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C J Palestro

Publications and source records attributed to C J Palestro.

At least 55 records · Page 3Linked to original sources
PubMed1993

Assessing collateral cerebral perfusion with technetium-99m-HMPAO SPECT during temporary internal carotid artery occlusion.

Cerebral infarction following internal carotid artery occlusion results from either embolism or inadequate collateral blood flow. Although risk of embolism can be minimized, detecting compromised collateral circulation is more difficult. Cerebral angiography, carotid stump pressures and clinical evaluation during internal carotid artery occlusion are of limited utility. Xenon-133 radionuclide studies and stable xenon computed tomography are not readily available. We evaluated 99mTc-HMPAO SPECT, during temporary carotid artery occlusion, in 20 patients considered for internal carotid artery occlusion. Fourteen demonstrated symmetric cerebral perfusion during occlusion; eleven underwent transient and three had permanent carotid artery occlusion without complications. Five patients had ipsilateral globally decreased perfusion during temporary occlusion. One patient underwent transient occlusion of this vessel and one underwent carotid sacrifice without bypass grafting; both recovered without sequelae. The three remaining patients underwent carotid artery bypass grafting prior to sacrifice of this vessel. One patient with a small focal perfusion defect underwent carotid artery sacrifice without bypass grafting and developed acute neurologic deficits postoperatively. These initial results suggest that symmetric cerebral perfusion during temporary occlusion indicates that internal carotid artery occlusion will be tolerated. Although its implications are not yet well defined, the abnormal study identifies patients potentially at risk for postocclusion complications, thus providing a basis for neurosurgical management.

Adolescent↗
PubMed1993

Indium-111-leukocyte imaging in Gaucher's disease.

A 29-yr-old man with Gaucher's disease and fever of unknown origin underwent 111In-labeled mixed autologous leukocyte scintigraphy. Although no focus of infection was identified, the resulting images were most unusual and were characterized by massive hepatomegaly, lack of central marrow activity and extensive lymph node uptake of labeled leukocytes. All of these findings could be explained on the basis of the patient's underlying disease. Hepatomegaly and absent central marrow activity correlated with extensive infiltration of these organs by Gaucher cells, while the lymph node findings were attributed to the presence of extramedullary hematopoiesis.

Adult↗
PubMed1992

Diagnosis of musculoskeletal infection using combined In-111 labeled leukocyte and Tc-99m SC marrow imaging.

Seventy-three patients with various underlying disorders that could potentially alter distribution of bone marrow underwent In-111 labeled autologous leukocyte and Tc-99m SC marrow imaging to exclude musculoskeletal infection. There were 22 cases of infection among the 73 patients studied. When interpreted in isolation, labeled leukocyte images were considered positive for infection when uptake of labeled cells in the region of interest exceeded uptake in the corresponding contralateral side. The sensitivity, specificity, and accuracy of the study using this criterion were 86%, 12%, and 34%, respectively. When interpreted in conjunction with sulfur colloid marrow images, studies were considered positive for infection when uptake in the region of interest on leukocyte and marrow images was spatially incongruent. The sensitivity, specificity, and accuracy of this dual tracer modality were 100%, 94%, and 96%, respectively. Three patients with infection and abnormal leukocyte/marrow images underwent repeat imaging after appropriate therapy. Images were interpreted as normal in two of them; both were infection free at subsequent surgery. Images of the third patient were interpreted as consistent with persistent infection, and operative cultures grew out Staphylococcus aureus. In summary, combined leukocyte/marrow imaging is a highly accurate method for diagnosing musculoskeletal infection and overcomes certain inherent limitations of labeled leukocyte imaging alone.

Adolescent↗
PubMed1992

Wound dressing activity mimicking infection on labeled leukocyte imaging.

Although labeled leukocyte imaging is an extremely useful technique for the localization of infection, false-positive results in inflammatory conditions where no infection exists have been described. False-positive results secondary to bleeding have also been reported. The authors recently observed intense uptake of labeled cells in the wound dressings of two patients undergoing leukocyte imaging. Repeat imaging after the removal of these dressings confirmed that the activity seen was in the dressings and did not represent focal infection, as originally thought. Based on these observations, the authors think it prudent to remove such dressings before performing leukocyte imaging.

Adult↗
PubMed1992

Leukocyte scanning with 111In is superior to magnetic resonance imaging in diagnosis of clinically unsuspected osteomyelitis in diabetic foot ulcers.

OBJECTIVE: To compare the accuracies of MRI and leukocyte scanning in diagnosing clinically unsuspected osteomyelitis in diabetic foot ulcers. RESEARCH DESIGN AND METHODS: A prospective study of 16 diabetic foot ulcers in 12 patients, including both ambulatory and hospitalized patients, was performed at a university medical center. Pedal images were obtained by leukocyte scanning with [111In]oxyquinoline and MRI. Definitive diagnosis of osteomyelitis then was determined by bone biopsy for culture and histology. RESULTS: Biopsy-proven osteomyelitis was present in 7 (44%) of the 16 foot ulcers. The diagnosis was suspected clinically in 0%. Leukocyte scanning was 100% sensitive, whereas MRI was only 29% sensitive in diagnosing osteomyelitis in diabetic foot ulcers. Specificities were 67 and 78%, respectively. The positive and negative predictive values (70 and 100%, respectively) for the leukocyte scan also were greater than those of MRI (50 and 58%, respectively). CONCLUSIONS: Leukocyte scanning is superior to MRI in detecting clinically unsuspected osteomyelitis in diabetic foot ulcers.

