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[Gastric emptying of semi-solid meal in normal man with special reference to relationship between plasma acetoaminophen concentrations and gastric emptying time].

Correlation between gastric emptying time measured by a radioisotope method and plasma acetoaminophen level was studied in 11 preoperative early gastric cancer in semisolid meal. A significant correlation was found between both gastric emptying half-time and plasma acetoaminophen level at 30, 45 minutes after ingestion of meal, and plasma acetoaminophen level at maximum. We conclude that acetoaminophen analysis is useful to measure gastric emptying at semisolid meal.

Acetaminophen↗

Distribution of mesenteric and splenic blood flow in cirrhosis of the liver as estimated by radionuclide angiography.

We used radionuclide angiography following an injection of 185 MBq Tc-99m tin colloid as a non-invasive method for measuring the mesenteric and portal components of the total hepatic circulation, according to the method of Fleming et al (J Nucl Med 24; 1983). Fifty-seven patients with cirrhosis and 33 controls were examined. The relative mesenteric flow (MF) and the relative portal flow (PF) were 68.6 +/- 8.5% and 78.6 +/- 5.9%, respectively, in the control group. These values were 42.0 +/- 16.4% and 70.9 +/- 8.9%, respectively in the cirrhosis group, and were significantly lower than in the controls. In the cirrhosis group, the reduction in PF was small, while that in MF was large. Consequently, we found that portal blood flow was relatively well maintained in the cirrhosis patients, while the contribution of splanchnic blood flow to the portal flow was relatively reduced.

Adult↗

An adult case with rhabdomyosarcoma of the liver.

An autopsy case of primary rhabdomyosarcoma of the liver in a 70-year-old man is described. The case could not be clinically differentiated from hepatocellular carcinoma. The tumor showed typical features of rhabdomyosarcoma; phosphotungstic acid hematoxylin (PTAH)-positive myofibrils and cross-striations were observed in the cytoplasm of highly plemorphic tumor cells.

Aged↗

Technetium-99m-labeled recombinant tissue plasminogen activator for the imaging of emboli in vivo.

Tissue-type plasminogen activator (t-PA) effectively lyses active thrombus by direct action. Recombinant t-PA (rt-PA) was labeled with technetium-99m (99mTc) to investigate the in vivo binding to fibrin clots in a feline cerebral embolism model created by insertion of an artificial fibrin clot within the carotid artery. 99mTc-rt-PA administered intravenously provided clearer imaging of clots after priming with cold rt-PA, with uptake peaking 5-10 minutes after the injection. 99mTc-labeled human serum albumin was not retained at clot sites. Systemically administered 99mTc-rt-PA binds to fibrin clots within carotid arteries in our feline model. Our results suggest that the interaction of intrinsic plasminogen activator inhibitors with extrinsically administered rt-PA may regulate the demonstration of a clot, although the precise mechanism is unclear.

Animals↗

Assessment of the brain areas perfused by superselective intra-arterial chemotherapy using single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime--technical note.

The brain areas perfused by superselective intra-arterial (i.a.) chemotherapy were assessed using single photon emission computed tomography (SPECT) with technetium-99m-hexamethyl-propyleneamine oxime (99mTc-HMPAO). A superselective catheter was introduced into the anterior, middle, or posterior cerebral artery of patients with malignant glioma for i.a. chemotherapy. 99mTc-HMPAO was subsequently injected via the same catheter used for chemotherapy, and a higher dose of 99mTc-HMPAO was injected intravenously to obtain adequate background brain images. Comparison of the SPECT images with magnetic resonance images could confirm complete perfusion of the tumor tissue. In two patients with malignant glioma, regions of interest were selected in the peritumoral brain area and a reference brain area, and the radioactivity was measured. The concentration of 99mTc-HMPAO was about 50 times higher in tissue perfused by superselective injection into anterior or middle cerebral artery compared to intravenous injection. 99mTc-HMPAO SPECT is readily available in many institutions and the information provided is useful for planning more effective and safe i.a. chemotherapy.

Adolescent↗

Lymphoscintigraphy in malignant melanoma: 99mTc antimony sulfur colloid.

Lymphoscintigrams were performed using technetium-99m antimony sulfur colloid in 21 patients with cutaneous malignant melanoma. Scintigraphic results were concordant with clinical prediction of lymph drainage in six of 11 patients with trunk melanoma, in five of seven patients with extremity lesions, and in none of three patients with scalp melanoma. Thirteen patients showed activity in more than one regional node group. Eleven patients had focal activity in areas other than regional node groups (i.e., in-transit or central lymph nodes). Lymphadenectomy was performed in 19 patients. In each case, the regional lymph node area chosen for resection was positive scintigraphically. The presence of 99mTc activity in excised lymph nodes was documented by scintillation counting and autoradiography. Metastatic disease was found in the resected nodes of 12 patients. Lymphoscintigraphy may be useful in planning lymphadenectomy in some patients with cutaneous melanoma.

Adult↗

Attenuation of radionuclide activity by metal-cup arthroplasties.

