Jainn-Shiun Chiu

Chronic edema from protein-losing enteropathy: scintigraphic diagnosis

Yi-Chun Chen, Shang-Jyh Hwang, Jainn-Shiun Chiu, Mei-Hua Chuang, Mei-Ing Chung and Yuh-Feng Wang Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China; Department of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China; Department of Pharmacy, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China and Graduate Institute of Pharmaceutical Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China Correspondence: Yuh-Feng Wang, Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, No. 2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan-Republic of China. E-mail: chenyichun0320@yahoo.com.tw

In vivo bio-distribution of intravenously injected Tc-99 m labeled ferrite nanoparticles bounded with biocompatible medicals

Superparamagnetic nanoparticles have been widely utilized for in vivo or in vitro biomedical applications. Knowledge on the distribution of injected particles in organs is necessary to gain access to diagnosis or therapeutics. Thus, an in vivo study on the bio-distribution of the directly Tc-99m-labeled ferrite nanoparticles which were intravenously injected into tail vein of Wistar rats is performed. The dynamic bio-distribution was monitored by gamma camera. The scintigrams show that the injected dose are taken up by liver and lung. From dynamic scintigraphic image, it is observed that the uptake of particles by the organ is very fast and completed within first few minutes after intravenous injection. To investigate to what extent the Tc-99m labeled ferrite beads can be further conjugated with therapeutic drug, poly(ethylene glycol) (PEG) and two types of herb medicines, i.e. the Gentiana comnination and Trionyx sinensis with a function for chronic hepatitis, were sequentially conjugated with the ferrite adio-beads. It is demonstrated that the relative radioactivity of liver compared to that by lung and heart is lowered by the PEG modification. We also have performed in vivo study by applying the commercially available Nd-Fe-B magnet onto the site before intravenous injection into rat. The result implies that the directly Tc-99m labeled ferrite nanoparticles, conjugated with biocompatible medicals, may implicate for diagnostic and therapeutic applications.

Outcome of surgical resection for protein-losing enteropathy in systemic lupus erythematosus

Protein-losing enteropathy (PLE) is an uncommon manifestation associated with systemic lupus erythematosus (SLE). Here, a case with SLE and concomitant hypoalbuminemia is reported. Technetium-99m albumin scintigraphy demonstrated a localized lesion in the ascending colon, and the diagnosis of SLE-related PLE was established. Due to a poor response to medical treatment, this patient received surgical resection, but relapse still developed later on. Recurrent protein-lose from the remaining of the colon was documented by repeated images. This report discusses the management of SLE-related PLE and the role of nuclear medicine scintigraphy in the investigation of PLE.

Fingerprint verification on medical image reporting system

The healthcare industry is recently going through extensive changes, through adoption of robust, interoperable healthcare information technology by means of electronic medical records (EMR). However, a major concern of EMR is adequate confidentiality of the individual records being managed electronically. Multiple access points over an open network like the Internet increases possible patient data interception. The obligation is on healthcare providers to procure information security solutions that do not hamper patient care while still providing the confidentiality of patient information. Medical images are also part of the EMR which need to be protected from unauthorized users. This study integrates the techniques of fingerprint verification, DICOM object, digital signature and digital envelope in order to ensure that access to the hospital Picture Archiving and Communication System (PACS) or radiology information system (RIS) is only by certified parties.

Atypical angioma serpiginosum.

Angioma serpiginosum is an uncommon, acquired vascular nevoid disorder with capillary dilation and proliferation in the papillary dermis. The eruptions are asymptomatic and characterized by grouped, erythematous to violaceous, serpiginous and punctate macules. The condition usually appears in females during adolescence on unilateral lower extremities and the buttocks. We report a rare case with a late onset and atypical distribution of lesions in a 48-year-old female patient who had groups of punctate lesions on her left foot for four to five years. Histopathological examination showed hyperkeratosis and multiple dilated and proliferated capillaries in the papillary dermis. Inflammation and extravasation of red blood cells were not found. According to the clinical and pathological findings, we established a diagnosis of angioma serpiginosum. She was treated with a pulsed dye laser, and the angiomatous lesions subsequently improved.

