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Atilano Carvalho P, Fradet J, Oliveira F, Charpail C, Guillo S. Searching for an Endoscopic All-Inside Classic Broström-Gould Technique. Arthrosc Tech 2022; 11:e697-e703. [PMID: 35493053 PMCID: PMC9052146 DOI: 10.1016/j.eats.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023] Open
Abstract
Ankle sprains represent one of the most common injuries sustained by professional and recreational athletes. For those who develop chronic instability requiring surgery, the Broström-Gould procedure has been advocated as the gold standard treatment. Many arthroscopic techniques have been developed in the attempt to replicate this procedure. However, since both calcaneofibular ligament and inferior extensor retinaculum are extra-capsular structures, some of these techniques include a stand-alone repair of the anterior talofibular ligament, while others add a mini-open or a percutaneous modification to perform the Gould augmentation. In our technique, lateral ankle endoscopy provides a clear view and access to these structures, allowing for an all-inside Broström-Gould using three portals. The procedure is safe and reproducible, resulting in a repair that mostly resembles the classical open technique.
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Affiliation(s)
- Pedro Atilano Carvalho
- SOS Pied Cheville Bordeaux-Mérignac, Clinique du Sport, Bordeaux-Mérignac, France
- Department of Orthopaedics and Traumatology, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
- Address correspondence to Pedro Atilano Carvalho, M.D., Department of Orthopaedics and Traumatology, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
| | - Juliette Fradet
- SOS Pied Cheville Bordeaux-Mérignac, Clinique du Sport, Bordeaux-Mérignac, France
| | - Filipa Oliveira
- SOS Pied Cheville Bordeaux-Mérignac, Clinique du Sport, Bordeaux-Mérignac, France
- Department of Orthopaedics and Traumatology, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Christel Charpail
- SOS Pied Cheville Bordeaux-Mérignac, Clinique du Sport, Bordeaux-Mérignac, France
| | - Stéphane Guillo
- SOS Pied Cheville Bordeaux-Mérignac, Clinique du Sport, Bordeaux-Mérignac, France
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Pires FP, Monteiro EL, Oliveira F, Carvalho PA, Teixeira JP, Miranda A. Traumatic Isolated Thumb Carpometacarpal Joint Dislocation - Report of Two Clinical Cases. Rev Bras Ortop 2021; 56:528-532. [PMID: 34483399 PMCID: PMC8405268 DOI: 10.1055/s-0040-1702950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022] Open
Abstract
Isolated thumb carpometacarpal joint dislocation is a rare lesion that accounts for less than 1% of all hand lesions. The authors present two cases of traumatic isolated thumb carpometacarpal joint dislocation. One of them was treated with closed reduction and cast immobilization, and the other was treated with closed reduction, Kirschner-wires pinning, and cast immobilization. The first patient had a good functional outcome and showed no signs of thumb carpometacarpal instability. The patient treated with Kirschner wires presented signs of clinical instability and radiological subluxation. Isolated thumb carpometacarpal dislocation is a rare lesion that can cause joint instability, which interferes with the normal function of the hand and can lead to articular degenerative changes. The best management of this lesion is still controversial, since there is lack of evidence in the literature showing superiority of one treatment over the other.
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Affiliation(s)
| | | | - Filipa Oliveira
- Centro Hospitalar de Entre Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
| | | | - João Pedro Teixeira
- Centro Hospitalar de Entre Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
| | - António Miranda
- Centro Hospitalar de Entre Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
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Atilano Carvalho P, Teixeira J, Oliveira F, Carvalho MS, Gomes M, Torres A. Tratamento artroscópico da doença de Freiberg – Relato de caso. Rev Bras Ortop 2020; 57:891-895. [PMID: 36226204 PMCID: PMC9550363 DOI: 10.1055/s-0040-1701282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022] Open
Abstract
Freiberg disease is a rare condition whose diagnosis requires a high clinical suspicion. Avascular necrosis of the metatarsal head progresses with articular collapse, leading to forefoot pain and limitation of the daily activities. Several surgical techniques have been described to address the disease, and since it is usually diagnosed in later-stages, most of them include joint-destructive procedures. The use of arthroscopy on the small joint of the foot has arisen in the last few years, but its application in Freiberg disease is still scant. Joint-preserving procedures have been advocated for cases of early-stage disease, aiming to relieve symptoms while preventing the progression of the disease. In the present report, we describe a successful treatment of a 12-year-old patient with early-stage Freiberg disease using core decompression and bone marrow graft through a minimally-invasive approach assisted by arthroscopy.
