A case of adult T-cell leukemia with metastatic calcification

We report a case of adult T-cell leukemia with increased uptake in both lungs which was detected by a bone scan using ^99mTc-MDP. This finding is thought to have been caused by the metastatic calcification which is associated with ectopic parathormone production.     

Lymphosarcoma in an ectopic pelvic spleen

Wandering spleen is a rare condition which can be diagnosed with facility by conventional nuclear medicine imaging techniques. We present one case in which generalized lymphosarcoma involving a wandering spleen was proved by percutaneous aspiration biopsy. Evaluation of a liver-spleen scan in which the normal splenic image is not definitely seen should include extension of the scan field to include the lower abdomen, because of the possibility of ectopic splenic position.     

Epidermal inclusion cyst of phalanx: a case report and review of the literature

Epidermal cyst within a toe phalanx is an extremely rare condition. It is important to differentiate this benign lesion, which can be easily treated by curettage, from other benign and malignant lesions of the bone with a similar clinical presentation, and which may require amputation of the toe. This report describes one such lesion in the mid-phalanx of the fourth toe in a 48-year-old woman, and which was successfully identified by intra-operative frozen diagnosis and treated by curettage.     

Radioprotection by dithiothreitol (DTT) at varying oxygen concentrations: predictions of a modified competition model and theory evaluation.

Cultures of Chinese hamster cells were treated with dithiothreitol (DTT) at varying concentrations, and exposed to radiation aerobically or at various oxygen tensions. The extent of radioprotection by DTT was calculated using the yield of DNA strand breaks as a measure of the radiation response. The curve of protection factors (PF) had a specific pattern, characterized by low PF values at low and high oxygen tensions with a peak at an intermediate tension. The peak value of the PF was increased and shifted to higher oxygen tensions as DTT concentrations increased. The experimentally observed pattern of the PF curves is incompatible with the Alper model of the competition hypothesis, which assumes that the entire radiation injury can be modified by sensitizers or protectors. On the other hand, the pattern is consistent with a model (X model) which is based upon a modification of the original hypothesis and assumes two types of radiation injury, only one of which is modifiable.     

The compression syndrome: A revaluation of the value of postural angiography (author's transl)]

A total of 136 patients with a compression syndrome of the upper limb were examined systematically by selective dynamic angiography as developed by the H?tel-Dieu Hospital in Montreal. The method consists of given multiple injections of a contrast medium with the patient's arm in thirteen different positions. This retrospective study demonstrated that this method carries very little risk and is well-tolerated by the patients. Conclusions are drawn from a comparative statistical analysis of the angiographic results and the therapy chosen. The practical value of the examination is not to confirm the anatomical site of the compression but to evaluate the characteristics of the stenosis before a decision is made whether to operate. In this respect, the positions in which the patient is sitting down and the arm is in abduction are those in which a difference is found between those patients operated upon and those given medical treatment, which is a point in favour of this particular procedure.     

Measurement of linear exposure nominal pose used in curietherapy]

The idea, and subsequent construction, of a dose rate meter for measuring linear exposure dose originated in those pilot centres of Curietherapie which wished to replace radium by the artificial radionucleides, Irdium-192, Caesium-137 etc. The aparatus makes it possible to measure, directly and quickly, the activity of a specified length of a linear source, a measurement which has only been possible until now by dividing the exposure dose by the length whose activity it is desired to know. If the dose-rate obtained by these two methods agrees, this apparatus shortens the time for which the sources need to be handled, thereby reducing the danger of irradiation to staff and technicians. The apparatus is thus able to reveal heterogeneity of activity along the length of a line-source. In the specific case of Iridium, our experience shows that wires which have been used in several applications may develop mechanical bends and constrictions, which can lead to fluctuation in dose rate along their length. The apparatus was first constructed in 1967, after preliminary experiments in 1965. As Curietherapy has become more widely used, the apparatus has undergone many modifications which is more precise and specific than it was initially. At the present time it can only be used with Iridium as wire, and with Caesium in the form of trains of seeds (corresponding to the AGS sources) or needles. Nevertheless, a third scale is under consideration, for use with newer radioelements, which may be used in future.     

