Abnormally high diffuse activity on bone scintigram. The importance of exposure time for its recognition

When the bone scintigram reveals high diffuse skeletal activity, it may be misinterpreted as normal. Some authors have reported such scintigrams in articles entitled "Significance of absent or faint kidney sign on bone scan" and "False negative bone scintigram". Three cases with bone metastasis showing high diffuse skeletal activity are presented in this paper. The recognition of abnormally high diffuse skeletal activity on bone scintigrams is discussed. The exposure time of all three cases was short when compared with normal cases, when the bone image was taken with a preset count. Therefore, exposure time is very important for objective differentiation between the cases showing high diffuse skeletal activity and normal cases.

A study on the relationship between the prognosis of chronic active hepatitis and the HBV associated antigen/antibody systems

The relationship between the prognosis of the disease based on liver histology and HB virus (HBV) associated antigen/antibody systems was investigated in twenty seven patients with chronic active hepatitis (CAH). These patients were followed up over extended periods with mean duration of 44.3 months. On initial liver biopsy five of twelve patients with CAH with spotty or focal necrosis were HBs antigen (HBsAg) positive, as were also five of six patients with sublobular necrosis and six of nine patients with lobular disorganization. Most of the HBsAg negative patients were anti-HBs or anti-HBc positive: HBV associated antigen or antibody was completely undetectable in only three of the twenty seven patients. There was no difference in the frequency of progression to liver cirrhosis (LC) between the sixteen HBsAg positive and the eleven HBsAg negative patients with CAH. On the other hand, progression to LC occurred in only one of seven HBe antigen (HBeAg) negative patients, compared to four of nine HBeAg positive patients, who were HbsAg positive. There were four patients who were HBeAg positive initially but then became HBeAg negative in the course of observation. LC developed in two of these four patients. These results suggest that in HBsAg positive patients with CAH the presence or absence of HBeAg and the variation in its level can provide useful indicators of the prognosis of the disease.

A case of idiopathic hypothalamic hypothyroidism

The availability of thyrotropin hormone (TRH) has made it possible to determine whether tropic hormone deficiency is caused by pituitary or hypothalamic dysfunction. A case of hypothalamic hypothyroidism was described ina a 17 year old woman. This patient was admitted for the evaluation of hypothyroidism and secondary amenorrhea. Her T3 and T4 were decreased, with an undetectable level of base line thyrotropin. the TRH test revealed normal but delayed response of TSH. Her base line prolactin and its response to TRH were normal. Adenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), and urinary 17-hydroxysteroids were also normal. ACTH response to metyrapone was normal. Evaluation of the pituitary-gonadal axis revealed a normal increase in both lutenizing hormone (LH) and follicle stimulating hormone (FSH) following the intravenous administration of lutenizing hormone releasing hormone (LHRH). These results suggest that she had hypothalamic hypothyroidism as an isolated disturbance in the hypothalamic-pituitary axis. A deficiency of TRH is probably caused by a disorder of hypothalamic function of unknown etiology since the extensive studies did not reveal any secondary causes. It is recommended that patients with amenorrhea and hypothyroidism be evaluated for possible hypothalamic hypothyroidism.

A case of thymoma arising from undescended thymus. High uptake of Thallium-201 Chloride

We present an unusual case of a cervical thymoma arising from an undescended thymus, which showed a remarkable accumulation of Thallium-201 Chloride on scintigraphy.

A case of congenital hepatic fibrosis: usefulness of hepatobiliary scintigraphy

A case of operatively proven congenital hepatic fibrosis was studied by scintigraphy with Tc-99m-phytate and Tc-99m-Pl (a hepatobiliary radiopharmaceutical). Two focal defects were recognized in the liver on the colloid liver scintigram. Ultrasound and contrast angiography suggested that the two focal defects were cystic lesions. Radionuclide hepatobiliary imaging was performed with Tc-99m-Pl, since intravenous cholangiography was unsatisfactory. One focal defect was proved to be a dilated intrahepatic bile duct and another was found to be cyst. Radionuclide hepatobiliary imaging with Tc-99m-Pl proved to be very useful in identifying dilated intrahepatic bile ducts in this patient as well as in following the progress of this disease.

Characteristic variation in electrophoretic pattern of plasma proteins in essential hypertension

In patients with essential hypertension, a variation in the plasma proteins was revealed by high-resolution sodium dodecyl sulphate polyacrylamide gel electrophoresis. This variation in plasma protein was not found in patients with hypertension secondary to renovascular or renal parenchymal disease.

Acid-base disturbance in patients with fulminant hepatic failure

Forty-two arterial blood pH and gas determinations were carried out on 11 patients with fulminant hepatic failure. The most common type of acid-base disturbance was that of respiratory alkalosis in 22 cases (52.4%). This was partially compensated in 13 subjects (31.0%) while an accompanying metabolic alkalosis was present in 9 (21.5%). Partially compensated metabolic acidosis was observed on 15 occasions (35.7%), all of which were in patients with laboratory evidence of impaired renal failure. The mental status of the patients was evaluated in each of the categories of acid-base disturbances. Some degree of correlation was evident between the PCO2 and the magnitude of base excess and that of the severity of the encephalopathy. The lower PCO2 and greater negative base excess values tended to be nearly always present in totally comatose subjects. By contrast, there was no clear cut relationship between pH and mental state.

Effect of diuretics on oxidative phosphorylation of dog kidney mitochondria

An effect of diuretics on cellular metabolism has been shown. In order to examine further the direct effect of diuretics on renal mitochondria, their effect on isolated cortical (C) and outer medullary (OM) mitochondrial respiration was examined. Oxygen consumption rate (QO2) was measured in a Gilson oxygraph utilizing either glutamate-malate or succinate as substrate. QO2, expressed in nanoatoms of O2 per milligram of protein per minute, was always higher in C than OM: 140.7 +/- 2.8 VS. 121.2 +/- 2.4 (P less than 0.001) with glutamate-malate and 181.1 +/- 6.3 vs. 129.7 +/- 5.2 (P less than 0.001) with succinate. A dose-response curve was constructed for each of the following: sodium ethacrynate, furosemide, chlorothiazide, acetazolamide and chlormerodrin. All diuretics inhibited C and OM equally. The 50% inhibitory molar concentration for EA was 6.2 times 10(-4); for furosemide 1.5 times 10(-3); for chlorothiazide 8.1 times 10(-3); for acetazolamide 10.8 times 10(-3); and for chlomerodrin 3.1 times 10(-5). Neither cysteine nor dithiothreitol inhibited the effect of EA. The effect of chlormerodrin was abolished by cysteine. These results demonstrate that while a difference exists between C and OM mitochondria during control studies, each of the diuretics examined exerted an equal inhibitory effect on mitochondrial respiration from both C and OM. Mercurials are the most potent inhibitors and presumably exert their effect by reacting with sulfhydryl groups. They are followed in potency by ethacrynic acid, furosemide, chlorothiazide and acetazolamide.