The Gamut approach to scintigram interpretation--diagnostic aid and teaching method.

A Gamut is defined as a complete list of anything. As utilized here, it indicates a complete list of the possible causes of a particular scintigram finding. The procedure for developing a Gamut is discussed, ant its use as a tool for instructing residents in nuclear medicine is described. Sample Gamuts are presented and the Gamut approach to scintigram differential diagnosis is described.

A prospective study of serial maternal serum zinc levels and pregnancy outcome.

A prospective study of 878 pregnant women in Adelaide, South Australia, examined the relationship of maternal serum zinc concentration to pregnancy outcome. Blood samples were obtained at weeks 18 and 32 of pregnancy, and from the umbilical cord. Additional detailed data were obtained, via standardised antenatal interview and review of clinical records, on antenatal care, personal, behavioural, and sociodemographic characteristics, and, subsequently, on delivery and neonatal assessment. Maternal mid-pregnancy zinc status was negatively correlated, although very weakly, with duration of gestation and with birthweight (including, in particular, the 18 recorded cases of intrauterine growth retardation). This finding accords with recent suggestions that, in non-experimental human studies in populations in which frank zinc deficiency is absent, maternal serum zinc level may be an outcome, rather than a determinant, of fetal growth later in pregnancy. Low mid-pregnancy zinc levels were associated with increased risk of intrapartum haemorrhage. In general, the greatest risk of having some complication or abnormality of delivery or neonatal functional status occurred in pregnant women who had both an initially below-average, and subsequently decreasing, serum zinc concentration. This corroborates other recent research. While it might be inferred that above-average fetal growth, by depressing maternal zinc status, could itself impair delivery and neonatal functioning, our data indicate that these effects operated independently.

Kinematics of the cervical spine.

This has been a review of some of the movements of the cervical spine. Much data remain to be accumulated and certainly much work must be done to evaluate the effect of forces in various directions upon these movements. Perhaps an improved understanding of these movements in association with an understanding of the pathogenesis of disc degeneration will enable us to better understand the development of spondylosis. Most important this review uncovers the fallacy of laying the blame for the development of cervical spondylosis solely at the door of increased or decreased mobility at certain area. Physical stress and tissue degeneration must be playing a significant role.

Somnofluoroscopy.

In the past 30 years, numerous studies have increased our knowledge of the physical process of sleep. One sleep disorder, sleep apnea, has been studied and found to be a serious and life-threatening condition. Diagnosis of sleep disorders is very difficult and requires the use of sophisticated equipment, highly trained personnel, and a unique environment. To confirm the most dangerous form of sleep apnea, obstructive sleep apnea, fluoroscopic evaluation of the upper airway during sleep was performed. This fluoroscopic evaluation of the upper airway during sleep has been termed "somnofluoroscopy."

Portal venous gas in a patient with Crohn's disease.

Portal venous gas usually occurs in the setting of an acute abdomen. Several causes for benign portal venous gas (PVG) have been reported. We describe the finding of PVG by computed tomography in a febrile patient with Crohn's disease and discuss the clinical implications of such a finding.

Acute traumatic pseudoaneurysm of the proximal left common carotid artery: a case report.

A case is presented in which closed head and chest trauma caused a pseudoaneurysm at the base of the left common carotid artery. There were no significant injuries apparent on clinical evaluation. A strikingly abnormal chest radiograph prompted arteriography, which was diagnostic. A mechanism for the injury is postulated.

Pulmonary lymphatics visualized during pedal lymphangiography.

Two cases of pulmonary lymphatic opacification during lymphangiography in the presence of a normal thoracic duct are reported. The most likely route of filling of the pulmonary lymphatics in the lower lobes is by reversed flow from the thoracic duct through the inferior pulmonary ligament lymphatics. Retrograde flow from the bronchomediastinal trunk is unlikely.

The influence of computed tomography on clinical decision making in the evaluation of a nonvisualizing kidney.

