Biomedical subjects
Publications and source records attributed to L Rosenthall.
This is a case report of a 12-month-old male suffering from severe combined immunodeficiency disease who demonstrated an intense concentration of MDP in the spleen. The precise mechanism for this accretion is not known and remains speculative.
An improved treatment method for hepatic malignancies with yttrium-90 incorporated into the matrix of glass microspheres was evaluated prospectively. Fifteen patients with 12 metastatic colorectal cancers, one carcinoid, one islet cell tumor, and one hepatoma were treated with three dose levels: 5,000 cGy (5,000 rad), ten patients; 7,500 cGy (7,500 rad), three patients; and 10,000 cGy (10,000 rad), two patients. Mean follow-up was 7 months (range, 2-12 months). Stable disease in the liver was seen in ten patients, four of whom had concurrent progression of extrahepatic disease, which resulted in two deaths. Two additional deaths were not directly related to the malignant process. Progression of liver disease was found in five patients, with three deaths occurring at 7-8 months. No procedural, hematologic, or pulmonary complications occurred. Late gastroduodenal ulceration occurred at 6-8 weeks in three patients who had histories of chronic alcohol abuse. This method of therapy seems to be feasible and efficient. Caution is necessary with high doses or with patients with a history of or predisposition to gastroduodenal ulcers.
We have compared technetium-99m (99mTc) red blood cell (RBC) venography to serial impedance plethysmography (IPG) in 110 consecutive patients with a first episode of clinically suspected deep vein thrombosis (DVT). IPG was performed at Day 0 and, if abnormal, contrast venography was also performed to rule out a falsely positive result. Patients with an initially normal IPG had the test repeated at Days 1, 3, 5 to 7, and 10 to 14. Contrast venography was not performed and anticoagulant treatment was withheld in all patients who remained normal during repeated IPG testing. Technetium-99m RBC venography was performed at Day 0 in patients with an initially abnormal IPG and during the period of serial IPG testing in those with an initially normal IPG. The sensitivity of [99mTc]RBC venography for proximal DVT was 0.68, with 95% confidence limits (CL) from 0.48 to 0.89. Specificity was 0.88 (95% CL from 0.81 to 0.95). When the findings of [99mTc]RBC venography for the entire lower extremity were compared to the reference method, the sensitivity increased to 0.90 (95% CL from 0.82 to 0.97) but the specificity decreased to 0.56 (95% CL from 0.51 to 0.62). Technetium-99m RBC venography is a sensitive but less specific method for detecting DVT of the entire lower extremity. An abnormal [99mTc]RBC venogram, particularly in the calf region, should always be confirmed by another diagnostic method.
Rats were made cirrhotic by carbon tetrachloride inhalation associated with phenobarbital in the drinking water over 10 weeks. After a 1-week recovery period a 99mTc sulphur colloid radioisotope scan of the liver was carried out on each animal following bolus injection into the iliac vein. Kupffer cells were then histologically identified by one of three methods: colloidal carbon uptake, iron staining after ferritin-dextran, or endogenous peroxidase staining. The degree of liver injury was classified into four pathological groups and these were correlated with the phagocytic capacity of each liver as recorded on the isotope scan. All three histological markers demonstrated that in normal liver, Kupffer cells are more plentiful in periportal areas. In cirrhotic liver, there were very few Kupffer cells in nodular regenerative areas, where continuous capillaries are found, but Kupffer cells were present in the remaining more normal trabecular-sinusoidal areas. Morphometric counting of carbon- and ferritin-labelled Kupffer cells demonstrated a significant decrease in cirrhotic livers. A close correlation was also found between increasing degree of liver injury and diminished hepatic phagocytic capacity, as demonstrated by the radioisotope scan. The study demonstrates that where regenerative liver is capillarized, with replacement of fenestrated sinusoids, Kupffer cells are absent.
In heart failure secondary to chronic mechanical overload, cardiac sympathetic neurons demonstrate depressed catecholamine synthetic and transport function. To assess the potential of sympathetic neuronal imaging for detection of depressed transport function, serial scintigrams were acquired after the intravenous administration of metaiodobenzylguanidine [131I] to 13 normal dogs, 3 autotransplanted (denervated) dogs, 5 dogs with left ventricular failure, and 5 dogs with compensated left ventricular hypertrophy due to a surgical arteriovenous shunt. Nine dogs were killed at 14 hours postinjection for determination of metaiodobenzylguanidine [131I] and endogenous norepinephrine content in left atrium, left ventricle, liver, and spleen. By 4 hours postinjection, autotransplanted dogs had a 39% reduction in mean left ventricular tracer accumulation, reflecting an absent intraneuronal tracer pool. Failure dogs demonstrated an accelerated early mean left ventricular tracer efflux rate (26.0%/hour versus 13.7%/hour in normals), reflecting a disproportionately increased extraneuronal tracer pool. They also showed reduced late left ventricular and left atrial concentrations of tracer, consistent with a reduced intraneuronal tracer pool. By contrast, compensated hypertrophy dogs demonstrated a normal early mean left ventricular tracer efflux rate (16.4%/hour) and essentially normal late left ventricular and left atrial concentrations of tracer. Metaiodobenzylguanidine [131I] scintigraphic findings reflect the integrity of the cardiac sympathetic neuronal transport system in canine mechanical-overload heart failure. Metaiodobenzylguanidine [123I] scintigraphy should be explored as a means of early detection of mechanical-overload heart failure in patients.
