[Malignant external otitis. Apropos of 7 recent cases]. / Les otites malignes externes. A propos de sept cas récents.

Seven recent malignant external otitis are described. The authors report criteria of both etiology, bacteriologic, radionuclide scanning computed tomography. Now, for the positive diagnosis, the radionuclide scanning is essential. The computed tomographic scan provided the best anatomic imaging of the infection process. The treatment of choice is systemic antibiotic therapy as fluoroquinolones antibiotic. This antibiotic is active against P. Aeruginosa and has an excellent bone penetration. Only one patient died and another suffered from osteomyelitis of the base of the skull. The radionuclide scanning is very important for criteria of healing, particularly about stoppage of systemic antibiotic therapy.

[Localization of pheochromocytomas by 131-I-meta-iodobenzylguanidine scintigraphy]. / Localisation des phéochromocytomes par la scintigraphie à la 131I-méta-iodobenzylguanidine.

Scintigraphy using 131I-labeled meta-iodobenzylguanidine was performed in 89 patients. A diagnosis of pheochromocytoma was indicated by urinalysis in 28 cases and confirmed histologically in the 27 patients who underwent surgery. The tumor was located using scintigraphy and computed tomography. Fourteen isolated and 6 malignant metastatic pheochromocytomas were found as well as 8 pheochromocytomas associated with genetic disease. Scintigraphy located the tumors in 22 out of 28 cases; however, 3 adrenal pheochromocytomas and 3 malignant pheochromocytomas were not detected. Radioisotope perfusion scanning was more sensitive than computed tomography for the detection of bilateral adrenal pheochromocytoma. In the only case of a multifocal tumor, a combination of scintigraphy and computed tomography located all pheochromocytomas which were later resected. The high number of patients without elevated urine catecholamines and in whom scintigraphy did not alter the diagnosis shows that his technique should be applied only after demonstration of catecholamine hypersection.

Gallium-67 scanning in the staging of cryptogenetic fibrosing alveolitis and hypersensitivity pneumonitis.

Gallium-67 citrate is known to localize within inflammatory sites. Gallium-67 scanning is used for the evaluation of lung inflammation (i.e. alveolitis) during interstitial lung diseases. We investigated 27 patients with cryptogenetic fibrosing alveolitis (n = 17) and hypersensitivity pneumonitis (n = 10) using gallium-67 lung scanning and lung function tests (forced vital capacity, diffusing capacity, resting and exercise blood gases). Investigations were performed before and after one year of methylprednisolone treatment. None of eight healthy volunteers had any abnormal gallium-67 uptake. In all patients with cryptogenetic fibrosing alveolitis an initial abnormal gallium-67 uptake was observed (mean fixation index: 163 +/- 18). In addition, analysis of lung function tests a year after initial evaluation showed that unchanged or improving patients presented initially with a lower gallium-67 index than patients with evidence of deterioration (153.9 +/- 23.7 vs 251.0 +/- 23.3.; p less than 0.01). Similarly, among patients with hypersensitivity pneumonitis the index was lower in unchanged or improving patients than in those with deterioration (74.9 +/- 22 vs 226.7 +/- 4.9; p less than 0.05). Thus gallium-67 scanning is useful in the management of cryptogenetic fibrosing alveolitis and hypersensitivity pneumonitis.

Pitfalls and solutions in neuroblastoma diagnosis using radioiodine MIBG: our experience about 50 cases.

We have been among the first authors to point out that false negative cases could be observed with 131I-MIBG scintigraphy for neuroblastoma. We have observed until now ten of such false negative cases, 7 with primary tumor and 3 with bone metastases. Fifty 131I-MIBG scans were performed in 35 children with histologically proven neuroblastoma (24 grade IV) and compared to bone scans, CT and NMR images, ultrasound and clinical results. The visualization of the primary tumor shows a higher sensitivity with MIBG (79%) than with bone scans (47%) and a 100% specificity with each method. MIBG and bone scans, for bone metastases, are similar in the sensitivity (87.5%) but MIBG is much more specific (100%) than bone scan (81%). These results clearly confirm the superiority of MIBG scan for detection of primary tumor as well as bone metastases. However, MIBG is not always the most appropriate investigation, as shown by 11 observed pitfalls. Ten false negative cases have been observed and must be considered: in five out of 10 cases, bone scans performed with 99m Tc-HMDP made the diagnosis (3/7 cases of primary tumor and 2/3 cases of bone metastases). Moreover, one case was not usable due to a large digestive uptake. Our aim is to understand the reasons of the false negative by a meticulous analysis of every single case. The optimal procedure for neuroblastoma diagnosis, extent and follow up clearly seems to be the following strategy: MIBG scan must be firstly performed; in case of non-demonstrative scan the bone scan, which is complementary, will greatly contribute to the diagnosis.

[Analysis by broncho-alveolar lavage of the pulmonary uptake of gallium 67 in idiopathic diffuse interstitial fibrosis and sarcoidosis]. / Analyse par lavage broncho-alvéolaire de la fixation pulmonaire du gallium 67 au cours des fibroses interstitielles diffuses idiopathiques et des sarcoïdoses.

