TECPR2-related hereditary sensory and autonomic neuropathy in two siblings from Palestine

Due to the majority of currently available genome data deriving from individuals of European ancestry, the clinical interpretation of genomic variants in individuals from diverse ethnic backgrounds remains a major diagnostic challenge. Here, we investigated the genetic cause of a complex neurodevelopmental phenotype in two Palestinian siblings. Whole exome sequencing identified a homozygous missense TECPR2 variant (Chr14(GRCh38):g.102425085G>A; NM_014844.5:c.745G>A, p.(Gly249Arg)) absent in gnomAD, segregating appropriately with the inheritance pattern in the family. Variant assessment with in silico pathogenicity prediction and protein modeling tools alongside population database frequencies led to classification as a variant of uncertain significance. As pathogenic TECPR2 variants are associated with hereditary sensory and autonomic neuropathy with intellectual disability, we reviewed previously published candidate TECPR2 missense variants to clarify clinical outcomes and variant classification using current approved guidelines, classifying a number of published variants as of uncertain significance. This work highlights genomic healthcare inequalities and the challenges in interpreting rare genetic variants in populations underrepresented in genomic databases. It also improves understanding of the clinical and genetic spectrum of TECPR2-related neuropathy and contributes to addressing genomic data disparity and inequalities of the genomic architecture in Palestinian populations.

Primary intravesical insertion of intrauterine device for 10 years: Clinical presentation and outcome

Intrauterine device (IUD) is considered the second most widely used method of contraception. Migration of the IUD into the urinary system has been reported. Nevertheless, a missed IUD which is mistakenly inserted into the bladder has rarely been reported. We report a female patient experienced recurrent urinary tract infection (UTI) for 10 years without appropriate evaluation. The underlying problem was an IUD that inserted into the bladder led to the formation of bladder stone. The clinical course and the endoscopic management of the stone and the IUD is reviewed in this case report.

An unusual case of Takayasu arteritis presenting with persistent cough in a young female patient: A case report

Takayasu arteritis (TA) is a chronic granulomatous inflammatory arteritis of large vessels. Females aged 20-40 are usually affected and the manifestations can range from asymptomatic disease to major cardiovascular and neurological abnormalities. Herein, we present a case of a 20-year-old female who had a persistent cough as the initial manifestation of an underlying TA. She had a free past medical history. The patient sought medical help multiple times and took many antibiotics with no improvement. Laboratory tests showed a marked elevation in inflammatory markers so the patient was admitted for further investigations. CT scan showed a circumferential mural thickening involving mainly the descending thoracic aorta which is highly suggestive of an underlying chronic granulomatous vasculitis behind this. Our patient was treated with a combination of corticosteroid and azathioprine and showed substantial improvement after 2 weeks. TA can present with various symptoms. Therefore, patients presenting with atypical symptoms and late-onset vascular symptoms need a high degree of suspicion with close follow-up to allow early detection of any complication.

A diagnostic challenge: misdiagnosing Blau syndrome as juvenile dermatomyositis in a pediatric patient

Introduction

Blau syndrome (BS) and juvenile dermatomyositis (JDM) are distinct conditions with different pathophysiological mechanisms. Accurate diagnosis of BS can be challenging due to overlapping clinical features with other inflammatory conditions. This case is being reported to highlight a pediatric case initially diagnosed with JDM, and subsequently found to have BS through genetic testing.

Case Presentation

We present the case of a 4-year-old Arab male initially diagnosed with JDM based on skin manifestations, negative histology for another disease, and no other clinical features suggestive of an alternate diagnosis. However, subsequent symptoms suggestive of BS emerged, leading to genetic testing confirmation of BS, marking the second reported case in the region. This unique clinical scenario highlights the challenges in diagnosing BS and the potential for misinterpretation of the skin rash as JDM. Accurate differentiation between these conditions is crucial to guide appropriate management and prevent delays in treatment.

Discussion

The diagnostic process for JDM involves clinical evaluation, laboratory investigations, imaging, and biopsy findings. However, muscle biopsy may yield false-negative results. BS has been misdiagnosed as other conditions, such as Kawasaki disease and juvenile idiopathic arthritis, due to overlapping clinical features. This case highlights the significance of a thorough diagnostic strategy for BS that takes into account any potentially negative histopathology findings. A precise diagnosis is essential since misdiagnosis can result in inadequate or delayed therapy.

