Intestinal activity visualized on radionuclide cisternography in patients with cerebrospinal fluid leak.

Several methods are used in conjunction with radionuclide cisternography for detecting cerebrospinal fluid (CSF) rhinorrhea or otorrhea, including positioning of the patient to induce drainage, placing cotton pledgets in the nostrils and ears for scintillation counting, and increasing the CSF pressure within the subarachnoid space. Presented here are three surgically proven cases of CSF leak where intestinal activity was detected at different intervals following the lumbar intrathecal administration of indium-111-DTPA for radionuclide cisternography. We recommend the addition of an abdominal image during radionuclide cisternography for CSF liquorrhea.

The effect of prolonged cardioplegic arrest on long-term ventricular function.

Twenty-five patients (15 coronary revascularizations and 10 valve replacements) having ischemic arrest times longer than 120 minutes (121 to 184 min) were studied by scintigraphy 7 to 27 months after operation. We sought to define if prolonged cardioplegic arrest could be correlated with late postoperative ventricular functional deterioration. Each patient had serial enzymes, EKG analyses, and a technetium pyrophosphate (PYP) scan immediately following operation to determine if an intraoperative infarct occurred which could predispose to functional deterioration. One coronary bypass patient (6.7%) suffered a perioperative myocardial infarct. After a follow-up period of 7 to 25 (mean 17.9) months, none of the 15 patients has developed recurrent angina, infarction or congestive heart failure. Comparing preoperative and late postoperative ventricular function, 3 patients (20%) had a greater than 10% fall in ejection fraction (EF) and 3 (20%) a greater than 10% rise. Mean EF (15 patients) prior to operation was 57.8 +/- 4.7% and at restudy 59.0 +/- 4.6%. One valve replacement patient (10%) suffered a perioperative infarction. After a follow-up period of 16 to 27 (mean 19.9) months, all patients continue to do well. Comparing preoperative to late postoperative ventricular function, 3 patients (30%), had a greater than 10% fall in EF and 2 (20%) a greater than 10% rise. Mean EF (10 patients) prior to operation was 60.5 +/- 5.0% and at restudy 60.1% +/- 5.8%. It is concluded that prolongation of cardioplegic arrest beyond 2 hours is well-tolerated in most patients. Routine early postoperative tests were not useful in prognosticating late functional deterioration in 4 of 6 patients not suffering a perioperative infarction, and in these patients depressed function may be secondary to myocardial fibrosis.

Thyroid imaging with iodine-125 and technetium-99m.

Eighty-eight patients referred consecutively for thyroid imaging were studied. Each patient was scanned with a 3'' rectilinear scanner using both 125I and 99mTc. The paired scans were evaluated independently by two physicians experienced in thyroid evaluation and image analysis. The images were ranked on a scale from 1 to 5 as follows: 1) 125I scan much better than the 99mTc scan, 2) ..., 3) 125I scan and 99mTc scan the same, 4) ..., 5) 99mTc scan much better than 125I scan. The scores were statistically analyzed by the sign test and transformed normal score methods. Categories analyzed were: A. Hypothyroid, B. Euthyroid, C. Hyperthroid, (A-C based upon RAIU measurements), D. Cold Nodules, E. Graves Disease, F. Hot-Nodules, G. Multinodular Nontoxic Goiter, H. Miscellaneous and I. Normal. The significance of this study is that regardless of the classification we used, in no category was the 99mTc scan considered better than the 125I scan. This finding is at variance with the observations of some others comparing 99mTc with other iodine radioisotopes. 99mTc may have some procedural advantages and does deliver a lower radidation dose to the thyroid.