BACKGROUND: Preoperative lymphoscintigraphy (LS) with 99mTc antimony sulphide colloid is now part of the routine management of patients with intermediate thickness melanoma at the Sydney Melanoma Unit. Over a 13-year period, 1375 patients have been examined using LS, and we have observed many unusual lymphatic drainage pathways, including direct drainage through the body wall to retroperitoneal and paravertebral lymph nodes from the skin of the back. The aim of this study was to determine the incidence of such drainage in the 542 patients who had primary melanoma sites on the posterior trunk. METHODS: The lymphoscintigrams performed on these patients were examined for the presence of direct lymphatic drainage through the posterior body wall to sentinel nodes in the retroperitoneal and paravertebral regions. RESULTS: Lymphatic drainage directly through the body wall to such lymph nodes occurred in 14 of these 542 patients. CONCLUSIONS: Preoperative knowledge of the presence of this lymph drainage pattern may influence surgical management, and follow-up investigations in these patients can be tailored to ensure that the relevant areas are examined with anatomic imaging or F18-FDG PET scans.

Back↗

PubMed1998

The musculoskeletal complications of cystic fibrosis.

OBJECTIVE: To determine the spectrum of musculoskeletal complications of cystic fibrosis (CF) in a paediatric population in Australia. METHOD: Clinical assessment followed by serology and bone scan on patients attending a specialized CF clinic. RESULTS: Of 125 patients studied, 21 had musculoskeletal complications, 17 attributable to CF. Eleven had joint involvement (six hypertrophic pulmonary osteoarthropathy (HPOA)), one CF arthropathy, two ciprofloxacin induced arthralgia, one joint contracture following long-line placement, one chest infection associated arthralgia), four kyphosis (two also with HPOA) and two thoracic deformity. HPOA was associated with older age, lower average pulmonary function and lower average Shwachman score. Three patients with HPOA died within 12 months of reporting symptoms. Kyphosis was also associated with older age and lower pulmonary function. CONCLUSION: Increasing age with deteriorating clinical and pulmonary function were associated with a higher incidence of musculoskeletal involvement. The development of symptomatic HPOA is a marker of poor prognosis.

Adolescent↗

PubMed1998

Exclusive lymphatic drainage from a melanoma on the back to intraabdominal lymph nodes.

Preoperative lymphoscintigraphy with Tc-99m antimony sulphide colloid was performed for a patient with a cutaneous melanoma on the left back. There was direct lymphatic drainage to retroperitoneal and paravertebral nodes but no drainage whatsoever to the axillary, inguinal, or triangular intermuscular space node fields, which would normally be expected to drain this area of the skin. Any attempt at sentinel lymph node biopsy in the axilla, groin, or triangular intermuscular space would have failed in this patient.

Abdomen↗

PubMed1998

Hepatobiliary scintigraphy in infancy.

Explore the source record for details and available documents.

Biliary Tract↗

PubMed1997

Tl-201 positive, Ga-67 negative hepatoblastoma: a case report of a 12-year-old boy.

Hepatoblastoma is a primary liver neoplasm in which prompt diagnosis and resection are critical to long-term survival. Nuclear scintigraphy plays an important role in the characterization of hepatic masses. The authors present an unusual case of hepatoblastoma in a 12-year-old boy in whom Ga-67 scintigraphy and serum alpha-fetoprotein were negative. Positive Tl-201 scintigraphy pointed toward the true malignant nature of the mass and should be considered in the investigation of hepatic masses in childhood.

Biomarkers, Tumor↗

PubMed1997

Single-dose isotope injection for both preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification in melanoma patients.

For patients with melanoma the 'sentinel' lymph node biopsy technique, although simple in concept, has the potential to provide misleading information if great care is not taken to ensure accurate sentinel node (SN) identification. The method initially reported involved lymphatic mapping by injection of blue dye around the primary melanoma site. Preoperative lymphoscintigraphy was subsequently shown to improve both the speed and accuracy of SN identification. More recently, intraoperative use of a hand-held gamma probe has been recommended, and it is likely that maximum reliability of SN biopsy will be achieved if all three manoeuvres are undertaken. As originally described, use of a gamma probe intraoperatively followed injection of tracer a short time before the surgical procedure. We report a simpler method of confirming SN identity with a gamma probe, using residual activity in the node following lymphoscintigraphy the previous day. In 21 patients close concordance with preoperative lymphoscintigram results and intraoperative findings after blue dye injection confirmed the reliability of the technique. Avoiding the need for repeat isotope administration on the day of surgery simplifies logistics, reduces costs, minimizes inconvenience and radiation dose for patients, and eliminates potential health and safety problems for operating theatre staff.