Conclusion

The diverse presentation of the skin rash in BS can pose difficulties for physicians in distinguishing it from other pediatric rheumatological conditions, such as JDM.

Exploring Anatomical Variations of Abdominal Arteries Through Computed Tomography: Classification, Prevalence and Implications

BACKGROUND AND AIMS

Variations in the branches of the abdominal aorta are relatively prevalent and can impact certain surgeries. The accurate identification and differentiation of these variations pre- and intraoperatively are crucial to avoid negative clinical sequelae. This study aimed to investigate the prevalence of variations in some branches of the abdominal aorta and to identify the most frequent variants as well as any rare variants not previously classified in the existing classification systems. The study's findings may help improve the understanding and management of these variations.

MATERIALS AND METHODS

This retrospective study was conducted at the Department of Radiology at An-Najah National University Hospital (NNUH) and included 550 abdominal computed tomography (CT) angiographic scans for patients (51.5% males, 48.5% females) performed between January 2017 and January 2023.

RESULTS

Variations were most common in the hepatic arteries (34.7%), followed by the renal arteries (31.3%). Variations in the celiac trunk were the least frequent (9.8%). The gastro-splenic trunk (type V) was the most common celiac trunk variant. The most common hepatic artery variant was the replacement of the right hepatic artery (type III). Accessory renal arteries were more frequent on the left side and among males (P = 0.01). The celiac trunk variations had a significant association with the hepatic artery variations (P = 0.001) and the renal artery variations (P = 0.011), respectively.

CONCLUSION

There is a high prevalence of anatomical variations in the described vessels, and it matches the results in the reported literature. Our findings also suggest the possible coexistence of variants. We have also encountered rare variants, especially in the hepatic arterial system. Some of the hepatic arterial system variants are not included in the older classification systems, calling for an extension of the old systems (Michel's and Hiatt classification systems) or replacement with the newer (CRL or EX-CRL classification systems) to account for rare variants not previously classified. Radiologists and surgeons should be proficient in identifying and differentiating these variations to take precautions and actions for each variant individually.

Anti-Zic4 Paraneoplastic Cerebellar Degeneration With Mesial Temporal Lobe Hyperintensity in a Patient With Papillary Thyroid Carcinoma: A Case Report and Review of the Literature

Paraneoplastic cerebellar degeneration (PCD), a subtype of paraneoplastic neurological syndromes (PNSs), is a rare autoimmune neurologic syndrome that usually develops secondary to an underlying malignancy. We present a 49-year-old patient that developed PCD secondary to occult papillary thyroid carcinoma. The patient had progressive difficulty ambulating for 3 years. A neurological exam revealed signs of cerebellar syndrome. Brain magnetic resonance imaging (MRI) showed significant cerebellar atrophy and mesial temporal lobe hyperintensity. Immunological testing was highly positive for anti-CV2 and anti-Zic4 onconeural antibodies. Positron emission tomography (PET)/Computerized tomography (CT) scan revealed significant hypermetabolic uptake of F-18 fluorodeoxyglucose (FGD) by a left thyroid nodule. Histological examination of the nodule was positive for papillary thyroid carcinoma, confirming the diagnosis of PCD. A trial of high-dose methylprednisolone failed to improve the patient's symptoms. This case highlights the importance of maintaining high suspicion for PCD while investigating cases of cerebellar degeneration. Early detection is essential to prevent irreversible damage in affected patients.

Prevalent MLC1 mutation causing autosomal recessive megalencephalic leukoencephalopathy in consanguineous Palestinian families

BACKGROUND

Recessive forms of megalencephalic leukoencephalopathy with subcortical cysts (MLC, OMIM 604004) is a rare early-onset leukodystrophy that presents with macrocephaly, seizures, slowly progressive gross motor deterioration, and MRI evidence of diffuse symmetric white matter swelling and subcortical cysts in the anterior temporal and frontoparietal regions. Later in the disease course, significant spasticity and ataxia develop, which may be accompanied by intellectual deterioration. This disease is caused mostly by biallelic pathogenic variants in the MLC1 gene.