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Affiliation(s)
| | - João Teixeira
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Filipa Oliveira
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Marta Gomes
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - António Torres
- Serviço de Ortopedia e Traumatologia, Hospital CUF Porto, Porto, Portugal
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Atilano Carvalho P, Monteiro A, Almeida B, Correia FH, Resende V, Nunes C, Lopes S. [The Epidemiological Profile of the Isolation of 'Problem' Microorganisms]. ACTA MEDICA PORT 2019; 32:600-605. [PMID: 31493364 DOI: 10.20344/amp.10838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 04/23/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Infections are a major problem and the presence of drug-resistant microorganisms has significant clinical and economic impact. The present study aims to evaluate the epidemiological profile of "problem" microorganisms isolated in a hospital in the north of Portugal. MATERIAL AND METHODS All isolated microorganisms were analyzed, between January 2014 and June 2015. Data obtained was then processed using statistical software. RESULTS We analyzed 8146 microbiological isolations and found a prevalence of 23% of 'problem' microorganisms (in descending order of frequency: Enterococcus, Pseudomonas, Staphylococcus aureus e Streptococcus pneumonia), 57.55% of which isolated in male patients. The most frequent mechanism of drug resistance for the overall sample was the production of extended-spectrum beta-lactamase, and resistance to oxacillin for 'problem' microorganisms. DISCUSSION In this sample, we observed a much higher prevalence of 'problem' microorganisms than that reported in other countries, which shows the need of improvement of surveillance mechanisms and treatment of these cases. Microorganisms that showed higher resistance were Staphylococcus aureus (resistant to oxacillin) and Enterococcus (resistant to vancomycin). Those were isolated in patients with a higher mean age compared to non-resistant microorganisms. Most of these microorganisms were isolated in hospitalized patients or intermediate and intensive care units, what relates them with healthcare associated infections. CONCLUSION The prevalence of infection by 'problem' microorganisms during the studied period was 23%. The detection and control of the spread of these microorganisms are paramount due to its impact on health costs, morbidity and survival of patients.
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Affiliation(s)
- Pedro Atilano Carvalho
- Serviço de Ortopedia. Centro Hospitalar de Entre o Douro e Vouga. Santa Maria da Feira. Portugal
| | - Ana Monteiro
- Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Bruno Almeida
- Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | | | - Vera Resende
- Serviço de Ortopedia. Centro Hospitalar de Entre o Douro e Vouga. Santa Maria da Feira. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Sílvia Lopes
- Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
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Guerreiro F, Dias M, Galatanu A, Correia JB, Alves E, Carvalho PA. W-Ta Composites Consolidated by Spark Plasma Sintering. Microsc Microanal 2015; 21 Suppl 5:27-28. [PMID: 26227694 DOI: 10.1017/s143192761501394x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- F Guerreiro
- 1Instituto de Plasmas e Fusão Nuclear,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais,1049-001,Lisboa,Portugal
| | - M Dias
- 1Instituto de Plasmas e Fusão Nuclear,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais,1049-001,Lisboa,Portugal
| | - A Galatanu
- 2National Institute of Materials Physics,Atomistilor Str.105bis,PO Box MG7,Magurele,Bucharest,Romania
| | - J B Correia
- 3LNEG,Laboratório Nacional de Energia e Geologia,Estrada do Paço do Lumiar,1649-038 Lisboa,Portugal
| | - E Alves
- 1Instituto de Plasmas e Fusão Nuclear,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais,1049-001,Lisboa,Portugal
| | - P A Carvalho
- 1Instituto de Plasmas e Fusão Nuclear,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais,1049-001,Lisboa,Portugal
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Gomes JF, Miranda RM, Santos TJ, Carvalho PA. Emission of nanoparticles during friction stir welding (FSW) of aluminium alloys. J Toxicol Environ Health A 2014; 77:924-930. [PMID: 25072724 DOI: 10.1080/15287394.2014.911132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Friction stir welding (FSW) is now well established as a welding process capable of joining some different types of metallic materials, as it was (1) found to be a reliable and economical way of producing high quality welds, and (2) considered a "clean" welding process that does not involve fusion of metal, as is the case with other traditional welding processes. The aim of this study was to determine whether the emission of particles during FSW in the nanorange of the most commonly used aluminum (Al) alloys, AA 5083 and AA 6082, originated from the Al alloy itself due to friction of the welding tool against the item that was being welded. Another goal was to measure Al alloys in the alveolar deposited surface area during FSW. Nanoparticles dimensions were predominantly in the 40- and 70-nm range. This study demonstrated that microparticles were also emitted during FSW but due to tool wear. However, the biological relevance and toxic manifestations of these microparticles remain to be determined.
