Myocardial imaging in man with I-123 meta-iodobenzylguanidine.

Meta-[123I]iodobenzylguanidine (m-[123I]IBG), a guanethidine analog, was used to image the myocardium in five normal male volunteers. Each subject received 2.0 mCi m-[123I]IBG intravenously. Four were given a bolus injection. Multiple myocardial scintigrams were obtained over a 2-hr period. Myocardial uptake was calculated by dividing the decay-corrected global myocardial count rate (after interpolated background correction) by the peak count rate during the first passage of the m-[123I]IBG bolus through the heart. The left ventricle could be visualized within 1-2 min of m-[123I]IBG injection. Mean myocardial uptake was 0.63% (range 0.45-0.78%) of injected dose at 5 min, and 0.76% (range 0.49-0.93%) at 2 hr (n = 4). m-[123I]IBG may provide quantitative information on myocardial catecholamine content.

Thallium-201 myocardial scintigraphy: a critical comparison of seven-pinhole tomography and conventional planar imaging.

Seven-pinhole tomographic and planar thallium-201 imaging was performed on 63 consecutive patients to assess the clinical value of these techniques. Significant coronary artery disease (stenosis greater than or equal to 70%) was present in 52 patients. Comparing the seven-pinhole results with those of the planar, the findings for sensitivity, specificity, and inter- and intraobserver agreement were, respectively, 94% against 75% (p less than 0.005), 91% against 91%, 86% against 79%, and 97% against 92%. In 25 patients in this group with a prior myocardial infarction, sensitivity was 100% for tomographic imaging and 92% for planar. In 27 patients without prior myocardial infarction, by contrast, sensitivity for tomographic imaging was 89% and for planar imaging 59% (p less than 0.01). Thus we conclude that both tomographic and planar imaging are highly sensitive for the detection of significant coronary artery disease, but tomographic imaging is significantly more sensitive in patients without prior myocardial infarction.

Tomographic thyroid scintigraphy: comparison with standard pinhole imaging: concise communication.

Coded-aperture imaging (CAI) and multiple-view pinhole imaging (PI) of the thyroid were compared in a prospective study in 136 consecutive patients. Following 10 mCi of pertechnetate, 200K-count pinhole images were obtained in the anterior, RAO, and LAO projections, and CAI data were obtained in the anterior position. Four coronal tomographic sections were reconstructed by computer. Five observers read the studies separately, and ROC curves were constructed. Based on 109 pairs of studies, the ROC curves revealed similar performance for all observers for both techniques. When four observers compared the studies subjectively they rated the CAI more useful in 36% of cases, the PI in 6%, and the two equal in 58%. The advantages offered by the tomograms included improved contrast, accurate size representation of the gland at all depths, freedom frm pinhole-type distortion, and faster data acquisition. The major disadvantage to tomography was the 2-hr computer-processing time required. It this can be reduced, CAI offers sufficient advantages over conventional pinhole imaging to warrant its routine use.

Comparison of observer performance reading from a video CRT vs. reading from film.

The developing trend for all medical images to be in digital form raises an important question: should diagnostic interpretations be made directly from a CRT or from some form of hard copy recording of the CRT? This question was studied by having two observers read a series of digital images of the thyroid including both conventional scintigrams and computer-generated tomograms. The CRT images were photographed in a carefully controlled fashion. Images were read once from film and a second time directly from the CRT. No significant difference in performance could be found for either display modality based on an ROC analysis. Although based on uncomplicated images and analysis, this result suggests that the decision to read from film or from the CRT can be made on other grounds than observer performance. This important result needs confirmation with more complex images such as ultrasound or CT.

Predictors of complications and hospital stay in gynecologic cancer surgery.

