Sestamibi retention in reactive lymph node hyperplasia: a cause of false-positive parathyroid localization.
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Biomedical subjects
Publications and source records attributed to K T Riese.
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A 57-yr-old woman was referred for preoperative scintigraphic localization of a parathyroid adenoma. Double-phase 99mTc-sestamibi imaging was performed followed by a separate-day [99mTc]pertechnetate thyroid scan. There was marked accumulation of both tracers by a right lower pole ¿thyroid' nodule which, at surgery, proved to be an intrathyroidal parathyroid adenoma. Hypervascularity is the presumed explanation for rare cases of pertechnetate-avid parathyroid adenomas.
The authors describe two patients in whom parathyroid adenomas were successfully localized with a Tc-99m sestamibi/pertechnetate subtraction technique, but who did not exhibit differential sestamibi retention on delayed imaging. Although the frequency of this occurrence is unclear, it suggests that some parathyroid adenomas will be missed if reliance is placed on sestamibi retention alone without simultaneous thyroid imaging.
OBJECTIVE: To determine the nature of reflux after esophagectomy and interposition of right colon. DESIGN: A case series. SETTING: A university hospital. PATIENTS: Five patients (mean age 43 years) in whom right colon had been interposed after total esophagectomy. INTERVENTIONS: Endoscopy and biopsy, manometry, 24-hour ambulatory pH testing. MAIN OUTCOME MEASURES: Endoscopic and histologic appearances of the colon, type of motor activity in the grafted colon and the type of reflux. RESULTS: In all patients the grafted colon was macroscopically and microscopically normal. There was nonperistaltic motor activity in the interposed colon in two patients. All patients had an abnormal pattern of alkaline reflux, and one patient had abnormal acid reflux. CONCLUSIONS: The clinical effect of alkaline reflux in patients with colonic interposition after total esophagectomy may be slight. Histologic and gross changes are likely to be minimal.
Analysis of the literature and our own experiences with two pediatric cases of salivary gland tumors have yielded the following information: 1) under the age of five years, nearly all parotid tumors are mesenchymal in origin; 2) malignant tumors of the parotid during childhood occur much more often in girls than in boys; 3) mucoepidermoid carcinoma is the most common salivary gland malignancy in children; 4) the second next most common is of the undifferentiated variety; 5) acinic cell carcinoma, in general, represent fewer than 3 per cent of all salivary gland tumors, and two-thirds of these occur in females. Lymph node metastasis is rare, recurrence being usually local or blood borne; 6) Acinic cell carcinoma are rare in childhood. They are not highly malignant, yet capable of killing. Local recurrences are frequent. The best primary treatment would appear to be complete surgical excision. Blood borne metastases may develop more than 20 years after initial treatment.
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