sodium-pertechnetate-tc-99m and Emergencies

In cases of severe colon bleeding, it is more important to know the site than the cause, in case surgery is required. Technetium-labeled red-cell scan (TLRCS) is known to identify the site of bleeding at the rate of 0.1 ml per minute or more. The aim of this retrospective study was to see whether TLRCS was a reliable indicator of the site of severe colon bleeding. A retrospective study was made of patients investigated in this way for acute, severe colon bleeding at St. Vincent's Hospital, Melbourne, from 1984 to 1988 (five years). TLRCS identified the site of bleeding in less than half of the cases but correctly identified the site in all nine patients in whom bleeding was so severe as to require emergency surgery, avoiding total colectomy in eight cases.

Topics: Aged; Aged, 80 and over; Colonic Diseases; Emergencies; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m

Correct diagnosis of subtorsion of the spermatic cord was established in 9 patients by gamma-camera scintigraphy with 99mTc sodium pertechnate. The tentative out-patient diagnosis in 8 patients was acute orchiepididymitis and 2 were suspected of having torsion of the spermatic cord. The scintigraphic image of spermatic cord subtorsion is very characteristic and allows precise diagnosis. At the site of the testis there is some degree of activity--the smaller the degree of torsion the higher the activity is. Around the testis there is a ring-shaped bank of increased activity. In torsion of the spermatic cord (torsion greater than 360 degrees) a cold zone is visualized at the site of the testis, surrounded by a ring of increased activity. In acute orchiepididymitis the testis is seen enlarged with evidence of increased capillary tissue blood flow; on later scintigrams the activity in the testis is strongly increased. Gamma-camera scintigraphy is a quick, exact and noninvasive method, which contributes much to estbich precise diagnosis in cases of acute scrotum. The scintigraphic image of subtorsion and torsion of the spermatic cord is very characteristic and explicit, allowing to distinguish this disease from acute orchiepididymitis. This in turn is of major importance for successful emergency operation to preserve the testis.

Topics: Adolescent; Adult; Emergencies; Epididymitis; Humans; Male; Orchitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord; Spermatic Cord Torsion

The potential of plasma measurement of D-dimer (DD), a specific derivative of crosslinked fibrin, for diagnosis or exclusion of pulmonary embolism was investigated in a prospective series of 171 consecutive patients who attended an emergency department with suspected pulmonary embolism. The diagnosis was made or excluded by means of a clinical decision-making process which included clinical evaluation, ventilation-perfusion (VQ) lung scan, and, as indicated, pulmonary angiography, venography, or non-invasive examination of the leg veins. Pulmonary embolism was diagnosed by this process in 55 (32%) of 170 patients with sufficient data. All but 1 of these 55 patients had a DD concentration of 500 micrograms/l or above. The sensitivity and specificity of this cutoff concentration for the presence of pulmonary embolism were 98% and 39%, respectively, which give positive and negative predictive values of 44% and 98%. Among the 115 patients (68%) who had inconclusive VQ scans, 31 were diagnosed as having pulmonary embolism. 29 of the remaining 84 patients without pulmonary embolism had DD concentrations below 500 micrograms/l, which means that further diagnostic procedures could have been avoided in a quarter of the patients with inconclusive VQ scans. The sensitivity of the plasma measurement of DD remained high even 3 and 7 days after presentation (96% and 93%). Plasma measurement of DD therefore has a definite place in the diagnostic procedure for suspected acute pulmonary embolism in attenders at emergency departments: a concentration below 500 micrograms/l rules out the diagnosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Emergencies; Evaluation Studies as Topic; Female; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Pulmonary Embolism; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Ventilation-Perfusion Ratio

Emergency blood pool scintigraphy was performed in a patient clinically diagnosed as having a liver abscess, in whom percutaneous drainage revealed that the lesion containing fresh blood. 99mTc-RBC images 18 h after the injection showed only patchy activity in the lesion, therefore, we considered there was no communication between the lesion and the circulating blood. Drainage of the lesion was performed again and the abscess with a blood clot was drained.

Topics: Adult; Diagnosis, Differential; Emergencies; Female; Humans; Liver Abscess; Liver Circulation; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Suction; Technetium