The pitfalls of planar three-phase bone scintigraphy in nontraumatic hip avascular osteonecrosis.

PURPOSE: This study documented the previously reported lower sensitivity of routine planar three-phase bone scintigraphy (BS) performed using a high-resolution parallel-hole collimator compared with MRI to diagnose nontraumatic avascular necrosis of the hip (AVN). METHODS: Six observers reviewed 143 bone scintigrams obtained in patients with nontraumatic hip pain (n = 120) or a control group (n = 23). All patients had a standard radiograph and MRI within 2 months of the BS. Of 280 hips, 148 (53%) were painful on the day of the examination. The osteonecrosis group (AVN) consisted of 93 instances of AVN in 58 patients. Although it departs from the clinical situation, this method evaluated the intrinsic performance of the imaging method. The data were analyzed using a receiver operating characteristic method. RESULTS: For the six observers, the A(z) values were 0.65, 0.67, 0.66, 0.67, 0.73, and 0.79, respectively, and 0.66, 0.71, 0.75, 0.81, 0.81, 0.82, and 0.84 after removing hip diseases other than AVN through data manipulation. Bone marrow edema, as seen on MRI, was the most frequently reported misleading sign in false-positive diagnoses, especially in the early or late phases of the disease. False-negative diagnoses misclassified the scans as "asymptomatic hips" in 28 of 30 cases. Twenty-two of 30 scans appeared normal, but these AVN lesions were small (<25%) and were discovered by chance on MRIs that displayed bilateral involvement associated with radiographic evidence (stage 0 or 1). Thirteen of 20 patients were followed for 3 or more years, and only one worsened. CONCLUSIONS: BS is not indicated to diagnose possible contralateral AVN if the hip is asymptomatic. This study emphasizes the results from the literature; if indicated, a radionuclide hip investigation requires the use of a pin-hole collimator, a SPECT study with scatter correction and iterative reconstruction algorithms, or both.

[Effect of preoperative administration of Lugol's solution on thyroid blood flow in hyperthyroidism]. / Effet de l'administration pré-opératoire du soluté de Lugol sur le débit sanguin thyroïdien dans l'hyperthyroïdie.

A study of 50 patients with hyperthyroidism was conducted to evaluate the effect of preoperative administration of Lugol's iodine solution on thyroid blood flow. Highly significant reductions in diameter, time-averaged velocity, and volume flow of the superior thyroid artery were demonstrated after administration of Lugol's solution. The Duplex ultrasound scanning used in this study is a noninvasive, inexpensive, accurate, and reproducible technique suitable for analysis of thyroid blood flow in hyperthyroidism. On the basis of current ultrasonographic results and low postoperative morbidity in patients, Lugol's solution is well tolerated and may be recommended for use before thyroidectomy, especially for diffuse toxic goiters and Graves disease.

Progress in the assessment of lymphatic spread in rectal cancer. Rectal endoscopic lymphoscintigraphy.

Rectal endoscopic lymphoscintigraphy was performed in 10 control subjects and in a series of 85 patients with adenocarcinoma of the rectum as a prospective study to evaluate lymphatic drainage of the rectum and lymphatic spread in rectal cancer. Complete cranial drainage was demonstrated in all control subjects, and internal iliac nodes were also visible in 50 percent of cases. Results were correlated with histologic node examination in all patients operated upon for rectal cancer. Rectal endoscopic lymphoscintigraphy was assessed for sensitivity (85 percent), specificity (68 percent), overall accuracy (76 percent), positive predictive value (71 percent), and negative predictive value (83 percent). False-negative and false-positive results are discussed. Rectal endoscopic lymphoscintigraphy represents the only method currently available for evaluation of lymphatic spread in rectal cancer.

[Thyroid microcarcinoma with a fatal outcome and 34 other unusually aggressive cases reported in the literature]. / Microcarcinome thyroïdien d'évolution fatale et trente-quatre autres cas inhabituellement agressifs rapportés dans la littérature.

