Scintigraphic hand osteoarthritis (OA)--prevalence, joint distribution, and association with OA at other sites.

OBJECTIVE: To assess the information available from routine bone scans on prevalence and joint distribution of osteoarthritis (OA), particularly of the hand. METHODS: Consecutive whole body bone scans of 414 patients, including a special hand projection, were analyzed for evidence of OA related uptake. After exclusions for various reasons, 297 scans were considered "representative" with regard to hand OA (108 male and 189 female patients). Kappa values for interreader agreement ranged from 0.61 to 0.82 for hand joints and was slightly lower for other joints. RESULTS: The prevalence of positive hand joints was low before the age of 40, but increased rapidly in the 5th and 6th decade to reach a plateau. Women had a higher prevalence of uptake than men in the carpometacarpal-1 (CMC1) joint and patella. Uptake was similar on the dominant and non-dominant sides in all joints with the exception of the shoulder. Subchondral knee uptake prevalence tended to decrease in the oldest age groups, but other joint sites showed a steadily increasing prevalence throughout life. Hand symptoms were related to distal interphalangeal (DIP) and CMC1 uptake, thumb symptoms with first metacarpophalangeal joint (MCP1) CMC1 uptake, and knee symptoms with the subchondral knee uptake pattern. Affected hand joint distribution was characterized by a strong bilateral concordance within rows, and an association was seen between subchondral knee uptake and hand involvement, particularly in the DIP joints, but to a lesser degree also with CMC1 and proximal interphalangeal (PIP) uptake. Association between spinal sites and between the forefoot and the knee was also observed. CONCLUSION: Bone scintigraphy is valuable method in epidemiological studies of OA, with acceptable interreader reproducibility and relation to joint symptoms. Although much of the current findings seem comparable with previous radiologic studies, they provide new ideas about age related patterns and joint subsets, possibly indicating a difference in pathogenetic mechanisms among joints in OA.

[198Au brachytherapy and external radiation compared with external radiation only in non-small cell lung cancer.].

OBJECTIVE: In this study the effect of a combination of radioactive gold (198Au) grain implantation and external radiation on survival and quality of life in patients with non-small cell lung cancer (NSCLC) and endobronchial lesions was compared to treatment with external radiation only. MATERIAL AND METHODS: Patients with NSCLC who were inoperable because of intrathoracic tumor spread or poor functional status, were randomized to receive either brachytherapy with 198Au implantation followed by external radiation with an intended maximum dosage of 60 Gy (group A), or external radiation only (group B). Time spent in hospital was used to reflect quality of life. RESULTS: There was no difference in age or performance status at entry into the study. Five of 10 patients in group A had squamous cell carcinoma as did five of eight patients in group B. The mean dose of external radiation was 46.6+/-4.0 Gy in group A and 54.8+/-2.8 Gy in group B (NS). Median survival among group A patients was 29 weeks and 30 weeks in group B. Patients in group A spent 7.4+/-2.8 weeks in hospital whereas patients in group B spent 18.5+/-9.0 weeks in hospital. This difference was not statistically significant (p=0.21). CONCLUSION: We conclude that the addition of brachy-therapy using 198Au gold grains did not improve significantly the results of standard radiotherapy in this randomized trial of patients with inoperable NSCLC.

Left ventricular myocardial perfusion and function in systemic sclerosis before and after diltiazem treatment.

To examine left ventricular (LV) myocardial perfusion and function, in systemic sclerosis. Myocardial perfusion was assessed at rest, during cold exposure, and at peak exercise in 10 patients with systemic sclerosis. Seven of the 10 patients were examined with Doppler echocardiography; before and after long-term diltiazem treatment. Compared with average resting values, isotope uptake was increased by 48% after exercise, compared with cold exposure the exercise value was increased by 35%. After 11 months of diltiazem treatment there was no change in myocardial uptake, compared with respective values before treatment. Doppler echocardiography showed an increase in LV end-diastolic diameter, fractional shortening, and left ventricular outflow tract velocity, after treatment. This indicates that long-term diltiazem treatment does not increase myocardial perfusion at rest, post-exercise, or during cold exposure. On the other hand diltiazem treatment may improve left ventricular performance.

Comparative evaluation of 99mTc-pertechnetate, 99mTc-diphosphonate, 99mTc-Solcocitran, 99mTc-iron-ascorbic acid and 67Ga-citrate as brain scanning agents.

The uptake of 99mTc-pertechnetate (TcO4), 99mTc-iron-ascorbic acid (Feasc), 99mTc-Solcocitran (Solcocitran), 99mTc-diphosphonate (HEDP) and 67Ga-citrate (Ga) in various brain lesions was compared. Influence of time from injection was also studied on the first three compounds. A rank correlation method was used to compare the scans which were judged visually by three independent observers. There was good agreement between the observers, as measured by Kendall's tau, but the concordance between rankings within the same type of lesion, as measured by Kendall's W, was rather poor. There was no significant difference in the uptake of TcO4, Feasc and Solcocitran. Ga showed generally poor uptake and its uptake in tumours and infarcts did not differ significantly. However, when HEDP and TcO4 were compared in two groups (I: Infarcts, haemorrhages and bone invading meningiomas, and II: Tumours not invaded into bone) a highly significant difference was obtained with much higher uptake of HEDP in Group I.

Over-all accuracy of 99mTc-pertechnetate brain scanning for brain tumours--study of 471 patients.

A 3-year follow-up and re-evaluation of all scans on all patients referred for brain scanning in Iceland during 1 year was performed in order to assess the diagnostic reliability of radioisotope scanning for brain tumours. The study included 471 patients. Of these 25 had primary brain tumours and 7 brain metastases. Scans were positive and correctly interpreted in 68% of the patients with primary brain tumours and in 3 of the 7 patients with metastases. The over-all accuracy of brain scanning for brain tumours defined as the total number of correct positive scans and correct negative scans versus total number of scans examined was 96%, this figure being mainly influenced by the high number of true negative scans.