Indium-111 antimyosin scintigraphy before and after coronary bypass surgery: unexpected preoperative myocardial uptakes.

The present study was designed to evaluate 111In-antimyosin scintigraphy in detecting pre- and post-operative myocardial infarction in patients undergoing coronary artery bypass surgery. Fab antimyosin scintigraphy has been shown to be sensitive and specific in detecting myocardial necrosis and to be potentially valuable in situations where other criteria are not reliable. In a previous study, postoperative antimyosin uptakes occurred in 82% of the studied patients. Sixteen consecutive patients with an indication of coronary artery surgery were assessed by preoperative coronary angiography, serial electrocardiograms, and myocardial scanning with 111Indium-labeled antimyosin antibodies performed before and after operation. In four patients, a recent myocardial infarction (1 to 3 months) was detected with an accurate localization when compared to the classic criteria of myocardial infarction. One more patient with a 21-year old myocardial infarction showed an intense uptake whereas there was no recent acute coronary event. Four other patients had an unexpected preoperative uptake, since there were no acute coronary events in their medical history. All preoperative scintigraphic uptakes were still present on the second scan performed postoperatively in these nine patients. Only one patient showed a new postoperative uptake when compared to the preoperative scan which was normal; this postoperative septal infarct was confirmed by a postoperative coronary angiography. Extracardiac uptakes (sternum and ribs) were frequently observed after operation and might hamper the interpretation of postoperative scintigrams. Unexpected preoperative uptakes may be related to non diagnosed small necrosis. A preoperative reference scan is required for an accurate interpretation of a postoperative 111In-antimyosin uptake. Moreover, extracardiac uptakes may limit the interpretation of perioperative cardiac damage.

Diagnosis of cerebral metastases by thallium 201.

We have studied the diagnostic potential of thallium 201 in cerebral metastases. Twenty-five patients with one or several metastases have been investigated with two tracers, 201T1 and sodium pertechnetate (99Tcm). With 201T1, all the cases gave a positive result within ten minutes of injection. In 88%, the definition was better, and in five cases (20%) small metastases which were invisible with 99Tcm could be demonstrated with 201T1. This radiotracer seems to promise greater diagnostic precision with an examination time of only 30 minutes.

Cinegammography and 3-D emission tomoscintigraphy for evaluation of revascularized mandibular bone grafts: a preliminary report.

The following reports a study conducted to investigate a scintigraphic monitoring procedure for bone free flap in mandibular reconstruction. This procedure is based on the one hand, on vascular and bone cinegammography, and on the other hand, on vascular and bone 3-D tomoscintigraphy. We used a prospective cohort study design. All patients who underwent free flap mandibular reconstruction from April 1993 to April 1998 in the Salpêtrière University Hospital, France (20 cases) have been evaluated in relation to this scintigraphic procedure. Vascular and bone scintigraphy were performed within the second week after surgery during 2 consecutive days. All images were read by one author (J.- Y. B.), who did not know the skin status of the flap. The results were compared with the viability of revascularized bone grafts as evaluated by the skin status and Greenberg classification based on bone radiographs three months after reconstruction. Vascular cinegammography seems to be closely related to anastomosis patency. Bone cinegammography gives appreciable information on bone viability. 3-D vascular tomoscintigraphy remains difficult to interpret. 3-D bone tomoscintigraphy gives precise information on the viability of the different segments of the bone flap. These results suggest that vascular and bone 3-D tomoscintigraphy coupled with cinegammography have an excellent prognostic value. In the event of partial failure it can give information on the location of the impaired patency and on the osseous fragment which has lost any viability.

[Indium III monoclonal antimyosin antibody scintigraphy for the detection of chronic myocardial infarction apart from the acute phase]. / Scintigraphie aux anticorps monoclonaux antimyosine marqués à l'indium 111 pour la détection de l'infarctus du myocarde en dehors de la phase aiguë.

Fab antimyosin scintigraphy has been shown to be sensitive and specific in detecting acute myocardial necrosis. This study was designed to evaluate the preoperative frequency of Indium-111 (In-111) antimyosin myocardial uptake in patients scheduled for coronary artery bypass surgery. The scintigraphic results were compared with other criteria of myocardial infarction (MI). Sixteen consecutive patients were included. Recent MI (1 to 3 months) were detected in four patients, with an accurate localization in three cases when compared to the classic criteria for MI. Two more patients had old Q wave MI: one did not show any uptake in the territory of MI whereas the second patient with a 21 year old infarct without recent acute coronary events showed an intense uptake consistent with the ECG and angiographic localization. Four other patients with stable angina showed limited uptakes that were unexpected, since there were no acute coronary events in their medical history, and ECG. Their left ventricle angiography were considered as normal. In these four cases, the scintigraphic location corresponded to a territory supplied by an occluded coronary artery (n = 2) or by a coronary artery with a tight stenosis requiring a bypass graft (n = 2). These antimyosin uptakes are probably related to small necroses which did not modify the ECG and did not alter the ventricular segmental wall motion. We conclude: 1) recent MI are detected by In-111 antimyosin scintigraphy; 2) In-111 antimyosin uptake may occur in patients without a diagnosis of recent myocardial infarction and correspond to older MI or limited necroses without detectable changes of the ECG and left ventricle angiography.

