Usefulness of Scintigraphic Swallowing Study in Brain Injury Patients with Laryngeal Aspiration

OBJECTIVE: We investigated the usefulness of the scintigraphic swallowing study in selecting the patients with low risk of aspiration pneumonia among those who showed small amount of laryngeal aspiration in videofluoroscopy. METHOD: Scintigraphic swallowing study was performed in 22 patients with brain injury who showed small amount of laryngeal aspiration in videofluoroscopy. Oral feeding was tried in the patients who showed airway clearing function or no aspiration in scintigraphic swallowing study, and they were followed up for possible aspiration pneumonia. RESULTS: Total of sixteen patients showed no aspiration in scintigraphic swallowing study. Five patients showed laryngeal aspiration, but preserved airway clearing function. One patient showed impairment of airway clearing function. Oral feeding was tried in 21 patients. Oral feeding was successful in 18 of 21 patients but not in 3 patients because of dysphagia or cough. Only 1 patient developed pneumonia after 246 days of follow up. CONCLUSION: Scintigraphic swallowing study is useful to select the patients with low risk of aspiration pneumonia among the patients who showed small amount of laryngeal aspiration in videofluoroscopy.

Correlation between Psychopathology and Dopamine Transporter Density in Striatum before and after Taking Olanzapine Assessed with IPT-SPECT in First Episode Schizophrenia / 대한정신약물학회지

OBJECTIVE: Using [123I]IPT-SPECT, we compared between the dopamine transporter (DAT) density of the basal ganglia in first-episode, patients with schizophrenia and DAT density in normal control subjects. We investigated the change between DAT density before and after taking olanzapine during 4weeks in patients with schizophrenia. We studied correlations between the clinical symptoms of schizophrenia and DAT density. METHODS: Ten patients with schizophrenia and ten healthy control subjects were included in this study. Brief Psychiatric Rating Scale (BPRS) and Montgomery-Asberg Depression Rating Scale (MADRS) were obtained before and after 4-week treatment with olanzapine in schizophrenic group. Nuclear imaging using [123I]IPT-SPECT was obtained in normal control subjects and schizophrenic group before taking olanzapine. After 4-week treatment with olanzapine, Nuclear imaging was obtained in schizophrenic group. RESULTS: There is significant negative correlation between BPRS total score, withdrawal subscale score after treatment and DAT density before treatment. There is significant positive correlation between the age of onset and DAT density after treatment and there is significant negative correlation between the duration of illness and DAT density after treatment. CONCLUSION: The data of this study suggest that DAT density in basal ganglia in patients with schizophrenia would be a predicting factor in treatment response.

Correlation between Psychopathology and Dopamine Transporter Density in Striatum before and after Taking Olanzapine Assessed with IPT-SPECT in First Episode Schizophrenia / 대한정신약물학회지

OBJECTIVE: Using [123I]IPT-SPECT, we compared between the dopamine transporter (DAT) density of the basal ganglia in first-episode, patients with schizophrenia and DAT density in normal control subjects. We investigated the change between DAT density before and after taking olanzapine during 4weeks in patients with schizophrenia. We studied correlations between the clinical symptoms of schizophrenia and DAT density. METHODS: Ten patients with schizophrenia and ten healthy control subjects were included in this study. Brief Psychiatric Rating Scale (BPRS) and Montgomery-Asberg Depression Rating Scale (MADRS) were obtained before and after 4-week treatment with olanzapine in schizophrenic group. Nuclear imaging using [123I]IPT-SPECT was obtained in normal control subjects and schizophrenic group before taking olanzapine. After 4-week treatment with olanzapine, Nuclear imaging was obtained in schizophrenic group. RESULTS: There is significant negative correlation between BPRS total score, withdrawal subscale score after treatment and DAT density before treatment. There is significant positive correlation between the age of onset and DAT density after treatment and there is significant negative correlation between the duration of illness and DAT density after treatment. CONCLUSION: The data of this study suggest that DAT density in basal ganglia in patients with schizophrenia would be a predicting factor in treatment response.

