The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease.

The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.

[Evaluation of inflammatory activity in chronic osteomyelitis. Contribution of scintigraphy with polyclonal antibodies]. / Avaliação de atividade inflamatória na osteomielite crônica. Contribuição da cintilografia com anticorpos policlonais.

BACKGROUND: Active chronic osteomyelitis or complicating osteomyelitis are difficult to be diagnosed by radiological imaging modalities, such as plain radiograph and CT. They frequently cause increased bone remodeling, leading to nonspecific uptake of Tc-99m-bone scan agents and gallium-67. New radiopharmaceuticals with greater infection avidity are being developed, including the nonspecific polyclonal immunoglobulin (IgG) labeled with technetium-99m. Tc-99m-IgG may be available as a ready to use kit, with no reported side effects, low patient absorbed radiation dose and low cost. MATERIAL AND METHODS: 23 bone segments with suspected active chronic osteomyelitis or violated bone osteomyelitis were studied by Tc-99m-IgG scintigraphy. All patients underwent standard three-phase bone scintigraphy using methylene diphosphonate (Tc-99m-MDP), gallium-67 scintigraphy and plain radiographs, compared with clinical evaluation and laboratory tests values. RESULTS: Infection was found in 8 sites. Sensitivity and specificity for Tc-99m-MDP, gallium-67 and Tc-99m-IgG scintigraphy were, respectively, 88 and 36%, 75 and 73%, 88 and 82%. CONCLUSION: Tc-99m-IgG may be usefull in the scintigraphic evaluation of osteomyelitis.

Avaliaçäo de atividade inflamatória na osteomielite crônica: contribuiçäo da cintilografia com anticorpos policlonais / Evaluation of inflammatory activity in chronic osteomyelitis: contribution of scintigraphy with polyclonal antibodies

OBJETIVO: O diagnóstico de osteomielite crônica em atividade ou sobreposta a outras patologias é difícil, pois estas situações mascaram os achados radiológicos de infecção. A especificidade da cintilografia do esqueleto ou com gálio-67 também é reduzida pela influência da remodelação óssea na captação destes radiofármacos. Anticorpos policlonais marcados com tecnécio-99m (Tc-99m-IgG) apresentam captação independente do metabolismo ósseo, sendo um dos radiofármacos em investigação para avaliação mais específica de infecção. CASUÍSTICA E MÉTODO: Neste estudo comparou-se a cintilografia com Tc-99m-IgG, cintilografia óssea trifásica e cintilografia com gálio-67 no diagnóstico da osteomielite crônica em atividade em 23 segmentos ósseos; correlacionando-as com dados clínico-laboratoriais e radiológicos. RESULTADOS: Oito dos 23 segmentos foram classificados como infectados, 11 não infectados e quatro inconclusivos. A sensibilidade e especificidade encontradas para cintilografia óssea, com gálio-67 e com Tc-99m-IgG foram, respectivamente, 88 e 36 por cento, 75 e 73 por cento, 88 e 82 por cento. CONCLUSÃO: Os resultados sugerem que a Tc-99m-IgG possa ser utilizada no diagnóstico da osteomielite crônica em atividade.

Brain SPECT in dementia. A clinical-scintigraphic correlation.

The aim of this study was to compare the accuracy of computed tomography (CT) and single photon emission computerized tomography (SPECT) in the diagnosis of dementia. Fifty-two patients with clinical diagnosis of dementia and 11 controls were studied. The scans were interpreted by one experienced neuroradiologist and one nuclear radiologist, both blinded to the clinical data. In the diagnosis of dementia, CT and SPECT showed equal sensitivity (82.7%) and statistically similar specificity (63.8 and 81.8%, respectively). The specificity of SPECT in diagnosing Alzheimer's disease (100%) was statistically superior to CT (69%). However, both methods showed similar sensitivity in detecting Alzheimer's disease. In conclusion, SPECT and CT showed similar accuracy in the diagnosis of dementia. The quite high specificity of SPECT in Alzheimer's disease may be useful for confirming that diagnosis, particularly for patients with presenile onset of the disease.

Cardiac and skeletal muscle scintigraphy in dermato- and polymyositis: clinical implications.

