Gastric emptying. Comparison of anterior only and geometric mean correction methods employing static and dynamic imaging.

Dynamic (continuous) and static imaging techniques were compared in the analysis of gastric emptying patterns in 16 consecutive adult patients with normal gastric half-emptying times assessed by dynamic imaging for 90 minutes under a dual head camera allowing simultaneous anterior and posterior imaging. Gastric t1/2 values were calculated for each patient based on four different data analysis methods: geometric mean corrected dynamic data (GD), anterior alone dynamic data (AD), geometric mean corrected simulated static data (GS), and anterior alone simulated static data (AS). The mean t1/2 values were: GD = 63.8 minutes, AD = 72.1 minutes, GS = 65.3 minutes, and AS = 73.0 minutes. Both the geometric mean corrected methods had a statistically different t1/2 than either of the anterior methods. Lag phase measurements, defined as a 2% decrease in gastric activity were: GD = 7 minutes, AD = 19 minutes, GS = 6 minutes, and AS = 16 minutes. Dynamic and static geometric mean methods provide similar gastric t1/2 calculations that are statistically different than anterior alone methods, and the lag phase is much shorter using either of the geometric mean methods.

Radiologic-pathologic correlation. Diffuse pontine astrocytoma.

This case demonstrated the classic gross, pathologic, CT, and MR findings of pontine astrocytoma. The role of functional brain imaging in identifying regrowth of tumor was illustrated and the differential diagnosis of a brain stem lesion summarized.

The renal effects of low-dose dopamine in thermally injured patients.

The renal effects of low-dose dopamine (LDD) therapy in hyperdynamic thermally injured patients are unknown. We investigated the renal effects of LDD in ten burn patients (mean +/- SEM age and % total body surface burned: 30.2 +/- 3.3 years and 53.4% +/- 7%) and six controls (mean age; 20.2 +/- 0.5 years). Administration of LDD significantly increased glomerular filtration rate, effective renal plasma flow, sodium excretion, and urine flow in the controls and effective renal plasma flow, urine flow, heart rate, and cardiac index in the patients. The chronotropic effect of dopamine appears to be a principal contributor to the patients' increased effective renal plasma flow. Sodium excretion was increased by LDD only in the patients in whom the predopamine sodium excretion exceeded 5 mEq/h. Lack of a consistent natriuretic effect and the consistent chronotropic effect suggest that the routine use of low-dose dopamine in burn patients is unwarranted. The side effects that attend the desired response determine clinical use, i.e., the potential for blood flow redistribution and increased cardiac work demands must be balanced against increased renal plasma flow and natriuresis.

The effects of danazol on a patient with familial dysalbuminemic hyperthyroxinemia.

Familial dysalbuminemic hyperthyroxinemia, a syndrome involving an abnormal affinity of albumin for thyroxine, results in elevated total thyroxine and free thyroxine index levels but normal triiodothyronine resin uptake and thyroid-stimulating hormone levels. Danazol is a synthetic androgen that increases triiodothyronine resin uptake and decreases total thyroxine, secondary to a decrease in thyroid-binding globulin levels. A 35-year-old woman with familial dysalbuminemic hyperthyroxinemia who was given danazol, in whom nervousness, insomnia, and weight gain developed, is described. Thyroid tests performed after initiation of danazol therapy revealed an increase in triiodothyronine resin uptake, with persistently elevated total thyroxine and free thyroxine index levels, and normal thyroid-stimulating hormone levels. Once the danazol was withdrawn, the symptoms resolved, the triiodothyronine resin uptake returned to normal, and the thyroid-stimulating hormone remained normal. The effects of danazol on a patient with familial dysalbuminemic hyperthyroxinemia correlate well with the effects on normals, and the ultrasensitive thyroid-stimulating hormone was the most useful test in separating hyperthyroxinemia from hyperthyroidism.

Scintigraphic evaluation of coralline hydroxyapatite ocular implants. Case reports on the use of planar and SPECT bone scintigraphy.

Previous reports on the application of bone scintigraphy to evaluate and assess the degree of vascular and soft tissue ingrowth into coralline ocular implants after operation are limited and SPECT imaging has not been reported. Two cases are described in which planar and SPECT imaging of Tc-99m MDP uptake in ocular implants were performed at approximately 3 and 15 months after surgery.

Diffuse abdominal uptake of technetium-99m-methylene diphosphonate in a patient on continuous ambulatory dialysis during bone scintigraphy.

Extra-skeletal uptake of bone seeking radiopharmaceuticals has been documented by scintigraphy. We present a case of diffuse uptake of 99mTc-methylene diphosphonate (MDP) in the abdomen of a patient while undergoing continuous ambulatory peritoneal dialysis (CAPD) who had no symptoms or findings referable to the abdomen. We hypothesized that the 99mTc-MDP crossed the peritoneal membrane across a concentration gradient. An in-vitro simulation confirms that 99mTc-MDP will cross a semi-permeable membrane. Diffuse uptake of 99mTc-MDP may be a normal variant in patients on CAPD who have no signs or symptoms of peritonitis.

Effect of dilantin on myocardial uptake of Tl-201 thallous chloride. A case report.

Dilantin has been reported to decrease myocardial uptake of Tl-201 thallous chloride by as much as 38.8% in rats. To date, no studies have been done in humans to document the effect of dilantin on the myocardial uptake of thallium or its effect clinically on the interpretation of images obtained while on dilantin. The authors report a case in which simultaneous exercise echocardiogram and Tl-201 myocardial scintigraphy and serial Tl-201 myocardial scintigraphy were performed but revealed no adverse effect on image quality or interpretation.

Familial dysalbuminemic hyperthyroxinemia associated with multinodular goiter and elevated radioiodine uptake. A case report.