A Case Of Rheumatoid Arthritis Accompanied By Severe Eosinophilia / 대한류마티스학회지

Wegener's granulomatosis (WG) is a syndrome characterized by necrotizing granulomatosis lesions in the upper and lower respiratory tracts, glomerulonephritis, and generalized vasculitis involving both arteries and veins. This syndrome usually affects the upper and lower respiratory tract and the kidneys. Some patients with WG have cardiac involvement such as pericarditis, myocarditis, valvulitis, arrhthymia, coronary arteritis, and rarely cardiomyopathy. Ocular manifestations include keratitis, conjuntivitis, scleritis, retro-orbital granuloma with proptosis. Uncommonly, blindness may occur due to retinal vasculitis and optic neuritis. We report a 45-year-old female patient with WG who had sinusitis and lung nodules. She complained of sudden chest pain. Electocardiography and nuclear myocardial perfusion study suggested transient myocardial ischemia. During the active course of the disease, she complained of severe pain in the right eye-ball with decreased visual acuity. Subsequently, she developed monocular blindness probably due to retinal vasculitis.

Early dipyridamole stress myocardial SPECT to detect residual stenosis of infarct related artery: comparison with coronary angiography and fractional flow reserve

BACKGROUND: The detection of residual stenosis of infarct related artery (IRA) at early stage after acute myocardial infarction (AMI) is crucial in clinical decision making for interventional revascularization. The aim of this study was to evaluate the relevancy of early dipyridamole stress myocardial SPECT to detect functionally and luminologically significant residual stenosis of IRA after AMI. METHOD: Twenty five consecutive patients (M:F=19:6, age: 56+/-13yrs) with AMI underwent SPECT and coronary angiography within 5 days of the attack. Infarct related arteries with FFR 70% were regarded to have functionally and morphologically significant residual stenosis. Reversible perfusion defect was defined if there was improvement of the perfusion score more than one grade in infarct segments on rest images of SPECT compared with stress images. RESULTS: Mean FFR and DST were 0.76+/-0.14 and 74+/-15%. SPECT showed no significant correlation with both FFR and DST with Kendall's coefficiency of 0.28 (p=0.05) and 0.13 (p=0.35). The sensitivity and specificity of SPECT to detect functionally and morphologically significant residual stenosis were 92%, 31% and 83%, 29%. CONCLUSION: The early dipyridamole stress myocardial SPECT after AMI does not seem to be a useful non-invasive test for the detection of functionally and luminologically significant residual stenosis of IRA.

Metastatic Follicular Thyroid Carcinoma to the Thymus in a 35-year-old Woman

Clinically detectable metastatic follicular thyroid carcinoma to the thymus is very rare in the literature and sometimes confused with false positive uptake of Iodine

Isolated Splenic Infarction in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is a multisystemic inflammatory autoimmune disease caused by various autoantibodies and immune complexes. Splenic involvement in SLE includes hypersplenism, splenic atrophy, and splenic infarction, which has rarely been reported. We report a case of SLE with isolated splenic infarction. A 20-year-old female patient was admitted complaining of general weakness, malar rash, and easy fatigue. She was diagnosed as having SLE with thrombocytopenia and received steroid treatment. On the 7th hospital day, she complained of severe left upper abdominal pain with sudden-onset. While abdominal ultrasonography showed only mild splenomegaly, abdominal CT and 99mTc-RBC splenic scintigraphy revealed segmental splenic infarction. She had no evidence of additional thrombotic event or hemorrhage. After administration of high dose steroid, abdominal pain subsided and splenic infarction was resolved.

Evaluation of Striatal Dopamine Transporter Density using 123I-beta-CIT SPECT in Schizophrenic Patients Treated with Olanzapine - Pilot study / 대한핵의학회잡지

No abstract available.

Iron Status in Adolescents and University Students in Incheon / 대한혈액학회지

BACKGROUND: Iron deficiency anemia (IDA) frequently occurs in adolescents because of accelerated physical growth in boys and girls. This was aimed at assessing the prevalence of iron deficiency and IDA in apparently healthy Korean adolescents according to the gender and age. METHODS: Apparently healthy students(M: F=1: 1.2) aged 11 to 24 years were included in this study and blood samples were obtained from April to May, 2000. Hemoglobin, hematocrit, red blood cell indices, serum ferritin, iron and total iron-binding capacity were measured. RESULTS: In males, the prevalence of iron deficiency was 15.7% in the 11~12 years group, 16.1% in the 13~14 years group, 9.9% in the 15~16 years group, and 6.4% in the 17~18 years group. In females, the prevalence of iron deficiency was 26.8% in 11~12 years group, 27.9% in the 13~14 years group, 38.8% in the 15~16 years group, 36.0% in the 17~18 years group, 30.9% in the 19~24 years group. The prevalence of IDA in males was 3.6% in 11~12 years, 2.1% in 13~14 years group, 1.9% in 15~16 years group, and 0.6% in 17~18 years group. The prevalence of IDA in females was 4.2% in 11~12 years, 9.7% 13~14 years, 20.4% in 15~16 years, 16.2% in 17~18 years group, and 12.4% in 19~24 years group. CONCLUSION: As the prevalence of iron deficiency and IDA were substantially greater than expected, studies of iron state in adolescent girls, especially middle to high school age, should be undertaken to assess iron deficiency.

