[Peroperative isotope detection].
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Biomedical subjects
Publications and source records attributed to X Marchandise.
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We analyzed the results of dual photon absorptiometry measurements in 43 normal children. Results were correlated with age, body weight, and stature. Reference stature-specific values for bone mineral content in children are proposed. Furthermore, our results show that mineralization continues beyond the end of statural growth.
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622 patients were operated on between 1966 and 1988. Urolithiasis was the most common presenting symptom (26%) but routine measurements of serum calcium led to detect 50% cases. At present, the disease is three times more frequent in women than in men. Estrogenic deprivation, neck irradiation (3.4%) and lithium therapy favor the occurrence of hyperparathyroidism (HPT); frequent association with goiter (19.8%), diabetes (8.3%) and multiple endocrine neoplasia (3.5%) has been noticed. Bone Gla protein concentrations correlate with calcium and HPT blood concentrations but do not reflect the severity of bone damage. Dual photon absorptiometry is now available for quantification and follow-up of bone demineralization, especially in asymptomatic forms of HPT.
20 patients submitted to surgery for colo-rectal malignancies, had I.V. injection of 500 microcuries of 125 I F (ab')2 anti CEA, 3 to 5 days preoperatively, after previous thyroid blockade by iodine. At the time of laparotomy, any obvious neoplastic growth or suspicious area was checked by "intra-operative scintigraphy" according to the technique already developed in thyroid surgery by Sten Lennquist. Result was considered as positive when the uptake ratio suspicious tissue/normal tissue was greater normal tissue than 1.5. 18 out of 19 pathologically proven carcinomas, 1 out of 3 liver metastasis, 3 out of 3 extra-hepatic deposits, and 3 out of 9 metastatic nodes only were positive at scintigraphy. These results are not correlated with preoperative plasma level of CEA. Perhaps some colo-rectal carcinomas might be able to secrete CEA but not to excrete it. Improvement of intraoperative decision-making by this method needs further experience to be appreciated. It was helpful in 2 of our 20 cases.
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The stomach may be used for esophageal reconstruction after resection of esophageal cancers. The aim of this study was to assess the motility of retrosternal esophagoplasty (RO) following the Akiyama procedure in 6 men (mean age: 56.7 years), at least two months after surgery by means of two techniques: a) manometry of the transplant with a multilumen perfused catheter in 50 and 40 cm from the incisor teeth including spontaneous (5 min) and poststimulation recordings, b) an isotopic method for assessing the gastric emptying of a meal labelled with 111In for the liquid phase and with 99mTc for the solid phase, compared to 12 volunteers as controls. Baseline pressure was 11.2 +/- 2.4 H2O cm without spontaneous activity. After dry and wet deglutition (5 ml of water), 6 patients showed synchronous rise in pressure, having mean amplitude of 12.7 +/- 2.3 cm H2O and lasting 4.3 +/- 1.2 s. Liquids T1/2 was 16.2 +/- 7.8 min in controls (p less than 0.01) and solids T1/2 was 17.7 +/- 6.4 min vs 61.7 +/- 16.5 min (p less than 0.001). The lack of propagated activity associated with rapid emptying of the meal through the plasty with no discrimination between solids and liquids suggests that RO does not participate actively in digestion.
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The assessment of bone mineral mass during growth, periods diseases or therapy which modify bone mineralization in the child is of great interest. Single-photon absorptiometry carried out on forearm bones informs on the mineral density of the compact bone of the appendicular skeleton. It is easy to perform in children and infants. Dual-photon absorptiometry appears to be the most accurate for measuring bone mineral content in endocrine and metabolic bone disorders. The low dose of radiation and the non-invasive nature of this high-precision method render it well-adapted and suitable for measuring bone mineralization in childhood.
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Twelve patients (2 with only bone metastases, 3 with only soft tissues metastases and 7 with bone and soft tissues metastases) were treated with 131-I-MIBG (specific activity: 20 mCi/mg), 100 to 200 mCi every 3-6 months. A dosimetric study was carried out before each administration. The follow-up ranged from 6 to 24 months and the number of doses ranged from 1 to 8, with 1.85-9 GBq per administration and a cumulative activity of 1.85-62. 2 GBq according to patients. The cumulative absorbed activity ranged from 850 to 9700 cGy. The following side effects were observed: a bone marrow hypoplasia (1 patient) and a transient increase in catecholamines (3 patients). The treatment was successful in 7 patients (3 with soft tissue metastases, 3 with bone and soft tissue metastases and one with bone metastases). This success consisted in clinical improvement and a decrease greater than 50% of hormonal values in the 7 patients and a decrease greater than 50% of tumoral masses in only 3 patients. No complete remission was obtained at this stage of the study. The disease recurred in 1 patient after a year of partial remission. There was no clear-cut relation between the number of doses and the results. This study shows that 131-I-MIBG can give encouraging though limited results.
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To assess directly the effect of ionic dissociation on the bioavailability of calcium, we used the double isotope inverse convolution method to compare the absorption of calcium gluconate and calcium pyrrolidone carboxylate, an organic, highly dissociated salt. Two tests were performed at a 2 day interval, using in random sequence either salt as a carrier. Forty-eight subjects of various age and clinical condition were studied. The use of the more dissociated salt consistently and significantly increased fractional absorption in a rather constant ratio. Moreover, it slowed absorption in normal subjects whatever their age, and accelerated it in patients with chronic renal failure or osteoporosis, leading to inferences on the alteration of calcium absorption in these conditions.
From 46 [123I]m IBG scans performed in 33 children, excellent specificity (96%) and good sensitivity (90%) appeared in the detection of neuroblastoma; less differentiated non catecholamine-excreting tumours remained undetected. As any localization to be seen was clearly visualized on the 24-h scan, the use of the [123I]m IBG (p, 5n) is recommended for the diagnosis, staging and follow-up of neuroblastoma in children.
In 56 valid subjects 60 years old or more, bone mineral content (BMC) of the second, third, and fourth lumbar vertebrae and of femoral neck was measured by dual-photon absorptiometry. Dorsal kyphosis and lumbar and dorso-lumbar scoliosis were determined from radiographs using the Cobb methods. Kyphosis was positively correlated with low BMC but not with scoliosis. Scoliosis was positively correlated with femoral neck BMC but not with vertebral BMC.
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