The clinical and imaging spectrum of findings in patients with congenital lobar emphysema.

Congenital lobar emphysema (CLE) is an important cause of infantile respiratory distress that may require surgical intervention. We retrospectively reviewed the clinical and imaging findings in eight infants with CLE. In our series, CLE was more common in females, predominantly involved the right lung, often presented with an opaque lobe from retained fetal lung fluid, and frequently involved the lower lobes, multiple segments or lobes, and both lungs. Most patients with CLE were diagnosed and managed on the basis of clinical and plain radiographic findings alone. Computed tomography, and occasionally ventilation/perfusion scintigraphy, were helpful in confirming the diagnosis and in guiding management decisions in several cases; bronchoscopy showed that stenosis of the right mainstem bronchus was the cause of CLE in one case. Three patients experienced progressive worsening of respiratory distress and required surgical resection of the affected lobe for cure; the remaining five patients were managed medically with eventual remission of symptoms.     

Quantitative analysis of radioaerosol inhalation and perfusion scintigraphy in dogs

A method was developed for the analysis of^99mTc MAA perfusion and^99mTc phytate colloid aerosol inhalation distribution patterns. Scintigraphic images were compared, based on the activity of corresponding picture elements (pixels). The possible mismatching in a pixel between both distributions was expressed in terms of a regional mismatching (common to a whole region) and an additional intraregional mismatching at the individual pixel level. Parameters characterizing the degree of regional and intraregional mismatching were introduced. The method was applied to 16 anesthetized healthy dogs in which a cranial-to-caudal gradient in regional mismatching was found.     

Coincidence of infectious osteomyelitis and disseminated neuroblastoma: A diagnostic dilemma solved by scintigraphic imaging

Summary The case of a 41/2-year-old girl with disseminated neuroblastoma and concomitant osteomyelitis is reported. Neuroblastoma was detected in the vertebral column, the right suprarenal fossa, the left side of cranium and in bone marrow aspirates. Osteomyelitis was present in the left femur and was due to Salmonella tennessee. For the first time in the literature the two lesions were demonstrated by means of simultaneous ¹³¹I-MIBG and ^99mTc-DPD scintigraphy. The diagnoses were proved by direct histological and microbiological studies.     

Assessment of myocardial necrosis immediately after intracoronary thrombolysis by intracoronary injection of technetium-99m pyrophosphate

To assess myocardial necrosis immediately after intracoronarythrombolysis, thallium-201 (TL-201) and technetium-99m pyrophosphate(Tc-99m PYP) were injected simultaneously into the coronaryartery in 25 patients with acute transmural myocardial infarction.In 17 of the 25 patients, the occluded coronary artery was reopened.Minutes after the intracoronary injection of Tc-99m PYP intothe reopened coronary artery a localized accumulation was seenwithin the area of the Tl-201 defect in all patients. Controlintravenous scintigraphy, which was performed in 8 of these17 patients 1–6 days later, and in 2 patients 18 and 42days after infarction, revealed a Tc- 99m PYP spot similar tothat of the acute intracoronary Tc-99m PYP scintigram in all10 patients. In the 8 of the 25 patients, in whom intracoronary thrombolysisfailed, no localized Tc-99m PYP accumulation was seen afterinjection into the infarct vessel. In 5 of these patients, acontrol intravenous scintigram, performed 1–8 days later,resulted in a Tc-99m PYP spot in the area of the Tl-201 defect. We conclude that, in the presence of therapeutic or spontaneousreperfusion, Tc-99m PYP scintigraphy may provide a useful methodof assessing myocardial necrosis during the early stage of anacute myocardial infarction.     

A case of idiopathic hypertrophic cranial pachymeningitis manifested only by positive rheumatoid factor and abnormal findings of the anterior falx

In this report, we present a rare case of a 52-year-old man with a unique form of hypertrophic pachymeningitis involving the anterior part of the falx and who was positive for rheumatoid factor. The clinical symptom was only headache, without any cranial nerve palsies or ataxia. Diagnosis was made by gallium scintigraphy and magnet resonance imaging but was not confirmed by dural biopsy. Treatment with corticosteroid alone was extremely effective for him, while in most cases hypertrophic pachymeningitis recurs or progresses despite the treatment.     

Chemokines in pathology and medicine

About 50 human chemokines and nearly 20 receptors have been identified and characterized in little more than a decade since the discovery of interleukin 8 (IL-8), the first chemotactic cytokine. Research in this field has dramatically changed our understanding of leucocyte traffic in inflammation and immunity. This paper has been written for scientists and practitioners in the field of medicine. It reviews in concise and intelligible form information that I consider useful for understanding the role of chemokines in human pathophysiology. The main areas covered are: (i) the basics of chemokine structures, mode of action, activities and selectivity; (ii) newer aspects of the broad involvement of chemokines in the regulation of immune defence and the housekeeping of the immune system; (iii) the role of chemokines in pathology as illustrated by animal models and studies of human diseases; and (iv) novel therapeutic approaches for a variety of inflammatory conditions, which are based on modulation of chemokine activity.     

