Biomedical subjects
Publications and source records attributed to D J Shawe.
The distinction between polymyalgia rheumatica and polymyositis is important for treatment and prognosis. Four elderly patients were diagnosed and treated for polymyalgia: raised creatine kinase led to muscle biopsy and a diagnosis of polymyositis.
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The use of SPECT with Bremsstrahlung radiation has been investigated in studies on patients undergoing 90Y therapy for persistent synovitis of the knee. In particular, its value in the estimation of 90Y uptake into Baker's cysts was assessed and, to this end, realistic 'knee phantoms' were employed in order to calibrate for cysts of different size. Problems associated with the measurement of the extensive Bremsstrahlung spectrum and the estimation of cyst volume have been discussed. It is shown that, although the apparent volume of a cyst is markedly dependent on the chosen count rate threshold, volumes greater than about 30 ml can be estimated with reasonable accuracy using a threshold of 50%. The uptake of 90Y in cysts, measured on 3 occasions within the first 2 days in 10 patients, showed wide variation (0%-40%) between patients and was poorly related to the size of cysts on arthrograms and to the clinical response to therapy. In these studies, the ability to analyse SPECT slices provided a distinct advantage over planar imaging for discriminating between 90Y uptake in cysts and adjacent sites. Retention of 90Y in the total knee was also widely variable, with losses of 2%-38% observed 2 days after injection which, in general, were not fully accounted for by uptake in liver or lymph nodes. The changing distribution of 90Y colloid in the knee during the first two days, as observed in some patients, might explain part of the discrepancy.
The presence of a Baker's cyst may diminish the therapeutic effect of intra-articular 90Y treatment to the knee joint. SPECT (single photon emission computed tomography) was used in 10 patients with Baker's cysts, treated with intra-articular 90Y for persistent synovitis of the knee, to measure the amount of radioisotope within the cyst. Comparison was made with the arthrographic appearances. The likelihood or extent of uptake into Baker's cysts of 90Y injected into the synovial cavity of the knee was not predictable from arthrograms. Deposition of 90Y in cysts was variable, ranging from little or no measurable uptake to a substantial proportion of the administered activity (40% in one case out of 10). It did not appear to relate to clinical response. The low mean uptake (6.3%) in cysts of nine out of 10 patients was probably insignificant in view of the large uncertainty in the prediction of synovial radiation dose.
A male infant with multiple congenital abnormalities and global retardation was found to have a translocation resulting in partial trisomy for the distal end of the long arm of chromosome 3. The phenotypically normal father carried a balanced reciprocal translocation between chromosomes 3 and 17.