OBJECTIVE: To test the hypothesis that comorbid medical conditions can predict length of hospital stay and incidence of postoperative complications. METHODS: We reviewed the medical records of 187 women who had surgery for known or suspected gynecologic malignancies during 1996 and 1997, and 179 were included in the present study. Information on each woman's comorbid medical conditions, surgical history, surgicopathologic cancer diagnosis, American Society of Anesthesiologists' classification, surgical procedures, and postoperative complications was collected and analyzed. RESULTS: Women with two or more comorbid medical conditions had significantly longer mean hospital stays (8.62 days) than those with none or one comorbid medical condition (6.43 days) (P <.001). Women with two or more postoperative complications had significantly longer mean hospital stays (11.88 days) than those with none or one complication (6.02 days) (P <.001). Women with two or more postoperative complications also had significantly more comorbid medical conditions (mean 2.5) than those with none or one complication (mean 1.7) (P <.001). The American Society of Anesthesiologists class also was a significant predictor of postoperative complications and length of hospitalization. Age over 60 years also was associated with statistically significant increase in comorbid medical conditions and significantly longer hospitalizations. CONCLUSION: Our findings indicated that certain high-risk patients can be identified before hospital admission based on comorbid medical conditions. Certain risk indices, such as the American Society of Anesthesiologists classification score, also can predict postoperative complications and length of hospital stay. This information can be used to coordinate preoperative and postoperative hospital care and be a reference for certain future disease management systems.

Ureteral assessment after radical hysterectomy.

Postoperative intravenous pyelography was performed in 233 patients with stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy between January 1962 and December 1985. Four patients developed symptoms of ureteral injury, two (0.8%) ureteral fistulae, and one (0.4%) stricture and obstruction due to recurrent carcinoma. No ureteral injuries were observed in 229 asymptomatic patients. A 5.2% incidence of transient severe ureteral dilatation occurred in asymptomatic patients, but resolved within a median of 94 days. A significant urinary tract anomaly was observed in 3.4% of preoperative pyelograms. All of these anomalies were apparent at surgery and presented no intraoperative difficulties. Three patients (1.3%) sustained intraoperative ureteral transections, which were diagnosed and repaired without sequelae. In patients with early cervical carcinoma having primary operative treatment, the role of routine preoperative and postoperative intravenous pyelography is questionable.

Intraoperative complications and unexpected pathology at the time of cesarean section.

During cesarean section, operative complications include injury to the uterus, urinary tract, and bowel. A variety of types of fetal injuries have been reported, and some are associated with permanent handicap. The relative risk of intraoperative complications varies widely depending on such clinical variables as gestational age, station of the presenting part, and the experience of the operating physician. Ideally, each physician should be able to review his or her rate and type of complications so that continuous improvement in technique is fostered. Gynecologic tumors (malignant and benign) are rarely associated with pregnancy, and their incidental finding at the time of cesarean section is also rare. Management of malignant tumors depends greatly on the stage of the tumor. Conservative management of early-stage malignant ovarian tumors is permissible. More advanced malignant ovarian tumors and malignant tumors of the uterus and fallopian tube should be treated aggressively with removal of the reproductive organs.

Telemetric monitoring of body temperature in the horse mare.

The objective of this study was to develop a radiotelemetric system capable of frequent monitoring of mare body temperature. A radio transmitter was implanted in the flank of each of four mares. Telemetered data were received by a pair of antennae placed at right angles in a 3.3 x 6.6-m stall and stored on a computer hard disk. The data were recorded every 5 minutes except when mares were out of the stall for a 1- to 2- hour exercise period. No effect of environmental temperature, ranging from 5 degrees C to 30 degrees C, on mare body temperature was apparent. The radiotelemetric system used in this study was effective for frequent measurement of mare body temperature.

Body temperature fluctuations in the periparturient horse mare.

