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Biomedical subjects

R J Lull

Publications and source records attributed to R J Lull.

At least 19 recordsLinked to original sources
PubMed1992

Tc-99m sestamibi myocardial imaging at rest for evaluation of cocaine-induced myocardial ischemia and infarction.

Many clinical cases of cocaine-induced myocardial infarction have been reported in the literature. Of the reported cases, patients tend to be young (in the third decade of life), chronic abusers with myocardial infarction typically involving the anterior left ventricular wall. This case report demonstrates the usefulness of two-phase (symptomatic and asymptomatic) Tc-99m sestamibi myocardial imaging at rest for definitive diagnosis of cocaine-induced myocardial ischemia and infarction.

Adult↗
PubMed1986

Asymptomatic total hip prosthesis: natural history determined using Tc-99m MDP bone scans.

A prospective study was performed with 97 patients who had undergone total hip replacement surgery and who were not experiencing pain or other symptoms or problems. The study was intended to determine the normal postoperative appearance of radionuclide scans of the hip following administration of technetium-99m methylene diphosphonate. Five areas of the prostheses were evaluated. Results showed that 6 months after implantation activity around the lesser trochanter and prosthesis shaft became insignificant. Activity around the acetabulum, greater trochanter, and prosthesis tip stabilized approximately 2 years after surgery; approximately 10% of patients in the study had persistent activity in these areas. Familiarity with this normal progression is fundamental to interpretation of postoperative bone scans in patients with total hip prosthesis.

Acetabulum↗
PubMed1985

Localization of lower gastrointestinal hemorrhage. Experience with red blood cells labeled in vitro with technetium Tc 99m.

Seventy-six patients clinically suspected of having lower gastrointestinal bleeding were studied by scintigraphy utilizing red blood cells labeled in vitro with technetium Tc 99m. Sixteen patients required emergency surgery; bleeding was accurately localized in 15 (94%). One patient (6%) had a normal scan. A 20-month mean follow-up of the 16 patients showed no recurrent bleeding. Of 60 patients not requiring emergency surgery, bleeding was localized in 11, but the bleeding ceased. Forty-nine of the 60 patients had normal scans and had no further hemorrhaging during hospitalization. A 21-month mean follow-up of 38 of the 49 patients showed no further bleeding episodes or surgical procedures in 29 patients; however, eight patients required surgical procedures, including seven for gastrointestinal malignancies. Scanning of red blood cells labeled in vitro with 99mTc is accurate and efficacious in localization of bleeding sites that require emergency surgery for lower gastrointestinal hemorrhage.

Adult↗
PubMed1984

Scintigraphy of gastrointestinal hemorrhage: superiority of 99mTc red blood cells over 99mTc sulfur colloid.

The relative efficacy of 99mTc sulfur colloid and in vitro-labeled 99mTc red blood cells in detecting and localizing gastrointestinal hemorrhage was evaluated in a prospective tandem study of 100 patients referred for suspicion of gastrointestinal tract hemorrhage. Thirty-eight true-positive scintigrams were obtained with 99mTc red blood cells, whereas 99mTc sulfur colloid detected only five sites of hemorrhage. Scintigraphic findings were corroborated by clinical, endoscopic, arteriographic, and surgical findings. 99mTc red blood cells were clearly superior, with a sensitivity of 93%, specificity of 95%, and overall accuracy of 94% in detecting and localizing gastrointestinal hemorrhage.

Adolescent↗
PubMed1983

Increased left ventricular ejection fraction after a meal: potential source of error in performance of radionuclide angiography.

The effect of a standardized meal on left ventricular (LV) ejection fraction (EF) was determined by equilibrium radionuclide angiography in 16 patients with stable congestive heart failure but without pulmonary or valvular heart disease. LVEF was determined in the fasting state and 15, 30, and 45 minutes after a meal. Patients with moderately depressed fasting LVEF (30 to 50%), Group I, had a mean increase of 6.9 +/- 2.9% (p less than 0.005) in the LVEF at 45 minutes after the meal. Patients with severely depressed fasting LVEF (less than 30%), Group II, had no change after the meal. It is concluded that significant increases in LVEF may occur after meals in patients with moderate but not severe left ventricular dysfunction. Equilibrium radionuclide angiography studies that are not standardized for patients' mealtimes may introduce an important unmeasured variable that will affect the validity of data in serial studies of left ventricular function.

