An audit of the management of heart murmurs on the postnatal wards.

BACKGROUND: Investigation and management of neonatal heart murmurs varies widely and is dependent on local resources. In order to standardise the management of heart murmurs in our hospital a guideline (based on clinical examination with selective cardiology review) was introduced. AIMS: To establish adherence to and safety of the guideline; to review workload implications and to define the causes of neonatal heart murmurs in our population. METHODS: Patients were prospectively identified over a 2-year period (August 2006 to July 2008). Case notes were reviewed and examination findings, investigations, follow up and diagnosis recorded. RESULTS: 89 babies were identified. The guideline was generally well adhered to. In total 51 (57%) of babies were referred for cardiology assessment. In 40 babies this assessment included an echocardiogram. 30 babies (34%) had an underlying cardiac malformation: 25 were identified before discharge home. 15/30 (50%) of the babies with a cardiac malformation remain under cardiology follow up at the age of 1 year. No baby discharged from follow up without cardiology review subsequently presented with a cardiac problem. CONCLUSION: A significant minority of babies with a heart murmur have an underlying cardiac malformation. Our guideline appears to ensure the timely identification of these babies and rationalises our use of specialist services.

The 99mTc-DTPA dynamic renal scan with deconvolution analysis.

Dynamic renal studies were performed with 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA). The results were analyzed by the method of mathematical deconvolution in order to obtain the impulse response function of the kidney. Regional analysis of the kidney was attempted by evaluating the independent responses of the renal parenchyma and renal pelvis to a bolus injection of 99mTc-DTPA.

Breast-milk radioactivity after a Tc-99m DTPA aerosol/Tc-99m MAA lung study.

Measurements were made of the concentration of Tc-99m activity in samples of breast milk following an administration of Tc-99m DTPA aerosol for a lung ventilation image and one of Tc-99m MAA for lung perfusion. The activity was 222 nCi/ml of milk (8.2 kBq/ml) at 2 hr after the MAA injection, and it was found to be excreted exponentially with an effective half-life of 4.6 hr. There was a small incorporation of Tc-99m into breast-milk protein. We conclude that the combined use of these two Tc-99m agents did not indicate the interruption of breast feeding beyond 24 hr after administration of the MAA, and that for an aerosol ventilation study alone, breast feeding need not be interrupted for more than 4 hr after the test.

Pneumothorax complicating aseptic cavitating pulmonary infarction.

This report documents a pulmonary infarction secondary to an angiographically proven pulmonary embolus with complicating aseptic cavitation and pneumothorax. These two rare complications of pulmonary infarction have not previously been clinically or radiographically documented to occur simultaneously. The patient recovered uneventfully.

Society of Breast Imaging residency and fellowship training curriculum.

A recently developed Society of Breast Imaging curriculum for residency training is intended to provide guidance to residents and their mentors, and to practicing radiologists who want to keep up to date in screening, diagnosis, and interventional procedures. The curriculum contains lists of key concepts in 14 subject areas: epidemiology; anatomy; pathology, and physiology; equipment and technique; quality control; interpretation; problem-solving mammography; ultrasound; interventional procedures; reporting and medicolegal aspects; screening; MR imaging; therapeutic considerations; and patient management principles. The curriculum also makes recommendations about residency training, including the number of examinations the resident should interpret, and the time the resident should spend in breast imaging. Recommendations for fellowship training are also discussed.

Technologic advances in breast imaging. Current and future strategies, controversies, and opportunities.

This article summarizes current strategies for breast imaging in the diagnosis of breast cancer. It describes how technologic advances, particularly image-guided percutaneous core biopsies, are rapidly changing these strategies. Sonography now plays a major role in the diagnosis of breast cancer. The future roles for MR imaging and scintimammography are also discussed.

A co-operative study on the clinical value of dynamic renal scanning with deconvolution analysis.

An international project was set up to study the clinical usefulness of intrarenal transit times derived from the renogram by deconvolution. A common data sheet, to collect clinical, biochemical, radiological and isotopic information, was completed by the centres. Five hundred and ninety-one patients were studied and the results analysed. The mean transit time (MTT) in normal kidneys was found to be 3.6 +/- 1.1 min. If the MTT is greater than 7.6 min, a kidney is likely to be obstructed. In vesico-ureteric reflux, the transit times are prolonged, but they are normal in infection, hypertension, parenchymal disease and minimally irradiated kidneys. In transplantation, when the kidney is normal, the transit times are shorter than in the natural kidney; in acute rejection, transit time are prolonged.