A follicular thyroid microcarcinoma was revealed by scapular metastases. Despite treatment, other metastases were the cause of death after a course of 14 years. In the medical literature there are at least thirty-four other examples of follicular or papillary carcinoma of less than 15 mm (previously called occult) that have either given rise to blood-born metastases or have been the cause of death. Present data from light and electron microscopy, immunohistochemistry and microspectrophotometry cannot differentiate between small and large carcinomas. Microcarcinomas (particularly papillary ones) are frequent in the general population and are found in 5% of thyroids. They are usually not aggressive. Those which show vascular or capsular invasion, a lack of lymphoid infiltrate and large cervical lymph node metastases are more likely to have an unfavorable course. The discovery of a microcarcinoma in a thyroid cells for an extended follow-up.

[Gastroesophageal reflux in asthmatic and chronic bronchitis patients]. / Reflux gastro-oesphagien chez les asthmatiques et les bronchitiques chroniques.

To determine the relationship between gastroesophageal (GE) reflux and pulmonary disease, we studied 21 asthmatics, 30 chronic bronchitics, 6 patients with GE reflux and no pulmonary symptoms, and 10 control subjects; GE reflux was diagnosed by pH monitoring and GE scintiscanning. Frequency of GE reflux in the asthmatics was 57%; in chronic bronchitis it was 56%. Pulmonary function tests did not show any differences between patients with or without reflux. The GE reflux episodes were more numerous but shorter in asthmatics than in chronic bronchitis. Patients with digestive symptoms alone were no different from chronic bronchitis with respect to reflux. The mechanism whereby reflux triggers pulmonary problems was investigated using the following 2 tests: scintiscan for pulmonary aspiration, and esophageal acid infusion (0.1N HCI). Six pulmonary aspirations were detected. Only asthmatics, with or without reflux, showed any significant variations in maximal expiratory flow at 50% and 25% of VC after HCI infusion. Thus, our results show that asthmatics differ from bronchitis patients by the characteristics of their reflux.

[190 cancers of the thyroid with a follow-up of more than 5 years]. / 190 cancers de la thyroïde. Avec plus de 5 ans de recul.

Outcome in 190 patients operated upon by first intention for thyroid cancer is analyzed after follow up over more than 5 years. No deaths due to cancer occurred in 57 cases of papillary cancer, but 7 cases presented pulmonary metastases, while the global-5-year survival rate in 63 cases of vesicular cancer (including 25% with preoperative metastases) was 60%. In the absence of preoperative metastases, ans if well differentiated forms are separated from moderately differentiated forms, the respective 5-year survivals were 88 and 45%. The 1-year survival rate for the 42 cases of anaplastic cancer was 15%, while the 5-year rate for 15 cases of medullary cancer was 80%.

Quantitative bone scintigraphy: usefulness in the survey of patients treated for bone metastasis of prostatic cancer.

The purpose of this study was to develop a quantitative bone scintigraphy (QBS) method in order to evaluate the evolution of bone metastases in patients treated for disseminated prostatic cancer. Data obtained by whole body scintigraphy after injection of 99mTc-methylene diphosphonate enabled us to define three indexes, GR, R1 and R2. They respectively represent the amount of activity retained in the bones, in the metastatic sites and in pathological sites related to the global activity of the skeleton. Repeated QBSs have been performed on 59 patients with prostatic carcinoma treated for bone metastasis with hormonal therapy. Results of QBS are well correlated to clinical findings, particularly pain evolution. In addition, the calculated indexes of QBS made it possible to distinguish three groups of patients according to regression, stabilization or evolution of their lesions under hormonal therapy. QBS seems to be a sensitive and useful test for the evaluation of the therapeutic efficiency on bone metastases from prostatic carcinoma.

Gastroesophageal reflux in patients with asthma and chronic bronchitis.

