Examining the relationship of concurrent obesity and tobacco use disorder on the development of substance use disorders and psychiatric conditions: Findings from the NESARC-III.

Background: Multimorbidity is linked to worse health outcomes than single health conditions. However, recent studies show that obesity may reduce the risk of developing substance use disorders (SUDs), particularly in vulnerable populations. We investigated how comorbid obesity and tobacco use disorder (TUD) relate to the risk of SUDs and psychiatric conditions. Methods: Data was used from 36,309 individuals who completed the National Epidemiological Survey on Alcohol and Related Conditions - Wave III. Individuals who met the DSM-5 criteria for TUD in the last year were defined as the TUD group. Obesity was defined as having a body mass index (BMI) greater than 30 kg/m2. Using this information, individuals were grouped into categories, with people being identified as either having obesity, TUD, both obesity and TUD, or not having either obesity or TUD (comparison). Groups were compared against their comorbid diagnoses of either an additional SUD or psychiatric conditions. Results: Controlling for demographic characteristics, we found that individuals with obesity including those individuals with TUD, had lower rates of comorbid SUD diagnosis than individuals with TUD alone. Additionally, individuals with combined TUD and obesity, and those with TUD alone, had the highest rates of comorbid psychiatric disorder diagnosis. Conclusions: The current study aligns with previous research suggesting that obesity may reduce risk of substance use disorders, even in individuals who have other risk factors promoting harmful substance use (e.g., tobacco use). These findings may inform targeted intervention strategies for this clinically relevant subpopulation.

The Society of Nuclear Medicine in the new millennium.

The Society of Nuclear Medicine (SNM), which was first organized in January 1954 by 12 men at the Davenport Hotel in Spokane, WA, has evolved into an international educational organization. It has more than 15,000 members, including physicians, scientists, technologists, and industrialists. The SNM has embarked on a new strategic plan that will make it the premier educational and scientific organization representing the specialty of nuclear medicine. The role of the Society in the new millennium and its relationship with other international nuclear medicine societies continue to evolve. The opportunity for joint educational programs, interchange of ideas, research, an international journal, educational activities, and the sharing of professional experiences awaits the SNM and its members in the new millennium. The Society has also reached out to other organizations and physicians who are involved in the clinical practice of nuclear medicine to forge new alliances that will strengthen the specialty of nuclear medicine. These alliances will allow nuclear medicine physicians to speak with a unified voice when faced with regulatory and reimbursement issues and will help in advancing the research, education, and clinical mission of the SNM.

Optimizing images of acute deep-vein thrombosis using technetium-99m-apcitide.

OBJECTIVE: The purpose of this paper is to introduce the nuclear medicine technologist to a new radiopharmaceutical, 99mTc-apcitide, for imaging acute venous thrombosis. After reading this paper, the technologist should be able to: (a) describe patient preparation for imaging with 99mTc-apcitide; (b) state the amount of 99mTc-apcitide that is administered to patients for imaging acute venous thrombosis; (c) explain patient positioning for optimal image acquisition; and (d) discuss gamma camera acquisition parameters and their importance in obtaining high-quality images. Clinical cases illustrate both the whole-body distribution and diagnostic value of 99mTc-apcitide in detecting acute deep-vein thrombosis.

Upper extremity radionuclide bone imaging: the wrist and hand.

Bone scintigraphy of the hands and wrists represents an important adjunct imaging technique that complements plain film radiographic examination. The use of the three-phase bone scan provides clinical information not only regarding osseous uptake but the blood flow and extravascular distribution of the radiotracer as well. Scintigraphic evaluation of the hands and wrists is employed in acute and chronic conditions. In the event of an equivocal or negative plain film, the bone scan can identify occult fractures. Of particular concern is the identification of scaphoid fractures due to the higher incidence of osteonecrosis. Work related injuries represent a significant health issue. The bone scan can be a part of the algorithm for evaluating chronic pain syndromes including reflex sympathetic dystrophy. The complimentary roles of bone scanning and imaging with gallium-67 citrate or radiolabeled leukocytes has proven useful in the evaluation of acute or chronic osteomyelitis. In addition, the diphosphonates are useful in identifying solitary and multiple primary bone tumors. In the case of primary bone tumor, thallium-201 can be used to evaluate response to therapy. Although uncommon in the hand and wrist, the bone scan can identify metastatic tumors or tumor-related conditions such as hypertrophic osteoarthropathy. Finally, bone scintigraphy may be useful in identifying location and extent in a variety of conditions such as fibrous dysplasia, histiocytosis X, and Paget's disease.

Scintigraphic imaging of lower-extremity acute venous thrombosis.

