Jejunal intussusception of a gastric lipoma: a review of literature.

Gastrointestinal intussusception is an uncommon condition caused by a pendunculated, gastric tumor being forced through the pyloric sphincter and into the duodenum. An extremely rare case of gastrojejunal intussusception caused by a giant gastric lipoma is described in this article. The patient presented with anemia and weight loss. Initial gastroduodenal endoscopy failed to establish the diagnosis but abdominal ultrasound and computed tomography revealed signs of intussusception possibly associated with a lipoma of the small bowel. At laparotomy a pendunculated, submucosal, gastric lipoma, measuring 10 x 5 cm was found to have been intussuscepted into the jejunum. It was reduced and removed through a gastrotomy. Recovery was uneventful.

Single-photon emission computed tomography and early death in acute ischemic stroke.

Single-photon emission computed tomography with thallium-201-labeled diethyldithiocarbamate was performed in 26 consecutive patients less than or equal to 24 hours after a supratentorial brain infarction. Computed tomography excluded other relevant pathology. Two observers assessed the initial regional cerebral blood flow deficit using a semiquantitative visual method. The size of the initial flow deficit correlated negatively with the Barthel Index score (performance of the activities of daily living) after 6 months but not with the motricity index score (a measure of severity of the hemiparesis) after 6 months. The initial flow deficit was strongly correlated with early death from tentorial herniation; all five patients with the largest initial flow deficits died less than or equal to 6 days after the stroke, but among the 21 patients with smaller initial flow deficits only one died early (p = 0.00018, Fisher's exact two-tailed test). Although depressed level of consciousness, conjugate gaze deviation, and severe hemiparesis were more prevalent in the group of six patients who died early, the differences in prevalence between this group and the 20 patients who survived were not significant. Single-photon emission computed tomography is a relatively simple method to semiquantitatively measure a blood flow disturbance immediately after its occurrence. The magnitude of this blood flow disturbance is strongly related to early death from tentorial herniation. Because of these properties, single-photon emission computed tomography to measure regional cerebral blood flow can be of great use in acute stroke research.

SPET brain imaging with 201 diethyldithiocarbamate in acute ischaemic stroke.

Thirty-five patients with acute ischaemic stroke were studied within 24 h after hospital admission with thallium 201 diethyldithiocarbamate single photon emission tomography (201Tl-DDC SPET) and X-ray computed tomography (CT). 201Tl-DDC is a non-redistributing agent that allows postponed imaging after early administration and early therapeutic intervention. In 16 patients both investigations were performed within 24 h after stroke onset. The sensitivity of SPET was 94% and of CT 81% in the first 24 h, when hypodensity and obliteration of sulci were used as CT reading criteria. When only hypodensity was used as a criterion, the sensitivity of CT was 50% in this group. Sensitivity of CT compared with SPET became increasingly better in patients with older infarcts (1-18 days). In two-thirds of patients, the lesion demonstrated on SPET was larger than that on CT, and this was especially so with older infarcts. Crossed cerebellar diaschisis occurred in 69% of patients. The high sensitivity of 201Tl-DDC SPET in the first 24 h after ischaemic stroke and the favourable properties of this radiopharmaceutical make it a method of interest in the assessment of initial perfusion defects in early experimental stroke therapies.

Cerebral blood flow imaging with thallium-201 diethyldithiocarbamate SPECT.

Thallium-201 diethyldithiocarbamate ([201TI]DDC) was studied in humans as an agent for cerebral blood flow imaging. Brain uptake proved to be complete 90 sec after injection with no appreciable washout or redistribution for hours. Intracarotid injection suggested an almost 100% extraction during the first passage. Whole-body distribution studies demonstrated a brain uptake of 4.3% of the dose compared with 0.9% for [201TI]chloride. No differences were found in the distribution of [201TI]DDC versus [201TI]chloride in other organs. After the injection of 3 mCi 201TI, good quality single photon emission computed tomographic (SPECT) images of the brain were obtained with both a rotating gamma camera and a multidetector system. In ischemic brain disease, perfusion defects were easily demonstrated. We conclude that [201TI]DDC is a suitable radiopharmaceutical for SPECT studies of cerebral blood flow.

Functional brain imaging with I123-amphetamine. First experience in the Netherlands.

Single Photon Emission Computed Tomography (SPECT) has been used in the last five years as a method for cerebral bloodflow imaging, especially in cerebral infarction. In this study the first experiences in the Netherlands are presented. In 57.6% of our patients lesions, defined by SPECT were larger than those found by CT. This was not only seen in patients with cerebral infarction but also in hematoma. In 33.3% the size of the lesions were comparable. In 10 out of 14 patients with a solitary lesion in one hemisphere a decreased perfusion was seen in the contralateral cerebellar hemisphere. This phenomenon is called crossed cerebellar diaschisis. One patient with probably Alzheimer disease, showing a specific flow pattern, is discussed.

Thallium-201 diethyldithiocarbamate: an alternative to iodine-123 N-isopropyl-p-iodoamphetamine.

The study of cerebral blood flow by single photon emission computed tomography (SPECT) requires lipophilic radiopharmaceuticals. The high cost and limited availability of N-isopropyl-p-[I-123]-iodoamphetamine ( [123I]IMP) led us to search for alternatives. Following our recent development of thallium-201 diethyldithiocarbamate ( [201TI]DDC), we have compared the brain uptake of [123I]IMP and [201TI]DDC in rabbits. The brain bound 1.14 +/- 0.28% (s.e.m.) of the dose of the injected [123I]IMP and 1.46 +/- 0.28% of the [201TI]DDC. Brain activity of [201TI]DDC remained stable from 1.5 min after injection up to at least 1 hr. The [201TI]DDC uptake was more instantaneous than that of [123I]IMP. The ratios of gray to white matter distribution were about equal: 1.41 for [123I]IMP and 1.44 for [201TI]DDC. The lungs retained 8.32% of the dose of [123I]IMP and only 0.53% of the [201TI]DDC. In brain macroautoradiography [201TI]DDC yielded images of good quality with excellent demarcation of gray and white matter, persisting for at least 45 min after injection. We conclude that [123I]IMP and [201TI]DDC are equally suitable for blood flow study of the rabbit brain. The first human tomographic results obtained in two healthy volunteers demonstrate that clinical application of SPECT [201TI]DDC may be feasible.

Spinal extradural lipomas. Report of two cases.

Two patients with intraspinal extradural lipomas without associated spina bifida are presented. This type of lipoma is benign and uncommon. A summary of the relevant literature is given. The clinical and myelographic differential diagnoses are discussed and a few conclusions are drawn.