Technetium-99m HIDA hepatobiliary scanning in evaluation of afferent loop syndrome.

A study of 118 patients, operated on with Billroth II gastrectomy for peptic disease and affected by postgastrectomy syndromes, was carried out. Fifty patients were investigated by means of technetium-99m HIDA hepatobiliary scanning. In 18 patients, in whom an afferent loop syndrome was clinically suspected, hepatobiliary scanning demonstrated an altered afferent loop emptying in 8 and atonic distension of the gallbladder without afferent loop motility changes in 10. Among the patients in the first group, four were treated with a biliary diversion surgical procedure and in the second group, two patients underwent cholecystectomy. Our findings indicate that biliary vomiting, right upper abdominal pain pyrosis, and biliary diarrhea in Billroth II gastrectomized patients are not always pathognomonic symptoms of afferent loop syndrome. Technetium-99m HIDA hepatobiliary scanning represents the only diagnostic means of afferent loop syndrome definition. A differential diagnosis of abnormal afferent loop emptying and gallbladder dyskinesia is necessary for the management planning of these patients, and furthermore, when a surgical treatment is required, biliary diversion with Roux-Y anastomosis or Braun's biliary diversion seems the treatment of choice for afferent loop syndrome, whereas cholecystectomy represents the best procedure for atonic distension of the gallbladder.

Regional cerebral blood flow and comorbid diagnosis in abstinent opioid addicts.

Studies using single photon emission computed tomography (SPECT) have found low cerebral blood flow (CBF) in frontal and parietal cortices in patients with chronic opiate dependence. In the present study, SPECT with 99mTc-HMPAO as tracer was used to compare 27 detoxified opiate addicts with nine healthy control subjects. All the subjects were evaluated with clinical psychiatric (DSM-IV), psychometric and neuropsychological measures. Compared with normal control subjects, the addicts showed a non-significant reduction of whole brain perfusion values. Significant hypoperfusion in the right frontal and left temporal lobes was found in addicts with comorbid depression, and a significant decrease in CBF in the right frontal lobe was observed in those with antisocial tendencies. A significant negative correlation emerged between Depression subscale scores on the Minnesota Multiphasic Personality Inventory and left temporal CBF in the patients. No significant correlations were found, however, between measures of cognition and CBF in opiate addicts. The asymmetrical findings in CBF that characterized the addicts relative to normal control subjects may be more closely related to mood and behavioral traits than to substance abuse, per se.

[Cystic kidney disease in the adult. Update]. / Malattia cistica renale dell'adulto. Contributo d'aggiornamento.

Genetic changes on the extracellular matrix of nephron basal lamina seem to underlie the pathogenesis of renal cystic disease, as also confirmed by experimental results. The cysts behave as dynamic structures and repeat some physiological features of the nephron segment which gave origin to them. These properties reflect, for instance, on the pharmacokinetics of antibacterial drugs. New imaging techniques detect more and more asymptomatic cystic formations of very little volume. Moreover, a better definition of some complications, such as haemorrhage and infections, is afforded by the RX- and RM-CT and the use of specific radiopharmaceuticals (67Ga-citrate, 99mTc-sulfur-colloids, 111In-labeled leucocytes).

[Tumors of the adrenal medulla: nosologic profile and diagnostic technics]. / Tumori della midollare surrenale: inquadramento nosologico e tecniche di diagnosi.

A nosologic re-arrangement of medullo-adrenal neoplasms has been looked for in this article, with particular regard to their common relationship to the complex histogenic system descending from the neuroectoderma-neural crista. The morpho-biologic features of these clinical entities are also reviewed, as well as the up to date laboratory and imaging techniques, with a stress on the high sensibility and specificity levels afforded, e.g., for some of these tumours by selected radio-isotopic examinations, due to their histogenetic, thereby biologic peculiarities.

[Tumors of the adrenal cortex. Physiopathologic basis of current diagnosis]. / Tumori del corticosurrene. Basi fisiopatologiche della diagnostica attuale.

A survey of functional and pathological features of adrenal tumours and of the pathogenetic pathways of related hormonal syndromes is presented. The up-to-date diagnostic means, with particular stress on nuclear techniques, are discussed.

Thallium-201 myocardial scintigraphy in patients with Wolff-Parkinson-White syndrome.

Wolff-Parkinson-White syndrome (WPW) is known to cause abnormal rest electrocardiogram and stress test. Thallium-201 myocardial scintigraphy has been particularly indicated for the noninvasive evaluation of coronary artery disease in these patients. The study group consisted of 11 WPW patients with abnormal ST-segment depression at rest electrocardiogram and/or stress test, with the absence of signs or symptoms of coronary artery disease. All the patients underwent exercise thallium-201 imaging associated with stress test by bicycle ergometer: 7 of them had ST-segment depression, but without other signs or symptoms of coronary artery disease. Transient and moderate myocardial perfusion defects were found in 5 of 11 patients. Perfusion defects in patients with WPW could derive from dyssynergy of ventricular activation, which could modify myocardial perfusion scintigraphy despite the absence of angiographic coronary stenosis. Previous reports and our data concluded that transient perfusion defects during exercise thallium-201 testing in WPW patients without cardiovascular disease may be observed. Thus, thallium-201 myocardial scintigraphy could present some limitations as a helpful adjunctive method for assessment of coronary artery disease in WPW patients.

