Alvaro E. A Magalhäes

Gallbladder Emptying in Normal Volunteers: Comparative Study Between Cholescintigraphy and Ultrasonography

To assess the reproducibility of and compare the patterns of gallbladder emptying after a fatty meal stimulus, the authors analyzed 10 healthy fasting volunteers (8 men; mean age, 32 years). Cholescintigraphy was obtained after intravenous injection of 185 MBq of Tc-99m DISIDA. A standardized fatty meal was provided 70 minutes after injection. The ejection fraction was measured sequentially by ultrasound and cholescintigraphy 15, 30, 45, and 60 minutes after eating. All patients had repeat studies within 1-3 weeks. The two methods showed a distinct gallbladder time course of emptying after the fatty meal stimulus. Nuclear medicine showed higher values of gallbladder ejection fraction at 45 and 60 minutes after eating when compared to ultrasound (P < 0.01). The plotted curves, using the four different periods of time, also showed different behavior due mainly to distinct angular coefficients (nuclear medicine, 2.6; ultrasound, 0.9). Good reproducibility of fatty meal-induced gallbladder ejection fraction at 30, 45, and 60 minutes was also observed using both methods. Thus, ultrasound and nuclear medicine are reproducible methods of studying gallbladder dynamics. However, nuclear medicine demonstrated continued excretion of bile at 45 and 60 minutes, whereas ultrasound did not show significant volume variations in these time frames.

Reação de fixação do complemento para cisticercose no líquido cefalorraquidjano: Emprego de novo antígeno por método quantitativo

O autor descreve um novo antigeno de Cysticercus cellulosae e apresenta os resultados obtidos com o seu emprego na reacao de fixacao do complemento com liquido cefalorraquidiano, para diagnostico da cisticercose cerebral. O antigeno e preparado com vesiculas de C. cellulosae obtidas de porcos infestados. As vesiculas sao lavadas varias vezes em solucao fisiologica e secadas em papel de filtro. O material seco e extraido com benzeno, durante 24 horas, a temperatura ambiente; o benzeno e desprezado e a extracao repetida varias vezes. O material e, entao, colocado no vacuo, sobre cloreto de calcio e, finalmente, extraido com 20 volumes de alcool metilico absoluto, durante 25 dias. O sobrenadante obtido apos centrifugacao (10.000 G durante 15 minutos a 3oC-6oC) e o antigeno que e conservado em geladeira. A reacao de fixacao do complemento e estandardizada, segundo o metodo da isofixacao, pela tecnica quantitativa de Wadsworth, Maltaner e Maltaner. Os resultados obtidos com liquidos cefalorraquidianos de pacientes com cisticercose cerebral e outras condicoes mostram que o metodo usado com o novo antigeno e recomendavel para o diagnostico da cisticercose cerebral humana.

Doppler demonstration of cystic vein dilatation secondary to portal vein thrombosis.

SummaryHigh-resolution duplex ultrasound was used to demonstrate vascular dilatation in the gallbladder wall in eight patients with portal vein thrombosis. Gallbladder thickening, combined with a higher incidence of gallstone disease in patients with chronic hepatic disease can be misinterpreted as acute cholecystitis. The Doppler is helpful in detecting the vascular cause of the gallbladder wall thickening thus helping to reduce the frequency of inappropriate cholecystectomy.

Brain spect in the pre-surgical evaluation of epileptic patients preliminary results

Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc_HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and hete-rogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.