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Affiliation(s)
- J F Gomes
- a ISEL-Instituto Superior de Engenharia de Lisboa , Área Departamental de Engenharia Química , Lisboa , Portugal
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Schwartz RB, Holman BL, Polak JF, Garada BM, Schwartz MS, Folkerth R, Carvalho PA, Loeffler JS, Shrieve DC, Black PM, Alexander E. Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy. J Neurosurg 1998; 89:60-8. [PMID: 9647173 DOI: 10.3171/jns.1998.89.1.0060] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. METHODS Studies in which SPECT with 201Tl and 99mTc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99mTc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan-Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I (201Tl ratio < 2 and 99mTc-HMPAO ratio < 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients (201Tl ratio < 2 and 99mTc-HMPAO ratio of > or = 0.5 or 201Tl ratio between 2 and 3.5 regardless of 99mTc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III (201Tl ratio > 3.5 and 99mTc-HMPAO ratio > or = 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p < 0.01): however, SPECT grouping was more closely associated with 1-year survival (p < 0.001) and was the only variable significantly associated with long-term survival (p < 0.005). CONCLUSIONS Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.
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Affiliation(s)
- R B Schwartz
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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dos Santos JL, da Silveira TR, Almeida H, Carvalho PA, Cerski CT. [Neonatal cholestasis: the delay in referring patients for differential diagnosis]. J Pediatr (Rio J) 1997; 73:32-6. [PMID: 14685435 DOI: 10.2223/jped.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE An efficient treatment of extrahepatic biliary atresia demands that the diagnostic differentiation between intra- and extrahepatic neonatal cholestasis be performed by the eighth week of life. This study aimed at evaluate the age of the patients admitted to a general hospital for differential diagnosis of cholestatic jaundice. METHODS Forty nine children from the Pediatric Service at Hospital de Clínicas, in Porto Alegre, have been studied between 1984 and 1991, according to the protocol for diagnostic elucidation followed by this hospital, which includes biliary tract scintigraphy with Tc-99m DISIDA and, depending on its results, an wedge or percutaneous liver biopsy. The ages of the children have been compared on the occasion of the procedures. Twenty six cases have been studied retrospectively and 23, prospectively. RESULTS Both the patients with intrahepatic and extrahepatic cholestasis underwent scintigraphy, on average at over eight weeks (age 77.94 +/- 42.98 days) and the histopathological study of the liver was performed approximately two weeks after scintigraphy. Only six patients (12.8% of the 47 cases) underwent the liver biopsy before the first eighth week of life. CONCLUSIONS A delay was observed in referring patients for differential diagnosis of neonatal cholestasis and the performance of tests. The need of hospitalization in order to conduct these procedures delays even further this diagnosis, which should be concluded by the eighth week of life.
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Affiliation(s)
- J L dos Santos
- Universidade Federal do Rio Grande do Sul, Pediatra do Hospital de Clínicas de Porto Alegre
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Kassis AI, Tumeh SS, Wen PY, Baranowska-Kortylewicz J, Van den Abbeele AD, Zimmerman RE, Carvalho PA, Garada BM, DeSisto WC, Bailey NO, Castronovo FP, Mariani G, Black PM, Adelstein SJ. Intratumoral administration of 5-[123I]iodo-2'-deoxyuridine in a patient with a brain tumor. J Nucl Med 1996; 37:19S-22S. [PMID: 8676198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED We have initiated a study in which patients suspected of having primary gliomas are given a single intracerebral injection of the thymidine analog 5-[123I]iodo-2'-deoxyuridine ([123I]IUdR). The purpose of the study is to determine the biodistribution of the radiopharmaceutical and to calculate dose estimates to the tumor and normal tissues. METHODS A patient with a cystic glioma was injected with [123I]IUdR. Whole-body scans and brain scans were obtained at various times after injection, and blood, urine and stools were collected and assayed for radioactivity to assess its biodistribution and clearance. RESULTS Scintigraphic imaging demonstrated that the distribution of radiolabeled IUdR was mainly confined to the tumor (injection site), stomach and bladder. Disappearance from the tumor site and blood clearance were delayed probably due to collection in the cystic lesion. Eighty percent of the injected dose was recovered in the urine. CONCLUSION The pharmacokinetics of [123I]IUdR locoregionally administered to a human glioma in situ resembled those observed in a rat glioma model where administration of the radiopharmaceutical radiolabeled with the Auger electron emitter 125I was therapeutically effective.
