Biomedical subjects
Publications and source records attributed to F H DeLand.
Acute hemiplegia of childhood is briefly reviewed with examples of various etiologies. The role of brain scans in diagnosing and following children with this syndrome is emphasized. Cerebral angiography and computer tomography represent complementary examinations in the evaluation of these patients.
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The distribution and elimination kinetics of Tc-99m pyridoxlidene glutamate (Tc-99m PG), of Tc-99m N-(2,6-dimethyl-phenylcarbamoylmethyl) iminodiacetic acid (Tc-99m HIDA), and of I-131 rose bengal in blood were quantitated after i.v. injection in rats. This was performed by use of a unique indwelling catheter that externalizes the systemic circulation, permitting continuous monitoring of blood radioactivity. The blood activity-time curves of Tc-99m PG and Tc-99m HIDA are described by the sum of three exponential functions. Only two exponentials are required in the case of I-131 rose bengal. The rank order for the rates of loss from blood was Tc-99m HIDA less than Tc-99m PG less than I-131 rose bengal. Bile was collected after administration of Tc-99m HIDA and Tc-99m PG. The total excretion of radioactivity over a 70-min period amounted to 95.7% and 42.8% of the dose of Tc-99m HIDA and Tc-99m PG, respectively. A linear compartmental kinetic model was developed to account for the disappearance from blood and the biliary excretion of these radiopharmaceuticals in rats.
A patient with a superior mediastinal mass on an admission chest radiograph was initially evaluated by an 131I thyroid scan which failed to demonstrate a substernal thyroid. However, the tomographic 67Ga scan clearly showed an abnormal uptake in the area corresponding to the mass lesion on radiographic examination. Subsequent resection and biopsy of the substernal mass revealed a poorly differentiated follicular carcinoma with foci of anaplastic carcinoma. The differential diagnosis of the anterior mediastinal mass and the usefullness of the tomographic gallium scan are briefly discussed.
In two children with histoplasmosis pulmonary perfusion and ventilation studies revealed mismatched abnormalities characterized by almost unilaterally absent perfusion but normal ventilation in the right lung. Chest roentgenograms demonstrated right hilar enlargement and pulmonary contrast angiograms revealed narrowing of the right pulmonary arteries by extrinsic fibrotic granulomata but no pulmonary emboli were present. Fibrosing mediastinitis due to histoplasmosis was found by mediastinoscopic examination in one of the patients. Non-embolic causes of V/Q mismatch lung imaging are discussed briefly, and the correlation with clinical findings is stressed for the diagnosis of pulmonary emboli.
In a patient with myelocytic anemia, hepatomegaly, and metastases suggested by radiographic evidence of sclerosis throughout the pelvis and spine, a liver-spleen scan revealed mild hepatomegaly and an absent splenic image. A bone scan demonstrated diffusely increased activity in all bones, especially in the joint regions. A bone marrow scan showed only hepatic activity but no significant uptake in the bone marrow. Ultrasonography and contrast angiography failed to identify a spleen. The findings from a bone marrow biopsy and a peripheral blood examination indicated myelofibrosis. The implications of an increased concentration of radiopharmaceuticals in bone are briefly discussed.
Radionuclide emisssion tomography and ultrasonography were obtained on a patient with recurrent epigastric pain. In the pancreatic region an ultrasonic scan revealed a conglomerated mass. Following administration of Se-75 selenomethionine, the multiplane longitudinal tomographic scan demonstrated marked concentration of activity in the region of the pancreas which corresponded to a large defect in the hilus of the liver observed on prior liver-spleen scan with Tc-99m sulfur colloid. Surgery revealed a poorly differentiated histiocytic lymphoma in the retroperitoneum. The radionuclide and echographic scans of the retroperitoneal lymphomas briefly discussed, and their complementary role as a diagnostic tool stressed.
Recently a new method was described, the 67Ga subtraction scanning method. 67Ga accumulates in neoplastic and inflammatory tissue. The subtraction method was applied for evaluating 38 patients with Hodgkin's disease and non-Hodgkin's lymphoma. The preliminary experiences are described. It was found that the diagnostic accuracy is comparable to that of 67Ga scanning. The subtraction method offers potential improvement of the accuracy for equivocal scans, but further technological refinement is needed before the method can be widely applicable.
Three patients with biopsy-proven liposarcoma were studied with inhalation of xenon-133, a gas highly soluble in fat. Increased concentration of radioactivity in the region of the tumor suggested the potential usefulness of radioxenon for the detection of lipomatous tumors.
The Tc-99m human serum albumin (HSA) system has been reinvestigated with gel filtration as the assay method. Other than Tc-99m HSA, two radioactive components have been isolated by this technique. Both components are tin-technetium colloids of differing particle sizes, and the relative quantity of each one is pH-dependent. The colloid has been further characterized by protein-induced x-ray emission analysis (PIXE) and by tissue distribution in rats. By this gel-filtration method, commercial Tc-99m HSA kits have been evaluated and have revealed varying amounts of colloids present.
Eight of ten cases of colo-rectal cancer having positive radionuclide bone scans were observed in a Radiation Oncology Clinic in one year. Eight were referred to the institution after treatment elsewhere. In a series of fifty cases with their definitive therapy and evaluation at this institution, 33% of those with bone scans were positive. Review of recent literature shows that 50% of colo-rectal carcinoma have positive bone scans, usually following a multiple and widespread distribution including ribs, pelvis, vertebrae, skull or extremities. These studies indicate that bone scanning may greatly increase precision in staging of colo-rectal carcinoma and aid in the recognition of the truly localized primary lesion. The mechanism of spread of bone metastases in colo-rectal carcinoma was presumably through Batson's plexus.
An improved means of detecting upper abdominal abscesses using the dual radionuclide subtraction technique was applied to 51 patients. 67Gallium citrate was used in the localization of the lesion and 99Tc-labeled human albumin microspheres and 99Tc sulfur colloid were used for subtracting out the interfering background from normal organ concentrations. The procedure provided the parameter capabilities for localization of the abscesses as well as information on their shape and size. Compared to nonsubtraction Ga procedures, 53% more abscesses were diagnosed using the subtraction technique.
A review of the literature of 2,155 reported patients with primary carcinoma of the pancreas, revealed 110 cases or 5% to have skeletal metastasis by radiographic or autopsy study. A study conducted over a 2 year period disclosed that 1 case of skeletal metastasis was detected by bone scanning in 16 patients with pancreatic carcinoma. This indicates a minimum skeletal metastasis rate of 6%. We feel these percentages are low and can be further defined by the more routine employment of the bone scan to evaluate patients with carcinoma of the pancreas. The true figure may be much higher, perhaps as high as 20%.
Osteoblastic bony metastases were observed in a case of medulloblastoma three years after surgery and radiation treatment. There was clinical response to COP therapy (cytoxin, oncovin, prednisone). Radiographic and isotopic bone scan study showed uniform increase in bone density. Serum calcium and phosphorous and acid phosphatase levels were normal. Alkaline phosphatase was elevated and declined with therapy without change in the bone appearance. This suggested an increase in bone deposition activity. However, no increase in calcitonin level was detected either during active disease or following a chemotherapy-induced remission.
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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.