Mei-Hua Chuang

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

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.

Magnetically directed targeting aggregation of radiolabelled ferrite nanoparticles

Ferrite magnetic nanoparticles (Fe3O4 or iron (II, III) oxide; 15-25nm of diameter) were developed. These magnetic nanoparticles are a potential vehicle for magnetically induced target aggregation in living animals. In this preliminary study, the radiochemical purity for the radiolabeled magnetic nanoparticles was examined, and the possibility of the magnetically induced targeting of the radio-nanoparticles was evaluated. Our results showed that radiolabeled ferrite nanoparticles can be used as magnetic targeting agents with high labeling efficiency and stability. These particles can be distributed within living animals via intravenous injection, and the biodistribution of the particles can be potentially controlled by external magnetism. These evaluations will be the groundwork for the future development of delivery techniques for radiopharmaceuticals through external magnetic control.

Effectiveness of Implementation of a New Drug Storage Label and Error-Reducing Process on the Accuracy of Drug Dispensing

This study evaluated the effectiveness of implementation of an improved storage label and an error-reducing process on the incidence of drug-dispensing errors. A total of 27 pharmacists (11 male and 16 female) were included. Questionnaires were distributed to pharmacists to measure their degree of satisfaction with the format and content of the labels. The questionnaires were completed before and one month after implementation of new label. Pharmacists were also requested to follow a new error-reducing dispensing process by circling the following items on the new storage label: drug name, appearance, packaging, dose, and formulation. The pharmacists’ degrees of satisfaction increased significantly after implementation of the new label with respect to these questionnaire items: all label format items, edition appropriateness, use of capital fonts to distinguish similar drug names, reminder images to help with drug differentiation, and complete label information. The outpatient monthly drug-dispensing error rate was significantly decreased.

Stability of the mixture of technetium-99m human serum albumin and lidocaine hydrochloride for clinical application.

AimTo evaluate the stability of the mixture of technetium-99m (99mTc) human serum albumin (HSA) with the local anesthetic lidocaine hydrochloride. Materials and methodsWe assessed three preparations of the radiotracer, 99mTc-HSA, filtered 99mTc-HSA, and a mixture of 99mTc-HSA with lidocaine hydrochloride and then filtered. Time sequence evaluation was performed on all the specimens (n=10) at 0, 30, 60, 90, 120, 150, and 180 min after preparation. Measurements of radiochemical purity as labeling stability and pH value change were conducted for each group of specimens. ResultsWe found no definite difference in the stability before and after the filtering procedure for 99mTc-HSA. However, we showed a decline of stability in the mixture of 99mTc-HSA with lidocaine. The filtered specimens showed a relatively higher pH value, towards a more neutral status, as compared with the unfiltered specimens. ConclusionThough pain relief for the patient receiving sentinel lymph node mapping is important, a preparation of a mixture of 99mTc-HSA and lidocaine may cause radiolabeling instability. Furthermore, compared with the filtered 99mTc–sulfur colloid, a filtering procedure does not change the labeling stability of the 99mTc-HSA. On the contrary, the filtered preparation was neutralized closer to the physiologic condition. For lymphoscintigraphic studies, our results suggested that pretreatment with local anesthesia followed by subdermal injection of a filtered 99mTc-HSA rather than a premixture with lidocaine is appropriate for clinical application.

Technetium-99m-Labeled Autologous Serum Albumin: A Personal-Exclusive Source of Serum Component

Technetium-99m human serum albumin (99mTc-HSA) is an important radiopharmaceutical required in nuclear medicine studies. However, the risk of transfusion-transmitted infection remains a major safety concern. Autopreparation of serum component acquired from patient provides a “personal-exclusive” source for radiolabeling. This paper is to evaluate the practicality of on-site elusion and subsequent radiolabeling efficacy for serum albumin. Results showed that the autologous elute contained more albumin fraction than serum without extraction procedure. Good radiochemical purity and stability were demonstrated after radiolabeling. Biodistribution study showed that labeled albumin accumulated immediately in the lung, liver, and kidney. It was cleared steadily and excreted in the urine. The biologic half-life was defined, and all samples passed the pyrogenicity and sterility tests. In conclusion, autoalbumin could be extracted and radiolabeled properly in a nuclear medicine setting. Moreover, the risk of transfusion-transmitted infection associated with nonautologous, multisource 99mTc-HSA agents can be reduced.