To determine the relationship between gastroesophageal (GE) reflux and pulmonary disease, we studied 21 asthmatics, 30 chronic bronchitics, 6 patients with GE reflux and no pulmonary symptoms, and 10 control subjects; GE reflux was diagnosed by pH monitoring and GE scintiscanning. Frequency of GE reflux in the asthmatics was 57%; in the chronic bronchitics it was 56%. Pulmonary function tests did not show any differences between patients with or without reflux. The GE reflux episodes were more numerous but shorter in asthmatics than in chronic bronchitics. Patients with digestive symptoms alone were no different from chronic bronchitics with respect to reflux. The mechanism whereby reflux triggers pulmonary problems was investigated using the following 2 tests: scintiscan for pulmonary aspiration, and esophageal acid infusion (0.1N HCl). Six pulmonary aspirations were detected. Only asthmatics, with or without reflux, showed any significant variations in maximal expiratory flow at 50% and 25% of VC after HCl infusion. Thus, our results show that asthmatics differ from chronic bronchitics by the characteristics of their reflux.

[Thyroid carcinoma in an adult cystic teratoma of the ovary with bony metastases]. / Carcinome thyroïdien sur tératome kystique adulte de l'ovaire avec métastases osseuses.

An oophorectomy specimen in a patient aged 36 showed a dermoid cyst with a struma ovarii and what was considered to be a folliculo-trabecular adenoma. Two osseous metastases appeared 4 and 8 years later respectively. The follow-up so far is 15 years. This is the twentieth reported case of mature cystic teratoma of the ovary containing metastating thyroid carcinoma.

Quantitative bone scan and bone metastases in prostatic cancer.

Bone scan is an essential method of investigation for the detection of metastases; it is also used to follow the evolution of the disease and the response to treatment in prostatic cancer. The authors tried a bone scan quantification method to better evaluate the efficiency of hormonal treatment. 28 patients were followed up by this method. Taken as a whole, quantitative scans show results very similar to those of standard scans. However, there are some differences between the two methods of interpretation. The quantitative method seems to be more effective.

Immunoradiometric assay for human thyroglobulin and variations in thyroid pathology.

A specific and sensitive double antibody radioimmunoassay for measuring human serum thyroglobulin (Tg) has been developed. Serum Tg levels are reported for patients with differentiated and undifferentiated thyroid carcinomas, post-treated and untreated hyperthyroidism, thyroiditis, and cold nodular goiters. We have studied results of serum Tg levels in the follow-up and care of patients who have undergone total thyroidectomy for differentiated thyroid carcinomas. Tg has no diagnostic value in the detection of thyroid cancer, but is a reliable index of metastatic growth in the follow-up of patients with differentiated carcinomas. In addition, serum Tg determination might be helpful in the aetiological diagnosis of bone or lung metastases of unknown origin.

[Recent advances in isotopic exploration of the skeletal system in prostate cancer (author's transl)]. / Mise au point sur les explorations isotopiques du squelette dans les cancers de la prostate.

Skeletal isotopic exploration is fundamental in patients with prostatic cancer. Bone scintiscan is reliable. Its sensibility can be increased by using new radioactive isotopes and quantitative isotopic explorations. Bone marrow histologic study is indicated in case of a doubtful diagnosis, when there is a discordance between radiological and isotopic exploration.

[Placental blood flow measured using xenon 133 (author's transl)]. / Mesure du débit placentaire par le xenon 133.

The authors have developed a method of measuring placental blood flow using intravenous injection of Xenon 133, the method being derived from that described by Rekonen. The technique is reliable and without any danger. The measurements were taken in the last 4 weeks of 25 normal pregnancies and 12 where intra-uterine growth was retarded. The placental blood flow is 92.02 +/- 16.34 ml s100 ml per minute in normal pregnancies at the end of which infants with a weight above or equal to the 10th percentile were born (the mean percentile was 46.69 +/- 25.36). The placental blood flow was 52.29 +/- 17.31 ml/100 ml per minute in cases with retarded intra-uterine growth where the infants were lighter than the 10th percentile (mean percentile 5.08 +/- 1.83). The difference between the two groups is highly significant (p less than 0.001).