Gastric emptying of semisolids and pouch motility following laparoscopic adjustable gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been popularized as an effective, safe, minimally invasive surgical technique for the treatment of morbid obesity. We performed a pilot study to evaluate gastric emptying of semisolid meals and antral motility following LAGB. METHODS: Gastric emptying half-time was compared in normal volunteers and morbidly obese patients before and 6-12 months after LAGB using sulfur colloid-labeled semisolid meals. RESULTS: There was no difference in mean age between groups. Women were prevalent in the group of obese patients. BMI was higher in patients before surgery (p < 0.001). Patients following LAGB demonstrated prolonged gastric pouch emptying (T1/2 = 36.6 +/- 9.8 min) compared to subjects without surgery (23.8 +/- 4.7 min) and healthy volunteers (22.8 +/- 6.8 min; p < 0.001). Similar gastric contractility was found all groups (3.3 +/- 0.4; p = 0.968). No cases of band slippage or pouch dilatation were observed during mean follow-up of 11.4 months. CONCLUSIONS: A standard normal gastric pouch emptying rate of semisolids in asymptomatic patients after LAGB was established. Postoperative prolongation of gastric emptying is a matter of mechanical delay without gastric pouch denervation. This study provides a first step of future functional evaluation of complications following this type of bariatric surgery.

Leukocyte scintigraphy SPECT/CT software fusion diagnosis of infected gastric band.

The prevalence of morbid obesity is increasing worldwide and presents a significant clinical problem. Laparoscopic adjustable gastric banding has been popularized as an effective, safe, minimally invasive surgical technique for the treatment of morbid obesity. Different diagnostic imaging modalities are crucial for follow-up of "banded" patients and detection of the different postoperative complications. We present a case report including detailed clinical, laboratory, radiological, and scintigraphic findings in a 50-year-old woman with an infected gastric band diagnosed by technetium 99m-hexamethyl propilenamine oxime-labeled leukocyte scintigraphy and discuss the value of integrated interpretation of anatomical and functional imaging modalities obtained by software fusion technique.

Growth Plate Suppression in an Adolescent Patient With Acute Lymphoblastic Leukemia After Treatment.

Osteotoxic effect is a common adverse effect of chemotherapy for childhood acute lymphoblastic leukemia. The pathophysiology of impaired bone growth is multifactorial and can affect both osteoblast and osteoclast function. Significant contribution in affecting skeletal metabolism belongs to high-dose corticosteroid treatment. We present the case of a 12-year-old adolescent girl who was treated for high-risk pro-B acute lymphoblastic leukemia. The Tc-MDP bone scan, as a sensitive indicator of osteoblastic activity, shows that growth plate inhibition after intensive treatment may be temporary and reversible.

Unilateral Tc-99m pertechnetate breast uptake: is it always benign?

Although the thyroid gland is the principal organ with the ability to concentrate iodide and take up Tc-99m pertechnetate, other tissues such as choroid plexus, salivary glands, mucoid cells of stomach, and lactating breast tissue also possess this property. The lactating mammary gland can concentrate iodide, which mediated by sodium/iodine symporter (NIS) is actively transported and secreted in the milk, to supply iodide to the newborn for the biosynthesis of thyroid hormones. The authors present an uncommon case of unilateral Tc-99m breast uptake in a breast-feeding woman.

Pituitary incidentalomas detected with technetium-99m MIBI in patients with suspected parathyroid adenoma: preliminary results.

Tc-99m MIBI (MIBI) is a cationic lipophilic agent, which has traditionally been used for myocardial perfusion scintigraphy, detection and monitoring of different benign and malignant tumors. The objective of this study was to evaluate the frequency of pituitary incidentalomas detected on MIBI scans performed on patients with suspected parathyroid adenomas and to provide semiquantitative analysis of tracer uptake in the pituitary region. Tomographic images of MIBI scans on 56 patients with suspected parathyroid adenomas (2006-2007) were analyzed retrospectively. Semiquantitative analysis of abnormal uptake was performed by drawing identical regions of interest (ROI) over the pituitary area and the normal brain on one transverse section that demonstrates the lesion most clearly. Pituitary uptake to normal brain uptake ratio was calculated in all cases. We found statistically significant differences of MIBI uptake in patients with pituitary adenomas, mean ratio: 29.78±12.17 (median 29.77, and range 19-41), compared with patients with no pathologic changes in this region, mean ratio was 5.88±1.82 (median was 5.95 and range 2.0- 9.2). As the groups are too small for statistical analysis, these results need to be confirmed in a larger cohort and should include more detailed biochemical correlation. MIBI parathyroid scintigraphy should be taken into account as a potential source of identifying pituitary incidentalomas. Clinical significance of these findings needs further evaluation.

Tc-99m methoxyisobutylisonitrile parathyroid scintigraphy: the value of adding a whole-body scan.

PURPOSE: The aim of this study was to estimate the frequency of incidental findings on Tc-99m-methoxyisobutylisonitrile (MIBI) scan performed for suspected parathyroid adenoma and to evaluate the benefit of additional whole-body scan. MATERIALS AND METHODS: A total of 109 patients (37 men and 72 women; age range, 16-96 years; mean, 58.42 years) with clinically suspected parathyroid adenoma underwent Tc-99m MIBI whole-body scans and single-photon emission computed tomography of the base of the skull, the neck, and the thorax. Each case with suspected abnormal tracer accumulation was analyzed and correlated with clinical information. RESULTS: MIBI single-photon emission computed tomography of the base of the skull, the neck, and the thorax and whole-body scans of 109 patients were assessed. A total of five incidental findings were detected. The anatomical distribution of the incidental findings was as follows: two (40%) were located in the head and neck areas and three (60%) were in the abdomen and pelvis. Two (40%) were detected in standard acquisition view, which includes the base of the skull, the neck, and the thorax. Three (60%) incidentalomas were detected in whole-body scan. In addition, we found 23 cases of abnormal tracer distribution that were correlated with known clinical history of patients. Three (13%) were located in the head and neck areas, 10 (43.6%) in the thoracic region, six (26%) in the abdomen and pelvis, and four (17.4%) in the extremities. CONCLUSION: Whole-body imaging in patients with suspected parathyroid adenoma who underwent MIBI scans does not alter patient management in most cases.

Intramuscular metastasis of carcinoid tumor: a rare manifestation.

A 43-year-old man presented with a 2-month history of left upper lobectomy due to an atypical lung carcinoid tumor. The patient was referred to our department for further evaluation. An In-111 octreotide (Octreoscan) whole body scan and single photon emission computed tomography were performed. The scans showed slightly increased diffused tracer uptake in the apex of the left lung, most probably due to postoperative changes. A focal area of increased uptake in the right lower abdomen was also noted. Fusing octreotide tomographic construction with CT images allowed accurate determination of the area of increased uptake to be in the right transverse abdominal muscle.

Unilateral urinothorax due to nephropleural fistula detected on Tc-99m diethylenetriamine pentaacetic acid renal scintigraphy.

Urinothorax or urothorax, the presence of urine in the pleural space, is a rare complication of percutaneous access to the kidney for the management of complex renal and proximal ureteral calculi and ureteropelvic junction obstruction. Other causes such as blunt renal trauma, ureteral instrumentation, or ureteral surgery have also been reported. The authors describe a patient with a massive left pleural effusion with total lung atelectasis. The diagnosis of urinothorax was confirmed by diuretic renography with Tc-99m diethylenetriamine pentaacetic acid.