Contact Thermography, 99mTc-Plasmin Scintimetry and 99mTc-Plasmin Scintigraphy as Screening Methods for Deep Venous Thrombosis Following Major Hip Surgery

Fifty-six patients scheduled for total hip alloplasty were screened for deep venous thrombosis by means of 99mTc-plasmin scintimetry, 99mTc-plasmin scintigraphy and contact thermography. Investigations were performed on the seventh postoperative day, and a total of 112 legs were examined. Bilateral ascending phlebography was used as reference procedure, and the criteria for deep venous thrombosis were intraluminal filling defects at phlebography. Six patients developed unilateral deep venous thrombosis. All three screening procedures revealed many false positive and several false negative results. The nosographic sensitivity/specificity was 33%/75% for scintimetry, 50%/91% for scintigraphy and 33%/87% for contact thermography, respectively. It is concluded that all three tests are of no value as screening methods for deep venous thrombosis following major elective hip surgery.

Fifteen minutes bone scintigraphy in patients with clinically suspected scaphoid fracture and normal x-rays

Occult fractures of the scaphoid bone occur frequently and may lead to non-union. The use of three-phase bone scintigraphy in patients with normal x-rays of the scaphoid after carpal injury is widely advocated.In this study, 40 patients with negative radiographs but clinically suspected scaphoid fracture, all had rapid bone scintigraphy with images taken 15 min after intravenous injection of 99 m-Technetium Hydroxymethylene diphosphonate. The scan was performed approximately 2 weeks after the trauma. We found 8 fractures of the scaphoid bone and 13 fractures of other carpal bones. In 5 cases the images were inconclusive. At follow-up 6 months to 2 years later we found no patients with non-union. We find this rapid version of the bone scan useful as a second line investigation for continuing wrist pain following trauma in the presence of normal radiography. This can result in a reduction in both time and costs required for the diagnostic process. If the results are inconclusive we recommend a delayed image. CT or MRI could also be considered. In rare cases a wrist arthroscopy may be considered.

Technetium-99m sestamibi and tetrofosmin myocardial single-photon emission tomography: can we use the same reference data base?

The aim of this study was to compare technetium-99m labelled tetrofosmin and sestamibi myocardial perfusion single-photon emission tomography (SPET) with one common sestamibi reference file for bull's eye imaging, with quantitation of the extent and severity of perfusion defects. Twenty patients suspected or known to have coronary artery disease participated in the study. Patients first underwent routine sestamibi myocardial SPET over 2 days, receiving doses of 400-600 MBq at stress and 600-800 MBq at rest. Then within the same week a 1-day tetrofosmin myocardial SPET study was performed, with a dose of 300 MBq at stress, followed 2.5 h later by a dose of 750 MBq at rest. Bull's eye images were generated for visual evaluation. Black-out defects according to the Cequal software analysis were only recorded if they comprised more than 10 pixels in men and 20 in women. According to the Cequal program, extent score and severity scores were expressed as number of pixels and deviations below reference limits. Five patients had normal myocardial SPET imaging with both radiotracers, while 15 had reversible, irreversible or partially reversible defects. The concordance of the results was high. The only two significant differences were that one patient had a reversible defect which appeared to be located in different myocardial regions (LAD vs RCA), and another patient had a defect that was partially reversible with sestamibi but irreversible with tetrofosmin. The results showed very high correlation coefficients for the extent and severity scores (linear correlation coefficient values of 0.99 and 0.94, respectively). In conclusion, it appears that changing between sestamibi and tetrofosmin has little influence on the interpretation of bull's eye images from the data file of a common reference population using one of the tracers.