The need for a radiopharmaceutical that will yield a definitive diagnosis of acute venous thrombosis in the lower extremities is evident from (1) the current difficulty in making a diagnosis on the basis of clinical signs and symptoms alone; (2) the sometimes inadequate or less sensitive diagnosis made on the basis of contrast venography or ultrasound; and (3) the need to prevent pulmonary embolism, death, and other long-term sequelae that may result from undetected acute venous thrombosis. A new radiopharmaceutical was recently approved for use in the scintigraphic imaging of acute venous thrombosis in the lower extremities of patients who have signs and symptoms of acute venous thrombosis. This radiopharmaceutical (ACUTECT) is a complex of the small synthetic peptide apcitide and the radionuclide technetium (Tc) 99m (99mTc-apcitide). Apcitide binds to glycoprotein IIb/IIIa receptors, which are expressed on the surface of activated platelets, making the radiopharmaceutical specific for acute, not chronic, thrombi. 99mTc-Apcitide allows accurate imaging of the entire lower extremities, including the calf. It has an excellent safety profile, is easy to administer by injection into an antecubital vein, and allows early imaging of acute deep-vein thrombosis (10 to 60 minutes postinjection). 99mTc-Apcitide may be used as an alternative to contrast venography and a complement to ultrasonography in the detection of acute venous thrombosis in the lower extremities.

Nuclear medicine approaches to musculoskeletal disease. Current status.

With the advent of bone scintigraphy, physicians achieved earlier detection of metastatic disease. In the prior two decades, bone imaging has expanded into the realm of tomography (SPECT, PET), and diverse clinical applications, including trauma, grafts, benign disease, and tumor imaging.

Nuclear medicine in private practice.

The private practice of nuclear medicine has evolved over the past decade. Federal and state regulatory agencies, reduction in reimbursement, and a shortage of qualified physicians and technologists will affect the practice of nuclear medicine in the 1990s and beyond. Only by being proactive and able to provide credible clinical information to our referring physicians can nuclear medicine position itself for the next decade. We must continue to educate referring physicians about the cost-effectiveness and functional and physiological nature of nuclear medicine. We need to encourage medical students and physicians in training to consider nuclear medicine as a career path, and we need to provide meaningful clinical information to our referral base. In addition to these challenges, we should also remember that nuclear medicine cannot survive in a vacuum. We must support our professional societies and have ongoing representation at all levels of government. Membership in the American Medical Association, the Society of Nuclear Medicine, the American College of Nuclear Physicians, the American College of Radiology, and the Radiological Society of North America all help strengthen our voice at the state and national levels. We must continue to effectively present our specialty's positions to the various state and federal agencies that regulate our practice. We must demand high quality studies from our peers and continue to be advocates for our patients.

Correlation of bioscintigraphy, contrast venography, and iodine-125 fibrinogen uptake test.

In 40 patients believed to have deep venous thrombosis, bioscintigrams performed with I-123 fibrinogen were available for comparison with either contrast venograms or I-125 fibrinogen uptake tests. If either contrast venography or the fibrinogen uptake test was accepted as a standard for comparison, the accuracy of bioscintigraphic imaging was 90%. Most discrepancies between the procedures could be interpreted as due to heparin treatment, although bioscintigrams often were positive in patients treated with heparin for a short interval of time. Additionally, bioscintigrams provided information to distinguish venous thrombosis from other sources for local accumulation of radioactivity. Bioscintigraphy seems to be a promising noninvasive method for the detection of deep venous thrombosis of the lower extremities.

Radionuclide bone imaging in the differential diagnosis of head and neck lesions. A preliminary report.

The use of technetium 99m pyrophosphate (99mTcPP) imaging in the evaluation of benign and malignant tumors of the head and neck has been limited. In a clinical prospective study, twenty-one patients with suspected benign or malignant lesions of the temporomandibular joint, temporal bone, maxilla, or mandible were evaluated with regard to clinical presentation, radiographic findings, preoperative 99mTcPP bone scan, and final pathologic diagnosis. Eleven of twenty-one patients had positive scans at the site of biopsy-proven disease. In three cases, a bone scan was the single positive diagnostic test prior to surgical intervention. 99mTcPP imaging offers an additional noninvasive technique in the preoperative evaluation of patients with lesions of the osseous structures of the head and neck.

The increasing incidence of hypothyroidism within one year after radioiodine therapy for toxic diffuse goiter.

Patients treated with 10 mCi of I-131 for toxic diffuse goiter in the period January 1974--June 1976 were evaluated for development of hypothyroidism. Fifty percent were hypothyroid within 3 mo and 69% within 1 yr of treatment. Our data suggest that there is a higher incidence of hypothyroidism after standard doses of I-131 in the 1970s as contrasted with treatment groups in the 1950s and 1960s. The pathophysiology of this increased incidence is not known with certainty; however, infrequent use of thionamide medication, together with recent increases in dietary iodine, may render the gland more radiosensitive.

Assessment of conventional criteria for the early diagnosis of thrombophlebitis with the 125I-fibrinogen uptake test.

Analysis of 55 positive tests of a total of 300 tests by conventional criteria revealed that 125I-fibrinogen provides useful information early enough for clinical management. Of the tests which were ultimately interpreted as positive by conventional criteria, at least one was positive at 3-4 hours in 67% of the tests and 98% of the tests were positive at 24 hours after the administration of 125I-fibrinogen. A 20% difference between contralateral identical locations of the legs and a 20% difference between adjacent locations of the ipsilateral leg were found with almost equal frequency in the positive tests, whereas a 20% increase at the same location was less sensitive. The 125I-fibrogen uptake test is a simple and accurate technique for early diagnosis of active thrombophlebitis.