Trends in myocardial infarction treatment in subjects aged 35-64 in Southwestern France, 1986-93

Background: This study examined the evolution of the heart to lung (H/L) ratio of monoclonal antimyosin antibody (MAA) uptake in patients with suspected acute myocarditis (AM) and its time-dependent diagnostic value in conjunction with echocardiographic findings. Methods: The study included 20 patients with a short history (<4 months) of heart failure symptoms and normal coronary arteries. All patients underwent cardiac antimyosin scintigraphy, echocardiography, right-heart catheterization and endomyocardial biopsy. Patients who survived beyond 1 year were reevaluated with a cardiac antimyosin scintigraphy and an echocardiographic study. Results: Endomyocardial biopsy in 8/20 patients revealed findings compatible with the diagnosis of idiopathic dilated cardiomyopathy (group I) and in the remaining 12/20 was diagnostic of AM (group II). At baseline evaluation of the antimyosin H/L ratio uptake was similar in groups I and II, at 1.95±0.19 and 2.16±0.51, respectively (P=0.222), while the left ventricular end diastolic diameter (LVEDd) was significantly higher in group I (68±12 mm) than in group II (56±11 mm, P=0.041). In these patients an initial positive MAA scintigraphy (H/L ratio>1.55) associated with an LVEDd≤62 mm was diagnostic of AM with a sensitivity of 67%, a specificity of 63% and a positive predictive value of 65%. Upon restudy, the H/L ratio of MAA uptake was significantly decreased in both groups, reaching almost identical levels. No difference was found in the LVEDd between the two groups. The positivity of cardiac antimyosin scintigraphy in conjunction with an LVEDd≤62 mm had a sensitivity of 45% and a specificity of 88% for the diagnosis of myocarditis. Conclusions: In patients with suspected AM a positive antimyosin scintigraphy accompanied by a non-dilated left ventricle is highly suggestive of AM, both at the early phase and 1 year after disease onset.     

Prognostic role of stress/rest myocardial perfusion scintigraphy in patients with cardiac syndrome x

Aim

The prognostic utility of myocardial perfusion scintigraphy (MPS) in patients with angiographically normal coronary arteries has not been evaluated yet. Our aim was to determine the prognostic role of positive MPS in patients with angina, positive exercise test and smooth coronary arteries (syndrome X).

Methods

A total of 156 patients with angina, positive exercise test, positive MPS and normal coronary arteries and 172 patients with angina and positive exercise test who had negative MPS were selected for study. The primary endpoint was combined all-cause mortality and hospitalizations for cardiac causes. The secondary endpoint was hospitalization for cardiac causes.

Results

Kaplan–Meier analysis showed a greater (p = 0.001) incidence of the primary endpoint in patients with positive MPS, compared to those with negative MPS. Additionally, Kaplan–Meier analysis for cardiovascular hospitalization showed a significant difference (p = 0.003) between the two groups. Cox regression analysis, adjusted for age, sex, BMI and antianginal therapy confirmed a significant risk increase for patients with positive MPS, with a hazard ratio (HR) = 3.20 (CI 95%: 1.14–9.02; p = 0.028). Cox analysis for cardiovascular hospitalization also showed a significant risk increase for patients with positive MPS (HR = 3.19; CI 95%: 1.13–9.00; p = 0.03). Finally, Cox analysis showed that patients with positive MPS tend to have a higher risk to remain symptomatic in the follow-up period (HR = 1.614; CI 95%: 0.999–2.607; p = 0.51).

Conclusions

This study shows that inducible myocardial hypoperfusion at MPS in patients with syndrome X could discriminate patients with a more severe prognosis, especially in terms of further hospitalization and symptomatic burden.     

Gastroparesis versus dyspepsia by intragastric meal distribution: new diagnostics and definitions ahead

Abstract

Gastroparesis often presents a challenge to the practicing gastroenterologist. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also significant disruption of social activities that often center around food. The treatment options that affect gastric function are limited and often disappointing. The female predominance, the mostly idiopathic and idiosyncratic nature of the illness, often with some common psychiatric co-morbidity, parallels other functional disorders of the gastrointestinal tract. These parallels have provided the rationale for studies investigating alternative diagnostic features of the gastric emptying test as employed in the clinical setting. Hence, not only the regular cut-offs of 60% or 10% gastric retention of a meal at 2 and 4?h, but also a new concept, the intragastric meal distribution at time 0 (IMD⁰) is now introduced as a plausible diagnostic feature that should be more aligned with the patients’ symptoms as they appear in close connection with the meal. Impaired gastric accommodation with absence of fundic relaxation followed by dumping of the meal into antrum is suggested to be diagnostic for functional dyspepsia and gastroparesis. The diagnostic cut-off is considered when more than 57% of the meal is distributed to the distal part of the stomach immediately on food intake. This new diagnostic feature of the gastric emptying profile lend support to better understanding of the patients’ symptoms and provides a new basis for pharmacological treatment options in gastroparesis that may provide an improved quality of life in affected individuals.