Empyema as a complication of retropharyngeal and neck abscesses in children

Empyema developing from retropharyngeal abscess is a rare complication. Two infants with clinical symptomatology and inital chest radiographic findings of pleural fluid which suggested the possibility of retrophoryngeal abscess are described. A child with submandibular and cervical abscesses is also reported; pleural fluid and mediastinal abscess developed less than 24 hours after admission. Pathological processes in the neck can spread into the chest or conversely, either by direct continuity or by dissection through the fascial planes enveloping the cervical compartments. The middle or visceral space which is in direct continuity with the mediastinum is generally the area in which cervicothoracic disease inter-relates.     

Clival chordoma manifesting as nasal bleeding. A case report

Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding.     

The role of 99mTc DMSA renal scintigraphy in Joubert syndrome

Joubert syndrome is a severe autosomal recessive disorder, which is characterized by hypotonia, impaired psychomotor development, retinal dystrophy with abnormal ocular movements and cerebellar vermis agenesis with dilatation of the fourth ventricle. Joubert syndrome type B is a developmental disorder of the nephronophtisis complex with multiple organ involvement. Although this syndrome is rare, since first described by Joubert et al in 1969, there have been several cases about the components and the chromosomal abnormalities related with it. Here we report 2 patients with Joubert syndrome in whom renal involvement was demonstrated by ultrasonography as renal cystic disorders which represented nephronophtisis. For each patient we performed renal cortical scintigraphy with 99mTc-DMSA ( 99mtechnetium-dimercaptosuccinic acid) which showed bilaterally decreased radiopharmaceutical uptake in kidneys due to tubulointerstitial nephropathy. Scintigraphy may have a great value in the diagnosis and evaluation of the presence and severity of renal involvement in Joubert syndrome since it can evaluate kidney parenchyma and functioning renal tissue.     

Usefulness of Grasping a Guiding Catheter with a Loop-Snare Wire for Stent Placement into the Vertebrobasilar Artery

In cases in which the subclavian artery is severely tortuous or branches with an extremely angulated origin, stent placement in the vertebrobasilar artery on the approach from the femoral artery is often technically difficult. We report two cases in which a stent placement procedure for the vertebrobasilar artery was successfully performed by grasping a guiding catheter with a loop-snare wire. This technique is useful for tortuous arteries or arteries branching with an extremely angulated origin.     

Radioprotection by Dithiothreitol (DTT) at Varying Oxygen Concentrations: Predictions of a Modified Competition Model and Theory Evaluation

Summary

Cultures of Chinese hamster cells were treated with dithiothreitol (DTT) at varying concentrations, and exposed to radiation aerobically or at various oxygen tensions. The extent of radioprotection by DTT was calculated using the yield of DNA strand breaks as a measure of the radiation response. The curve of protection factors (PF) had a specific pattern, characterized by low PF values at low and high oxygen tensions with a peak at an intermediate tension. The peak value of the PF was increased and shifted to higher oxygen tensions as DTT concentrations increased. The experimentally observed pattern of the PF curves is incompatible with the Alper model of the competition hypothesis, which assumes that the entire radiation injury can be modified by sensitizers or protectors. On the other hand, the pattern is consistent with a model (X model) which is based upon a modification of the original hypothesis and assumes two types of radiation injury, only one of which is modifiable.     

Three dimensional optimization method for the interstitional afterloading therapy (author's transl)]

The authors present a new method for the interstitial therapy working with an Ir-192 source which is displaced step by step. After having been fed with the tumor parameters, the computer calculates for every stopping point the duration of stay of the source which provides a threedimensional optimization. The practical application of the method is discussed and the optimization procedure is compared with other similar methods.     

Palliative Radiofrequency Ablation for Recurrent Prostate Cancer

Percutaneous radiofrequency ablation (RFA) is a minimally invasive local therapy for cancer. Its efficacy is now becoming well documented in many different organs, including liver, kidney, and lung. The goal of RFA is typically complete eradication of a tumor in lieu of an invasive surgical procedure. However, RFA can also play an important role in the palliative care of cancer patients. Tumors which are surgically unresectable and incompatible for complete ablation present the opportunity for RFA to be used in a new paradigm. Cancer pain runs the gamut from minor discomfort relieved with mild pain medication to unrelenting suffering for the patient, poorly controlled by conventional means. RFA is a tool which can potentially palliate intractable cancer pain. We present here a case in which RFA provided pain relief in a patient with metastatic prostate cancer with pain uncontrolled by conventional methods.     

