PubMed Health⌕ Search

Biomedical subjects

W J Shih

Publications and source records attributed to W J Shih.

At least 181 records · Page 10Linked to original sources
PubMed1988

Paget's disease mimicing skeletal metastases in a patient with coexisting prostatic carcinoma.

We present a 93-year-old man with prostatic carcinoma whose 99mTc-HMDP skeletal images showed multiple areas of abnormally increased radioactivity in the bone and virtual absence of renal activity. These findings were interpreted as representing multiple skeletal metastases. When correlated with concurrent radiographs, the abnormalities were found to be due to Paget's disease. Multiple areas of bone involvement are not rare in Paget's disease. We reemphasize that an abnormal bone scintigram should always be correlated with regional radiographs to rule out conditions other than malignancy.

Aged↗
PubMed1988

Malunion of a femoral fracture mimicking osteomyelitis in three phase bone imaging.

A case of greatly increased blood flow in the region of a fracture with malunion of the left femur, both in the flow and immediate blood pool studies during three phase bone imaging, is presented. The sluggish left femoral artery flow resulted from the greatly increased regional perfusion and is similar to the findings in acute osteomyelitis. The sluggish left femoral artery flow and greatly increased regional perfusion of the site is probably best explained as a regional "neurovascular flush" resulting from the pain caused by the malunion of the fracture and/or hyperemia in the area of the malunion responding to inflammation.

Aged↗
PubMed1988

Detection of pulmonary edema and hemorrhage using indium-111 chloride images: rat model.

Pulmonary edema and/or hemorrhage (PEH) induced by IV injection of norepinephrine was demonstrated in six rats by In-111 chloride lung/heart imaging. The anesthetized rats were positioned under a gamma camera using a pinhole collimator. After In-111 chloride IV injection, analog thorax images were obtained and dynamic data were recorded at 30 seconds/frame for 20 min before and after induced PEH. The gamma camera was interfaced to a computer which generated the curve of the lung/heart radioactivity ratio which rose from 0.4-0.5 at baseline to 1.0-1.4 at the end of the study. The image after IV norepinephrine injection showed a reversal of the lung/heart radioactivity concentration. In-111 chloride instantly binds to plasma transferrin yielding an excellent intravascular imaging agent. Leakage of this tracer into alevoli indicates loss of aveolar membrane wall competence. Pulmonary edema, as in acute respiratory distress syndrome, is difficult to diagnose radiographically and this In-111 chloride lung/heart imaging technique may be potentially useful.

Animals↗
PubMed1987

Secondary lymphoma of the thyroid in 99mTc-pertechnetate scintigraphy.

We present markedly decreased radioactivity in the right on a 99mTc-pertechnetate thyroid image in a patient with secondary lymphoma of the thyroid. At autopsy, the right lobe of the thyroid was replaced by lymphoma tissue. Markedly decreased radioactivity on the images may be explained by lymphoma cell infiltration or replacement of thyroid tissue with a resultant attenuation effect as well as interference of the trapping mechanism of the thyroid folicular cell. While cold areas in a radionuclide scintigram may present difficulties in interpretation, a high index of secondary lymphoma suspicion should be made by a combination of the scintigraphic findings and history of malignant lymphoma.

Aged↗
PubMed1987

Tc-99m labeled triethelene tetraamine polysterene resin gastric emptying studies in bulimia patients.

To evaluate gastric emptying in patients with bulimia, 20 patients (all women, ranging in age from 12 to 49 years) with upper gastrointestinal symptoms ingested 150-200 microCi 99mTc-triethelene tetraamine polysterene resin in cereal and had scintigraphy in the supine position. Data were accumulated at 5 min intervals to determine the gastric emptying time (GET). The results showed that the gastric emptying time was prolonged in 12 patients and decreased in 8. All 12 patients with prolonged emptying time were given 10 mg metoclopramide intravenously; 9 of these had a good response and 3 had no response. Although all patients had subjective symptoms of gastric dysfunction, the results indicate that about 60% had delayed and 40% had rapid gastric emptying. The findings of two extremes of gastric emptying time remain to be explained, however, this enables (a) objective documentation of gastric emptying as this technique (b) can separate those patients with rapid GET from those with prolonged GET, who might benefit from metoclopramide.

Adolescent↗
PubMed1987

Equivocal findings on cranial CT but apparent cerebral lesion(s) on conventional radionuclide imaging.

Four patients with different disease entities (multiple cerebral metastases, cerebral infarct, cerebritis, and encephalitis) in whom x-ray computed tomography was either equivocal or negative showed apparent cerebral lesions by radionuclide studies. Equivocal CTs in the patients with multiple cerebral metastases or cerebral infarction may be attributed to the contraindication of contrast media and/or lack of cooperation during the examination procedure. In patients with cerebritis or encephalitis, radionuclide studies have proven to be more sensitive than CT early in the infectious disease process. In certain circumstances it is clinically beneficial and cost effective to evaluate the patient primarily by radionuclide scintigraphy.

Adult↗
PubMed1987

Extensive gastric varices demonstrated by technetium-99m red blood cell scintigraphy.

An alcohol abuse patient complicated by chronic pancreatitis had splenic vein thrombosis leading to gastric varices and underwent abdominal Tc-99m red blood cell scintigraphy. First pass study, sequential images up to 1 hour, and a 2.5 hour image showed abnormal radioactivity in the left side of the abdomen and midabdomen. In 24 hour images, the high level of activity in the left side persisted; in addition, there was accumulation of radioactivity in the cecum, ascending, transverse colon, the splenic flexure, and descending colon. A splenectomy was performed and during the surgical procedure, a large dilated vein in the greater omentum was noted. It is reemphasized that delayed imaging up to 24 hours is important when the results of earlier images are equivocal or negative.

Alcoholism↗
PubMed1987

Scintigraphic findings in acute gangrenous cholecystitis.

Nine patients who had surgically proven acute gangrenous cholecystitis and Tc-99m DISIDA scintigrams were reviewed retrospectively. Three types of scintigraphic findings were presented: 1) nonvisualization of the gallbladder, three cases; 2) nonvisualization of the gallbladder plus a rim sign, two cases; and 3) nonvisualization of the gallbladder plus an enlarged photon deficient area corresponding to the gallbladder fossa, four cases. A rim sign or an enlarged gallbladder fossa reflect the direct spread of inflammation from the gallbladder into the liver, causing impaired hepatocyte function. An enlarged gallbladder fossa may represent a later stage of a rim sign. Presumably tracer excretion by hepatocytes is affected initially by the inflammatory process, followed by impairment of tracer concentrating ability. Since the gallbladder may be suspended occasionally by a mesentery and not in contact with the liver, the secondary signs may be absent in acute gangrenous cholecystitis.

Acute Disease↗
PubMed1987

Disorders of gallbladder function related to duodenogastric reflux in technetium-99m DISIDA hepatobiliary scintigraphy.

Controversy exists over the relation between gallbladder dysfunction and the propensity for duodenogastric reflux. To evaluate this, Tc-99m DISIDA hepatobiliary imaging studies in 120 patients were reviewed, excluding patients who had had cholecystectomy or subtotal gastrectomy before scintigraphy. Serial images were obtained at 5, 10, 15, 30, 45, and 60 minutes and up to 24 hours, if indicated, after intravenous injection of 5-10 mCi of Tc-99m DISIDA. Normally, the liver, bile ducts, gallbladder, common bile duct, and bowel are visualized sequentially. Reversal of the normal sequence of gallbladder (GB) and bowel visualization indicates GB dysfunction; nonvisualization of the GB reflects cystic duct obstruction or absent GB function. Duodenogastric reflux is identified by radiotracer localized in the area just below or immediately adjacent to the tip of the left hepatic lobe. The intragastric location of the tracer may be verified by oral administration of 300 uCi of Tc-99m sulfur colloid. Twenty-nine patients had duodenogastric reflux between 10 and 60 minutes after injection. Of the 29 patients, 22 had a nonvisualized gallbladder, four had reversal of appearance of GB and bowel activity, and three had a normal study. GB dysfunction or nonfunction is more frequently demonstrated when duodenogastric reflux is present than with normal gallbladder function (P less than 0.001). In conclusion, gallbladder malfunction is closely associated with duodenogastric reflux, an abnormality that may be diagnosed noninvasively by Tc-99m DISIDA hepatobiliary scintigraphy.

Adult↗
PubMed1987

Iodine-123 HIPDM brain imaging findings in subacute spongiform encephalopathy (Creutzfeldt-Jakob disease).

Decreased perfusion of the left frontal and left temporoparietal cortex has been shown in [123I] HIPDM planar and single photon emission computed tomographic images of a patient with Creutzfeldt-Jakob disease (CJD) that was proven by brain biopsy and subsequent autopsy. An EEG showed diffuse, periodic discharges most prominent to the left hemisphere. Concurrent head computed tomography (CT), nuclear magnetic resonance (NMR), and cerebral angiographic studies were negative. Abnormalities demonstrated by [123I]HPDM imaging and by EEG may represent changes in neurophysiological and neurochemical status while cerebral angiography, CT, and possibly NMR register only anatomic or structural lesions. Premortem diagnosis of CJD depends on brain biopsy; the availability of the [123I] HIPDM study may provide regional cerebral neurochemical and neurophysiological information, guiding or avoiding brain biopsy in the appropriate clinical setting.

Aged↗
PubMed1987

Imipenem/cilastatin for pediatric infections in hospitalized patients.

One hundred and four children who were hospitalized for documented or suspected non-CNS bacterial infections (56 males/48 females, 22 days to 15 years old) were treated with intravenous imipenem/cilastatin for 9.4 days (range 3 to 28 days). Children up to three years of age received 100 mg/kg/day and older children 60 mg/kg/day, administered in four divided doses. Bacterial pathogens were isolated before therapy in 85%. Diagnoses in the 74 evaluable patients included bronchopneumonia with or without empyema (20%), peritonitis complicating appendicitis (16%), skin/soft tissue abscesses (14%), septicemia (11%) and miscellaneous other infections (39%). Among evaluable patients, 95% were clinically cured or improved. One patients, a marasmic child with pneumonitis due to pseudomonas, died during therapy. One evaluable patient each with shigellosis, Klebsiella pneumoniae empyema and streptococcal pneumonia had bacteriologic eradication or suppression but, due partly to noninfectious complications, had no overall clinical improvement. Most bacterial isolates (101/108) were eradicated, including many gram-negative and gram-positive aerobes and anaerobes; three pathogens persisted (one Proteus mirabilis and one Salmonella typhi, one Staphylococcus aureus); and one Escherichia coli pyelonephritis recurred after therapy ended too early. Imipenem/cilastatin was well tolerated by 91% of children. Clinical adverse experiences (AEs), none serious except for the one death, occurred in 19%; 12% were judged possibly related to imipenem/cilastatin, but none probably or definitely related. No serious laboratory AEs occurred; the most common AEs were eosinophilia (11%), urine discoloration, and infusion site pain. Imipenem/cilastatin is well tolerated and has excellent clinical efficacy in a wide variety of pediatric infections.

Adolescent↗