Gallbladder emptying in normal volunteers. Comparative study between cholescintigraphy and ultrasonography.

To assess the reproducibility of and compare the patterns of gallbladder emptying after a fatty meal stimulus, the authors analyzed 10 healthy fasting volunteers (8 men; mean age, 32 years). Cholescintigraphy was obtained after intravenous injection of 185 MBq of Tc-99m DISIDA. A standardized fatty meal was provided 70 minutes after injection. The ejection fraction was measured sequentially by ultrasound and cholescintigraphy 15, 30, 45, and 60 minutes after eating. All patients had repeat studies within 1-3 weeks. The two methods showed a distinct gallbladder time course of emptying after the fatty meal stimulus. Nuclear medicine showed higher values of gallbladder ejection fraction at 45 and 60 minutes after eating when compared to ultrasound (P < 0.01). The plotted curves, using the four different periods of time, also showed different behavior due mainly to distinct angular coefficients (nuclear medicine, 2.6; ultrasound, 0.9). Good reproducibility of fatty meal-induced gallbladder ejection fraction at 30, 45, and 60 minutes was also observed using both methods. Thus, ultrasound and nuclear medicine are reproducible methods of studying gallbladder dynamics. However, nuclear medicine demonstrated continued excretion of bile at 45 and 60 minutes, whereas ultrasound did not show significant volume variations in these time frames.

Changes in condylar position following bilateral sagittal split ramus osteotomy with setback.

The purpose of this study was to evaluate the changes in condylar position following bilateral sagittal split ramus osteotomy with 5- and 10-mm setback in 1 symmetric human cadaver mandibles. A Plexiglas device was constructed to determine the mandibular morphology and the movements of the condyle and the proximal segments before and after surgery. There was no statistically significant relationship between mandibular morphology or the magnitude of setback and changes in condylar position postsurgery. All condyles and rami tipped in a highly variable fashion in the coronal plane. In the axial plane, the lateral pole of the condyles rotated predominantly anteriorly; the left side rotated significantly more than did the right. In the sample studied, the position of the condylar and proximal segments was altered in a highly variable and unpredictable manner, regardless of the magnitude of setback or the morphology of the mandible.

Facial anthropometrics versus cephalometry as predictors for surgical treatment in patients with Class III dentofacial deformities.

The purpose of this study was to determine statistically the relative importance of facial anthropometrics and cephalometry in diagnosing the specific jaw deformity in patients with Class III relationships, ie, the contribution that maxillary deficiency and/or mandibular prognathism made to the Class III deformity. Frontal and right profile photographic views and pretreatment lateral cephalometric radiographs of 20 randomly selected Class III patients were analyzed. Correlation and multiple-regression analyses were utilized to determine the relative importance of clinical diagnosis and cephalometric diagnosis in determining the actual surgery performed. In addition, these analyses determined the relative importance of the various facial anthropometrics and cephalometric parameters critical to making the specific diagnosis of maxillary deficiency and/ or mandibular prognathism. It was concluded that a jaw-specific diagnosis of the Class III population studied was best made with facial anthropometrics rather than cephalometry, and the most important predictive facial features on which to based this diagnosis were paranasal configuration and chin projection. Although the overall cephalometric diagnosis had no statistically significant correlation to the actual surgery preformed, two individual cephalometric parameters, maxillary first molar to pterygoid vertical and mandibular plane angle, were found to statistically correlate to the actual surgery performed. These cephalometric parameters should be scrutinized along with the facial anthropometric data when the jaw-specific surgery is selected.

Brain SPECT in the pre-surgical evaluation of epileptic patients. Preliminary results.

Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n = 10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

Feocromocitoma intratorácico: relato de caso / Intrathoracic pheochromocytoma: a case report

Os autores apresentam um caso de feocromocitoma intratorácico demonstrado e localizado através da cintilografia com MIBG-131, e sua correlaçäo com a radiografia convencional e tomografia computadorizada

Colangiocarcinomas. Avaliacao pela ultra-sonografia e correlacao com a colangiografia transparieto-hepatica. / Cholangiocarcinomas. Evaluation by ultrasound and correlation with transparietohepatic cholangiography

Os autores estudaram pela ultra-sonografia e pela colangiografia transparieto-hepatica 21 casos de colangiocarcinomas. Estes dois metodos possuem grande importancia no diagnostico da ictericia obstrutiva e de suas causas. A utilizacao combinada destes dois metodos estabelece com precisao o diagnostico, o grau de envolvimento da arvore biliar fornecendo informacoes importantes com relacao a ressecabilidade cirurgica do tumor. E proposta uma classificacao sonografica destas lesoes tumorais estabelecendo-se correlacao com o prognostico cirurgico. Os colangiocarcinomas devem ser incluidos no diagnostico diferencial das ictericias obstrutivas sendo de grande importancia sua identificacao precoce em razao de seu prognostico favoravel nestes casos

Linfoma histiocitico renal (reticulossarcoma). Apresentacao de caso. / Renal histiocytic lymphoma (reticulosarcoma). Case report

Os autores apresentam um caso de infiltracao renal por linfoma histiocitico primitivo do baco, salientando os aspectos clinicos, radiograficos e angiograficos