Effect of Reconstruction-Method after a Radical Subtotal Gastrectomy on Gallbladder Motility

PURPOSE: An increased incidence of gallstones has been widely reported in patients who had undergone a gastrectomy. But, there has been little information about the pathophysiologic mechanism for the occurrence of gallstones after gastric surgery. Many investigators have considered the cause to be decreased gallbladder motility due to vagal denervation. We observed higher increase in the incidence of gallbladder stones in patients who underwent a Billroth II gastrojejunostomy than in those who underwent a Billroth I gastrojejunostomy after radical subtotal gastrectomy. METHODS: We prospectively studied the change in the motility of the gallbladder after a gastrectomy. The gallbladder ejection fraction (EF) was compared pre- and postoperatively by using gallbladder scintigraphy with 2,6-diisopropyl-iminodiacetic acid (DISIDA). RESULTS: Twenty patients underwent a Billroth(B) I anastomosis and twelve patients underwent a B-II anastmosis after the gastrectomy. The means of the EF of the B-I group were 75.9%, 46.4%, 68.1% at the preoperative period, at 1 month and 6 months after the gastrectomy respectively. Those of B-II group were 78.2%, 45.3%, 56.3%, respectively. There was no statistically significant difference of EF between the two groups at postoperative 1 month, but the difference at postoperative 6months was statistically significant. The differences of EF between preoperative period and postoperative 1 month, 6 months were significant in the B-I group andthe B-II group. CONCLUSION: At 6 months postoperative period, there was more recovered gallbladder motility after a gastrectomy with B-I anastomosis than with B-II anastomosis.

Ga-67 SPECT Finding in Tuberculous Pericarditis with Mediastinal Mass: A case report / 대한핵의학회잡지

No abstract available.

A Case of Alagille's Syndrome / 대한핵의학회잡지

This is a case report of a 5-month-old male who was brought in to hospital for evaluation of jaundice from birth. The baby had a history of ileal atresia operated 2 days after birth. At the age of one month, Tc-99m DISIDA hepatobiliary scintigraphy was performed at other hospital and reported to show good hepatic uptake of the tracer but no uptake in the billiary tree, gall bladder, or intestine for 24 hours post injection. He was judged to have biliary atresia. However, subsequent exploratory laparotomy revealed that the hepatobiliary tree appeared intact and that there was a gall bladder. Additionally, the patient had central aorto-pulmonary shunt for the right ventricular septal defect with pulmonary stenosis of a peripheral type at the age of 4 months. The second hepatobiliary scintigraphy was performed on admission at the age of 5 months, showing a gall bladder but no intestinal uptake up to 24 hours. Retrospectively, the histological specimen of the liver obtained at the exploratory laparotomy was re-evaluated, and by the histological findings coupled with clinical data, arteriohepatic dysplasia (Alagille's syndrome) was diagnosed. In this report, we emphasize the diagnostic limitation of hepatobiliary scintigraphy and the importance of overall clinical and histologic evaluation in a case of Alagille's syndrome. (Korean J Nucl Med 2000;34:154-158)

Echocardiographic Assessment of Left Ventricular Systolic Function in Comparision with Automatic Quantification of 201TI Gated Peerfusion SPECT