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Affiliation(s)
- A I Kassis
- Harvard Medical School, Boston, Massachusetts, USA
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Janicek MJ, Schwartz RB, Carvalho PA, Garada B, Holman BL. Tc-99m HMPAO brain perfusion SPECT in acute aphasia. Correlation with clinical and structural findings. Clin Nucl Med 1993; 18:1032-8. [PMID: 8293621 DOI: 10.1097/00003072-199312000-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Tc-99m hexamethylpropylene amineoxime (HMPAO) brain perfusion SPECT was correlated with CT, MRI, and clinical findings in 17 patients with acute and subacute aphasia to determine its diagnostic potential in the early phases of stroke-associated language dysfunction. SPECT was performed using a dedicated brain imaging system after intravenous injection of 20 mCi (740 MBq) of Tc-99m HMPAO. Transaxial and three-dimensional surface rendered images were evaluated visually, and perfusion defects were correlated with CT, MRI, and a standard battery of clinical tests for aphasia. Clinical examination was insufficient for anatomic localization of aphasia in more than 40% of patients. CT exams were normal in 5 patients, although SPECT demonstrated perfusion defects in all 17. Nonfluent aphasia was present in only 6 of 10 patients with perfusion defects in Broca's area and fluent aphasia was present in only 5 of 10 patients with lesions in Wernicke's area. Auditory comprehension defect was associated with perfusion defects in the inferior parietal region in 9 of 12 patients (P = 0.05); reading and writing abnormalities were associated with perfusion defects in the posterior frontal, superior and inferior parietal cortex, and superior temporal gyri, and repetition deficit was associated with defects involving the inferior parietal cortex, the supramarginal and angular gyri, and the ipsilateral thalamus in 8 of 11 patients (P < 0.05). Brain perfusion SPECT should be included in the initial evaluation of aphasic patients, because clinical tests of aphasia and morphological imaging have limited value for accurately determining the extent and location of functional deficits.
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Affiliation(s)
- M J Janicek
- Department of Radiology, Brigham & Women's Hospital, Boston, MA 02115
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11
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Alexander E, Loeffler JS, Schwartz RB, Johnson KA, Carvalho PA, Garada BM, Zimmerman RE, Holman BL. Thallium-201 technetium-99m HMPAO single-photon emission computed tomography (SPECT) imaging for guiding stereotactic craniotomies in heavily irradiated malignant glioma patients. Acta Neurochir (Wien) 1993; 122:215-7. [PMID: 8372710 DOI: 10.1007/bf01405531] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
SPECT scanning with Tl-201 and Tc-99m offers a unique, inexpensive functional imaging modality to combine with CT stereotactic craniotomy for guiding resection of necrosis and/or tumour in patients treated with escalated doses of radiation (> 6000 cGy) by either brachytherapy or radiosurgery. Thirty-two cases were analyzed, with a detailed description of the imaging and operative techniques.
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Affiliation(s)
- E Alexander
- Department of Surgery (Neurosurgery), Harvard Medical School, Brigham and Women's Hospital, Boston, Massechusetts
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12
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Carvalho PA, Schwartz RB, Alexander E, Garada BM, Zimmerman RE, Loeffler JS, Holman BL. Detection of recurrent gliomas with quantitative thallium-201/technetium-99m HMPAO single-photon emission computerized tomography. J Neurosurg 1992; 77:565-70. [PMID: 1527616 DOI: 10.3171/jns.1992.77.4.0565] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Deteriorating clinical status after high-dose radiation therapy for high-grade gliomas may be due to radiation changes or may signal recurrent or residual tumor mass. The two conditions cannot be distinguished reliably by computerized tomography (CT) or magnetic resonance (MR) imaging. The authors assessed the ability of sequential thallium-201 chloride (201Tl) and technetium-99m hexamethylpropylene amine oxime (99mTc HMPAO) single-photon emission CT (SPECT) to distinguish tumor recurrence from radiation changes after high-dose (greater than or equal to 600 cGy) radiation therapy for malignant gliomas. Preoperative tumor/nontumor uptake ratios were analyzed in 32 patients and correlated with the presence of gross tumor at the time of reoperation. In 12 of 13 patients with 201Tl tumor/scalp ratios of 3.5 or greater, recurrent tumor was present. The authors found 99mTc HMPAO SPECT to be useful for identifying the absence of solid tumor recurrence in patients with low to moderate 201Tl uptake (ratio 1.1 to 3.4) and low perfusion to that site. In 11 of 12 patients with 99mTc HMPAO tumor/cerebellum ratios of 0.50 or less, no recurrent tumor mass was present. Three of seven patients with 201Tl ratios of 3.4 or less and 99mTc HMPAO ratios of 0.51 or more had recurrent tumor found at surgery; thus the test was not predictive in this group. It is concluded that the use of sequential 201Tl and 99mTc HMPAO SPECT accurately identifies the presence of tumor recurrence versus radiation changes in most patients with high-grade astrocytomas who have undergone tumor resection and high-dose radiation therapy.
