Parenchymal Activity Research Articles

Синдром полигландулярной недостаточности с проявлениями аутоиммунного гепатита в детском возрасте

This article presents a review and a case report of autoimmune polyglandular syndrome type 1 (APS-1) in a child with autoimmune hepatitis (AIH) as a first clinical manifestation. The duration of the disease was 9 years. The first signs of hepatitis (jaundice, hepatosplenomegaly, impaired pigment metabolism, cytolysis) with a high degree of activity and a morphological picture of monolobular liver cirrhosis with stromal and parenchymal activity were noted at the age of 2.5 years. The child received therapy with prednisolone. After one year, symptoms not typical of AIH were noted: salting food, candidiasis of the nail plates on hands and feet. Upon repeated examination, the diagnosis of APS-1 (hypoparathyroidism, candidiasis, autoimmune thyroiditis, chronic adrenal insufficiency, autoimmune hepatitis) was confirmed genetically – the homozygous R257X mutation was detected. The therapy was corrected: fludrocortisone and diflucan were added, therapy was continued with gradual transition to a maintenance dose of prednisolone. This case report demonstrates the difficulty of early APS-1 diagnosis, resulting in late initiation of baseline therapy, which can determine the prognosis of the disease. Key words: children, autoimmune polyglandular syndrome, autoimmune hepatitis

Metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging according to primary tumor uptake and background parenchymal enhancement.

This study was aimed at investigating metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging (DTPI) according to primary tumor uptake and determining whether this technique is affected by background parenchymal enhancement (BPE). A total of 189 patients with newly diagnosed breast cancer who underwent DTPI examination were retrospectively evaluated. DTPI was performed using a standard FDG/PET protocol followed by delayed image acquisition at 120min after injection. Patients were divided into two groups according to primary tumor uptake as breast cancer with low maximum standard uptake value (SUVmax) (< 2.5) and high SUVmax (≥ 2.5). The maximal SUV of the primary breast tumor (T-SUVmax), contralateral breast parenchyma uptake (B-SUVmax) according to different BPE grades, tumor to background ratio (T/B-SUVmax), and their percentage changes between early and delayed images (retention index, RI) were calculated. For primary tumor uptake, tumors with high SUV had a significant increase in mean T-SUVmax between early and delayed images (8.17 vs. 9.16, P < 0.001), and %RI T-SUVmax was 10.52%. Conversely, mean T-SUVmax did not change between early and delayed images for tumors with low SUV (1.96 vs. 1.94, P = 0.610), and %RI T-SUVmax was -1.41%. The mean %RI B-SUVmax was -12.43% for minimal BPE, -14.19% for mild BPE, -19.49% for moderate BPE, and -21.25% for marked BPE grade, indicating that higher BPE grades undergo better washouts on delayed imaging (β = -3.220, P < 0.001 for trend). The %RI T/B-SUVmax of both breast cancer groups with low SUV and high SUV was 18.86% and 32.47%, respectively. Breast cancer with low SUV undergoes no significant change in SUV on DTPI; however, washing of background parenchymal activity was evident over time, resulting in significantly increased tumor contrast in delayed images, which leads to increased sensitivity. Breast parenchymal washout was more significant with increased BPE level. Therefore, DTPI is expected to be more useful for evaluating breast lesions in regions with marked BPE on MRI.

No delayed imaging or CCK administration is needed in most cases when bowel excretion does not occur but gallbladder fills promptly.

