[Brain tomographic imaging with HMPAO].
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Biomedical subjects
Publications and source records attributed to Y Krausz.
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In the last two decades, brain imaging has become an integral part of clinical and research psychiatry. Single photon computed emission tomography (SPECT) is rapidly gaining acceptance as one of the major imaging techniques available, along with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Each of these techniques has its assets and drawbacks. This review concerns SPECT, a highly prevalent imaging technique whose potential value in brain imaging has not been appreciated until recently. Its purpose is to expose practicing clinicians and research psychiatrists alike to the attributes of this instrument, which is available in most nuclear medicine departments today. An effort is made to provide a comprehensive account of this technique, including a brief summary of the basic principles, the various methods of its application, and recent findings in most psychiatric disorders. Analogies to its "aristocratic cousin," PET, are presented to emphasize similarities and differences. Finally, directions for future development and implementation of SPECT are suggested.
A retrospective analysis of 52 patients with hip pain following total hip replacement was made. Each of them was evaluated by plain radiographs, technetium 99m pyrophosphate scans, arthrography with plain film subtraction technique, and culture of joint fluid. In 30 cases there was evidence of prosthetic loosening, and in 21 of these lymphatic opacification during arthrography was seen. In 15 cases with lymphatic opacification the diagnosis of prosthetic loosening was subsequently confirmed by prosthetic revision. In none of the 22 cases in which no evidence of prosthetic loosening was seen was there lymphatic opacification. It is concluded that lymphatic opacification during arthrography for pain following total hip prosthesis is a valuable ancillary sign of loosening.
Temporal lobe epilepsy is diagnosed by clinical symptoms and signs and by localization of an epileptogenic focus. A brain SPECT study of two patients with temporal lobe epilepsy, using 99mTc-HMPAO, was used to demonstrate a perfusion abnormality in the temporal lobe, while brain CT and MRI were non-contributory. The electroencephalogram, though abnormal, did not localize the diseased area. The potential role of the SPECT study in diagnosis and localization of temporal lobe epilepsy is discussed.
Three patients with clinical suspicion of pheochromocytoma were studied with metaiodobenzylguanidine (MIBG) labeled with I-123 or I-131. In these three patients, marked uptake of the radiopharmaceutical was demonstrated in tissues that were subsequently proven not to be of neural crest origin. Furthermore, extensive biochemical evaluations and long-term followup definitively excluded pheochromocytoma in all three. Therefore, these three cases represent unexpected "false-positive" MIBG uptake.
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Neck metastases secondary to thyroid cancer are rarely visualized scintigraphically in the presence of a functioning thyroid gland. We present a patient with cervical lymph node metastases that take up 99mTc pertechnetate in the presence of hyperfunctioning thyroid tissue and discuss the pathophysiology of this phenomenon.
Thromboembolic events associated with significant morbidity and mortality have been observed in patients with beta-thalassemia major (TM). These include arterial as well as venous thrombosis and the development of early arteriosclerosis. To elucidate the possibility that TM patients may develop a hypercoagulable state we carried out a study of platelet kinetics on ten patients with TM and four patients with thalassemia intermedia (TI). Autologous platelets were labeled with indium-111-oxine, and the platelet lifespan (PLS) was determined. A significant shortening of PLS was observed in 13 out of 14 patients examined. The mean PLS (+/- 1 SD) in ten patients (8 TM, 2 TI) who underwent splenectomy was 107 +/- 36 hr (control splenectomized 248 + 51 hr) (P less than .001) and in four nonsplenectomized patients (2 TM, 2 TI) was 102 +/- 64 hr (control 224 + 23 hr) (P less than .01). The short PLS in addition to reported findings of increased circulating platelet aggregates and the decreased response of TM platelets to aggregating agents suggests in vivo platelet activation in thalassemic patients.
A Tc-99m HM-PAO brain SPECT study of a patient with biopsy-proven Creutzfeld-Jakob disease demonstrated perfusion defects in the left frontal and right temporoparietal areas. A brain CT was normal. The clinical potential of this imaging modality in the evaluation of dementia is discussed.
A previously healthy two year old boy had an adenoviral infection at the age of 13 months and developed hyperlucency of the left lung, chronic respiratory distress, and failure to thrive. Bronchodilators and steroid treatment had no effect. Radionuclide lung scans using an intravenous bolus of xenon-133 both before and after treatment showed substantially reduced function on the hyperlucent side and modestly reduced function on the other side. Fibreoptic bronchoscopy showed no structural abnormalities. Partial forced expiratory flow volume (PEFV) curves, generated from end inspiration by rapid compression of the chest wall with an inflatable jacket, were obtained from the total respiratory system and from each lung separately by inflating a Fogarty catheter in the contralateral mainstem bronchus. Expiratory flow rates and volumes during both tidal breathing and PEFV manoeuvres were considerably decreased in the hyperlucent lung. PEFV curves from the "healthy" right lung and from the total respiratory system were similar in shape and showed a moderately obstructive pattern. The right lung ventilated about four times as much as the left when measured by bronchospirometry and about three times as much when measured by the radionuclide technique. The lung scans appeared to reflect adequately the functional abnormality in this infant with the Swyer-James syndrome.
