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Biomedical subjects

R G Latimer

Publications and source records attributed to R G Latimer.

18 recordsLinked to original sources
PubMed1995

Technetium-99m-sestamibi single agent localization versus high resolution ultrasonography for the preoperative localization of parathyroid glands in patients with primary hyperparathyroidism.

Technetium 99m sestamibi, a newer radionuclide agent, has shown promise in parathyroid scintigraphy. Recent studies using technetium 99m sestamibi in conjunction with subtraction iodine I123 imaging have demonstrated accuracy for localizing parathyroid glands in patients with hyperparathyroidism. The effectiveness of technetium 99m sestamibi scanning as a single agent was compared prospectively with conventional high resolution ultrasonography for the preoperative localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Seventeen patients with primary hyperparathyroidism had preoperative evaluation with high resolution ultrasonography and technetium 99m sestamibi radionuclide scanning. All patients underwent bilateral neck exploration. Ultrasound results were made available to the surgeon preoperatively; however, technetium 99m sestamibi results were withheld unless specifically asked for by the surgeon intraoperatively. Comparison of the imaging studies were correlated with the operative and histological findings. Of 17 patients, 12 had solitary adenomas and four had diffuse hyperplasia. In one patient no abnormal glands were discovered. In patients with technetium 99m sestamibi localization, a solitary adenoma was identified correctly in 10 of 12 patients (83%). Three of four patients with diffuse hyperplasia had parathyroid sestamibi scans showing nonfocal or diffuse uptake in multiple glands. High resolution ultrasonography correctly identified only six of 12 patients with solitary parathyroid adenomas (50%). Of the patients with diffuse hyperplasia, two ultrasound studies showed a single enlarged gland, one study was negative, and one localized two questionable, enlarged glands. Technetium 99m sestamibi is effective as a single agent for preoperative parathyroid scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1994

Tc-99 hexamethylpropyleneamineoxide scanning for the detection of acute appendicitis.

BACKGROUND: Patients with acute lower abdominal pain remain a diagnostic challenge. Although acute appendicitis is the most common surgical disorder, its accurate and timely diagnosis can be difficult. Historically, females of childbearing age are the most difficult patient group in whom to make the diagnosis of acute appendicitis; they have reported negative laparotomy rates ranging from 30 to 50 percent. Tc-99 hexamethylpropyleneamineoxide (HMPAO) labeled leukocyte scan has previously been shown to be very accurate in the detection of acute appendicitis. STUDY DESIGN: One year ago, a blinded study using Tc-99 HMPAO labeled leukocyte scan was reported for the detection of acute appendicitis. That study consisted of 27 patients who presented with abdominal pain. The present report is a follow-up study of 37 additional patients in whom the Tc-99 HMPAO leukocyte scan was used to diagnose or discount acute appendicitis. RESULTS: Twenty-seven patients had histologically proved acute appendicitis. Twenty-three of these were correctly diagnosed using the leukocyte scan, for a sensitivity rate of 85 percent. The overall specificity rate was 93 percent, with an overall accuracy rate of 89 percent. Thirty-one of 64 patients were females of reproductive age and represented 56 percent of all patients in the study with appendicitis. In this group, the Tc-99 HMPAO leukocyte scan had a sensitivity rate of 87 percent, specificity rate of 92 percent, and an overall accuracy rate of 89 percent. The Tc-99 HMPAO leukocyte scan also proved to be valuable in the diagnosis of other intra-abdominal inflammatory conditions. Eight scans interpreted as negative for acute appendicitis were positive for other conditions, including five that were positive for diverticulitis, one for a tumor, one for a tubo-ovarian abscess, and one for a small intestinal infarction. CONCLUSIONS: The Tc-99 HMPAO leukocyte scan is a highly accurate, diagnostic, and minimally invasive test of use in patients with abdominal pain of unclear cause, in which the differential diagnosis includes acute appendicitis. It is of particular value in females of childbearing age, in whom the cause of lower abdominal pain is unclear.

Abdominal Pain↗
PubMed1992

Detection of acute appendicitis by technetium 99 HMPAO scanning.