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Three patients with total knee arthroplasties, in which the tibial and patellar articulating surfaces consisted of a polyethylene-carbon fiber composite, demonstrated technetium-99m methylene diphosphonate (MDP) deposition in the intraarticular space, whereas, the gallium-67 citrate images were normal. This was shown to be due to a synovial giant cell foreign body reaction to particulate carbon fiber debris in one patient who required surgical revision of the prosthesis.
The utility of radiophosphate bone scanning in the detection of complications following total knee replacement (TKR) is not yet fully established. A difficulty associated with the use of bone scanning is the persistent increased uptake seen around the prosthetic joint long after surgery, despite the absence of symptoms. In order to better characterize the time course of radiophosphate uptake, bone scans obtained 1 mo-12 yr after surgery were analyzed in 30 asymptomatic patients with 37 TKR. Uptake was graded 0-4+ in the femoral and tibial components. Scans of 18 implants were obtained 1 yr or less after surgery (Group 1), and 19 were obtained greater than 1 yr after surgery (Group 2). Mean uptake scores were as follows: femoral component Group 1 = 3.0 +/- 1.1; Group 2 = 1.8 +/- 0.9 (p less than 0.05); tibial component Group 1 = 3.2 +/- 0.8; Group 2 = 2.6 +/- 1.1 (not significant). Persistent increased uptake, particularly in the tibial component, reflects mechanical stresses peculiar to knee prostheses, and tends to undermine confidence in diagnosing loosening on the basis of a single study.
A correlation was made between the incidence and intensity of 99mTc-methylene diphosphonate (MDP) concentration and the radiographic incidence and volume of heterotopic calcium deposition in 44 patients with hip arthroplasties, as well as with the duration of the hip implants. The incidence of soft tissue para-articular MDP concentration was 95% compared to a 68% incidence of radiographically visible heterotopic calcium, bone or both. The concentration of MDP did not decrease on average with the age of the implant, which ranged from 6 months to 15 years, even though radiographs showed evidence of mature ossification in many of them. The cause of these sustained high uptakes is open to speculation, but the findings indicate that radiophosphate imaging is not a reliable means of assessing maturation of heterotopic bone associated with hip arthroplasty.
Imaging features of a case of sternoclavicular hyperostosis are described, and the pathologic and clinical features of this uncommon entity are discussed.
Subperiosteal bone formation, in contradistinction to resorption, is an unusual occurrence in renal osteodystrophy, and particularly rare in the long bones of the lower extremities according to the radiological literature. Two cases are presented with radiographic and radiophosphate evidence of subperiosteal bone formation in the femora and tibiae, and both showed histologic changes of profound secondary hyperparathyroidism.
Twenty-two patients had combined radiographic and radiocolloid arthrography. The two procedures were in agreement in 86% of the patients as to whether the femoral component was loose or not. Fourteen patients has surgical revision of the prosthesis and in 3 (23%) radiographic arthrography was falsely negative. No false negative results were obtained with radiocolloid arthrography thus far. The radionuclide method cannot be used to assess the acetabular component.
The half-value layers of stainless steel, bone cement, and polyethylene were measured for 99mTc, 67Ga, 111In, and 201TI to render some insight into the attenuating effects of the metallic cup and other components used in surface-replacement revision arthroplasty. On theoretic consideration, a twofold increase in 99mTc-methylene diphosphonate in bone inside the cup should not be attenuated to the point of escaping detection on the radionuclide images of the hip. 67Ga, using the 184 and 300 keV peaks, and 111In have greater half-value layers than 99mTc and are subject to less attenuation by the metallic cup.
There were 23 patients who had revisions of their failed hip arthroplasties and a prior radiophosphate assessment of the joint components. In this selected group of patients the true positive incidence of abnormal scintigraphic findings for femoral component loosening was 19 out of 20 (95%) and the true negative incidence was two out of two by the criteria adopted. The true positive incidence of such findings, indicating acetabular component loosening, was seven out of seven, and the true negative was nine out of 10. Some of these patients also had contrast arthrography and the incidences of true positive and true negative findings for femoral component loosening were seven out of 15 (47%) and one out of one, respectively. Prediction of the status of the acetabulum was poorer using this technique with true positive and true negative incidences of four out of nine and two out of five, respectively.
The circulation in microvascularized rib grafts has been compared with that in conventional rib grafts and in those augmented by a direct vascular bundle implantation into the bone grafts. A new experimental model has been designed to correlate vascular perfusion, bone scan patterns, tetracycline labeling, and histological findings in these bone grafts. Posterior microvascularized rib grafts were found to have a circulatory pattern identical to that of the normal rib. Failed microvascularized rib grafts were revascularized more slowly than conventional rib grafts. Vascular bundles implanted into rib grafts remained patent and increased the rate of revascularization. The stripping or preservation of periosteum had no observable effects on the rate or pattern of conventional rib graft revascularization. The circulation in rib grafts was accurately reflected in technetium 99 bone scans, as was the patency of the anastomoses of microvascularized rib grafts and of implanted vascular bundles. In contrast, tetracycline labeling was repeatedly observed in avascular areas of bone grafts and, therefore, is not a reliable indicator of bone graft circulation.
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The intensity of synovitis induced by the intraarticular injection of 70 mg of zymosan into rabbit knee joints was assessed using the radiopharmaceutical 67gallium citrate (67Ga). Maximal uptake of 67Ga was observed 5 days after zymosan administration. The distribution of 67Ga in the intraarticular and paraarticular structures was quantitated and highest concentrations were found in the synovial membrane. The short term quantitative evaluation of zymosan induced arthritis is possible using scintigraphic technique.
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