SPECT attenuation artifacts in normal and overweight persons: insights from a retrospective comparison of Rb-82 positron emission tomography and TI-201 SPECT myocardial perfusion imaging

PURPOSE: Myocardial perfusion imaging can be performed using SPECT or positron emission tomography (PET). SPECT has lower specificity than PET, largely as a result of attenuation artifacts; however, it is more widely available. The authors describe a study of the effect of sex and body weight on the incidence of SPECT attenuation artifacts using a retrospective comparison of TI-201 SPECT and Rb PET. METHODS: One hundred sixty-one persons (101 men, 60 women; 81 normal weight, 80 overweight) underwent TI-201 SPECT and Rb PET. The incidence of observed perfusion defects was studied in territories of the three major coronary arteries. SPECT and PET results were also compared with those of angiography in a subset of 75 patients. RESULTS: One hundred fourteen defects were reported on Rb PET compared with 176 defects with TI-201 SPECT. Excess TI-201 SPECT defects occurred in male and female, normal-weight and overweight persons. The average specificity was 64% for TI-201 SPECT and 84% for Rb PET, reflecting this difference. CONCLUSIONS: Attenuation artifacts in TI-201 SPECT occur frequently and are not confined to easily identifiable subgroups of patients. Therefore, measures to improve specificity of SPECT (e.g., prone or gated imaging) or alternative imaging techniques such as PET have potential advantages for everyone, not simply for obese patients and women with large breasts. In addition, awareness of the prevalence of SPECT attenuation artifacts, in both sexes and all weight categories, may contribute to improved accuracy of interpretation.     

Allopurinol-Induced Recurrent DRESS Syndrome: Pathophysiology and Treatment

Hyperuricemia is present in approximately 5% of the population. The vast majority is asymptomatic and at no clinical risk. Allopurinol, an analog of hypoxanthine, has been widely used in clinical practice for more than 30 years for the treatment of hyperuricemia and gout. Two percent of patients develop a mild exanthema when on this drug, which usually resolves after withdrawal of the drug. A syndrome characterized by exfoliative dermatitis, hepatitis, interstitial nephritis, and eosinophilia, termed allopurinol hypersensitivity syndrome, has been described, and its etiology related to the accumulation of one of allopurinol's metabolites, oxypurinol, of which clearance is decreased in the setting of renal insufficiency and the use of thiazide diuretics. The term DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) Syndrome has been recently used to describe an entity presenting with similar features.     

Health‐related quality of life among Darier’s disease patients

Background Darier’s disease (DD) is an autosomal dominant skin disorder characterized by persistent eruption of hyperkeratotic papules. The effect of DD on quality of life (QOL) has been assessed in only one study, which found no correlation between the Dermatology Life Quality Index (DLQI) score and clinical severity of the disease. The correlation between health‐related quality of life (HRQL) and other diseases and patient characteristics has not been studied. Objectives To examine the HRQL of patients with DD and to evaluate the association between HRQL scores and disease and patient characteristics. Methods A total of 74 DD patients completed three QOL questionnaires: DLQI, EQ‐5D, and one specially designed for the study. The data reported in this study were collected as part of a larger study on the clinical characteristics of DD; the socio‐demographic and clinical data were used in the statistical analysis of the current study. Results Mean DLQI was 5.41 ± 5.57 and the mean EQ‐Visual Analogue Scale (VAS), was 70.84 ± 19.25. DLQI and EQ‐VAS were significantly associated with skin area affected, disease severity, age at onset of DD and a seborrhoeic distribution pattern of DD. Stepwise linear regression showed skin area affected to be the most significant variable in the predication of DLQI (beta = 0.183; SE = 0.04; P < 0.001), and disease severity the most significant variable in the predication of EQ‐VAS (beta = ?9.15; SE = 3.21; P < 0.006). Conclusions Darier’s disease has a negative impact on HRQL of patients and the HRQL is associated with various disease characteristics, mainly skin area affected and clinical severity.     

Importance of delaying balloon angioplasty in patients with unstable angina pectoris

Angioplasty in patients with unstable coronary artery disease is associated with higher complication rates compared with patients with stable disease. In this report we describe our results from a group of patients with unstable disease (unstable angina pectoris and postmyocardial infarction) where a strategy of delaying angioplasty for >5 days after admission was undertaken. Included are 2069 consecutive patients: 1197 treated for stable angina pectoris and 872 treated during admission for unstable angina or myocardial infarction. There was no difference between the two groups in angioplasty success (92.1% stable, 92.3% unstable), failure to dilate without complication (6.4% stable, 6.1 % unstable), or in the rate of major complications: death (0.5% stable, 1.1% unstable), Q-wave myocardial infarction (0.9% stable, 1.1% unstable), and emergency coronary artery bypass (0.6% stable, 0.3% unstable). The duration of hospitalization following angioplasty was longer in the unstable group (5.6 ± 8.1 days vs. 4.2 ± 4.1 days; p < 0.001) because of longer duration of hep-arin infusion. There was no difference between groups in minor complications such as groin hematoma and pseudoa-neurysm, renal failure, or infections. It was concluded that delaying angioplasty in unstable patients for > 5 days after admission is a safe and effective therapeutic strategy for this group of patients. The need for prolonged heparin infusion after angioplasty is increased in unstable patients and thus the duration of hospitalization after the procedure is longer.     

