Nilo E. Herrera

Placental pathology at term associated with elevated midtrimester maternal serum α-fetoprotein concentration

Reports have supported an association between elevated midtrimester maternal serum alpha-fetoprotein concentrations (unexplained by fetal anomalies) and intrauterine growth retardation. Our observations show an association between such elevations of maternal serum alpha-fetoprotein levels and two types of placental pathology at delivery, chronic villitis and placental vascular lesions of infarction or intervillous thrombosis. If chronic villitis was present, the frequency of intrauterine growth retardation was significantly increased, whereas no increase in intrauterine growth retardation was found in the absence of placental pathology.

Adenosarcoma of uterus and ovary. A clinicopathologic study of two cases

We report the clinical and pathologic features of two cases of adenosarcoma. Our first case occurred in the ovary of a 51‐year‐old woman with extensive pelvic involvement. She was treated vigorously with radiation and chemotherapy and at the present time almost 9 years later the patient is free of disease. This represents a case with one of the longest survival reported in the literature. Our second case occurred in a 37‐year‐old woman and was limited to the endometrium.

Brain Death: Confirmation by Radionuclide Cerebral Angiography

Dynamic radionuclide cerebral angiography was performed in 14 patients with suspected brain death. In 10 of 14 patients, no intracranial arterial perfusion was demonstrable, thus confirming brain death. In four patients, faint venous activity was seen in the sagittal sinus only. All these patients also eventually died. Radionuclide cerebral angiography provides a simple and noninvasive means to confirm brain death in critically ill patients maintained on life support systems particularly when an electroencephalogram and four vessel contrast angiography may be either impractical or equivocal.

Aberrant cerebrospinal fluid pathway. Detection by scintigraphy.

Radionuclide cisternography is routinely performed for assessment of normal and abnormal pathways and the hydrodynamics of cerebrospinal fluid (CSF). An unusual case of a woman in whom cisternography provided the diagnosis of an iatrosenic spinopleural fistula with a large CSF collection in the pleural cavity, following surgical resection of a vertebra for a malignant tumor is presented.

Parathyroid adenomas and hyperplasia. Dual radionuclide scintigraphy and bone densitometry studies.

Dual radionuclide imaging of the neck (Tc-99m pertechnetate and TI-201 thallous chloride) was performed in 22 patients with chemical evidence of hyperparathyroidism (elevated blood calcium and parathormone [PTH] levels). Of these, 19 of 22 had localization of a TI-201 “excess” area on radiothallium-radiotechnetium subtraction images. In 13 patients who have had operative confirmation at this writing, the dual radionuclide imaging was positive in 12 (12/13 = 92.3%). One patient had two parathyroid adenomas, both of which were seen on the images; thus, overall detection was 13 out of 14 or 92.8%. The parathyroid adenomas visualized weighed from 0.06 to 3.0 g; the one not detected weighed 0.25 g. In three patients with parathyroid hyperplasia secondary to renal disease, the subtraction imaging detected eight of 12 glands (66.7%). The forearm bone mineral content and bone density were determined in eight patients with parathyroid adenomas; results were abnormally low in five of these eight. One of the three patients with secondary hyperparathyroidism had an abnormally low radial bone mass. The combination of dual radionuclide imaging and radial bone mass determination may present a useful approach in both localizing abnormal parathyroid tissue and in examining its functional consequences.

Iodine-123 assay using a radionuclide calibrator

Iodine-123 (123I), an accelerator-produced radionuclide, gained wide acceptance recently in medical applications. Radionuclide dose calibrators are commonly used to assay radioactivities of radiopharmaceuticals, and should be maintained to read within +/- 5%, both for constancy and accuracy. Radionuclidic impurities present in commercial 123I preparations may produce an assay error larger than 10%. The type and quantity of impurities depend on the mode of production of 123I. The impurities can be reduced by either increasing the energy of the proton beam (over 60 MeV) and using the 127I (p,5n) 133Xe leads to 123I indirect reaction or using lower energies and highly enriched (better than 99%) 124Te (or 122Te) target for the direct production of 123I via 124Te (p, 2n) 123I or 122Te (d, n) 123I. A survey of radionuclide calibrators was undertaken to investigate the extent of the 123I assay error due to impurities present in commercially available preparations of 123I. Results from 24 calibrators indicate that the activity of a (p, 2n) 123I capsule is overestimated on average by 22% two half-lives after calibration time, while the activity of a (p, 5n) 123I capsule remains within the accuracy of the radionuclide calibrator of +/- 5%. The 124I fraction increases significantly with time during the useful life of a (p, 2n) 123I capsule introducing large 123I assay errors.

Abnormal distribution of 99mTc-sulfur colloid in a patient with systemic amyloidosis.

Marked pulmonary uptake of 99mTc-sulfur colloid in a patient with monoclonal gammopathy and histologically proven amyloidosis is described and discussed.

Granulomatous hepatitis: spectrum of scintigraphic manifestations.

Four cases of granulomatous hepatitis are presented. Hepatocellular disease in general and the clinical, histological and scintigraphic manifestations of granulomatous hepatitis are discussed.

College of American Pathologists “series x” program

Physical parameters that control detectability of low contrast lesions by current Nuclear Medicine imaging instruments are presented. The findings were derived from statistical analysis of data collected over a period of 6 yr by the Nuclear Medicine Resource Committee of the College of American Pathologists using the external Quality Control technique known as Interlaboratory Comparison.

Nuclear medicine studies of aging—III. Radial bone mineral content by single and dual photon absorptiometry

Measurement of bone mineral content of the radius has been possible by single photon absorptiometry. Recently, dual photon devices have become widely used for measuring the quantity of lumbar vertebral bone mineral. Therefore, we studied the utility of a dual beam machine for quantifying the bone mineral content of the radius, and compared results with those obtained by single photon absorptiometry in the same patient on the same day. There was an excellent correlation between single and dual beam measurements of the radius. The present study indicates that a dual photon machine can be used for assessing not only vertebral, but radial bone mineral content as well. This may facilitate studies of the two sites by use of one machine.