The half-value layers of stainless steel, bone cement, and polyethylene were measured for 99mTc, 67Ga, 111In, and 201TI to render some insight into the attenuating effects of the metallic cup and other components used in surface-replacement revision arthroplasty. On theoretic consideration, a twofold increase in 99mTc-methylene diphosphonate in bone inside the cup should not be attenuated to the point of escaping detection on the radionuclide images of the hip. 67Ga, using the 184 and 300 keV peaks, and 111In have greater half-value layers than 99mTc and are subject to less attenuation by the metallic cup.

Aged↗

Chronic osteomyelitis: monitoring by 99mTc phosphate and 67Ga citrate imaging.

Thirteen patients with chronic osteomyelitis, treated for 6 months with rifampin, had serial 99mTc phosphate and 67Ga scans to determine their value in assessing response to treatment. In patients who responded to treatment, gallium scans were deemed more accurate than 99mTc phosphate bone scans. The gallium scans, although still abnormal at the end of 6 months of antibiotic therapy, showed an improvement trend in all the responders except one in whom fracture recurred. Worsening or lack of improvement on gallium scans predicted active bone infection in five of six "clinical-failure" patients who had documented active bone infection. 67Ga scans eventually became normal in all patients who remained asymptomatic (excluding one with recurrent fracture). 99mTc phosphate scans became normal in only one of five clinical responders. All nonresponders had persistently abnormal scans, although after 6 months of therapy only four of seven showed worsening or no improvement on the scan. Therefore, 67Ga is preferred over 99mTc phosphate bone scans in the assessment of response to therapy in chronic bone infection. Clinical utility of the gallium scan is most significant in patients whose clinical assessment is uncertain, but routine use of this technique does not appear to be warranted. Gallium images are most valuable when obtained over a period of time, so that the trend of improvement versus nonimprovement is evident.

Chronic Disease↗

Lymphoma of the skeleton: scintigraphic evaluation.

We retrospectively reviewed the 99mTc-diphosphonate scans of 980 patients with Hodgkin or non-Hodgkin lymphoma to define the typical appearance and distribution of skeletal lesions. The results were compared with the presence of skeletal symptoms and the findings on 67Ga-citrate scintigraphy, when available. Forty (4%) of the 980 patients had 77 scintigrams showing osseous involvement; there was an average of 3.5 lesions per study. Compared with patients with non-Hodgkin lymphoma, patients with Hodgkin disease had significantly fewer axial lesions (44% vs 82%, p less than .000001, two-tailed test) and more frequent involvement of the extremities. Subtle lesions were common. Of the lesions detected by scintigraphy, significantly more were detected by 99mTc-diphosphonate imaging (95%) than were detected by 67Ga-citrate (44%) (p less than .00001, two-tailed test), and most of these were far less apparent on the 67Ga-citrate study. Skeletal pain was an insensitive but specific indicator of skeletal disease. These results show that skeletal scintigraphy in patients with lymphoma typically reveals multiple subtle and asymptomatic lesions with frequent extremity involvement. Diffusely increased calvarial activity is commonly seen and often persists in proved remission. Increased juxtaarticular activity is specific for malignant skeletal involvement.

Adolescent↗

Bone disease in adolescents with acne fulminans and severe cystic acne: radiologic and scintigraphic findings.

OBJECTIVE: Acne fulminans is an uncommon form of ulcerative acne with acute onset. It usually affects adolescent boys who have associated musculoskeletal pain and septic fever. Osteolytic bone lesions have been reported in these patients. Severe cystic acne occurs almost equally in both sexes, but it has a less dramatic clinical course than acne fulminans and rarely causes ulcerative skin lesions and systemic symptoms. In this study we investigated the imaging features of bone lesions associated with acne fulminans and determined if patients with severe cystic acne have similar bone lesions. SUBJECTS AND METHODS: From 1970 through 1991, 24 patients with acne fulminans were treated in the dermatologic departments of Finnish hospitals. Radiologic (plain radiographs or conventional tomograms) or scintigraphic data were available for 21 patients and analyzed retrospectively. For comparison, 20 consecutive patients with severe cystic acne were examined prospectively with scintigraphy. RESULTS: Ten patients (48%) with acne fulminans had lytic bone lesions on the radiographs, and the bone scans showed increased uptake in 14 patients (67%). Destructive lesions resembling osteomyelitis were seen in seven patients. The bones of the anterior chest wall were predominantly involved: sternum in four patients, clavicle in three patients, and acromion scapulae in one patient. Sternoclavicular hyperostosis was seen in six patients. Four patients had small lytic lesions in the epiphyseal growth plate or a periosteal reaction. Follow-up was performed in eight patients with acne fulminans and in seven revealed either normal findings or sclerosis and hyperostosis in the previously affected areas of the sternum and clavicles. Slightly increased uptake of radionuclide, usually in the sternum or around the sternoclavicular joints, was seen in nine patients with severe cystic acne, but these findings were regarded as normal and radiographs were not obtained. CONCLUSION: Lytic lesions in the bones of the anterior chest wall and in the epiphyseal growth plates are common in patients with acne fulminans, but do not seem to occur in patients with severe cystic acne. The prognosis of bone disease associated with acne fulminans appears to be good, and the chronic sequelae, if any, are mild sclerosis and hyperostosis of the affected bones. Acne fulminans should be added to the list of dermatoses associated with bone lesions detectable by radiologic and scintigraphic methods.

