Small-airways dysfunction in never smoking asbestos exposed Danish plumbers

Summary Among 701 Copenhagen plumbers we examined the lung function of 23 never smokers, who had removed asbestos insulation and intermittently been exposed to high levels of asbestos for about 25 years without being exposed to welding fume. The plumbers had significantly lower TLC, MEF₂₅, MEF₅₀, closing volume and closing capacity in comparison to 23 never smoking electricians without asbestos exposure. There was no reduction in TL_CO. Pulmonary clearance of aerosolized ^99mTc-DTPA was normal indicating that the asbestos had not induced increases in pulmonary epithelial permeability. However, in 11 of the 23 plumbers the ^99m-Tc-DTPA ventilation scintigrams had a slightly irregular and spotty appearance, which together with the results of the lung function tests are suggestive of small airways' dysfunction. None of the subjects had symptoms or clinical signs of lung disease.     

Fluorine-18 fluorodeoxyglucose positron emission tomography and iodine-131 whole-body scintigraphy in the follow-up of differentiated thyroid cancer

Metastases of differentiated thyroid cancer may show different uptake patterns for fluorine-18 fluorodeoxyglucose and [¹³¹I]NaI. FDG positron emission tomography (PET), iodine-131 whole-body scintigraphy (¹³¹I WBS) and magnetic resonance imaging were performed in 58 unselected patients, and spiral computed tomography (CT) of the lung in 25 patients. Thirty-eight patients presented with papillary carcinomas, 15 patients with follicular carcinomas and five patients with variants of follicular carcinoma. Primary tumour stage (pT) was pT1 in 3, pT2 in 19, pT3 in 11 and pT4 in 25 cases. For the detection of metastases, FDG PET was found to have a sensitivity of 50%, ¹³¹I WBS a sensitivity of 61%, and the two methods combined a sensitivity of 86%. When FDG PET was limited to patients with elevated thyroglobulin (Tg) levels and negative ¹³¹I WBS, the sensitivity of this algorithm was 82%. Of the 21 patients with lymph node metastases, seven presented with FDG uptake but no iodine uptake. In four of them, a second FDG hot spot appeared in a lymph node metastasis of normal size. Five of the seven patients underwent surgery. None of the eight patients with pulmonary metastases smaller than 1 cm exhibited FDG uptake, while five of them had iodine uptake. All had positive results on spiral CT. In conclusion, FDG PET cannot be substituted for ¹³¹I WBS. If the Tg level is elevated and ¹³¹I WBS is negative, FDG PET can be used to detect lymph node metastases and complements anatomical imaging. A spiral CT of the lung is useful to exclude pulmonary metastases before planning a dissection of iodine-negative lymph node metastases. Received 2 May and in revised form 8 July 1997     

胆汁反流性胃炎的胃运动功能研究

目的:探讨胃排空改变以及胃窦平滑肌电节律紊乱在胆汁反流性胃炎发病中的可能机制。方法:对59例有慢性上消化道症状的慢性胃炎病人,根据胃镜下可见显著胆汁反流,胃液呈深黄色或深绿色,胃液pH≥3.0,甘胆酸浓度>58μg/ml,胃粘膜病理积分>9,判断为病理性胆汁反流(部分病人经:显象进一步证实)。胃镜下未见胆汁反流,胃液清亮,其余指标均未达上述标准者判断为非胆汁反流性。选出18例胆汁反流性胃炎病人(BRG组)和17例非胆汁反流性胃炎病人(NRG组),上述检查正常的10名健康志愿者(HC组)作为对照受检者进食一份双核素标记的标准餐,用照相机以1帧/2分钟连续动态照相120分钟,部分受试者又在空腹时检测胃窦肌电。结果:BRG组有明显的固、液体双相排空延迟,以固相延滞期(SLP)延长较为突出,而固体半排空时间(HSET)延长在很大程度上受到SLP延长的影响:NRG组仅有HSET显著延长。进一步胃电检测结果表明,各组间平均慢渡频率(MSWF)无显著性差异,出现胃电节律失常(DRM)在各组的分布为HC组1/7、NRG组3/10和BRG组7/13,严重程度BRG>NRG>HC。结论:胆汁反流性胃炎者有较严重的胃窦功能不良,且胃肌电可予进一步证实,胃底和十二指肠动力异常也可能与胆汁反流性胃炎的发病有关。     

