A giant sauropod dinosaur from an Upper Cretaceous mangrove deposit in Egypt.

We describe a giant titanosaurid sauropod dinosaur discovered in coastal deposits in the Upper Cretaceous Bahariya Formation of Egypt, a unit that has produced three Tyrannosaurus-sized theropods and numerous other vertebrate taxa. Paralititan stromeri is the first tetrapod reported from Bahariya since 1935. Its 1.69-meter-long humerus is longer than that of any known Cretaceous sauropod. The autochthonous scavenged skeleton was preserved in mangrove deposits, raising the possibility that titanosaurids and their predators habitually entered such environments.

Long-term follow-up by exercise radionuclide angiography of patients after valve replacement for aortic regurgitation.

The long-term effects of valve replacement for chronic isolated aortic regurgitation as assessed by first-pass exercise radionuclide angiography have never been reported. We studied 20 males and 5 females before, 15 months postoperatively, and from 29 to 109 (mean 62 +/- 21) months following valve replacement with exercise radionuclide angiography. Mean peak heart rate did not change for the three studies. Peak systolic blood pressure decreased from 201 +/- 42 mmHg to 185 +/- 24 mmHg at 15 months and further declined to 177 +/- 32 mmHg by the long-term study (p less than 0.03). The mean resting left ventricular ejection fraction improved from 44 +/- 15% preoperatively to 57 +/- 18% at 15 months (p less than 0.002) with no further improvement by the long-term evaluation. The postexercise ejection fraction improved from 42 +/- 13% preoperatively to 61 +/- 21% at 15 months (p less than 0.002) also with no change by the long-term study. The duration of exercise improved from 9.7 +/- 4.6 min to 11.9 +/- 3.4 min (p less than 0.03) at 15 months with no additional improvement long term. Improvement in resting and postexercise ejection fraction and in exercise duration is maximal at 15 months. Accuracy and cost containment suggest that assessment of the maximal change in ejection fraction by exercise radionuclide angiography after aortic valve replacement in asymptomatic patients be limited to the 15-month interval.

An unusual case of pulmonary emboli.

The authors present an interesting case of pulmonary embolus serendipitously diagnosed during an evaluation for a presumed metastatic pulmonary nodule.

Exercise first-pass radionuclide assessment of left and right ventricular function and valvular regurgitation in symptomatic mitral valve prolapse.

The changes in right ventricular (RV) and left ventricular (LV) function and in regurgitant fractions on first-pass exercise radionuclide angiography (RNA) were assessed in 29 consecutive patients with symptomatic mitral valve prolapse (MVP). The mean right ventricular ejection fraction (RVEF) was 35 +/- 8% at rest and 46 +/- 15% after exercise (p less than 0.001). The mean left ventricular ejection fraction (LVEF) was 62 +/- 11% at rest and 74 +/- 13% after exercise (p less than 0.001). Seven of 29 patients had an abnormal RV response and 6 had an abnormal LV response. Eight had abnormal wall motion after exercise. A total of 12/29 patients (41%) had one or more abnormalities. The mean left-sided regurgitant fraction before exercise was 27 +/- 17% in 21/29 patients (72%) and 31 +/- 21% after exercise (p = ns). An additional 5 patients (17%) developed left-sided regurgitation after exercise. These findings indicate that wall motion abnormalities and abnormal RVEF and LVEF responses to exercise occur in symptomatic MVP patients. In addition, 26/29 (89.6%) had left-sided regurgitation after exercise. Since the presence of a murmur did not correlate with the presence of mitral regurgitation by RNA, then symptomatic patients with MVP should have first-pass exercise RNA to assess the presence of regurgitation at rest and after exercise. Antibiotic prophylaxis is recommended in MVP patients with systolic murmurs or with regurgitation. Since patients without murmurs can have regurgitation, further study is necessary to determine the need for endocarditis prophylaxis in these patients.

Radionuclide esophageal and intestinal transit scintigraphy in patients undergoing radiation therapy.

Radiation esophagitis and enteritis are common and significant side effects of radiation therapy. Non-invasive assessment of functional and/or anatomic changes responsible for the symptoms produced by radiation esophagitis and enteritis has been unsatisfactory. This paper demonstrates the value of radionuclide esophageal and intestinal transit scintigraphy in patients undergoing mediastinal or abdominal radiation.

Ilioportal shunt during a venogram/lung scan.

An interesting case of ilioportal shunting in a patient with seminoma and infrarenal thrombosis of the inferior vena cava, iliac and femoral veins is presented. This case demonstrates the utility of the nuclear venogram/lung scan for revealing venous collaterals in an ilioportal shunt, and illustrates shunting of femoral venous drainage into the mesenteric circulation, the portal veins, and the liver.

Subcapsular bile leak following percutaneous drainage.

The authors describe the scintigraphic appearance of a case of subcapsular biliary leak. Hepatobiliary scintigraphy using Tc-99m labeled radiopharmaceuticals is employed primarily for the diagnosis of acute cholecystitis and for the demonstration of biliary tract patentcy. This procedure can also provide functional and morphologic information for evaluation of biliary tract trauma.

A positive indium-III bone marrow scan in metastatic breast carcinoma. Case report.

Indium is generally presumed to localize in the bone marrow within the erythroid cell line. Fibrosis, inflammation, lymphoma, extended field radiation, chemotherapy, or combinations of both treatment modalities generally depress the uptake of indium by the marrow a complex fashion. We report a case of metastatic breast carcinoma and pancytopenia in which the In-111 scan appeared qualitatively similar to a Tc-99m MDP bone scan. Findings were confirmed by bone marrow biopsy.

