Oktay Yapici

The role of coughing as a gastroesophageal-reflux provoking maneuver: the scintigraphical evaluation.

BackgroundAttempts have been made to improve the positivity of the radionuclide detection of gastroesophageal reflux (GER). The aim of this study was to examine the possible contribution of coughing as a provoking maneuver in GER scintigraphy. MethodsOne hundred and twenty-five patients (mean age: 9.2±3.2 years) who had a clinical probability of having GER and were fully able to cooperate for coughing on command were included in the study. The patients were asked to cough gently four to six times per minute in the 2nd, 4th, and 6th 10-min periods within a 60-min total study time. The presence and number of GER episodes were noted for each period in all patients. ResultsSixty-one of 125 patients (48.8%) showed no scintigraphic finding of GER and were interpreted as normal. In the remaining 64 patients (51.2%), GER was observed and these patients were interpreted as abnormal (GER+). Among patients with abnormal results, 25 (39%) presented GER episodes only during the coughing intervals of the study. In 33 (51.6%) patients, the reflux was seen both at coughing and noncoughing periods. In only six patients (9.4%) with GER in noncoughing periods, coughing did not provoke any reflux episodes. No overall correlation between cough-provoked frequency of reflux, number of GER episodes, and symptom severity was found in 64 GER+ patients (P>0.5); but in the subgroup of patients presenting GER episodes only during the coughing intervals, 60% (15 of 25), presented GER episodes only in one of the three cough-provoked intervals and also had the lowest symptom severity scores. ConclusionThe results of our study showed that 39% (25 of 64) of the observed GER findings were achieved exclusively by means of cough provocation.

Evaluation of metastatic bone disease with pentavalent 99Tcm-dimercaptosuccinic acid: A comparison with whole-body scanning and 4/24 hour quantitation of vertebral lesions

The aim of this study was to establish the value of 99Tcm(V)-DMSA scintigraphy in the detection of metastatic bone lesions and compare the results to 99Tcm-MDP bone scintigraphy. Thirty-four patients presenting with metastatic bone disease (Group 1) and 12 controls with degenerative skeletal lesions (Group 2) were studied. Conventional bone scanning and 99Tcm(V)-DMSA whole-body scanning were performed on all patients. All scans were interpreted visually. Furthermore, lesion-to-normal bone ratios (L/N) in vertebral metastases on the 4 and 24 h bone scans were obtained in 58 lesions of cancer patients and in 23 benign (degenerative) vertebral lesions of the control group. 99Tcm-MDP L/N ratios at 24 h (3.08±0.32) were significantly higher than those at 4 h (2.48±0.24) in the malignant foci (P<0.001). No significant difference was observed in benign lesions (P>0.05). In 167 (164 metastatic, 3 traumatic) of 186 99Tcm-MDP positive lesions (90%) of Group 1, 99Tcm(V)-DMSA uptake was observed. The remaining 19 lesions (10%) were 99Tcm(V)-DMSA negative. Fourteen of these 19 sites were diagnosed as benign. The remaining five foci were malignant. In four lung cancer metastases showing no 99Tcm-MDP uptake, 99Tcm(V)-DMSA uptake was observed. There was no 99Tcm(V)-DMSA accumulation in any of the 99Tcm-MDP positive degenerative lesions of Group 2. All quantitatively evaluated (n = 42) vertebral metastatic foci and two compression fractures in Group 1 showed 99Tcm(V)-DMSA accumulation and an increased 99Tcm-MDP L/N ratio at 24 h. A total of 36 degenerative lesions (Groups 1 and 2) and one compression fracture (Group 1) showed neither 99Tcm(V)-DMSA uptake nor an increased 99Tcm-MDP L/N ratio at 24 h. Our results indicate that quantitative 4/24 h analysis of vertebral lesions on 99Tcm-MDP scans has a similar diagnostic value to 99Tcm(V)-DMSA imaging in the detection of bone metastases. However, the accumulation of 99Tcm(V)-DMSA in four lung cancer metastases showing no 99Tcm-MDP uptake is encouraging and justifies further research in patients with proven bone metastases and negative bone scans.

Acute renal failure with acyclovir treatment in a child with leukemia

Acyclovir is an effective, frequently used antiviral agent. Adverse effects of this drug are well known and are especially seen with high doses and/or dehydration. In this article, we report a 6-year-old boy with leukemia with nonoliguric acute renal failure in normal hydration status after using acyclovir treatment. He had no preexisting renal impairment, and there were no additional symptoms. Dimercaptosuccinic acid radionucleid scyntigraphy and other laboratory findings revealed impairment of proximal tubule function, in addition to distal tubule. We emphasize that renal functions should be monitored carefully during treatment with acyclovir, and asymptomatic nephrotoxicity must be kept in mind.

Pentavalent technetium-99m DMSA uptake in pseudofractures of osteomalacia.

Tc-99m MDP and Tc-99m (V) DMSA images are described from a 49-year-old woman with chronic renal insufficiency complicated by osteomalacia. Clinical, biochemical, and radiologic bone profiles were compatible with osteomalacia. Osteomalacia is a condition associated with disorders in which mineralization of the organic matrix is defective. All bone lesions visualized with Tc-99m MDP also showed increased uptake of Tc-99m (V) DMSA. Tc-99m (V) DMSA accumulation has been reported in many malignant and some benign conditions. Pseudofractures in osteomalacia could be included in the spectrum of benign lesions that accumulate Tc-99m (V) DMSA.