核素唾液腺显像的定量分析软件开发与应用

目的开发定量分析唾液腺功能及其图象显示的程序。方法应用Aladdin语言编写ROI模块提取各唾液腺及甲状腺区域的摄取数据及本底,用曲线函数生成各ROI的时间-放射性活度曲线,对曲线数据处理,计算唾液腺摄取、排泌指数等指标,然后把图象、曲线及计算结果显示在一个模板内。结果同一幅输出界面图可显示唾液腺的形态、ROI示意图、唾液腺的摄取与排泌功能数值及其曲线,以标准化的显示格式提供给临床医师。不同操作者处理同一资料的功能指标结果基本一致,软件计算的功能指数与图象显示结果及临床诊断基本相符。结论开发的唾液腺功能定量分析软件,程序运行稳定,结果重复性好。     

Multiple myeloma: Early vertebral involvement assessed by computerised tomography

Routine radiography is the primary method of evaluating skeletal involvement by myeloma. In contrast, radio-isotope bone scans have a low sensitivity, the medium being taken up only at sites of active or reactive bone formation. A group of six patients with multiple myeloma, established by clinical and laboratory findings, had no radiological evidence of bone involvement. Computerised tomography (CT) of the vertebral column revealed limited lytic lesions of the vertebral spongiosa in four of the patients. The three-dimensional ability of CT to look inside the vertebrae permits early detection of spinal lesions associated with myeloma. As a supplementary investigation, three additional patients, with frank radiographic evidence of extensive myelomatous bone lesions were examined similarly by CT. In these patients the technique showed involvement of the vertebral column to be more widespread and to affect many more vertebral bodies than had been evident in orthodox radiological examinations. CT permits earlier demonstration of early vertebral lesions and is more accurate in the delineation of the extent of vertebral involvement than conventional radiography.     

Comparison of non-invasive approaches to red marrow dosimetry for radiolabelled monoclonal antibodies

Red marrow is usually the dose-limiting organ during radioimmunotherapy. Several non-invasive approaches to calculate the red marrow dose have been proposed. We compared four approaches to analyse the differences in calculated red marrow doses. The data were obtained from immunoscintigraphy of two antibodies with different red marrow kinetics [iodine-131-16.88 IgM and indium- 111-OV-TL-3 F(ab)₂]. The approaches are based on, respectively, homogeneously distributed activity in the body, a red marrow-blood activity concentration ratio of 0.3, scintigraphic quantification, and a combination of the second and third approaches. This fourth approach may be more adequate because of its independence from the chosen antibody. In addition, the influence of activity accumulation in liver, kidneys or cancellous bone on red marrow dose was studied. The calculated red marrow dose varied between 0.14 and 0.42 mGy/MBq for ¹¹¹ In-OV TL-3 and between 0.13 and 0.68 mGy/MBq for ¹³¹I-16-88. If the radiopharmaceutical shows high affinity for cancellous bone or another organ situated near the red marrow, the activity in these organs must be included in dose calculations. This study shows a large variation in calculated red marrow dose and selection of the definitive non-invasive approach awaits validation. Correspondence to: M.A.B.D. Plaizier     