On hepatobiliary scintigraphy, "preferential gallbladder (GB) filling without tracer excretion into the small bowel (SB) [p-GB-no-SB]" is occasionally seen on images obtained up to an hour. In such cases, many practitioners administer cholecystokinin (CCK) (even when the measurement of GB ejection fraction is not indicated) or obtain delayed images (DI) to exclude common bile duct (CBD) obstruction. We aimed (1) to assess the prevalence of clinically relevant CBD obstruction found by CCK administration or DI in this circumstance and (2) to find imaging findings and/or parameters that can be used to triage patients who do or do not need such maneuvers. Of 1244 scans reviewed, 1089 were excluded because of one or more of the following reasons: SB visualized within 60min, GB not visualized within 60min, severely decreased hepatic function, and less than 1month of clinical follow-up after scanning. The remaining 155 showed p-GB-no-SB with clinical follow-up available for ≥ 1month. For the 155 scans, clearance of liver parenchymal activity was assessed. Of the 155 scans, 142 showed visually prompt clearance of liver parenchymal activity (group A), while 13 scans showed mild to moderately delayed clearance of liver parenchymal activity with or without initial decreased hepatic uptake (group B). 134 of 142 in group A had additional imaging (99 CCK or 35 DI); all 134 showed SB visualization. Eight remaining scans were terminated without additional imaging. None of the 142 had any event attributable to CBD obstruction on follow-up. All 13 in group B had additional imaging (9 CCK, 4 DI); SB visualized in 11, but not in two; clinical follow-up revealed no CBD obstruction in 11. ERCP revealed CBD obstruction in the latter two. When a HIDA scan shows p-GB-no-SB, the probability of identifying clinically relevant CBD obstruction by additional imaging with CCK or DI is virtually zero in an acute clinical setting if clearance of liver parenchymal activity is prompt. Additional imaging with CCK or DI can be reserved for only those showing abnormal clearance of liver parenchymal activity.

Super Scan Caused by Parathyroid Carcinoma Observed Both in 18F-FDG PET/CT Scan and Tc-99m MDP Bone Scintigraphy

Super scan is a well-known finding described in skeletal scintigraphy characterized by uniform symmetrically increased radiopharmaceutical uptake by bones and consequently diminished renal parenchymal activity. Sy et al. hypothesized that the faint visualization of renal cortex in bone scintigraphy might be the result of increased uptake of radiopharmaceutical by pathologic bones and reduced phosphate excretion. The super scan on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been observed in various conditions such as prostate cancer, lung cancer, renal adenocarcinoma, gastric cancer and primitive neuroectodermal tumor of the kidney. Herein we report the first case of super scan in a 68-year-old-woman with parathyroid carcinoma observed both in 18F-FDG PET/CT and Tc-99m methylene diphosphonate bone scintigraphy. There were extensive hypermetabolic lesions throughout the skeleton in 18F-FDG PET/CT. In contrast to the intense hypermetabolism of the skeleton; the liver, skeletal muscles of the limbs, mediastinum, bowel and especially the brain showed very low FDG uptake. Additionally, there was increased skeletal radiotracer uptake relative to soft tissue, and faint genitourinary tract activity in bone scintigraphy.

Abstract 3475: A Plasminogen Activator Inhibitor-based Therapy of Infection-Sensitized Hypoxia-Ischemia Injury in Newborn Rodent Brains

Introduction: The combination of intrauterine infection and hypoxia-ischemia (HI) is a severe threat to immature brains. Further, infection may alter the response to HI in immature brains, but key steps of the switch are unclear. Better understanding these differential responses may suggest new therapeutic targets in neonatal care. This is particular urgent for premature infants who have a high incidence of chorioamnionitis and HI insults, but are unfit for hypothermia therapy. Hypothesis: (1) Infection pre-exposure significantly amplifies the nuclear factor-kappa B (NF-κB) signaling activity following HI in a tissue-plasminogen activator (tPA)-dependant manner. (2) CPAI, a stable-mutant form of plasminogen activator inhibitor-1 (PAI-1) that resists pure HI, also confers significant protection against infection-sensitized HI brain injury in newborns. Methods: Seven-day-old Wistar rat pups were injected with a low-dose lipopolysaccharide (LPS, 0.3 mg/kg, IP) 4 h before imposing cerebral HI using the Rice-Vannucci model, followed by post-hypoxia injection of CPAI or saline into cerebral ventricles. The brains were collected between 4-24 h recovery for biochemical and histological analyses, at 7 d to measure damage, or at 2 months of age for behavioral testing and diffusion tensor imaging of the white-matter (WM). Results: LPS mitigated HI-induced parenchymal tPA activity, but intensified NF-kB signaling, microglia activation, synthesis of chemoattractive cytokines, damage to blood-brain-barrier, and brain tissue loss, which were all significantly ameliorated by the CPAI treatment. The therapeutic window of CPAI was at least 4 h after the LPS/HI insult. CPAI-treated pups also developed near-normal motor and WM functions at 2 months of age. Conclusions: Infection alters the immature brain response to HI by activating tPA-dependent NF-_B signaling but diminishing the tPA proteolytic activity. Because CPAI effectively inhibits both proteolytic and pro-inflammatory functions of tPA, it may be a promising therapeutic of infection-sensitized neonatal HI brain injury.