Bleeding diathesis is not necessarily one of the conspicuous and serious characteristics of the macrothrombocytopenic syndromes, which include the May-Hegglin anomaly. Nevertheless, occasionally prolonged bleeding time may endanger organs or even life. We report a case of a young girl with severe thrombocytopenia due to May-Hegglin anomaly, who was facing blindness because of intraocular haemorrhages. Being unable to intervene in the pathogenesis of the disease, we performed splenectomy after proving splenic sequestration of platelets. This procedure allowed the performance of a successful bilateral vitrectomy.
Calcium and cAMP are interdependent regulators of glucose-induced insulin release. In the present study we investigated the importance of cAMP and calcium-binding proteins for biphasic insulin secretion by assessing the effects of two phenothiazines known to block such proteins, trifluoroperazine (TFP) and promethazine (PMZ). In isolated rat islets, during 60-min incubations with 16.7 mmol/l glucose both agents inhibited the insulin response with ID50 values of 15 mumol/l for TFP and 5 mumol/l for PMZ. Both agents decreased the maximal insulin response without gross changes in the islet sensitivity to glucose. TFP (15 mumol/l), whereas inducing 50% inhibition of second-phase insulin release, totally suppressed the cAMP response to glucose and the accompanying first-phase insulin secretion (5-min incubations); these effects of TFP could be partially reversed by isobutyl methylxanthine (IBMX). In contrast, 5 mumol/l PMZ, which produced 60% inhibition of second-phase insulin release, had no effect on first-phase insulin and cAMP responses to glucose. Furthermore, IBMX did not modify the inhibitory effect of PMZ on second-phase insulin secretion. The following is concluded: 1. TFP acts preferentially on first-phase insulin release and inhibits cAMP formation; this suggests that calmodulin plays a major role in mediating the initial glucose effect on secretion via stimulation of cAMP. 2. The islet probably contains calcium-sensitive proteins other than calmodulin, since the low concentrations of PMZ shown to inhibit second-phase insulin release lack effects on calmodulin. Synexin could be such a protein.(ABSTRACT TRUNCATED AT 250 WORDS)
The association of idiopathic pericarditis and pregnancy is described in 3 patients. The disease preceded the onset of pregnancy in 2 patients and appeared during the sixth month in the third. All pregnancies reached term and the deliveries were uneventful. One patient had mild heart failure before the pregnancy. This deteriorated slightly during its course. The remaining 2 patients had no signs of heart failure and none of the 3 had arrhythmias or embolic phenomena. Two patients were treated with aspirin and prednisone and one was treated for heart failure only. All patientts are still symptomatic and require treatment 9 months, 1 year and 21 years after the pregnancy. Two of the patients underwent partial pericardiectomy.
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Osteolytic lesions are not known to be associated with chronic lymphocytic leukemia and are rare in macroglobulinemia of Waldenström. In the present paper we report a patient suffering from macroglobulinemia associated with chronic lymphocytic leukemia in whom osteolytic lesions, resembling those of multiple myeloma were found. Treatment with chlorambucil resulted in normalization of the peripheral blood smear, but the malignant infiltration of the bone marrow continued and manifested itself by appearance of new osteolytic lesions, though some of the old lesions underwent recalcification after treatment.
The epidemiologic, clinical and laboratory features of 40 adults with acute viral hepatitis type B were compared with those of 40 adults with hepatitis non-B. Overall, the clinical presentations were remarkably similar and the etiology could not be determined in individual cases. An exception to this was that all post-transfusion cases in this series were affected by hepatitis B. Men predominated in both the hepatitis B and non-B groups. There was a tendency to seasonal clustering in summer/autumn in both groups. Hepatitis B patients were significantly older and 59% of them had a history of possible parenteral exposure during the six months preceding admission. On the other hand 76% of patients with hepatitis non-B had no apparent parenteral exposure. Dental treatment, injections and contact with jaundiced patients were recorded in both groups and were therefore of no value in determining the exact etiology in individual cases. Fever was more common in hepatitis non-B, while the onset of the disease was insidious and afebrile in 80% of patients with hepatitis B. As a group, patients with hepatitis B had more extensive liver injury and a more prolonged clinical course, and the only fatality was in this group. Cholestatic features were rare and extrahepatic immune complex disease was extremely uncommon in both hepatitis B and non-B.
A patient who developed thrombosis on a Björk-Shiley aortic valve prosthesis is reported. The patient presented with severe angina pectoris and the main physical findings were absence of the closing click of the prosthetic valve and the presence of systolic and diastolic aortic murmurs. Echocardiography showed early closure of the mitral valve and depressed left ventricular function. An emergency operation was performed and the clot was removed. The patient's recovery was uneventful and he is well one year after surgery. Awareness of the possibility of valve thrombosis is necessary in view of the need for emergency surgical treatment. The literature on the subject is reviewed.