Helicoidal enteromyotomy in rats: an experimental model of intestinal lengthening.

Short bowel syndrome (SBS) is a congenital or acquired condition of poor absorption resulting from a reduced surface of the enteric mucosa. In most cases, it spontaneously resolves via an adaptive process in the remaining intestine. Intestinal lengthening is one therapeutic method used for refractory SBS. The present study evaluates the intestinal changes and weight gains following a new lengthening technique (helicoidal enteromyotomy) performed in growing rats. Thirty Wistar rats underwent enteromyotomy (group I) in a 5-cm jejunal segment or laparotomy only (group II). No animal underwent intestinal resection. Postoperatively monitored weight was animals were sacrificed on the day 28. Measurements were made of the anterior and middle half-perimeters and the length of the marked-out intestinal segment. Two animals in group I were excluded due to infraction of the technique (perforation of the mucosa). Group I had an initial weight loss, although variance analysis (ANOVA) showed that the speed of the weight gain was similar in the two groups after the postoperative day 4 (P =.245). When the half-perimeter dimensions and length of the manipulated intestinal segment were compared, group I showed an increased caliber and length (P <.001, for both comparisons). There was no baseline difference in caliber between the two groups (P =.127). Our results led us to conclude that helicoidal enteromyotomy increases intestinal length and caliber without causing upstream dilatation or interfering in weight gain.

Physiological changes in Pachinko players; beta-endorphin, catecholamines, immune system substances and heart rate.

Pachinko is a popular form of recreation in Japan. However, in recent years, along with Pachinko's popularity, "Pachinko dependence" has become topical news. The purpose of this study was to investigate beta-endorphin, catecholamines, immune system responses and heart rate during the playing of Pachinko. The following significant results were observed. (1) Plasma concentration of beta-endorphin increased before playing Pachinko and while in the Pachinko-center (p < 0.05). (2) Beta-endorphin and norepinephrine increased when the player began to win (i.e. at "Fever-start") compared to baseline (p < 0.05). (3) Beta-endorphin, norepinephrine and dopamine increased when the winning streak finished (i.e. at "Fever-end") compared to baseline (p < 0.05-0.01). (4) Norepinephrine increased past 30 minutes after "Fever-end" compared to baseline (p < 0.05). (5) Heart rate increased before "Fever-start" compared to baseline, peaked at "Fever-start" and rapidly decreased to match rates measured at rest. But the increase was observed from 200 seconds after "Fever-start" (p < 0.05-0.001). (6) There was a positive correlation between the number of hours subjects played Pachinko in a week and the differences between beta-endorphin levels at "Fever-start" and those at rest (p < 0.05). (7) The number of T-cells decreased while the number of NK cells increased at "Fever-start" compared to baseline (p < .05). These results suggest that intracerebral substances such as beta-endorphin and dopamine are involved in the habit-forming behavior associated with Pachinko.

[Usefulness of 99mTc-MIBI SPECT in the metastatic lesions of thyroid cancer].

99mTc-MIBI is widely used as a tumor-seeking agent for parathyroid tumor, lung cancer, etc. We tried to detect the metastatic lesions of thyroid cancer by 99mTc-MIBI SPECT and evaluated 131I-uptake in the region of 99mTc-MIBI accumulation. Twenty-seven cases of thyroid cancer (23 papillary adenocarcinoma, 3 follicular adenocarcinoma, 1 unknown) were examined by 99mTc-MIBI. All cases were confirmed by surgery. Thyroglobulin was measured in all cases before 99mTc-MIBI SPECT. 131I-therapy (4.5-5.5 GBq) was performed on 24 patients and whole body scintigram was taken 7-10 days after. Thirty minutes after an injection of 99mTc-MIBI (740 MBq), SPECT with a three-head gamma camera was performed. Abnormal accumulation of 99mTc-MIBI was noted in 14 patients, all cases detected on CT or MRI. In 11 of the 13 cases in which accumulation was not visualized, no metastasis was detected. Most cases of abnormal accumulation on 99mTc-MIBI showed a high level of thyroglobulin. Metastatic lesions of follicular adenocarcinoma in three patients (right humerus, axillary region and sternum) showed strong accumulation of 99mTc-MIBI, and 131I was strongly taken up in these lesions. 131I was also taken up in the metastatic lesions of papillary adenocarcinoma with marked accumulation of 99mTc-MIBI. 99mTc-MIBI did not accumulate in a case with diffuse pulmonary uptake of 131I. 99mTc-MIBI SPECT could detect occult metastatic lesions in the soft tissue more clearly than CT or MRI. In conclusion, 99mTc-MIBI study might be useful as a follow-up study of patients after surgery for thyroid cancer.

[Can 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) evaluate the renal function without blood sampling?: consensus report from multicenter study].

A multicenter study was undertaken in Japan to evaluate the correlation between the percentage of renal uptake of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) estimated by the count-based gamma camera method and the blood clearance of 99mTc-MAG3. Twenty four centers were enrolled and 172 cases were finally analyzed in this study. The renal clearance of 99mTc-MAG3 (TER) was obtained by using a single blood sample taken at 44 min after injection. Comparison of TER and renal uptake provided a coefficient of correlation of 0.874; suggesting that sufficiently accurate quantification of renal function could be obtained from the renal uptake estimate by the gamma camera method. This study also showed that the comparison of renal function might be feasible among patients under the same protocols, although precise and careful consideration is required in each center.