METHODS

In this study, we analysed the clinical and molecular architecture of 6 individuals, belonging to 4 unrelated consanguineous Palestinian families, presenting with consistent MLC features. We sequenced the entire coding and flanking intronic regions of the MLC1 gene.

RESULTS

In all recruited individuals, we detected one recurrent homozygous splice donor mutation NM_015166.4: c.423 + 1G > A. All parents were heterozygous carriers. The mutation abolishes a highly conserved splice site in humans and other species. In silico splice predictors suggested the loss of a canonical splice donor site (CADD score 33.0. SpliceAI: 0.980). The c.423 + 1G > A variant is rare; it was detected in only 4 heterozygous carriers in gnomAD.

CONCLUSION

In this study, we identified a recurrent MLC1 variant (c.423 + 1G > A) as the cause of MLC among a group of Palestinian patients originating from a particular region of the country. Cost-effective studies should be performed to evaluate the implementation of carrier screening in adults originating from this region. Our findings have the potential to contribute to improved genetic diagnosis and carrier testing for individuals within this population and the wider community.

Dismembered pyeloplasty for post-traumatic ureteropelvic junction avulsion in a child

Non – iatrogenic ureteral injury is rare because of the well-protected retroperitoneal location of the ureter with an incidence of less than 1%. Furthermore, isolated ureteropelvic junction (UPJ) avulsion as a result of acceleration/deceleration injury is extremely uncommon and may lead to significant morbidity if the diagnosis has not been made early using CT scan with delayed execratory phase. Endourological management of partial ureteric injuries is feasible, however, uretero-ureterostomy is the standard of care for complete upper ureteric injuries. We present a fourteen years old boy presented with UPJ avulsion secondary to blunt trauma treated with dismembered pyeloplasty approach.

Laparoscopic heminephrectomy in a horseshoe kidney affected by xanthogranulomatous pyelonephritis: A modified approach

Horseshoe kidney (HSK) is a common congenital kidney anomaly that is encountered frequently by urologists. It is rare for HSK to be affected by xanthogranulomatous pyelonephritis (XGP), a potentially life-threatening condition. The standard of care for XGP is open nephrectomy, but recently a few case reports have been published showing the feasibility of minimally invasive surgery to deal with XGP. We present a case of HSK affected by XGP treated successfully with modified laparoscopic transperitoneal heminephrectomy. The rarity of such a combination, the modified approach, and the successful outcome encouraged us to report it.

Clinical and Radiological Predictors of Early Intervention in Acute Ureteral Colic

PURPOSE

Acute ureteric colic (AUC) is generally one of the most common reasons for emergency department attendance. Expectant management is recommended in non-complicated ureteral calculi. However, data regarding the optimal duration of observation or indications of early intervention (EI) are not well understood. This article describes the clinical and radiological factors that promote EI in AUC.

PATIENTS AND METHODS

This was an observational and retrospective cohort study. Patients with AUC diagnosed based on non-contrast computerized tomography (NCCT) between 2019 and 2020 were enrolled in the study. These patients were classified into two main categories: spontaneous passage of stone (SSP) and EI. In addition, a comparative analysis was performed to identify clinical and radiological variables that promote EI.

RESULTS

One-hundred and sixty-one patients were included. High WBCs are associated with a significant increase in EI. Forty-three percent (n=37) of patients with serum WBCs higher than 10 had an EI, while 23% had SSP (n=17;p<0.001). High CRP level is also significantly associated with EI (n=36; 86%; p<0.001). Upper and middle ureteral calculi are statistically associated with EI (n=54; 62%) in comparison to the SSP cohort (n=22; 30%;p<0.001). EI is also linked to the maximal length of ureteric calculi (MCL) of 9 mm (6-13mm), and HU density of stone of 700 (430-990) H.U (p<0.001). Ureteric stone volume of 0.2 (0.06-0.3) cm³ is significantly associated with EI (p<0.001). Ureteral wall thickness of 3 (2-3 mm), the presence of extrarenal pelvis (n=20; 23%), and AP diameter of renal pelvis 18 (13-28 mm) are all significantly associated with a higher rate of EI (p<0.001). Multiple binary logistic regression analysis showed that MCL is the strongest predictor of EI.