Severe postappendectomy bleeding.

Postappendectomy bleeding is a rare and occasionally catastrophic phenomenon. Three cases of bleeding, two into the retroperitoneum and one into the gastrointestinal tract, are reported, and 13 other cases collected from the literature are reviewed. Retroperitoneal hematoma may require reoperation because of infection. Bleeding in the gastrointestinal tract may occur early (mean, 4 days), or late (mean, 7 years). An unligated stump or slippage of the tie around the stump are the main causes of early bleeding. Sixty-six per cent of the patients recovered without further bleeding. All six patients with late rectal bleeding required surgery for control of the bleeder. Causes included ulceration, vascular malformation, or granuloma.

Excretion of radioactivity in breast milk following injection of 99Tcm-DTPA.

Measurements were made of the concentration of radioactivity in the breast milk of a patient following a 2 mCi (74 MBq) 99Tcm-DTPA dynamic renal scan. The concentration of activity was 0.88 nCi-1 ml at 2.75 h after injection and it decreased exponentially with an effective halflife of 4.3 h. The potential radiation dose to a breast-fed infant was small enough to conclude that breast feeding need only be interrupted for 4 h after injection.

Potential radiation dose to a breast-fed infant following administration of sodium 32P-phosphate to the mother.

A 32P uptake test to diagnose an intraocular tumour was performed on a lactating woman. Breast feeding of her infant had been stopped and after injection of the 32P, a sample of breast milk on two consecutive days was collected. The concentration of 32P in the milk was greater in the second sample than the first, but it was calculated that the potential whole body radiation dose to her infant on the second day would not have exceeded 180 microSv (18 mrem).

99Tcm-MDP, 67Ga-citrate and 111In-leucocytes for detecting prosthetic hip infection.

An assessment was made of the roles of 99Tcm-MDP, 67Ga-citrate and 111In-leucocytes in identifying infected hip prostheses. Fifty painful prosthetic hips were investigated with a 99Tcm-MDP bone scan and an 111In-labelled leucocyte scan (ILLS). In 32 cases, a 67Ga-citrate scan was also performed. Normal or focal MDP uptake was obtained only in uninfected hips. Diffuse uptake of MDP was obtained only in infected hips and in one case of non-septic synovitis which also produced a false positive ILLS. A focal MDP uptake superimposed on a diffuse pattern was obtained in both infected and uninfected hips. The ILLS was abnormal in eight out of 11 cases of infection and in two out of 39 cases without infection. The 67Ga scan was abnormal in five out of six cases of infection and in five out of 26 cases without infection. It was concluded that a 99Tcm bone scan should be performed first on a painful prosthetic hip, and that for detecting infection, an ILLS was more specific but less sensitive than a 67Ga-citrate scan.

A study of leucocyte labelling efficiencies obtained with 111In-oxine.

The range of leucocyte labelling efficiencies with 111In-oxine for a group of patients extended significantly (P = 0.05) below that obtained for a series of labellings of the same normal blood from a volunteer. A retrospective analysis was made of the results in the two groups to identify the cause of this difference in range. The labelling efficiency for patients did not vary with the volume of 111In-oxine, and was independent of the whole blood leucocyte concentration. The difference between the average labelling efficiencies obtained for a group of patients and the normal series labelled by the same operator was more significant than the difference in average labelling efficiencies obtained by different operators. It was concluded that biological variation in patients' blood, rather than operator technique, must have been a more important cause to the difference in the labelling efficiency range between patients and normal. It was also concluded that variations of contaminant platelet-bound activity and of plasma viscosity were greater in the patient group than the normal series, and contributed to this difference in labelling efficiency range.

Resorption of a first permanent molar.

A case is presented of an unerupted maxillary second premolar causing the severe resorption of a first molar tooth. This case underlines the need for adequate radiographic evidence before recommending the extraction of teeth for the relief of crowding.