Ernesto Lubin

Ectopic thyroid gland. A clinical study of 30 children and review.

Of 108 children being treated at our Institute for primary (nongoitrous) hypothyroidism, tests with radioactive iodine 131I uptake showed that 26 of them (24%) had an ectopic thyroid gland. Four euthyroid children also had anterior swellings of the neck which, in each case, proved to be an ectopic thyroid gland. Of the 30 children studied, 20 were girls and 10 were boys. Nine patients were diagnosed within the first year of life. Growth retardation, manifest in 20 patients, was the most common clinical finding at the time of diagnosis. Delayed bone age was a feature in all of them. Growth, after diagnosis was within normal limits in 83% of the infants who were treated within the first two years of life; only 50% of the children diagnosed later grew within normal limits. Similarly, mental function was best preserved in those patients in whom treatment was initiated within the first two years of life.

Well-differentiated thyroid carcinoma

PURPOSE This study presents our experience with 728 patients treated in our department for well-differentiated thyroid carcinoma between 1954-1994. MATERIALS AND METHODS The retrospective evaluation of the prognostic implications of the clinical and pathological findings was performed. Age, sex, histological variants, tumor size, and locoregional and distant spread were evaluated as risk factors in relation to the prognosis. RESULTS During follow-up, which ranged from 1 to 31 years, 125 locoregional and/or distant metastases developed (17.2% of the patients), 87 of which occurred in the first 10 years after initial therapy. Thirty-two patients with papillary cancer and 20 with follicular cancer died of causes related to malignancy of the thyroid. CONCLUSION The experience gained in our department has led us to adopt an aggressive approach in the treatment of patients with well-differentiated carcinoma of the thyroid gland.

Lung perfusion scans in patients with congenital heart defects

In 63 patients with various congenital heart defects, lung perfusion was evaluated with technetium-99mm macroaggregated albumin. Right lung perfusion abnormalities were documented in 34 patients (54%). A particularly high incidence occurred in patients who had undergone a systemic to pulmonary artery shunt operation as an initial palliative procedure or who had had right ventricular outflow reconstruction and in those with bilateral pulmonary artery stenosis. Serial studies were helpful in evaluating the functional results of different transcatheter interventions for optimizing pulmonary blood flow. The quantitative relative perfusion radionuclide method was a more sensitive means of detecting cases of abnormal lung perfusion than was chest radiology.

Amiodarone-induced thyroid gland dysfunction

Of a population of 400 patients treated with amiodarone, 97 underwent thyroid function evaluation. Of these, 20 patients proved to be thyrotoxic and 16 hypothyroid. In thyrotoxic patients, symptoms developed 2 to 36 months after starting treatment with amiodarone, the most specific laboratory finding being a high total T3 (TT3). No antithyroid treatment proved useful. Thyroid function returned to normal 3 to 7 months after stopping amiodarone therapy. In the hypothyroid group, a high thyroid-stimulating hormone was the most specific laboratory finding. These patients were treated with substitute therapy with or without withdrawal of amiodarone. The iodine content of the thyroid gland in part of this population taking amiodarone was measured by in vivo x-ray fluorescence. Patients in whom thyrotoxicosis developed showed especially high iodine contents. During treatment with amiodarone, patients at high risk of thyrotoxicosis were recognized by increasing TT3 values and higher iodine thyroid levels. A reduction in maintenance dose should be considered in this specific population.

The Treatment of Osteitis Pubis with Heparin

We treated 7 patients with osteitis pubis by heparinization. Of the 7 patients 2 had a dramatic improvement. Small doses of heparin given routinely preoperatively and postoperatively were not found to prevent the development of osteitis pubis. In view of these results as well as the fact that there presently is no effective method of treatment of this disorder, it is considered justifiable to subject all patients with postoperative osteitis pubis to a therapeutic trial with heparinization.

