A 63-year-old male who had subtotal gastrectomy for early gastric cancer three months ago underwent Tc-99m bone scintigraphy for the evaluation of skeletal metastases. He had no symptoms such as fever, tenderness, or wound discharge. On physical examination, the surgical scar along the midline of the upper abdomen had keloid formation and there was no radiographic evidence of calcification. Bone scintigraphy (Fig. 1A & 1B) demonstrated an unusual linear increased uptake along the midline of the upper abdomen that corresponded to the skin incision for subtotal gastrectomy. Usually, an incisional scar will not be visualized in Tc-99m methylene diphosphate (MDP) scintigraphy beyond two weeks after surgery.1) Upon reviewing the literature, there were only a few reports where localization of Tc-99m MDP in surgical scars were found two months after surgery.2) It was also reported that a few cases with Tc-99m MDP uptake in the keloid scar developed after surgery. Although there are several potential mechanisms that may explain the uptake of Tc-99m MDP in scar tissue, the primary mechanism in older scars is suggested to be a result of pathological calcification.2) Siddiqui et al3) suggested it could be due to microscopic calcification in small resolving hematomas. However, the primary mechanism in keloid scar is not well-known. We should obtain oblique or lateral views to differentiate the uptake in healing surgical scars from the artifactual uptake.
Abdomen ; Cicatrix ; Fever ; Gastrectomy* ; Hematoma ; Humans ; Keloid* ; Male ; Middle Aged ; Neoplasm Metastasis ; Physical Examination ; Radionuclide Imaging ; Skin ; Stomach Neoplasms ; Technetium Tc 99m Medronate* ; Wounds and Injuries

A 60-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the other represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.1-4) A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.4) Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.
Blood-Brain Barrier ; Brain ; Cerebral Infarction* ; Extracellular Space ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis* ; Prostate ; Radionuclide Imaging* ; Ribs ; Skull ; Spine ; Technetium Tc 99m Medronate*

No abstract available.
Lymphoma, T-Cell, Cutaneous*

No abstract available.
Pericardial Effusion* ; Radionuclide Imaging* ; Technetium Tc 99m Medronate*

No abstract available.
Cough* ; Humans ; Hydrogen-Ion Concentration*

High-dose aprotinin (Hammersmith regimen) has been widely used for years to control postoperative bleeding and reduce blood consumption in cardiac surgery but had known to cause some side-effects and had disadvantage in cost-effectiveness. The prospective controlled study of 33 patients undergoing cardiopulmonary bypass was performed to evaluate the efficacy for reducing postoperative bleeding and unfavorable effects of low-dose aprotinin. The level of hemoglobin and platelet in the blood and the amount of postoperative bleeding were assessed preoperatively, and postoperatively for the study of hemostatic function. The level of BUN and serum creatinine in the blood, levels of urine creatinine, total protein, albumin, alpha-1-microglobulin and creatinine clearance were assessed before and after the operation for the study of renal function. The aprotinin group had a significant reduction in chest tube drainage; 243+/- 123 ml versus 406+/-303 ml (P=0.037) during 6 hours immediate-postoperatively, 494+/-358 ml versus 869+/-570 ml (P=0.045) during 24 hours postoperatively. The ratio of alpha-1-microglobulin/creatinine and microalbumin/creatinine in the urine were slightly increased in the aprotinin group postoperatively in comparison with the control group but there were no statistically significant difference (55+/-23 versus 24+/-10 in the alpha-1-microglobulin/creatinine, 56+/-19 versus 38+/-25 in the microalbumin/creatinine at post- operative 3rd day). There were no significant difference between two groups in other parameters of renal function, too. This study showed that low-dose aprotinin is an effective means of reducing postoperative bleeding without inducing significant renal dysfunction.
Aprotinin* ; Blood Platelets ; Cardiopulmonary Bypass* ; Chest Tubes ; Creatinine ; Drainage ; Hemorrhage* ; Humans ; Prospective Studies ; Renal Insufficiency ; Thoracic Surgery

PURPOSE: We determined whether the uptake of Ga-67 by cultured cells occur by both transferrin (Tf)-dependent and independent mechanisms and the mechanism and magnitude of its uptake may vary as the degree of expression of the transformed phenotype. MATERIALS AND METHODS: Uptake of Ga-67 between the tansformed and untransformed cells was compared. Cells were incubated with Ga-67 in either the presence or absence of Tf and with complete medium containing Ga-67 after preincubating with anti-Tf receptor antibodies at 37oC in 8% CO2. Monolayers of cells were washed and trypsinized. Radioactivity and protein content of the samples were determined. RESULTS: Uptake of Ga-67 by cultured cells occurred both in Tf-bound and ionic form and was increased with radioactivity and time. The magnitude for the uptake of Tf-bound form was approximately 3 and 6-fold greater than ionic form. In the presence of Tf, uptake of Ga-67 was 2-fold greater in the transformed cells. Conversely, In the absence of Tf, it was 1.5-fold greater in the untransformed cells. Regardless of blocking the Tf receptor by anti-Tf receptor antibodies, a significant amount of intracellular Ga-67 uptake was found. CONCLUSION: Dual mechanisms exist for the uptake of Ga-67 by cultured cells. The primary important one was the Tf-dependent system. Tf-dependent and independent mechanisms and the magnitude operated oppositely in the transformed cells when compared to their untransformed counterpart.
Antibodies ; Cells, Cultured* ; Phenotype ; Radioactivity ; Transferrin ; Trypsin