The pulmonary fixation of Gallium 67 has been studied by broncho-alveolar lavage (LBA) in a group of 10 cases of stage II pulmonary sarcoid, proven histologically, and in a group of 11 cases of idiopathic diffuse interstitial fibrosis (FID). The pulmonary activity of Gallium 67 was measured in vitro in a quantitative manner on a centrifuged clump and a supernatant of LBA as well as on the serum and in vivo in a semi-quantitative manner by the Line index. The alveolar Gallium activity has been correlated with different cytological and biochemical parameters of the lavage liquid. There was a narrow correlation in the serum between the Gallium 67 activity and the level of circulating transferrin. The fixation of Gallium in the cellular clump of LBA depends on the number of macrophages present in the clump and the total available radioactivity. The macrophages of the sarcoid and fibrosis cases picked up the gallium in a similar fashion, with an affinity all the more important as the total available radioactivity was weak. The radioactivity of the supernatant of the lavage liquid was quantitatively important and narrowly tied to the diffusible proteins present in the lavage. There was no correlation between the semi-quantitative Line index and the cytological or biochemical data in the fibrosis cases. In the sarcoid cases there was an inverse correlation with the polymorphonuclear leukocyte count. The semi-quantitative index was only correlated with alveolar gallium fixation level in the fibrosis group.(ABSTRACT TRUNCATED AT 250 WORDS)

Radionuclide bone imaging in diaphyseal aclasis with malignant change.

Chondrosarcoma is a rare complication in hereditary multiple exostoses. The six patients in this study have had a complete follow-up and constitute the largest group of such cases to have been studied so far. Five patients had histologic evidence of malignancy. Since histologic examination can be very difficult, any other diagnostic features, may it be clinical, radiologic, or scintigraphical, should be taken into account for early surgical treatment. Bone scintigraphic examination is a valuable adjunct to early diagnosis of malignant change by showing highest uptake in malignant areas. It is also very useful for posttherapeutic follow-up.

The hyperactive halo as a sign of renal graft death in 99mTc-DTPA studies.

In scintigraphic studies of renal transplants the absence of renal perfusion and clearance have been demonstrated to have many possible pathologic etiologies, vascular obstructions, and rejections. Increased perinephric activity was suggested as a sign of renal infarction and its absence may indicate potential renal viability. A case is presented in which a hyperactive halo was seen when the graft was dying.

[Endolymphatic curietherapy by lymphography with labelled lipiodol in Hodgkin's disease. A report on 408 cases (author's transl)]. / La curiethérapie endolymphatique par lymphographie au lipiodol marqué dans la maladie de Hodgkin. 408 observations.

The results of 373 lymphography examinations with radioactive lipiodol, conducted in 408 patients with Hodgkin's disease for diagnostic and prophylactic therapeutic purposes, during investigations carried out from 1966 to 1973 are analyzed. Tolerance was always excellent, especially from the hematological point of view. The efficacy of the procedure can be assessed by the fact that there were only 6% of failures (21/373) in glandular regions irradiated in this way for prophylactic purposes. Relapses occur more frequently in the inguino-iliac and lumbo-aortic regions than in the pelvic chains which were perfectly protected. This technique also enables both pelvic irradiation and ovarian protection in young women without any risk of failure. The procedure is particularly indicated in the following cases: supradiaphragmatic stages I and II, whatever the sex, and stage III especially in women. In sub-diaphragmatic stages I and II, it allows, in favourable cases, the ovarian function in women to remain intact by limiting external irradiation to invaded regions only.

[Bone scanning in children: technic and indications. Apropos of 50 cases]. / La scintigraphie osseuse chez l'enfant: technique et indications. A propos de 50 observations.

In children, radionuclide skeletal imaging with 99m Tc M. D.P. has been performed in 50 cases. Scans are done immediately, 20 minutes and three hours after injection. Osteomyelitis has been studied in 24 cases, Legg Perthes disease and benign bone tumors in the others. The scintigraphic patterns are very sensitive but not characteristic. However this exam seems to be essential in some orthopedic disorders of children.

[Comparison of serum levels of beta2-microglobulin and carcino-embryonic antigen in the follow-up of lung cancer (author's transl)]. / Comparaison des taux sériques de la beta2-microglobuline et de l'antigène carcino-embryonnaire dans la surveillance du cancer broncho-pulmonaire.

Serum levels of carcino-embryonic antigen (CEA) and beta2-microglobulin (beta2m) were assayed on 133 sera during follow-up of 31 patients with lung carcinoma (squamous cell ca. without recurrence : 2, squamous cell ca. with recurrence : 11, anaplastic cell ca. : 4, adenocarcinoma : 2, unclassifiable : 5). Normal creatinine (less than or equal to 12 mg/l) levels were found in all sera. CEA and beta2m levels showed no correlation nor in these groups, nor in the whole. The squamous cell carcinomas with recurrence showed the largest dispersion for CEA as for beta2m levels. However, the trends of serial beta2m values did not correlate with clinical features. Increasing or decreasing levels of CEA and beta2m levels showed no correlation in the whole nor in patients undergoing radiotherapy. In our experience, beta2m levels failed to correlate with clinical findings during the follow-up of lung cancer patients.

[Encephalic pseudotumoral toxoplasmosis in the course of blood diseases]. / Toxoplasmose encéphalique pseudo-tumorale au cours d'une hémopathie. Deux observations

The authors report two cases, the first pathological and the second clinical of pseudo-tumoural cerebral toxoplasmosis, occurring during the course of blood diseases. They refer to the conditions of appearance of this rare complication, with only twenty cases recorded in the literature, during malignant blood diseases. They stress the primordial role of immunological deficiency related either to the underlying disease (especially Hodgkin's disease) or to immuno-suppressive therapy. The clinical picture, with little in the way of typical features, is thus that of a diffuse méningo-encéphalitis. Pseudo-tumoural forms are rare. The authors also stress the minimum conditions required for the validity of the dye test and the value of the diagnosis of cerebral toxoplasmosis. An association of sulphadiazine-purimethamine, active and effective, cured the second patient.