Demonstration of post-traumatic bile leak using technetium-99m DISIDA.

A 25-year-old miner was admitted with an acute abdomen and marked pallor following a crush injury to the abdomen. CT showed an irregular, patchy appearance of the posterosuperior portion of the liver with a coefficient of density appreciably less than the rest of the liver, consistent with the presence of a hepatic hematoma. The patient was treated conservatively. During the two weeks that followed, fluid accumulated in the peritoneal cavity. At laparotomy, a large volume of bile- and blood-stained fluid was found in the peritoneal cavity. Tc-99m DISIDA imaging was done after laparotomy.

The clinical value of scintigraphic brain scanning. Experience at the Hillbrow Hospital, Johannesburg, South Africa.

Patients were referred to the Department of Nuclear Medicine for brain scintigraphy to be screened for possible intracranial pathology. These referrals were made in order to reduce the heavy load on the transmission computerized tomography (TCT) facilities. Great clinical importance, therefore, has been attached to scintigraphic findings; this emphasizes the need for an accurate assessment of the predictive value of this procedure.

[CT-guided transthoracic needle aspiration of solitary lung lesions. Personal experience in 118 cases]. / Citoaspirazione transtoracica con guida TC di lesioni polmonari singole. Esperienza personale in 118 casi.

Fast-scan CT is widely and frequently used to guide fine-needle aspiration biopsy (FNAB) of questionable lung nodules. To investigate technical problems, complications, diagnostic accuracy and indications of this technique, the findings were reviewed relative to 118 patients with negative transbronchial biopsy and sputum cytology who underwent CT-guided FNAB of solitary lung lesions. Over a 25-month period, 73 men and 45 women underwent CT-guided FNAB of lung lesions. The CT unit was a GE 9800; 22-gauge 7/9-cm spinal needles were used in most cases, while 22-G 15-cm Chiba needles were used in 6 cases. In 114 patients one FNAB was performed, 4 patients only requiring the maneuver to be repeated. Regarding the malignant nature of the lesions, there were 70 true positive, 36 true negative, 12 false negative and no false positive cytologic findings; sensitivity was 85.36%, specificity and positive predictive value were 100%, negative predictive value was 75% and diagnostic accuracy 89.83%. Only minor complications occurred: 5 cases of hemophtoe, 7 of peripheral bleeding, 4 of chest pain, 4 vagal reactions and 10 cases of pneumothorax, only one of them requiring drainage. In our experience, only one pass per patient is required and the presence of the cytopathologist is unnecessary, since in most of our cases (114/118) the diagnosis was made at the first FNAB performed by the radiologist. CT allowed the lesions to be approached easily and precisely, which is useful especially in small, peripheral or hilar, nodules missed or poorly defined by radiology. To conclude, CT-guided transthoracic FNAB can be suggested as the method of choice to diagnose lung lesions which are difficult to puncture endoscopically because of size or location, and in suspected metastases. Moreover, FNAB can be used as second-line method in the lesions where endoscopic biopsy cannot be performed or whose findings are negative.

The use of a monoclonal antibody against alpha-fetoprotein for the radioimmunodetection of hepatocellular carcinoma.

The purpose of this study was to investigate the use of a radiolabeled mouse monoclonal antibody (and its F(ab')2 fragment) against alpha-fetoprotein in the scintigraphic diagnosis of hepatocellular carcinoma. Twenty-six southern African Blacks and one Caucasian with hepatocellular carcinoma and four patients with other malignant tumors of the liver were studied. Although six hepatocellular carcinomas appeared to selectively concentrate alpha-fetoprotein antibody, one of these tumors was not producing alpha-fetoprotein. Moreover, in another 18 patients with alpha-fetoprotein-producing hepatocellular carcinomas, uptake of alpha-fetoprotein antibody was at best only equal to that in nontumorous hepatic tissue, and three hepatocellular carcinomas that were not producing alpha-fetoprotein concentrated the antibody to the same extent as did the alpha-fetoprotein-producing tumors and hepatic tissue. All four tumors other than hepatocellular carcinoma concentrated alpha-fetoprotein antibody as well as did hepatic tissue. These findings suggest that the penetration of hepatocellular carcinomas by alpha-fetoprotein antibody is a passive and nonselective process. This conclusion is supported by an in vitro study in which a non-alpha-fetoprotein-producing hepatic metastasis took up as much radiolabeled alpha-fetoprotein antibody as did three of four alpha-fetoprotein-producing hepatocellular carcinomas. A likely explanation for the failure of alpha-fetoprotein monoclonal antibody to be selectively concentrated by hepatocellular carcinomas is that alpha-fetoprotein is an export protein and is not expressed on the cell membranes of malignant hepatocytes.