Scanning Systems and Protocols Used During Imaging for Acute Pulmonary Embolism: How Much Do Our Clinical Colleagues Know?

RATIONALE AND OBJECTIVES: The imaging systems and protocols used during ventilation-perfusion lung (V-P) scintigraphy and computed tomographic (CT) pulmonary angiography (CTPA) can affect diagnostic performance. We investigated the level of awareness of these factors among US clinicians who refer patients for imaging for suspected acute pulmonary embolism. MATERIALS AND METHODS: Between September 2004 and February 2005, we conducted a mail survey of 855 physicians selected at random from three professional organizations. We asked participants how important the availability of state-of-the-art equipment was in their imaging decisions, whether V-P scintigraphy was performed with planar or single-photon emission CT (SPECT) equipment in their communities, to identify the most advanced type of CT scanner used for CTPA, and whether CT venography (CTV) was performed routinely after CTPA. RESULTS: We received completed surveys from 240 (29.8%) physicians practicing in 44 states. One hundred sixty-six respondents (70.9%) indicated that state-of-the-art equipment was an extremely or very important factor when they made imaging decisions. However, 191 clinicians (80.3%) did not know whether SPECT equipment was used for V-P scintigraphy, and 119 (50.6%) did not know the type of CT scanner used for CTPA in their communities. Of respondents, 39.2% reported access to multidetector row CT technology for CTPA, whereas 10.2% referred patients to facilities using single-detector CT. Only 9.3% of respondents indicated that CTV was performed routinely after CTPA. CONCLUSION: Although state-of-the-art equipment is important to them, clinicians practicing in the United States have limited knowledge of the equipment being used during CTPA and V-P scintigraphy scanning in their communities. Radiologists should intensify efforts to familiarize their clinical colleagues with the equipment they use.     

Plasminogen receptors, urokinase receptors, and their modulation on human endothelial cells

Endothelial cells are centrally involved in regulation of fibrinolysis, and receptors for plasminogen and urokinase provide a mechanism by which cells can regulate their fibrinolytic function. Therefore, the existence and characteristics of receptors for these fibrinolytic components on cultured human umbilical vein endothelial cells were examined. We verified the presence of plasminogen receptors on these cells (Kd = 2.1 +/- 1.3 mumol/L, and 1.8 +/- 1.3 x 10(7) binding sites/cell). These binding parameters and other characteristics indicate that these receptors are closely related to the plasminogen receptors on many circulating and adherent cells. Specific binding sites that interact with two-chain urokinase of mol wt 55,000 with a dissociation constant of 2.1 +/- 1.7 nmol/L, with 2.9 +/- 2.9 x 10(5) sites/cell were also identified. Single-chain urokinase of mol wt 55,000, but not the two-chain degradation product of mol wt 33,000 bound to the cells, implicating the amino-terminal aspects of the ligand in receptor recognition. When endothelial cells were stimulated with thrombin, an agent that modulates their fibrinolytic potential, both receptor types were modestly affected; urokinase binding increased 17%, whereas plasminogen binding decreased 19%. The presence and modulation of plasminogen and urokinase receptors provide a potentially important additional mechanism by which endothelial cells may regulate fibrinolysis.     

Gray-scale echographic visualization of a parathyroid adenoma

A large parathyroid adenoma and a smaller follicular thyroid adenoma were visualized with a combination of radionuclide imaging and gray-scale ultrasound in a patient with primary hyperparathyroidism.     

Glucose-6-phosphate dehydrogenase of malaria parasite Plasmodium falciparum

Plasmodium falciparum growth is impaired in glucose-6-phosphate dehydrogenase (G6PD)-deficient red blood cells (RBCs), and malaria has been implicated in the spreading of deficient variants in malaria- endemic areas. Recent reports suggest that the malaria parasite can adapt itself to grow in these variant RBCs by producing its own G6PD, but studies on parasite G6PD are very limited. In this report, we define the properties of the parasite G6PD. G6PD was partially purified from infected and uninfected variant RBCs associated with severe G6PD deficiency. G6PD from infected RBCs contained two components separable by starch gel electrophoresis: a major component (approximately 90% activity) with a very slow anodal electrophoretic mobility and a minor component (approximately 10% activity) with the same mobility as the host G6PD. Parasite G6PD exhibited much higher affinity (low Km) to G6P and nicotinamide-adenine dinucleotide phosphate (NADP) than did human G6PD. Southern blot hybridization indicated that the parasite genome contained nucleotide sequences that were hybridizable with the human G6PD cDNA. These data indicate that the parasite is capable of adapting to G6PD-deficient RBCs by producing its own G6PD.     

Lumbar myelography with iohexol and metrizamide: a comparative multicenter prospective study

Diagnostic quality of radiographs and adverse reactions associated with the use of metrizamide and iohexol as contrast agents in lumbar myelography were compared in a prospective randomized double blind study in 350 patients at seven centers. The contrast media were administered in comparable volumes at a concentration of 180 mg I per ml. Overall quality of radiographic visualization was graded good or excellent in 95% of 175 metrizamide studies and in 98% of 175 iohexol studies. Ninety-three patients examined using metrizamide (53%) and 130 patients examined using iohexol (74%) experienced no discomfort during or after myelography. Postmyelographic headache was associated with 38% of metrizamide examinations and 21% of iohexol examinations. Nausea and vomiting were also more common with metrizamide. Five patients examined using metrizamide (3%) experienced transient confusion and disorientation following lumbar myelography. No such reactions were observed following iohexol myelography.