PURPOSE: The aim of this study was to evaluate whether T1-201 reinjection distinguishes viable from non-viable myocardium in patients with reverse redistribution after acute myocardial infarction. MATERIALS AND METHODS: We studied 42 patients with acute myocardial infarction (age, 55+/-12 years). Eighteen (43%) out of 42 showed reverse redistribution on dipyridamole stress-4 hour redistribution T1-201 single photon emission computed tomography (SPECT). T1-201 reinjection was performed at 24 hours. Reverse redistribution was defined as worsening of perfusion defect at 4 hour delayed scan. All patients underwent follow-up echocardiography in 4 months to assess regional wall motion improvement. T1-201 uptake on reinjection images were analyzed for the prediction of myocardial wall motion improvement. RESULTS: Of 36 segments with reverse redistribution, 17 segments showed normal wall motion on echocardiography, while 19 segments showed all motion abnormalities. Of 19 the segments with reverse redistribution, 11 (58%) showed enhanced uptake after 24 hour reinjection. Myocardial wall motion was improved in 10 of 11 segments (90%) with enhanced uptake on reinjection. Wall motion improvement was not seen in 5 of 8 segments (63%) without enhanced thallium uptake. When myocardial viability was assessed by the uptake on reinjection image, nine of 10 segments (90%) with normal or mildly decreased uptake showed improved wall motion. Wall motion was not improved in 5 of 9 segments (56%) with severely decreased uptake. CONCLUSION: In patients with acute myocardial ifarction, T1-201 reinjection imaging on myocardial segments with reverse redistribution has a high positive predictive value in the assessment of myocardial viability.
Dipyridamole ; Echocardiography ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Myocardium* ; Perfusion ; Thallium* ; Tomography, Emission-Computed, Single-Photon

PURPOSE: We evaluated the importance of redistribution and 24 hour reinjection images in Tl-201 SPECT assessment of myocardial viability after acute myocardial infarction (AMI). MATERIALS AND METHODS: We performed dipyridamole stress-4 hour redistribution-24 hour reinjection Tl-201 SPECT in 43 patients with recent AMI (4-16 days). The myocardium was divided into 16 segments and perfusion grade was measured visually with 4 point score from 0 to 3 (absent uptake to normal uptake). A perfusion defect with stress score 2 was considered moderate. A defect was considered severe if the stress score was 0 or l (absent uptake or severe perfusion decrease). Moderate defect on stress image were considered viable and segments with severe defect were considered viable if they showed improvement of 1 score or more on redistribution or reinjection images. We compared the results of viability assess-ment in stress-redistribution and stress-reinjection images. RESULTS: On visual analysis, 344 of 688 segments (50%) had abnormal perfusion. Fifty two (15%) had moderate perfusion defects and 292 (85%) had severe perfusion defects on stress image. Of 292 severe stress defects, 53 were irreversible on redistribution and reversible on reinjection images, and 15 were reversible on redistribution and irreversible on reinjection images. Two hundred twenty four of 292 segments (76.7%) showed concordant results on stress-redistribution and stress-reinjection images. Therefore 24 hour reinjection image changed viability status from necrotic to viable in 53 segments of 292 severe stress defect (18%). However, myocardial viability was underestimated in only 5% (15/292) of severe defects by 24 hour reinjection. CONCLUSION: The 24 hour reinjection imaging is useful in the assessment of rnyocardial viability. It is more sensitive than 4 hour redistribution imaging. However, both redistribution and reinjection images are needed since they complement each other.
Complement System Proteins ; Dipyridamole ; Humans ; Myocardial Infarction* ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon

PURPOSE: ATP (adenosine triphosphate) is a potent coronary vasodilator with a rapid onset of action and a very short half-life. Myocardial perfusion scintigraphy with intravenous ATP has not yet been sufficiently proven in the diagnosis, follow-up, and risk stratification of coronary artery disease. The purpose of this study was to evaluate the safety, feasibility and diagnostic accuracy of pharmacologic stress thallium-201 myocardial SPECT using an intravenous ATP infusion in patients with suspected coronary artery disease. MATERIALS AND METHODS: Thalliurn-201 myocardial SPECT in 319 patients with suspected coronary artery disease were performed after the infusion of ATP (0.08 mg/kg/min for 6 rnin). The adverse effects were carefully monitored. Coronary angiography was also performed within 3 weeks. RESULTS: Although 76.5% of the patients had sorne adverse effects, they were transient, mild, and well tolerated. In all patients, the ATP infusion protocol was completed and only 2 patients required aminophylline. The adverse effects were dyspnea in 63%, headache in 31%, flushing in 21%, chest pain in 14% and abdominal discomfort in 5% of the patients. The sensitivity and specificity were 80% and 90% respectively. CONCLUSION: Thallium-201 myocardial SPECT after 6 min-infusion of ATP at a rate of 0.08 mg/kg/min is safe and has a diagnostic value in detecting coronary artery disease.
Adenosine Triphosphate* ; Aminophylline ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis* ; Dyspnea ; Flushing ; Follow-Up Studies ; Half-Life ; Headache ; Humans ; Infusions, Intravenous* ; Perfusion Imaging ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

We report a 37 year-old-female patient with papillary thyroid cancer treated by surgery who demonstrated residual thyroid and bilateral breast uptake on a diagnostic I-131 whole body scan. She had an extrathyroidal extension needing I-131 ablative therapy. Her galactorrhea was investigated and treated with low doses of bromocriptine prior to I-131 therapy. Her galactorrhea was due to the decreased secretion of PIF induced by empty sella.
Breast* ; Bromocriptine ; Empty Sella Syndrome* ; Female ; Galactorrhea ; Humans ; Hyperprolactinemia* ; Pregnancy ; Thyroid Gland* ; Thyroid Neoplasms* ; Whole Body Imaging

Agrobacterium radiobacter is a rare human pathogen and a few cases were reported in the world. The peritoneal cavity in patient maintained on peritoneal dialysis serves as an excellent incubator and culture medium for microorganisms. We experienced a rare human infection as peritonitis with A. radiobacter in Inha University Hospital, Inchon, Korea. The patient was 36 year-old female and maintained on CAPD for one year. She had two times of CAPD peritonitis. She visited to the hospital because of turbid peritoneal fluid. On initial physical examination, she showed mild abdominal tenderness and elevated body temperature. Laboratory findings showed leukocytosis and anemia with elevated serum creatinine level. The analysis of peritoneal fluid showed white blood cell count as many as 1860/mm3 and it's culture revealed A. radiobacter. She received vancomycin and aminoglycoside antibiotics via intraperitoneal route and the CAPD catheter was removed. She was maintained on hemodialysis and reveived isepamicin 100mg a day via intravenous for 7 days. We report our experience of peritonitis caused by A. radiobacter and review the literature of similar cases of peritonitis.
Adult ; Agrobacterium tumefaciens* ; Agrobacterium* ; Anemia ; Anti-Bacterial Agents ; Ascitic Fluid ; Body Temperature ; Catheters ; Creatinine ; Female ; Humans ; Incheon ; Incubators ; Korea ; Leukocyte Count ; Leukocytosis ; Peritoneal Cavity ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Physical Examination ; Renal Dialysis ; Vancomycin