Prediction of target range of intact parathyroid hormone in hemodialysis patients with artificial neural network

The application of artificial neural network (ANN) to predict outcome and explore potential relationships among clinical data is increasing being used in many clinical scenarios. The aim of this study was to validate whether an ANN is a useful tool for predicting the target range of plasma intact parathyroid hormone (iPTH) concentration in hemodialysis patients. An ANN was constructed with input variables collected retrospectively from an internal validation group (n = 129) of hemodialysis patients. Plasma iPTH was the dichotomous outcome variable, either target group (150 ng/L<or= iPTH <or=300 ng/L) or non-target group (iPTH< 150 ng/L or iPTH hormone >300 ng/L). After internal validation, the ANN was prospectively tested in an external validation group (n = 32) of hemodialysis patients. The final ANN was a multilayer perceptron network with six predictors including age, diabetes, hypertension, and blood biochemistries (hemoglobin, albumin, calcium). The externally validated ANN provided excellent discrimination as appraised by area under the receiver operating characteristic curve (0.83 +/- 0.11, p = 0.003). The Hosmer-Lemeshow statistic was 5.02 (p= 0.08 > 0.05) which represented a good-fit calibration. These results suggest that an ANN, which is based on limited clinical data, is able to accurately forecast the target range of plasma iPTH concentration in hemodialysis patients.

Application of Upper Extremity Radionuclide Venography as a Diagnostic Approach for Port-A Catheter Thrombosis

Background: To investigate the role of upper extremity radionuclide venography as a potential diagnostic modality in the assessment of venous thrombosis associated with a Port‐A catheter. Methods: Fourteen symptomatic patients who had received Port‐A catheter implantation were enrolled. A dynamic nuclear medicine flow study was performed with intravenous administration of Technetium‐99m macroaggregated albumin to both upper extremities. Imaging patterns of the venous system were categorized as patency, partial obstruction, and total occlusion. Results: The findings of the dynamic images clearly demonstrated clinical problems. Three patients were free of a definite venous flow change. Three patients had partial obstruction of venous return. A significant cut‐off of venous return was demonstrated in 8 patients, and total occlusions were hence diagnosed. All patients underwent this procedure smoothly without any complication. Conclusion: These results suggest that upper extremity radionuclide venography is an easily performed and effective method for diagnosing Port‐A catheter thrombosis in clinical practice.

Diagnostic Value of I-131 NP-59 SPECT/CT Scintigraphy in Patients with Subclinical or Atypical Features of Primary Aldosteronism

Accumulating evidence has shown the adverse effect of long-term hyperaldosteronism on cardiovascular morbidity that is independent of blood pressure. However, the diagnosis of primary aldosteronism (PA) remains a challenge for patients who present with subtle or atypical features or have chronic kidney disease (CKD). SPECT/CT has proven valuable in the diagnosis of a number of conditions. The aim of this study was to determine the usefulness of I-131 NP-59 SPECT/CT in patients with atypical presentations of PA and in those with CKD. The records of 15 patients with PA were retrospectively analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s) in CKD patients with suspected PA. Patients using NP-59 SPECT/CT imaging, compared with those not performing this procedure, significantly featured nearly normal serum potassium levels, normal aldosterone-renin ratio, and smaller adrenal size on CT and pathological examination and tended to feature stage 1 hypertension and non-suppressed plasma renin activity. These findings show that noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in patients with subclinical or atypical features of PA and those with CKD.

Peritoneo-scrotal shunting diagnosed by Tc-99m DTPA SPECT/CT imaging

Yi-Chun Chen, Yu-Chieh Su, Jainn-Shiun Chiu, Chang-Kuo Wei and Yuh-Feng Wang Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Department of Nuclear Medicine, Shuang-Ho Hospital, Taipei County, Taiwan; Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan and Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

Make Your DiagnosisThe Case ∣ A woman with persistent chest pain and palpitations after coronary stenting

Y-C Chen, Y-C Su, J-E Tzeng, C-K Wei, J-S Chiu, C-W Lin and Y-F Wang Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Department of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan and Department of Medical Imaging, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan