Inferior vena cava obstruction and diffuse hepatic uptake on lower extremity radionuclide venogram.

Two patients with dissimilar but advanced malignancies and lower extremity swelling underwent bilateral lower extremity radionuclide venograms, several months apart. Both patients' scintigrams showed multiple collaterals in the abdomen and pelvis, consistent with inferior vena cava obstruction, and hepatic uptake in a diffuse pattern. One patient also had multiple bilateral pulmonary emboli on a lung scan. Although diffuse hepatic uptake has been mentioned before with inferior vena cava obstruction, it has usually been incidental to focal hepatic uptake near the porta hepatis. The case results in this study demonstrated that inferior vena cava obstruction can manifest itself solely as diffuse hepatic uptake on nuclear venograms. The authors believe that either pattern can be corroborative of inferior vena cava obstruction on a nuclear venogram.

Scintigraphic assessment of pericardio-peritoneal window patency. Relevance to peritoneal dialysis.

To alleviate recurrent pericardial effusion secondary to systemic lupus erythematosus, pericardio-peritoneal window was performed. Subsequently, end stage renal disease developed and the patient required peritoneal dialysis. Patency of the pericardio-peritoneal window was demonstrated by intraperitoneal injection of Tc-99m SC through a Tenckhoff catheter, which prompted special counsel to the patient in order to prevent infectious pericarditis potentially complicating peritoneal dialysis induced-peritonitis.

Graves' disease and concurrent thyroid carcinoma. The importance of thyroid scintigraphy in Graves' disease.

A woman with Graves' disease and unsuspected coexisting thyroid cancer is presented. Although rare, this association has to be considered. It has been noticed that thyroid cancer is more common in hyperthyroid than euthyroid persons. Thus, thyroid scintigraphy is very important in the initial workup of Graves' disease. It helps determine whether medical or surgical therapy is more appropriate in a particular patient.

Chloramine-T induced binding of monoclonal antibody B72.3 to concanavalin-A.

The effects of chloramine-T (CT) on monoclonal antibody B72.3 were studied with particular reference to Con-A lectin binding. After exposure to chloramine-T concentrations from 0.8 to 4.0 mg/mL (115-574 mol CT/mol B72.3), B.72.3 showed progressive binding to agarose-linked Con-A. This behavior was paralleled by decreasing immunoreactivity and increasing fragmentation and aggregation of B72.3 demonstrated by SDS-PAGE and size exclusion HPLC.

The origin of biexponential T2 relaxation in muscle water.

Two theories have been proposed to explain the multiexponential transverse relaxation of muscle water protons: "anatomical" and "chemical" compartmentation. In an attempt to obtain evidence to support one or the other of these two theories, interstitial and intracellular macromolecular preparations were studied and compared with rat muscle tissue by proton NMR transverse relaxation (T2) measurements. All macromolecule preparations displayed monoexponential T2 decay. Membrane alteration with DMSO/glycerin did not eliminate the biexponential T2 decay of muscle tissue. Maceration converted biexponential T2 decay of muscle tissue to single exponential decay. It is concluded that the observed two component exponential T2 decay of muscle represents anatomical compartmentation of tissue water, probably intracellular versus extracellular.

Clinical, biochemical, and neuropathologic findings following transplantation of adrenal medulla to the caudate nucleus for treatment of Parkinson's disease.

We transplanted autologous adrenal medullary tissue into the caudate nucleus of 3 patients with advanced Parkinson's disease. The 1st patient, a 59-year-old man with parkinsonian symptoms for 15 years, had mild improvement in his motor functioning after the operation. However, his postoperative course was characterized by prolonged drowsiness and complex visual hallucinations. The patient died suddenly 8 months after the transplant, and an autopsy revealed coronary atherosclerosis. Examination of the graft site showed necrotic adrenal medullary tissue surrounded by inflammatory cells. The 2nd patient, a 50-year-old man with a 21-year history of parkinsonian symptoms, improved the most after the procedure. The 3rd patient, a 43-year-old man with 12 years of parkinsonian symptoms, had mild improvement in his motor functioning. CSF homovanillic acid increased postoperatively in the 3 patients, but then returned to preoperative levels in all except the 2nd patient. The anatomic, neurochemical, and physiologic basis for the modest clinical improvement shown in these patients is not yet understood.