Bone island (enostosis): current concept — a review

An enostosis or bone island represents a focus of mature compact (cortical) bone within the cancellous bone (spongiosa). Thought by some to be a tumor-like condition and by others a hamartoma, this benign lesion is probably congenital or developmental in origin and reflects failure of resorption during endochondral ossification. A bone island can be virtually diagnosed based on its characteristic clinical and radiologic features. Typically asymptomatic, the lesion is usually an incidental finding, with a preference for the pelvis, femur, and other long bones, although it may be found anywhere in the skeleton, including the spine. Plain radiography reveals a homogeneously dense, sclerotic focus in the cancellous bone with distinctive radiating bony streaks (thorny radiation) that blend with the trabeculae of the host bone, creating a feathered or brush-like border. On CT scan, a bone island appears as a low-attenuation focus, and on MRI sequences it shows low signal intensity like cortical bone. A distinguishing feature of bone islands is that they are usually cold on skeletal scintigraphy. Thus, bone scan has been and continues to be the means of differentiating bone islands from the more aggressive entities. However, reports of histologically confirmed bone islands that were scintigraphically active have raised a note of caution about relying on this modality in the differential consideration of lesions otherwise characteristic of bone islands. Guides to the correct diagnosis should be looked for in the individual clinical situation and in the morphologic features of the lesion on plain radiography, CT, and MRI, without regard to the lesion's activity on bone scan. If such a lesion, however, is symptomatic and hot on scintigraphy, it demands close observation with follow-up imaging studies.     

Somatostatin receptor scintigraphy during treatment with lanreotide in patients with neuroendocrine tumors

To investigate possible changes in somatostatin receptor expression during treatment with high dose lanreotide, eight patients with neuroendocrine tumors were investigated by [¹¹¹In-DTPA-D-Phe¹]-octreotide scintigraphy before and during treatment. The spleen-to-background ratio decreased in all patients, whereas tumor-to-background ratio revealed a heterogeneous pattern with an average increase of 50% (−79% to +1,087%). This finding indicates that lanreotide treatment may influence the binding of radioactively labeled somatostatin to the spleen, while changes in the binding to functioning somatostatin receptors in tumor cells are more complex and not clearly related to treatment.     

Gallium scintigraphy in Hansen's disease

Gallium 67 imaging was used in 12 patients with documented Hansen's disease undergoing treatment or not, in an attempt to determine the pattern of the disease. Diagnosis was confirmed by histopathology in all patients. The Mitsuda reaction was seen in all patients. Specific nuclear studies were performed when needed to evaluate particular organs better. Gallium 67 images show homogeneous, diffuse and moderate accumulation over the entire skin surface (except for the face) of untreated patients with multibacillary disease. The facial skin in these cases presented homogeneous, diffuse but very marked uptake of gallium. Internal organ involvement was variable. There was a very good correlation among clinical, scintigraphic, immunological and histopathological data. The pattern of the body skin (skin outlining) and facial skin (beard distribution) may be distinct for untreated patients with multibacillary leprosy.     

Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring,scintigraphy, and endoscopy

BackgroundThe effect of laparoscopic sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) has been a controversial issue. There have been limited studies on this aspect and most of the published studies are retrospective. Therefore, a prospective study was designed to objectively assess the problem. The objective of this study was to assess the impact of SG on symptoms of gastroesophageal reflux using questionnaire, endoscopy, and radionuclide scintigraphy.MethodsThirty-two patients undergoing laparoscopic sleeve gastrectomy were assessed for gastroesophageal reflux using Carlsson Dent Questionnaire and GERD questionnaire before and after surgery at three monthly intervals. They were also subjected to upper GI endoscopy (UGIE) and radionuclide scintigraphy both pre- and postoperatively.ResultsMean preoperative weight and body mass index were 126.5 kg and 47.8 kg/m2, respectively. Mean percent excess weight loss at 12 months was 64.3 ± 18.4. Both the Carlsson Dent Score (CDS) and Severity Score (SS) exhibited a decline from 2.88 to 1.63 (p<0.05) and 2.28 to 1.06 (p<0.05), respectively after 12 months. Radionuclide scintigraphy revealed a significant rise of GERD from 6.25% to 78.1% in the postoperative period (p<0.001). UGIE showed a rise in incidence of esophagitis from 18.8% to 25%; however, there was improvement in all patients except one in terms of reduction of severity of esophagitis.ConclusionPresence of GERD may not be considered as a contra-indication for sleeve gastrectomy. There is improvement of GERD as assessed by symptom questionnaires, as well as improvement in grade of esophagitis. The new onset GERD detected on scintigraphy may not be pathologic as there is a decrease in total acid production postsurgery; however, it still remains an important issue and needs long-term follow-up.