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Biomedical subjects

I P Murray

Publications and source records attributed to I P Murray.

At least 19 recordsLinked to original sources
PubMed1995

Multiple flexion-stress vertebral end-plate fractures. An osteogenesis imperfecta presentation.

A 28-year-old woman underwent bone scintigraphy for a 7-day history of severe back pain of sudden onset. Intense linear accumulation of Tc-99m HDP was present in several lower thoracic and lumbar vertebrae without vertebral body deformity. Intense uptake was also present in other thoracic vertebrae with vertebral body changes. X-rays demonstrated osteopenia and dual photon densitometry studies confirmed a significant degree of osteoporosis. Endocrine assessment identified that she and other female members of the family had osteogenesis imperfecta, Sillence type 1. This disorder should be considered in all differential diagnoses of nonobvious traumatic fractures of the vertebrae in healthy young adults.

Adult↗
PubMed1994

Prominence of the C2 vertebra on SPECT. A normal variant.

Mild preferential focal uptake of Tc-99m HDP in the spinous process of C2 was identified with SPECT of the cervical spine performed in patients in whom the indication for bone scintigraphy was suspected of lesions in the limbs. Its presence in all 21 subjects indicates that such uptake is a normal finding.

Adolescent↗
PubMed1993

The role of SPECT in the evaluation of skeletal trauma.

Single photon emission computed tomography (SPECT) has, in the last decade, established a critical role in routine diagnosis. Skeletal scintigraphy exemplifies the impact in improving detection of lesions by delineation of their site and size. The advantage of minimizing the superimposed radioactivity from overlying and underlying structures is typified by the readiness with which avascular necrosis of the femoral head can be identified by removal of the surrounding hyperaemia which masks the classical photopaenia. However, the ability to achieve an accurate image at a plane at a prescribed depth is most characteristically shown by the study of a vertebra, a bone of irregular contour and subject to a variety of pathological disorders at different sites within it. The various focal abnormalities resulting from these can be localized exactly, readily distinguishing, for example, those in the body from those in the natural arch. In particular, the alterations resulting from trauma, such as pars interarticularis stress fracture, are readily seen. Consequently SPECT has an indispensable role in the investigation and management of low back pain. However, the ability of SPECT to delineate abnormal accumulation has provided a new approach to the evaluation of knee pain, especially when acute such as that resulting from athletic injury, since the identification of the presence or absence of focal abnormalities can be critical to patient management. The frequency of these various disorders in which SPECT is so useful explains why the procedure has become such a routine high-volume examination is so many departments.

Femur Head Necrosis↗
PubMed1993

The role of thallium scintigraphy in excluding malignancy in bone.

Scintigraphy with thallium-201 was performed on 22 patients in whom a solitary abnormality in bone was suspected of being malignant. In three patients, an additional lesion was subsequently identified. Preferential TI-201 uptake was found in 7 of 8 malignant lesions, but was absent in 16 of 17 abnormalities that proved to be benign. The use of TI-201 scanning is considered to offer high negative predictive value in the assessment of possible malignant change in bone.

Adolescent↗
PubMed1992

Comparison of DMSA scintigraphy with intravenous urography for the detection of renal scarring and its correlation with vesicoureteric reflux.

A series of 208 patients was prospectively assessed for reflux nephropathy by intravenous urography (IVU) and 99mTc-dimercaptosuccinate (DMSA) scintigraphy. All patients were studied at least 3 months after their most recent urinary tract infection and micturating cystourethrography (MCU) was performed prior to the scintigraphic studies. DMSA scintigraphy detected significantly more cortical abnormalities than did IVU. There was also a correlation between cortical abnormalities in the DMSA studies and the degree of reflux on MCU. The validity of DMSA as a cortical imaging agent is evaluated and the histological evidence for its efficacy derived from the animal model is reviewed, lending weight to its establishment as the "gold standard" for renal cortical scarring.

Child↗
PubMed1992

A ventilatory assistance device for use with Technegas.

The demand for high-quality ventilation imaging of the lungs has resulted in the advent of Technegas, which has proven its superiority to the more conventional agents in a number of clinical trials. Images of similar diagnostic quality have been difficult to obtain in patients who are uncooperative, intubated or very young. With this problem as the impetus, a ventilatory assistance device (VAD) was designed to exploit the superior imaging qualities of Technegas. The Technegas generator was interposed between the patient and the VAD, allowing the controlled movement of Technegas into the patient from the generator. Utilizing this device, the problems of increased dead space, turbulent gas flow and possible contamination were circumvented. Twenty patients, comprising nine children and eleven adults, were studied for various indications including assessment of pulmonary parenchymal disease, suspected pulmonary embolism and the lung clearance of modified Technegas. In all cases, images of diagnostic quality were obtained with ease, facilitating relevant clinical decision making. We conclude from this preliminary appraisal that the VAD is a simple, safe addition to the Technegas generator for imaging a group of patients in whom images of diagnostic quality have traditionally proven difficult to obtain.