BACKGROUND AND OBJECTIVES: Assessment of left ventricular systolic function is an important clinical variable with respect to diagnosis, prognosis and treatment in various clinical situation. Automatic quantification of ventricular volume and ejection fraction by delineating 3 dimensional endocardial boundaries from the gated perfusion SPECT was validated. The purposes of this study were to assess the agreement of left ventricular ejection fraction determined by two-dimensional echocardiography and automatic quantification of perfusion SPECT and compare different echocardiographic methods with the reference method, automatic quantification of perfusion SPECT. METHOD: Twenty seven patients (20 men, 7 women; mean age 60+/-12) with acute myocardial infarction (anterior: 16, inferior: 7, lateral: 4) and twenty one patients (12 men, 9 women; mean age 60+/-12) without myocardial infarction history and regional wall motion abnormality in echocardiography were studied. All patients had two-dimensional echocardiography and 201Tl perfusion SPECT performed within 5 days of each other. Ejection fraction of left ventricle was calculated by echocardiography using modified Simpson's method and M-mode method. Also, ejection fraction of left ventricle was estimated by 201Tl perfusion SPECT using automatic software (quantitative gated SPECT[QGS]; Cedars-Sinai Medical Center, Los Angels, CA). RESULTS: The agreement of ejection fraction between M-mode method and QGS (limit of agreement -3.48, 3.2; average limit of agreement 6.68) in control group was better than that between modified Simpson's method and QGS (limit of agreement 0.04, 8.42; limit of agreement average limit of agreement 8.38). But, The agreement of ejection fraction between modified Simpson's method and QGS in the acute myocardial infarction group (limit of agreement; -15.31, 10.01; average limit of agreement 12.66) was better than that between M-mode method and QGS (limit of agreement -17.82, 13.86; average limit of agreement 15.84). The agreement of ejection fraction between modified Simpson's method and QGS (limit of agreement; -8.49, 5.74; average limit of agreement 7.12) in the anterior myocardial infarction was more accordancy than lateral and inferior wall infarction (limit of agreement; -12.11, 13.74; average limit of agreement 12.92). CONCLUSION: The M-mode method in patients without regional wall motion abnormality and modified Simpson's method in patients with regional wall motion abnormality, especially in anterior wall infarction seen to be useful method for the assessment of left ventricular ejection fraction.

Correlation between Reverse Redistribution and Subendocardial Myocardial Infarction Observed in Myocardial Contrast Echocardiography / 대한핵의학회잡지

PURPOSE: The aim of this study is to better understand the pattern and nature of reverse redistribution (RR) in myocardial perfusion imaging. MATERIALS AND METHODS: In consecutive 20 acute myocardial infarction (MI) patients, frequency of RR was correlated with that of subendocardial MI that was detected by myocardial contrast echocardiography (MCE). RR was judged to be present when there was more than one grade of worsening in perfusion at 24 hr delayed images compared with the initial rest images. MCE evaluated the significant lack of opacification in the subendocardial myocardium relative to the subepi-cardial myocardium to suggest the subendocardial MI. Kendall's nonparametric correlation coefficiency was calculated. RESULTS: Concordant cases were 15 of 20 (75%) and correlation was statistically significant (p=0.0285). CONCLUSION: Our results suggested that RR was correlated with MCE-detected nontransmural MI.

Tc-99m HMPAO White Blood Cell Scintigraphy of an Enterovesical Fistula Complicating Crohn's Disease / 대한핵의학회잡지

Computed tomography (CT) seems to be the best imaging modality to diagnose an enterovesical fistula, but is not always able to demonstrate enterovesical fistula itself. In this case report, we present Tc-99m HMPAO white blood cell (WBC) scintigraphic findings of an enterovesical fistula complicating Crohn's disease. A 22 year-old male presented with a one-month history of urinary symptoms such as dysuria, hematuria, and frequency. The patient had intermittent right lower quadrant pain, diarrhea and hematochezia. Enterovesical fistula was highly suggestive in pelvic CT which showed air density in the urinary bladder, but cystoscopy failed to find an opening of the fistula. Tc-99m HMPAO WBC scintigraphy for evaluation of inflammatory bowel disease incidentally demonstrated enterovesical fistular tract. Crohn's disease was later confirmed by histologic examination of the surgical specimen. In our patient, Tc-99m HMPAO WBC imaging was helpful in determining the location of the fistula as well as assessing the disease activity and extent of the Crohn's disease.