Scintigraphy with nanocolloid Tc 99m in patients with small cell lung cancer, with special reference to bone marrow and hepatic metastasis

Nineteen patients with newly diagnosed small cell lung cancer (SCLC) were examined with a nanocolloid Tc-99m bone marrow whole body imaging (scintigraphy) in order to detect bone marrow metastasis. Bilateral bone marrow biopsy taken from the posterior iliac crest was used as a reference. The scintigraphy was considered abnormal if a focal lesion was present and/or if the bone marrow activity expanded to more than one-third of the proximal part of the extremities. In 3 of the 19 patients, microscopical bone marrow metastasis and cold spots (focal lesions) on the scintigram were present. An additional 9 patients had expansion of the activity. Eight patients showed scintigraphic focal lesions in the liver. SCLC metastasis was confirmed in 4 patients, while 1 patient had focal necroses. The results indicate that cold spots rather than expansion of activity with bone marrow scintigraphy detected bone marrow involvement of the disease in patients with SCLC.

Bone marrow investigation with technetium-99m microcolloid and magnetic resonance imaging in patients with malignant myelolympho-proliferative diseases

In 63 patients with primary extramedullary malignant lymphoma or plasmacytoma, a study was performed in order to evaluate bone marrow involvement. All patients underwent a 99mTc microcolloid bone marrow whole body imaging (scintigraphy), using a gamma camera interfaced with a computer, followed by nuclear magnetic resonance bone marrow imaging (MRI), (1.5 Tesla). MR images were made of the lumbosacral region, the pelvic region, both femoral and other parts of the skeleton, according to focal lesions in the scintigraphy. A posterior iliac crest bone marrow biopsy was used as a standard reference. In the present study, both scintigraphy and MRI showed a dissiminated or focal involvement or a combination of both. In 53 of the 63 patients (84%) the results were in accordance. Pathological MR signals or pathological findings in scintigraphy did not always correspond to tumorous bone marrow involvement, and were shown to reflect reactive changes in the central part of the skeleton in combination with a periphery radionuclide extention interpreted as a periphery compensatory hematopoietic proliferation. The negative predictive value of scintigraphy and MRI was 92% and 100%, respectively. When combining the results of both examinations, the positive predictive value increased from 49% to 58%, if the bone marrow biopsy is accepted as gold standard. The results indicate that bone marrow investigation performed simultaneously using scintigraphy and MRI is superior both to the use of either of the methods alone and to the traditional iliac crest bone marrow biopsy.

Plasma catecholamine level and portal venous pressure as guides to prognosis in patients with cirrhosis

Circulating noradrenaline is increased in patients with cirrhosis, especially in decompensated patients with ascites. Eighty-one patients with alcoholic cirrhosis were followed for up to 8 years in order to establish a possible relationship between plasma catecholamines, haemodynamics, and routine clinical and biochemical variables and survival. Forty-seven (58%) of the patients died during the follow-up period. Univariate analysis showed that plasma noradrenaline and adrenaline concentrations, portal pressure, indocyanine green clearance, serum sodium, bilirubin, and albumin concentrations, and the presence of ascites or cardiovascular disease were of significant prognostic value. In a multivariate analysis (Cox regression model), plasma noradrenaline concentration, portal pressure, serum bilirubin concentration, and the presence of ascites and cardiovascular disease remained significant independent predictors of survival. The results suggest that determination of the circulating level of noradrenaline and portal pressure may add to the prognostic information on survival obtained from routine tests. Thus, the activity of the sympathetic nervous system may indicate the severity of cirrhosis with respect to survival.

Contact thermography, 99mTc-plasmin scintimetry and 99mTc-plasmin scintigraphy as screening methods for deep venous thrombosis following major hip surgery

Fifty-six patients scheduled for total hip alloplasty were screened for deep venous thrombosis by means of 99mTc-plasmin scintimetry, 99mTc-plasmin scintigraphy and contact thermography. Investigations were performed on the seventh postoperative day, and a total of 112 legs were examined. Bilateral ascending phlebography was used as reference procedure, and the criteria for deep venous thrombosis were intraluminal filling defects at phlebography. Six patients developed unilateral deep venous thrombosis. All three screening procedures revealed many false positive and several false negative results. The nosographic sensitivity/specificity was 33%/75% for scintimetry, 50%/91% for scintigraphy and 33%/87% for contact thermography, respectively. It is concluded that all three tests are of no value as screening methods for deep venous thrombosis following major elective hip surgery.

