[Colorectal cancer screening based on quantitative determining of fecal hemoglobin and transferrin].

To reduce mortality rate from cancer there has been developed a program of colorectal cancer screening. It was conducted a pilot implementation of the methodology of colorectal cancer screening based on quantitative immunochemical determination of fecal hemoglobin and transferrin with colonoscopy. The study included 10307 men and women aged 50 years and older without symptoms of the disease who received containers for a 2-day collection of stool samples. There were returned 9455 sets with samples (91.8%). Of these an excess hemoglobin level and/or transferrin above the threshold was in 1354 (14.3%). 1164 patients (86% of positive) underwent colonoscopy. Colon diseases were found in 662 patients including polyps in 237. The efficiency of a 2-day test to detect polyps was significantly higher compared to a 1-day. Colorectal cancer was revealed in 23 people--2.4 per 1000 patients. 87% of patients had cancer of stages I and II, 13%--in stage III. The results of the introduction of screening program confirm the possibility of its use in practical public health.

Ga-67 citrate in diagnosing tracheoesophageal fistula in a patient with AIDS. Case report.

Increased radiopharmaceutical uptake in the mediastinum and/or hilum on Ga-67 citrate scan in patients with AIDS has been attributed, to date, mostly to infectious etiologies. Because other complications are being reported in these patients, awareness of their presentation in diagnostic imaging is important. Tracheoesophageal fistula can also be accompanied by a focal area of increased uptake in the mediastinum. In this patient, a Ga-67 citrate scan was the first modality of diagnostic imaging to raise suspicion of such a diagnosis.

Long-term results and patterns of disease recurrence after radical operations for lung cancer.

Long-term results and patterns of disease recurrences after radical operations for lung cancer between 1975 and 1984 were investigated. Eight hundred fifty-two patients (76.1%) with lung cancer underwent operations during this period. Radical operations were performed on 648 patients. There were 326 (50.6%) pneumonectomies, 314 (48.5%) lung resections (lobectomies), and 8 (1.2%) segmentectomies. Long-term survival rates of 542 patients were studied. In 49.2% of the patients survival was beyond 3 years; in 33% of the patients it was beyond 5 years. Five-year survival was observed in 40.3% +/- 2.5% of patients with N1 and in 19% +/- 4.9% of patients with N2 disease. The differences in survival rates between patients with epidermoid cancer and adenocarcinoma were slight and statistically insignificant. The prognosis was poor in patients with small-cell cancer, large-cell cancer, and dimorphous cancer. The causes of death were studied in 193 patients. Disease recurrence was diagnosed in 75.1% of cases. Bronchopulmonary and concomitant diseases accounted for 19.7% of deaths in these patients. In 5.2% of the patients malignant tumors occurred in other organs. Local-regional recurrences were diagnosed in 33.8% of patients, distant metastases occurred in 55.2% of patients, and 11% of patients had combined disease recurrences. The problem of disease recurrence classification is discussed in the article.

Gallbladder visualization during technetium-99m RBC blood pool imaging. Case report and literature review.

Gallbladder visualization occurred after a Tc-99m red blood cell (RBC) cardiac gated blood pool scan. To date, seven cases of gallbladder visualization after the intravenous injection of Tc-99m RBCs have been reported. In the previous six patients the gallbladder was visualized incidentally during a search for gastrointestinal (GI) bleeding. All of the patients were anemic, six of seven had chronic renal failure, and five of seven had received multiple blood transfusions. When interpreting GI bleeding scans in patients with anemia and renal failure, awareness of the possibility of gallbladder visualization in the delayed images is important to avoid false-positive results.

Cost/benefit analysis and capital investment decisions in nuclear cardiology.

This paper demonstrates an application of Cost-Benefit Analysis as an aid in capital investment medical decision making. Specifically, a cost-benefit analysis is used to compare three nuclear cardiology instruments (i.e. Nuclear Stethoscope, Mobile Camera/Computer and Fixed Cardiac Computer). The study examined both non-quantitative and quantitative comparative factors. Results of the study show: (1) Conversion of the non-quantitative factors into a numerical system (via medical opinion) greatly delineates the relative merits of each instrument. (2) Simulating the stochastic economic and equipment utilization factors reveals instrument selection to be a function of patient flow and amortization procedures. (3) Adjusting the quantitative assessment of each instrument by the non-quantitative assessment (via the numerical system) aids in the capital investment decision.

Radionuclide ventriculography following coronary bypass surgery: correlation with arteriographic findings.

Radionuclide ventriculography demonstrates improved left ventricular performance during exercise following coronary bypass operation, but few data are available that compare the nuclear ventriculographic findings with arteriographic evaluation. We report the findings in 25 patients in whom both tests were performed within a short period of time. coronary bypass operations had been performed six weeks to nine years previously. Ejection fraction (EF) increased during stress in 5 completely revascularized patients. Exercise provoked deterioration in regional wall motion in 9 of 20 (45%) patients with incomplete revascularization, and EF failed to rise during exercise in 15 (75%). Although resting EF was similar in both completely revascularized patients and in those who were not (0.06 versus 0.58), EF during exercise was significantly greater in completely revascularized patients (0.68 +/- 0.02 versus 0.55 +/- 0.03, p less than 0.01). Exercise-provoked decline in EF in patients with coronary artery bypass grafts reflects continued significant occlusive disease.

