Evaluation of brain perfusion with technetium-99m bicisate single-photon emission tomography in patients with depressive disorder before and after drug treatment.

Depression is one of the most common psychiatric illnesses. Its influence on brain perfusion has been demonstrated, but conflicting data exist on follow-up after drug treatment. The aim of our study was to evaluate the effects of antidepressant drugs on regional cerebral blood flow (rCBF) in patients with depression after 3 weeks and 6 months of drug therapy. Clinical criteria for depression without psychosis were met according to psychiatric evaluation. Severity of depression was evaluated with the Hamilton Depression Rating Scale (HAMD) before every scintigraphic study. rCBF was assessed using technetium-99m bicisate (Neurolite) brain single-photon emission tomography in nine patients with severe depression before the beginning of antidepressant drug therapy and 3 weeks and six months after initiation of therapy. Only patients with no change in antidepressant medication during the study were included. No antipsychotic drugs were used. Cerebellum was used as the reference region. rCBF was evaluated for eight regions in each study in three consecutive transversal slices. Follow-up studies were compared with the baseline study. The mean HAMD score was 25.5 points initially, 16 at the second examination and 8.8 after 6 months. Global CBF was decreased compared with the reference region in drug-free patients. Perfusion of left frontal and temporal regions was significantly lower (P < 0.005) in comparison with the contralateral side. After therapy, a moderate decrease in perfusion was seen in the right frontal region (P < 0.05). Perfusion decreased further after 6 months in the right frontal (P < 0.005) and temporal regions (P < 0.01). The highly significant asymmetry in perfusion between the left and right frontal and temporal lobes almost disappeared during treatment. Our findings implicate dysfunction of the frontal and temporal cortex in clinically depressed patients before specific drug treatment. Clinical improvement and decreases in HAMD score after 3 weeks and after 6 months reflect the treatment effect on mood-related rCBF changes.

Relevance of Tc-99m DMSA scintigraphy in renal transplant parenchymal imaging.

Tc-99m DMSA renal scintigraphy was performed in 40 renal grafts. Cyclosporin A and glucocorticoids were given to all patients as antirejection therapy, and 11 also were given azathioprine. The kidneys were transplanted 1 to 97 months before the investigation. Seventy percent of kidneys had diffusely altered distribution of Tc-99m DMSA, and 43% had focal clear-cut parenchymal defects. The frequency of parenchymal defects observed on the DMSA scans was higher in patients who suffered manifest acute rejection episodes (8/16 versus 9/24 patients, borderline significance, P < 0.06), but had no relation to the living or cadaveric donor transplant or its function. A combination of peritubular edema and interstitial fibrosis is considered the most probable explanation of diffuse changes. The high frequency of clear-cut parenchymal defects most likely results from symptomatic or asymptomatic rejection episodes complicated by renal transplant infarcts.

Long-term follow-up after heterotopic splenic autotransplantation for traumatic splenic rupture.

The trapping function of the heterotopic splenic autotransplants (HSA) in 13 polytraumatized patients, aged 5-38 yr, was evaluated using heat damaged technetium-99m-labeled autologous red blood cells in early (1-7 mo) and late (3-4.5 yr) period after heterotopic autotransplantation to the omentum. The intensity of tracer accumulation was graded in comparison to the liver uptake. The splenic tissue surface was calculated on anterior projection each time. The shapes of the transplants were compared and new uptake foci suggesting spontaneous splenosis were looked for on both scans. The average surface of HSA was 28.2 (+/- 14.7) cm2 on early and 44.1 (+/- 14.3) cm2 on late examination (p less than 0.003) and the increase in intensity of tracer accumulation on both occasions was significant as well (p less than 0.0001). In three patients, some additional splenotic foci were found on follow-up scans. Howell-Jolly bodies in peripheral blood were detected in six of eight patients in early and remained detectable in lower number in three of eight patients on follow-up. No serious infection was noticed in our group of patients. Our work confirmed the excellent survival rates of HSA with improving trapping function and no important spread from original implantation site on long-term follow-up.

Reproducibility of quantitative hexakis-2-methoxyisobutylisonitrile single photon emission tomography in stable coronary artery disease.

The quantification of myocardial perfusion abnormalities is necessary to allow comparison of repeated studies, especially in the evaluation of the success of medical, interventional or combined treatment in stable coronary artery disease or in evolving myocardial infarction. The purpose of this study was to assess inter-observer reproducibility of tomographic study processing using a semi-automatic quantitative programme. Technetium 99m hexakis-2-methoxyisobutylisonitrile (99mTc-Sestamibi) was chosen for tomographic imaging of repeated rest-stress studies in patients with stable coronary artery disease. The quantification was performed using a modification of the Cedars polar coding and comparison with the normal data base. The perfusion defects were quantified separately for each standard perfusion area [left anterior descending (LAD), right coronary (RCA) and left circumflex (LCX) arteries] and total area of hypoperfused myocardium. The inter-observer variability for 40 tomographic studies was accomplished. The defects were the largest in the LAD perfusion area (average 19.7% of the normalized LAD supply area) with an inter-observer correlation of 0.84 for this region. The greatest variability was found for the LCX region (r = 0.55) and is attributed to a small average perfusion defect (7.1%), only 18 studies having abnormal perfusion in this area. In total, an average 14.3% of the left ventricular myocardium was significantly hypoperfused, and the inter-observer correlation was 0.87. These results show good inter-observer reproducibility using semi-automatic quantitation of perfusion defects. Careful interpretation of smaller defects in the evaluation of treatment results is advised when repeated 99mTc-Sestamibi single photon emission tomography studies are processed by more than one observer.

Romano-Ward syndrome: case report, family study and signal averaged electrocardiogram.

A family with the Romano-Ward syndrome is described. A 28-year-old woman had episodes of syncope due to self-terminating ventricular tachycardia torsades de pointes. During lidocaine treatment she developed a sustained ventricular tachycardia and cardiopulmonary resuscitation was necessary. Propranolol reduced ventricular ectopic activity, but the QTc interval remained prolonged. A "threshold" in QT duration for the generation of complex ventricular arrhythmias was observed in the patient. There were no late ventricular potentials noted in the signal averaged ECG in the patient and in members of her family.