Gallium localization in peritonitis. Two case reports.

Diffuse abdominal localization of gallium was found in two patients with peritonitis, one due to M. tuberculosis and the other presumably pyogenic. Gallium scanning may be useful in the diagnosis of peritonitis and perhaps of other serosal infections.

The radionuclide diagnosis of horseshoe kidney.

The authors present an interesting case of horseshoe kidney diagnosed by nuclear imaging.

Hepatobiliary-lung imaging. A case report.

The use of combined hepatobiliary-lung imaging in the diagnosis and evaluation of a subphrenic process is described.

Intravenous adenosine (adenoscan) versus exercise in the noninvasive assessment of coronary artery disease by SPECT.

Fifteen patients at a mean age of 58 underwent adenosine and maximal exercise thallium SPECT imaging. All scans were performed 1 week apart and within 4 weeks of cardiac catheterization. SPECT imaging was performed after the infusion of 140 micrograms/kg/min of adenosine for 6 minutes. Mean heart rate increment during adenosine administration was 67 +/- 3.7 to 77 +/- 4.1. Mean blood pressure was 136 +/- 7.2 to 135 +/- 6.2 systolic and 78 +/- 1.8 to 68 +/- 2.6 diastolic. No adverse hemodynamic effects were observed. There were no changes in PR or QRS in intervals. Five stress ECGs were ischemic. No ST changes were observed with adenosine. Although 68% of the patients had symptoms of flushing, light-headedness, and dizziness during adenosine infusion, symptoms resolved within 1 minute of dosage adjustment or termination of the infusion in all but one patient, who required theophylline. Sensitivity for coronary artery detection was 77% and specificity 100%. Concordance between adenoscans and exercise thallium scintigraphy was high (13/15 = 87%). In two patients, there were minor scintigraphic differences. The authors conclude that adenosine is a sensitive, specific, and safe alternative to exercise testing in patients referred for thallium imaging and may be preferable to dipyridamole.

Initial experience with SPECT imaging of the brain using I-123 p-iodoamphetamine in focal epilepsy.

Nineteen patients with complex partial seizures refractory to medical treatment were examined with routine electroencephalography (EEG), video EEG monitoring, computed tomography or magnetic resonance imaging, neuropsychological tests and interictal single photon emission computed tomography (SPECT) with I-123 iodoamphetamine (INT). In 18 patients, SPECT identified areas of focal reduction in tracer uptake that correlated with the epileptogenic focus identified on the EEG. In addition, SPECT disclosed other areas of neurologic dysfunction as elicited on neuropsychological tests. Thus, IMP SPECT is a useful tool for localizing epileptogenic foci and their associated dynamic deficits.

Nuclear medicine and pediatric nephrology.

Radionuclide cystography and renal scintigraphy are the diagnostic procedures of choice in conjunction with ultrasonography in the workup of pediatric urologic or nephrologic patients. Two interesting case reports--a six-month old and a three-month old--are presented.

Who makes the abortion decision?: law, practice, and the limits of the liberal solution.

PIP: Since abortion is an important aspect of women's control over reproduction, barriers to abortion threaten women's efforts to attain equality. The ensuing discussion rests upon 2 assumptions: 1) That women want and need control over their reproductive capacity, and 2) that women want personal access to abortion and desire the availability of abortion to women generally. Under Roe v. Wade, abortions can only be performed if physicians choose to do them; this has left 4/5ths of US counties without an abortion provider. Roe neither compelled the availability of abortion services to all interested women, nor did it establish a "women's entitlement to an abortion based on her decision... "While the liberal solution in the Law may provide formal new rights, these rights are often ineffective because they fail to address attitudes firmly rooted in the social structure. Feminists' radical, self-help approach of becoming their own abortion providers offers a limited solution because of 1) geography and regional culture: the "paucity of abortion providers is likely to be replicated for feminist health collectives"; 2) the legal risk in underground institutions; and 3) the woman's choice, i.e., will the tradition-minded women use an alternative medical facility? Finally, "the woman's own decision-making process may be the ultimate barrier to abortion." The high visibility and intense emotions brought to contemporary abortion discussions in the post-Roe era may be far more chilling to individual decision than the relative silence of the 1950s. Psychological, as well as physical, availability of abortion must be kept in mind. For the future, social scientists can provide awareness of the social context in which the legal definition of abortion rights confronts the lives of women.^ieng

Endocrine changes and clinical outcome after laparoscopic ovarian resection in women with polycystic ovaries.

Ovarian laparoscopic resection was applied to 23 sterile patients affected with polycystic ovarian disease (PCOD) resistant to different pharmacological treatments, in order to induce ovulation. After resection, 56% of the patients had spontaneous ovulatory cycles and 13 pregnancies arose. Ten of the pregnancies were spontaneous and three followed treatment with clomiphene. Hormone changes were assessed in 15 patients, including five with spontaneous menstruation but without ovulation and five with persistent amenorrhoea for 3 months after resection. A significant decrease in both androstenedione and testosterone levels occurred in all patients. These decreases were not related to the clinical results of resection. Luteinizing hormone (LH) did not vary greatly in any group after resection. Mean values and mean pulsatility of follicle stimulating hormone (FSH) increased significantly only in pregnant patients or those with spontaneous ovulatory cycles. The results of gonadotrophin-releasing hormone (GnRH) assays did not change after resection. The mechanisms involved in the resumption of cyclic function of the hypophyseal-ovarian axis after resection are discussed briefly.