Familial dysalbumenic hyperthyroxenemia characterized by elevations in serum total thyroxine (T4) and free-thyroxine index and normal free T4 and radioiodine uptake has been previously described. This syndrome is secondary to an autosomal dominant inheritance in which affected individuals are mistakenly diagnosed as thyrotoxic because of the elevation of serum levels of total T4 and free T4. The excess T4 level is caused by the presence of an abnormal serum protein that binds excess T4, thereby raising the level of total T4. The authors report the case of a patient with familial dysalbumenic hyperthyroxenemia who presented with superimposed multinodular goiter and an elevated 24-hour radioiodide uptake.

Dissociation of blood volume and flow in regulation of salt and water balance in burn patients.

The relationship between effective blood volume and related hormones in burn patients following resuscitation is not well understood. Previous reports have suggested that hormone secretion is altered by a resetting of neural control mechanisms. Serum and urine sodium, plasma renin activity, serum ADH, cardiac index, effective renal plasma flow, and total blood volume were measured in seven burn patients (mean age, total burn size, and postburn day: 32 years, 56%, and 9 days, respectively). The same values (with the exception of cardiac index and blood volume) were measured in 10 control patients (mean age, 24 years). The blood volume of patients was measured by 51chromium red blood cell (RBC) labeling and compared to normal predicted values based on body surface area and sex. Mean serum sodium and osmolality were 138 mmol/L (millimolar) and 286 mosm/kg, respectively, in both patients and control subjects. Mean +/- standard error of the mean total blood volume in the patients was low, 81% +/- 4% of predicted values. Cardiac index and renal plasma flow were significantly elevated. Plasma renin activity and antidiuretic hormone (ADH) levels were elevated and altered in the direction expected from blood volume measurements despite the findings of increased blood flow. Dissociation of organ flow and hormonal response suggests that simultaneous direct blood volume measurements are necessary to elucidate factors other than altered neural control settings to explain hormonal changes in the flow phase of injury. Depressed total blood volume appears to promote elevated ADH levels in burn patients following resuscitation. Whether there is an additional role of altered neural control settings remains to be established.

The value of urine creatinine analysis in the evaluation on Schilling tests.

We performed a prospective study to assess the clinical value of evaluating the adequacy of 24-hour urine specimens submitted for Schilling tests. A total of 121 specimens were evaluated of which 51 had abnormal vitamin B12 excretion values. Of those 51, there were 23 with apparently inadequate total creatinine content (implying a collection of less than 24 hours). Six of 12 specimens with less than 600 ml had adequate total creatinine content as well as normal vitamin B12 excretion. Compared with evaluation of specimen volume alone, these data support the inexpensive urine creatinine assay as a valuable source of information regarding the adequacy of 24-hour urine collections thereby improving the specificity of the Schilling test.

Gallbladder perforation during liver biopsy diagnosed using hepatobiliary scintigraphy: a case report.

Serious complications of liver biopsy are uncommon with injury to the gallbladder being rare. Rapid diagnosis and proper management of injuries to the biliary system are necessary because of potential morbidity associated with bile peritonitis. Scintigraphy is an accepted means of evaluating traumatic injuries of the gallbladder and biliary tree. The authors present a case of iatrogenic perforation of the gallbladder during liver biopsy demonstrated by hepatobiliary scintigraphy. CT and surgical correlation are provided.

Dermatitis herpetiformis and glomerulonephritis. Case report and review of the literature.

A patient who had a history of successfully treated dermatitis herpetiformis and in whom membranous glomerulopathy later developed is described. The predominant immunoglobulin present in the renal biopsy specimen was IgA. It is suggested that the dermatologic and renal diseases had a common immunologic origin. A review of the literature dealing with dermatitis herpetiformis and glomerulonephritis is included.

Metoclopramide kinetics in patients with impaired renal function and clearance by hemodialysis.

Metoclopramide kinetics were examined in 24 adult patients with diminished renal function and in eight healthy subjects with normal renal function. Creatinine clearance correlated with metoclopramide plasma clearance, renal clearance, nonrenal clearance, and elimination t1/2. Regardless of renal function, renal clearance accounted for less than or equal to 21% of total plasma clearance. Nonrenal clearance was reduced in patients and accounted for most of the reduction in plasma clearance. The comparatively small plasma clearances in patients imply that maintenance doses should be reduced accordingly to avoid drug cumulation. Metoclopramide clearance by hemodialysis was also assessed in four patients. Metoclopramide losses from hemodialysis were relatively small compared to estimates of total body metoclopramide stores. Compensatory dosage increases are probably unnecessary for most patients. These data also suggest that hemodialysis is not likely to be effective in metoclopramide overdose.

Cutaneous nonpulmonary Mycobacterium chelonei infection. Successful treatment with sulfonamides in an immunosuppressed patient.

A 52-year-old man, who had received immunosuppressive therapy for four years after renal transplantation, had a deep-set skin infection in his thigh caused by Mycobacterium chelonei. In vitro studies indicated that the organism was resistant to antimycobacterial agents but potentially sensitive to high-dose sulfonamide therapy. Repeated surgical excisions failed to eradicate the infection, as documented by histopathologic examination. The combination of a reduced dose of immunosuppressive medication and the administration of high-dose sulfonamide therapy resulted in clinical recovery.

Chronic myelogenous leukemia with nephrotic syndrome.

A patient with chronic myelogenous leukemia was initially seen with nephrotic syndrome. Minimal-change glomerulonephritis was verified by open renal biopsy, and the patient showed good response to treatment with a diuretic and prednisone. We believe this represents the first reported case of nephrotic syndrome in myelogenous leukemia.