Salivary gland scintigraphy in Sjögren's syndrome: are quantitative indices the answer?

We evaluated the role of quantitative indices derived from dynamic 99mTc-pertechnetate salivary scintigraphy in the differentiation between a group of patients with Sjögren's syndrome (SS), a group of patients without xerostomia, but with underlying autoimmune disorders, and a group of controls. Seventeen patients with SS (group A), 18 patients with autoimmune disorders (group B) and 15 controls (group C) underwent dynamic salivary gland scintigraphy. Functional indices for the parotid and submandibular glands were calculated and comparisons were made between the groups. There were no significant differences between the three groups in terms of the maximum accumulation (MA), maximum secretion (MS) and pre-stimulatory oral index (PRI). The uptake ratios (URs) for both the right and left parotid glands and the left submandibular gland in group A were significantly lower than those in group C, but no different from those in group B. The URs for the parotid glands in group B were significantly less than those in group C. The percentage uptake by the right parotid gland at 4 min (U4) was significantly lower in group A than in groups B or C, and lower than the percentage uptake by the left parotid gland at 4 min in group A. The rest of the U4 values and all of the uptakes at 14 min (U14) were not significantly different between the three groups. The time taken for the right parotid gland to reach peak activity (Tmax) was significantly less in group A than in the other groups, but other glands showed no significant differences. It can be concluded that MA, MS and PRI cannot be used to differentiate between the three groups. The URs in groups A and B were no different, but were significantly lower than those in group C. However, the extensive overlap between xerostomic patients and normal controls for all the quantitative indices calculated imposes a severe limitation on their discriminatory power.

The role of scintigraphy with technetium-99m nanocolloid in patients with peripheral joint pain.

We studied 51 patients with peripheral joint pain to assess the ability of technetium-99m-nanocolloid (99mTc NC) scintigraphy to distinguish patients with active joint disease from those without, irrespective of their underlying aetiology. Patients with peripheral joint pain due to various causes were clinically categorised as either having objective signs of active joint disease or not. Their clinical diagnoses were not made known to the nuclear physician until after scanning. Each patient was given an intravenous injection of 555 MBq of 99mTc NC 1 h prior to taking spot views of the peripheral joints. Seventeen patients with low backache but without peripheral joint pain were imaged in an identical manner to exclude peripheral joint involvement. The latter formed a control group. 99mTc NC scintigraphy demonstrated a sensitivity of 89% for identifying at least one affected joint per patient, a specificity of 87.5%, a negative predictive value (npv) of 87.5%, a positive predictive value (ppv) of 89%, and overall accuracy of 88%. There were three false negative and three false positive cases. The scan was negative in all control subjects. 99mTc NC scintigraphy proved to be sensitive in patients with active joint disease and demonstrated a good correlation with clinical assessment. The value of the high specificity, npv and negative controls together made the test highly discriminatory in excluding patients without active peripheral joint disease.

99Tc(m) nanocolloid scintigraphy: a reliable way to detect active joint disease in patients with peripheral joint pain.

We evaluated 99Tc(m) nanocolloid (NC) scintigraphy as a method for identifying patients with active joint disease in a group with peripheral joint pain of varying aetiology. Fifty-nine patients with peripheral joint pain were divided into two groups: those with clinical signs of active joint inflammation and those without objective signs. Thirty-four patients clinically diagnosed as having active joint disease had a total of 117 joints (95 large and 22 small) involved. 99Tc(m) NC identified 96 (79 large and 17 small) of these joints. Twenty-five patients were negative clinically. Twenty-two of these were scan negative. The other three had a total of 11 scan positive joints. The correlation coefficient between clinical and scan findings was 0.79. There was no significant difference shown between clinical evaluation and scintigraphy (z=-1.64, P = 0.1004). 99Tc(m) NC proved to be an effective method for identifying patients with active peripheral joint disease from among a group with arthralgia.

Tc-99m erythrocyte localization of an intramuscular hemangioma of the arm.

An unusual case of intramuscular hemangioma of the left triceps muscle is presented. This tumor may infiltrate the muscle and be misdiagnosed as a malignant neoplasm.