Cerebral infarction: diagnosis and assessment of prognosis by using 123IMP-SPECT and CT.

A multicenter prospective study was performed in 49 patients with 77 regions of cerebral infarction. Each patient was evaluated in the acute (0-5 days) and subacute (6-17 days) phases by (1) clinical neurologic examination, (2) CT scans, and (3) N-isopropyl-p-123I-iodoamphetamine (123IMP) single-photon emission CT (SPECT) scans. The abilities of the scans to (1) detect a lesion and (2) predict the clinical outcome were assessed. For lesion detection, 123IMP-SPECT was superior to CT in the first 2 days, but the scans were equally effective 3-5 days after onset. In the subacute phase, IV contrast-enhanced CT was superior to 123IMP-SPECT and unenhanced CT. The clinical outcome was only mildly correlated with the results of the acute and subacute 123IMP-SPECT and the acute CT scans. Reduction in lesion size on the subacute scans did not correlate with clinical improvement. We conclude that the parameters measured by CT and 123IMP-SPECT in patients with acute cerebral infarction cannot reliably be used to predict clinical outcome. 124I contamination of 123IMP and the use of low-energy collimators may have decreased lesion detectability.

Ectopic thyroid in the right carotid triangle.

A neck mass in the right carotid triangle of a 28-year-old woman was found to be the only thyroid tissue she possessed. Resection of the mass led to clinical and biochemical hypothyroidism. A possible explanation for the unlikely occurrence of lateral aberrant thyroid tissue and absence of a thyroid gland in the usual location is offered. It is suggested that patients with midline or low lateral neck masses undergo isotopic scanning of the thyroid gland before any iodinated contrast materials are administered or surgery performed.

Technetium-99m labeled RBC imaging in gastrointestinal bleeding from gastric leiomyoma.

Tc-99m labeled RBC imaging is becoming increasingly useful in detecting gastrointestinal (GI) bleeding sites. A patient is presented who had massive GI bleeding from an unsuspected gastric leiomyoma in whom a Tc-99m sulfur colloid GI bleed image was negative. The Tc-99m labeled RBC imaging done on the day after sulfur colloid imaging revealed increased gastric activity due to active bleeding from an intragastric leiomyoma. Tc-99m labeled RBC imaging helped in early detection of the bleeding site resulting in its successful treatment. This experience also reinforces the assertion that Tc-99m labeled RBC imaging may be more helpful than Tc-99m sulfur colloid imaging in patients with upper GI or intermittent bleeding.

New 111In labeling of IgG: 111In-oxine mediated chelation.

Current methods of 111In chelate conjugation labeling of antibodies expose the protein to pH 5-6 during 111In chelation. These conditions could be detrimental if the antibody is acid labile. We have successfully labeled human IgG via the cyclic anhydride of DPTA and 111In-oxyquinoline(oxine). Chelation was achieved at pH 6.9-8.4 and was complete within 1 min at room temperature. The chelation was sensitive to trace metal contamination on labware and in some reagents (including commercial 111In-oxine).

Technetium-99m labeled red blood cells in the evaluation of hemangiosarcoma.

Imaging with Tc-99m labeled red blood cells (RBC) is increasingly being used in the detection of acute gastro-intestinal bleeding, especially in patients with intermittent bleeding. A patient is presented in whom the labeled RBC scan was helpful in the incidental discovery of a previously unsuspected probable angiosarcoma of the right femur and adjacent soft tissues of the right hip due to the "blood pool" or "blush effect" of the labeled cells. The labeled RBC scan also identified extravasation due to active gastrointestinal bleeding from a previously unknown angiosarcoma of the ascending colon. Thus, the Tc-99m labeled RBC scan was useful in simultaneously detecting extravasation and blood pool effect at two remote tumor sites in the same patient.

