peritonitis complicating liver biopsy.

After an ultrasound-guided percutaneous liver biopsy, a 37-year-old woman developed a clinical syndrome suggestive of bile peritonitis, despite the presence of nondilated bile ducts and a surgically absent gallbladder. The diagnosis was established via hepatobiliary scintigraphy, which demonstrated aberrant biliary flow, as well as by culdocentesis, which yielded bilious fluid. The patient was managed medically and recovered uneventfully; follow-up biliary scanning established resolution of bile extravasation.

Adult↗
PubMed1988

Extrahepatic biliary obstruction versus intrahepatic disorder. Differentiation with hepatobiliary scintigraphy and ultrasonography.

In 43 patients with various hepatobiliary disorders, we compared retrospectively the sensitivity and specificity of hepatobiliary scintigraphy and ultrasonography in diagnosing extrahepatic biliary obstruction. Hepatic uptake of radioactivity from the circulation was assessed by early scintiscan at 2 min, and the clearance ratio was combined with transit time in the interpretation of hepatobiliary scintiscans. The transit time was defined as the time taken by detectable radioactivity to appear in the extrahepatic biliary tree or small intestine, whichever occurred sooner. The sensitivity and specificity were 92% and 97%, respectively. However, the specificity dropped to 74% when biliary-bowel transit time, i.e., time taken for detectable radioactivity to appear in small intestine only, was used instead of transit time in the interpretation of the scintiscans. The sensitivity and specificity of ultrasonography were 55% and 94%, respectively. We conclude that hepatobiliary scintiscan is more sensitive than ultrasonography and is reliable for diagnosing extrahepatic biliary obstruction when it is done and interpreted by the method described here.

Adolescent↗
PubMed1986

Stippled ribs: a potential pitfall in bone scan interpretation.

A retrospective evaluation of 100 consecutive bone scans was performed to determine the incidence and clinical importance, if any, of increased uptake at the insertion of the iliocostalis thoracis portion of the erector spinae muscle group (rib stippling). Rib stippling was deemed present if a focal area of increased technetium-99m methylene diphosphonate [( 99mTc]MDP) was identified within the posterior angle of three or more consecutive ribs. Seven of 100 (three bilateral, four unilateral) patients demonstrated rib stippling. Foci intensity was less than the scapular tips, but greater than the adjacent ribs. No patient had a history of chest trauma, pain and/or an abnormal radiograph. Even though increased uptake within the posterior angle of the ribs is an uncommon finding (7%), its recognition as a normal bone scan finding is important to prevent bone scan misinterpretations. Its characteristic scintigraphic appearance and location should serve to differentiate it from the increased uptake of trauma and/or tumor.

Back↗
PubMed1986

Indium-111 leukocyte scintigraphy in Wegener's granulomatosis involving the spleen.

Indium-111-labeled leukocyte scintigraphy was performed on a 44-yr-old man to exclude an occult abscess. Four- and twenty-four-hour images of the abdomen revealed splenic photopenia except for a rim of activity medially. A subsequent computed tomography (CT) study demonstrated necrosis or hemorrhage of the spleen except for a medial rim. Exploratory laparotomy demonstrated necrotizing vasculitis with granuloma formation consistent with Wegener's granulomatosis and a rim of viable splenic tissue corresponding to the radionuclide and CT studies.

Adult↗
PubMed1985

The sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis.

To determine the sensitivity of hepatobiliary imaging (HBI) and strict- and liberal-criteria real-time ultrasonography (RTUS), we retrospectively analyzed 100 cases of pathologically proved acute cholecystitis (AC). A positive HBI was one in which there was nonvisualization of the gallbladder up to four hours after the administration of technetium Tc 99m-disofenin. In the absence of hypoalbuminemia, cirrhosis, or ascites, pathognomonic RTUS findings (strict criteria) for AC were wall edema and/or pericholecystic fluid. Findings indicative of AC (liberal criteria) included the demonstration of stones, a thick gallbladder wall, nonshadowing echoes, or the ultrasonographic Murphy's sign. Of the 100 cases of AC, 91 were calculous, and nine were acalculous. Four of 100 patients had associated choledocholithiasis. The sensitivities in detecting calculous AC were as follows: HBI, 97%; liberal-criteria RTUS, 86%; and strict-criteria RTUS, 24%. The sensitivities in detecting acalculous AC were as follows: HBI, 100%; liberal-criteria RTUS, 89%; and strict-criteria RTUS, 44%.

Acute Disease↗
PubMed1985

Enterobiliary fistulae: a potential cause of a false-negative hepatobiliary study in the diagnosis of acute cholecystitis.

Cholescintigraphy has gained widespread acceptance in detection of acute cholecystitis (AC). Gallbladder (GB) visualization within 4 h effectively rules out A.C. with a high degree of specificity. We present a case of A.C. in a patient who had a normal scintigraphic appearance of the G.B. at 30 min with what appeared to be entero-gastric reflux, and which retrospectively proved to be A. C. with a cholecystocolic fistula.

Acute Disease↗
PubMed1985

Bile ascites in adults. Diagnosis using hepatobiliary scintigraphy and paracentesis.

Hepatobiliary scintigraphy has been recognized as a useful diagnostic tool in detecting the presence and site of bile leaks. The authors report a case of bile ascites secondary to a postsurgical biliary leak, the scintigraphic findings in bile ascites, and the potential use of paracentesis, in combination with hepatobiliary scintigraphy, in confirming the presence of bile ascites and a bile leak.

Adult↗
PubMed1985

Cholecystokinin cholescintigraphic findings in the cystic duct syndrome.

Fourteen patients with a cystic duct syndrome (CDS) underwent cholecystokinin (CCK) cholescintigraphy. All patients presented with persistent postprandial right upper quadrant pain and biliary colic. None of the patients had an abnormal oral cholecystography, gallbladder (GB) ultrasound exam or upper GI series. Each patient (NPO after 12 a.m.) received 5 mCi of technetium-99m disofenin. When the GB maximally filled, 0.02 microgram/kg CCK was administered (3 min) intravenously. Background corrected gallbladder ejection fractions (GBEFs) were determined every 5 min X 4 by rationing the pre-CCK GB counts minus post-CCK GB counts to pre-CCK GB counts. GBEFs were: 12% (3 patients), 17% (2), 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5%, and 22% (1 each). All patients underwent a surgical exploration and all had macro- or microscopically abnormal cystic ducts (five fibrotic, seven elongated and narrow, two kinked) with (12 patients) or without (2 patients) concomitant chronic cholecystitis. No patient with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low EF response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both.

Adolescent↗
PubMed1984

The dilated common duct sign. A potential indicator of a sphincter of Oddi dyskinesia.

The cholescintigraphic findings of a Sphincter of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the Sphincter of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. We postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the Sphincter of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.

Ampulla of Vater↗