Nonvisualization of a kidney in an elderly man was investigated by computed tomography (CT). Simple low lying ureteral obstruction was excluded, multiple pathologic abnormalities were identified and causes for the nonvisualization are postulated. This case report demonstrates the important effect CT scanning produced on the clinical management of the patient in question.

CT-guided fine needle aspiration of a periaortic collection.

Patients with infected aortic grafts suffer considerable morbidity and mortality. Therefore, it is important to make the diagnosis of infection to provide a reasonable chance for survival. Clinical signs of infection are usually apparent in the postoperative period. If absent, the diagnosis becomes more difficult. CT scanning is beneficial in detecting periaortic fluid and gas collections; however, it cannot differentiate postoperative gas from infection in all cases. This is especially true during the first 2 weeks after operation. CT-guided fine needle aspiration can provide a safe and reliable means to answer this clinical question.

Colon carcinoma in a right inguinal hernia.

A patient had an ascending colon carcinoma in a right inguinal hernia sac, the first such instance to be reported. A second patient had a left colon carcinoma in a left inguinal hernia sac. Both patients had gastrointestinal symptoms and anemia which warranted a barium enema.

Renal vein thrombosis: an underdiagnosed complication of multiple renal abnormalities.

Thirty-one cases of renal vein thrombosis (RVT) were reviewed retrospectively for clinical laboratory, and radiographic findings. An underlying renal disorder was present in 28 cases, absent in only 3. This supports other evidence that RVT is usually a complication of renal disease rather than a primary event, and that nephrotic syndrome may be due to renal disease rather than RVT. The findings also confirmed the large spectrum of urographic appearances in RVT, and were used as a basis for developing specific and liberal indications for renal venography.

Acute arterial gastrointestinal hemorrhage: efficacy of transcatheter control.

Sixty-five sites of arterial gastrointestinal hemorrhage in 63 patients were managed with transcatheter therapy. Arterial vasopressin infusion was attempted primarily for all but three sites; embolization was used in these cases and in those for whom vasopressin infusion failed to control bleeding. The results obtained suggest that this regimen, that is, primary vasopressin infusion with embolization reserved for infusion failures or contraindications, is more effective for control of arterial gastrointestinal hemorrhage than the use of either method alone. The role of primary embolization for control of this type of bleeding may need reassessment.

Transthoracic needle biopsy of small pulmonary nodules.

PURPOSE: To evaluate the diagnostic accuracy, complications, and usefulness of transthoracic needle biopsy of small pulmonary nodules. MATERIALS AND METHODS: Between January 1993 and January 1995, 302 patients underwent transthoracic needle biopsy of pulmonary lesions. Sixty-four lesions (in 62 patients) represented small nodules, defined as lesions of 15 mm or less maximum diameter. A total of 75 biopsies were performed in the 64 lesions. Approximately 90% of the biopsies were performed with computed tomographic guidance. RESULTS: There were 21 benign lesions and 43 cancers (36 primary, seven metastatic). Transthoracic needle biopsy findings were positive for cancer in 40 cases. In all three false-negative lesions, only one biopsy was performed. There were 21 true-negative results and no false-positive results. Positive and negative predictive values were 100% and 88%, respectively. Pneumothorax occurred in 20 (27%) of 75 biopsies, but chest tube placement was necessary in only three cases (4%). Surgery or thoracoscopy was avoided in 31 patients: 17 of 20 patients with benign disease, seven patients with metastatic disease, and seven patients with inoperable lung cancer. CONCLUSION: Transthoracic needle biopsy of small pulmonary nodules can produce diagnostic yields comparable with published results of transthoracic needle biopsy of larger lesions.

Late complications at repair site of operated coarctation of aorta.

Late complications at the repair site of coarctation of the aorta include aneurysms and persistent coarctation. Aneurysms are usually due to failure of the surgical anastomosis and can occur many years after repair. Continued aortic coarctation may be due to either repair failure or failure of the anastomotic site to grow with the patient. Three cases are presented and the literature reviewed.