Depreotide Scanning in Sarcoidosis: A Pilot Study

radiographs (CXRs). The results of 99m Tc-DP scintigraphy were positive for sarcoidosis in 18 individuals (81.8%; 95% confidence interval, 59.7 to 94.8%). Of the four persons lacking 99m Tc-DP uptake, all had normalized their CXRs since the time of presentation. In the entire sample, the intraclass correlation between radiographic stage determined by CXR vs that determined by 99m Tc-DP scintigraphy was robust ( 0.79; p 0.0005). Among patients with positive 99m Tc-DP scan findings, the correlation was stronger ( 0.94; p < 0.0001). Flow rates and lung volumes were lower in patients with parenchymal activity on 99m Tc-DP scintigraphy (mean FEV1, 68.6 13.9% predicted vs 84.5 10.7% predicted, respectively [p 0.012]; mean FVC, 74.0 16.0% predicted vs 88.4 12.7% predicted [p 0.041]). 99m Tc-DP scintigraphy correctly identified all sites of known nonpulmonary visceral involvement with sarcoidosis. Conclusions: The results of 99m Tc-DP imaging are often positive in sarcoidosis patients, and correlate with disease stage determined by CXR and pulmonary function. 99m Tc-DP scintigraphy does not preclude the need for biopsy if this is indicated to confirm the diagnosis of sarcoidosis or to exclude the possibility of malignancy. 99m Tc-DP scintigraphy merits further study in the evaluation and management of sarcoidosis. (CHEST 2004; 126:1337–1343)

Depreotide scanning in sarcoidosis: a pilot study.

To determine whether sarcoidosis results in uptake on (99m)Tc-labeled depreotide (DP) scintigraphy and to generate preliminary data to guide the development of future trials exploring this imaging modality in sarcoidosis patients. Prospective cohort trial among a convenience sample of patients with sarcoidosis. Tertiary care medical center pulmonary clinic. Subjects in whom sarcoidosis has been diagnosed based on a biopsy revealing nonnecrotizing granulomas. Two hours after IV administration of (99m)Tc-DP, all patients underwent whole-body anterior and posterior planar imaging, followed by thoracic single-photon emission CT scanning. Images were interpreted by two nuclear medicine physicians who were blinded to the patient's clinical status. The study cohort included 22 subjects (mean [+/- SD] age, 41.3 +/- 9.3 years; 40% female). Approximately half of the cohort had stage I disease determined by chest radiographs (CXRs). The results of (99m)Tc-DP scintigraphy were positive for sarcoidosis in 18 individuals (81.8%; 95% confidence interval, 59.7 to 94.8%). Of the four persons lacking (99m)Tc-DP uptake, all had normalized their CXRs since the time of presentation. In the entire sample, the intraclass correlation between radiographic stage determined by CXR vs that determined by (99m)Tc-DP scintigraphy was robust (kappa = 0.79; p = 0.0005). Among patients with positive (99m)Tc-DP scan findings, the correlation was stronger (kappa = 0.94; p < 0.0001). Flow rates and lung volumes were lower in patients with parenchymal activity on (99m)Tc-DP scintigraphy (mean FEV(1), 68.6 +/- 13.9% predicted vs 84.5 +/- 10.7% predicted, respectively [p = 0.012]; mean FVC, 74.0 +/- 16.0% predicted vs 88.4 +/- 12.7% predicted [p = 0.041]). (99m)Tc-DP scintigraphy correctly identified all sites of known nonpulmonary visceral involvement with sarcoidosis. The results of (99m)Tc-DP imaging are often positive in sarcoidosis patients, and correlate with disease stage determined by CXR and pulmonary function. (99m)Tc-DP scintigraphy does not preclude the need for biopsy if this is indicated to confirm the diagnosis of sarcoidosis or to exclude the possibility of malignancy. (99m)Tc-DP scintigraphy merits further study in the evaluation and management of sarcoidosis.