Contractile Reserve versus Cell Membrane Integrity for Predicting Contractile Recovery after Reperfusion in Acute Myocardial Infarction and Their Relationship

BACKGROUND: Early prediction of functional recovery could have very important prognostic and therapeutic implication. Modalities evaluating functional recovery of dysynergic segments have included metabolic and perfusion imaging as well as assessment of contractile reserve in response to inotropic agent. Dobutamine stress echocardiography(DSE) assesses contractile reserve whereas rest and 24hr delayed Tl-201 SPECT(T1-201) assesses cell membrane integrity. Does contractile reserve always imply cell membrane integrity? If not, which one could be more useful predictor of contractile recovery of the infarcted segment after restoration of the infarct related artery(IRA) in acute myocardial infarction(AMI)? The aim of this study was to evaluate comparative accuracy of contractile reserve and cell membrane integrity in predicting contractile recovery and their relation. METHODS: We prospectively compared DSE with Tl-201 in 22 of 34 patients with acute myocardial infarction from August 1996 to September 1997. AU patients underwent coronary angiography and got revascularization treatment if they had significant stenosis. DSE and Tl-201 were done within 24hrs after successful restoration without flow limiting residual stenosis. An intravenous infusion of dobutamine(5(mg/kg/min) was started with an infusion pump and continued in 3-minute dose increment up to 20(mg/kg/min under continuous ECG and echocardiographic monitoring. Regional wall motion was assessed according to 16-segment model from American Society of Echocardiography recommendation. Wall motion was scored as 1 (normal), 2(mild to moderate hypokinesia), 3(severe hypokinesia), 4(akinesia), 5(dyskinesia). The improvement of wall motion score(WMS) more than 1 from asynergy during dobutmine infusion was considered to have contractile reserve. SPECT images were obtained at rest and 24hours later. The Tl-201 images were analyzed visually according to 16 segment model, scored by grade 0: normal uptake, 1: mild to moderate decreased, 2: severe decreased, 3: defect. Those segments were considered to have a cellular integrity if the defect at rest improved more than grade 1 on delayed images. All patients underwent 1 month follow up echocardiography after discharge. The improvement of WMS more than score 1 from asynergy at follow up was considered to have contractile recovery. RESULTS: 71 akinetic segments out of total of 352 segments were analyzed. There was no significant difference of sensitivity(88 vs 82%), specificity(82 vs 82%), and accuracy(86 vs 81%) in predicting contractile recovery between DSE and Tl-201. The agreement between contractile reserve and cellular integrity was 73% with kappa value of 0.42(p=0.001). CONCLUSION: Contractile reserve has similar sensitivity, specificity and predictive value with cell membrane integrity in predicting contractile recovery. However contractile reserve immediately after restoration does not necessarily imply cell membrane integrity in acute myocardial inFarction.

Leptin levels in amniotic fluid and maternal blood at mid-trimester: Relations to gestational age, fetal sex, fetal weight estimated by ultrasound, and maternal BMI / 대한산부인과학회잡지

OBJECTIVES: Leptin is a 16-kD protein encoded by the ob/ob gene and represent the amount of body fat. In pregnancy, it is thought to act in intrauterine fetal growth and energy metabolism. In this study, we investigated the effect of gestational age, fetal sex, maternal body mass index (BMI), and fetal weight estimated by ultrasound on amniotic fluid and maternal serum leptin levels at mid-trimester, respectively. METHODS: Amniotic fluid and maternal blood sampling were collected from women who was performed for genetic amniocentesis at mid-trimester (n = 26). Leptin concentrations were measured by a specific radioimmunoassay (RIA) employing human recombinant leptin. Mean gestational age was 18.19+/-1.77 weeks. Mean maternal BMI was 23.83 +/-5.12kg/m2. Male fetus was 10, and female 16. Mean fetal weight estimated by ultrasound was 254.42+/-83.80gm. RESULTS: Mean maternal leptin level( 12.49+/-4.46 ng/mL) was significantly higher than mean amniotic leptin level(5.06+/-3.20 ng/mL)( p = 0.0001) at mid-trimester. But there was no significant correlationship between maternal and amniotic leptin levels( p = 0.1376). Maternal leptin concentrations at mid-trimester were correlated positively with maternal BMI(y = 2.24 + 0.43 x, R2 = 0.494, p = 0.0103). In contrast, leptin levels in amniotic fluid did not correlate with maternal leptin levels, gestational age, fetal sex, maternal BMI, and fetal weight estimated by ultrasound respectively. CONCLUSION: Maternal leptin level was higher than amniotic leptin level and could represent maternal fat mass. It was suggested that amniotic leptin level was not associated with several factors such as maternal, fetal, and amniotic factors.