Joseph P. Kriss

Reproducibility of thallium-201 myocardial imaging.

Seventy-six thallium-201 myocardial perfusion studies were performed on twenty-five patients to assess their reproducibility and the effect of varying the level of exercise on the results of imaging. Each patient had a thallium-201 study at rest. Fourteen patients had studies on two occasions at maximum exercise, and twelve patients had studies both at light and at maximum exercise. Of 70 segments in the 14 patients assessed on each of two maximum exercise tests, 64 (91%) were reproducible. Only 53% (16/30) of the ischemic defects present at maximum exercise were seen in the light exercise study in the 12 patients assessed at two levels of exercise. Correlation of perfusion defects with arteriographically proven significant coronary stenosis was good for the left anterior descending and right coronary arteries, but not as good for circumflex artery disease. Thallium-201 myocardial imaging at maximum exercise is reproducible within acceptable limits, but careful attention to exercise technique is essential for valid comparative studies.

Radiotherapy of lymphoid diseases of the orbit

Thirty-two patients with orbital pseudotumor (18), reactive lymphoid hyperplasia (2), atypical lymphoid infiltrate (4) or malignant lymphoma (8) were treated in the Division of Radiation Therapy at Stanford University between January 1973 and May 1983. Of the 20 patients with pseudotumor or reactive lymphoid hyperplasia, 10 had unilateral lesions and 10 had bilateral lesions. Biopsy samples were obtained in 15 patients; in five patients with bilateral disease the diagnosis was made on the basis of computed tomography (CT) and clinical findings. The majority of patients were referred because of disease refractory to treatment with corticosteroids. The patients were given a mean dose of 2360 rad using complex, individualized megavoltage techniques including lens shielding. Radiotherapy was well tolerated with no significant acute or late complications. Fifteen patients had complete resolution of symptoms after treatment; five had continued symptoms. Of the 12 patients with malignant lymphoma or atypical lymphoid infiltrate, four had systemic lymphoma with orbital involvement and eight had orbital involvement only. The diagnosis was made by biopsy in all patients and immunophenotyping was done in six cases, of which 5 were monoclonal. Patients were evaluated with a chest radiograph, lymphogram or abdominal CT, bone marrow biopsy and orbital CT. A mean dose of 3625 rad was delivered to the orbit only. Most of the patients received complex megavoltage treatment using bolus. All patients in this group had a complete response and local control. There were no relapses in those with localized disease. Two patients developed cataracts. Carefully planned orbital radiotherapy provides local control without symptomatic sequelae for orbital masses ranging from pseudotumor to malignant lymphoma.

Gallium-67 citrate scanning in Hodgkin's disease and non-Hodgkin's lymphoma

Gallium‐67 citrate scintigraphy was performed in 33 patients with Hodgkins disease and 25 patients with non‐Hodgkins lymphoma. Three hundred twenty‐eight sites of potential involvement were investigated. Confirmation of involvement was made by physical examination, roentgenographic evaluation and histopathologic examination of tissue obtained at diagnostic laparotomy. The results of scintigraphy correlated with all other clinicopathologic data in only 35% of patients, the true‐positive rate being significantly higher above the diaphragm (61%) than below (40%). The overall true‐positive and true‐negative rates were 53 and 90%, respectively. A significant correlation existed between tumor histology and scanning accuracy; the true‐positive rate in Hodgkins disease was 74% compared to only 13% in patients with lymphocytic lymphoma. A similar variation of 67Ga concentration with tumor histology was also noted in 70 tissue specimens obtained from 28 patients at the time of diagnostic laparotomy or biopsy. The routine use of 67Ga‐citrate to detect splenic involvement with tumor appeared to be precluded by the low true‐positive and high false‐negative rates of 57 and 27%, respectively. Gallium‐67‐citrate scintigraphy may be useful as an adjunct to established clinical staging procedures in untreated patients and in the detection of recurrent disease in treated patients. Our data indicate it is not sufficiently reliable to replace established methods presently used for clinical staging.

Treatment of orbital pseudotumor (idiopathic orbital inflammation) by radiation therapy

Abstract Orbital pseudotumor is a non-specific inflammatory condition which clinically may simulate a neoplasm. This report describes the Stanford University Medical Center experience with orbital radiotherapy in the treatment of five patients with orbital pseudotumor, three with bilateral involvement, two with unilateral lesions. Four patients with computed tomography (CT) scans had characteristic findings of pseudotumor; four had the diagnosis confirmed by biopsy. There was no evidence of an alternative diagnosis or systemic disease in any of the patients. Therapy consisted of 2000 rad of fractionated radiotherapy over 10 days with a 4 MeV linear accelerator. Each patient experienced dramatic and rapid improvement in symptoms and signs. Exophthalmometric measurements improved by 8, 8, 6, and 5 millimeters respectively in those with proptosis. There has been no recurrence after a mean follow up of 30 months and no complications of treatment. Orbital radiotherapy may be a preferable alternative to surgical or corticosteroid treatment for pseudotumor. Because of the variability in presentation, radiotherapy must be individualized so that orbital lesions are treated effectively while adjacent normal structures are shielded.