CONCLUSION

MCL is an independent and robust predictor of EI in AUC. Biochemical variables and radiological characteristics can also act as an adjunct to promote EI.

Global Analysis of Research Trends on Kidney Function After Nephron-Sparing Surgery: A Bibliometric and Visualised Study

BACKGROUND

Nephron-sparing surgery (NSS) for small renal masses (SRMs) is currently the standard of care to treat renal cell carcinoma (RCC). The concept of partial resection of RCC has mainly been developed to preserve kidney function. Therefore, we have performed this study to explore the research activity that has been undertaken since the early twenty-first century to investigate the advantages of NSS on preserving kidney function and preventing chronic kidney disease (CKD).

METHODS

Based on the Scopus database, this bibliometric study was used to reveal publication patterns in the kidney function and NSS research field. The data were analysed with VOSviewer version 1.6.16 software, which was used to create a network visualisation map that included research hotspots in this area.

RESULTS

A total of 449 scientific publications focused on renal function in NSS between 2001 and 2020. One hundred and seventy (38%) of the total published articles originated from the USA. Journal of Urology, European Urology, and Journal of Endourology were the top publications detailing research in this field. Half (50%) of the top 10 cited articles were published in the Journal of Urology, with an average citation of around 200 per article. The three most encountered research themes were comparative studies between partial and radical nephrectomy in terms of kidney function and development of CKD, the impact of type and duration of ischemia during resection on glomerular filtration rate (GFR) decline, and the effect of different surgical approaches on intermediate and long-term kidney function.

CONCLUSION

NSS for SRMs and RCC and its impact on kidney function is a hot topic in the literature, and the amount of published data has consistently been rising since 2000. However, even though hundreds of documents have studied this topic from various perspectives, there is a compelling need to answer several questions such as the overall survival (OS) benefit of performing NSS in localised RCC and head-to-head comparison of robotic-assisted versus laparoscopic NSS in terms of warm ischemia time and long-term decline in GFR.

An assessment of medical students' proficiency regarding the hazards of radiological examinations on the health of workers and patients: a cross-sectional study from Palestine

BACKGROUND

The use of radiological examination is increasing worldwide. Since radiation exposure can result in many health hazards, medical professionals, as well as medical students, should possess adequate knowledge regarding radiation and its related hazards to protect themselves and the patients. Many studies have assessed medical students' knowledge on this topic, but never in Palestine. In this study, we aimed to examine Palestinian medical students' awareness and knowledge regarding radiological examination modalities and their risks on themselves and their patients.

METHODS

This was an observational, cross-sectional, population-based study, conducted to assess the awareness of radiation exposure and its risks among Palestinian medical students. An online questionnaire was implemented on medical students at An-Najah National University. A total knowledge score that ranged from 0 to 22 was calculated for each participant, with higher scores indicating better knowledge regarding radiation doses and the related hazards.

RESULTS

Two hundred eighty and seven students participated in our study, with a response rate of 71%. The average knowledge score of the participants was 10.97 ± 4.31 out of a maximum of 22 points. Male participants and participants in advanced study years achieved better knowledge scores (p-values were 0.034 and < 0.001, respectively). Perceived radiology knowledge was significantly associated with the actual knowledge score among the participants (p-value< 0.001). Receiving radiology lectures in fourth and fifth years significantly affected the participants' knowledge score (p-values were < 0.001).

CONCLUSIONS

We found a severe lack of knowledge regarding radiation doses and related risks among medical students. Therefore, we recommend that medical schools update and supplement their curriculum regarding knowledge on radiation.

A study of the anatomic variations of the pancreatico-biliary system in Palestine: a national study

Background: The objective of this study is to assess the frequency of anatomic variations of the biliary system in the Palestinian population in patients undergoing MRCPs.Methods: For a period of 3 years, from March 2016 to January 2019, a total of 401 MRCPS were performed in different Palestinian Medical Centers for different indications. 346 Images were included in the study. Images were evaluated independently by two expert radiologists for the presence of variations in the anatomy of gallbladder, cystic duct, common bile duct, pancreatic duct, pancreas and intrahepatic ducts.Results: About 78% of the images had normal anatomy of Intra-hepatic ducts. Right posterior duct joining the right anterior duct by its lateral side was observed in 12.6% of images and triple confluence in 8.5% of images. About 12% of the gallbladder images have anatomical variation; multi-septate in 4.1% of images and ectopic in 3.7% images. For the cystic duct, it was abnormally low in 9.6% of images and high in 5.3% of images. The cystic duct was found parallel in 2.3% of images. Variations of the pancreatic duct were evident in 3.9% of the images.Conclusions: anatomical variations of the pancreatico-biliary system are common and they are worth the attention to prevent major complications during hepatobiliary surgeries.

