Solid gastric emptying after highly selective vagotomy and pyloroplasty in patients with obstructing duodenal ulcer.

Before being superseded by medical management, highly selective vagotomy (HSV) without drainage was the procedure of choice for uncomplicated duodenal ulcer. It is also justified for complications, including perforation and bleeding in selected cases. This prospective study evaluated the effects of HSV plus drainage on solid gastric emptying in 20 patients with chronic duodenal ulcer and pyloric stenosis. Patients were treated with HSV plus pyloroplasty (Heineke-Mikulicz pyloroplasty in five patients, Finney pyloroplasty in six patients and Jaboulay gastroduodenostomy in nine patients) and underwent solid-phase gastric emptying scintigraphic studies pre-operatively and 2 months and 6 months post-operatively. Results were compared with those from 10 controls. No significant differences were observed between the different types of pyloroplasty, although emptying was slightly faster in the gastroduodenostomy group. Gastric emptying returned to normal by 6 months post-operatively. In conclusion, HSV plus pyloroplasty is effective and can be used for the relief of stenosis in selected cases of duodenal ulcer.

Lung uptake on a bone scan: a case of pulmonary Waldenstrom's macroglobulinemia.

Pulmonary involvement secondary to Waldenstrom's macroglobulinemia (WMG) is described in a 40-year-old male by incidental findings on a bone scan. He was examined for right leg pain, and bone scan revealed unexpected pulmonary uptake of Tc-99m MDP. CT scan of the thorax revealed pleural effusion and slightly disseminated micronoduler density increase in the right lung and parenchymal infiltration in the left lung. Transdermal lung biopsy demonstrated diffuse infiltration of lymphoplasmocytoids. Reporting the presence of pulmonary involvement is important because it may prevent morbidity from pulmonary dysfunction.

Diagnosis of coronary artery disease with Tl-201 SPECT in patients with left bundle branch block: importance of alternative interpretation approaches for left anterior descending coronary lesions.

Left bundle branch block (LBBB) is a strong predictor of mortality in the presence of coronary artery disease (CAD). Noninvasive evaluation of CAD in these patients has some difficulties. Exercise-induced electrocardiographic ST segment changes are nondiagnostic, and several scintigraphic studies have reported false-positive anteroseptal and septal perfusion defects up to 80%. The authors aimed to assess the diagnostic accuracy of thallium-201 (Tl-201) exercise myocardial single photon emission computerized tomography (SPECT) in comparison with coronary angiography (CAG) for detection of CAD in patients with LBBB. Seventy-seven consecutive patients suffering from chest pain with complete and permanent LBBB were included in the study. All patients (40 women, 37 men, mean age = 54 +/- 7 years) were studied with Tl-201 exercise SPECT and coronary angiography. Tl-201 exercise SPECT for diagnosis of left anterior descending (LAD) artery lesions was interpreted by using three different approaches: method A (conventional approach), method B (involvement of anterior and septal wall regardless of apical wall), and method C (apical approach: involvement of anterior septal and apical wall). Methods A and B gave a sensitivity of 100% each but a specificity of 47% and 56%, respectively. Although method C gave a higher value of specificity than that of methods A and B (98% vs 47% and 56%, respectively p < 0.05), the sensitivity of method C significantly decreased in respect to methods A and B (33% vs 100% p < 0.01). Isolated septal defects were evaluated separately. Isolated septal defects on exercise Tl-201 SPECT were detected in 11 patients, and none of them had CAD according to CAG results. Isolated septal wall involvement had a sensitivity of 0% and a specificity of 74%. The sensitivity and specificity of Tl-201 SPECT for diagnosis of CAD in the right coronary and left circumflex artery territories were 91% and 89%, respectively. In conclusion, the apical approach increased the specificity and decreased the sensitivity of the test. Isolated septal defects seem to have no value for diagnosis of CAD in patients with left bundle branch block.

Role of technetium tetrofosmin scintimammography in the diagnosis of malignant breast masses and axillary lymph node involvement: a comparative study with mammography and histopathology.

OBJECTIVE: To assess the role of Technetium-99m (99mTc) tetrofosmin scintimammography in the detection of breast cancer and involvement of axillary nodes. DESIGN: Open study. SETTING: General hospital, Turkey. SUBJECTS: 128 women who presented with masses in the breast. INTERVENTIONS: Scintimammography, standard mammography, and either excision or fine-needle aspiration biopsy to confirm the diagnosis. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive value of scintimammography compared with mammography. RESULTS: Sensitivity, specificity, and positive and negative predictive value (%) of 99mTc scintimammography were 95, 96, 97 and 92, respectively. The corresponding figures for standard mammography were 87, 26, 68 and 52. Scintimammography changed the 34 false positive mammograms into true negatives, at the expense of four false negatives. The sensitivity of scintimammography in detecting axillary lymph node metastases was 72% and specificity 100%. CONCLUSION: Scintimammography with 99mTc tetrofosmin seems to be of value in the detection of breast malignancy and axillary metastases. It may help to avoid unnecessary operations in patients whose mammograms do not give a definite diagnosis.