Radioisotopic Angiocardiography: Wide Scope of Applicability in Diagnosis and Evaluation of Therapy in Diseases of the Heart and Great Vessels

Radioisotopic angiocardiography has been performed in 120 patients after the intravenous injection of 99mTc pertechnetate. A scintillation camera and a variable time-lapse videoscintiscope were used. The results indicate that the method permits identification and physiologic assessment of a wide variety of congenital and acquired cardiovascular lesions, including septal defects, valvular stenosis and incompetence, aneurysm, tumor, venous obstruction, ventricular hypertrophy, and effusion. Emphasis particularly is given, therefore, to the wide scope of applicability of the procedure.The diagnostic criteria employed for a representative group of these lesions are presented together with illustrative examples to demonstrate the type and quality of the information which may be obtained with the method. The procedure is rapid and safe and does not require hospitalization, heart catheterization, or special preparation of the patient, advantages which favor its use as a diagnostic screening test. In addition to its diagnostic uses, radioisotopic angiography may offer a useful and convenient method of assessing the effects of therapy or of following the course of disease.

Unruptured aneurysm of the sinus of Valsalva producing right ventricular outflow obstruction

Abstract A case of sinus of Valsalva aneurysm producing right ventricular outflow obstruction is presented. The aneurysm had not ruptured, and no associated ventricular septal defect was present; symptoms were due to right ventricular overload rather than to an intracardiac shunt. Diagnostic clues included chest pain, dyspnea, a pulmonic ejection murmur and suggestions of right ventricular hypertrophy in the electrocardiogram, vectorcardiogram and apex cardiogram. The lesion was demonstrated by venous (radioisotope) and intracardiac angiography and by cardiac catheterization, and was corrected at surgery.

Lipid vesicle interaction with emt-6 tumor cells and effect on subsequent cell growth.

Abstract Artificial lipid vesicles of varying composition were incubated with EMT-6 tumor cells, after which the transfer of vesicle lipids to the cells and their growth in vitro were determined. Vesicles composed of phosphatidylcholine, cholesterol, and gangliosides could transfer phosphatidylcholine and cholesterol to the cells, but this transfer had no effect on the subsequent growth of the cells. However, preincubation of the cells with vesicles containing sterylamine or phosphatidylserine did inhibit the subsequent growth of the cells in a tissue culture assay system. It might be possible to deliver to certain cells growth inhibitory compounds carried in lipid vesicles.

Technetium-99m pyrophosphate myocardial uptake in patients with stable angina pectoris.

99m-technetium (Tc) pyrophosphate myocardial scintigrams of 55 patients with stable angina pectoris were compared with those of 13 normal subjects. The mean scintigraphic score, obtained by averaging the blinded interpretations of four readers scoring on an integral scale from 0 to 4, was significantly higher for the patients with angina than for the control subjects (1.36 compared with 0.48, P less than 0.001). Among the patients with angina, those who had a prior myocardial infarction had a higher mean scintigraphic grade than those without a previous infarction (1.73 versus 1.15, P less than 0.005), and the mean grade in both groups was higher than that of control subjects (P less than 0.001). Radionuclide uptake was predominantly diffuse in the patients with angina pectoris (70%), although in those with greater uptake accumulation tended to be localized. Three of the 68 subjects had high levels of radionuclide uptake but no clinical evidence of acute myocardial injury. This study demonstrates that excess myocardial accumulation of 99m-Tc pyrophosphate can occur in patients with stable angina pectoris.

Scintiphotographic studies of acquired cardiovascular disease

Radionuclide angiocardiography, performed after the intravenous injection of 99m Tc-pertechnetate, is a simple, rapid, and safe procedure that permits identification and physiologic assessment of a wide variety of acquired cardiovascular lesions, including valvular stenosis and/or insufficiency, myocardial lesions, and lesions of the great vessels. The simplicity of the procedure lends itself to repeated measurements to assess the effects of therapy or to follow the course of the disease. the diagnostic criteria employed for a representative group of these acquired lesions are presented together with illustrative examples to demonstrate the type and quality of the information that may be obtained with the method.

The Accuracy of 111InCl3 as a Bone Marrow Scanning Agent

The number of normal cellular elements present in bone marrow biopsies was compared to the extent of uptake at corresponding sites on 111InCl3 bone marrow scans in 87 patients with malignant lymphoma. Of the biopsies free of tumor, 49/54 interpreted as normocellular and 16/17 hypocellular or aplastic confirmed the scan interpretation. Of the biopsies demonstrating tumor, 10/11 of those interpreted as normocellular and 14/15 hypocellular or aplastic confirmed the scan interpretation. The 111InCl3 bone marrow scan is accurate in depicting the presence or absence of normal marrow elements, but is of value in detecting tumor only when the normal elements are extensively replaced.