Reference values for 99mTc-MAG3 renography determined in healthy, potential renal donors.

Reference values for 99mTc-MAG3 renography were determined and the influence of sex and age (< 50/ > or = 50 years) was elucidated. Sixty-eight potential renal donors were evaluated by renography among other tests. Through examination of their records 41 healthy subjects with a normal renal arteriography were included in this study and the reference values of the functional distribution (the split function, SF), the time to peak renal parenchymal activity (Tmax) and the residual activity (RA) were calculated. For Tmax there was no significant influence of sex or age. Mean RA increased significantly with age (20.5 vs. 23.2%, P = 0.03), but no difference was found between sexes. Mean SF (right kidney) was significantly higher among males. When a diuresis of at least 2 ml min-1 is demanded we found the following normal ranges: SF > 41%, Tmax < 4.3 min and RA < 33.7%.

Refinement of the positive predictive value of gallbladder nonvisualization after morphine administration for acute cholecystitis based on the temporal pattern of common bile duct activity.

The authors previously reported two major patterns in the time-activity curve of the common hepatic bile duct (BD) after morphine administration in patients with gallbladder nonvisualization. The first pattern consists of a gradual increase in BD activity (of variable duration) occurring during a simultaneous decrease in liver parenchymal activity (BD increase), representing the physiologic effects of morphine administration. The second pattern consists of a continuous decrease in BD activity that parallels the activity in the liver parenchyma (BD decrease), representing lower or no physiologic effects of morphine administration. The authors hypothesize that gallbladder nonvisualization associated with a continuous decrease in BD activity after morphine administration will have a lower positive predictive value (PPV) for acute cholecystitis than gallbladder nonvisualization associated with an increase in BD activity. Thirty-six patients who had morphine-augmented cholescintigraphy were divided into two groups: 19 with BD increase after morphine administration and 17 with BD decrease. Of the 36 patients, 22 had acute cholecystitis. The positive predictive value (PPV) of gallbladder nonvisualization was 61%. All of the remaining 14 had chronic cholecystitis. Of 19 patients with BD increase, 15 had acute cholecystitis (PPV = 79%), whereas only 7 of 17 patients with BD increase (PPV = 41 %) had acute cholecystitis (P = 0.023 by the one-tailed and 0.038 by the two-tailed Fisher exact tests). Gallbladder nonvisualization after morphine administration with the pattern of BD decrease is not as reliable (intermediate probability in this series) for the diagnosis of acute cholecystitis as is nonvisualization of the gallbladder in patients with a pattern of BD increase (high probability).

Functional magnetic resonance imaging measures of blood flow patterns in the human auditory cortex in response to sound.

Functional Magnetic Resonance Imaging (fMRI) holds exciting potential as a research and clinical tool for exploring the human auditory system. This noninvasive technique allows the measurement of discrete changes in cerebral cortical blood flow in response to sensory stimuli, allowing determination of precise neuroanatomical locations of the underlying brain parenchymal activity. Application of fMRI in auditory research, however, has been limited. One problem is that fMRI utilizing echo-planar imaging technology (EPI) generates intense noise that could potentially affect the results of auditory experiments. Also, issues relating to the reliability of fMRI for listeners with normal hearing need to be resolved before this technique can be used to study listeners with hearing loss. This preliminary study examines the feasibility of using fMRI in auditory research by performing a simple set of experiments to test the reliability of scanning parameters that use a high resolution and high signal-to-noise ratio unlike that presently reported in the literature. We used consonant-vowel (CV) speech stimuli to investigate whether or not we could observe reproducible and consistent changes in cortical blood flow in listeners during a single scanning session, across more than one scanning session, and in more than one listener. In addition, we wanted to determine if there were differences between CV speech and nonspeech complex stimuli across listeners. Our study shows reproducibility within and across listeners for CV speech stimuli. Results were reproducible for CV speech stimuli within fMRI scanning sessions for 5 out of 9 listeners and were reproducible for 6 out of 8 listeners across fMRI scanning sessions. Results of nonspeech complex stimuli across listeners showed activity in 4 out of 9 individuals tested.