The Use of Autologous 111In-Labelled Platelets and Scintigraphy to Illustrate Enhanced Platelet Activity During Erection in the Chacma Baboon

The demonstration of thrombelastographic hypercoagulability in the penile blood during erection, and the accompanying deposition of fibrin on to the endothelial layer of the deep penile artery and trabecular surface inspired this investigation of the possible role that platelets might play in the process. The blood-pooling pattern in the penis during and after erection from electro-stimulation was studied in 9 male adult baboons (Papio ursinus) using in vivo 99mTc-labelled red blood cells and scintigraphy. Platelet activity was similarly investigated after administering autologous 111In-labelled platelets to the baboons. The results indicate an enhanced platelet concentration with respect to blood-pooling during erection, and an entrapment of platelets after erection.

Radial nerve lacerations--the outcome of end-to-end repairs in penetrating trauma

Due to its mostly motor content, repair of the radial nerve is considered to yield favourable results. This is despite the fact that there are limited studies looking at the outcomes of end-to-end repair secondary to sharp penetrating trauma. We retrospectively reviewed the outcome of a series of repaired level 2 and level 3 radial nerves following penetrating stab injuries. Twenty-seven cases with adequate follow-up were included. All the patients underwent direct end-to-end repair. We evaluated the motor recovery of the target muscles using the British Medical Research Council (MRC) grading system. Wrist extension recovered in 93% of cases at a mean of six months. Finger extension recovered in 74% and thumb extension in 52% of cases within the follow-up period. We conclude that end-to-end repair is possible in the majority of level 2 and level 3 radial nerve lacerations secondary to penetrating stab injuries. Acceptable results can be expected.

A baboon model for in vivo assessment of mucociliary lung clearance

A suitable baboon model (Papio ursinus) for assessing inhibitory effects on mucociliary lung clearance was required. Clearance of various dimensions of nebulized particles (99mTc-labelled) was monitored with the animals (n = 6) under either ketamine or pentobarbitone anaesthesia. The best prospect of substantial and reproducible clearance in spite of the inhibition by the anaesthesia were obtained with pentobarbitone, and using nebulized radiolabelled particles of diameter range between 10 and 45 microns, thus avoiding trapping in the non-ciliary alveoli.

Prostaglandin E1 and papaverine: a comparative study on the ability to increase the penile bloodpool as measured by the 99mTc-penogram in the baboon model

The evaluation of arterial blood supply and venous drainage of the penis is essential in assessing the impotent male. The vaso-active drugs prostaglandin E1 and papaverine, as intracavernous injections, cause penile erections in humans by influencing the arterial blood supply and venous drainage. These drugs were used in the normal baboon and in vascular compromised baboons using a 99mTc-penogram to quantify the vascular status of the penis. Ligation of the A. Iliaca Interna was performed to change the penile blood supply, thus compromising the vascular supply. It was observed that pre- and post-operatively, the increase in the penile bloodpool was more dramatic although not significantly so (P less than 0.05), but more variable after papaverine than with prostaglandin E1. The effect was even more enhanced (P less than 0.05) in the vascular compromised baboons so that the occurrence of priapism after papaverine can speculatively not be excluded. Also the more consistent vasoactive response after prostaglandin E1 seems to establish it as the superior intracavernous injectable agent.

Quantitative evaluation of the penile vascular status by means of the 99mTc-penogram in conjunction with either papaverine or prostaglandin E1 in the anaesthetised baboon model

The evaluation of both the arterial blood supply and the venous drainage of the penis is essential in the assessment of the impotent male. The vasoactive drugs papaverine and prostaglandin E1, as intracavernous injections, cause penile erections by influencing arterial blood supply and venous drainage. These drugs were used in a baboon model together with a 99mTc-penogram to provide information on the vascular status of the penis. An increase in penile blood pool was observed, more dramatic and rapid after administration of papaverine. A quantitative assessment of the vascular status seems possible and will next be monitored in a vascular-compromised baboon for purposes of clinical application.

