No osteoporosis detected by quantitative computed tomography in postmenopausal black females.

Problems associated with postmenopausal osteoporosis are believed to be almost non-existent in black South African females, but published data on their bone mineral density are lacking. In this study, vertebral quantitative computed tomography was performed on 30 postmenopausal black women with no complaints other than those attributable to oestrogen deficiency. The mineral bone density was plotted against those 'normals' of similar age provided by the Somaton DR H (Siemens) data base. In all instances the vertebral bone mineral density obtained was higher in the study group.

Diagnostic reliability of radionuclide ventriculography in detecting left ventricular hypertrophy. Echocardiographic and ECG correlations.

Left ventricular hypertrophy (LVH) is frequently present in patients referred for radionuclide ventriculography (RVG) for evaluation of left ventricular function. During interpretation of these studies, the nuclear medicine physician may have the subjective impression that increased septal thickening is present because of the abnormally prominent separation of the right and left ventricular blood pools. To examine the diagnostic reliability of this finding, we retrospectively reviewed the RVG studies of 43 consecutive patients and correlated the finding of subjectively increased septal thickness with established echocardiographic (ECHO) criteria and commonly used electrocardiographic (ECG) indices of LVH. Using standard ECHO measurements of septal thickness as a gold standard, RVG interpretation of septal thickening demonstrated a sensitivity of 0.69, specificity of 0.70, and accuracy of 0.70. When compared with standard ECG criteria for LVH, RVG performed quite favorably in the diagnosis of LVH confirmed by ECHO left ventricular mass index. We conclude that scintigraphic evidence of LVH should be reported when RVG studies are interpreted.

Central venous catheters. Technique and experience at Red Cross War Memorial Children's Hospital, Cape Town, 1987-1990.

Central venous catheters can be of major benefit to children in whom prolonged intravenous access is required. For their everyday use, however, the known associated morbidity needs to be at an acceptably low level. Experience with 44 central venous catheters in 31 children (3318 catheter days over a 40-month period) is reported. The complication rate of catheter sepsis (0.3/100 catheter days), thrombosis (1 catheter), and technical problems (17, of which 6 required removal) justified catheter usage. Provided catheters are correctly inserted and the patients meticulously nursed, these catheters offer major advantages to infants and children requiring long-term intravenous access, particularly for parenteral nutrition.

Recurrent Paget's disease of the vulva after simple vulvectomy and skin grafting. A case report.

A patient with recurrent Paget's disease of the vulva 11 years after simple vulvectomy and skin grafting is presented. This is the first report of an intra-epithelial vulvar Paget lesion with recurrence in a skin graft. The current hypotheses regarding the histogenesis of Paget's disease of the vulva are discussed.

Stages IB and IIA carcinoma of the cervix treated by radiation and radical hysterectomy. Findings and results in 184 patients.

Although the results of both radiotherapy and radical surgery for stages IB and IIA carcinoma of the cervix are good, a small percentage of cancers are resistant to radiation therapy. Combined radiation and surgery therefore seems an attractive alternative. A study of 184 patients in whom radium application was followed by radical abdominal hysterectomy and pelvic lymphadenectomy 6 weeks later is reported. The uncorrected 5-year survival rate of 85.7% is not significantly better than results obtained by surgery alone or radiotherapy alone. Some guidelines are suggested to rationalise individual treatment of these patients.

Effect of Sn(II) ion concentration and heparin on technetium-99m red blood cell labeling.

While convenience and economy favor the use of in vivo methods for labeling red blood cells (RBCs) with [99mTc]pertechnetate, previous reports suggested that patient medication such as heparin might interfere and thus result in inferior quality images. In this study, using a canine model, the role of stannous Sn(II) ion in in vivo and in vitro labeling of RBCs both in the presence and absence of a therapeutic dose of heparin was investigated. Our results showed that Sn(II) ion concentration of 20 micrograms/kg body weight levels provided better than 80% in vivo labeling efficiency enabling high quality blood-pool images even in the presence of therapeutic doses of heparin.

Chronic knee pain assessed by SPECT: comparison with other modalities.

Twenty-seven patients with chronic knee pain were examined prospectively using conventional radiography, radionuclide angiography, planar bone scintigraphy, and single-photon emission computed tomographic (SPECT) bone scintigraphy. When the results of subsequent arthroscopic examination of all three compartments of the knee were correlated with those of the noninvasive methods, SPECT bone scintigraphy was found to be most sensitive for evaluating the extent of osteoarthritis. Differences in detection sensitivity for articular cartilage damage and synovitis were greatest in the patellofemoral compartment. The frequency with which hyperemia was present in association with cartilage damage and synovitis indicates that osteoarthritis of the knee is capable of producing hyperemia and further implies that increased perfusion cannot be used to distinguish with confidence between osteoarthritis and septic processes involving the knee. SPECT (1.00) and planar (0.91) bone scintigraphy were highly sensitive indicators of torn menisci in a subgroup of 14 patients, each having a prearthroscopic clinical diagnosis of a torn meniscus. This result suggests that for patients with chronic knee pain and clinical suggestion of a torn meniscus, bone scintigraphy has significant potential as a high-sensitivity, prearthroscopic screening examination.

Detection of femoral head avascular necrosis in adults by SPECT.

Twenty-one adult patients with the clinical diagnosis of avascular necrosis (AVN) of the femoral head were examined with radionuclide angiography, planar bone scintigraphy, and single photon emission computed tomography (SPECT). A final diagnosis of AVN was established for 15 symptomatic patients with a total of 20 involved hips. SPECT and planar bone scintigraphy were considered positive for AVN only if a photopenic bony defect could be identified. Using SPECT bone scintigraphy, 12 of 15 symptomatic patients and 17 of 20 involved hips (sensitivity of 0.85) were correctly identified, whereas with planar imaging only eight of 15 patients and 11 of 20 involved hips were detected. There were no false-positive diagnoses on SPECT or planar bone scintigraphy. In addition, hyperemia in the region of the proximal femoral metaphysis was demonstrated in six of 20 involved hips. It is concluded that by identifying a photopenic defect that is not evident on planar views, SPECT can contribute to the diagnosis of AVN of the femoral head. In addition, metaphyseal hyperemia appears to be a promising new scintigraphic sign of AVN worthy of further investigation.

Painful spondylolysis or spondylolisthesis studied by radiography and single-photon emission computed tomography.

Planar bone scintigraphy (PBS) and single-photon emission computed tomography (SPECT) were compared in 19 adults with radiographic evidence of spondylolysis and/or spondylolisthesis. SPECT was more sensitive than PBS when used to identify symptomatic patients and sites of "painful" defects in the pars interarticularis. In addition, SPECT allowed more accurate localization than PBS. In 6 patients, spondylolysis or spondylolisthesis was unrelated to low back pain, and SPECT images of the posterior neural arch were normal. The authors conclude that when spondylolysis or spondylolisthesis is the cause of low back pain, pars defects are frequently heralded by increased scintigraphic activity which is best detected and localized by SPECT.

[Leiomyoma and leiomyosarcoma of the vulva]. / Leiomioom en leiomiosarkoom van die vulva.

Patients with leiomyoma and leiomyosarcoma of the vulva are described. The clinical features of these conditions are summarized and the diagnostic criteria for differentiating leiomyomas from leiomyosarcomas are mentioned. The treatment and follow-up of patients with vulval leiomyosarcomas is discussed briefly.

Clearance from the anterior chamber of RBCs from human diabetics.

Erythrocytes from diabetic patients manifest decreased deformability and increased adherence. These abnormal membrane properties may diminish the ability of erythrocytes (RBCs) from diabetics to undergo deformation in passage through the trabecular meshwork. Using sodium chromate Cr 51-labeled RBCs from type I diabetic patients with proliferative retinopathy and normal control subjects, we studied RBC clearance from the rabbit anterior chamber. The mean time for 50% clearance (T50) of RBCs from diabetics (76 hours) was significantly longer than that for RBCs from normal subjects (19.5 hours). In this model, RBCs from diabetics have a slower clearance from the anterior chamber than do RBCs from normal subjects.

Gamma camera energy windows for Tc-99m bone scintigraphy: effect of asymmetry on contrast resolution. Work in progress.

By raising the lower threshold of the Tc-99m energy window, rejection of scattered photons can be made more efficient. Unfortunately, with most gamma cameras significant nonuniformities are produced when the window is changed to an asymmetric setting. Recently introduced designs with gain stabilization of the photomultiplier tubes and improved energy correction maintain field uniformity even for an asymmetric window. To assess the impact of an asymmetric energy window on clinical images, 33 Tc-99m-MDP scintigrams of the lumbar spine were taken with symmetrical (126-154 keV) and asymmetric windows (135-154 keV). Bone:soft tissue ratios improved with the asymmetric window, and the resulting images were preferred by the physicians questioned.

Concentration of In-111-oxine-labeled autologous leukocytes in noninfected and nonrejecting renal allografts: concise communication.

Autologous leukocytes labeled with In-111 oxine (ILL) concentrated in the renal allografts of eight patients for whom transplant rejection, infection, or acute tubular necrosis (ATN) could be excluded. All patients had good-to-adequate renal function at the time of ILL scintigraphy, and none developed rejection or renal transplant failure during a 1-mo follow-up period. It is concluded that normally functioning renal allografts without evidence of rejection, infection, or ATN often will concentrate ILL. When a baseline study is not available for comparison, this phenomenon limits the value of ILL scintigraphy as a diagnostic test for transplant rejection or infection.

Persisting cyclic ovarian activity in cervical cancer after surgical transposition of the ovaries and pelvic irradiation.

The effect of surgical transposition of the ovaries on gonadal function was investigated in ten young women with carcinoma of the uterine cervix, stages I and II. Gonadotrophin-, oestradiol- and progesterone-levels were determined before and during pelvic irradiation. A control group consisted of seven patients with cervical cancer who did not undergo ovaria transposition. In the control group gonadotrophins began to rise after radiation doses of 560-2400 rad (FSH) and 1130-2600 rad (LH) respectively. The excessive secretion was not seen in patients who had ovarian lifting. Ovulatory cycles occurred during or after pelvic irradiation in seven women of the study group, either spontaneously or induced by clomiphene treatment. This indicates that transposition preceding radiotherapy is an effective means of preserving ovarian secretion in young women in whom malignancies of the pelvic region demand irradiation.

Stress incontinence in the Black female.

Primary stress incontinence is probably caused by abnormality of the expulsive forces of micturition or by deficiency of the retaining forces, or both. These factors were examined and compared in Indian and Black patients, and the findings partially explain the rarity of primary stress incontinence in the latter group.