The impact of a shipboard weight control program.

OBJECTIVE: The specific aim was to determine whether a multifaceted approach to weight loss and physical readiness could be implemented onboard a deployed combatant ship of the U.S. Navy. RESEARCH METHODS AND PROCEDURES: Thirty-nine men (31+/-6 years old, mean+/-standard deviation) assigned to the USS ENTERPRISE (CVN 65) during a 6-month Mediterranean deployment who had failed their previous Physical Readiness Test due to excessive body weight (108+/-11 kg overweight) were randomly assigned to nutrition, cognitive-behavioral obesity treatment plus exercise or to the Navy's usual treatment (control), which is exercise alone. RESULTS: Outcomes for the treatment group were significantly better than the controls, with 8.6+/-5.0 vs. 5.0+/-4.1 kg weight loss, 8% vs. 5% reduction in original body weight, and body fat loss of 7% vs. 5%. Triglycerides declined significantly greater in the treatment group than the controls (145 mg/dL to 109 mg/dL vs. 146 mg/dL to 145 mg/dL, p<0.05), whereas depression and eating behaviors significantly improved among treated men. Problematic environmental factors were the limited variety of heart healthy foods in the galley, short meal breaks, and long mess hall lines that led to eating snacks from vending machines and frequent port calls. DISCUSSION: Although greater weight loss than would be expected of a Navy usual care group diluted the treatment effect, the treated men still fared significantly better. The physical readiness implication of this research has the potential to impact Navy health promotion programs and policy, the health and well-being of its personnel, and the Navy's ability to meet mission requirements.

Hereditary nephropathic systemic amyloidosis caused by a novel variant apolipoprotein A-I.

We report a family with autosomal-dominant hereditary systemic amyloidosis in three generations, presenting with renal involvement. Two members of the current generation received renal transplants for end-stage renal failure 16 and 18 years ago, and remain very well clinically despite massive visceral amyloidosis. Two other members of this generation, aged 32 and 47 years, have massive systemic amyloid but no clinical disability. Individuals known to be affected in previous generations died of renal failure in early adult life. Amyloid deposits in the proband, one of the transplanted individuals, were composed of apolipoprotein A-I (apoA-I), and among living family members there was complete concordance between amyloidosis and the presence of a novel 9 base pair in-frame deletion mutation in exon 4 of the apoA-I gene, causing a loss of residues Glu70Phe71Trp72. This predicts the acquisition of a single extra positive charge by mature apoA-I, and this variant was detected in the plasma of all carriers. All the previously reported amyloidogenic variants of apoA-I also carry an extra positive charge, indicating that this electrostatic change is likely to be relevant to the amyloidogenicity of apoA-I.

Technetium-99m-sestamibi uptake in myeloma.

A number of reports describe how 99mTc-sestamibi detects benign and malignant primary and metastatic tumors. We report abnormal 99mTc-sestamibi uptake in nine sites in a 53-yr-old patient with histologically and biochemically proven IgG kappa-secreting myeloma. The 99mTc-sestamibi study was undertaken for an unrelated hyperparathyroidism.

Is there a place for radionuclide bone scintigraphy in the management of radiograph-negative scaphoid trauma?

OBJECTIVE: To evaluate the role of radionuclide bone scanning in patients with suspected scaphoid trauma, particularly in those with negative radiographs. DESIGN: Prospective. Radionuclide scans and carpal bone radiography were performed on all participants in the early post-injury period. SETTING: Cape Town tertiary centre trauma unit. PARTICIPANTS: Fifty patients who presented with clinical features suggestive of scaphoid trauma. MAIN OUTCOME MEASURE: Definitive radiographic diagnosis of fracture or persistent clinical features of scaphoid trauma. RESULTS: All patients who had fractures demonstrated on standard radiography either at the initial visit (13 patients) or at 2 weeks (8 patients) had positive scintiscans (sensitivity 100%). Four of 6 patients who had a positive scan but negative first and second radiographs had persistent tenderness on clinical examination which required extended immobilisation in a plaster cast. The overall positive predictive value of scintigraphy was 93%. All patients with a negative scan were clinically and radiologically negative at 2 weeks (negative predictive value 100%). Evidence of multifocal injury was present in 12 scans, but only 1 radiograph. Thirty-one patients (62%) were scanned within 48 hours of injury. CONCLUSION: Bone scintigraphy can be used in radiograph-negative scaphoid area injury to exclude the need for further follow-up reliably, but those with positive scans still require clinical examination and radiography at 2 weeks.

