[Examination of regional limph nodes in penile carcinoma by 99M Tc-MIBI scintigraphy]. / Exploración de ganglios regionales en carcinoma de pene mediante gammagrafía con 99mTc-MIBI.

99mTc-MIBI scintigraphy has proven utility as a clinically valuable technique for the diagnosis of various primary and recurrent malignant lesions. We report the case of a 65 year old man with penile squamous cell carcinoma and clinically questionable bilateral inguinal lymph nodes. 99mTc-MIBI scan shows increased focal uptake in both groins and in the right iliac region. The patient underwent penile amputation with bilateral lymphadenectomy. Histopathologic report revealed metastatic lymph nodes in all lymphatic basins seen with 99mTc-MIBI. We conclude that this technique has the potential of supplying clinically relevant information for the diagnosis of regional extension of patients with penile carcinoma.

Exploración de ganglios regionales en carcinoma de pene mediantegammagrafía con 99mTc-MIBI / Examination of regional lymph nodes in penile carcinoma by 99mtc-mibi scintigraphy

La evaluación gammagráfica con 99mTc-MIBI es una técnica de probada utilidad clínica en la evaluación de varias lesiones tumorales primarias y metastásicas. Presentamos el caso de un hombre de 65 años con diagnóstico de carcinoma escamoso de pene y adenopatías inguinales clínicamente dudosas a nivel bilateral. El estudio con 99mTc-MIBI muestra hipercaptación focal en ambas regiones inguinales y en la región ilíaca derecha. El paciente fue sometido a amputación de pene y vaciamiento ganglionar bilateral, revelando el análisis anatomopatológico ganglios con infiltración metastásica en todos los territorios ganglionares marcados por el 99mTc-MIBI. Se concluye que la técnica propuesta tiene el potencial de aportar información clínicamente relevante en el diagnóstico de extensión regional de pacientes con carcinoma de pene (AU)

Evaluation of ocular tumors with technetium-99m-MIBI: planar pinhole technique or SPECT?

OBJECTIVE: This study compares 2 imaging protocols, planar pinhole technique (PPHT) and SPECT, for evaluating ocular masses with 99mTc-MIBI. METHODS: Sixteen patients with ocular lesions were studied. Planar images were acquired 10 min after the injection of 740 MBq 99mTc-MIBI with an LFOV camera fitted with a pinhole collimator (5.0 mm). A SPECT study was performed immediately after the planar study, using a 360 degrees orbit, 64 steps, 20 s/stop, a 128 x 128 matrix, and a low-energy high-resolution (LEHR) collimator. Twelve lesions (9.5-18.0 mm) proved to be malignant: 8 primary tumors (ocular melanoma); 3 local relapses of different tumors of the conjunctiva; and 1 ocular metastasis from breast cancer. The remaining 4 lesions (10.0-16.0 mm) were benign: 1 inflammatory lesion; 1 benign intraocular calcification; and 2 naevi. RESULTS: SPECT images showed 11 of 12 malignant lesions (91.6%), whereas the planar technique demonstrated only 4 of the 12 lesions (33.3%). One false-positive result, the inflammatory lesion, was visualized by both techniques. The remaining benign lesions were not detected with either method. CONCLUSION: Technetium-99m-MIBI SPECT is a sensitive technique for detecting malignant ocular tumors. SPECT imaging is a better alternative to planar imaging for ocular tumors.

Scintigraphic evaluation of malignant melanoma lesions with Tc-99m tetrofosmin.

Two cases of malignant melanoma (primary and metastatic lesions) imaged with Tc-99m tetrofosmin are reported. One patient showed intense uptake in a primary skin lesion of the thorax, and the other patient had accumulation in skin, cerebellum, breast, and lymph node metastases. Like Tc-99m MIBI, Tc-99m tetrofosmin imaging may be of clinical relevance in the evaluation of suspicious skin lesions and in patients with known cutaneous malignant melanoma in the assessment of recurrent disease during follow-up evaluation.

