Evaluation of nasal mucociliary clearance after medical or surgical treatment of chronic rhinosinusitis.

An evaluation of mucociliary clearance, with the use of rhinoscintigraphy and other objectives and subjectives measures, in medically and surgically treated patients with chronic rhinosinusitis, as well in patients with or without nasal polyposis, can add to the understanding of ciliary function and its role in the pathogenesis of chronic rhinosinusitis. Thirty-four patients medically treated and 21 surgically treated (FESS) patients evaluated with rhinoscintigraphy, CT-scans, and SNOT-20. Nine of the surgically treated patients had nasal polyps and studied as a separate group. Although the various groups differ on Lund-Mackay scores (H = 11.659, P = 0.003) and SNOT-20 results (F = 26.904, P < 0.001), a statistically significant difference between mucociliary transport velocity (MTV) values could not be found. Moreover, multiple linear regression could not prove a statistically significant correlation between MTV and other variables. The various groups of chronic rhinosinusitis patients cannot be differentiated on the basis of possible nasal mucociliary clearance alternations.

Preliminary results of the use of Re-186-HEDP for palliation of pain in patients with metastatic bone disease.

We evaluated the effectiveness of Re-186-HEDP in 25 patients with painful metastatic bone disease. Twenty-five patients with known prostatic (n = 19), non-small-cell lung cancer (n = 1) and breast cancer (n = 5) and multiple confirmed skeletal metastases were studied. All were taking analgesics daily (nonsteroidal antiinflammatory drugs/opiates). Re-186-HEDP (mean 35.2 mCi) was administered and patients were monitored for at least 50 days. In five patients, a repeat dose was administered 9 to 10 weeks later. The evaluation of the analgesic effect was based on a "pain diary" and by recording the use of analgesics. In 80% (20 of 25) of the patients, the effect was significant palliation, moderate in 3 patients (12%), and insignificant in 2 (8%). No significant myelotoxicity was observed. Transient pain flare was recorded in 8 of 25 patients. These results indicate that Re-186-HEDP can offer pain palliation in patients with painful bone metastases without being complicated by significant myelotoxicity.

Scintigraphic imaging of sarcomatous tumors with [(111)In-DTPA-phe-1]-octreotide.

The objective of the present study was to investigate the efficacy of (111)In-DTPA-octreotide (OC) for in vivo scintigraphic imaging of these relatively uncommon tumors. Thirteen patients (9 males, 4 females, mean age 59 years) with known sarcomatous lesions were studied. All patients had known lesions as demonstrated by previous investigation with other modalities, e.g. CAT, MRI. Following intravenous injection of 10 microg of OC labeled with 2.8-4.2 mCi (111)In, planar imaging was done at 6 +/- 1 and 22 +/- 2 h, respectively. Histologic verification was obtained in all cases, either from fine needle aspiration or from surgically removed tissue. Positive imaging was observed in 12/13 cases (92.3%). One scan was false-negative (7.7%). Occult lesions were demonstrated in two patients. The histologic typing and the scintigraphy results were: fibrosarcoma (1+/1), embryonic rhabdomyosarcoma (1+/1), leiomyosarcomas (3+/3), liposarcomas (2+/2), uterine sarcomas (2+/2), HIV (-) Kaposi sarcoma (1+/1), osteosarcoma (1+/1), chondrosarcoma (1-/1) and neurogenous sarcoma (1+/1). OC appears to have properties that lead to a new indication for its use. Other possible applications relate to the therapeutic use of octreotide either unlabeled or labeled with a beta-emitting radionuclide, as well as its use in radioimmunoguided surgery. Regarding the latter, our preliminary results are encouraging.

Radioimmunoscintigraphy in patients with ovarian cancer.

The targeting potential of three different monoclonal antibodies (MAbs) was assessed in patients with ovarian cancer. HMFG1, OC-125 and H17E2 labelled with 111In or 123I were evaluated prospectively for their ability to localize ovarian tumour. Forty two patients with ovarian cancer, aged 40-78 years (median = 58 years) were studied using OC-125 (n = 9), HMFG1 (n = 11) and H17E2 (n = 22). Imaging data were compared with the CT and the surgical findings. Presence of tumour was confirmed in 35/42 (83%) patients (8/9 OC-125, 10/11 HMFG1 and 17/22 H17E2) and correlated well with the conventional radiology diagnostic methods. One patient with a negative H17E2 scan and a large abdominal mass detected at laparotomy revealed a PLAP-negative tumour on immunohistochemistry. Scintigraphy revealed the presence of active disease, confirmed by laparotomy/laparoscopy in 6/8 patients considered to be in clinical remission. The sensitivity of the method was high enough and the diagnostic contribution of this approach should be further evaluated.

Technetium-99m-tetrofosmin for parathyroid scintigraphy: comparison to thallium-technetium scanning.