The objective of this study was to determine the pattern of mare deep body temperature fluctuations associated with parturition using biotelemetry. A radio transmitter was implanted in one flank in each of six mares. Telemetered data were received by a pair of antennae placed at right angles in a 3.3 x 6.6-m stall and stored on a computer hard disk. Hourly temperature data were recorded for the period of -168 through 168 hours post partum. A decrease of 0.76 degrees C in body temperature began at 4 hours prior to parturition (P < 0.1) then decreased rapidly between the 3 hours prior to and the time of parturition (Time 0). The lowest mean body temperature recorded was at the time of parturition (36.58 +/- 0.16 degrees C; P < 0.001). A supranormal increase in mean body temperature began one hour post partum, peaked at 38.02 +/- 0.08 degrees C and remained elevated for 48 hours post partum until gradually decreasing to the level of the prepartum mean by 106 hours.

Equine body temperature and progesterone fluctuations during estrus and near parturition.

Body temperature and serum progesterone concentrations were measured in mares to determine if a change in either could be useful in predicting estrus, ovulation or parturition. There was no significant correlation (P > 0.1) between rectal temperature and the environmental temperature or progesterone concentration. Progesterone concentration did correlate with stage of estrous cycle and the stage of pregnancy. Significant differences (P < 0.05) in temperature were noted at different times throughout the day. No change in temperature occurred that could be utilized to predict estrus, ovulation or parturition. The changes in serum progesterone concentration were only useful in detecting estrus.

Uterine electromyographic activity in horse mares as measured by radiotelemetry.

The objective of this study was to determine if radiotelemetry could be used to measure myometrial electromyographic (EMG) activity. A radio transmitter with one pair of biopotential leads was implanted in the flank ipsilateral to the pregnant uterine horn at least five weeks prior to the expected date of parturition in two mares. The biopotential leads were implanted in the base of the pregnant uterine horn. Telemetered data were received by a pair of antennae placed at right angles in a 3.3 by 6.6-m stall. Data were recorded on VHS format videocassette tapes continuously for the 24h prior to and following parturition. Simultaneous physiograph recordings were made as a hard copy reference. In addition, 10 mg of prostaglandin F(2 alpha) was administered to two mares in the luteal phase of the estrous cycle. Myometrial EMG during parturition was increased similarly to that of previously published reports that used myometrial electrodes wired directly to a physiograph. Prostaglandin F(2 alpha) also caused an increase in myometrial EMG activity within 8 min of administration. This study demonstrated that radiotelemetry can be used for measuring myometrial EMG activity.

Retained surgical needle in the perineum. Report of a case with a novel method of search and rescue.

BACKGROUND: Retrieval of a broken or lost surgical needle can be a difficult task, often requiring extensive surgical exploration. CASE: A surgical needle was retained in the perineum. Needle-hookwire placement with biplane fluoroscopy allowed the precise localization and marking of the foreign body; surgical removal without extensive exploration was therefore possible. CONCLUSION: The use of needle-hookwire localization with biplane fluoroscopy should be considered for retrieval of foreign bodies in the perineum.

Surgical resection of endometriosis after prior hysterectomy.

Twenty-seven patients who underwent laparotomy after a prior hysterectomy for endometriosis were studied. The mean interval from index surgery to repeat surgery was 7.8 years. Abdominal/pelvic pain was the most common presenting complaint, followed by the objective finding of a pelvic mass. Six patients were taking estrogen replacement therapy. Physical findings suggested a pelvic mass or nodularity in 15 patients. Extensive pelvic adhesions with dense involvement of the ovaries was common. Surgery in 2 patients was complicated by an enterotomy, with 4 patients requiring a bowel resection and anastomosis. Postoperatively, 5 patients developed fever, 3 a postoperative ileus, 1 a wound breakdown, and 1 a small bowel obstruction. The mean hospital stay was 5 days. We conclude that in patients who have undergone a hysterectomy as treatment for endometriosis, subsequent surgery to remove the ovaries involved with recurrent endometriosis carries considerable morbidity. In light of readily available estrogen replacement therapy, conservation of the ovaries in patients who are undergoing a hysterectomy for endometriosis should be applied with caution.

Turbo-gracilis myocutaneous flap for perineal reconstruction.