Biopsy↗
PubMed1992

Indium-111-leukocyte and gallium-67 imaging in acute sarcoidosis: report of two patients.

Two young women with acute sarcoidosis underwent (111)In-labeled autologous leukocyte imaging because of persistent fevers. Images of one of the women demonstrated faint thoracic lymph node uptake of labeled cells, but no discrete focus suggestive of infection was seen. Images of the second woman were normal. Gallium-67 imaging, performed 48 hr after the leukocyte studies, revealed multiple areas of abnormal radiotracer accumulation corresponding to regions of active sarcoid in both women. These cases suggest that leukocyte imaging is not useful for assessing the extent of disease in patients with sarcoidosis. This technique may be valuable, however, in excluding superimposed infection in these individuals.

Acute Disease↗
PubMed1992

In-111 labeled leukocyte imaging in a case of pseudogout.

In-111 labeled leukocyte scintigraphy was performed on a 90-year-old woman who had a fever and left lower extremity pain for 3 days. Leukocyte images demonstrated abnormal activity in the left knee and ankle. Aspiration of the left knee joint yielded cloudy yellow fluid with a leukocyte count of 30,000 per mm3 (75% polymorphonuclear leukocytes, 1% lymphocytes, and 24% monocytes). Cultures of the aspirate were reported as no growth. Microscopic examination of the aspirate revealed the presence of rod-shaped crystals of calcium pyrophosphate dihydrate, confirming the diagnosis of calcium pyrophosphate deposition disease, also known as pseudogout. The acute arthritis of pseudogout stimulates an intense leukocyte response; therefore, labeled leukocyte images performed on patients suspected of having this condition must be interpreted cautiously because scintigraphically it may not be possible to distinguish pseudogout from septic arthritis.

Aged↗
PubMed1992

Diffuse pulmonary uptake of indium-111-labeled leukocytes in drug-induced pneumonitis.

Indium-111-labeled-leukocyte scintigraphy was performed on three febrile patients, two of whom had no signs or symptoms referable to the respiratory tract. The third patient had dyspnea on exertion, unchanged over two months. Their past histories were remarkable in that all three had recently undergone chemotherapy for malignancy (2 lymphoma, 1 malignant thymoma). Diffuse pulmonary uptake of labeled leukocytes was observed in all three individuals. As a direct result of leukocyte imaging, all three underwent fiberoptic bronchoscopy and transbronchial biopsy. The final diagnosis in each of these patients was drug-induced pneumonitis, which responded to treatment with corticosteroids. This entity should be added to the group of conditions, both infectious and noninfectious, that cause diffuse pulmonary uptake on labeled leukocyte images. Moreover, in the appropriate clinical setting, even in the absence of pulmonary signs or symptoms, diffuse pulmonary uptake of labeled leukocytes should alert the physician to the possibility of drug-induced pneumonitis.

Aged↗
PubMed1991

Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline.

OBJECTIVE: The prevalence of osteomyelitis in diabetic foot ulcers is unknown. Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation. We therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers. We compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings. Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment. DESIGN: Cohort study. SETTING: Institutional and private, ambulatory and hospitalized patients. PATIENTS: Consecutive sample of 54 diabetic patients. Thirty-five patients with 41 foot ulcers were included. RESULTS: As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers. Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician. Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination. All patients with ulcers that exposed bone had osteomyelitis. Of the imaging tests, the leukocyte scan had the highest sensitivity, 89%. In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days. CONCLUSION: The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected. Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment. We recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis. Diabetic patients with foot ulcers that do not expose bone should undergo leukocyte scanning, which eliminates the risk of bone biopsy in diagnosing osteomyelitis and allows for the diagnosis and treatment of this well-known but often silent precursor of lower extremity amputation.

Diabetes Mellitus, Type 2↗
PubMed1991

Role of in-111 labeled leukocyte scintigraphy in the diagnosis of intracerebral lesions.

The differential diagnosis of intracerebral enhancing lesions on contrast computed tomography includes tumors, abscesses, and cerebrovascular accidents. Particularly important is the differentiation between tumor and abscess. While In-111 labeled leukocyte imaging is an accurate test for identification of foci of infection in general, the role of this procedure in the evaluation of the intracranial lesion is not well established. We undertook a retrospective review of 16 patients with contrast enhancing intracerebral lesions identified on computed tomography, who were also studied with labeled leukocyte imaging. Final diagnoses were: abscess (n = 2), primary brain tumor (n = 6), metastasis (n = 4), dermoid cyst (n = 1), and cerebral infarct (n = 3). There were two positive labeled leukocyte studies; both were cerebral abscesses. No labeled leukocyte activity was identified in any of the tumors or infarcts. We conclude that In-111 labeled leukocyte imaging is an accurate method of differentiating infectious from noninfectious causes of intracerebral lesions identified on computed tomography.

Adult↗