[Study of variations in the regional blood volume in the limbs under effort or thermal stress in arterial conditions (author's transl)]. / Etude des variations du volume sanguin régional au niveau des membres sous stimulus d'effort ou thermique dans les artériopathies.

The method of measuring the regional blood volume by labelling the erythrocytes with Technetium-99m has been applied to two groups of patients suffering either from arteritis of the lower limbs or from Raynaud's syndrome. A reduction in the blood volume during physical effort has been observed in arteritis of the lower limbs, followed by a rise of varying extent depending on the severity of the condition. In some cases surgical treatment has produced a particularly obvious effect on the variations in the blood volume, accompanied by a favourable clinical evolution. It has been found in patients suffering from Raynaud's syndrome that the reduction in the blood volume continues after the end of the exposition of the patients' hands to a temperature of 10 degrees C.

[Measurement of multiregional blood volumes: a cerebral vascular autoregulatory phenomenon (author's transl)]. / Mesure du volume sanguin multi-régional: phénomène d'autorégulation vasculaire cérébral.

The variations in regional cerebral blood volume (RCBV) during controlled severe hypotension induced by sodium nitroprusside were studied in a series of 29 patients with aneurysms (14), meningiomas (6) and arteriovenous malformations. Two characteristic variations were noted. The RCBV and mean blood pressure (MPB) vary inversely, this type of variation being known as "Active variation". When pathological lesions are present the RCBV and MBP are modified in the same direction in the regions affected and this is called "Passive variation". A quantitative study in 21 patients showed that in the healthy regions there was a change from the active to the passive mode of variation for a MBP situated between 44 and 52 mm of mercury.

[Bone scintigraphy in metastases]. / La scintigraphie osseuse dans les métastases.

The three fold interest of bone scintiscanning is discussed in relation to 182 cases of bone metastases of various origins. Firstly, this technic facilitates early diagnosis of invasion of the bone by the detection of metastatic lesions which, in 7.7% of cases are still infraradiologic, or even of reflex algodystrophy of the legs, which can be detected only from a scintiscan, long before X-ray plates can show the lumbar metastasis which is responsible. Secondly, the method is able to pick up more metastatic sites in 54.4% of cases than can be detected by X-ray; this is confirmed by investigation of the S/R ratio (ratio of the number of strongly binding sites to the number of sites showing radiologic damage) which is greater than unity for a considerable period. Thirdly, repeated scintiscanography provides a prognosis, because the survival time appears to be fairly closely correlated with the regression, stability or extension of strongly binding sites, although a "flare phenomenon" may give the erroneous impression that the metastatic process has deteriorated. Repeated scintiscanography also provides a good way of evaluating the efficacy of medical treatment, particularly in the case of bone metastases of mammary or prostatic origin. Sometimes, the decision for or against prophylactic or palliative orthopedic surgery may be based to a considerable extent on data provided by scintiscan.

The effect of tin on the tissue distribution of 99mTc-sodium pertechnetate.

When tin complex is administered prior to the injection of 99mTc-sodium pertechnetate, the distribution of the tracer is altered such that: (a) the concentration at foci of cerebral pathology is drastically reduced; (b) the concentration in the stomach (mucus cells), thyroid and salivary glands, and choroid plexus is greatly increased; and (c) there is a shift of the tracer from the plasma to the red blood cells. Bone studies utilizing a tin complex should be done after other organs have been evaluated.

Cerebral and extracerebral blood volume in generalized seizures in the baboon Papio papio.

Relative variations of the cerebral and extracerebral blood volume (CBV) were measured continuously by a novel atraumatic method in baboons to explore the relationship between changes in the systemic circulation and in the cerebral (and extracerebral) vascular responses, before, during and after generalized seizures induced by photic stimulation. Major bursts of generalized spikes and waves are accompanied by an increase of the mean arterial pressure and of the cerebral blood volume and a decrease of the nasal blood volume. During the seizure discharge a substantial increase in CBV occurs, associated with a dramatic increase in arterial pressure. However, the greatest increase in CBV occurs after the peak mean arterial pressure. The results show that the CBV does not passively follow the blood pressure and demonstrate the dramatic responsiveness of the nasal region to seizure discharge.

Importance of the plasma refilling rate in the genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration-haemodialysis.