Cat scratch disease encephalopathy in an immunocompetent patient

Cat scratch disease (CSD) is typically a self-limited regional lymphadenopathy in children and young adults that is caused by Bartonella henselae. The majority of CSD cases resolve spontaneously; however, many systemic complications have been described. We report an unusual case of CSD presenting as an epitrochlear arm mass and complicated by encephalopathy. Identification of B. henselae DNA in the affected lymph node and cerebrospinal fluid confirmed the diagnosis of CSD. Systemic antibiotic therapy was administered and the patient improved without any neurological deficit.     

Bacteriological aspects of Darier’s disease

Background There are no established data on the prevalence of bacterial colonization of lesional skin, nares and perineum in Darier’s disease (DD), or its contribution to the clinical manifestations of the disease. Objective To determine the prevalence of bacterial colonization of lesional skin and Staphylococcus aureus (S. aureus) in nares and perineum in 75 patients with DD, the association of these parameters with disease and patient characteristics, and the features of the bacterial skin infection in this group. Methods Medical interviews and physical examinations were performed. Bacteria were isolated from swabs taken from lesional skin, nares and perineum. Results S. aureus was isolated in 68%, 47% and 22% of lesional skin, nares and perineum cultures respectively. Subjects with positive S. aureus culture from lesional skin and/or nares had a statistically significant higher percentage of skin area affected and a more severe disease than patients with negative culture. Thirty of the 75 patients (40%) recalled bacterial skin infection, most often on the chest. Conclusions Patients with DD have high prevalence of S. aureus colonization in lesional skin and nares, with a correlation between disease severity and extent of the colonization. Further studies examining the consequences of S. aureus eradication in those sites may establish the need for S. aureus lesional skin and nares colonization screening and eradication as part of the treatment of DD exacerbations.     

Laryngo-tracheal anastomosis: post-operative evaluation by helical CT and computerized reformations

OBJECTIVE: Our purpose was to evaluate the role of post-operative helical computed tomography (CT) and computerized reformations in patients after laryngo-tracheal segmental resection with anastomosis. METHODS: Helical CT and computerized reformations were obtained in 11 consecutive patients who underwent laryngo-tracheal resection with anastomosis for obstruction or stenosis caused by longstanding intubation or tracheostomy. Post-operative computer assisted cross-sectional area, coronal and sagittal diameter measurements at the level of maximal narrowing of the trachea were compared with clinical assessment in all patients. The additive value of various coronal and sagittal computerized reformations over axial images was subjectively evaluated by a consensus of a thoracic radiologist and a neuroradiologist who were blinded to clinical information. RESULTS: Various degrees of restriction in daily activities were reported by patients with cross-sectional area narrowing of more than 50%, by 4/6 patients with cross-sectional area of less than 90mm(2), by 4/5 and 4/6 patients with coronal or sagittal narrowing of more than 25% respectively, and by 4/5 patients with sagittal diameter of less than 12mm. All five patients with cross-sectional area stenosis of less than 50% assessed themselves as 'asymptomatic'. Sagittal multi-planar and volume rendering reformations clarified or added additional information over axial images in all six patients with significant cross-sectional area stenosis (>50%). Volume rendering scores were significantly higher than minimal intensity projection reformations (P=0.01). CONCLUSION: Our preliminary results suggest that CT-based cross-sectional area and diameter measurements of the trachea represent a clinically helpful tool for post-operative evaluation of patients with tracheoplasty. The need for post-operative endoscopy may be obviated in some cases.     

Radiological findings of the urinary tract in hypospadias: a report of 110 cases.

One hundred and ten patients with hypospadias underwent excretory urography and micturating cysto-urethrography before surgical correction. Urographic studies revealed abnormalities in 50 patients (45%), mainly anomalies of ascent and rotation of the kidneys. None of these patients required corrective surgery. Voiding cysto-urethrography disclosed disease of the urinary tract in 65 of 110 patients (59%). Meatal stenosis was found in 38 patients and a rudimentary vagina or a prostatic utricle was revealed in 11 others. Vesico-ureteral reflux was present in 14 patients, seven of whom had meatal stenosis as well. Cystitis was found in eight and a stricture of the membraneous urethra in one patient. The voiding cysto-urethrogram is able to demonstrate functionally significant meatal stenosis, genital abnormalities and vesico-ureteral reflux. It can also serve as a useful baseline for comparison with postoperative studies. We therefore consider that it should be included in the preoperative work-up of every patient with hypospadias. Excretory urography, however, is perhaps indicated only in those with urinary tract infection, or in patients otherwise symptomatic.     

Nephroureterectomy through a single lumbar incision combined with endoscopic incision of a bladder cuff.

Nephroureterectomy is the accepted approach in treating upper urinary tract carcinoma. We present a modification of transurethral resection of the intramural ureter, using endoscopic incision of a bladder cuff around the ureteral ostium as the first step in performing nephroureterectomy through a single lumbar incision.