Influence of GB virus C viraemia on the clinical, virological and histological features of early hepatitis C-related hepatic disease

Background/Aims: GB virus C is a newly described RNA virus. The aims of this study were to determine the prevalence of GB virus C infection in patients with chronic type C hepatitis and to examine the clinical, virological and histological features in hepatitis C and GB virus C co-infected patients. Methods/Results: One hundred and sixty patients with hepatitis C infection were studied. GBV-C RNA was detected in 33 160 (20.6%) patients; co-infected patients with hepatitis C and GB virus C infection were significantly younger ( p=0.04). No difference was found between the two groups according to gender and biochemical parameters. Seventy-two of the 160 patients, for whom a liver tissue specimen taken simultaneously with the serum was available and who had compensated liver disease, were studied separately. The source of infection, duration of infection, HCV genotype and HCV RNA concentrations did not differ between 15 72 patients with dual infection and 57 72 with hepatitis C infection alone. Patients with co-infection had significantly higher degrees of portal and periportal inflammation ( p=0.0006 and 0.01, respectively). No difference was observed in parenchymal activity score or extent of fibrosis. Conclusions: These results indicate a relatively high prevalence of GB virus C infection in younger patients with chronic hepatitis C, suggesting a common route of transmission. Although GB virus C co-infection does not alter the biochemical and virological profile of patients with HCV hepatitis, there is an association between GB virus C and hepatitis C viraemia and portal and periportal inflammation.

Normal Ranges of Renal Physiological Parameters for Technetium-99m Mercaptoacetyltriglycine and the Influence of Age and Sex Using a Camera-Based Method

162 normal Chinese men and women underwent a ^99mTc MAG3 renal study. Seventy-two males and 90 females were evaluated in 5 age groups: group 1, 61–80 years; group 2, 51–60 years; group 3, 41–50 years; group 4, 31–40 years, and group 5, 21–30 years. Each subject was required to fit the following criteria: (1) clinically no history of renal, urinary disorders and systemic diseases, normal blood pressure, kidney morphology, urinary examination and serum creatinine, and (2) for the gamma camera study normal hydration and renal images, and no pelvic, ureteric dilatation or retention of tracer should be found. The normal range of common physiological parameters for ^99mTc MAG3 renal studies was measured in normal subjects. The effective renal plasma flow (ERPF, camera-based Schlegel method), percent function in each kidney (renal index, RI), time of peak renal parenchymal activity (T_max) and half time of parenchymal activity following the peak (T¹/₂) were evaluated. The T_max and T¹/₂ were determined with regions of interest over the entire kidney. The results showed that (1) between the sexes, there were no significant differences for any parameter; (2) between the age groups, the only significant difference was a decrease in ERPF, normalized for body surface area, with increasing age (group 1, 511.3 ± 91.2; group 2, 559.5 ± 102.1; group 3, 577.1 ± 79.2; group 4, 607.8 ± 101.1, and group 5, 610.2 ± 109.2), and (3) the RI, T_max and T¹/₂ were symmetrical and did not vary between the sexes or age groups (left vs. right: RI = 49.6 ± 2.2 vs. 50.4 ± 2.2%, T_max = 3.63 ± 1.13 vs. 3.75 ± 1.11 min, and T¹/₂ = 5.38 ± 1.65 vs. 5.83 ± 1.88 min). We find that (1) ERPF for ^99mTc MAG3 decreases with age in normal Chinese, which is similar to the results of Western countries, and (2) the RI, T_max and T¹/₂ were symmetrical and did not vary between the sexes or age groups in normal Chinese, and are also similar to the results of Western countries.

Relief of Common Bile Duct Obstruction During the Course of Hepatobiliary Scintigraphy

Hepatobiliary scintigraphy performed in a patient suspected of having common bile duct obstruction showed persistence of the hepatic parenchymal phase and no bile duct or gallbladder activity during the first hour of imaging. On endoscopic retrograde cholangiopancreatography examination several hours later, an obstructing gallstone was identified in the common bile duct, and the stone was extracted in conjunction with a papillotomy. Delayed scintigraphic images at 6 hours were unchanged from the earlier views, but imaging at 24 hours showed tracer activity in the small bowel and colon along with persistent hepatic parenchymal activity. These results demonstrate that hepatobiliary radiopharmaceuticals remain in an excretable form in the liver in patients with complete common duct obstruction, but that resumption of bile flow and tracer excretion does not occur until a number of hours after relief of the obstruction.