Apical hypertrophic cardiomyopathy: a case of slow flow in lad and malign ventricular arrhythmia

The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of epicardial coronary artery disease. Patients often present with acute coronary syndrome. Histopathologic studies have revealed the existence of fibromuscular hyperplasia and myofibrilar hypertrophy. Apical hypertrophic cardiomyopathy is a benign progressive form of hypertrophic cardiomyopathy, that is rarely observed in western communities. It remains commonly asymptomatic until advanced ages. Syncope, arrhythmia or sudden death may be the first symptom. We report a case of slow coronary arterial flow in a 71-year-old male patient with apical hypertrophic cardiomyopathy who experienced chest pain and sudden cardiac arrest due to ventricular arrhythmia.

Orbital Drainage of Different Sizes of Colloids in Rabbits: A Dynamic Scintigraphic Study

PURPOSE To investigate the drainage patterns of radiolabeled colloids of different sizes injected into the orbital cavity in an animal model. METHODS Twenty-one orbits of 11 rabbits were included in the study. In group 1, human serum macroaggregates with particle sizes of 10 to 100 microm, labeled with 10 mL of 1480 MBq (40 mCi) technetium pertechnetate Tc 99m (99mTc), were used. In group 2, human serum albumin colloidal particles with particle sizes of 50 to 80 nm, labeled with 5 mL of 740 MBq (20 mCi) 99mTc, were used. In group 3, colloidal tin with particle sizes of 300 to 600 nm, labeled with 9 mL of 1665 MBq (45 mCi) 99mTc, were used. The dynamic acquisition of liver for 10 minutes (120 frames for 5 seconds) in a 128 x 128 matrix was acquired immediately after intraorbital injection and at the end of the second hour. RESULTS The liver in groups 2 and 3 and the lung in group 1 were visualized in 10 seconds or less in six, five, and four rabbits, respectively. The injected activity persisted in the orbits in varying percentages in all rabbits at the end of acquisition. CONCLUSIONS Intraorbital injections have a great potential for systemic absorption and should not be considered as local pharmaceutical administration.

Early Response to Everolimus Therapy Detected on 68Ga-DOTATATE PET/CT in a Patient With Pancreatic Neuroendocrine Tumor.

Everolimus is a mammalian target of rapamycin inhibitor that has been recently approved for the treatment of patients with advanced progressive pancreatic neuroendocrine tumor. Here, we present a case in which an early therapy response to everolimus was effectively demonstrated by Ga-DOTATATE PET/CT.

Intracoronary versus intravenous injection of 99mTc-tetrofosmin: comparison of myocardial perfusion patterns and wall motion.

ObjectivesThe accuracy of viability and defect size detection by 99mTc-tetrofosmin has been discussed by several authors. The lower myocardial extraction fraction of the latter compared with 99mTc-sestamibi or 201Tl has often been emphasized. We hypothesized that the intracoronary (i.c.) injection of tracer activity, i.e. higher than that theoretically achievable in the case of intravenous (i.v.) administration, could demonstrate the clinical relevance of this finding intra-individually. In this study, myocardial perfusion images obtained after tracer injection down the infarct-related artery were compared with i.v. injection images in the same patients. The trial also provided us with the opportunity to compare the wall motion values calculated using conventional 99mTc-tetrofosmin gated single-photon emission computed tomography (SPECT) studies with those obtained using optimal target/background ratios after i.c. injection. MethodsFourteen patients with acute myocardial infarction, no history of previous cardiac events, single vessel disease and no visible collaterals in the coronary arteriogram were included in the study. Electrocardiogram gated SPECT was carried out separately after i.c. and i.v. injections of the tracer within 5–7 days following thrombolytic therapy. Myocardial perfusion patterns were compared by contingency table analysis after semi-quantitative visual scoring. Segmental wall motion was compared using quantified polar map data in a subset of patients (eight of 14) with normal to moderately hypoperfused myocardium supplied by the left coronary artery. ResultsVisual perfusion scores of both studies showed good concordance (kappa, 0.70), with complete agreement in 94 of 119 segments. Nearly all of the discordant segments (24 of 25) were mildly better scored in i.c. studies than in i.v. studies. The mean wall motion values calculated on polar maps of 78 segments for i.c. and i.v. studies were 8.4±1.2 mm and 8.2±1.3 mm (mean Δ wall motion=0.23 mm), respectively. High segmental wall motion correlation was observed (R=0.90; P<0.0001). ConclusionIt can be concluded that infarct-related myocardial perfusion scores obtained after i.c. and i.v. injections of 99mTc-tetrofosmin compare favourably, with a total agreement rate of 79%. However, the additional information obtained in 21% of the total number of myocardial segments by i.c. injection may indicate a mild underestimation of myocardial viability by i.v. injection. Conventional gated SPECT using i.v. 99mTc-tetrofosmin was demonstrated to be a reliable technique in the detection of true wall motion.