Radionuclide evaluation of the interventricular septum following coronary artery bypass surgery.

The cases of 25 consecutive patients who had undergone radionuclide ventriculography both before and after coronary artery bypass surgery and who had had normal septal motion before surgery were reviewed. Abnormal septal motion was present in 22 patients (88%) postoperatively. In contrast, a new motion abnormality appeared following surgery in the apical segments of only 5 of 21 patients (24%) and in the lateral segments of 1 of 22 (5%) patients. All patients improved clinically following surgery, and only two had evidence of intraoperative myocardial infarction. Postoperatively, thallium imaging revealed normal septal perfusion in all six patients who underwent this examination. Thus, it appears that ischemic injury does not always account for this phenomenon, which is a potential source of confusion in patients after coronary bypass operations. It is concluded that radionuclide ventriculography identifies the same aberration of ventricular septal motion that is seen during echocardiographic examination of patients who have undergone surgery.

Diagnostic efficiency of gallium 67 citrate scans in Hodgkin's disease.

The findings of 49 67Ga citrate scans were correlated with all clinical information obtained by other diagnostic modalities in untreated and treated patients with histopathologically proven Hodgkin's disease (539 sites). Eleven nodal and extranodal sites were analyzed in terms of sensitivity, specificity, accuracy and, subsequently, by calculations of the posterior probability for the presence of disease at positive and negative sites by scan using Bayes' theorem. Lowest posterior probabilities for the presence of disease at positive sites were seen in lung parenchyma (66 percent) and spleen (67 percent) in untreated patients and for treated patients in adbominal nodes an inguinal nodes (both 66 percent), whereas the scan was a good method for detecting Hodgkin's disease at all other sites where posterior probabilities were near 100 percent. Figures for the posterior probability of disease at negative sites by scan showed it was a good modality for ruling out Hodgkin's involvement in axillary nodes, perihilar nodes, lung parenchyma, inguinal nodes, and bone marrow (all less than 10 percent); however, it was not as satisfactory in ruling out disease in untreated cervical nodes (20 percent), supraclavicular nodes (11 percent), and especially in the intraabdominal sites of spleen (35 percent), abdominal nodes (33 percent), and periaortic nodes (27 percent).

Thyroid scanning of the patient with history of childhood irradiation.

The utilization of external radiation for the treatment of benign conditions of the head and neck is no longer employed because of the discovered association of local irradiation with the development of thyroidal cancer. This practice was widespread until two or three decades ago. It is also known that there is a very long latent period between previous radiation and the development of thyroid cancer. In consequence, a substantial number of persons can be expected to develop thyroidal malignancy each year until the turn of the millenium, and even later. If this association is real, then early diagnosis is especially important because of the excellent therapeutic results that can be obtained with early diagnosis. Physical examination performed on a regular basis is the most important single diagnostic aid. A statistically significant improvement in sensitivity is obtained when palpation is performed in conjunction with radioisotopic thyroid scanning. The scan helps by identifying areas of abnormality and--even more importantly--by allowing distinction of those nodules which are hypofunctioning and thus more likely to be malignant.

Clinical decision-making with treadmill testing and thallium 201.

Fifty patients were prospectively evaluated for myocardial ischemia utilizing treadmill testing and thallium-201 imaging. By coronary angiography, 43 had significant coronary stenosis and seven were normal. The sensitivity, specificity, accuracy and predictive value of treadmill testing alone (81 per cent, 71 per cent, 80 per cent and 95 per cent) did not statistically differ from that of thallium-201 imaging (70 per cent, 86 per cent, 72 per cent and 97 per cent). Combined treadmill testing and thallium-201 imaging (84 per cent, 71 per cent, 80 per cent and 98 per cent) did not significantly affect the results of treadmill testing alone. Thallium-201 imaging failed to identify a number of patients with high risk lesions. The high prevalence of disease, the presentation of typical angina, preselection bias, multiple lead monitoring and exclusion of patients with abnormalities on the resting electrocardiogram probably accounted for failure of thallium-201 imaging to improve the results obtained with treadmill testing. The use of thallium-201 imaging in certain subsets of patient (resting electrocardiographic abnormalities, nondiagnostic treadmill testing, atypical chest pain or asymptomatic patients with abnormalities on treadmill testing) may be of value. However, the use of thallium-201 imaging as a routine screening procedure for myocardial ischemia in patients with typical angina, without due consideration of the prevalence of the disease in the population, is not justified.

Role of bone scanning in carcinoma of the breast.

This paper consists of a review of the current literature, as well as the authors' experience, concerning the diagnosis and treatment of carcinoma of the breast with special reference to the role of radioisotopic bone scanning. Recommendations are made regarding the appropriate use of this technique at the time of initial diagnosis and over the course of subsequent management.