Kasabach-Merritt syndrome (KMS) consists of thrombocytopenia, microangiopathic hemolytic anemia, and localized consumption coagulopathy that develops within vascular hemangioma. This syndrome may also be associated with occult hemangiomas located at various sites. Tc-99m RBC scintigraphy and SPECT have proven to be reliable for confirming or excluding hemangioma. Total body blood pool imaging study during the scintigraphy also provides a means of screening for occult lesions. The authors report the case of a 29-year-old man who presented with a giant hepatic hemangioma complicated by KMS, and underwent Tc-99m RBC scintigraphy and SPECT including a total body blood pool imaging study.
Adult ; Anemia, Hemolytic ; Disseminated Intravascular Coagulation ; Hemangioma ; Humans ; Kasabach-Merritt Syndrome ; Mass Screening ; Thrombocytopenia ; Tomography, Emission-Computed, Single-Photon

PURPOSE: To assess the relative frequency of benign and metastatic nodules in patients in whom nodules were resected due to suspected metastasis, and to compare the CT features of these nodules with pathologic findings in resected specimens. MATERIALS AND METHODS: Ninety-four pulmonary nodules resected by pulmonary metastasectomy in 31 patients with extrathoracic malignancies were included in our study. We retrospectively analyzed the CT features of each nodule with regard to size, shape, margin characteristics, the presence or absence of cavity, location and distance from the pleura. RESULTS: Among 94 resected nodules, 67 (71 %) were metastatic, and 27 (29 %), were benign. Among the pathologically benign nodules, involvement was as follows : fibrosis (n=14), intrapulmonary lymph node (n=7), necrosis (n=3), organizing pneumonia (n=2) and xanthogranulomatous inflammation (n=1). The mean diameter of metastatic nodules was 10.9 (range, 1-30) mm, and that of benign nodules 6.0 (range, 1-30) mm. Statistically significant differences in nodule size were found between the two groups (p<0.05), though CT revealed no significant differences in terms of shape, margin, the presence or absence of cavity, location and distance from the pleura. CONCLUSIONS: Twenty-nine percent of surgically resected nodules in patients with extrathoracic malignancies were benign. Although the possibility of metastatic nodule increases with larger nodule size, the correct diagnosis of pulmonary nodules requires histopathologic confirmation or monitoring of serial changes in nodule size.
Diagnosis ; Fibrosis ; Humans ; Inflammation ; Lymph Nodes ; Metastasectomy ; Necrosis ; Neoplasm Metastasis ; Pleura ; Pneumonia ; Retrospective Studies

PURPOSE: To assess the relative frequency of benign and metastatic nodules in patients in whom nodules were resected due to suspected metastasis, and to compare the CT features of these nodules with pathologic findings in resected specimens. MATERIALS AND METHODS: Ninety-four pulmonary nodules resected by pulmonary metastasectomy in 31 patients with extrathoracic malignancies were included in our study. We retrospectively analyzed the CT features of each nodule with regard to size, shape, margin characteristics, the presence or absence of cavity, location and distance from the pleura. RESULTS: Among 94 resected nodules, 67 (71 %) were metastatic, and 27 (29 %), were benign. Among the pathologically benign nodules, involvement was as follows : fibrosis (n=14), intrapulmonary lymph node (n=7), necrosis (n=3), organizing pneumonia (n=2) and xanthogranulomatous inflammation (n=1). The mean diameter of metastatic nodules was 10.9 (range, 1-30) mm, and that of benign nodules 6.0 (range, 1-30) mm. Statistically significant differences in nodule size were found between the two groups (p<0.05), though CT revealed no significant differences in terms of shape, margin, the presence or absence of cavity, location and distance from the pleura. CONCLUSIONS: Twenty-nine percent of surgically resected nodules in patients with extrathoracic malignancies were benign. Although the possibility of metastatic nodule increases with larger nodule size, the correct diagnosis of pulmonary nodules requires histopathologic confirmation or monitoring of serial changes in nodule size.
Diagnosis ; Fibrosis ; Humans ; Inflammation ; Lymph Nodes ; Metastasectomy ; Necrosis ; Neoplasm Metastasis ; Pleura ; Pneumonia ; Retrospective Studies