Floating myodil—A new sign of fat in the ventricles

Summary A case in which a remarkable seriies of CT studies demonstrated a dermoid cyst is reported. There was leakage of fat into the ventricular system which caused hydrocephalus due to adhesions partly obstructing the fourth ventricular outlets. The latter was confirmed by a ventriculogram using Myodil which dissolved in, or combined with, the fat produced by the tumour. This resulted in a high attenuation substance of lower specific gravity than CSF, which appeared to cause acute ventriculitis.     

Microcirculatory considerations in NMR flow imaging

Regional flow estimation can be accomplished either by measuring the concentration of a deposited tracer whose extraction during transit through the organ is 100%, or by observing the time course of concentration of a tracer whose transport passage through the organ is flow-limited. The deposition method is simpler and applies not only to microspheres or other large particles that lodge in the microcirculation, but also to molecular markers which are trapped. It has the advantage of having substantial time in which to observe the local concentrations by external detection. In contrast, flow-limited markers must traverse the tissue without barrier limitation or other diffusional influence on the exchange. When the marker is limited strictly to the intravascular space, the transit time through the organ is short and observations must be made rapidly with a high resolution technique. An indicator which distributes throughout a large volume of distribution within the tissue has a slower washout, providing more time in which to make observations; tracer water is a suitable marker, except perhaps in the brain. For flow measurement by NMR, markers which fulfill these criteria without causing side effects are needed.     

Ultrasonic diagnosis of non-palpable germinal tumors of the testis. Apropos of 2 cases

The germ cell tumors are the most common type of testicular malignant tumors (90%). About 30% are revealed by metastasis usually into the retroperitoneum, with clinically normal testis. Ultrasound reveals a bright echogenic focus into the testis which is typical, considering the clinical presentation, for a regressed germ-cell tumor and guides the side of the orchidectomy which allows to suppress a still active tumoral tissue which will not be eradicated by chemotherapy. Two typical cases with sonographic guidance are reported herein and confronted with the cases previously described in the literature.     

3T-MRI, elastography, digital mammography, and FDG-PET CT findings of subcutaneous panniculitis-like T-cell lymphoma (SPTCL) of the breast

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of cutaneous lymphoma, which is characterized by infiltration of neoplastic cytotoxic T cells into the subcutaneous tissue. We here report the case of a 66-year-old woman with SPTCL of the breast, which is a very uncommon location. Multiple suspicious irregular small masses in the subcutaneous fat were detected by mammography, and sonograms revealed hyperechoic masses. Elastography was useful to improve depiction and delineation of SPTCL in the hyperechoic subcutaneous fat, and dynamic contrast-enhanced MRI examinations showed multiple irregular rim enhanced masses with persistent enhancement. FDG-PET CT images showed hypermetabolism in areas corresponding to other imaging techniques. MRI can be useful for diagnosis of fat necrosis, which is a primary radiologic feature of SPTCL. However, fat necrosis has multitude of appearances by various imaging techniques, which typically indicate a benign disease, but may indicate a malignancy. Therefore, an ultrasonographically guided core needle biopsy is useful for a diagnosis of SPTCL of the breast. The presence of multiple subcutaneous nodules throughout the body on CT imaging may be an important finding that suggests a diagnosis of SPTCL.     

Use of ultralong echo time imaging to assist in measuring the velocity of perfused flow in vivo

The measurement of the velocity of perfused flow in tissue in vivo is complicated by the presence of stationary as well as moving spins and by a variety of dephasing phenomena which affect signal amplitudes. This paper describes a technique by which, using flow-sensitized spin-echo sequences with a set of very long TE times, the velocity of the moving component can be assessed.     

Ultrasonic evaluation of the obstructed duplex kidney.

The problem of a duplex collecting system associated with an obstructed ectopic ureter or ureterocele is common in pediatric urology. Four such patients were studied by gray scale ultrasound which was useful in demonstrating the dilated upper pole collecting system as well as an ectopic ureter and a ureterocele. Although the diagnosis of a nonfunctioning upper pole unit in a duplex kidney is usually suggested by the urogram, ultrasound provides a noninvasive means of confirmation which is independant of function. Further, ultrasound-guided puncture with antegrade pyelography demonstrates the course of the ectopic ureter, thus providing a more complete preoperative evaluation.