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Biomedical subjects

M Taavitsainen

Publications and source records attributed to M Taavitsainen.

At least 73 records · Page 4Linked to original sources

The detection of duodenogastric reflux with a non-invasive method using cholescintigraphy.

A non-invasive method to detect duodenogastric reflux is presented. The distribution of a hepatobiliary tracer 99mTc-diethyl-IDA is recorded after an intravenous injection of the substance for one hour. Normally the tracer is excreted through the liver into the biliary tract and into the duodenum, and the further passage proceeds it aborally in the intestine. In duodenogastric reflux, the radioactive tracer enters the stomach where it can be recorded with a gamma camera as a sign of the reflux. The identification of the intragastric tracer is sometimes difficult. A computerized recording with high frequency of frames and rotations of the patient aid in the detection of duodenogastric reflux. A computerized recording also gives a possibility for semiquantitative estimation of regurgitated duodenal fluid. The observed frequencies of duodenogastric reflux were 10 and 13.5 per cent in the two patient groups that were studied.

Bile Reflux↗

Body disappearance and liver mean transit time of 99m-Tc-diethyl-IDA.

The body disappearances and the liver mean transit times of a hepatobiliary tracer, 99mTc-diethyl IDA, were measured from 100 cholescintigraphies of 98 patients. Fifteen patients had no hepatobiliary disease; their mean body disappearance was 6.6, SD 1.1%/min, and mean liver mean transit time 32, SD 19 min. The values within 2 SDs, disappearance greater than or equal to 4.4%/min and mean transit time less than or equal to 70 min, were used as reference values. Disappearance constants below 4.4%/min were observed 29% and mean transit times exceeding 70 min in 49% of the examinations performed on patients with some hepatobiliary abnormality. The calculated parameters were compared with the levels of serum bilirubin and ASAT. Disappearance constants below 4.4%/min were seen in 33% and mean transit times exceeding 70 min in 55% of the patients who had either abnormal serum bilirubin or ASAT due to a hepatobiliary disease. The correlation between the serum bilirubin and the disappearance was -0.13, and between ASAT and body disappearance it was -0.28. The corresponding correlation coefficients of serum bilirubin and ASAT with the liver mean transit times were 0.33 and 0.44. Long mean transit times in relation to bilirubin and ASAT were seen in some acute cases. Short mean transit times in relation to bilirubin and ASAT were seen with falling serum levels of the latter.

Adolescent↗

Cholescintigraphy in the determination of disturbed hepatobiliary function in acute cholecystitis.

The hepatobiliary transit of 99mTc-diethyl-IDA was studied in 50 cases of acute cholecystitis. The intrahepatic transit was characterized by the liver mean transit time of the tracer. The extrahepatic passage through the biliary tract was assessed from a series of scintigrams. The data were classified according to previously obtained knowledge of normal and pathological states of the liver and the biliary tract. (Normal liver mean transit time less than or equal to 70 minutes, normal appearance-time of the tracer in the biliary tract less than or equal to 15 minutes and in the intestine less than or equal to 20 minutes, no retention of the tracer in the biliary tract in cases of later appearance-times). Abnormal hepatobiliary transit of the tracer was recorded in 27 cases; it was retarded at the intrahepatic level in 11 cases, at the gallbladder neck in 3 cases, distally in the biliary tract in 12 cases, and a tight extrahepatic obstruction was seen in 1 case. In consequence, acute cholecystitis is often associated with disturbed hepatobiliary function. The functional changes in acute cholecystitis were similar to those associated with other hepatobiliary disorders of either intrahepatic or extrahepatic origin.

Acute Disease↗

[Cholescintigraphy].

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Biliary Tract Diseases↗

Cholescintigraphy in the diagnosis of acute cholecystitis.

Technetium-99-m-diethyl-IDA (Solco HIDA) cholescintigraphy was performed on 50 patients with suspected acute cholecysitis. The final diagnosis was acute cholecytitis in 34 cases, other biliary tract disease in 5 cases and nonbiliary disease in 11 cases. A nonfilling gallbladder was regarded as indicative of acute cholecystitis. The sensitivity in detecting acute cholecystitis was about 90%, the specificity about 80%; the predictive value of a positive test was about 90% and that of a negative test about 80%. The false positives consisted of two cases of acute pancreatitis with normal gallbladders and one case of coincidental chronic gallbladder disease and duodenal ulcer. The false negatives were examined after one week's treatment. A severe common bile duct obstruction could be detected in cholescintigraphy, but a slight obstruction was not always distinguishable from conditions in which the bile flow was normal.