Adolescent↗
PubMed1991

Optimising technetium 99m diethylene triamine penta-acetate lung clearance in patients with the acquired immunodeficiency syndrome.

Pneumocystis carinii pneumonia (PCP) has become a major cause of morbidity and mortality due to infectious diseases, largely as a result of the acquired immunodeficiency syndrome (AIDS) epidemic. Since the mortality from recurrent infection is between 40% and 60%, early diagnosis and therapy are the keys to survival. The role of technetium 99m diethylene triamine penta-acetate (DTPA) aerosol pulmonary clearance was studied in 81 patients with AIDS. The mathematical technique of curve stripping was found to be the optimal method of analysis and to provide an overall sensitivity of 94% for the detection of interstitial pneumonitis. The procedure was superior to standard pathology parameters and radiography and more convenient than gallium 67 scintigraphy.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Cardiopulmonary bypass, profound hypothermia, and circulatory arrest for neurosurgery.

Six female and 4 male patients (age, 23 to 75 years) underwent operation for difficult intracranial lesions. Preoperative diagnoses included four giant intracranial aneurysms, three base of skull glomus jugulare tumors, two arteriovenous malformations, and one cerebellar hemangioblastoma. All lesions were inoperable or nearly so by standard neurosurgical techniques. All patients were placed on total bypass via groin cannulations. Bypass times ranged from 111 to 269 minutes (mean, 174 minutes) with cooling times of 26 to 83 minutes (mean, 48 minutes) and warming times of 68 to 110 minutes (mean, 83 minutes). Circulatory arrest times ranged from 1.25 to 60 minutes with 1 patient not requiring arrest. The lowest core temperatures recorded varied from 8.4 degrees to 13.7 degrees C. There was one postoperative death and one major complication, both in patients with arteriovenous malformations. Eight patients (80%) have achieved an excellent result. Profound hypothermia with the option of circulatory arrest and exsanguination has been an indispensable adjunct to the safe management of intracranial aneurysm, glomus jugulare tumor, and hemangioblastoma.

Adult↗
PubMed1990

Gallium scintigraphy in AIDS.

The acquired immunodeficiency syndrome (AIDS) is a growing problem in Australia: 438 new cases were added in 1988, resulting in the cumulative total of 1562 patients up to November 1989. The cumulative death rate stands at 54%, the majority of deaths being due to secondary infections and malignancies. The clinical presentation of these problems is often non-specific and protean; early diagnosis is the key to successful treatment and survival. Whole body gallium-67 scintigraphy offers an early diagnostic window into many of these infections and malignancies. Although the findings may be non-specific, the procedure is sensitive and may indicate the need for urgent empirical therapy or direct the more definitive investigation. A review of our experience with gallium-67 scanning in 56 AIDS patients at the Prince of Wales/Prince Henry Hospitals confirms its role in presaging significant clinical deterioration in patients with AIDS.

Abdomen↗
PubMed1990

Verbum sapienti.

Explore the source record for details and available documents.

Writing↗
PubMed1990

SPECT for acute knee pain.

In the assessment of acute knee pain following recent trauma frequently related to sporting activities, bone scintigraphy was performed on 52 patients; in 40 of these patients, scintigraphy immediately preceded arthroscopy. SPECT was critical in providing delineation and sitting of the abnormalities; this would not have been feasible with conventional planar imaging in 45 of the patients. Multiple sites of focal uptake were frequently visualized at ligamentous insertions or in intra-articular areas of cartilaginous erosion. Damaged anterior cruciate ligaments were only identified in 5 out of 10 patients, occurring when there was avulsion of the tibial attachment, but changes resulting from patellar injury were demonstrated in all 8 patients. The most characteristic scintigraphic change resulted from meniscal tears, which was diagnosed in 31 out of 35 patients in whom the lesion had been suspected clinically. In the identification of this common injury, SPECT had a sensitivity of 88%, specificity of 87%, and diagnostic accuracy of 88%. Thus, although trauma readily induces scintigraphic abnormalities in and around the knee, the patterns of alteration associated with particular lesions can be identified by SPECT and can provide considerable assistance in management, particularly in determining the need for arthroscopy.

Anterior Cruciate Ligament Injuries↗
PubMed1990

Pediatric solid tumors: evaluation by gallium-67 SPECT studies.

A retrospective review of 37 children with a variety of solid tumors who underwent 60 67Ga single-photon emission computed tomographic (SPECT) studies was performed. These studies were correlated with clinical and radiological findings and, where possible, histopathologic confirmation. In all studies, SPECT gave better definition and better anatomic localization of disease sites than obtained with planar views. SPECT detected more lesions in the head and neck (planar 16, SPECT 19), chest (planar 39, SPECT 45), and abdomen (planar 22, SPECT 24). In six of 20 patients scanned following chemotherapy, SPECT was useful in demonstrating that tracer accumulation in a normally located and shaped thymus indicated uptake resulting from thymic regeneration rather than tumor recurrence. It is concluded that 67Ga SPECT studies are very useful in the pediatric population, where perhaps because of their small size, interpretation of standard planar views may be difficult.

Adolescent↗