Tc-99m DISIDA Hepatobiliary Scintigraphy in AIDS Cholangitis

Sixteen patients with documented AIDS cholangitis who underwent Tc-99m DISIDA hepatobiliary scintigraphy were retrospectively reviewed to assess the spectrum of changes observed in this disease. AIDS cholangitis was documented by either ERCP with aspiration/biopsy or the presence of typical sonographic/CT abnormalities with positive stool culture and a minimum of 6 months follow-up. Images were graded as regards parenchymal function (blood pool clearance, peak parenchymal activity, and degree of parenchymal retention), gallbladder visualization, presence of ductal dilatation, and time of intestinal activity. Three patterns were identified: 1) focal ductal dilatation with focal narrowing and focal or diffuse parenchymal retention; 2) ductal dilatation, without narrowing, and diffuse parenchymal retention; and 3) severe diffuse parenchymal retention with or without ductal abnormality. All 16 studies revealed abnormal parenchymal retention. Gallbladder nonvisualization was demonstrated in nine studies and delayed in two. The hepatobiliary scan is a very sensitive technique for evaluating AIDS cholangitis. Although a spectrum of findings may be observed, parenchymal retention with some degree of ductal abnormality is the most commonly observed pattern.

Endotoxin stimulation of liver parenchymal cell phosphofructokinase activity requires nonparenchymal cells.

The rate of carbohydrate flux through phosphofructokinase (measured as the rate of [3-3H]glucose detritiation) was increased fourfold in rat liver parenchymal cells incubated with conditioned medium from lipopolysaccharide-stimulated adherent liver non-parenchymal cells. The rate was not affected in parenchymal cells incubated either with lipopolysaccharide directly or with conditioned medium from non-stimulated non-parenchymal cells. The stimulation of carbohydrate flux through phosphofructokinase by conditioned medium was not duplicated by peptide cytokines known to be released by lipopolysaccharide-activated liver non-parenchymal cells (interleukin-1, interleukin-6, tumor necrosis factor-alpha, and transforming growth factor-beta) or platelet activating factor. Furthermore, formation of the active conditioned medium was not prevented by inclusion of cycloheximide or dexamethasone to inhibit cytokine synthesis, or indomethacin or BW755c to inhibit arachidonic acid metabolism, during lipopolysaccharide-stimulation of the non-parenchymal cells. The results indicate that intercellular communication between lipopolysaccharide-stimulated liver non-parenchymal cells and parenchymal cells by soluble mediators is responsible for the stimulation of liver phosphofructokinase activity during endotoxin-induced shock. Studies to isolate and identify the factor(s) in the conditioned medium are currently in progress.

Quantitative changes in acid phosphatase, alkaline phosphatase and 5‘‐nucleotidase activity in rat liver after experimentally induced cholestasis

Acid phosphatase, alkaline phosphatase and 5'-nucleotidase activities were analyzed cytophotometrically in cryostat sections of rat liver up to 8 weeks after ligation and transsection of the common bile duct. Ligation resulted in cholestasis and induced alterations in both localization and activity of the enzyme investigated. The cellular distribution but not the activity of acid phosphatase changed in liver parenchyma. In control liver, the final reaction product was localized as discrete granules in the bile canalicular region of hepatocytes. The final reaction product was precipitated more diffusely within the cytoplasm after induction of cholestasis, most probably due to increased fragility of lysosomal membranes. In control liver, alkaline phosphatase activity was low and localized in the bile canalicular plasma membranes only. The total parenchymal activity increased threefold after the induction of cholestasis and is considered to be a compensatory mechanism in order to enhance the excretion of bile salts from hepatocytes. 5'-Nucleotidase was present at the bile canalicular and sinusoidal surfaces of plasma membranes of hepatocytes in control liver; total activity in pericentral areas was significantly higher than in periportal areas. Induction of cholestasis resulted in higher total activity and redistribution of the activity over all three surfaces of the plasma membranes, whereas heterogeneity over the different zones of the acinus disappeared. The appearance of the enzyme at lateral plasma membranes is suggested to be related to the formation of new sites for bile salt transport out of the hepatocytes. With respect to all three enzymes studied, alterations of liver parenchymal cells due to a disturbed bile transport were already established during the first week of cholestasis.