To determine the role of scintigraphy in the detection of skeletal and cardiac involvement in dermato- and polymyositis (DM/PM), we studied 30 patients with a confirmed diagnosis of DM/PM (23 females, 7 males; mean age: 35 years). Technetium-99m pyrophosphate (99mTc-PYP) and gallium-67 scans showed similar sensitivity, specificity and accuracy in the detection of skeletal muscle involvement when compared with serum enzymes (70%, 100% and 80%, respectively). Compared with the clinical parameters, 99mTc-PYP showed 70% and 67Ga 65% accuracy. Abnormal PYP cardiac uptake was observed in 57% of patients, whereas abnormal 67Ga cardiac uptake was seen in only 15%. Electrocardiography was abnormal in 40%, rest gated blood pool study in 23%, and chest X-ray in 13%. In conclusion, both 99mTc-PYP and 67Ga can be useful in the detection of the active phase of muscle disease. However, 99mTc-PYP seems to be more effective than 67Ga in the early diagnosis of cardiac involvement.

Left ventricular function during dynamic exercise in untrained and moderately trained subjects.

The influence of exercise training on left ventricular function at rest (R), at anaerobic threshold (AT), and during peak exercise (PE) was evaluated in 12 healthy untrained and 13 trained (T) subjects who underwent Doppler echocardiography at R and radionuclide ventriculography at R and during exercise. The end-diastolic volume and stroke volume were significantly higher in the T group than in the untrained group at R. The ejection fraction rose significantly from R to AT and from AT to PE (80.0 +/- 0.84 vs. 83.6 +/- 0.91%), but no significant difference was observed between groups. The peak diastolic filling rate rose significantly during exercise, with a further significant increase observed in the T group (AT, 6.38 +/- 0.40 vs. 5.01 +/- 0.16 end-diastolic counts/s; PE, 8.24 +/- 0.42 vs. 7.15 +/- 0.35 end-diastolic counts/s). The percent variation of minimal systolic counts fell significantly at AT and PE in relation to R. Our data demonstrate that exercise training produces a significant increase in peak diastolic filling rate but no change in systolic function during exercise and that metabolic acidosis caused by exercise does not limit systolic function.

[Typology of performance of graduate course disciplines in medicine at the Medical School of the University of São Paulo]. / Tipologia do desempenho das disciplinas do curso de graduação em medicina da Faculdade de Medicina da Universidade de São Paulo-analise trienal.

The results of the program for the evaluation of the curriculum of the graduation course of the Medical Faculty of the University of São Paulo are presented and discussed. Following disciplines received special attention: practice in a hospital for infections diseases, orthopedics and traumatology, medical imagery, propedeutics and preventive and social pediatrics. These disciplines were chosen in an aleatory way among those that correspond to the four models of the behaviour: increasing, decreasing, decreasing/increasing and increasing/decreasing.

Brain SPECT in the pre-surgical evaluation of epileptic patients. Preliminary results.

Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n = 10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

Amplitude analysis of stress technetium-99m methoxy isobutylisonitrile images in coronary artery disease.

To determine the role of rest and stress gated technetium-99m methoxyisobutylisonitrile (sestamibi), in the detection of coronary artery disease, routine Fourier analysis of these images was performed with the best septal left anterior oblique (LAO) position of 20 patients (17 men, 3 women; aged 40-75 years) who also underwent rest or redistribution/stress single photon emission tomography (SPET) (99mTc-sestamibi and Thallium-201), gated blood pool imaging and coronary angiogram. There were 6 patients with single-vessel disease, 6 with two-vessel disease, 4 with three-vessel disease, 2 with coronary spasms, 1 with a patent graft and 1 with anginal episodes but a normal angiogram result. Three normal volunteers (2 women, 1 man; aged 24-26 years) also had rest and stress gated blood pool as well as rest and stress gated 99mTc-sestamibi imaging. Rest and stress 99mTc-sestamibi amplitude and phase images depicted regional myocardial wall shortening from the outer layer of the myocardium to the center of the left ventricle as follows: a high amplitude halo of maximal negative count rate variation; a circular thinner halo of negligible amplitude; a central region of maximal positive count rate variation, as the images evolved from end-diastole to end-systole. Similar patterns with regional differences represented abnormal myocardial wall shortening. 99mTc-sestamibi and 201Tl SPET images were in agreement in 90% of the patients and 92% of myocardial regions. 201Tl SPET detected 83% of angiographically proven lesions, as compared with 80% for 99mTc-setamibi SPET and 80% for the amplitude images. The amplitude images demonstrated a larger number of other abnormalities not predicted on the angiogram, probably because they were able to detect regions with a potential for flow improvement and transient regional wall shortening abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Radioisotopic assessment of peripheral and cardiac muscle involvement and dysfunction in polymyositis/dermatomyositis.