Adult↗

Intravenous cholangiography and cholescintigraphy in the diagnosis of hepatobiliary disease.

The diagnostic yields of intravenous cholangiography (IVC) and 99mTc-diethyl-IDA cholescintigraphy (CS) were compared in 50 patients; 19 had acute cholecystitis, 5 pancreatitis, 4 obstructive disease of the common bile duct, 5 chronic gallbladder disease, 6 parenchymal liver disease and 11 had other intra-abdominal diseases. The comparison of IVC and CS covered three aspects: the definition of the biliary tract structures, their morphologic changes and an assessment of bile flow through the cystic duct and the common bile duct. The definition of the main intrahepatic bile ducts was better with IVC; that of the common bile duct and the gallbladder was better with CS. Morphologic details such as calculi or local changes in duct calibre were detected only in IVC. Measurements of common bile duct calibre obtained from operative cholangiograms correlated better with those from the IVCs than with those from the CSs. CS was more sensitive in the diagnosis of cystic duct obstruction. Bile flow in the common bile duct was estimated in the cases where the gallbladder did not fill. Delayed emptying of the common bile duct was revealed in IVC in 1 and in CS in 3 out of 6 cases with disturbed bile flow. The morphologic findings in IVC gave indication of the obstructive condition in the 1 case with retarded flow and in 2 additional cases. CS provided functional information for which the concentration of the tracer was sufficient except in one case. IVC provided morphologic and functional information, but the excretion of the contrast medium was insufficient for a morphologic assessment of the common bile duct in 16 cases and for a functional assessment in 11 cases.

Adolescent↗

Sonographic measurement of vertebral dislocation in spondylolisthesis.

The vertebral dislocation in spondylolisthesis was measured by both sonography and roentgenography in 20 patients with spondylolysis and 6-28 mm of spondylolisthesis. The two methods were applied independently of each other. The difference between the sonographic and roentgenographic measure of vertebral dislocation was 0-3 mm (mean 1.3 mm). The accuracy of sonography is sufficient for clinical work. The advantage of sonography is that the radiation burden of patients with spondylolysis can be decreased by replacing roentgenographic follow-up with sonography.

Adolescent↗

The Leriche syndrome. A comparative investigation using angiography, computed tomography and ultrasonography.

Nine patients with Leriche syndrome were examined with angiography, computed tomography and routine abdominal ultrasonography. The diagnosis was readily obtained with angiography and computed tomography, while ultrasonography conducted with a linear array real time scanner failed to establish essential features of the disorder. This is mainly because the thrombosed portion of the aorta does not produce any striking alteration of the echo structure of the vessel. Contrast computed tomography defines the abnormalities of the aorta in great detail.

Adult↗

Computed tomography in pre- and postoperative evaluation of aortic dissection.

Thirty-seven patients with angiographically or operatively confirmed acute, chronic or postoperative aortic dissection were examined by means of dynamic CT and the results compared with those obtained by angiography and ultrasonography (US). The diagnostic accuracy was 87 per cent for CT, 97 per cent for angiography, and 76 per cent for US, although US was only available in less than half of the cases. The highest accuracy (95%) of CT was achieved in the pre-operative group, which is comparable with the 97 per cent accuracy achieved using angiography. Three patients in the postoperative group had false negative CTs, resulting in an overall accuracy of 82 per cent as compared with 100 per cent for angiography. Despite its diagnostic capacity, CT could not define the complete extent of dissection in four patients. The descending thoracic aorta was the area most difficult for CT examinations because of frequent artifacts in the images.

Adult↗

Ultrasonic guidance for percutaneous puncture and drainage in acute cholecystitis.

Thirteen patients presenting with acute cholecystitis and considered high surgical risks were treated with a percutaneous needling procedure under ultrasonic guidance. The gallbladder was drained following simple needle puncture in six cases while a drainage catheter was inserted in seven. A premedication of 0.5 mg of atropine and 50 mg of pethidine was given. The gallbladder became decompressed in all cases, and pain was instantly relieved. Impacted stones were freed from the cystic duct in two cases and from the papilla of Vater in another two cases. The patients' condition improved and elective cholecystectomy was performed in four cases, while a further three patients await surgery. In five cases the acute stage of the disease subsided; surgical treatment was refrained from because of gallbladder carcinoma with metastases in one patient and other diseases in the remainder. One patient died of gastric carcinoma. One patient with ischemic heart disease had systemic hypotension for six hours after the drainage and one had slight haemorrhage for four hours. No other complications were noted. In addition, the procedure was also carried out as a diagnostic study in one patient in whom the site of bile leakage was determined by filling the biliary tree with contrast medium from the gallbladder. Guided aspiration and percutaneous drainage of the gallbladder is helpful in patients with severe acute cholecystitis attended with a high surgical risk.