Investigation by scintigraphic methods of neutrophil kinetics under normal and septic shock conditions in the experimental baboon model

The purpose of this study was the correlation of neutrophil kinetics with the pathogenic course of septic shock in the baboon model. Radioactively labelled neutrophils were traced in vivo in normal baboons (n = 6) and in Escherichia coli-infected baboons, which were reinjected with labelled autologous neutrophils either 2 h after the onset of the E. coli infusion (procedure A) (n = 3) or simultaneously with the infusion (procedure B) (n = 3). Cell isolation was done according to a method developed in this laboratory. The cells were labelled with tropolonate In 111, resuspended in 1-2 ml plasma and reinjected. One-minute images were taken every 5th min and then hourly for 4 h with a gamma camera and analysed with a data processor. Time-activity curves were obtained for neutrophil washout from the lungs and neutrophil accumulation in the liver and spleen. These curves were compared for normal baboons and for those treated according to procedures A and B. A significant retention of neutrophils in the lungs of baboons with E. coli-induced septic shock was noted as well as an abnormally slow rate of accumulation in the liver and spleen. It also seems that any lung injury which could be attributed to changes in neutrophil behaviour should be traced back to events during the early exposure of neutrophils to bacterial infection.

Scintigraphic phase analysis of abnormal A-V conduction in a baboon

During an interventional cardiac investigation on an anaesthetised baboon (Papio ursinus) the animal developed A-V block. Scintigraphic phase analysis leading to quantified intraventricular delays and histogram characteristics pointed to abnormalities which persisted even after A-V block was replaced by nodal tachycardia as was reflected by the electrocardiogram. This indicated towards an increased diagnostic sensitivity with the use of phase analytical methods.

Fourier phase parameters with possible diagnostic importance as obtained from the radionuclide ventriculograms of normal baboons with and without cardiac catheterization and under prolonged anaesthesia

The possible diagnostic importance of parameters defined from radionuclide ventriculograms and Fourier phase analysis was investigated for data from normal baboons (Papio ursinus) under prolonged anaesthesia (7 hours). Of the 14 animals, 7 were studied using indwelling cardiac catheters. Phase angle differences between the electromechanical activation of the septum and left lateral wall (LLW), and again between the activation of the septum and the apex indicated no significant differences (p greater than 0.05) for the consecutive hourly values for both catheterized and non-catheterized baboons. Consequently, average values and their ranges (mean +/- 1 S.D.) were obtained for these parameters in each group, and they did not differ significantly between the two groups. As could be expected, the activation delays between the septum and LLW, and the septum and apex differed with the latter being significantly longer. The phase angle histogram parameters of atrial peak width, left ventricular plus right ventricular peak width, (LV + RV), LV-to-RV peak separation and LV-to-atrial peak separation were similarly analysed and found not to change significantly between hourly measurements or because of catheterization. Therefore mean normal values and ranges were also obtained for these parameters, possibly to serve as baselines in the diagnosis of subtle conduction pathology.

A progressive radiorenographic (99mTc-DTPA) presentation of surgically induced renal vein hypertension in baboons

A 99mTc-DTPA radiorenographic study, supported by excretory urography, blood chemistry and eventually histology was performed on 8 chacma baboons (Papio ursinus) after surgical induction of unilateral renal vein hypertension. Frequent sequential repeat renograms during 6 post-operative months detected fluctuating renal behaviour but did not reveal typical course of the disease. Neither did any one of the radiorenographic parameters (TP, T1/2, FF, relative clearances and perfusion) prove to be more sensitive than the others in detecting abnormalities. Initial microscopic or macroscopic haematuria and proteinuria in general eventually cleared up. Light microscopy demonstrated only mild abnormalities. The effects of venous occlusion of the kidney and the prognosis seemed to be variable as was reflected by radiorenography.

