Nathan A. Solomon

Scintigraphic differentiation of bone infarction from osteomyelitis in children with sickle cell disease

Bone scans or bone marrow scans or both were obtained during 42 episodes of bone pain in 40 children with sickle cell disease, and the usefulness of these procedures was compared. On the basis of the subsequent clinical course, a diagnosis of bone infarction was made in 34 episodes, and osteomyelitis in eight. Among 22 patients with bone infarction, uptake on bone scan was increased in 14, decreased in three, and normal in five. Seven of eight patients with osteomyelitis had increased uptake on bone scan; one had normal uptake. In contrast, marrow scan uptake was markedly decreased in 15 of 16 patients with bone infarction, and was normal in five of five patients with osteomyelitis. Thus, decreased uptake on bone marrow scan in a patient with sickle cell disease and bone pain almost invariably indicates infarction, whereas normal uptake strongly suggests the diagnosis of osteomyelitis. We found marrow scans more useful than bone scans for this differential diagnosis.

Extraction of Tc(V) from Radiopharmaceuticals

Abstract The oxidation state of technetium in several radiopharmaceutical preparations was investigated by forming uncharged complexes of known valence and high stability, followed by extraction into chloroform. Successful extractions by 8-hydroxyquinoline (oxine) which forms a Tc(V) uncharged complex, showed that SnCl 2 -reduced Tc-gluconate, citrate, and mannitol complexes at 2 × 10 −9 M concentration were Tc(V) compounds. Extractions by diphenylcarbazone showed that Tc-pyrophosphate and Tc-HEDP complexes were Tc(IV) or perhaps Tc(III). By means of oxine extraction, it was found that the reaction of pertechnetate with SnCl 2 solutions, produced mostly Tc(V) in diluted pertechnetate and SnCl 2 solutions, but further reduction was observed as the SnCl 2 concentration was raised. A reported displacement of Tc-pyrophosphate and Tc-HEDP by Na-gluconate and displacement of Tc-DTPA by cyclam in alkaline solution was shown to involve oxidation, probably by traces of air. The Tc-DMSA complex produced by SnCl 2 reduction contains some Tc(IV), but the problem is complicated by the existence of four or more compounds. Diphenylcarbazone is not an ideal extractant because the chemistry of its reaction with Tc is not understood, and it is not as efective in extracting Tc(IV) as oxine is for Tc(V).

Pancreatic pseudocysts involving the spleen

Pancreatic pseudocyst involving the splenic parenchyma itself is an unusual complication of pancreatitis. The diagnosis is best established by arteriography, isotopic studies, and sonography. Once confirmed, surgical intervention is mandatory because of the danger of secondary hemorrhage.

Technetium-sulfur colloid

The chemistry of the technetium-sulfur colloid produced by the reaction of sodium thiosulfate with acid was investigated. A commercial kit was duplicated, and analyses of elemental sulfur, bisulfite and residual thiosulfate were carried out. The colloidal dispersions were filtered through Nuclepore graded membranes, and the percentages of sulfur and of 99mTc in the various filtrates were determined. In all cases--with varying acid, thiosulfate and time of incubation--there was a rough agreement between the two percentages for particles 0.4 micron in diameter or more. However, for small particles (less than 0.1 micron) there was virtually no sulfur, but there was an appreciable percentage of technetium. It was concluded that the technetium sulfide nuclei formed first, and that the supersaturated sulfur deposited in part on them and in part on its own nuclei. It was found that raising the pH of the preparation to weakly alkaline values and reheating the solution dissolved most of the deposited sulfur by the reaction with sulfite to form thiosulfate, leaving much smaller, virtually sulfur-free technetium sulfide particles. Such a preparation was found to be as efficient as the technetium-antimony sulfide colloid for lymphograms in dogs. Potassium trithionate, K2S3O6, used in place of sodium thiosulfate, produced small Tc-S colloid particles with less sulfur than the conventional thiosulfate-acid system.

Complexes of technetium with polyhydric ligands

Abstract Polyhydric complexes of Tc(V) show absorption bands near 500 nm, with molar absorptivity coefficients of about 100. The shorter-chain compounds like ethylene glycol produce complexes which quickly disproportionate to Tc(IV) (as TcO2) and Tc(VII) (asTcO4−) on acidification. The longer-chain ligands like mannitol and gluconate do not. However, while the mannitol complex shows no change in spectrum from pH 12 to pH 3, the gluconate and glucoheptonate compounds show a definite spectral change on acidification, starting at pH 5. Electrophoresis similarity showed a change in mobility with pH for Tc-glucoheptonate, but none for Tc-mannitol. It was concluded that the carboxylic acid group of glucoheptonate was not binding the technetium. In 25 molal choline chloride the glucoheptonate-Tc mole ratio was 1:1 or less. A similar result emerged from a similar experiment in methylcellosolve as solvent.

Persisting Perfusion Defects After Bronchoscopic Removal or Spontaneous Expulsion of Aspirated Foreign Objects

Follow-up lung scans were obtained in 9 children to determine whether perfusion lung scanning could be used to verify completeness of foreign-body removal. In 4 patients, extensive perfusion defects were present 4-19 days after removal of the object. In 1 patient, the area of hypoperfusion was larger than the territory served by a persistently obstructed lobar bronchus. Follow-up lung scans are of limited value for verifying completeness of foreign-body removal and localization of retained fragments.

A complication of percutaneous transluminal angioplasty in the transplanted kidney

The following case report illustrates a complication that can occur as a consequence of implementing percutaneous transluminal angioplasty for correction of renal artery stenosis in a transplanted kidney. Immediately following the procedure, there was severe spasm of upper and lower branches of the renal artery and thrombosis of the arterial supply to the middle portion of the kidney.

Extravasation of Contrast Material from Vascular Ectasia of the Cecum Detected with99mTc-Pertechnetate

A case of vascular ectasia of the cecum is presented. The isotopic pattern did not differ from that of Meckels diverticulum. The authors suggest that studies with 99mTc may be helpful in screening for areas of pathology in cases of lower gastrointestinal bleeding.

Radionuclide Angiogram in Combination with Barium-Sulfate-99mTechnetium-Pertechnetate Mixture

99mTc-pertechnetate angiocardiography performed simultaneously with radionuclide esophagography (barium-sulfate-99mTc-pertechnetate mixture) was used to rule out a mediastinal mass in a child with known congenital heart disease. The mass proved to be the left atrium. This technique is useful in evaluating the cardiac silhouette as well as mediastinal masses.