Antimony↗

PubMed1997

Fat distribution in children and adolescents--the influence of sex and hormones.

A significant proportion of the morbidity related to obesity is now recognized to be related to the regional distribution of fat. The advent of dual energy X-ray absorptiometry has facilitated the assessment of body composition in a number of investigations on body fat. From current data, including the authors' own study of trunk and leg fat in 335 children and young adults, it is evident that gender differences for total body fat, percentage of body fat and distribution of fat occur after the pubertal years. Males develop a distribution of fat which favours central deposition of fat irrespective of their total body fat--a distribution that is, unfortunately, associated with a number of adverse implications on health. Furthermore, this tendency to increasing abdominal fat is independent of adipose tissue mass. Hormonal regulators of adipose tissue, including growth hormone which is already known to increase free fatty acids and decrease fat cell mass, need to be studied to account for these gender differences.

Adipose Tissue↗

PubMed1997

Pediatric nuclear oncology.

Nuclear medicine plays an important and increasing role in the management of childhood malignancy. This is particularly true in the solid tumours of childhood. It is also helpful in the management of the complications of cancer treatment such as the infections which often accompany immune suppression in oncology patients. Scintigraphy is a complementary investigation to other radiological techniques and adds the functional dimension to anatomical investigations such as CT, MRI and ultrasound. Scintigraphy is used in the initial diagnosis, staging, assessment of tumour response to treatment, detection of recurrence and the diagnosis of complications. In selected malignancies radionuclides are also used in treatment. This review discusses the technical considerations relating to children and the specific techniques relating to pediatric oncology. Specific tumours and the various applications of radionuclides are discussed in particular lymphoma, primary bone tumours, soft tissue sarcomas, neuroblastoma, Iangerhan's cell histiocytosis, Wilms' tumour, brain tumours and leukemia. Uncommon tumours are also discussed and how radionuclides are useful in the investigation of various complications which occur in oncology patients.

Child↗

PubMed1996

Direct lymphatic drainage from the skin of the forearm to a supraclavicular node.

Lymphoscintigraphy with Tc-99m antimony sulfur colloid was performed on a patient with cutaneous melanoma of the left forearm to define the sentinel nodes before surgery. The patient was found to have direct lymphatic drainage from the left forearm through a clearly seen lymph channel to a sentinel lymph node in the left supraclavicular fossa, and drainage through a separate channel to two sentinel nodes in the left axilla. Surprising patterns of lymphatic drainage can be seen from the forearm, as well as other parts of the skin, and lymphoscintigraphy will enable such patients to be identified before sentinel node biopsy.

Axilla↗

PubMed1996

Volumetric bone mineral density in normal subjects, aged 5-27 years.

Concerns have been raised regarding the validity of using areal bone mineral density (aBMD) as a substitute for the true volumetric bone mineral density (vBMD) in the pediatric population. We studied 209 normal subjects (109 males), aged 5-27 yr, to examine the influence of age, gender and growth on vBMD. The femoral neck, midthird of the femoral shaft, and the four lumbar vertebral bodies (L1-L4) were studied. Using data on bone width and height obtained by dual energy x-ray absorptiometry, bone volume was calculated with the assumption that all three sites are cylinders. In contrast to aBMD, vBMD of the femoral neck bore no relationship to age or weight in both sexes, but was significantly related to height in females (r2 = 0.07; P = 0.01). Similarly, vBMD of the femoral shaft (vFBMD) did not change with age or height in either sex. In females, a significant inverse relationship was seen between vFBMD and weight (r2 = 0.14; P = 0.001). Male subjects had higher vFBMD than females (mean +/- SD, 0.73 +/- 0.11 vs. 0.70 +/- 0.12; P = 0.047), but no sex difference was seen in vBMD of the femoral neck. Conversely, vBMD of L1-L4 remained age and growth dependent, although the strength of the relationship was weaker than that for aBMD (data not shown). In conclusion, the vBMD of the femoral neck and shaft is independent of age and is less dependent on growth variables in children and young adults than is aBMD. These observations offer a different perspective from our previous concepts of aBMD.

Absorptiometry, Photon↗

PubMed1996

Lymphatic drainage to triangular intermuscular space lymph nodes in melanoma on the back.