UNLABELLED: The efficacy of 99mTc-tetrofosmin for the detection of parathyroid lesions was investigated prospectively in patients with hyperparathyroidism referred for surgical treatment. METHODS: Twenty-seven patients with primary and 18 with tertiary hyperparathyroidism were studied. Twelve patients had undergone one or more previous neck explorations. Static imaging with 201Tl was performed first, immediately followed by a 30-min 99mTc-tetrofosmin dynamic study. Delayed views of up to 3 hr postinjection were also obtained. Technetium-99m-pertechnetate was used for thyroid delineation. The tetrofosmin/99mTc-pertechnetate subtraction scan (TF/TC), the single-tracer washout technique and the thallium/technetium subtraction (TL/TC) were compared. Quantification of relative uptakes of tracers in the thyroid and abnormal parathyroids was accomplished by measuring activity within regions of interest. Kinetics of tetrofosmin in the thyroid and abnormal parathyroids were studied by evaluating the plots of the parathyroid to thyroid ratios against time as well as by calculation of the half-clearance times from the slow component of the time-activity curves. RESULTS: The overall sensitivity, specificity and accuracy of TF/TC and TL/TC were 76%, 92% and 83% and 52%, 85% and 65%, respectively. The respective sensitivities were 87% and 70% for adenomas and 72% and 46% for hyperplasia. The parathyroid-to-thyroid activity ratios of tetrofosmin were significantly higher than those of thallium (p < 0.001). The tetrofosmin single-tracer washout study was less accurate than the subtraction technique (overall sensitivity and specificity, 70% and 69%, respectively). The washout properties of tetrofosmin in abnormal parathyroids were not substantially different from those in the thyroid, with a few exceptions (p = 0.4). No correlation of half-clearance times with parathyroid size, degree of early uptake, parathyroid hormone levels or histology could be established. Comparing adenomas to hyperplasia in respect to tetrofosmin retention, a statistically significant difference was observed (p = 0.005). CONCLUSION: Technetium-99m-tetrofosmin is suitable for parathyroid imaging. The kinetic properties of this agent in parathyroid and thyroid tissues do not warrant differential washout protocols. The diagnostic impact of the observed difference in tetrofosmin kinetics between parathyroid adenomas and hyperplasia requires further investigation.

Successful localization of an occult ACTH-secreting bronchial carcinoid tumour with 111indium-DTPA labelled octreotide.

Ectopic ACTH secretion due to occult carcinoid tumours is an occasional cause of ACTH dependent Cushing's syndrome. In many cases the ectopic source may be obvious, but sometimes no obvious source is evident, the so-called occult ectopic syndrome. Due to their small size, localization of such occult tumours, particularly bronchial carcinoids, may be extremely difficult. Whole body CT and venous sampling studies have been used but are not always successful in determining the site of such lesions. We report a 40-year-old patient with the ectopic ACTH syndrome due to a 0.6-cm bronchial carcinoid tumour which was successfully localized by 111indium-DTPA labelled octreotide scintigraphy.

Fibrin glue for sealing the needle track in fine-needle percutaneous lung biopsy using a coaxial system: Part II--Clinical study.

PURPOSE: Following percutaneous lung biopsy (PLB), we used fibrin glue as a sealant in 26 patients for the purpose of decreasing the incidence of pneumothorax. METHODS: All 26 patients (group A) had chronic obstructive pulmonary disease (COPD). The results for group A were compared with a control group of 32 patients (group B), also with COPD and in whom fibrin glue was not used. All biopsies were conducted under computed tomography (CT) using a coaxial needle system consisting of 19-gauge and 22-gauge needles. RESULTS: Pneumothorax developed in five patients (19.2%) in group A and in one instance, drainage was required (3.8%). In group B, pneumothorax developed in 13 patients (40.6%) and in six instances (18.8%) drainage was required. Comparing the use of chest-tube drainage in the two groups, a statistical significance was observed, p < 0.0025). No adverse reactions related to the fibrin glue were observed. CONCLUSION: Our results indicate that fibrin glue is a safe sealing material for lung PLB and serves to decrease the incidence and, in particular, the severity of pneumothorax, especially in high-risk patients.

Fibrin glue for sealing the needle track after percutaneous lung biopsy: Part I--Experimental study.

PURPOSE: Evaluate the effectiveness of fibrin glue for the embolic occlusion of needle tracks following percutaneous lung biopsy (PLB). METHODS: Twenty-six rabbits underwent computed tomography (CT)-guided PLB using a coaxial system consisting of 19- and 22-gauge needles. Thirteen rabbits were used as controls (group A). In 13 other rabbits (group B), fibrin glue labelled with I131 fibrinogen and contrast medium was injected into the track. Both groups were examined by CT for the presence and severity of pneumothorax (mild: less than 20%; severe: more than 20%). Group B was also examined scintigraphically and their lungs were studied histologically. RESULTS: In group A, pneumothorax developed in eight animals (61.6%) and was severe in six (46.1%) whereas in group B, pneumothorax developed in five animals (38.5%) and was severe in one (7.7%). Though the difference between the two groups in overall incidence of pneumothorax was not significant (p > 0.1), it was significantly higher (p < 0.025) for severe pneumothorax in group A. No signs of systemic embolism were observed. CONCLUSIONS: Based on this animal model, fibrin glue is a safe and useful sealant following PLB and reduces the incidence of severe pneumothorax.