Scintigraphic Phase Analysis of Abnormal A-V Conduction in a Baboon

During an interventional cardiac investigation on an anaesthetised baboon (Papio ursinus) the animal developed A-V block. Scintigraphic phase analysis leading to quantified intraventricular delays and histogram characteristics pointed to abnormalities which persisted even after A-V block was replaced by nodal tachycardia as was reflected by the electrocardiogram. This indicated towards an increased diagnostic sensitivity with the use of phase analytical methods.

Phase mapping from left ventricular radionuclide ventriculograms: interobserver reliability and accuracy of the programme

Phase analysis of data from radionuclide ventriculograms is known to provide space-time information on the mechanical emptying of pixels located in the ventricular regions. It could therefore perhaps be useful for detecting abnormal sequences of contraction of the ventricles as well as to localize sites of premature electromechanical action. The phase programme used in this investigation is designed to trace the electromechanical action of the ventricles from colour-coded phase images (first harmonic Fourier transform), not only visually from a cinematic representation, but particularly from a data output of x, y coordinates and phase angles of sites chosen as they empty in the ventricular regions. Six healthy baboons were subjected to conventional radionuclide ventriculography, performed hourly for the duration of 11 h under anaesthesia. The programme was used by two independent observers to map the progression of emptying for each of the thus acquired 66 left ventricular phase images. The interobserver reliability and the accuracy achieved in mapping normal contraction patterns was found to be good. Abnormalities which appeared during the prolonged anaesthesia and which were confirmed with 12 lead electrocardiography were likewise detected consistently.

The effect of an oral gold preparation on the gastrointestinal tract motility in two species of experimental animals

The oral gold preparation, auranofin, used in rheumatoid arthritis has been reputed to cause chronic diarrhea. To investigate this the G.I. tract motility was measured before auranofin therapy and after 1, 3, and 5 weeks of therapy using scintigraphy following indium-111-labeled meals in three beagle dogs. The gastric emptying times of the dogs accelerated throughout the duration of the experiment, although the large bowel transit times did not seem to be affected. The affect of auranofin on the stools of the baboon Papio ursinus was also noted. The baboon stools were observed for any change in consistency. Sigmoidoscopic examination including mucosal biopsies was carried out monthly over a 6-month period. The baboon's stools were noted to become very soft in consistency, but histology indicated no mucosal changes.

The sensitivity of radionuclide and thermodilution techniques to detect cardiac dysfunction in the baboon model during prolonged anaesthesia

This study was undertaken to evaluate the fluctuations of cardiac parameters in a baboon model during pentobarbitone anaesthesia which will serve as a baseline control for shock studies. Thermodilution and radionuclide methods were used to determine cardiac parameters. Radionuclide studies were repeated without any cardiac catheters to assess the effect of these on cardiac performance. The results represent baseline fluctuations in cardiac parameters against which cardiac dysfunction can be diagnosed in shock studies. The results also indicate that cardiac catheterisation does not affect cardiac performance significantly.

The Sensitivity of Radionuclide and Thermodilution Techniques to Detect Cardiac Dysfunction in the Baboon Model During Prolonged Anaesthesia

This study was undertaken to evaluate the fluctuations of cardiac parameters in a baboon model during pentobarbitone anaesthesia which will serve as a baseline control for shock studies. Thermodilution and radionuclide methods were used to determine cardiac parameters. Radionuclide studies were repeated without any cardiac catheters to assess the effect of these on cardiac performance. The results represent baseline fluctuations in cardiac parameters against which cardiac dysfunction can be diagnosed in shock studies. The results also indicate that cardiac catheterisation does not affect cardiac performance significantly.

Entrapment of platelets in the penis during and after erection

Because of the development of hypercoagulability and the deposition of fibrin in the penis during erection a study of the possible role of platelets in this process was undertaken. Platelet response was studied in 9 adult chacma baboons (Papio ursinus) using autologous in vitro indium-111-labelled platelets and sequential scintigraphy of the penis during erection. The blood pooling pattern was obtained using in vivo technetium-99m-labelled red cells in a similar investigation. A statistically significant retention of platelets occurred during and after erection, which could not be attributed to blood pooling (P less than 0,05). Entrapment of platelets could lead to enhanced activity and activation, and might play a significant role in hypercoagulability and fibrin deposition during erection. Therefore platelets could be an important factor in the pathogenesis of ageing impotence.