BACKGROUND: Extended-spectrum beta-lactamases (ESBLs) confer resistance to extended-spectrum cephalosporin (e.g., cefotaxime, ceftazidime) and aztreonam. But the diversity of ESBLs results in various susceptibility profiles with different beta-lactams. To study the relative in vitro activities of various beta-lactams and non-beta-lactam antibiotics against the clinical isolates of ESBL-producing K. pneumoniae, we determined the MIC (minimum inhibitory concentration) of various antimicrobials. METHODS: Fifty-seven isolates of K. pneumoniae which produced ESBL and 63 isolates which did not produce ESBL from 3 university hospitals in Korea were tested. The MIC values of antimicrobials were determined by agar dilution method and detection of ESBL production was performed by double disk synergy test. RESULTS: The MIC values of beta-lactams against K. pneumoniae which produced ESBLs exhibited heterogeneous susceptability profiles. In differentiation of ESBL production, MIC value of 8 ug/mL (breakpoint of intermediate resistance) of ceftazidime was more sensitive and more specific than that of cefotaxime or aztreonam. MIC50 values of gentamicin, amikacin and ciprofloxacin against K. pneumoniae that produced ESBL were significantly higher than those against Non-ESBL producing isolates (P<0.001), suggesting that ESBL producing isolates are multi-drug resistant. CONCLUSION: The level of resistance to various beta-lactams of K. pneumoniae which produced ESBL was heterogeneous. ESBL-producing K. pneumoniae showed higher resistance to aminoglycoside and quinolone antibiotics. Ceftazidime was the most appropriate antibiotic to differentiate ESBL production.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Aztreonam ; beta-Lactamases* ; beta-Lactams ; Cefotaxime ; Ceftazidime ; Ciprofloxacin ; Gentamicins ; Hospitals, University ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Pneumonia

BACKGROUND: Flow cytometric analysis for CD34 has been widely used for hematopoietic stem cell enumeration. The procedure is simple and rapid for clinical use but the lack of standardization resulted in great intralaboratory variations. In 1995, a guideline for CD34 analysis was established by International Society of Hematotherapy and Gene Engineering (ISHAGE) for reliable testing. We performed CD34 analysis using the ISHAGE guideline in umbilical cord blood (UCB), mobilized peripheral blood (MPB) and leukapheresis product (LP) and compared the results with those of in-house method. METHODS: CD34 analyses were performed in thirty units each of UCB, MPB and LP according to the ISHAGE guideline and in-house method and the results were analyzed by the t-test. Both methods used CD45FITC/CD34PE and its isotype controls. In ISHAGE guideline, among CD34+/ CD45+ cells, only those with low forward scattering, low to intermediate side scattering and low to intermediate CD45 fluorescent intensity were identified as stem cells, and the percentage of those cells among CD45+ cells was calculated. In in-house method, cells expressing both CD34 and CD45 antigens were selected by isotype control and the percentage of CD34+/CD45+ cells among CD45+ cells were calculated. RESULTS: Significant differences were observed in the percentages of CD34+ cells in UCB, MPB and LP between ISHAGE guideline (0.25%, 0.42%, 0.80%) and in-house method (0.40%, 0.55%, 1.20%) (P<0.001). So were the CD34+ cell counts : mean values of CD34+ cells in microliter of UCB, MPB and LP were 20, 40, 1,392 by ISHAGE guideline, and 35, 62, 2,079 by in-house method (P<0.001). CONCLUSION: ISHAGE guideline for CD34 enumaration was considered as a simple, rapid and reliable method for clinical setting and to have economic benefits because no additionalmonoclonal antibodies were required.
Antibodies ; Antigens, CD45 ; Cell Count ; Fetal Blood ; Hematopoietic Stem Cells ; Leukapheresis ; Stem Cells

Infantile hemangioendothelioma (IHE) is a benign tumor of the liver composed of anastomosing vascular channels lined by plump endothelial cells. The major clinical findings of IHE are abdominal mass, hepatomegaly, cutaneous hemangioma, congestive heart failure, anemia and disseminated intravascular coagulopathy. Precise diagnosis of IHE is crucial because medical therapies using steroid and/or interferon can be tried unless there are grave compressive symptoms. Along with CT scan and MRI studies, scintigraphic evaluation with 99mTc-RBC offers an accurate method of identification of these lesions, and allows differentiation from other common primary or secondary hepatic masses. We report two cases of giant IHE of the liver those were diagnosed with 99mTc- RBC scan and confirmed with pathologic evaluation after surgical removal.
Anemia ; Diagnosis ; Endothelial Cells ; Heart Failure ; Hemangioendothelioma* ; Hemangioma ; Hepatomegaly ; Interferons ; Liver* ; Magnetic Resonance Imaging ; Radionuclide Imaging* ; Tomography, X-Ray Computed