Hepatic venous oxygen content in alcoholic cirrhosis and non-cirrhotic alcoholic liver disease

Blood gas analyses and hepatic blood flow were determined during hepatic vein catheterization in order to establish a possible hypoxic component in alcoholic liver disease. Fifty-six patients (9 non-cirrhotic liver disease, 14 cirrhosis Child-Turcotte class A, 23 class B, 10 class C) and 10 control subjects were studied. Mean hepatic venous oxygen saturation and tension were almost the same in all groups, and hepatic blood flow was inversely correlated to the arteriohepatic venous oxygen difference (r = -0.53, P less than 0.01). Splanchnic oxygen uptake was similar in all groups studied. The arterio-hepatic venous difference of base excess was small and of the same size in all groups, indicating no enhanced production of lactic acid in the liver. Our results do not support the concept that hepatic venous oxygen content is low in alcoholic liver disease and thereby contributes to hypoxic liver damage.

Graded compression Stockings with and without Heparin-Dihydroergotamine in the Prevention of Deep Venous Thrombosis following Elective Hip Alloplasty

Two hundred and five patients scheduled for total hip alloplasty were randomized to one of the following two regimes, in order to prevent postoperative thromboembolism. (1) Graded compression stockings and heparin 5000 iu/dihydroergotamine 0.5 mg twice a day subcutaneously. (2) Graded compression stockings and placebo twice a day subcutaneously. Screening for deep venous thrombosis (DVT) was carried out by 99mTc-plasmin scintimetry and whenever this was indicative for DVT, ascending phlebography was performed. The definitive criteria for DVT were intraluminal filling defects on phlebography. If DVT was diagnosed, pulmonary perfusion/ventilation scintigraphy was performed. In the group receiving heparin/dihydroergotamine 11 of 96 patients (11%) developed DVT and in the placebo group 25 of 109 patients (23%) developed DVT (P < 0.05). One patient in the combination treatment group and seven patients in the placebo group developed pulmonary embolism ( P < 0.05). It is concluded that the combination of graded compression stockings, low dose heparin and dihydroergotamine is superior to graded compression stockings alone in preventing thromboembolism following total hip alloplasty.

C-reactive protein in femoral head necrosis

Serum concentrations of C-reactive protein (CRP), alpha 1-antitrypsin, orosomucoid, and haptoglobin were determined in 28 patients with a medial fracture of the femoral neck. The serum concentrations were compared with the result of hip scintigraphy with technetium-99m pyrophosphate, a method which can detect femoral head necrosis and predict the development of late segmental collapse. Serum concentrations of the four acute-phase proteins were measured immediately before osteosynthesis and at the time of hip scintigraphy 1 to 4, 8 to 13, and 37 to 47 days postoperatively. During the same period 15 patients had constantly normal, five varying abnormal/normal, and eight constantly abnormal scintigrams, the latter indicating femoral head necrosis. All four acute-phase proteins had a typical course of concentration changes, which were most pronounced for CRP. However, none of them were useful for the detection of femoral head necrosis or the prediction of late segmental collapse, since the observed serum concentrations could not be used to distinguish between the three scintigraphic groups.

Serum lithium minimum and diuresis

Serum lithium was analyzed over a 24-hour period in patients who were receiving lithium in one daily dose. Linear regression was performed with urine volume as the independent variable and lithium dose, maximum serum lithium concentration. 12-hour serum lithium, minimum serum lithium, length of treatment, and age of patients as the dependent variables. Only minimum serum lithium and urine volume showed a good positive correlation.

Lithium effect on temperature rhythm in psychiatric patients

The diurnal rhythm of oral temperature was studied in 55 lithium treated patients, 51 other psychiatric patients, and 58 healthy subjects. The lithium treated patients had a higher temperature than the normal controls during the 24-hour period and their temperature maximum was shifted towards an earlier time. When the lithium intake was postponed for 12 hours, temperature temporarily decreased to control values, but returned to the higher level after the lithium dose. The temperature results are discussed in relation to lithium induced changes in electrolyte metabolism.