SPECT Gallium-67 Scanning in Early Human Immunodeficiency Virus (HIV) Infection Failure of Scanning Abnormalities to Correlate with Immunologic Staging

The use of gallium scanning in the treatment of patients with AIDS has been well described. In this study, 27 HIV-infected patients (Walter Reed Staging Classification I-V) with normal chest roentgenograms were evaluated to determine the occurrence of thoracic gallium abnormalities in early HIV infection. SPECT was used for gallium scanning. Patients received gallium injection on day 1 and bronchoalveolar lavage on day 2, and scanning was performed on day 3. Twenty-eight scans in 27 patients were performed. Mean nodal SPECT activity was compared with corresponding values for lung parenchyma, bronchoalveolar lavage cell counts, and peripheral blood T4 lymphocyte counts. No relationship between nodal and parenchymal activity and cell counts was observed. Although visual scan interpretation was unaffected, gallium activity was significantly increased in the region of bronchoalveolar lavage compared with uptake in other lung regions. It is concluded that SPECT gallium scanning demonstrates significant gallium avidity in recently lavaged lung areas, although no impact on visual scan interpretation was seen. Further, no correlation was seen between the degree of nodal uptake and the immunologic status of these patients with early HIV infection.

Evaluation of Intense Renal Parenchymal Activity ("Hot Kidneys") on Bone Scintigraphy

The bone scintigrams of 600 patients performed over a 12-month period were reviewed. Thirty-six demonstrated abnormalities of the urinary tract of which six cases of intense renal parenchymal activity ("hot kidneys") were found. Two cases were related to treatment with the new antineoplastic agent mitoxantrone. In one patient it was related to treatment with calcitonin. Neither of these associations has been previously reported. Recognized causes of hypercalcemia and recent radiotherapy were present in two patients. No cause could be found in the final patient.

Measurement of Renal Parenchymal Transit Time of 99mTc-MAG3 Using Factor Analysis

Renal parenchymal transit time of the recently introduced radiopharmaceutical 99mTc-MAG3 (mercaptoacetylglycylglycinel) was measured in 37 kidneys, using factor analysis to separate parenchymal activity from that in the collecting system. A new factor algorithm was employed, based on prior interpolative background subtraction and use of the fact that the initial slope of the collecting system factor time-activity curve must be zero. The only operator intervention required was selection of a rectangular region enclosing the kidney (by identifying two points at opposite corners). Transit time was calculated from the factor time-activity curves both by deconvolution of the parenchymal factor curve and also by measuring the appearance time for collecting system activity from the collecting system factor curve. There was substantial agreement between the two methods. Factor analysis led to a narrower range of normal values than a conventional cortical region-of-interest method, presumably by decreasing crosstalk from the collecting system. In preliminary trials, the parenchymal transit time did not well separate four obstructed from seventeen unobstructed kidneys, but it successfully (p less than 0.05) separated six transplanted kidneys with acute rejection or acute tubular necrosis from 10 normal transplants.

Partial hepatectomy decreases pancreatic parenchymal enzyme activity

In previous studies of liver regeneration following partial hepatectomy (PH) in rats, we noted a decrease in serum amylase activity. The present study was carried out to determine if the decrease in serum amylase following PH corresponds to a decrease in pancreatic parenchymal exocrine enzyme activity. Male Wistar rats (275 g) underwent either 60% PH or sham laparotomy (SL). A third group, serving as controls (CON), received no surgical procedure. All groups were pair-fed a nutritionally balanced diet. After 48 hr, pancreas, blood, and liver were removed for analysis. Results showed that PH decreased pancreatic parenchymal protein by 43%, lipase by 44%, and trypsin by 22% compared to controls. Serum amylase decreased by 28%, a finding similar to previous experiments. However, pancreatic parenchymal amylase activity was not affected. It remains to be determined whether the reduced pancreatic function affects digestion and absorption.