The turbo-gracilis flap, which has been described previously for the purpose of extending the unreliable gracilis skin island, and previously applied in forearm reanimation surgery, is now adapted for reconstruction in the perineal region. We present a case report of a patient with previous vulvar carcinoma treated with resection and radiation who presented with a very large defect of the perineal region. Reconstruction was carried out using a turbo-gracilis flap. The advantages of the flap are well demonstrated in the successful reconstruction, in that it provides an extensive amount of well-vascularized tissue due to an extended gracilis skin island which is vascularized by way of a vein graft from the proximal pedicle blood supply to a distal gracilis pedicle which, in turn, supplies the extended skin island. This allows an extensive amount of tissue to be harvested from a single donor site and ensures the viability of the skin island. A review of the advantages and disadvantages of various types of perineal reconstruction is also presented and contrasted with the turbo-gracilis method.

Recurrent catamenial hemopneumothorax.

A case of recurrent hemorrhagic catamenial hemopneumothorax resulting from diffuse pleural endometriosis is presented. The pathogenesis of this rare entity is discussed, and the immediate and long-term surgical and medical options for therapy are reviewed.

Correlation between endometrial cells on Papanicolaou smear and endometrial carcinoma.

BACKGROUND: A retrospective study was done to assess the correlation between endometrial cells on routine cervical cytology and carcinoma of the endometrium. METHODS: In a 4-year period, endometrial cells of some type were identified on the Papanicolaou (Pap) smears of 61 women, of whom 52 had further diagnostic evaluation of the endometrium. Data were analyzed with a multivariate stepwise logistic regression. RESULTS: The results indicated an association of endometrial cells in Pap smears with carcinoma of the endometrium in seven patients (13.5%). In 45 patients (86.5%), the final diagnosis was benign. Factors that impacted the diagnosis of carcinoma were the findings of atypical or cancerous endometrial cells on Pap smear and abnormal vaginal bleeding. CONCLUSIONS: These data indicate the importance of further diagnostic evaluation with endometrial sampling in postmenopausal patients with endometrial cells seen in Pap smears, especially those with abnormal bleeding.

Chemotherapeutic complete remission in patients with metastatic ovarian dysgerminoma. Potential for cure and preservation of reproductive capacity.

Two patients with metastatic dysgerminoma of the ovary were treated with a combination of etoposide, bleomycin, and cisplatin at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston. Both patients achieved a complete remission. Patient 1 developed a massive recurrence in the para-aortic lymph nodes 21 months after diagnosis and treatment with right salpingo-oophorectomy alone. She received four cycles of chemotherapy and is free of disease 21 months from the start of chemotherapy. Patient 2 had Stage III dysgerminoma and a lymphangiogram positive for tumor in the para-aortic lymph nodes. After surgery she received three cycles of chemotherapy and is free of disease 20 months from the start of chemotherapy. Both complete remissions were documented with second-look laparotomy. Chemotherapy may be an alternative to radiotherapy for the treatment of metastatic dysgerminoma and should also be considered for selected patients with Stage I disease. A literature review further supports the conclusion that additional clinical trials might expand the indications for chemotherapy in patients with this disease.

Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies.

BACKGROUND: Identification of sentinel lymph nodes may allow prediction of metastatic disease in cancer patients. We did a prospective study to determine whether lymphazurin dye could identify sentinel lymph nodes in patients with cervical, uterine, and vulvar cancer. METHODS: In 33 patients having surgery for either uterine, cervical, or vulvar carcinoma, lymphazurin dye was injected into the respective organs before the tumor and node dissection began. Sentinel lymph nodes were identified and dissected in situ. RESULTS: The identification rate of sentinel lymph nodes was 0/8 (0%) for uterine cancer patients, 2/13 (15.4%) for cervical cancer patients, and 9/12 for vulvar cancer patients (75%). CONCLUSIONS: In a limited number of patients, lymphazurin day may be useful in identifying or assessing the sentinel nodes draining vulvar and cervical cancers. The role of this procedure in treatment planning for patients with gynecologic malignancies is yet to be determined.