Role of TC99M MIBI inevaluation of skeletal malignancy

The aim of our study is to assess the value of 99mTc-hexakis-2-methoxyisobutylisonitrile [MIBI] scintigraphy to detect viable boney tumor in patients with clinical and radiological features of primary or metastatic skeletal tumors. This is a prospective study included thirty six patients with different bone malignancies [17 cases with primary lesions and 19 cases with metastatic boney lesions]. All patients were subjected to Tc99m MDP bone scan [BS] and Tc99m MIBI scans. Planar whole body scintigraphy was performed 2 hours after intravenous injection of 20-30 mCi of Tc99m MDP, and after 1 to 2 weeks a Tc-99m MIBI scan was performed using 15-20 mCi and planar imaging was done 15 min post injection. Thirty of 36 patients represented by bone lesions in BS showed increased MIBI uptake, with sensitivity 83.3%. In cases of primary bone tumors 3 patients out of 17 showed no tracer uptake in MIBI scan and also 3 patients of metastatic bone lesions out of 19 showed no tracer uptake in MIBI scan. The MIBI scan can detect more 41 sites of tracer uptake in these patients not seen in Bs. Tc-99m MDP bone and Tc-99m MIBI scans are complementary to each other. The sensitivity of detection of malignant bone tumor is more for combined BS and MIBI than each one alone

Evaluation of biliary dyskinesia in diabetic patients with and without autonomic neuropathy and factors affecting it

Diabetes mellitus is known as one of the factors causing the cholesterol gallstone. Though the pathophysiologic mechanisms of this phenomenon are unclear, hypotheses such as reduced gallbladder motility were presented to explain the higher incidence of gallstones in diabetes. The aim of our study was to study gall bladder motor function in diabetic patients with and without autonomic neuropathy to reach the pathogenesis of gallbladder dysfunction in diabetic patients and to correlate GB dyskinesia with demographic features [Age, sex, BMI Body Mass index and waist to hip ratio], duration of illness, fasting and two hours post-prandial blood glucose levels, lipogram and type of antihyperglycemic drugs. Our study included fifty persons, 30 type 2 diabetic patients divided into two groups, group [A] included 15 patients with autonomic neuropathy and group [B] included 15 patients without autonomic neuropathy, and 20 age matched healthy persons. All studied groups were subjected to the following: Careful history and clinical examination, measurement of body weight, height, and BMI. Measurement of waist circumference and hip circumference, calculation of waist/hip ratio and assessment of Cardiovascular autonomic function by the bedside tests of Ewing et al. [1985], which are: Heart rate response to standing, heart rate response to Valsalva maneuver, heart rate response to deep breathing, systolic blood pressure response to standing, diastolic blood pressure response to sustained hand grip. Fasting and two hours post-prandial blood glucose levels with follow up for 3 months, liver function tests, lipogram, blood urea and serum creatinine. Abdominal ultrasonograhy and Tc99m hepato-immuno-diacetate hepatobiliary scintigraphy after 6 hours fasting and 30 minutes after fatty meals for 30 minutes to measure the gallbladder ejection fraction. The results of our study revealed that GBEF was lower in type 2 diabetic patients in comparison with the control group. It was also found that GREF was lower in diabetic patients with autonomic neuropathy than in those without. In our study we discovered that GBEF was lower in type 2 diabetic patients with autonomic neuropathy than in those without and there is inverse correlation between GBEF and fasting and after two hours blood glucose levels. We did not find any correlation between the duration of diabetes mellitus and GBEF probably because of the small sample of patients with long duration and no correlation was found between GBEF and demographic features or lipogram. Furthermore, we did not find a significant correlation between GBEF and the type of antihyperglycemic drugs

Reoperative thyroid surgery: approach and hazards

This study included 34 patients [25 females and 9 males with an age range from 25 to 72 years and a mean age of 38 years] subjected to reoperative thyroid surgery. 131I thyroid scan and whole body scan were performed. Surgical techniques were attempted, where different surgical procedures were performed. 131I ablation of thyroid remnants was carried out in patients with thyroid cancer and for those with relapsed toxic goiter. Operative complications were studied. Follow-up of patients with complications and those with thyroid cancer was done. The results showed that morphologically unilateral thyroid with isthmic involvement were found in 50% of patients. Diffuse thyroid enlargement accounted for about one-third of patients. Histologically, recurrent nodular goiter was found in 56% of patients, followed by recurrent toxic goiter [21%], thyroid carcinoma [21%] and chronic lymphocytic thyroiditis [one patient]. Surgically, the majority of patients were explored with standard Kocher incision [85%] and the remaining with adding lateral cervical approach. Extracapsular thyroidectomy was the commonest technique. Hemithyroidectomy followed by subtotal thyroidectomy were the commonest procedure, followed by near-total and total thyroidectomy. Recurrent laryngeal nerve was identified in 35% of patients, mainly in its lower cervical course, followed by middle third in relation to inferior thyroid artery. Temporary recurrent laryngeal nerve palsy occurred in 12% and permanent unilateral nerve palsy in 6% of patients. Parathyroid glands were identified in 24% of cases. Temporary and permanent hypocalcemia occurred in 15% and 12%, respectively. Complete ablation with 131I was achieved in four patients of thyroid carcinoma and partial ablation with 131I in the remaining three patients