ECG-gated blood-pool study of carotid arterial pulsation as a sign of stenosis: concise communication.

The large elastic arteries, such as the carotids, pulsate (expand and contract) in synchrony with the heart beat. These pulsations should be reduced by significant stenosis. This hypothesis was studied in 15 men by obtaining sequential ECG-gated labeled blood-pool images of these vessels in anterior and lateral oblique views. These were computer processed by a functional program that displays each pixel with an intensity proportional to its change in activity level during the cardiac cycle. Blank areas indicated lack of pulsation and were correlated with angiographic studies. The blank skip areas were present when there was 50% or greater narrowing in arterial diameter (94% sensitivity) but were not seen in patients with normal or minimally diseased vessels (25% or less narrowing). They were present inconsistently in the four vessels with 25 to 50% narrowing.

Radioisotope therapy in bone and joint disease.

The short range tissue destruction of beta-emitting radioisotopes can be utilized in painful metastatic disease of the skeleton by employing a radionuclide that is specifically metabolized in or adjacent to these lesions. Sodium phosphate P 32 has been used for this purpose for the past 25 yr. It uptake in skeletal tumor and in osteoblastic new bone adjacent to tumor can be markedly increased by pharmacologic stimulation using androgenic steroids, or during rebound deposition after a course of parathyroid hormone. Although efficacy in terms of subjective pain relief is high, more objective signs of success are often lacking, and survival, while more confortable, is not prolonged. Marrow depression is the most significant side effect. A beta-emitting, bone-seeking isotope, 89Sr, may have a better therapeutic/toxic ratio, and should receive further trial. Radiation-induced necrosis has also been applied, though more hesitantly, to the proliferative, destructive, but nonmalignant synovium in rheumatoid disease. Here, a number of colloidal preparations, most commonly 198Au, have been employed. Again, relief of symptoms, particularly recurrent joint effusions, is quite high, although the basic disease process is not reversed. The major hazard here appears to be leakage of material to regional lymph nodes, resulting in irradiation of circulating lymphocytes. Although chromosomal damage can be detected when such cells are then cultured, the actual consequences of this, if any, are not presently known. Both shorter-lived (165Dy) and longer-lived (32P) larger-size colloids are being evaluated, which may prove safer in this regard than 198Au.

Ultrasonography of the testis--correlation with radiotracer perfusion.

Ultrasonic study of testicular disease and paratesticular masses was carried out in 20 cases. In eight of these, comparison was made with pertechnetate perfusion studies performed concurrently. Testicular torsion was well revealed by both techniques. Acute orchitis, in the early stages, was shown more clearly by radiotracer, unless there was associated epididymal swelling or hydrocele. Chronic complications of inflammation, particularly abscess formation, were seen best by ultrasonography. Paratesticular masses could be studied only by ultrasound. These included both solid and cystic masses due to chronic epididymitis.

Retroperitoneal bleeding hemodialysis patients. A cause for morbidity and mortality.

Retroperitoneal bleeding in hemodialysis patients has been rearely reported. The diagnosis of this entity in the nondialysis patient is difficult, and factors such as chronic anemia and hypotensive episodes during hemodialysis are adding difficulty to the early diagnosis and therapeutic approach. A patient receiving long-term hemodialysis anticoagulation therapy had retroperitoneal bleeding and died without having his condition diagnosed: the retroperitoneal bleeding was masked by other events occurring during hemodialysis.

Multiform thyroid cancer-scintigraphic and echographic features.

In a patient with multinodular goiter, one of the three solid nodules harboring follicular carcinoma appeared functional in the 99mTc-pertechnetate image, yet "cystic" in both A-and B-mode echogram studies. The other two nodules corresponded in their image and echogram features and contained papillary and anaplastic carcinomas, and Hashimoto's thyroiditis. Clinical acumen proved to be the best guide in the management of this patient.

Intestinal perfusion studies using 133Xe during correction of mesenteric vascular insufficiency: case report.

Radioxenon clearance studies of bowel perfusion were obtained during laparotomy in a patient with mesenteric vascular insufficiency. These studies were obtained both before and immediately after bypass of the occluded superior mesenteric artery. Although clearance rates improved after the bypass surgery, normal rates were not achieved.

Diagnosis of hepatic hemangioma using multiple-radionuclide and ultrasound techniques.

Two cases of heptatic hemangioma are reported in which multiple-radionuclide and ultrasound techniques were combined in the diagnostic process. Blood pool imaging rather than perfusion imaging proved to be the most definitive diagnostic procedure. The application of radionuclide and ultrasound studies in the differential diagnosis of focal lesions of the liver is discussed.

Spontaneous drainage of a large cystic tumor.

A case is described of a 58 year old male who presented with a large mass on the left side of the abdomen which was found to be cystic by ultrasound. A presumptive diagnosis of pancreatic pseudocyst was made. Shortly thereafter, the mass drained spontaneously further suggesting this diagnosis. At surgery a month later, however, the mass was found to be a metastic leiomyosarcoma with cystic degeneration that had eroded into the gastric wall. This case serves to illustrate that cystic abdominal masses, even ones that drain spontaneously into the gastrointestinal tract, may not be pancreatic pseudocysts.