Perioperative blood transfusion and survival of breast cancer patients after modified radical mastectomy.

To investigate the effect of perioperative blood transfusion on the survival of patients with breast cancer, the authors reviewed the clinical records of 455 patients who underwent modified radical mastectomy between 1960 and 1979. Thirty-eight patients (8.4%) received blood transfusions. For stage I patients who received perioperative transfusions, 5- and 10-year survival rates were 53% and 47%; for the no-transfusion group, the rates were 93% and 85%. There was also a significant difference in disease-free survival for stage I patients: for the transfusion group, 5- and 10-year survival rates were 47%; for the group not receiving a transfusion, the rates were 89% and 84%. For stage II patients, there was no difference in total or disease-free survival between those who received transfusions and those who did not, and both groups had comparable distribution of nodes.

Evaluation of 99Tcm Technegas ventilation scintigraphy in the diagnosis of pulmonary embolism.

In the diagnosis of pulmonary embolism, perfusion lung scintigraphy offers high sensitivity but low specificity. The specificity can be significantly increased by the use of combined ventilation and perfusion studies. Most aspects of perfusion lung scintigraphy are uniformly accepted but the technique of ventilation imaging varies from centre to centre. This study describes a new technique for the performance of ventilation scintigraphy using a suspension of ultrafine carbon particles labelled with 99Tcm ("Technegas"). The technique combines the ready availability of 99Tcm and its optimal imaging properties with an easily administered radiopharmaceutical of particle size sufficiently small to deposit in the alveoli. Of 63 patients studied by conventional perfusion scintigraphy plus Technegas ventilation scintigraphy, images of diagnostic quality were obtained in all. 31 of these patients also had a ventilation study using 81Krm gas and in only one instance did the two methods of ventilation imaging lead to differing interpretations. We conclude that high quality diagnostic images may be obtained using this new technique, which can be made available on both a routine and an emergency basis, thus improving the service provided for patients suspected of having pulmonary embolism.

Excretion of iodine-123-hippuran, technetium-99m-red blood cells, and technetium-99m-macroaggregated albumin into breast milk.

The amount of radioactivity excreted in breast milk following three different nuclear medicine procedures on twelve nursing mothers has been measured. Some of this information has already been incorporated into the latest guidelines on suspension of feeding after maternal radiopharmaceutical administration. The overall radiation dose that the patients' babies would have sustained had breast feeding not been interrupted has been estimated as an effective dose equivalent. A model has been developed to describe the relationship between clearance of activity from the milk, time between expressions, and the fraction of milk expressed. Some simple guidance is given on calculation of suitable interruption times for any individual mother from counts on her milk samples.

Observations on the BT PABA/14C-PABA tubeless test of pancreatic function.

The diagnostic accuracy of the BT PABA/14C-PABA tubeless test of pancreatic function was assessed in a prospective study of 140 patients. Drug or isotopic interference invalidated 16 tests (11.4%). The sensitivity of the PABA/14C excretion index was 76.7% and the specificity 85.7% using the mean -2 SD value of 0.82 as the cut-off point; 74.4% sensitivity and 95.7% specificity using the mean -3 SD value of 0.76. The potential usefulness and limitations of this modern version of the PABA test are discussed.

The plasma protein binding of HIDA.

By using Sephadex gel column chromatography to separate substances into their various components according to molecular weight, we have investigated the effect of incubating several "brands" of HIDA in plasma, in vitro. The results show that such incubation has no effect on either dimethyl HIDA, or diethyl HIDA, but that in the case of para-butyl HIDA, incubation in plasma increases the Rf value to that of HSA (human serum albumin). This indicates that para-butyl HIDA becomes bound to plasma proteins, in contrast to both dimethyl HIDA and diethyl HIDA.

The preparation and composition of HIDA.

The compositions of four "brands" of Tc-HIDA-dimethyl HIDA (Sorin Biomedica), diethyl HIDA (Solco), diethyl HIDA (The Radiochemical Centre), and para-butyl HIDA (Sorin Biomedica)--were investigated at varying times after their preparation from "instant kits", by using Sephadex gel column chromatography. Up to three peaks of activity were seen in each chromatogram, representing free reduced technetium, the monocomplex, and the biscomplex of Tc-HIDA respectively. In all cases the free reduced technetium component diminished to reach a plateau at less than 4% of total activity, by 1 h. In both "brands" of diethyl HIDA there was a transformation from the monocomplex to the biscomplex which took about one hour. The rate of this transformation was increased by raising the temperature of incubation, or by agitation during incubation. In the para-butyl HIDA this transformation was again noted, but was incomplete. In the dimethyl HIDA the monocomplex form was not seen. There was no noticeable disintegration of any Tc-HIDA complex up to 6 h. It is suggested that HIDA should be incubated for 1 h after preparation, before use, to achieve a stable composition.

Intracellular electrolyte depletion in patients with ileostomies.

Fourteen apparently healthy patients with ileostomies were found to be depleted of total exchangeable sodium and potassium, but had normal serum electrolyte concentrations and normal extracellular fluid and total body water volumes. The low exchangeable sodium and potassiums were thus primarily due to depletion of the intracellular compartment. There was no evidence of renal or intestinal conservation of these ions and plasma aldosterone, renin activity, and prolactin concentrations were normal in most and only moderately raised in a few. This apparent lack of any hormonal compensatory change to the electrolyte depletion may be due to the normality of the extracellular fluid volume and electrolyte concentrations. These patients seem to have adapted to a stable but depleted intracellular sodium and potassium state.

Value of exchangeable electrolyte measurement in the treatment of myasthenia gravis.

We have investigated electrolyte exchange in myasthenia gravis before and after corticotrophin therapy, using a four-isotope dilution technique. Clinical deterioration in patients on corticotrophin is associated with a fall of more than 20% in the intracellular potassium concentration, suggesting that all myasthenics so treated should be given potassium supplementation.

123-Iodine: a new isotope for functional renal scanning.

The results are presented of functional renal scanning in 11 urological patients using 123-iodine labelled Hippuran--a new radiopharmaceutical. The 123-iodine isotope possesses distinct advantages over existing isotopes, permitting high resolution imaging whilst delivering a low integrated radiation dose. It is hoped that the expense of this cyclotron-produced isotope will not mitigate against full evaluation of its promising potential.