99mTc-pyrophosphate musculoskeletal imaging and 99mTc-red blood cell gated blood pool imaging were performed on 10 patients with documented polymyositis/dermatomyositis. Abnormal 99mTc-pyrophosphate uptake by peripheral muscles was found in 8 patients (6 mild, 2 marked). Cardiac uptake occurred in 5 patients and was 3+ in 2 with cardiovascular symptoms. These 2 patients also had abnormal EF on gated blood pool imaging. Patients without myocardial 99mTc-pyrophosphate uptake had normal EF. Patients with myocardial 99mTc-pyrophosphate uptake had abnormal wall motion, in proportion to the degree of uptake. Response to therapy and outcome were poorer in patients with marked scintigraphic changes. These findings suggest that the magnitude of 99mTc-pyrophosphate myocardial uptake may have prognostic implications in these patients.

Feocromocitoma intratorácico: relato de caso / Intrathoracic pheochromocytoma: a case report

Os autores apresentam um caso de feocromocitoma intratorácico demonstrado e localizado através da cintilografia com MIBG-131, e sua correlaçäo com a radiografia convencional e tomografia computadorizada

Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy.

Endomyocardial biopsy seems to be the most accurate method to use for diagnosis and follow-up of acute rejection of the transplanted heart. This investigation compared a noninvasive procedure, gallium-67 imaging, with endomyocardial biopsy in the detection of acute rejection in heart transplantation. Seven male patients (aged 41 to 54 years) sequentially had 46 gallium-67 scintigrams and 46 endomyocardial biopsies between 1 week and 8 months after transplantation. Both studies were obtained in the same day, 48 hours after the administration of an intravenous injection of gallium-67 citrate. Cardiac uptake was graded as negative, mild, moderate, and marked according to an increasing count ratio with rib and sternal uptakes. Histologic findings were graded as negative, mild acute rejection, moderate acute rejection, severe acute rejection, resolving rejection, and nonspecific reaction. Negative biopsies were not found with moderate uptake, and neither moderate nor severe acute rejection were found with negative scintigrams. Imaging sensitivity was 83% with 17% false negatives and 9% false positives. Of seven studies with moderate uptake, five showed moderate acute rejection, and the patients had specific therapy with a decline in uptake, which correlated with resolving rejection. It is conceivable that in the future this technique may be used as a screening procedure for sequential endomyocardial biopsies in the follow-up of heart transplant patients.

Origem anomala da arteria descendente anterior em arteria coronaria direita. Relato de dois casos / Anomalous origin of the anterior descending from the right coronary artery.Report of 2 cases

O significado clinico de determinadas anomalias coronarias ainda esta esclarecido. Sao relatados casos incomuns de dois pacientes com origem anomala da arteria descendente anterior em coronaria direita, com trajeto subpulmonar. Ambos apresentavam certas evidencias de alteracoes isquemicas, traduzidas pela sintomatologia, manifestacoes eletricas ou cintilografia miocardica. O mecanismo fisiopatologico da isquemia miocardica que possa advir anomalia e obscuro

Endocardite infecciosa aguda por Enterobacter sp relacionada a presenca de cateter venoso central como complicacacao de cetoacidose diabetica. Relato de um caso. / Acute infective endocarditis due to Enterobacter sp related to the presence of central venous catheter as a complication of diabetic ketoacidosis.Report of a case

Os autores apresentam o caso de uma paciente de 42 anos de idade, portadora de diabete melito insulino-dependente, sem evidencia de cardiopatia previa, que desenvolveu cetoacidose diabetica severa, seguindo-se endocardite aguda por Enterobacter sp, relacionada a presenca de cateter venoso central. A paciente faleceu, sem que as manifestacoes clinicas permitissem aclarar o diagnostico, que foi feito a necropsia. Os autores discutem a endocardite como complicacao, sua etiologia, os fatores facilitadores da infeccao e os diagnosticos precoce e diferencial