The diagnosis of acute appendicitis can be difficult. Barium enemas, computed tomography (CT) scans, ultrasound examinations and Indium scans are used to aid in making the diagnosis with varying degrees of success. This blinded, prospective study reports the use of a Technetium 99-m Hexamethylpropyleneamineoxide (HMPAO) labelled white blood cell scan in 30 patients with suspected appendicitis. Autologous white blood counts from 25 cc of whole blood labelled with Tc-99 HMPAO were reinjected into patients. Abdominal imaging was performed at a half hour postinjection and repeated at 2 to 4 hours postinjection. A positive study showed an increased isotope uptake in the right lower quadrant. Nineteen patients had histologically proven appendicitis. Three of these patients were excluded because they were operated on before scan completion. Thirteen of the remaining 16 patients with appendicitis had positive studies (false negative rate = 19%). All patients without appendicitis had either negative scans or scans that detected other intra-abdominal diseases, such as diverticulitis, tubo-ovarian abscess, or small bowel infarction (false positive rate = 0%). Overall, this Tc-99 HMPAO study had a sensitivity of 81 per cent, a specificity of 100 per cent and an overall accuracy of 89 per cent. The 4-hour Tc-99 HMPAO WBC scan is a useful, noninvasive test for confirming the clinical diagnosis of acute appendicitis, but it may prove more valuable as a diagnostic study to rule out appendicitis in patients that have abdominal pain of unclear etiology.

Acute Disease↗
PubMed1988

Acute hemodialysis in the surgical intensive care unit.

Records of postoperative patients requiring acute hemodialysis admitted to the surgical intensive care unit from January 1, 1984 to June 30, 1986 were retrospectively reviewed. Twenty one patients, 9 men and 12 women (mean age 72 years) had an overall mortality of 86 per cent. The mortality rate with impaired preoperative renal function (Ccr less than 41 ml/min) was 100 per cent versus 80 per cent for patients with normal clearances. Prior to the onset of renal failure nine patients (43%) experienced hypotension and seven (33%) received nephrotoxic drugs or dyes. Blood culture documented sepsis was uniformly fatal. Any additional organ system failure (cardiac, pulmonary, hepatic or hematologic) adversely affected survival (P less than 0.01). Nineteen of twenty patients (95%) were fluid overloaded (mean 10.0L) at dialysis institution, determined by measured output over input. Commonly observed cardiac and/or pulmonary system failure is exacerbated by overhydration, therefore early dialysis and/or judicious fluid restriction may be preventative and could improve survival.

Acute Kidney Injury↗
PubMed1980

Myocardial revascularization in patients with chronic renal failure.

Symptomatic coronary artery disease in patients with chronic renal failure can complicate their management in a dialysis program. Hypotension associated with hemodialysis and the anemia of chronic renal disease can produce anginal episodes refractory to medical management. Untreated coronary artery disease may be a contraindication to renal transplantation in an otherwise acceptable candidate. We have encountered three cases of coronary artery disease severe enough to necessitate coronary bypass in patients from our long-term hemodialysis program. All three patients had uncomplicated postoperative courses, none had perioperative infarction, and in all three patients postoperative angiography demonstrated patency of all grafts. One patient subsequently underwent successful renal transplantation; the other two patients have continued in hemodialyses since bypass. We believe our experience and the reported experience of others confirm the feasibility of coronary bypass grafting in patients with chronic renal failure.

Adult↗
PubMed1975

Surgical intervention in intestinal amebiasis.

Operative intervention in patients with unrecognized and untreated amebomas or acute fulminating amebic colitis may result in severe complications. Nevertheless, certain clinical presentations of intestinal amebiasis require surgical procedures varying from drainage of an abscess to a subtotal colectomy. If, in patients with acute fulminating amebic colitis, the signs or symptoms of intraperitoneal or impending perforation develop, unremitting diarrhea associated with anemia and hypoproteinemia continues, or localized abscsses fail to improve with chemotherapy, operative intervention is indicated. Complications of amebomas that require operative intervention include failure to respond to chemotherapy, perforation, hemorrhage, ulceration, stricture or fistula formation and obstruction. Anti-amebic chemotherapy can reduce intestinal complications so elective operative procedures should be delayed to allow time for adequate treatment.

Abscess↗