Southern Taiwan Findings from the Institute for Safe Medication Practices Medication Safety Self Assessment for Hospitals Survey

Objective: Using the Institute for Safe Medication Practices (ISMP(superscript ®)) Medication Safety Self Assessment(superscript ®) for Hospitals 2004 edition, we surveyed hospital medication use processes in southern Taiwan. The results can be used for healthcare quality improvement and related policy establishment in the future. Materials and Methods: Based on the current practice model in Taiwan, we translated and modified ISMP(superscript ®) Medication Safety Self Assessment(superscript®) for Hospitals 2004 edition. The self assessment survey is divided into 10 domains, 20 core characteristics and 235 items. Surveys were distributed to all hospitals in three counties of southern Taiwan. Results: Out of a total of 63 hospitals in southern Taiwan, 53 hospitals completed the survey (completion rate 84%) and 10 hospitals declined to participate. The 53 participating hospitals scored highest in domains related to environmental factors, workflow and staffing patterns (65.48%). Scores for other domains were, in order: communication of drug orders and other drug information (59.36%); drug standardization, storage and distribution (57.94%); drug labeling, packaging and nomenclature (55.90%); patient education (39.33); quality processes and risk management (38.92%); staff competency and education (36.75%); medication device acquisition, use and monitoring (36.75%); patient information (35.40%); drug information (31.80%). Conclusions: The results demonstrate that enormous opportunities exist to improve medication safety, especially in domains related to patient information and drug information. In addition, improvements and implementation are needed in domains related to medication device acquisition, use and monitoring, staff competency and education, quality processes and risk management, and patient education.

Clinical Application of On-site Prepared Technetinum-99m Human Serum Albumin for Scintigraphic Detecting of Protein-losing Enteropathy

Background: Abdominal scintigraphy performed with technetium-99m ((superscript 99 m) Tc)-labeled human serum albumin (HSA) provides direct evidence of protein-losing enteropathy (PLE). However, because of transfusioninduced infections, the safety of serum products is a major concern. We previously developed an on-site preparation of (superscript 99 m) Tc-HSA using domestic serum products, which showed good labeling efficiency, stability, and bioavailability. The purpose of this pilot study was to initially evaluate those preparations of (superscript 99 m) Tc-labeled HSA for clinical application. Methods: HSA was locally acquired and appropriately screened for infectious diseases. (superscript 99 m) Tc-HSA was prepared according to our previous protocol. It was intravenous administration to patients with clinically suspected PLE. Sequential abdominal images were acquired by a gamma camera. Sites of obvious PLE were localized after the radiolabeled HSA was administered. Patients were monitored for adverse events. Results: Five patients with clinical suspicious of PLE were enrolled in this pilot study. Areas of protein loss were demonstrated in two patients. Another three cases, the origin of diminished serum albumin levels remained undetermined. All patients tolerated with procedure well with no specific adverse effects or major complaints. Conclusion: Scintigraphy with (superscript 99 m) Tc-HSA is noninvasive and can be used to detect, localize, and follow up cases of occult or intermittent PLE. Our pilot study demonstrated that this on-site prepared (superscript 99 m) Tc-HSA was appropriate for clinical application. Procedure of on-site radiolabeling from the native serum product was easy to be performed and achieved good labeling efficiency and bioavailability. It might also reduce the incidence of transfusion-induced infections. This technique resulted in good image quality and improved patient safety.

Blood Collection Tubes and the Impact on Clinical Analysis of Total T3 and Total T4 in Radioimmunoassay

Background: Accurate laboratory studies are essential for accurate diagnosis. However, several factors may affect test results. This study sought to identify the impacts of two different collecting tubes on clinical analysis results. Methods: Glass and plastic collection tubes were used for blood collection in 970 subjects. Two thyroid related hormones, total triiodothyronine (TT3) and total thyroxine (TT4), were examined by means of radioimmunoassay. Blood samples were collected into the tubes simultaneously and randomly. Results: Test values were significantly higher among specimens in glass BD Vacutainer(superscript TM) tube than the plastic BD Vacutainer SST(superscript TM) tube (TT3: 113.7ng/dL vs. 110.3ng/dL; P＜0.0001 and TT4: 8.5µg/dL vs. 8.39µg/dL; P=0.0013). Regression analysis by Passing-Boblok method revealed there is no definite difference in the TT3. However, negative proportional difference was found in TT4 analysis. Conclusion: The collection tube can influence analytic outcomes. Medical laboratories should pay more attention to variations in results caused by different collecting tubes.

Value of Gallium-67 Inflammatory Scan in Investigation of Acute Pyelonephritis in Pediatric Patient

We report a case of urinary tract infection. 99mTc-DMSA renal scan was performed and revealed perfusion defects of the lower portion of left kidney. For the differentiation acute pyelonephritis from scar formation, 67Ga inflammatory scan was acquired. Incidentally, we found that more acute and advanced inflammation involvement not only associated with the lower portion but also the upper pole of left kidney. We revised our previous diagnostic impression from 99mTc-DMSA renal scan after reviewed this patient’s 67Ga inflammatory image. Accordingly, we though that 67Ga inflammatory scan can be a useful diagnostic tool in the early investigation of children renal infection.