Detection of recurrent malignant melanoma with 99mTc-MIBI scintigraphy.

Initial reports suggest that 99mTc-methoxyisobutylisonitrile (MIBI) scanning may be of clinical value in staging patients with malignant melanoma. We carried out a study to evaluate the potential of this technique in the detection of recurrent disease. Whole-body 99mTC-MIBI scans were performed in 81 patients with a history of a surgically excised MM: 28 with known recurrent lesions and 53 during follow-up without evidence of disease. Images started 10 min post-injection, using a dose of 740 MBq. Diagnoses were confirmed by cytological/histological examination or at least one conventional imaging modality. Blinded interpretations of the MIBI scans were performed. Whole-body MIBI scanning correctly detected 68 (92%) of 74 metastatic lesions in the following sites: regional lymph nodes (n=23), non-regional lymph nodes (n=10), skin (n=16), brain/cerebellum (n=6), lung (n=8), bone (n=4) and breast (n=1). The technique failed to detect three subcutaneous regressive lesions (< 1 cm), one liver metastasis, one spleen metastasis and a case of multiple small lesions of the duodenal mucous membrane. In 14 patients the procedure detected previously unknown metastatic lesions. These results suggest that 99mTc-MIBI scanning is an effective imaging modality for whole-body screening of metastatic disease in malignant melanoma patients with the potential to influence treatment planning.

99Tc(m)-MIBI scanning of the thyroid gland in patients with markedly decreased pertechnetate uptake.

Diffusely reduced 99Tc(m)-pertechnetate uptake is a relatively infrequent but annoying finding that impairs evaluation of the thyroid gland. We studied 32 female patients aged 19-85 years with markedly reduced pertechnetate uptake. The following causes of reduced pertechnetate uptake were recognized: treatment with iodinated pharmaceuticals (n = 15), suppression therapy with T4 (n = 11), subacute thyroiditis (n = 5) and massive tumour replacement (n = 1). 99Tc(m)-MIBI thyroid scintigraphy was performed within 24 h of the pertechnetate study. The results were correlated with neck ultrasound, serum TSH (n = 25) and surgical findings in patients who had been operated on. The technique identified the following conditions: normally sized thyroids (n = 4), diffuse goitres (n = 8), multinodular goitres (n = 17) and solitary thyroid nodules (n = 3). Moreover, substernal goitres were identified in nine patients. This condition was confirmed at surgery in seven patients. Ultrasonography was concordant in 29 of 32 patients in terms of thyroid size and structure, but failed to demonstrate substernal thyroid tissue. Our results suggest that 99Tc(m)-MIBI scintigraphy may contribute to the diagnosis of thyroid pathology and treatment planning in patients with diffusely decreased 99Tc(m)-pertechnetate uptake.

Scintigraphic detection of invasive cutaneous malignant melanoma with Tc-99m MIBI.

Malignant melanoma is a relatively uncommon cancer of increasing incidence. The authors report on two cases of malignant melanoma lesions (primary and lymph node metastasis) imaged with Tc-99m MIBI. One patient revealed intense accumulation of the radiotracer in a primary skin lesion of the thorax, whereas the other patient showed increased Tc-99m MIBI uptake in a lymph node metastasis of the neck. Tc-99m MIBI imaging could be helpful in the evaluation of patients with suspicious skin lesions and in patients with known cutaneous malignant melanoma, in the investigation of lymph nodal invasion, local recurrence, and metastatic spread.

Thyroid imaging with Tc-99m MIBI in patients with solitary cold single nodules on pertechnetate imaging.