Precision of dual photon absorptiometry measurements.

One of the important uses of bone absorptiometry is to examine the rate of bone mineral change in order to evaluate therapy and to identify individuals who need therapy. Generally, this involves comparing the difference between two scans obtained months to years apart. This study investigates the precision of dual photon absorptiometry using a human torso phantom, normal subjects, and abnormal patients. These studies showed that bone mineral calculated as g/cm2 was more precise than g/cm. Reanalysis of the same scan by the same individual produced an average error equivalent to that produced by scanning and analyzing the same subject on multiple occasions. Interobserver analysis error was essentially equal to the intraobserver error. In order to obtain maximum precision, care must be taken that the integrated area of a repeat scan is identical to the previous scan. Our findings indicate that to be confident (95%) of a real change between two scans a difference of at least 5.6% must be measured.

Serial changes in markers of disease activity with corticosteroid treatment in sarcoidosis.

Serial changes in various markers of disease activity with corticosteroid therapy were assessed in 12 patients with active sarcoidosis. After six weeks of treatment with 40 mg daily of prednisone, all but one patient demonstrated symptomatic and radiographic improvement. For the entire patient group, there were corresponding improvements in forced vital capacity, from 59.2 +/- 5.5 to 70.5 +/- 5.3 percent of the predicted value (p less than 0.001, Student paired t test), serum angiotensin-converting enzyme levels, from 66.0 +/- 12.1 to 28.2 +/- 4.0 U/ml (p = 0.003), 67gallium lung scanning scores, from 3.6 +/- 0.2 to 0.8 +/- 0.3 (p less than 0.001), serum gamma globulin levels, from 2.40 +/- 0.2 to 1.5 +/- 0.1 g/dl (p less than 0.001), and erythrocyte sedimentation rate, from 26.8 +/- 2.7 to 14.8 +/- 3.0 mm per hour (p less than 0.001). Changes in percent of bronchoalveolar lavage fluid lymphocytes were less impressive (from 28.7 +/- 4.9 to 21.2 +/- 5.1, p = 0.034), but the geometric mean number of bronchoalveolar lavage fluid-IgG-secreting cells decreased from 23,861 to 3,830 (p = 0.013). Serial evaluations in five patients treated with decreasing doses of alternate-day prednisone for an additional 10 1/2 months indicated that changes in 67gallium lung scanning scores corresponded most closely to the clinical course in five of five patients. Determination of serum angiotensin-converting enzyme levels also closely paralleled the clinical course in four of five patients, whereas the other parameters measured were more variable markers of clinical response. However, abnormalities of bronchoalveolar lavage fluid-IgG-secreting cells often persisted in the absence of clinically evident disease, and the percentages of bronchoalveolar lavage fluid lymphocytes were frequently normal in patients who responded subsequently to corticosteroids. Larger prospective studies are warranted to more extensively evaluate various measurements of disease activity, especially bronchoalveolar lavage fluid analysis, in sarcoidosis.

Radionuclide cisternography for the study of arachnoid cysts: a case report.

A patient with agenesis of the temporal lobe and an arachnoid cyst was studied by radionuclide cisternography. The value of cisternography in establishing communication between the cyst and the subarachnoid space is emphasized.

Hepatic adenomas and focal nodular hyperplasia of the liver in young women on oral contraceptives: case reports.

Two cases of hepatic adenoma and one of focal nodular hyperplasia presumably associated with the use of oral contraceptives, are reported. Special reference is made to their clinical presentation, which may be totally asymptomatic. Liver-function tests are of little diagnostic value, but valuable information may be obtained from both liver scanning and hepatic angiography. Histologic differences and clinical similarities between hepatic adenoma and focal nodular hyperplasia of the liver are discussed.