Lung scan evaluation of thrombolytic therapy for pulmonary embolism.

UNLABELLED: Data from three trials of thrombolytic therapy for pulmonary embolism (PE) were combined to assess the utility of perfusion lung scan defect scoring in predicting the response to thrombolytic therapy. METHODS: Pre- and post-therapy lung scans and duration of symptoms were available for a total of 221 patients, 167 were treated with various thrombolytic regimes and 54 were treated with heparin alone. RESULTS: Improvement in the lung scan defect score was correlated with larger initial defect score (r = 0.53), segmental appearance (r = 0.31) and shorter duration of symptoms (r = 0.20). There was no significant residual correlation between improvement and segmental appearance in a multiple regression analysis after accounting for initial defect score and duration of symptoms. Two lung scan scoring methods (segmental and anterior-posterior method) provided similar results with low interobserver variability (r = 0.90 for both methods). CONCLUSION: This study indicates that the baseline perfusion lung scan defect severity helps to predict the response to thrombolytic therapy.

Gastric Ga-67 uptake in patients with lymphoma.

Gastric accumulation of Ga-67 greater than that seen in the liver was observed in 16 of 162 (9.8%) patients with lymphoma. Endoscopic biopsies in six patients showed one instance each of histiocytic lymphoma, mixed cellularity Hodgkin's disease, adenocarcinoma, and hiatal hernia with mucosal deformity, as well as two instances of benign gastric ulcer. All six patients had chronic gastric symptoms, as well as persistent radiogallium accumulation on sequential examinations of 2 years duration. The remaining 10 patients exhibited transient radiotracer gastric uptake and only two has gastric symptoms. Persistent gastric Ga-67 accumulation is not common in lymphoma and warrants endoscopy when accompanied by prolonged symptoms.

Gallium-67 scintigraphy as an aid in the detection of spinal epidural abscess.

Gadolinium-enhanced MRI is considered the study of choice for diagnosing spinal epidural abscess (SEA). Most of such cases, however, are not suspected initially, and thus do not benefit from the procedure. A case of SEA is described in which positive Ga-67 scintigraphy shortly before onset of lower extremity dysfunction was instrumental in obtaining an emergency gadolinium-enhanced MRI and establishing the diagnosis.

Identification of penile prosthetic infection on 67gallium scan.

We report on a patient who presented with unexplained fever 7 weeks after placement of a penile prosthesis. A whole body 67gallium scan demonstrated a peri-prosthetic infection, which was confirmed at surgery.

Intrathoracic splenosis mimicking metastatic lung cancer.

A case of posttraumatic intrathoracic splenosis mimicking lung cancer is presented. The diagnosis was made by a radiocolloid liver-spleen study followed by a heat-damaged Tc-99m labeled red cell scan. A favorable change in the staging of the patient's real contralateral lung cancer resulted.

Gastric uptake of gallium-67 in AIDS.

We describe gastric localization of 67Ga in 13 patients with acquired immunodeficiency syndrome (AIDS) among 148 referred primarily to rule out Pneumocystis carinii pneumonia (PCP). Endoscopic biopsies in five of the patients indicated cytomegalovirus (CMV) infection in one, gastritis in two, and normal tissue in two. Other associated, but nongastric, infections in these 13 patients included esophageal candidiasis, PCP, Mycobacterium avium-intracellulare (MAI) complex, coccidioidomycosis, toxoplasmosis and Isospora belli. Only six of the patients exhibited gastric symptoms, and even fewer proved to have gastric pathology. Although gastric 67Ga uptake in a patient with AIDS may not require specific treatment, opportunistic infections as a possible cause of gastritis should be considered.

Pulmonary embolism: segmental appearance of perfusion lung scan defects correlates with successful response to thrombolytic therapy.

Lung scan data from a series of 45 patients receiving thrombolytic therapy were reviewed to determine if any pattern on the pretherapy perfusion lung scans could be identified that predicted response to therapy. A segmental appearance on the pretherapy scans (complete or nearly complete absence of perfusion in a whole segment or a very large subsegment) was correlated with the amount of improvement in perfusion on lung scans obtained 24 hours after the start of thrombolytic therapy. As a group, patients with a segmental appearance on the pretherapy lung scans had more improvement in the perfusion reduction score than patients with a nonsegmental appearance (P less than .005). However, the correlation between segmental appearance and a favorable response to thrombolytic therapy was not strong enough to allow use of this appearance in the selection of patients for therapy.

Hepatic scintigraphic changes associated with gestational trophoblastic disease.

We reviewed the results of radionuclide liver imaging in 70 patients newly referred for evaluation and treatment of persistent gestational trophoblastic tumors. Some 58 patients (83%) had abnormal liver scans but no focal defects and no discernible hepatic malignancy. These diffusely abnormal scans may reflect chemotherapeutic and/or hormonal effects on the liver and should not be interpreted as indicative of metastases.

