Detection of acute infection/inflammation with Tc-99m labeled intact polyvalent human IgG.

Intact polyvalent human immune globulin (IgG) labeled with Tc-99m by a mild chemical method was investigated with animals infected with either S. aureus or E. coli in the thigh muscle. Focal infection was clearly visualized by Tc-99m IgG scintigraphy within 1 h postinjection. Tc-99m IgG appeared to be concentrated in the liver, spleen, kidneys and urinary bladder. It cleared rapidly via the kidneys resulting minimal of tissue background activity and high infection-to-normal organ ratios. At 24 h postinjection, the ratios of infectious lesion to blood, normal muscle and bone averaged 10:1, 23:1, and 24:1 for S. aureus infection vs 4:1, 9:1 and 9:1 for E. coli infection, respectively. Tc-99m labeled IgG also concentrated in terpentine-induced aseptic inflammatory lesion with a target-to-blood ratio of 4:1, bone 6:1 and normal muscle about 10:1. These findings suggest potential value of Tc-99m IgG as an imaging agent for the early detection of focal infection and inflammation.

Intramesenteric perforation of sigmoid diverticulitis with nonfatal venous intravasation.

Complications from barium enema are rare (0.035 per cent). A patient with venous intravasation during barium enema complicated by pylephlebitis and portal vein obstruction is the tenth to be reported on, the fourth to survive. This accident was associated with colon disease in eight of the patients studied, five of whom had diverticular disease.

A problem in hemodialysis management: fibromuscular dysplasia of radial and ulnar arteries--report of a case.

Fibromuscular dysplasia (medial type) of the radial and ulna arteries, hitherto unreported, has been demonstrated angiographically following the malfunction of an arteriovenous shunt created for dialysis. Retrograde dilatation of the segmental stenoses caused some improvement in flow. No causal relationship is claimed between fibromuscular dysplasia and the arteriovenous shunt.

The problem of dizziness and syncope in old age: transient ischemic attacks versus hypersensitive carotid sinus reflex.

In the elderly, a transient ischemic attack (TIA) and a hypersensitive carotid sinus reflex (HCSR) often co-exist and can pose a diagnostic challenge. Seven cases are presented. HCSR is a relative condition; besides increased irritability of the receptor or target organs, susceptibility of the nerve center to ischemia probably is induced by a slow heart rate or low blood pressure in any patient with pre-existing occlusive cerebrovascular disease. Dizziness and syncope of this type represent hemodynamic TIA in contrast to thromboembolic TIA. The carotid sinus massage test is recommended for differentiating the two types of TIA; the treatments differ. At present there is no uniform management that can be applied to either TIA or HCSR routinely. Therefore, treatment should be approached on an individual basis, keeping in mind the different pathophysiologic factors operating in the specific patient.