The usefulness of gallium-67 citrate scanning in testicular seminoma.

An analysis of 77 consecutive patients with a histologic diagnosis of seminoma testis, assessed and treated at the Cross Cancer Institute between 1977 and 1982, is presented. Ga-67 citrate was first used in the assessment of patients with malignant testicular tumors in 1973. Following three years of study that supported the observation of the gallium-avid nature of seminoma, gallium scans became routine in the initial staging assessment and were used also when recurrence was suspected. From 1977 through 1982, 72 patients with biopsy-proven seminoma testis were assessed initially for extent of disease by Ga-67 scanning. Comparison with intravenous pyelography and bipedal lymphography was possible for accuracy of tumor assessment. The scan sensitivity was 83%, and the specificity was 95%. During the same period, gallium was studied in nonseminomatous testicular tumors but the results were disappointing and its use was discontinued. The gallium-avid nature of seminoma testis may be useful in determining the extent of disease.

Detecting bone marrow metastases at the time of examining the liver with radiocolloid.

In a prospective study of 200 different consecutive patients with cancer, the bone marrow of the lumbar spine and pelvis has been examined at the time of obtaining a radiocolloid examination of liver and spleen. The images were examined "blind" by three observers who all agreed about the findings in 177 (89%) of the patients. Agreement by any two was considered to be definitive. The radiocolloid marrow examinations in this selected population had an accuracy of 0.97, sensitivity of 0.80, and specificity of 0.98 in diagnosing metastatic disease when validated by all other available evidence, or follow-up. Of the patients thus examined, 16 (8%) had abnormal marrow scan findings reflecting metastatic disease, eight (4%) at the time radiographs were normal, and two at the time bone scintigraphy was normal. Excluding patients with bowel cancer, in whom the detection rate was zero, 16 (12.4%) marrow examinations were abnormal. As a result we now obtain "saturated" images of the marrow incidental to radiocolloid examinations of the liver and spleen in patients with cancer other than that of the bowel.

The cryoprotective effects of dimethyl sulfoxide on human bone marrow as studied by 31P nuclear magnetic resonance spectroscopy.

31P nuclear magnetic resonance spectroscopy has been used to study freshly aspirated normal human bone marrow samples. The pH within the intact cells of the samples was determined from the chemical-shift position of the resonance for inorganic phosphate within the cell; the intracellular pH was found to be 7.35 for fresh bone marrow. The chemical-shift positions of the alpha and beta phosphate resonances of adenosine 5'-triphosphate were used to assess the fraction of this metabolite complexed with Mg2+. It was found that 84% of the total intracellular adenosine 5'-triphosphate was in the Mg2+-complexed form. The concentration of Mg2+ uncomplexed to any ligand was 0.4 mM. The areas of the resonances for the major phosphorus-containing metabolites were used to determine intracellular concentrations. For fresh human bone marrow, the intracellular concentrations determined were phosphate monoesters less than 0.3 mM, 2,3-diphosphoglycerate 3.9 +/- 1.0 mM, inorganic phosphate 1.2 +/- 0.6 mM, phosphodiesters 2.8 +/- 1.0 mM, adenosine 5'-triphosphate 1.6 +/- 0.4 mM, adenosine 5-diphosphate less than 0.2 mM, and nicotinamide adenine dinucleotide less than 0.2 mM. These metabolite concentrations within the intact cell samples did not change over 2.0 h and changed only gradually over a 24-h period. 31P nuclear magnetic resonance spectroscopy was then used to study the cryopreservation of normal human bone marrow in the presence of increasing concentrations of the penetrating cryopreservative dimethyl sulfoxide. Dimethyl sulfoxide alone without freezing was found to cause some gradual hydrolysis of 2,3-diphosphoglycerate, presumably by stimulating diphosphoglycerate phosphatase. The effect of freezing human bone marrow to liquid nitrogen temperatures, storage, and rapid thawing was a dramatic fall in intracellular adenosine 5'-triphosphate levels. The half-life of the metabolite, after thawing, was about 0.3 h. If the bone marrow was frozen in the presence of 2.5, 5.0, and 7.5% dimethyl sulfoxide, the post-thaw half-life was prolonged to 0.4, 0.5, and 0.6 h, respectively. 15% dimethyl sulfoxide afforded complete cryoprotection, with adenosine 5'-triphosphate levels constant for 15 h after thawing the human bone marrow.

Abnormal biodistribution of radiogallium in persons treated with phenytoin.

After incidentally observing a patient in whom abnormal uptake of gallium-67 citrate appeared to be explained by treatment with phenytoin, we have conducted a prospective study. Of sixteen persons with a seizure disorder treated with phenytoin, five (31%) had abnormal uptake of radiogallium either in the mediastinum, pulmonary hilum or both. Of nineteen historical control patients only one had such abnormal uptake. Phenytoin may thus cause the false-positive uptake of radiogallium in lymph nodes; this finding may also prove to have nosological importance in identifying patients at particular risk of the side-effects of this drug.

Gray-scale ultrasonography as a screening procedure in the detection of gallbladder disease.

The sonographic and surgical findings in 180 patients who underwent cholecystectomy for gallbladder disease were reviewed and correlated. Four abnormal groups were established. In Group I, the gallbladder was visible and contained structures which cast an acoustic shadow. In Group II, there was constant shadowing in the region of the gallbladder fossa, but the gallbladder itself was not visible. In Group III, there was a constant, immobile, echo-dense, nonshadowing area in the gallbladder wall. In Group IV, nonshadowing echoes were seen within the gallbladder lumen. The overall accuracy of ultrasound was 98.9%; the false-negative rate was 2.2%, the false-positive rate 2.8%. 5.6% of Group I patients had normal oral cholecystograms. Because of its high accuracy, minimal preparation, speed of diagnosis, and cost-effectiveness, the authors recommend that ultrasonic cholecystography be considered as a screening method, particularly for small polyps (< 4 mm).