Hematologic abnormalities in adolescents who take oral contraceptive pills.

PIP: Sexually active patients (12 to 19 years of age) participated in a study designed to determine if adolescents who take oral contraceptives are susceptible to hematologic abnormalities. This involved individual medical histories recording vitamin ingestin, alcohol consumption, type of contraceptive used, duration of usage and menstrual cycle. Blood samples were drawn for determinations of serum folate, B12, ferritin, blood count and polymorphonuclear leukocyte lobe count. Results indicate that adolescents with nutritionally poor diets are potentially high risks for developing folic acid deficiency while taking oral contraceptives. The data indicate no significant differences in the mean hemoglobin, red blood cell indices or polylobe count in either the patient or control group. The authors stress a need to gather more data on the effects of long term contraceptive pill usage. It is concluded that although contraceptive pill use appears to increase the risk of developing cellular folate deficiency, especially in white women, the pill appears to offer some protection against iron deficiency and is not associated with anemia.^ieng

Elevation of serum uric acid as a clue to alcohol abuse.

Hyperuricemia in unselected admissions to a general hospital was found to be a significant correlate of alcohol abuse in male subjects. Unexplained elevation of the serum uric acid level should always stimulate inquiry for the behavioral features of alcoholism.

The effect of cancer chemotherapeutic agents on the liver-spleen scan.

The effects of short-term cancer chemotherapy on the liver-spleen scintiscans of 15 patients were assessed. Half of these exhibited minimal and transient changes in the pattern of radiocolloid distribution and/or chemical liver-function tests. No examples of new focal defects were seen. The data suggest that cytotoxic drugs are capable of inducing minor scan changes that might be attributed erroneously to intrinsic hepatic disease.

Evaluation of hepatobiliary imaging by radionuclide scintigraphy, ultrasonography, and contrast cholangiography.

Cholescintigraphy, ultrasonography, and contrast cholangiography were compared in 60 patients. Among those having abdominal pain but no biliary disease or jaundice, cholescintigraphy was normal in 14/14, ultrasound in 10/13, and cholangiography in 13/14. Jaundice due to hepatocellular disease was correctly distinguished from complete biliary obstruction by cholescintigraphy in 17/17 patients and by ultrasound in 14/17. In cholelithiasis, ultrasound was abnormal in 10/12 and cholangiography in 7/9. Cholescintigraphy appeared most sensitive to active cholecystitis; only cholangiography and ultrasound visualized gallstones.

A sex difference in the serum vitamin B-12 levels of hospitalized alcoholics.

The relationship of elevated serum vitamin B-12 concentration to alcoholism in general hospital patients was studied both in a retrospective and in a prospective group of patients. Alcoholism was the most common disease correlate of vitamin B-12 elevations in females. Of the unselected female alcoholics, 61% had a serum vitamin B-12 concentration larger than or equal to 1000 ng/liter at the time of admission; only 17% of the nonalcoholics, whatever their other disease, exhibited such high values. The sensitivity of high B-12 levels for alcoholism in females paralleled that of high SGOT, GGT and MCV values. In contrast, males (approximately 70% of our alcoholics) far less often exhibited B-12 elevations even when SGOT, GGT and MCV were abnormally high. Elevation of serum B-12 concentration should always raise the suspicion of alcohol abuse, especially in females.

Optimizing the clinical value of hepatic scintiphotography.

Hepatic scintiphotography serves as a highly useful anatomic liver function test. When the descriptive features of the liver scan are carefully related to underlying pathology, the resulting data base permits a detection sensitivity of 90% for metastatic cancer and for the diffuse parenchymal diseases. The consequences of false positive (FP) interpretations for patient care must be minimized by attention to perceptual and technical details, by incorporating other tests into the evaluative algorithm, and by knowledge of the distribution of diseases in the population examined. The liver scan would be more beneficially applied to patient management if referring physicians were made aware of its capabilities. They, in turn, must develop more explicit strategies for disease management in order that scintiphotography be effectively applied in clinical decision making.

Congenital hypertrophic pyloric stenosis: the role of gastrin reevaluated.

In order to evaluate the potential role of gastrin in the etiology of pyloric stenosis, serum gastrin levels were measured in cord blood of affected infants, matched controls, and mothers of both. No differences were identified when values from infants with pyloric stenosis were compared with those from control infants. Mean cord serum gastrin levels of the infants were significantly greater than the mean maternal gastrin levels. The data effectively dismiss the possibility that elevated serum gastrin concentration in mother or infant at the time of delivery can be implicated as a cause of pyloric stenosis.