Diagnostic correlates of discharge against medical advice.

The clinical histories of patients discharged against medical advice from a general hospital were studied to discern important diagnostic correlates of this event. Drug addiction occurred in 22% of the 73 test subjects and in none of 175 random controls. Chronic alcoholism was diagnosed in 42% of patients discharged prematurely vs 15% of controls (P less than .01). Discharge against advice should be considered a clue to the presence of one of these conditions if not previously appreciated. Since both are identifiable chronic disorders, early counseling is recommended to prevent such noncompliant behavior and its consequences for effective hospital care.

Criteria for the diagnosis of alcoholism.

Manifestations of alcoholism in general hospital patients were studied retrospectively by review of medical records to determine their frequency of occurrence. Pathophysiological indications of alcoholism were far more commonly recorded than were behavioral or psychological changes, although most diagnostic clues were notable by their absence from a majority of the records. Optimizing the diagnostic efficacy of those features of alcoholism that did occur may require application of the methods of statistical decision making. Absence from the charts of behavioral criteria and of indications of tolerance reflects deficiencies in both patient interviewing and medical record keeping. The traditional structure of the medical history may require modification to ensure recording of these more specific manifestations. In addition, continued efforts are needed to improve the undergraduate and the direct-care education of physicians.

Elevation of serum uric acid as a clue to alcohol abuse.

Hyperuricemia in unselected admissions to a general hospital was found to be a significant correlate of alcohol abuse in male subjects. Unexplained elevation of the serum uric acid level should always stimulate inquiry for the behavioral features of alcoholism.

Congenital hypertrophic pyloric stenosis: the role of gastrin reevaluated.

In order to evaluate the potential role of gastrin in the etiology of pyloric stenosis, serum gastrin levels were measured in cord blood of affected infants, matched controls, and mothers of both. No differences were identified when values from infants with pyloric stenosis were compared with those from control infants. Mean cord serum gastrin levels of the infants were significantly greater than the mean maternal gastrin levels. The data effectively dismiss the possibility that elevated serum gastrin concentration in mother or infant at the time of delivery can be implicated as a cause of pyloric stenosis.

Liver scintigraphic features associated with alcoholism.

The relationships between scintigraphic features and clinical alcoholism were studied by review of 2,406 liver scintiphotos. Two distinct patterns were significantly associated with alcoholism: (a) heterogeneous distribution of radiocolloid in the liver, and (b) jointly increased uptake of tracer by the spleen and vertebral bone marrow. A total of 13 overall patterns were found to distinguish, with considerable reliability, alcoholics from all other patients. This finding reflects the frequency with which alcohol abuse is associated with hepatic dysfunction in hospital patients. These observations indicate an important role for the nuclear medicine physician in detection of alcoholism among patients referred for liver-spleen imaging, and they form a basis for comparison with the diagnostic efficacy of other methods of evaluating diffuse liver diseases.

Scintigraphic criteria for hepatic metastases from cancer of the colon and breast.

Scintigraphic criteria for hepatic metastases were studied by examination of 333 liver scintigrams performed on 275 patients with primary cancers of the colon or breast. Focal defects in radiocolloid distribution correctly signaled the presence of metastatic colon carcinoma in 88% of the patients with that disease and incorrectly pointed to only 6% of the patients without such metastases. In contrast, the same criterion detected only 67% of hepatic metastases from breast carcinoma. This lower sensitivity could be improved to 87% by adding heterogeneity or hepatomegaly to the criteria for abnormality when patients with breast cancer are examined. Scintigraphic indicators of metastatic disease may vary according to the site of primary cancer.

Gastric uptake of gallium-67 in AIDS.

We describe gastric localization of 67Ga in 13 patients with acquired immunodeficiency syndrome (AIDS) among 148 referred primarily to rule out Pneumocystis carinii pneumonia (PCP). Endoscopic biopsies in five of the patients indicated cytomegalovirus (CMV) infection in one, gastritis in two, and normal tissue in two. Other associated, but nongastric, infections in these 13 patients included esophageal candidiasis, PCP, Mycobacterium avium-intracellulare (MAI) complex, coccidioidomycosis, toxoplasmosis and Isospora belli. Only six of the patients exhibited gastric symptoms, and even fewer proved to have gastric pathology. Although gastric 67Ga uptake in a patient with AIDS may not require specific treatment, opportunistic infections as a possible cause of gastritis should be considered.