Adult↗
PubMed1983

Radionuclide evaluation of lung trauma.

Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs.

Adolescent↗
PubMed1983

Scintigraphic detection of occult hemorrhage using RBCs labeled in vitro with technetium Tc 99m sodium pertechnetate.

Scintigraphy with RBCs labeled with technetium Tc 99m sodium pertechnetate effectively located the source of hemorrhage in a patient receiving long-term anticoagulant therapy. (The patient was initially seen with a large hematoma on the flank.) More important, the procedure was used to monitor activity in this otherwise-occult bleeding site. Scintigraphic studies may be useful in the management of these difficult clinical problems.

Aged↗
PubMed1980

Radionuclide imaging in the assessment of lung injury.

Nuclear medicine imaging techniques are being more widely applied to study a variety of lung injuries. Ventilation and perfusion imaging is often superior to other roentgenographic techniques for establishing the diagnosis and demonstrating the extent of such injuries. At several large burn centers, the Xe-133 washout technique has become the cornerstone for diagnosing early inhalation injury. The overall accuracy of this procedure is 92%. Regional decreases in ventilation and perfusion can reliably localize aspirated radiolucent foreign bodies. Disproportionate perfusion changes are often the earliest indicator of radiation pneumonitis and other forms of vascular injury. Other types of injury, such as gastropulmonary aspiration, blunt trauma, and near-drowning, require further evaluation before the ultimate role of nuclear imaging is defined. An imaging technique to assess capillary permeability in the adult respiratory distress syndrome would be of great clinical benefits.

Blast Injuries↗
PubMed1980

Hepatoma visualization with Tc-99m pyridoxylidene glutamate.

Tc-99m sulfur colloid is concentrated in Kupffer cells of the liver, whereas the new biliary agents are processed by hepatic parenchymal cells. A case of primary hepatocellular carcinoma, appearing as a defect on sulfur-colloid liver scan and visualized on a biliary scan, is presented. The possible role of biliary scanning in the evaluation of a defect on sulfur-colloid liver scan is discussed.

Aged↗
PubMed1977

The use of steroids in inhalation injury.

Steroids exert no beneficial effect upon acute pulmonary dysfunction created by nitrogen tetroxide inhalation and may worsen small airway obstruction in the early phases of injury. Treatment, therefore, is still largely symptomatic and supportive.

Animals↗
PubMed1976

Use of 133xenon in early diagnosis of inhalation injury.

133Xenon lung scanning post-thermal injury was used to detect inhalation injury in 86 patients admitted to the United States Army Institute of Surgical Research during 1974. Inhalation injury was indicated by the 37 (43%) positive scans. Based on all available clinicopathologic evidence, 11 (13%) of the scans were erroneous with seven (8%) falsely positive and four (5%) falsely negative. Eighty-six per cent of the scans were "appropriate." Addition of bronchoscopy and/or pulmonary function testing appeared to improve diagnostic accuracy. By using any pair of tests, falsely negative diagnoses were virtually eliminated. Inhalation injury, as expected, had an adverse effect on survival rates. The group of patients whose expected mortality lay between 40 and 59% were most notably affected. One hundred per cent (five of five) of those with inhalation injury died; only one of eight without inhalation injury died.

Bronchoscopy↗
PubMed1976

Bronchial adenoma causing unilateral absence of pulmonary perfusion.

This case of bronchial adenoma is used as a clinical model demonstrating absence of pulmonary perfusion by 131I-MAA scanning secondary to bronchial obstruction. Radiographic and radionuclide studies are correlated and other causes of pulmonary hypoperfusion discussed. The literature and related cases are reviewed.

Adenoma↗