Aged↗

Sensitivity of 111In-granulocyte scintigraphy in various local infections.

Eighty-eight patients with 105 foci of bacterial infection were investigated by 111In-granulocyte scintigraphy. The overall sensitivity of this method was 74 per cent. A negative correlation between duration of signs and symptoms and the intensity of the granulocyte accumulations was found, and patients having false negative scintigraphy also had a significantly longer history of infection, clearly demonstrating the importance of performing scintigraphy in the acute phase of an infection. Scintigraphy performed after negative or equivocal computed tomography (CT) or ultrasound (US) investigations in patients with strongly suggested occult infection revealed many foci of infection, particularly in areas not covered by CT or US, showing the superiority of 111In-granulocyte scintigraphy over the two other methods when localizing symptoms are absent.

Adolescent↗

Detection of soft-tissue and skeletal infections with ultra low-field (0.02 T) MR imaging.

To evaluate the use of ultra low-field (0.02 T) magnetic resonance (MR) imaging in the diagnosis of musculoskeletal infection, MR examinations with T2 weighted sequences were performed in 61 patients thought to be suffering from one of four major diagnostic categories: Soft-tissue abscesses (n = 22), osteomyelitis (n = 21), septic arthritis (n = 9) and spondylitis (n = 9). Infection was confirmed for 37 of these 61 patients. The verified abscesses, arthritis, spondylitis and acute osteomyelitis could be detected by 0.02 T MR. The sensitivity was poor in cases of chronic osteomyelitis. There was one false positive finding in a patient with a possible soft tissue infection. The 0.02 T MR examination failed four times. Two patients were too heavy and another 2 patients had magnetic material in or near the scanning field. Compared with computed tomography and isotope scanning, 0.02 T MR proved a little more informative, but without any statistical significance.

Abscess↗

Aspiration biopsy in renal angiomyolipoma.

Ultrasound guided aspiration biopsy of renal mass lesions was performed in 56 patients in whom renal cell carcinoma could not be excluded due to equivocal imaging results. Cytology showed non-malignant mesenchymal cells consistent with angiomyolipoma in 12 patients. In 5 of these patients the diagnosis was ensured by open biopsy. No nephrectomy was performed. In 6 of the 7 patients not operated upon the tumours remained unchanged with no evidence of malignancy during a 3-36 months' follow-up period. Aspiration biopsy is an easy and safe method for diagnosing renal angiomyolipoma in cases where computed tomography is not diagnostic for this disease.

Biopsy, Needle↗

Ultrasonically guided fine-needle aspiration biopsy in focal pancreatic lesions.

Ultrasonically guided fine-needle aspiration biopsy was performed in 100 patients with a focal pancreatic lesion. The lesion was a well-defined solid mass of 1 to 4 cm in 37 cases, a well-defined solid mass of 4.5 to 10 cm in 28 cases, an intrapancreatic cystic lesion in 23 cases, and an ill-defined prominent area in 12 cases. The samples were taken with a one-hand instrument and 0.7 to 0.9 mm disposable needles without a puncture adaptor. The material was sufficient for cytologic analysis in 98 cases. Malignant cells were obtained in 44 of the 49 cases with pancreatic carcinoma and lymphoma cells in one case with lymphomatous infiltration. Four of the six cases of cystadenoma could be identified cytologically. In solid inflammatory lesions, the nature of the lesion was seen in 12 of the 17 cases. There were no false positive reports of malignancy. The solid prominent areas of normal pancreatic tissue yielded normal cytologic samples. Aspirates of cystic lesions in the pancreas revealed one malignant case, and infected lesions could be differentiated from non-infected in the rest. There was one complication in a patient with an obstructed and dilated common bile duct. The aspiration procedure caused severe pain and the operation was performed earlier than scheduled. Diagnostic material is obtained in the majority of ultrasound guided aspiration biopsies of the pancreas. In malignancy, false negative results occur in about 10 per cent of cases.

Adult↗