A comparison of 111In-labelled polymer beads and 99mTc-Sn-colloid as solid food and semi-solid food tracers for scintigraphic gastric emptying studies

In order to establish the efficacy of labelling a solid meal and a semi-solid meal with either 111In-labelled polymer beads or 99mTc-tin colloid beagle dogs were fed variously labelled meals of different consistencies and then monitored by scintigraphy for gastric motility patterns. The labelling with each tracer was either performed by thoroughly mixing it into the food before cooking, or alternatively by surface labelling after the food had been cooked. For the 99mTc-Sn-colloid tracer no difference was found in the measured gastric emptying times resulting from either pre-cooking labelling or surface labelling of the meals. Cooking the tracer together with the ingredients does however seem to promote a firm entrapment of the 111In-polymer beads into a solid protein, and in this manner the 111In-labelled resin appears to be a reliable solid food tracer. Surface labelling with 111In-polymer beads of a solid meal with a smooth texture fails totally and the tracer empties with the liquid phase.

The detection and evaluation of drug-induced changes in the gastrointestinal motility of beagle dogs using a 111In-labelled resin mixed into a standard meal as tracer

An investigation was performed to establish the usefulness of 111In-labelled polymer beads mixed into a standard meal as a tracer of gastrointestinal(GI)-motility changes due to the influence of various drugs. The labelled polymer beads were well mixed into the food, which was then fed to healthy beagle dogs undergoing drug therapy. GI motility was monitored using a gamma camera and data processor. The results were compared to those obtained from corresponding placebo studies on the same dogs. A significant acceleration of gastric emptying and colon transit was noted under the influence of a gastric and intestinal prokinetic coded R51619. No influence on GI motility could, however, be detected after the administration of a calcium-blocking agent to the dogs.

The use of autologous 111In-labelled platelets and scintigraphy to illustrate enhanced platelet activity during erection in the chacma baboon

The demonstration of thrombelastographic hypercoagulability in the penile blood during erection, and the accompanying deposition of fibrin onto the endothelial layer of the deep penile artery and trabecular surface inspired this investigation of the possible role that platelets might play in the process. The bloodpooling pattern in the penis during and after erection from electro-stimulation was studied in 9 male adult baboons (Papio ursinus) using in vivo 99mTc-labelled red blood cells and scintigraphy. Platelet activity was similarly investigated after administering autologous 111In-labelled platelets to the baboons. The results indicate an enhanced platelet concentration with respect to bloodpooling during erection, and an entrapment of platelets after erection.

Detection of abscesses and lymphosarcoma with 111In-deferoxamine mesylate

Indium-111 deferoxamine was used to delineate induced abscesses or different ages in a baboon, and lymph nodes in a case of canine spontaneous lymphosarcoma, by means of gamma-scintigraphy. Positive results were obtained already 1 hr after administration of the scanning agent, and the lesion-to-background ratio improved progressively with time. The tissue distribution of the radiopharmaceutical was determined in rats, and showed a relatively high isotope retention in the kidneys.

Detection of Abscesses and Lymphosarcoma with 111In-Deferoxamine Mesylate

Indium-111-deferoxamin wurde zum Nachweis sowohl induzierter Abszesse unterschiedlichen Alters in einem Pavian als auch der Lymphknoten in einem Fall von spontanem Lymphosarkom bei Hunden mittels Gamma-Szintigraphie nachzuweisen. Positive Resultate wurden bereits 1 Std. nach der Verabreichung erzielt; das Verhältnis von Target zu Hintergrund verbesserte sich ständig im Laufe der Zeit. Die Gewebeverteilung des Radiopharmakons wurde bei Ratten bestimmt und eine relativ hohe Isotopenkonzentration in den Nieren beobachtet.

In vivo nuclear techniques in veterinary medicine

A description is given of the more relevant procedures of diagnostic nuclear medicine as well as of future trends in this field, especially with regard to in vivo research and clinical applications at the biochemical level. The part played by animal models in the past and present is emphasised. The inclusion of a nuclear medicine facility, as equipped and run by the Atomic Energy Board at the H.A. Grové Animal Research Centre is put into perspective.