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Affiliation(s)
- P A Carvalho
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Carvalho PA, Chiu ML, Kronauge JF, Kawamura M, Jones AG, Holman BL, Piwnica-Worms D. Subcellular distribution and analysis of technetium-99m-MIBI in isolated perfused rat hearts. J Nucl Med 1992; 33:1516-22. [PMID: 1634944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To address the apparent discrepancy between cultured cells and whole heart preparations, Langendorff-perfused rat hearts loaded with hexakis (2-methoxyisobutyl isonitrile) technetium (I) (99mTc-MIBI) were fractionated by a standard differential centrifugation method and fractional contents of 99mTc-MIBI were correlated with the mitochondrial marker, malate dehydrogenase (MDH), and mitochondrial substrates. The "cytosolic" fraction nominally contained 89% +/- 3% of total 99mTc-MIBI, but also contained 91% +/- 1% of total MDH activity by this method. Chromatographic analysis of activity in the "cytosolic" fraction demonstrated greater than 95% of the agent was present as the original free cationic complex; binding to a small molecular weight cytosolic protein was not involved in localization. Addition of the mitochondrial uncoupler CCCP (5 microM) to both "mitochondrial" and "cell fragment" pellets released up to 84% +/- 8% of 99mTc-MIBI content and addition of the mitochondrial substrate succinate (10 microM) in the presence of rotenone (1 microM) enhanced 99mTc-MIBI content by up to 139% +/- 52% over the control. These correlative data from rat hearts indicate that approximately 90% of 99mTc-MIBI activity in vivo is associated with mitochondria in an energy-dependent manner as a free cationic complex, but migrates during fractionation/centrifugation.
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Affiliation(s)
- P A Carvalho
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A. The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium-99m-HMPAO SPECT. J Nucl Med 1992; 33:181-5. [PMID: 1732438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Alzheimer's disease produces regional abnormalities in brain blood flow and metabolism that may result in recognizable scintigraphic patterns. We determined the predictive value of 99mTc-HMPAO SPECT for the presence of Alzheimer's disease based on a prospective study of 132 consecutive patients coming to our nuclear medicine clinical unit for evaluation of their memory loss or cognitive abnormalities. During clinical follow-up averaging 10.1 mo, a final diagnosis was established in 113 patients, 52 of which had Alzheimer's disease. The probability of Alzheimer's disease was determined for seven scintigraphic patterns. The probability was 19% that patients with memory loss and normal perfusion had Alzheimer's disease. For abnormal perfusion patterns, the probability of Alzheimer's disease was 82% with bilateral temporoparietal defects, 77% with bilateral temporoparietal defects with additional defects, 57% with unilateral temporoparietal defects, 43% with frontal defects only, 18% with other large defects and 0% with multiple small cortical defects. We conclude that for 99mTc-HMPAO SPECT the predictive value of bilateral temporoparietal defects for Alzheimer's disease is high, while the perfusion patterns of unilateral temporoparietal perfusion defects and frontal defects only, which occur in 20% of patients with Alzheimer's disease, are not predictive of that disease.
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Affiliation(s)
- B L Holman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115
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Abstract
We treated a 62-year-old woman who developed a dramatic change in personality and behavior following a discrete left-sided medial thalamic infarction involving the dorsomedial nucleus. Neuropsychological testing demonstrated severe impairment of complex executive behaviors that are usually associated with frontal lobe function. Electroencephalography and single-photon emission computed tomography strongly implicated dysfunction of the ipsilateral frontal lobe. This case further supports a functional and physiologic thalamofrontal linkage as part of a broader cerebral network modulating complex human behavior.
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Affiliation(s)
- T A Sandson
- Behavioral Neurology Unit, Beth Israel Hospital, Boston, MA 02215
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16
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Carvalho PA, Vekshtein VI, Tumeh SS, Alajaji G, Nagel JS, Kirshenbaum J, DeSisto WC, Holman BL. Tc-99m MIBI SPECT in the assessment of myocardial reperfusion after percutaneous transluminal coronary angioplasty. Clin Nucl Med 1991; 16:819-25. [PMID: 1752091 DOI: 10.1097/00003072-199111000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tc-99m MIBI SPECT was used to assess the early benefits of successful percutaneous transluminal coronary angioplasty (PTCA) in nine consecutive patients. SPECT stress studies were done by artificial cardiac pacing just prior to PTCA and 16-20 hours later, with perfusion images obtained 2-3 hours after pacing stress and Tc-99m MIBI injection. Angiographic restenosis was demonstrated in three patients at a later date, and all of these showed no significant improvement on the perfusion study after PTCA. All four patients asymptomatic at 7 months following PTCA had an average 15% improvement in segmental perfusion after the procedure. In two patients symptomatic after PTCA, one showed angiographic patency and had greater than 15% improvement in perfusion, while the second showed no scintigraphic improvement (no angiographic data obtained). This preliminary study suggests that Tc-99m MIBI is an important adjunct to angiography in estimating the amount of myocardium "at risk" before and after PTCA.