Thyroid imaging was performed in 30 patients with the standard pertechnetate technique, as well as with Tc-99m MIBI using a double-phase acquisition protocol. All patients had normal thyroid function confirmed by hormone measurements and cold solitary thyroid nodules, which were evaluated by pertechnetate scanning. Tc-99m MIBI scans were reported as showing cold (N = 14), warm (N = 7), or hot (N = 9) nodules. Nodule classification was made according to fine needle aspiration biopsy findings in 20 patients. The remaining 10 proceeded to surgery and had histopathologic confirmation of their lesions. Although all cold nodules with Tc-99m MIBI were cystic, six of the warm nodules were benign lesions. No histologically proven benign nodule was hot with Tc-99m MIBI. Of the hot nodules, seven were suspicious for follicular carcinoma with fine needle aspiration biopsy (N = 3), or had histologically proven papillary carcinoma (N = 4). Delayed images in five of seven of these lesions showed nodular retention of the radiopharmaceutical. In conclusion, double-phase Tc-99m MIBI scanning of the thyroid gland could be helpful in the preoperative assessment of patients with cold solitary thyroid nodules in order to evaluate the malignancy probability of these lesions.

Tc-99m isonitrile uptake in a brain metastatic lesion. Comparison with Tc-99m DTPA using planar and SPECT imaging.

Tc-99m isonitrile uptake in a metastatic brain tumor is demonstrated using planar and SPECT imaging. Comparison with Tc-99m DTPA shows a different distribution pattern and uptake intensity, suggesting a different mechanism for both tracers. It is possible that Tc-99m CPI could reflect metabolic activity of the tumor cells and might be useful to evaluate the grade of malignancy as well as the recurrence of brain tumors.

Estudio cooperativo con diisopropil-IDA - 99mTc en afecciones de vias biliares. / Cooperative study with diisopropyl-IDA-99mTc in biliary tract diseases

Se presentan los resultados de un estudio cooperativo sobre la exploracion de la via biliar con 99mTc diisopropil-IDA. Se estudiaron 15 voluntarios normales y 75 pacientes portadores de colecistitis aguda (CA), y cronica (CC), ictericias hepatocelulares (IHC), obstructivas coledocianas incompletas (ICI) y completas (ICC).Se determino el comportamiento biologico del radiofarmaco en los dos grupos estudiados a traves de la medida de los tiempos de captacion y aparicion en el parenquima hepatico, en la via biliar principal intra y extrahepatica, en la vesicula, en el duodeno y en los rinones. Se describen los modelos fisiopatologicos encontrados en la CA, CC, IHC, ICI, ICC. Se concluye que el procedimiento tiene indicacion de eleccion en la CA, que su valor es limitado en la CC y que en las ictericias salvo en situaciones muy especiales el metodo aporta muy poca informacion de utilidad clinica. Se destaca la posibilidad que Servicios Latinoamericanos realicen trabajos cientificos en forma conjunta acrecentando su nivel de eficacia

Estudio cooperativo con diisopropil-IDA - 99mTc en afecciones de vias biliares. / Cooperative study with diisopropyl-IDA-99mTc in biliary tract diseases

Se presentan los resultados de un estudio cooperativo sobre la exploracion de la via biliar con 99mTc diisopropil-IDA. Se estudiaron 15 voluntarios normales y 75 pacientes portadores de colecistitis aguda (CA), y cronica (CC), ictericias hepatocelulares (IHC), obstructivas coledocianas incompletas (ICI) y completas (ICC).Se determino el comportamiento biologico del radiofarmaco en los dos grupos estudiados a traves de la medida de los tiempos de captacion y aparicion en el parenquima hepatico, en la via biliar principal intra y extrahepatica, en la vesicula, en el duodeno y en los rinones. Se describen los modelos fisiopatologicos encontrados en la CA, CC, IHC, ICI, ICC. Se concluye que el procedimiento tiene indicacion de eleccion en la CA, que su valor es limitado en la CC y que en las ictericias salvo en situaciones muy especiales el metodo aporta muy poca informacion de utilidad clinica. Se destaca la posibilidad que Servicios Latinoamericanos realicen trabajos cientificos en forma conjunta acrecentando su nivel de eficacia

