Chemical cholecystitis associated with hepatic arterial chemotherapy delivered by a permanently implanted pump.

The introduction of chemotherapeutic agents directly into the proper hepatic artery via an indwelling catheter results in perfusion of the gallbladder, because the cystic artery is usually a branch of the right hepatic artery. Five gallbladders, removed two to 16 months after insertion of permanently implanted Infusaid model 400 pumps, were examined. All of the gallbladders had significant arteritis, with narrowing or occlusion of lumina or necrosis of vessel walls. Fibrosis of the gallbladder wall was also a constant finding. Nuclear atypia of mucosal epithelium and connective tissue was common. Varying degrees of acute and chronic inflammation were present. These abnormalities may have a radiomimetic and direct irritant pathogenesis.

Hepatobiliary scintigraphy in patients receiving hepatic artery infusion chemotherapy.

Hepatic artery infusion chemotherapy is used in the treatment of certain selected hepatic tumors, especially metastatic adenocarcinoma of the colon. Chemical cholecystitis has been recognized recently as a complication of hepatic artery infusion chemotherapy. We performed hepatobiliary scans on ten patients receiving hepatic artery infusion chemotherapy. All ten patients had abnormal hepatobiliary scintigraphy. We present case reports of three patients with abnormal hepatobiliary scans who have required cholecystectomy for symptoms of chemical cholecystitis to illustrate the clinical, scintigraphic, and pathologic findings in these patients.

Monitoring ventricular function at rest and during exercise with a nonimaging nuclear detector.

A portable nonimaging device, the nuclear stethoscope, for measuring beat to beat ventricular time-activity curves in normal people and patients with heart disease, both at rest and during exercise, is being developed and evaluated. The latest device has several operating modes that facilitate left ventricular and background localization, measurement of transit times and automatic calculation and display of left ventricular ejection fraction. The correlation coefficient of left ventricular ejection fraction obtained with the device and with a camera-computer system was 0.92 in 35 subjects. During bicycle exercise the ejection fraction in 15 normal persons increased from 44 to 64 percent (P less than 0.001), whereas among 12 patients with heart disease it was unchanged in 5 and decreased in 7.

Gated and cinematic perfusion lung imaging in dogs with experimental pulmonary embolism.

To determine how pulmonary respiratory motion affects detection of pulmonary emboli, 11 dogs had routine lung scans and gated or cinematic perfusion images after undergoing autologous experimental pulmonary embolism. Six dogs had routine six-view perfusion studies, plus end-inspiratory and end-expiratory gated perfusion studies performed with a physiologic synchronizer set to 80% threshold. Five other dogs had three-view ungated and cinematic (post., LPO, RPO) perfusion images. Cinematic studies were acquired by synchronizing a camera-computer system to the Harvard respirator that ventilated the dog. Before death, all animals received i.v. India ink to outline pulmonary perfusion defects, and postmortem lung dissection verified sites of emboli. An ROC curve analysis of randomized perfusion studies showed that end-inspiratory gated images yielded true-positive rates 5--10% higher than ungated images at any given false-positive rate. Lesion detection by cinematic studies was comparable to detection by ungated images, but detection by end-expiratory images was worse. End-inspiratory gated imaging may be useful as an occasional adjunct to routine perfusion lung imaging.