Thallium-201 myocardial perfusion imaging in patients with systemic lupus erythematosus.

The cardiovascular system is frequently affected in systemic lupus erythematosus (SLE). The observation of clinical manifestations related to the presence of coronary artery disease has not been frequently documented in young SLE patients. In these patients, the presence of inflammatory or thrombotic vascular lesions is often documented by anatomo-histological studies in the absence of previous clinical manifestations. The purpose of this study was to evaluate the presence of myocardial perfusion defects in SLE patients. The study was carried out in 15 patients without clinical signs of myocardial ischemia, 1 male and 14 females, 24 to 64 years old, with a mean SLE duration of 10.2 +/- 7.5 years. All the patients had normal blood pressure; electrocardiogram and Doppler-echocardiographic analysis showed values in the normal range. All the patients underwent thallium-201 exercise stress imaging repeated 3 hours later at rest, with tomographic SPECT analysis. Exercise test was carried out until submaximal load, without induction of ST segment alterations or symptoms. Scintigraphic scan showed normal thallium-201 SPECT imaging in 11/15 patients, while the other 4 patients had a slight perfusion defect, 3 of them in the inferior segment, in 2 non reversible and in 1 reversible; 1 patient had a non reversible defect in the septal segment. These slight perfusion defects, prevalently non reversible, may sometimes be a false positive imaging. Our results are in contrast with the literature observations concerning the frequent incidence of thallium-201 perfusion defects in SLE patients. In young asymptomatic SLE patients, our study does not report very important data indicating myocardial ischemia and suggesting the presence of significant coronary obstruction or vasculitis.

[Myocardial perfusion in coronary disease: thallium-201 planar scintigraphy]. / La perfusione miocardica nella cardiopatia coronarica: scintigrafia planare con tallio-201.

This research evaluated the diagnostic and analytic effectiveness of 201-thallium imaging in a group of patients with coronary artery disease, each one of them with different localization, extent and number of coronary vessel obstructions. The thallium-201 imaging was performed immediately after ergometric test and repeated 4 hours later. In a large percentage of patients thallium-201 imaging of reversible and irreversible perfusion defects have been found; thallium-201 scintigraphy showed a greater sensitivity than exercise ECG. With particular evidence 201-Tl imaging showed perfusion defects in a high percentage of patients with obstruction of one and two coronary vessels; in these patients, in the former especially, the results of exercise ECGs showed a lower sensitivity. Both thallium-201 and exercise ECG had a similar sensitivity in patients with obstruction of three coronary vessels. In patients with obstruction of one or two vessels, thallium-201 imaging clearly showed a regional hypoperfusion corresponding to the specific perfusion coronary vessels, while exercise ECG gave aspecific topographic results. Irreversible perfusion defects resulted corresponding to the myocardial segments that were infarcted, but were also observed in patients without previous myocardial infarction.

[Conservative treatment of splenic injuries in childhood]. / Trattamento conservativo dei traumi splenici nell'infanzia.

From 1978 to 1983, 11 children with splenic traumas were observed at the Pediatric Surgery of Parma. The diagnosis was confirmed by splenic scintigraphy with 99m Technetium. Those patients whose condition was stable with intravenous fluids or blood transfusions were not operated on. Emergency laparotomy was necessary only in 3 cases of 11 patients, when the general conditions were unstable.

[Use of a standard radioactive paste in the study of esophago-gastric kinesis (author's transl)]. / Impiego di un pasto normale radioattivo nello studio della cinesi esofago-gastrica.

The behaviour of esophago-gastric kinesis has been studied comparatively by administering BaSO4 and normal food respectively, labelled with 1 mCi of 99mTc-DTPA. The results are discussed and the differences observed are stressed. These confirm the non-physiological nature of the conventional opaque paste employed in X-ray diagnosis.

[The diagnostic accuracy of liver scanning by Tc99m s.c. (Confrontation with autoptic reports) (author's transl)]. / Significatività dell'epatoscintigrafia con Tc99m s.c. (confronto con materiale autoptico)

The Authors for an exact valuation of the diagnosis of epatic diseases by Tc99m s.c. verified all autoptic reports of the Ospedali Riuniti in Parma during the 3 last years. The Authors value diagnostic accuracy concerning the examinated cases of the epatic scanning.

[Usefulness of a study with 99m Tc-labelled erythrocytes for the recognition of hepatic angioma in the staging of cancer patients]. / Utilità dell'indagine con eritrociti marcati con 99mTc per il riconoscimento degli angiomi epatici nella stadiazione dei pazienti neoplastici.

