Lymphoscintigraphic analysis in chromoblastomycosis.

BACKGROUND: One of the main complications of chromoblastomycosis is lymphedema. The purpose of this study was to evaluate the lymphatic system of the limbs of patients with chromoblastomycosis using lymphoscintigraphy. It is a reliable, objective and noninvasive means of supporting the diagnosis of lymphedema. METHODS: Lymphoscintigraphy was performed in seven patients with chromoblastomycosis, six with lesions in the lower limb and one in the upper limb. Tc-99 m dextran was injected into the interdigital spaces of the upper or lower extremities. The qualitative parameters analyzed were the visibilization of the lymph vessels and the lymph nodes, dermal backflow, and existence of collateral vessels. All patients were treated with the association of itraconazole and cryotherapy with liquid nitrogen. RESULTS: Three out of the 14 extremities examined had lymphedema clinically, and the lymphoscintigraphy showed abnormalities in the qualitative parameters; whereas these parameters were normal in the extremities without lymphedema. During the treatment of chromoblastomycosis, a second lymphoscintigraphy exam was performed on 10 limbs and did not show any improvement of the previous lymphoscintigraphic alterations. CONCLUSIONS: The qualitative lymphoscintigraphy was a reliable method to show the morphology of the lymph vessels and confirm objectively the diagnosis of lymphedema secondary to chromoblastomycosis. The association of oral itraconazole and cryotherapy did not modify the lymphatic alterations in chromoblastomycosis.

Efeito da compressäo pneumática intermitente sequencial sobre o linfedema dos embros inferiores: avaliaçäo quantitativa pela linfocintilografia / Effect of sequential intermittent pneumatic compression (SIPC) on lymphedema of the lower extremities: quantitative evaluation by lymphoscintigraphy

Para avaliar o efeito da compressäo pneumática intermitente sequencial sobre o transporte do Dextran marcado com tecnécio 99m em pacientes com linfedema de extremidades inferiores estudamos 11 pacientes.Foram oito mulheres e três homens com idade média de 44,6 anos.Foram realizadas duas linfocintilografias: a primeira considerada o controle (sem compresäo); a segunda foi realizada com compressäo pneumática de três horas, iniciada logo após a injeçäo do radioisótopo.Antes do início da compressäo e logo após o término foram feitas medidas em seis locais marcados para verificar a efetividade da compressäo na reduçäo do volume da extremidade.A análise quantitativa foi realizada pelo cálculo do "clearance" do radioisótopo em quatro locais determinados (perna, joelho, coxa e regiäo inguinal) em ambas as linfocintilografias.Observou-se reduçäo significante entre dos diâmetros das extremidades, porém näo foi observada diferença significativa entre os valores do "clearance" sem e com compressäo.Concluímos que a compressäo pneumática intermitente sequencial foi efetiva para reduzier o diâmetro, porém näo alterou o transporte do radioisótopo nas extremidades estudadas, em três horas de compressäo.

Mapeamento radioisotópico do foco arritmogênico em portadores de cardiopatia chagásica crônica e taquicardia ventricular sustentada / Radionuclide Angiography for Localization of the Site of Origin of Sustained Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy

PURPOSE--To localize the site of the origin of sustained ventricular tachycardia in chronic chagasic cardiomyopathy patients refractory to antiarrhythmic therapy by radionuclide angiography techniques. METHODS--Five patients underwent radionuclide angiography by intravenous administration of 25mCi 99mTc. The images were obtained in sinus rhythm and during sustained ventricular tachycardia induced in the electrophysiologic laboratory for endocardial mapping. Amplitude and phase images were obtained resulting in a contraction wave synchronic to ventricular dispolarization. RESULTS--All patients had haemodynamic stability during the arrhythmia. One patient had incessant ventricular tachycardia. Mean ejection fraction was 0.38. In 4 patients the site of the origin of ventricular tachycardia was posterior and in one it was localized in the interventricular septum. There was identity in the site of the origin of ventricular tachycardia obtained by endocardial mapping or radionuclide angiography in all patients. The therapy was chemical ablation in 3 patients, surgical aneurysmectomy in one and pharmacologic therapy in the last patient. CONCLUSION--The site of the origin of ventricular tachycardia can be estimated by analyzing the contraction wave obtained by radionuclide angiography techniques in patients with hemodynamic stable sustained ventricular tachycardia.