Dipyridamole first-pass radionuclide ventriculography: Prediction of future cardiac events

Dipyridamole thallium myocardial perfusion imaging is a useful alternative to stress testing in the diagnostic and prognostic assessment of patients with coronary artery disease. The diagnostic use of dipyridamole radionuclide ventriculography is much more controversial, but no long-term prognostic studies have been reported. Imaging results of 159 consecutive patients who were referred for dipyridamole first-pass radionuclide ventriculography were correlated with subsequent cardiac events over a mean follow-up period of 11 months. An abnormal response to dipyridamole infusion (any reduction in wall motion or absolute decrease in global left ventricular ejection fraction of > or = 5 ejection fraction units) was associated with an increased incidence of nonfatal myocardial infarction (4.5% vs 0%, p < 0.05) and cardiac-related death (9% vs 1%, p < 0.001). The sensitivity, specificity, and negative predictive value of dipyridamole first-pass radionuclide ventriculography in predicting future cardiac events were 86%, 71%, and 98%, respectively, with a relative risk of 15 (confidence interval 12.06 to 18.1). In conclusion, dipyridamole first-pass radionuclide ventriculography demonstrated significant prognostic value in a large unselected patient population. This technique may provide a widely applicable and useful alternative to dipyridamole thallium perfusion imaging in the assessment of cardiac risk in patients with coronary artery disease.

Scintigraphic evaluation of parenchymal malakoplakia in a transplanted kidney.

The scintigraphic evaluation of a rare case of parenchymal malakoplakia in a transplanted kidney is presented. Uptake of Tc-99m DMSA in the involved area was reduced and the Ga-67 uptake was increased.

Radionuclide cystography: the significance of retention time of the refluxed radioisotope

We studied 36 patients with vesicoureteral reflux into 45 renal units by means of isotope cystography and a dynamic renal function scan performed 24 to 48 hours after the cystography. Functional impairment was found in 21 renal units. To evaluate the significance of the time between voiding and complete disappearance of the radioisotope that refluxed from the kidney (retention time) the presence of the labeled particles in the kidney was followed continuously and intermittently during a prolonged interval. There was a significant difference between the retention time found in the impaired kidneys and that in the normally functioning kidneys. In 91.7 per cent of the normally functioning kidneys retention time was less than 5 minutes, whereas in 86 per cent of the impaired kidneys it was more than 10 minutes and in 56 per cent it was more than 20 minutes. No significant correlation was found between the retention time and intrarenal reflux or dilatation of the collecting system (patients classified as having radiological grades III and IV reflux were not included in this study). A retention time greater than 10 minutes may be correlated with decreased renal function. The retention of technetium sulfur colloid particles may be analogous to the retention of similar size bacteria and suggests a possible pathophysiologic explanation for the development of renal dysfunction owing to the prolonged presence of bacteria in the kidney after reflux.

A comparative evaluation of lymphoscintigraphy versus lymphangiography and computerized tomography scanning in diagnosis of lymph node metastases in advanced bladder cancer.

The potential of lymphoscintigraphy to detect lymph node metastases compared to lymphangiography and computerized tomography scanning was evaluated in 26 patients who underwent radical cystectomy for invasive bladder cancer. Four-view images of the abdominoperineal area were taken 90 to 120 minutes after 99mtechnetium-rhenium sulfide was injected into 2 interdigital spaces in each foot. Results of lymphoscintigraphy interpretation correlated with surgical and histological findings: a correct diagnosis was made in 61.5 per cent of the patients, while 23.1 per cent had false positive and 15.4 per cent had false negative results. Although computerized tomography was the most accurate method to detect lymph node metastases (correct diagnosis in 73.1 per cent of the patients) no significant difference was found among the 3 diagnostic methods. False positive interpretation of lymphoscintigraphy was twice as common as that of the radiological studies (23 versus 11.5 per cent). The possibilities that may cause image variation interpreted as a false positive result are discussed. Because lymphoscintigraphy is an easier and less time-consuming study than lymphangiography, the former method is suggested to be an additional and sometimes (for example if short-term followup studies are required) preferred modality to evaluate the extent of lymph node involvement in cases of invasive bladder cancer.

Scintigraphic detection of vascular and urological complications in the transplanted kidney: 133 cases

A total of 133 consecutive kidneys, grafted during the past 2 years, were followed by scintigraphy. Patterns of prerenal, renal, and postrenal complications were recognized. Vascular thrombosis diagnosed by photodeficiency of the transplanted kidney was diagnosed and confirmed in 10 patients. Fourteen patients having postrenal urological complications (12 leaks and 2 ureteral obstructions) were all recognized in the late phase of the scintigraphic study. The differentiation between the known parenchymatous causes of anuria was less satisfactory. As a whole, all cases were recognized in which the complication was due to causes that required surgical intervention.