Acne Vulgaris↗

Effect of a static magnetic field on blood flow to the metacarpus in horses.

OBJECTIVE: To determine the effect of a static magnetic field on relative blood flow to the metacarpus of horses. DESIGN: Randomized controlled clinical trial. ANIMALS: 6 healthy adult horses. PROCEDURE: Red blood cells were radiolabeled in vivo by administration of technetium Tc 99m (pyro- and trimeta-) phosphates, and scintigraphic images were obtained 30 minutes later. A magnetic wrap that emitted a static magnetic field was applied to 1 metacarpus and a control wrap was applied to the contralateral metacarpus. Forty-eight hours later, the wraps were removed, and scintigraphy was repeated. Relative perfusion ratios were calculated by dividing mean count per pixel for the portion of the metacarpus under the wrap by mean count per pixel for a portion of the distal aspect of the antebrachium that was not in the magnetic field. RESULTS: The difference between the relative perfusion ratio prior to application of the wrap and the ratio after application of the wrap for limbs that received the magnetic wrap was not significantly different from the difference in ratio for limbs that received the control wrap. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in horses, the static magnetic field associated with application of commercially available magnetic wraps for 48 hours does not increase blood flow to the portion of the metacarpus underneath the wrap.

Animals↗

Urinary 99m-Tc-diphosphonate excretion as a simple method to quantify bone metabolism.

Twenty-four-hour whole-body retention (WBR) of 99m-Tc-methylene-diphosphonate (an index of bone turnover) was determined by whole-body counting (WBRs) and complementarily by urine counting (WBRu) in nineteen subjects with normal to highly increased bone turnover. WBRs and WBRu correlated well (r = 0.94, P less than 0.001), and gave almost the same results. Both WBRs correlated equally well with serum alkaline phosphatase and urine hydroxyproline/creatinine (r = 0.82-0.93). Coefficient of variation in WBRu was 7.0%, determined by duplicate measurements in sixteen normals. The injected dose of diphosphonate did not influence WBRu. However, since almost 50% of the diphosphonate excreted in urine appeared during the first few hours after the i.v. injection, the method of WBRu requires careful urine collection. Thus, the simple WBRu determination provides the same information on bone metabolism as does the more cumbersome and expensive WBRs technique.

Adult↗

Oesophagus scintigraphy in patients with diabetes mellitus.

Oesophagus scintigraphy with 99mTc was used to evaluate oesophageal motility in 40 patients with insulin-dependent diabetes mellitus. Abnormal oesophageal function was found in one third of the patients, although none reported oesophageal symptoms. The patients with abnormal oesophageal motility had a high frequency of abnormal autonomic nerve function tests compared with controls.

Adult↗

Hiatus hernia in gastroesophageal reflux disease.

Upper gastrointestinal endoscopy and radiologic examination were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. Hiatus hernia (HH) was found in 50 patients diagnosed by radiography or endoscopy, or both, in 22, 19, and 9 patients respectively. Severe endoscopic esophagitis (grades III and IV) was found more often (p less than 0.05) in the patients with HH than in those without. The same was true for the early positive timed acid perfusion tests (p less than 0.02). Furthermore, the patients with HH more often had reflux by the standard acid reflux test (42 of 50 versus 28 of 51; p less than 0.01), gastroesophageal scintigraphy (47 of 50 versus 40 of 51; p less than 0.05), and radiography (20 of 50 versus 2 of 51; p less than 0.001) than the patients without HH. The results show that severe GER disease can occur without an associated HH and indicate that patients with symptoms of GER disease and associated HH are likely to have a more severe GER disease than those without HH.

Barium Sulfate↗

The acid perfusion test in gastroesophageal reflux disease.

An acid perfusion test, isotope scanning, endoscopy, and esophageal biopsy were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. A positive acid perfusion test within 30 min (APT) and within 5 min (TAPT) was found in 70.2% and 37.6% of the patients, respectively. A positive APT was found significantly more often in patients with than without endoscopic esophagitis, whereas a positive TAPT was found significantly more often in patients with severe symptoms than in patients with moderate symptoms and in a significantly higher proportion of patients with than without GER by scintigraphy. Neither the APT nor the TAPT showed any dependency on the presence of histologic esophagitis. Most (97%) patients with a negative acid perfusion test, in addition to typical symptoms, also presented with scintigraphic, endoscopic, or histologic evidence of GER disease. Although it shows that the acid perfusion test, particularly when early positive, may serve as a weak predictor of the severity of GER disease, the present study gives little support to the test's clinical usefulness.

Adult↗