The effects of ultrafiltration (UF) on plasma volume (PV) have been studied in eight patients using regular dialysis (RD) and controlled sequential ultrafiltration-haemodialysis (CSU) performed with a Rhodial 75 dialysis system. For a given value of UF the reduction of PV is determined by the plasma refilling rate. During CSU ultrafiltration induces a rapid increase in oncotic pressure without decreasing plasma osmolality. The high plasma refilling rate which can reach 1500 ml/hr allows moderate hypovolaemia despite high rates of UF and contributes to the usual good clinical tolerance of CSU. During RD a rapid decrease in plasma osmolality contributes to a water shift from the vascular space towards the interstitial and intracellular spaces and severe hypovolaemia can occur despite moderate ultrafiltration. CSU offers an adequate treatment for sodium overloaded patients with hypervolaemia, but is of no benefit in routine conditions.

[Studies of the kinetics of bone concentration of mdp-tc 99m in Paget's disease and various treatment methods]. / Etude de la cinétique de la concentration osseuse du 99mMDP-Tc dans la maladie de Paget et de ses variations sous traitement.

We did 27 bone scintiscans in 20 patients, 15 of whom had Paget's disease. Early variations of isotopic activity were analyzed in the pagetic bone, and in normal bone and muscle tissue using 3 parameters: A1 or the period of maximum activity obtained when the isotope was first injected into the circulation, A2 or the isotopic activity at 30 minutes, and P or slope of the curve in the change of activity between 15 and 30 minutes. These scintigraphic parameters, which seem to reflect the importance of the vascular phase (parameter A1) and of the metabolic activity of the bone (parameter A2/A1 and P) proved to be a good guide in following the course of Paget's disease. In 6 patients with Paget's disease who were treated with calcitonin (5 cases) or by etidronate disodium (1 case), we compared the changes in these isotopic parameters with the clinical and laboratory findings before and after treatment. We were able to note a good correlation between the clinical course of the illness and the scintiscans in most cases.

[New data from a comparative study of cerebral blood volume and EEG during epileptic seizures in Papio papio (author's transl)]. / Donnees nouvelles apportees par l'etude correlative du volume sanguin cerebral et de l'EEG au cours de crises e'epilepsie chez le Papio papio.

A new approach to the cerebral and extracerebral circulation phenomenon, during generalized seizure discharges (GSD) in the baboon is described. It is based upon the measurement of comparative variations of the regional blood volume (RBV) a new technique. First results demonstrate the existence of an extracerebral vascular structure of the face which is quite sensitive to the ictal phenomenon and which we have named the 'nasal region'. On the whole, when bursts of spike/waves occur the mean arterial blood pressure (MBP) and cerebral blood volume (CBV) increase moderately whereas the nasal blood volume (NBV) decreases. During the generalized seizure discharge, variations are much larger, increasing for MBP and CBV and decreasing for NBV. CBV variations do not passively follow those of MBP.

Diagnosis of cerebral lesions by Thallium 201.

The authors describe the diagnostic possibilities of Thallium 201 in cerebral lesions of various kinds. Two radiopharmaceuticals were used in 124 patients: thallium 201 citrate and technetium-99m pertechnetate labelled. When 201Tl was used, all cases of definite cerebral lesion gave a positive result within 10 minutes of injection. In 85.4% the definition was better, and small metastases which were invisible with 99mTc could be demonstrated. More than two-thirds of the time, neoplastic lesions were better defined and distinguished from adjacent normal areas of hyperactivity. 201Tl promises greater diagnostic usefulness with an examination time of only 30 minutes.

[Correlation between the regional blood volume and epileptic seizures in Papio papio]. / Corrélation entre volume sanguin régional et crise d'épilepsie chez le Papio papio.

The method of labelling red cells with technetium-99m was used to measured regional blood volume auring different types of epileptic seizures induced in the Baboon Papio papio. During seizures the cerebral blood volume increases and there is simultaneously a decrease of blood volume in nasal and hepatic regions, and a transitory increase of blood volume in the forepaws.

Hemodynamic changes induced by regular hemodialysis and sequential ultrafiltration hemodialysis: A comparative study.

The effects of a mean ultrafiltration of 2000 ml on hemodynamics during regular hemodialysis (RD) and during sequential ultrafiltration hemodialysis (SUH) have been compared in ten patients on maintenance dialysis. Each patient was submitted to two dialysis sessions at 2 days' interval. The hemodynamic studies were performed with a thermistor Swan-Ganz catheter. The control values of mean systemic arterial pressure, cardiac output, and heart rate were similar with either RD or SUH. During ultrafiltration without diffusion, there was an immediate prolonged and significant decrease in cardiac and stroke indexes and in pulmonary wedge pressure. The mean systemic arterial pressure remained unchanged as long as the total vascular resistance was significantly increased. During the diffusion period of SUH, total vascular resistance decreased, and seven patients became hypotensive. When ultrafiltration was associated with diffusion during RD, the total vascular resistance remained stable, despite a decrease in cardiac index. This was found to result in severe hypotensive episodes, despite a moderate ultrafiltration. These results suggest that diffusion can induce arterial vasodilation and poor hemodynamic adaptation to ultrafiltration-induced hypovolemia SUH, undertaken under careful medical control, appears to be an excellent procedure to deplete severely overhydrated dialyzed patients, but it should not be used routinely as a substitute for RD.