Elma G. Briscoe

CD4 lymphocytes in the blood of HIV+ individuals migrate rapidly to lymph nodes and bone marrow: support for homing theory of CD4 cell depletion

The mechanism(s) by which human immunodeficiency virus (HIV) causes depletion of CD4 lymphocytes remains unknown. Evidence has been reported for a mechanism involving HIV binding to (and signaling) resting CD4 lymphocytes in lymphoid tissues, resulting in up‐regulation of lymph node homing receptors and enhanced homing after these cells enter the blood, and induction of apoptosis in many of these cells during the homing process, caused by secondary signaling through homing receptors. Supportive evidence for this as a major pathogenic mechanism requires demonstration that CD4 lymphocytes in HIV+ individuals do migrate to lymph nodes at enhanced rates. Studies herein show that freshly isolated CD4 lymphocytes labeled with 111Indium and intravenously reinfused back into HIV+ human donors do home to peripheral lymph nodes at rates two times faster than normal. They also home at enhanced rates to iliac and vertebral bone marrow. In contrast, two hepatitis B virus‐infected subjects displayed less than normal rates of blood CD4 lymphocyte migration to peripheral lymph nodes and bone marrow. Furthermore, the increased CD4 lymphocyte homing rates in HIV+ subjects returned to normal levels after effective, highly active antiretroviral therapy treatment, showing that the enhanced homing correlated with active HIV replication. This is the first direct demonstration of where and how fast CD4 lymphocytes in the blood traffic to tissues in normal and HIV‐infected humans. The results support the theory that the disappearance of CD4 lymphocytes from the blood of HIV+ patients is a result of their enhanced migration out of the blood (homing) and dying in extravascular tissues.

Three-phase Tc-99m labeled RBC scintigraphy of a splenic hemangioma

A 46-year-old man presented with right upper quadrant pain with a clinical suspicion of cholelithiasis and was referred for an abdominal ultrasound (US). On US evaluation, the liver and gallbladder were normal. Incidentally noted a homogeneous, well demarcated, hyperechoic, 5-cm mass in the inferior portion of the spleen. A subsequent Tc-99m labeled RBC scan showed a 5-cm photopenic area in the inferior portion of the spleen on perfusion and early blood pool images. Subsequent filling in on delayed images with slightly increased uptake relative to surrounding splenic tissue was seen on the final images (85 min). Splenic hemangiomas are rare neoplasms, although they still represent the most common primary neoplasm of the spleen. The incidence of splenic hemangiomas ranges from 0.03-14% in autopsy studies.

Role of Nurses in Daily Nuclear Medicine

The aim of this study is to demonstrate the role of nurses during daily nuclear medicine procedures and to discuss the influence of nurses in quality of patient care, patient preparation and radiation safety in nuclear medicine. Methods: Data was collected from the day to day involvement of nurses during daily nuclear medicine procedures. There are several nuclear medicine procedures identified where the nurses are involved in various tasks. Those imaging studies include many procedures in Oncology, Renal, hepatobiliary, cardiac, thyroid and gastrointestinal Scintigraphy. Results: Nurses spend a significant amount of time during cardiac imaging starting from taking history, review of patient preparation, medications, and laboratory data to ultimately performing clinical examination. For Renal Scintigraphy nurses have an important function, especially in children, starting from placing a Foley catheter, to hydrating after inserting an intravenous line, administering Ace inhibitor medication, if needed, and monitoring vital signs. For thyroid imaging, the role of nurses includes administering thyrogen injections. For gastrointestinal imaging, nurses play a key role in administering drugs like morphine sulfate, cholecystokinin and taking care of various tubes including Gastric, Jejunostomy, Nasogastric tubes and suctioning as needed. Nurses also have an important role taking care of patients during other unexpected emergencies like seizures and cardiac arrest. More important task of nurses includes assisting the technologists how to use and inject radiopharmaceuticals through the central lines, Porta catheter and Hickman catheters. During PET/CT imaging nurses monitor blood glucose and adverse reactions to iodine contrast. Nurses with special training in radiation safety discuss with the patients and other personnel the potential side effects of ionizing radiation. Conclusion: Nurses have an important role in various tasks in assisting the technologists, physicians and patients to carry out daily nuclear medicine procedures. Nurses are essential in providing quality patient care and are crucial in saving patients lives in emergencies during nuclear medicine imaging procedures.

Peritoneoscintigraphy using Tc-99m MAA for diagnosis of diaphragmatic disruptions in trauma patients.

The diagnosis of diaphragmatic disruptions secondary to blunt trauma is difficult because the patients are usually asymptomatic. Delay in recognition of this injury can be life threatening. The presence of previous pulmonary pathology makes the diagnosis even more difficult to establish. In this report, a diaphragmatic tear was diagnosed using intraperitoneal instillation of Tc-99m MAA.

Agenesis of the right lobe of the liver.

A 70-year-old man had hepatobiliary scintigraphy, which showed agenesis of the right lobe of the liver and hypertrophy of the left lobe. There was no scintigraphic evidence of emptying of the radiotracer into the small bowel. Agenesis of the right lobe of the liver is an extremely rare congenital an

Renal hemorrhage detection with Tc-99m labeled erythrocytes in a patient with polycystic disease

A 47-year-old man with polycystic kidney disease, who was on hemodialysis for several years, presented with gross hematuria. Although radionuclide imaging is successfully used to detect minimal gastrointestinal bleeding with Tc-99m labeled RBCs, this technique is not usually applied to the evaluation of genitourinary bleeding because there is some excretion of free pertechnetate by the kidneys. The authors report the successful identification of a renal hemorrhage in a patient with polycystic kidneys using labeled RBC scintigraphy. This finding is important because it guided the surgeon to remove the appropriate kidney.