METHODS: Lymphoscintigraphy with 99mTc-antimony sulphide colloid was performed on patients with cutaneous melanoma of the back to define draining node fields and sentinel nodes before surgery. RESULTS: One patient was found to have drainage from the back to sentinel lymph nodes in the triangular intermuscular spaces bilaterally, above and lateral to the scapula. Subsequently, drainage to this node field has been found in 26% of 42 consecutive patients who have had lymphoscintigraphy performed for melanoma on the back. CONCLUSION: When performing lymphoscintigraphy to locate draining node fields and sentinel nodes in patients with melanoma on the back, it is important to look for drainage to the triangular intermuscular space node field by obtaining posterior and lateral scans. Any sentinel lymph nodes found in this field should be marked prior to surgery in the same way as nodes in other node fields are delineated so that they may be removed at surgery.

Adult↗

PubMed1995

Body-composition assessment by dual-energy x-ray absorptiometry in subjects aged 4-26 y.

This cross-sectional study describes the body composition of 265 normal subjects (137 males and 128 females) aged 4-26 y determined by dual-energy x-ray absorptiometry (DXA). Lean tissue mass (LTM) and bone mineral content (BMC) increased with age in females until 13.4 and 15.7 y, respectively, and in males until 16.6 and 17.4 y, respectively. A strong relation between LTM and BMC was found for each sex (r = 0.98, P = 0.0001 for males; r = 0.98, P = 0.0001 for females). DXA percent body fat (%BFDXA) increased with age in females (r = 0.52, P < 0.001) but not in males and was higher in females than in males at all ages. Trunk to leg fat ratio (TLFR) was calculated as DXA trunk fat/leg fat. In post-pubertal age the TLFR was higher in males than in females (1.01 +/- 0.23 and 0.75 +/- 0.16, P = 0.001), but there was no sex difference in younger children. DXA weight underestimated scale weight by a mean of 0.83 kg. %BFDXA correlated with %BF by skinfold thickness measurement with good agreement for males but overestimated %BF by skinfold thickness for females. These normative data for body composition demonstrate significant sex differences in all body compartments after the pubertal years.

Absorptiometry, Photon↗

PubMed1995

Intrahepatic bile duct dilatation and cholestasis in autosomal recessive polycystic kidney disease. Demonstration with hepatobiliary scintigraphy.

Fifteen patients with the clinical and radiologic features of autosomal recessive polycystic kidney disease were investigated with radionuclide hepatobiliary scintigraphy. In nine patients (60%), cholestasis and intrahepatic bile duct dilatation were demonstrated. A 10th child had scintigraphic evidence of cholestasis, but the bile ducts were not dilated. The other five children has normal h hepatobiliary scans. The authors conclude that intrahepatic bile duct dilatation with cholestasis (Caroli's disease) is part of the clinical spectrum of autosomal recessive polycystic kidney disease and that hepatobiliary scintigraphy can be of value in determining the extent of hepatobiliary disease in this group of patients.

Bile Ducts↗

PubMed1995

Clinical and diagnostic features of osteomyelitis occurring in the first three months of life.

We report a retrospective study of 94 infants, ages < 4 months, who underwent investigation for possible osteomyelitis during a 9-year period. Of the 30 babies with proven osteomyelitis (radiographic changes or positive bone cultures or positive blood cultures plus a compatible clinical picture), 17 were preterm artificially ventilated babies and 4 were full term infants receiving intensive care. An etiologic organism was isolated from 28: methicillin-susceptible Staphylococcus aureus, 16; methicillin-resistant S. aureus (MRSA), 7; Escherichia coli, 3; and group B Streptococcus, 2. MRSA occurred exclusively in the preterm group. Osteomyelitis was multifocal in 40% and associated with septic arthritis in 47%. The long bones were frequently affected (80%) whereas the flat bones were often sites of clinically silent disease. Twenty-five (83.3%) of the 30 babies with proven osteomyelitis had focal clinical signs or evidence of disseminated staphylococcal disease. Only 10 were febrile. Four of 27 babies investigated because of positive blood cultures for S. aureus but no focal signs had osteomyelitis, as did only 1 of 27 babies with suspected sepsis but no focal signs. The sensitivity of 99mTc bone scanning was 84%, specificity 89%, positive predictive value 79% and negative predictive value 92%. The addition of gallium scanning (in 39 of the 94 infants) improved the respective figures to 90, 97, 93 and 95% and was useful in interpreting equivocal bone scans.

Arthritis, Infectious↗