Radionuclide angiography for the diagnosis of thyroid cancer.

The conventional static thyroid scan is sensitive but nonspecific in detecting thyroid tumors. Radionuclide angiography is a noninvasive and simple technique that can improve the specificity of the conventional scan significantly, since it can demonstrate hypervascularity of tumors. Our case reports demonstrated hypervascularity of the primary tumor and metastatic cervical lymph nodes.

Anesthesia by the pediatric specialist.

There is increasing evidence that involvement of pediatric anesthesiologists in the perioperative care of infants and children can positively impact outcome. Considerable data have emerged in the past several years that clearly show that infants and small children experience untoward events at a much higher rate than do older children and adults. Herein the author presents some of this literature as well as data suggesting that anesthesiologists with interest and additional training in the care of infants and children can improve anesthesia outcomes. Even in these days of cost containment, it makes sense to provide the best pediatric team to care for the pediatric patient during the perioperative experience.

Raising eyebrows: problems that get anesthesiologists' attention.

There are many clinical situations of concern that may be unique to pediatric anesthesiologists. The author discusses four of the more common presentations: asthma, cystic fibrosis, anterior mediastinal masses, and latex allergy. Many such issues can be resolved before surgery by consultation with members of the operating team. Some issues may require additional input from nonsurgical pediatric specialists. By maintaining good communication between the anesthesiologist and the surgeon, delays and cancellations can be minimized and patient care enhanced.

Inefficacy of routine laboratory analysis of CSF obtained during myelography for suspected disc disease.

The routine laboratory analysis of cerebrospinal fluid (CSF) obtained during myelography is performed in many institutions. The records of 100 consecutive patients who had myelography for suspected disc disease were reviewed retrospectively. The laboratory analysis of the CSF obtained during myelography did not benefit patient management in any instance. In one case, the CSF results adversely affected patient management. The CSF analysis did not add any information to the myelogram result. The CSF protein level did not correlate in a statistically significant way with the degree of disc protrusion seen myelographically.

Maximum-likelihood multiresolution laser radar range imaging.

Maximum-likelihood range imaging is considered for pulsed-imager operation of a coherent laser radar. The expectation-maximization (EM) algorithm is used to develop an explicit procedure for maximum-likelihood fitting of a multiresolution (wavelet) basis-at a sequence of increasingly fine resolutions-to laser radar range data. Specialization to the Haar-wavelet basis yields a procedure that is both computationally efficient and numerically robust. Basic analytical properties of the estimation algorithm and its performance are presented, along with results based on simulated and real laser radar range data. It is shown that the weights associated with the expectation-maximization iterations provide a reliable indicator for terminating the coarse-to-fine resolution progression. At the weight-determined stopping point, estimation performance approaches the ultimate limit set by the complete-data bound.

The diagnosis of pneumothorax by radionuclide lung scan.

A case of pneumothorax diagnosed by ventilation-perfusion lung scintigraphy is reported. The diagnosis was not suspected clinically initially and a chest x-ray taken before the lung scan was also interpreted as normal.

Scintiangiographic demonstration of parasitization of systemic blood supply by inflammatory lung disease.

An unusual case in which a computed tomogram demonstrated abnormal, enlarged vessels in the right lower lobe of the lung and suggested an arteriovenous malformation is presented. A scintiangiogram showed abnormal systemic supply to this area in the aortic phase. Contrast angiography demonstrated hypertrophy of the right inferior phrenic artery with abnormal systemic supply to the pleura and parenchyma of the right lower lobe, presumably on the basis of old infection.

Occult gastric bleeding demonstrated by bone scan and Tc-99m-DTPA renal scan.

A patient is described who had coagulopathy and clinically intermittent gastrointestinal bleeding. The bleeding site was clearly shown on renal and bone imaging performed at a time when the patient was considered clinically to have stopped bleeding. A bleeding gastric ulcer was subsequently demonstrated by radionuclide and contrast angiography, and at surgery.

Primary tuberculosis diagnosed by gallium scan.

We report a case of tuberculosis which, although clinically unsuspected, was diagnosed on a 67Ga scan. It is well known that 67Ga scintigraphy may be used as an adjunct to radiography for assessing extent and localization of inflammatory activity and for follow-up and progression evaluation of diffuse granulomatous diseases such as sarcoid and tuberculosis.

Frequency of anesthetic cardiac arrests in infants: effect of pediatric anesthesiologists.

STUDY OBJECTIVE: To determine whether the presence of pediatric anesthesiologists decreases the frequency of anesthetic-related cardiac arrests in infants (children who are 1 year of age or younger). DESIGN: A comparative retrospective study of anesthetics and cardiac arrests during a 7-year period. SETTING: The main operating room (OR) suite of a large university hospital. PATIENTS: All patients age 1 year or less undergoing surgical anesthesia from July 1983 through March 1990. INTERVENTIONS: Computerized anesthetic and operative patients records were queried for patient age, ASA physical status, body weight, surgical procedure, intraoperative complications, and the identity of the attending anesthesiologist. In each case, it was determined whether a pediatric anesthesiologist was in attendance and whether a cardiac arrest due to anesthesia occurred. Pediatric anesthesiologists were identified as those with pediatric fellowship training or the equivalent. The study population was divided into two groups: (1) the pediatric anesthesiologist group, with 2,310 patients whose anesthetics were supervised by pediatric anesthesiologists; (2) the nonpediatric anesthesiologist group, with 2,033 patients. MEASUREMENTS AND MAIN RESULTS: Mean age and weight were comparable in the two groups, and the distribution of physical status did not differ. No anesthesia-related cardiac arrests occurred in the pediatric anesthesiologist group; four anesthetic cardiac arrests occurred in the nonpediatric anesthesiologist group, for a frequency of 19.7 per 10,000 anesthetics. This difference between provider groups is significant (Fisher's exact probability test, p = 0.048). CONCLUSIONS: The results suggest that the use of pediatric anesthesiologists for all infants 1 year of age or younger might decrease anesthetic morbidity in this age-group.

Optimum adaptive imaging imaging through atmospheric turbulence.

Recent results for the atmospheric mode decomposition are applied to an idealized imaging problem in which the receiver has a priori knowledge of the channel impulse response and mode decomposition. It is shown that a channel-matched filter receiver is essentially optimum and, on the average, achieves diffraction-limited performance. Furthermore, when the transmitting aperture lies within a single isoplanatic patch, this system may be realized without a priori channel knowledge by transmitted reference techniques.