Cavernous hemangiomas are the commonest benign tumors of the liver. Unfortunately, neither US nor CT allows cavernous hemangiomas to be positively discriminated from more dangerous lesions, e.g. metastases. Blood-pool scintigraphy has been reported to be a reliable technique for diagnosing hemangiomas of the liver: in fact, among the liver lesions in which 99m Tc-red blood cells gradually accumulate, only hemangiomas present an increased accumulation of radiotracers as soon as 2 hours afterwards. To determine the present value of blood-pool scintigraphy in oncological patients, we studied 17 patients whose US staging had shown dubious focal liver lesions. This technique allowed one or more hemangiomas to be diagnosed in 15 cases, and metastatic lesions in 2 cases. Scintigraphy with 99m Tc-labelled red blood cells proves thus to be an accurate method for the identification of cavernous hemangiomas of the liver in case of dubious US findings.

[Value of cerebral scintiscanning with Tc 99m pertechnetate. Comparative evaluation of neuroradiological diagnosis (statistical study)]. / Significatività della scintigrafia cerebrale con 99m Tc pertecnetato. Valutazione comparativa con la diagnostica neuro radiologica (contributo statistico)

Authors have analyzed the efficacy of brain scanning detecting in neurological diseases and compare this examin with usualy neuro-radiological screenings. They have noted an absolute diagnostic accuracy (100%) in various cases of vascular diseases and a great accuracy (81,8%) in cases of brain tumors.

[Left ventricular function a short time after myocardial revascularization surgery: radioisotope angiographic study]. / La funzione ventricolare sinistra a breve termine dall'intervento di rivascolarizzazione miocardica: studio angiografico radioisotopico.

The short-term effects after coronary bypass surgery on left ventricular function were studied in 65 patients with coronary artery disease. Each patient underwent gated radionuclide left ventriculography on the second-third day before and 5-7 days after coronary bypass surgery. After surgery, global ventricular ejection fraction had a significant increase, anteroseptal wall motion was unchanged, while apical motion and mainly inferoposterior motion were significantly increased. The most important improvement of inferoposterior motion was observed in 18 patients who had complete revascularization of the previously infarcted inferior segments, while in the 11 patients with incomplete revascularization of the same area, inferoposterior motion had a slight increase. There was a slightly significant direct linear correlation between size and direction of the anteroseptal and inferoposterior motion changes. The patients were divided in subgroups related to the site and number of obstructed coronary vessels as well as of implanted grafts; the computed parameters showed similar changes in all subgroups. After surgery, peak ejection rate showed an evident increase, and time to peak reciprocally shortened. Peak filling rate, which had reduced preoperative values, was found clearly improved, with a corresponding shortening of the time to peak; these results confirmed that diastolic ventricular damage was a reversible disturbance related to myocardial ischemia. In 8 of the 65 patients, 24 hours urinary catecholamine levels showed similar values at both pre and postoperative radionuclide controls. In conclusion, the radionuclide angiography showed an evident improvement of left ventricular function during a short period following surgery, suggesting a better myocardial perfusion after revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

[Selective coronary scintiscanning]. / La scintigrafia coronarica selettiva.

30 patients, undergoing coronary angiography for diagnostic and/or bypass surgery evaluation, have been studied also by intracoronary scintigraphy (IS). Scintigraphic and angiographic data have been compared: --21 cases had concordant results: normal in 2 patients (quite normal coronary system); pathological in 19, accounting for a damage both of the principal coronary artery branches and the arteriolar-capillary system: --6 cases had a pathological angiography with a normal IS: an indication of a normal myocardial perfusion; --in 3 cases a normal angiography was coupled with a pathological IS, pointing out a damage of the arteriolar-capillary system. On the basis of these results and of the literature, the AA. emphasize that the IS, allowing an exact evaluation of the myocardial perfusion, complete the essential morphological informations of the coronary angiography and it is specifically useful: --in the candidates to bypass coronary surgery; a viable myocardium is important both for surgery indication and results; --in bypassed patients to assess patency and the actual blood delivery (also for the low reliability of e.v. Thallium); --in patients with typical angina and positive stress test but with normal coronary angiography, to establish an organic lesion of the arteriolar-capillary system.

Antiinflammatory drugs and gastric emptying. A comparison between acetylsalicylic acid and carprofen.

Continuing their studies of gastric emptying modifications induced by nonsteroid anti-inflammatory drugs, the authors investigated the effects of 6-chloro-a-methylcarbazole-2-acetic acid (carprofen, Imadyl) versus those of acteylsalicylic acid (ASA) in an open crossover study of 10 healthy volunteers with normal gastric motility. The subjects received a standard meal labeled with 99Tc DTPA and were monitored for gastric emptying over time by scintiscanning with a gamma ray camera wired to a computer. Each subject was examined in basal conditions and after dosing with carprofen and ASA in random sequence with a 10-day washout period between tests. With the ASA treatment, all subjects showed considerable prolongation of gastric transit compared to pretreatment values, both in terms of first discharge of labeled bolus into the duodenum and of percent gastric radioactivity dissipated at 20 min. With carprofen, both parameters were influenced in the same direction to a significantly lower degree, to the point where the difference from pretreatment values was statistically improbable.