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Affiliation(s)
- P A Carvalho
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115
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17
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Holman BL, Zimmerman RE, Johnson KA, Carvalho PA, Schwartz RB, Loeffler JS, Alexander E, Pelizzari CA, Chen GT. Computer-assisted superimposition of magnetic resonance and high-resolution technetium-99m-HMPAO and thallium-201 SPECT images of the brain. J Nucl Med 1991; 32:1478-84. [PMID: 1869966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A method for registering three-dimensional CT, MR, and PET data sets that require no special patient immobilization or other precise positioning measures was adapted to high-resolution SPECT and MRI and was applied in 14 subjects (five normal volunteers, four patients with dementia (Alzheimer's disease), two patients with recurrent glioblastoma, and three patients with focal lesions (stroke, arachnoid cyst and head trauma]. T2-weighted axial magnetic resonance images and transaxial 99mTc-HMPAO and 201Tl images acquired with an annular gamma camera were merged using an objective registration (translation, rotation and rescaling) program. In the normal subjects and patients with dementia and focal lesions, focal areas of high uptake corresponded to gray matter structures. Focal lesions observed on MRI corresponded to perfusion defects on SPECT. In the patients who had undergone surgical resection of glioblastoma followed by interstitial brachytherapy, increased 201Tl corresponding to recurrent tumor could be localized from the superimposed images. The method was evaluated by measuring the residuals in all subjects and translational errors due to superimposition of deep structures in the 12 subjects with normal thalamic anatomy and 99mTc-HMPAO uptake. This method for superimposing magnetic resonance and high-resolution SPECT images of the brain is a useful technique for correlating regional function with brain anatomy.
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Affiliation(s)
- B L Holman
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115
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18
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Holman BL, Carvalho PA, Mendelson J, Teoh SK, Nardin R, Hallgring E, Hebben N, Johnson KA. Brain perfusion is abnormal in cocaine-dependent polydrug users: a study using technetium-99m-HMPAO and ASPECT. J Nucl Med 1991; 32:1206-10. [PMID: 2045934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Cocaine abuse is widespread and has been associated with serious neurovascular complications. We studied a group of cocaine-dependent polydrug users with 99mTc-HMPAO and high-resolution SPECT and compared their perfusion pattern to cerebral perfusion in a group of older control subjects. Sixteen of 18 cocaine-dependent polydrug users had abnormal perfusion characterized primarily as small focal defects involving inferoparietal, temporal, and anterofrontal cortex and basal ganglia. Psychometric testing was abnormal in all 18 cocaine-dependent subjects. No relation was found between the severity of SPECT abnormalities and mode of administration or frequency or length of cocaine use. All 15 older normal subjects had normal cerebral perfusion. While the focal perfusion abnormalities to the cortex and basal ganglia could be explained by the profound vasoconstrictor effects of cocaine, the combinational use of multiple substances including cannabis and alcohol may play a contributory role. This study documents the high incidence of functional brain abnormalities in cocaine-dependent chronic polydrug users without corresponding abnormalities on imaging studies of cerebral anatomy and morphology.
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Affiliation(s)
- B L Holman
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115
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19
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Carvalho PA, Schwartz RB, Alexander E, Loeffler JS, Zimmerman RE, Nagel JS, Holman BL. Extracranial metastatic glioblastoma: appearance on thallium-201-chloride/technetium-99m-HMPAO SPECT images. J Nucl Med 1991; 32:322-4. [PMID: 1846913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Sequential thallium-201-chloride and technetium-99m-hexamethylpropyleneamine oxime single-photon emission computed tomography (SPECT) images were obtained in a patient with extracranial metastatic glioblastoma multiforme. Thallium-201 uptake was high (three times the scalp background) in all pathologically confirmed extracranial metastases and moderate (1.6 times scalp background) intracranially, where most biopsy specimens showed gliosis with scattered atypical astrocytes. Technetium-99m-HMPAO uptake was decreased intracranially in the right frontal and parietal lobes which had been irradiated. It was also decreased in one well-encapsulated scalp lesion and high in another scalp mass with less defined borders. Possible mechanisms of tumor uptake of these agents are reviewed.