Fe-52 imaging of intrathoracic extramedullary hematopoiesis in a patient with beta-thalassemia.

Fe-52 scintigraphy was used to confirm extramedullary hematopoiesis in a patient with beta-thalassemia and intrathoracic masses. Imaging was performed on a standard gamma camera with a high-energy collimator. Tc-99m labeled tin colloid and In-111 chloride scintigraphy failed to reveal uptake by the masses. The exclusion of malignancy obviated the need for invasive diagnostic measures.

Tc-99m leukocyte scintigraphy in infective endocarditis.

A 56-year-old man with Staphylococcal aureus septicemia and clinically suspected infective endocarditis was imaged using Tc-99m HMPAO leukocytes. Although abnormal uptake was seen at 3 hours after injection, 24-hour images demonstrated marked concentration of radiolabeled leukocytes in a myocardial abscess and large posterior parietal infarct. In addition, multiple splenic infarcts were shown. The Tc-99m labeled leukocyte scan proved to be an excellent whole body screening procedure for diagnosing sites of infection and infarction in this patient.

Fatal Capnocytophaga canimorsus (DF-2) septicaemia. A case report.

A 45-year-old man died 2 months after being bitten on the hand by a dog. He developed the rare but characteristic clinical picture of fulminant septicaemia and peripheral gangrene caused by a Gram-negative bacillus, Capnocytophaga canimorsus, previously known as dysgonic fermenter type 2 (DF-2), which is an occasional commensal in the oral flora of dogs and cats. This disease must be anticipated and dog bites appropriately managed to avoid the mortality associated with infection by this micro-organism. Initial treatment includes appropriate prophylactic antibiotics and debridement, while early exchange transfusion and emergency amputation may be of value in fulminant cases.

Pentavalent technetium-99m (V)-DMSA uptake in a pheochromocytoma in a patient with Sipple's syndrome.

This case report describes 99mTc(V)-dimercaptosuccinic acid (DMSA) accumulation in a pheochromocytoma in a patient with Sipple's syndrome. Scintigraphy with 99mTc(V)-DMSA demonstrated uptake in medullary carcinoma of the thyroid gland (MCT). Iodine-131 metaiodobenzylguanidine (MIBG) scintigraphy showed the bilateral pheochromocytomas but did not demonstrate uptake in the MCT.

Scintigraphy in benign bone tumours. A report of 4 cases.

Four cases are presented to show the value of bone scintigraphy as an aid in the diagnosis of benign bone tumours. Scintigraphy is not only capable of localising these tumours but is also a useful monitor of local recurrence after surgery. In addition, a whole-body bone scan done at the same time will exclude active multifocal disease.

Scintigraphy in skeletal trauma.

Five case reports demonstrate the value of bone scintigraphy in trauma. The bone scans clearly demonstrated fractures of the hip and pelvis that were not radiologically evident or the presence of which was doubtful, and also identified a number of unsuspected fractures in a patient with multiple injuries.

Scintigraphy in a patient with complicated osteopetrosis.

Skeletal, reticuloendothelial and renal images were obtained on a patient with osteopetrosis using Tc-99m MDP, Tc-99m HSA millimicrospheres and Tc-99m DTPA respectively. The bone scan showed increased uptake in multiple fracture sites, in the frontal bone, and in the splayed metaphyses of long bones while the remainder of the skeleton appeared normal. Reticuloendothelial images demonstrated an absence of bone marrow activity, hepatosplenomegaly and a site of extramedullary hematopoiesis. A renogram demonstrated a left kidney displaced and distorted by the massive splenomegaly.