Centellografia osea y determinacion de parathormona en insuficientes renales en hemodialisis cronica. / Bone scintigraphy and parathormone determination in renal insufficiency in chronic hemodialysis

Con objetivo de brindar un aporte diagnostico a la interpretacion de las alteraciones del metabolismo fosfocalcico en la insuficiencia renal; se realizo el estudio combinado de PTH y centellograma oseo en un grupo de pacientes en hemodialisis cronica. Esta metodologia de estudio permitio clasificar humoralmente a los enfermos en tres grupos: normo, hipo o hipercalcemicos, frente al aumento de los niveles de PTH. A su vez la centellografia osea en la etapa prerradiologica subdividio al grupo en: normales (estadio 0), con hipercaptacion moderada (estadio I) y con hipercaptacion severa (estadio II)

Estudio cuantitativo de CEA por radioinmunoanalisis en extractos de tejidos tumorales benignos y malignos del aparato genital femenino. / Quantitative study of the CEA by radioimmunoanalysis in tissue extracts of benign and malign tumors of the female genital tract

El motivo de este trabajo es realizar un estudio cuantitativo del CEA en extractos de tumores benignos y malignos del aparato genital femenino. Se demuestra que la actividad de CEA es detectable por RIA,mediante extraccion con acido perclorico, en diversos extractos histicos

Estudio de la perdida sanguinea intestinal (PSI) en relacion a la vida media globular y la fibrogastroscopia en insuficientes renales en hemodialisis cronica. / Intestinal blood loss (IBL) related to red cell life span and fibrogastroscopy in patients with renal insufficiency in chronic hemodialysis

Se estudiaron 10 pacientes con el objeto de analizar el valor de la determinacion de la perdida sanguinea intestinal (PSI), en los insuficientes renales en hemodialisis cronica. Se determino la P.S.I. y la vida media globular por medio de la marcacion del globulo rojo con 51Cr. A todos los pacientes se les realizaron estudios fibrogastroscopicos.Del analisis de los resultados se concluye que el estudio de PSI es de utilidad para el "Screening test" para cuantificar la magnitud de la perdida, para sustentar la indicacion de la fibrogastroscopia y para fundamentar la exploracion distal o la biopsia del tubo digestivo a los pacientes con insuficiencia renal cronica

Reflujo gastro esofagico en pediatria. / Gastroesophageal reflux in pediatrics

Se estudiaron 15 ninos con reflujo gastro esofagico. Sus manifestaciones clinicas predominantes fueron cuadros respiratorios prolongados y recidivantes o vomitos. La edad media de presentacion de los sintomas fue de 6 meses. La edad media de diagnostico fue de 9 meses. Las tecnicas empleadas para el diagnostico fueron: el estudio radiologico del esofago gastroduodeno, la manometria esofagica, la esofagoscopia con biopsia, y el centellograma con tecnesio. Los pacientes recibieron tratamiento postural, antiacidos y dieta durante un lapso de seis meses. Catorce de 15 pacientes evolucionaron a la desaparicion de los sintomas. El pronostico estuvo condicionado a la precocidad del diagnostico y tratamiento

Estudio de la incidencia de la carencia de hierro en ninos menores de 2 anos.(Comunicacion preliminar). / Occurrence of iron deficiency in children less than two years old. (Preliminary communication)

La carencia de hierro aparece actualmente como la segunda enfermedad nutricional asociada al subdesarrollo y a todo objeto de multiples estudios a nivel mundial. En Uruguay no existen estudios oficiales. En el presente trabajo se estudian desde este punto de vista, 100 ninos de consulta externa del hospital "Dr. Pedro Visca", Montevideo. Se estudiaron a traves del examen clinico y la valoracion de los examenes de sangre periferica y de los depositos de hierro. Esto ultimo determinando la ferritina serica por IRMA (radio inmunoensayo). Se encontraron valores inferiores a los tomados como limite de la normalidad, en el 72% de los casos para la ferritina, en el 65% para la sideremia y en el 59% para la hemoglobina