David Milstein

Identification of epidural neoplasm: radiography and bone scintigraphy in the symptomatic and asymptomatic spine

Early identification and treatment of epidural neoplasm, before the development of significant neurologic deficits, provides the best opportunity for a favorable outcome. Among the many patients with symptoms, signs, or scintigraphic or radiographic findings suggesting possible epidural disease, a small proportion will have the lesion. The selection of patients for definitive imaging of the epidural space should be based on a determination of the risk of this complication. In this study, the medical records, plain spinal radiographs, bone scintigraphs and myelograms of 43 patients were analyzed retrospectively to assess the risk of epidural disease associated with specific clinical, radiographic, and scintigraphic findings. Cervical, thoracic, and lumbosacral spinal segments were evaluated independently. Symptomatic segments (SS) (N = 41), defined by focal pain or neurologic dysfunction, were distinguished from asymptomatic segments (AS). At SS, epidural disease was found at 86% and 8% of abnormal and normal spinal radiographs, respectively (P < 0.001), and at 69% and 0% of abnormal and normal scintigrams, respectively (P < 0.001), whereas at AS epidural disease occurred in 43% and 3% of abnormal and normal spinal radiographs, respectively (P < 0.001), and 14% and 7% of abnormal and normal scintigrams, respectively (P = NS). Vertebral collapse was highly predictive of an epidural lesion. Epidural disease occurred in 12% of SS and 0% of AS with an abnormal scintigram and normal radiograph, 86% of SS and 45% of AS with abnormalities on both scintigram and radiograph, and at two AS when both were normal. Decision analysis applied to these data yielded a specific conditional probability of epidural disease for each combination of clinical, scintigraphic, and radiographic findings. These data provide a basis for the selection of patients for additional evaluation of the epidural space before neurologic deficits develop.

PRIMARY CALYCOURETEROSTOMY FOR PELVIOURETERAL JUNCTION OBSTRUCTION: INDICATIONS AND RESULTS

AbstractCalycoureterostomy has been used as a secondary procedure rather than nephrectomy, interposition of bowel segment or autotransplantation in unusually difficult cases of pelvioureteral junction obstruction. We have performed 18 calycoureterostomies, 15 of which were done as the primary treatment for pelvioureteral junction obstruction. This is the first report to analyze the results of primary calycoureterostomy in a sizable series of patients. The details of the cases as well as the indications and results of the procedure are presented.

Applications of nuclear medicine in genitourinary imaging

Major advances in nuclear medicine instrumentation and radiopharmaceuticals for renal studies have occurred during the last decade. Current nuclear medicine methodology can be applied for accurate evaluation of renal function and for renal imaging in a wide variety of clinical situations. Total renal function can be estimated from the plasma clearance of agents excreted by glomerular filtration or tubular secretion, and individual function can be estimated by imaging combined with renography. A major area of radionuclide application is in the evaluation of obstructive uropathy. The introduction of diuretic renography and the use of computer-generated regions of interest offer the clinician added useful data which may aid in diagnosis and management. Imaging is of proven value also in trauma, renovascular hypertension, and acute and chronic renal failure. Methods for the evaluation of residual urine, vesicoureteral reflux, and testicular torsion have achieved increasing clinical use. These many procedures assure a meaningful and useful role for the application of nuclear medicine in genitourinary imaging.

Single‐use percutaneous catheters for intraperitoneal P32 therapy

Background. Intraperitoneal (IP) radioactive chromic phosphate (P32) remains investigational in the treatment of patients with ovarian and/or endometrial cancer. Single‐use percutaneously placed catheters offer the advantage of therapy without additional surgery.

Utility of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in a child with chronic granulomatous disease.

We report the fluorodeoxyglucose positron emission tomography/ computed tomography (FDG - PET/CT) findings in an 11-month-old boy with suspected milk protein allergy, presented to the hospital with 2-month history of fever of unknown origin and failure to thrive. It showed FDG avid lymphadenopathy above and below the diaphragm and splenic focus, which could represent diffuse inflammatory process or lymphoma. Subsequent jejunal biopsy showed non-necrotizing granulomas.

Kyphoscoliosis preventing gallbladder assessment

A 92-year-old woman reported nonspecific epigastric abdominal pain and had mild elevation of the serum SGOT (177) and significantly elevated levels of alkaline phosphatase. Abdominal ultrasound showed a distended, thickened gallbladder containing stones and surrounded by pericystic fluid. Hepatobiliary imaging demonstrated an unusual configuration of the liver, almost a mirror image of its expected appearance on the anterior view. Intense activity was noted in the intrahepatic biliary radicals, but these drained promptly. Gastrointestinal activity appeared by 55 minutes after injection. No definite gallbladder activity could be identified. CT showed significant scoliosis with marked distortion and displacement of the liver and other abdominal viscera.