The effect of cancer chemotherapeutic agents on the liver-spleen scan.

The effects of short-term cancer chemotherapy on the liver-spleen scintiscans of 15 patients were assessed. Half of these exhibited minimal and transient changes in the pattern of radiocolloid distribution and/or chemical liver-function tests. No examples of new focal defects were seen. The data suggest that cytotoxic drugs are capable of inducing minor scan changes that might be attributed erroneously to intrinsic hepatic disease.

Lung scan evaluation of thrombolytic therapy for pulmonary embolism.

UNLABELLED: Data from three trials of thrombolytic therapy for pulmonary embolism (PE) were combined to assess the utility of perfusion lung scan defect scoring in predicting the response to thrombolytic therapy. METHODS: Pre- and post-therapy lung scans and duration of symptoms were available for a total of 221 patients, 167 were treated with various thrombolytic regimes and 54 were treated with heparin alone. RESULTS: Improvement in the lung scan defect score was correlated with larger initial defect score (r = 0.53), segmental appearance (r = 0.31) and shorter duration of symptoms (r = 0.20). There was no significant residual correlation between improvement and segmental appearance in a multiple regression analysis after accounting for initial defect score and duration of symptoms. Two lung scan scoring methods (segmental and anterior-posterior method) provided similar results with low interobserver variability (r = 0.90 for both methods). CONCLUSION: This study indicates that the baseline perfusion lung scan defect severity helps to predict the response to thrombolytic therapy.

Optimizing the clinical value of hepatic scintiphotography.

Hepatic scintiphotography serves as a highly useful anatomic liver function test. When the descriptive features of the liver scan are carefully related to underlying pathology, the resulting data base permits a detection sensitivity of 90% for metastatic cancer and for the diffuse parenchymal diseases. The consequences of false positive (FP) interpretations for patient care must be minimized by attention to perceptual and technical details, by incorporating other tests into the evaluative algorithm, and by knowledge of the distribution of diseases in the population examined. The liver scan would be more beneficially applied to patient management if referring physicians were made aware of its capabilities. They, in turn, must develop more explicit strategies for disease management in order that scintiphotography be effectively applied in clinical decision making.

Detection of hepatic metastases from cancer of the breast.

The liver scan and CEA assay were employed as a composite to increase the accuracy with which hepatic metastases from breast cancer may be detected. The number of false-positive interpretations was markedly reduced in this selected groups of patients. Other combinations of tests were examined and found less effective. In view of the potential benefits found in this study, it appears worthwhile to extend the principles applied here to other groups of patients at different stages of this disease and with other primary tumors.

Gastric Ga-67 uptake in patients with lymphoma.

Gastric accumulation of Ga-67 greater than that seen in the liver was observed in 16 of 162 (9.8%) patients with lymphoma. Endoscopic biopsies in six patients showed one instance each of histiocytic lymphoma, mixed cellularity Hodgkin's disease, adenocarcinoma, and hiatal hernia with mucosal deformity, as well as two instances of benign gastric ulcer. All six patients had chronic gastric symptoms, as well as persistent radiogallium accumulation on sequential examinations of 2 years duration. The remaining 10 patients exhibited transient radiotracer gastric uptake and only two has gastric symptoms. Persistent gastric Ga-67 accumulation is not common in lymphoma and warrants endoscopy when accompanied by prolonged symptoms.

Gallium-67 scintigraphy as an aid in the detection of spinal epidural abscess.

Gadolinium-enhanced MRI is considered the study of choice for diagnosing spinal epidural abscess (SEA). Most of such cases, however, are not suspected initially, and thus do not benefit from the procedure. A case of SEA is described in which positive Ga-67 scintigraphy shortly before onset of lower extremity dysfunction was instrumental in obtaining an emergency gadolinium-enhanced MRI and establishing the diagnosis.

Intrathoracic splenosis mimicking metastatic lung cancer.

A case of posttraumatic intrathoracic splenosis mimicking lung cancer is presented. The diagnosis was made by a radiocolloid liver-spleen study followed by a heat-damaged Tc-99m labeled red cell scan. A favorable change in the staging of the patient's real contralateral lung cancer resulted.