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S Lantsberg

Publications and source records attributed to S Lantsberg.

7 recordsLinked to original sources

[Latent, non-suppurative mastoiditis. Apropos of 62 cases].

The term masked mastoiditis defines a subclinical infectious inflammatory process of the mucosal lining and bony structures of the mastoid air cells with an intact tympanic membrane. The disease follows an apparently well treated recent acute otitis media. Probably due to an anaerobic colonizing flora, the developing bone infection is of low grade without pus formation. The clinical features of the disease are not overt as those in coalescent mastoiditis. The intact ear drum does not reflect the severity of bone eroding disease which is characterized by non-exudative but proliferative changes. Hence there is no pus formation. The incidence of complications is high. Plain X-ray film and CT scan do not specifically define the disease process. Bone scan indicates the bone invading nature of the mastoid infection. The osteoblastic reaction secondary to osteitis is demonstrated by the high uptake of the isotope in the involved mastoid. Antibiotics may cure the disease process but in most of the cases surgery in unavoidable.

Adolescent

[Masked mastoiditis].

Masked mastoiditis defines a subclinical infectious inflammatory process of the mucosal lining and the bony structure of the mastoid air cells, with intact tympanic membrane. It follows an apparently well-treated recent acute otitis media. Because of obstruction of the tympanic diaphragm by mucosal swelling, polypoid mucosa or granulation tissue, a complete separation of the tubo-tympanic cavity from the mastoid air cell system results. The latter remains unaereated and the local infectious mucosal disease progresses to osteitis. Probably due to colonizing flora in this unventilated media, the developing bone infection is low-grade, without pus formation. The clinical features of the disease are not overt as those in coalescent mastoiditis. The intact ear drum does not reflect the severity of bone-eroding disease within the mastoid. Since this disease is characterized not by exudative but by proliferative changes, there is no pus formation. The incidence of complications is high. Plain x-ray and CT scan do not specifically define the disease process, but bone scan indicates the bone-invading nature of the mastoid infection. The osteoblastic reaction secondary to osteitis is demonstrated by high uptake of the isotope in the involved mastoid. Antibiotics may cure the disease, but in most cases surgery is unavoidable.

Adolescent

Radionuclide imaging of soft tissue masses with Tc-99m DTPA.

A scintigraphic study was carried out on 48 patients presenting with palpable soft tissue masses. Imaging was carried out using Tc-99m DTPA in three phases (dynamic, blood pool after 5 minutes, followed by late scans after 2 hours). The resultant uptake of the agent was categorized as consistently positive (14 cases), initially positive but progressively negative (7 cases), initially negative but progressively positive (7 cases), and consistently negative (20 cases). Histopathologic examinations were carried out for all cases following biopsy. A variety of malignant and benign masses were found to localize DTPA, whereas all masses that did not concentrate the agent were proven to be lipomas. In order to determine whether the uptake of DTPA bore any relationship to blood flow, additional studies using Tc-99m labeled red cells were carried out on 15 patients with soft tissue tumors. There was no correlation between blood flow or pooling and the degree of Tc-99m DTPA uptake by the palpable masses. The sensitivity of DTPA uptake as indicative of nonlipomatous tissue was 100%, and its specificity was 91%. The predictive probability that a lesion was a liopoma if there was no DTPA uptake at any phase was 100%.

Erythrocytes

Evaluation of bile duct complications after orthotopic liver transplantation by hepatobiliary scanning.

A new radiopharmaceutical for hepatobiliary scanning, 99Tcm Iodida, which has significant advantages in patients with high bilirubinaemia, was used to assess biliary tract complications in 30 consecutive liver transplant patients. There was adequate hepatic extraction and excretion for diagnostic imaging even in patients with serum bilirubin levels up to 877 mumol l-1 (51.6 mg dl-1). Twelve out of 12 cases (100%) without any biliary complication were correctly diagnosed. Extrahepatic obstruction was recognized in 5 out of 7 cases (71%). In one case the scintigraphic findings showed no perfusion of the transplanted liver caused by vascular thrombosis due to acute rejection. One small biliary leak was missed. The correct diagnosis of intrahepatic cholestasis was made in 3 out of 9 patients. However six equivocal studies were observed in profoundly jaundiced patients with bilirubin levels above 400 mumol l-1 due to difficulties in differentiating extrahepatic obstruction from severe intrahepatic cholestasis. Quantitative analysis of the kinetics of 99Tcm Iodida may permit better discrimination between the wide variety of disease in the posttransplant period.

Adolescent

Diagnosis of acute cholecystitis by 99mTc-iminodiacetic acid cholescintigraphy.

99mTc-iminodiacetic acid (IDA) compounds are concentrated by hepatocytes and excreted into the biliary system. The utility of 99mTc-IDA imaging in 116 patients with suspected acute cholecystitis was studied retrospectively over a 2-year period. Visualization of the gallbladder ruled out obstructed cystic duct and acute cholecystitis with a high degree of accuracy.

Acute Disease