Backgroud and Objectives: 18F-FDG Positron emission tomography (18F-FDG PET) is a noninvasive diagnostic tool for many kinds of human cancer, where glucose transporter-1 (Glut-1) acts as a main transporter in the uptake of 18F-FDG in cancer cells. The object of this study is to assess the expression of Glut-1 in human papillary carcinoma and the relationship between the expression and the uptake of 18F-FDG PET. SUBJECTS AND METHOD: We evaluated 30 patients diagnosed as papillary carcinoma. Tumor sizes were measured and Glut-1 expression rate (ER), expression intensity (EI) and total expression score (ES) were analyzed. 18F-FDG PET was performed in 19 patients and standardized uptake value (SUV) was measured in each case. The correlations between ER and SUV, ES and SUV, tumor sizes and SUV, ER and tumor sizes were analyzed statistically. RESULTS: 96.7% (29/30) of tumors were Glut-1 positive, the mean ER was 67.42+/-22.89% and the mean ES 131.8+/-71. Tumor cells showed higher expression of Glut-1 than normal thyroid tissue. 18F-FDG uptake was positive in 81% (17/21) of solitary thyroid papillary carcinoma and negative in 19% (4/21). The average SUV of the PET positive group was 6.75+/-4.8, ER 71.25 +/-20.6% and ES 134.68+/-51.4. The average size of PET positive tumors was 3.37+/-2.94 cm2 and that of negative tumors was 0.43+/-0.45 cm2. Both ER and ES of Glut-1 were correlated with SUV significantly. The size and SUV were also correlated significantly. But the size and ER were not correlated significantly. CONCLUSION: Thyroid papillary carcinoma has high ER of Glut-1 and there is a positive correlation between Glut-1 expression and the uptake of 18F-FDG PET. The size of tumor can also affect the 18F-FDG uptake. But there is no correlation between the size and Glut-1 expression and further studies are needed to find the mechanisms and to decide the cut-off value.
Carcinoma, Papillary ; Electrons ; Fluorodeoxyglucose F18 ; Glucose ; Humans ; Positron-Emission Tomography ; Thyroid Gland

BACKGROUND AND OBJECTIVES : Several studies have reported that (18)F-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) imaging is physiologically increased at the intact vocal cord in patients with unilateral vocal cord paralysis, which is explained by a compensatory mechanism of the intact vocal cord. We aimed to evaluate internal laryngeal muscles related to phonation and the compensatory mechanism in patients with unilateral vocal cord paralysis. SUBJECTS AND METHOD : We performed (18)FDG-PET imaging and neck computed tomography (CT) scan in the normal control group composed of 13 subjects and the paralyzed group composed of 11 patients with unilateral vocal cord paralysis. The two groups were divided into two groups, phonating and silent, before performing (18)FDG-PET. (18)FDG-PET and neck CT images by Syntegra. A specialist in nuclear medicine performed all the test measurements, the standardized uptake value (SUV) in the interarytenoid muscle (IA), both thyroarytenoid muscles (TA), and both lateral cricoarytenoid muscles (LCA). The mean SUVs were statistically analyzed. RESULTS : In the Normal-Phonating group, the mean SUV of IA was the highest, with 3.68+/-0.96 (Mean+/-SD), followed by that of LCA, with 2.34+/-0.67. However, when compared with the same muscles in the Phonating-Silent group, only the SUV of IA was significantly increased by phonation. In the Paralyzed-Silent group, the SUV of TA in the intact side was the highest, with 2.30+/-0.39. In the Paralyzed-Phonating group, the SUV of TA in the intact side, IA, and LCA in the intact side were 5.88+/-2.65, 3.92+/-1.65, and 3.87+/-1.37, respectively. When compared with the same muscles in the Phonating-Silent group, the SUVs of TA and IA were significantly increased. CONCLUSION : The muscle related to the compensatory mechanism in patients with unilateral vocal cord paralysis is thyroarytenoid muscle in the intact side. The interarytenoid muscle plays a major role in the mechanism of phonation in humans.
Humans ; Laryngeal Muscles* ; Muscles ; Neck ; Nuclear Medicine ; Phonation* ; Positron-Emission Tomography ; Specialization ; Vocal Cord Paralysis* ; Vocal Cords