Long-term follow-up of residual mediastinal-hilar Ga-67 uptake after treatment for Hodgkin's and non-Hodgkin's lymphomas: what degree of Ga-67 uptake is significant?

PURPOSE: Ga-67 planar and SPECT images of 85 patients after treatment for mediastinal-hilar (M-H) lymphoma were reviewed retrospectively. Forty-seven patients had Hodgkin's disease and 38 patients had non-Hodgkin's lymphoma. The entire period was 7 years after diagnosis. The main goal was visual assessment of the significance of mild (grades 1 or 2) Ga-67 uptake in the M-H area as compared with Ga-67 uptake in bone marrow. METHODS: Residual Ga-67 mediastinal uptake after a complete course of chemotherapy or other treatments was defined as normal (no residual) M-H uptake, borderline (M-H residual uptake with intensity less than that or equal to the sternum, spine, or both), and abnormal (M-H residual uptake with intensity greater than that of the sternum or spine). RESULTS: Among the 38 patients (45%) with no residual M-H uptake, four (one Hodgkin's disease and three non-Hodgkin's lymphoma) experienced recurrence: two in the mediastinum and two in the abdomen. Among the 45 patients (53%) with borderline M-H uptake, five experienced recurrence: two in the mediastinum and three in other sites. The two patients (2%) with abnormal (M-H) uptake never responded to treatment. No significant statistical difference in tumor recurrence was found between no residual and borderline uptake (P = 0.21). CONCLUSIONS: Visual assessment of M-H Ga-67 uptake (without quantification) could be useful to differentiate active residual tumor from nonactive residual uptake.

Treatment of patients with suspected pulmonary embolism and intermediate-probability lung scans: is diagnostic imaging underused?

OBJECTIVE: We compared patient treatment with imaging strategy in patients with clinically suspected pulmonary embolism (PE) and intermediate-probability lung scans (IPLS). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 214 consecutive patients with clinically suspected PE with IPLS. RESULTS: Treatment (full anticoagulation, filter placement, or both) was given in 66 (31%) of 214 patients. Only 37% of patients were treated on the basis of definitive diagnostic imaging results. Most patients (134 [63%] of 214) were treated without an imaging diagnosis: 30 (14%) of 214 patients were treated for acute PE on clinical grounds, and the diagnosis of PE was not excluded in 104 (49%) of 214 patients. CONCLUSION: Most patients with IPLS are treated without a definitive imaging diagnosis. This lack of diagnosis may result in the overtreatment of patients who do not have acute PE or, more importantly, in the undertreatment of patients who do have acute PE. Further studies are necessary to evaluate the impact of the current management strategies on patient outcome.

Gastric Ga-67 uptake in patients with lymphoma.

Gastric accumulation of Ga-67 greater than that seen in the liver was observed in 16 of 162 (9.8%) patients with lymphoma. Endoscopic biopsies in six patients showed one instance each of histiocytic lymphoma, mixed cellularity Hodgkin's disease, adenocarcinoma, and hiatal hernia with mucosal deformity, as well as two instances of benign gastric ulcer. All six patients had chronic gastric symptoms, as well as persistent radiogallium accumulation on sequential examinations of 2 years duration. The remaining 10 patients exhibited transient radiotracer gastric uptake and only two has gastric symptoms. Persistent gastric Ga-67 accumulation is not common in lymphoma and warrants endoscopy when accompanied by prolonged symptoms.

Gastric uptake of gallium-67 in AIDS.

We describe gastric localization of 67Ga in 13 patients with acquired immunodeficiency syndrome (AIDS) among 148 referred primarily to rule out Pneumocystis carinii pneumonia (PCP). Endoscopic biopsies in five of the patients indicated cytomegalovirus (CMV) infection in one, gastritis in two, and normal tissue in two. Other associated, but nongastric, infections in these 13 patients included esophageal candidiasis, PCP, Mycobacterium avium-intracellulare (MAI) complex, coccidioidomycosis, toxoplasmosis and Isospora belli. Only six of the patients exhibited gastric symptoms, and even fewer proved to have gastric pathology. Although gastric 67Ga uptake in a patient with AIDS may not require specific treatment, opportunistic infections as a possible cause of gastritis should be considered.

The fate of acetabular allografts after bipolar revision arthroplasty of the hip. A radiographic review.

We reviewed the radiographs of thirty-one patients (thirty-two hips) who had had revision of the acetabular component of a total hip arthroplasty with a bipolar socket supplemented by allograft and were followed for twenty-four to forty-eight months. The grafts were categorized according to their consistency (solid or crushed bone), the location of the acetabular defect (peripheral [rim] or central), and the extent of the acetabular defect (contained--the medial part of the acetabular wall was intact, or non-contained--it was deficient). We recorded the time to incorporation of the graft, the amount of migration of the socket in the superior and medial axes, and the percentage of graft remaining at the time of the most recent follow-up. The time to healing was similar for all categories of grafts. The central, contained, solid grafts had less resorption than did the central, contained, crushed-bone grafts, as evidenced by less migration of the socket during follow-up. The non-contained grafts, in both peripheral and central locations, were associated with high rates of migration and of instability of the socket.

Lipohemarthrosis of the knee: a review of recent experiences.

The radiographs of 268 patients with knee trauma were retrospectively reviewed. In 15 patients with intraarticular fracture, the images demonstrated fat-fluid levels. In 28 other patients with intraarticular fracture, only joint effusion without a fat-fluid level was depicted. The presence of a fat-fluid level in the knee indicated fracture in all patients in whom it was seen. The absence of such a level, however, did not exclude intraarticular fracture.

Evaluation of a nonconstrained total shoulder prosthesis.

We reviewed the radiographs and medical records of 76 patients with 98 nonconstrained total shoulder prostheses: 68 were inserted for rheumatoid arthritis, 25 for osteoarthritis, and five for avascular necrosis. The radiographic follow-up averaged 36 months. Radiographic evidence of postoperative complications was noted in 37 (38%) of 98 shoulders: dislocation of the humeral head (six), upward migration of the humerus (24), loosening of the glenoid compartment (15), loosening of the humeral component (five), subsidence of the humeral component (seven), and heterotopic bone formation (six). Patients with a dislocated prosthesis had limitation of motion, poor function, and residual pain. No increase in pain was associated with proximal subluxation of the humerus. No correlations were found between any of the radiographic findings (the presence of radiolucent lines about the glenoid or humeral components, humeral subsidence, or ectopic ossification) and any of the clinical findings (pain relief, range of motion, motor power, or functional improvement).

Fungal diseases in Shiraz.

In 122 patients with fungal diseases studied over a six month period, sixty were seen with dermatophyte infections. Tinea pedis, cruris and ungruium occurred mainly in adult males attending the private hospital and tinea corporis and capitis children attending the University Hospital. The organisms found were Trichophyton rubrum, T. mentagrophytes, T. schonleinii, T. tonsurans, Epidermophyton floccosum and Microsporum canis. Infections with Candida albicans occurred both in the urban and rural population and included case of familial chronic muco-cutaneous candidiasis. Pityriasis versicolor was the commonest fungal disease seen.