[Characteristics of radiopharmaceutical delivered from 99mTc-DTPA in the technegas generator].

99mTc-DTPA aerosol permeates the alveolar membrane by an intercellular pathway. Measurement of the clearance rate of 99mTc-DTPA aerosol is useful for assessing injury of the lung epithelium. Pertechnegas (P-gas) is also used to assess epithelial permeability, but its clearance is too rapid to evaluate lung epithelial permeability. The aims of this study were first to generate 99mTc-DTPA fine aerosol (D-gas), second to characterize D-gas by radiochromatography and an in vivo study in the rat, and third to investigate the clinical significance of D-gas in comparison with 99mTc-DTPA aerosol and P-gas. We generated D-gas in a chamber with an atmosphere of 3% oxygen and 97% argon inside the Technegas Generator. The clearance half-time of D-gas was 19.8 +/- 4.0 min in eight normal non-smoker subjects, 12.0 +/- 2.8 min in four smoker subjects, and 31 +/- 11.2 min in three with idiopathic interstitial pneumonia (IIP). In radiochromatography, the development of D-gas was the same as that of P-gas and different from that of 99mTc-DTPA solution. In the in vivo study using a rat, the distribution of intravenously injected D-gas solution was the same as that of 99mTcO4-, but different from that of 99mTc-DTPA solution. These results suggest that 99mTc-DTPA separates to free 99mTcO4- in the chamber of the Technegas Generator and that D-gas behaves in the same manner as P-gas. In conclusion, D-gas has no clinical significance for the assessment of epithelial permeability.

[Uptake of Tc-99m hexakis 2-methoxy isobutyl isonitrile in lung or mediastinal lesions by SPECT].

The uptake of Tc-99m hexakis 2-methoxy isobutyl isonitrile (99mTc-MIBI) was evaluated in 18 patients with various lung or mediastinal lesions by SPECT. The patients consisted of seven with lung cancers, three with lung cancers who were treated with chemotherapy and were disease free, and one each with malignant lymphoma, esophageal cancer, thyroid cancer involving the mediastinum, malignant thymoma, pneumonia, granuloma, sarcoidosis and neurinoma. SPECT imaging (30 min, 600 MBq) was performed after intravenous injection. Strong uptake of 99mTc-MIBI was noted in all malignant tumors except malignant lymphoma. The mean tumor to normal lung tissue uptake ratio (T/N ratio) was 2.26. The mean in lung cancer was 2.31. Slight accumulation was present in pneumonia and granuloma (mean T/N = 1.24). No accumulation was present in a case of non-Hodgkin's lymphoma and neurinoma. Moderate uptake was noted in one case of sarcoidosis (T/N = 1.46). No abnormal accumulation of 99mTc-MIBI was seen in post-therapeutic lung cancer. These results suggested that 99mTc-MIBI SPECT could be useful in differentiating between malignant and benign lesions.

[The usefulness of 201TlCl scintigraphy for the diagnosis of breast tumor].

The usefulness of 201TlCl SPECT (Tl SPECT) for the diagnosis of breast cancer was evaluated in 14 patients with various breast tumors (9 with invasive ductal carcinoma, 2 with fibroadenoma and 3 with benign process). These tumors ranged in size from 1.5 cm x 1.5 cm to 15.0 cm x 14.0 cm. Tl SPECT was carried out 2 hours after the intravenous injection of 201TlCl (185 MBq). For quantitative study, ROIs were set in the tumor (T), normal tissue of the opposite breast (B) and myocardium (M). Count ratios of T/B and T/M were calculated. Eight patients with breast cancer and a case of fibroadenoma showed intense accumulation of 201TlCl in the tumors. The T/B ratio was 1.20 +/- 0.68 and the T/M ratio was 0.68 +/- 0.31 in the 9 cases. Lymph node metastasis was detected in 2 of 6 cases that were confirmed at operation. No remarkable accumulation of 201TlCl was seen in 4 patients with benign process. One patient with benign tumor showed a false positive result. The rates of accuracy of mammography and ultrasonography for the same subjects were 82% and 84%, respectively. The results suggest that 201TlCl SPECT might be useful to assess breast cancer in cases in which the findings of other modalities are equivocal.

[Dual nuclides SPECT for ventilation and perfusion study].

Dual nuclides SPECT using 81mKr and 99mTc-MAA for ventilation and perfusion study was performed in 24 subjects. Crosstalk of 81mKr to 99mTc-energy window was about 7.5% when ventilation and perfusion study were performed by 370 MBq of 81mKr gas and 185 MBq of 99mTc-MAA. Areas of low V/Q was significantly larger in SPECT study than in planar study, in 11 cases with various pulmonary diseases. High V/Q mismatches were also more clearly delineated in SPECT than in planar study. Dual nuclides SPECT study has advantages of obtaining V/Q distribution without movement artifacts and of simultaneous acquisition of ventilation and perfusion image. Area of high V/Q became larger in SPECT with crosstalk than in SPECT without crosstalk, but in the low V/Q area no significant difference was noted between SPECT with crosstalk and without crosstalk.