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Affiliation(s)
- P A Carvalho
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115
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20
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Schwartz RB, Carvalho PA, Alexander E, Loeffler JS, Folkerth R, Holman BL. Radiation necrosis vs high-grade recurrent glioma: differentiation by using dual-isotope SPECT with 201TI and 99mTc-HMPAO. AJNR Am J Neuroradiol 1991; 12:1187-92. [PMID: 1763749 PMCID: PMC8331462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Conventional imaging techniques are often unreliable in distinguishing between radiation necrosis and recurrent glioma in patients who are symptomatic after high-dose radiotherapy. We performed dual-isotope single-photon emission computed tomography (SPECT) with the use of thallium-201 (201TI) and the perfusion agent 99mTc-hexamethyl-propyleneamine oxime (HMPAO) to aid in this differentiation in 15 patients with glioma prior to biopsy. We found that dual-isotope SPECT scanning correlated with the pathologic findings in 14 of the 15 cases. All patients with high 201TI uptake in their treated tumor beds had local tumor recurrence, and all patients with low 201TI uptake showed only radiation changes without evidence of solid tumor. In patients with an intermediate level of 201TI concentration in their tumor bed, 99mTc-HMPAO uptake differentiated those patients with active tumor from those without; three of four patients with preserved or increased perfusion had pathologic evidence of solid tumor, whereas none of the four patients with decreased perfusion to the tumor bed had evidence of local recurrence. We believe that dual-isotope SPECT with 201TI and 99mTc-HMPAO may be useful in differentiating sites of likely tumor growth from nonspecific radiation changes in patients treated for malignant glioma.
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Affiliation(s)
- R B Schwartz
- Department of Radiology, Harvard Medical School, Boston, MA
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21
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Tumeh SS, Carvalho PA, van den Abbeele AD, Maguire JH, Rauh DA, Neptune M, Kassis AI. Detection of focal infection by 111In-human polyclonal IgG. J Nucl Biol Med (1991) 1991; 35:4-9. [PMID: 1932174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Eleven patients with suspected foci of inflammation and/or infection were scanned with 111In-labeled polyclonal human IgG. Seven patients were suspected of having the source of their infection in the abdomen, three in the musculoskeletal system and one in the thoracic aorta. The test was truly positive in seven patients, truly negative in three and falsely negative in one. All the true positive cases showed abnormally increased radiopharmaceutical uptake at the site of infection by six hours, suggesting the diagnosis, although the intensity of uptake increased progressively 24 hours later. There were no untoward effects noted in this series. This examination is potentially useful in the early depiction of focal sources of infection/inflammation.
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Affiliation(s)
- S S Tumeh
- Department of Radiology, Brigham & Women's Hospital, Boston, Massachusetts 02115
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22
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Holman BL, Carvalho PA, Zimmerman RE, Johnson KA, Tumeh SS, Smith AP, Genna S. Brain perfusion SPECT using an annular single crystal camera: initial clinical experience. J Nucl Med 1990; 31:1456-61. [PMID: 2395011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The annular single-crystal brain camera (ASPECT) is a digital SPECT system with a single-crystal sodium iodide thallium Nal(Tl) ring detector and collimator system designed to view the patient's head from three angles simultaneously. The ring is rotated concentrically to the detector for three-dimensional reconstruction over a 21.4 cm (diameter) by 10.7 cm (length) field of view. We evaluated the system clinically by imaging a Hoffman brain phantom and seven subjects, of whom two were normal controls, three had previous cerebral infarction and two had dementia. The ASPECT system produced tomographic images of high spatial resolution. In normal subjects, the separation of striata from thalami by the posterior limbs of the internal capsules was much clearer on ASPECT images than on rotating gamma camera images. The high spatial resolution obtained with the ASPECT system translates into superior anatomical representation of the brain compared to the standard rotating gamma camera.
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Affiliation(s)
- B L Holman
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115
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23
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Franceschi M, Guimond J, Zimmerman RE, Picard MV, English RJ, Carvalho PA, Tumeh SS, Holman BL. Myocardial clearance of Tc-99m hexakis-2-methoxy-2-methylpropyl isonitrile (MIBI) in patients with coronary artery disease. Clin Nucl Med 1990; 15:307-12. [PMID: 2140305 DOI: 10.1097/00003072-199005000-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Myocardial clearance of the new cationic, lypophilic myocardial perfusion agent, Tc-99m-hexakis-2-methoxy-2-methylpropyl isonitrile (MIBI) was studied in nine patients with coronary artery disease. Regional time-activity curves were determined from serial postexercise myocardial SPECT images after a single dose of Tc-99m MIBI. There were significant differences between the clearance rates from normal and ischemic myocardium. Tc-99m MIBI washout from normal myocardium was 27 +/- 8% by 6 hours after injection. Clearance from mild myocardial defects (initial activity greater than 60% of the activity in normal myocardium) was 16% by 6 hours in six patients. No washout was detected by 6 hours in the three patients with severe myocardial defects. The ratio between the activity in ischemic and normal myocardium increased from 0.70 +/- 0.08 to 0.80 +/- 0.13 and 0.84 +/- 0.13 at 4 and 6 hours after injection in the patients with mild defects. In the patients with large defects, the ratio increased from 0.42 +/- 0.09 to 0.54 +/- 0.07 at 6 hours. It is concluded that, while redistribution is substantially slower than with Tl-201, image interpretation and data evaluation should be approached cautiously when imaging is delayed 4 hours or more after injection of Tc-99m MIBI. Quantitative techniques aimed at evaluating the extent and intensity of myocardial ischemia will be particularly affected.
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Affiliation(s)
- M Franceschi
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115
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24
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Parab PB, Rajasekariah GR, Carvalho PA, Subrahmanyam D. Differential recognition of Brugia malayi antigens by bancroftian filariasis sera. Indian J Med Res 1990; 91:138-43. [PMID: 2188906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Individuals residing in an area endemic to Wuchereria bancrofti infection were broadly categorised as endemic normals (EN), microfilaraemics (mf + ve) and elephantoids i.e., chronic lymphatic filariasis (EL). The immune status of these three groups was examined in terms of (i) specific antibody levels; (ii) ability to induce antibody dependent cellular cytotoxicity (ADCC) to microfilariae; and (iii) ability to recognise different microfilarial antigens by immunoblotting. All three groups of endemic residents were indistinguishable in their antibody levels as measured by ELISA with B. malayi microfilarial antigen. Many endemic normal sera and most elephantoid sera exerted strong cytotoxicity against W. bancrofti microfilariae whereas none of the mf + ve sera had any such activity. Immunoblotting studies revealed that a protein with mol. wt of 79 KDa was the only one among the proteins of B. malayi microfilarial extracts that was consistently recognised by sera from all endemic residents. Endemic normal sera and elephantoid sera, which exerted maximum cytotoxicity, together specifically recognised three proteins with molecular weights 25, 58 and 68 KDa and these three proteins could be among the candidate antigens that induce resistance to filarial infection.
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Affiliation(s)
- P B Parab
- Pharma Division, Hindustan Ciba-Geigy Limited, Bombay
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25
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Carvalho PA, Rajasekariah GR, Desphande L, Parab PB, Rao UR, Subrahmanyam D. Evaluation of in vitro released Wuchereria bancrofti third stage larval antigens for detection of Bancroftian filariasis. Trop Med Parasitol 1990; 41:71-2. [PMID: 2187228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Three types of in vitro released excretory, secretory and metabolic antigens of Wuchereria bancrofti third larval stage (L3ESM) are evaluated in ELISA test to detect infected individuals in the endemic area. A total of 104 reference sera are used to predict the sensitivity of these antigens. None of L3 ESM antigens, although homologous in nature, did not identify correctly the categorised reference sera. This study clearly indicated a need for defined antigens to detect W. bancrofti infection early in the endemic residents.
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Affiliation(s)
- P A Carvalho
- Research Centre, Hindustan Ciba-Geigy Ltd., Goregaon East, Bombay, India
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26
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Rajasekariah GR, Deshpande L, Parab PB, Chandrashekar R, Carvalho PA, Subrahmanyam D. Wuchereria bancrofti larvae in naturally infected Culex quinquefasciatus. Ann Trop Med Parasitol 1988; 82:637-9. [PMID: 3076752 DOI: 10.1080/00034983.1988.11812303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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27
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Parab PB, Rajasekariah GR, Carvalho PA, Subrahmanyam D. Analysis of B. malayi microfilarial antigens by immunoblotting. Immunol Invest 1988; 17:517-29. [PMID: 3235116 DOI: 10.3109/08820138809030585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BALB/C mice were immunized with heavy or low infection of live B. malayi microfilariae or immunised with different fractions of the microfilarial antigens. Antibody levels and antibody dependent macrophage mediated cytotoxicity to B. malayi microfilariae were determined in the immunized sera. Antigens responsible for induction of antibodies were recognised in B. malayi microfilarial extract by immunoblotting. Appearance of cytotoxic antibodies correlates with recognition of certain common antigens in microfilarial extract such as 45, 54, 62, 66 and 76 KDa mol. wt. proteins.
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Affiliation(s)
- P B Parab
- Pharma Division, Research Centre, HINDUSTAN CIBA-GEIGY Ltd., Bombay, India
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