sodium-pertechnetate-tc-99m and Pain

Developments over the past decade have allowed one to visualize the right and left ventricles using radionuclide techniques and to study the influence of a wide range of physiologic, pharmacologic and surgical interventions on global and regional ventricular function thereby providing important diagnostic insight and improved therapeutic capabilities. These tests are relatively non-invasive, they can be performed serially, they may be performed in patients that are seriously ill, and they have no recognized risk other than low level radiation exposure. With continued improvement in noninvasive imaging and processing and in the sophistication of associated computer systems, one may expect significant and wide ranging additional contributions in the assessment of myocardial function using radionuclide ventriculographic techniques.

Topics: Cardiac Output; Coronary Disease; Diastole; Exercise Test; Heart; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Myocardial Infarction; Pain; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Technetium; Thorax; Ventricular Function

A unique pain syndrome, triggered by gustatory stimuli in the absence of anatomic obstruction of the parotid duct, complicated carotid endarterectomy. We documented asymmetric parotid vasodilatation and sympathetic dysfunction in cutaneous areas overlaying the gland. We postulate that damage to the sympathetic innervation of the parotid gland resulted in unopposed parasympathetically mediated glandular vasodilatation. Vasoactive intestinal polypeptide may have played a role in producing symptoms. A similar syndrome occurs in patients with acute pandysautonomia.

Topics: Carotid Arteries; Endarterectomy; Humans; Male; Middle Aged; Pain; Parotid Gland; Radiography; Sodium Pertechnetate Tc 99m; Taste

Complications of popliteal cysts may closely mimic the clinical features of a deep venous thrombosis. We assessed the sensitivity and specificity of the non-invasive procedures of radionuclide venography and popliteal space ultrasound examination compared with those of contrast venography and arthrography, respectively, and then prospectively studied 23 non-surgical patients with acutely painful, swollen calves to determine the utility of these techniques. The cause of this symptom was popliteal cyst complications in 10 patients, deep venous thrombosis in seven patients, and both conditions in two patients. Radionuclide venography was highly reliable and ultrasound examination was specific but only moderately sensitive in these studies. The painful, swollen calf may be investigated adequately in most cases by means of noninvasive invasive techniques; contrast venography and arthrography should be reserved for only a minority of patients.

Topics: Adult; Aged; Arthrography; Cysts; Diagnosis, Differential; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Evaluation Studies as Topic; Female; Humans; Leg; Male; Middle Aged; Pain; Phlebography; Popliteal Vein; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thrombophlebitis; Ultrasonography

The efficacy and merit of testicular imaging, utilizing Tc-99m pertechnetate, were studied prospectively in a group of patients who presented with acute onset of scrotal pain. Consecutive admissions were studied. All were managed according to the likelihood of the problem being testicular torsion, which was determined from the clinical history, physical examination and the routine laboratory data. The final diagnostic outcome, whether by surgical exploration or clinical progress with conservative treatment, is collated with the preoperative scintigraphic interpretations, made with respect to predefined criteria. Analysis of the pretreatment images obtained in 57 patients shows that the radionuclide study is highly reliable in cases of testicular torsion and epididymo-orchitis. It appears to be much less dependable, however, in the other acute scrotal conditions. Torsions that are intermittent in nature or corrected manually apparently can have variable presentations. Certain difficulties and potential pitfalls encountered in interpreting the scintigraphic studies are discussed.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aged; Child; Epididymitis; Genital Diseases, Male; Humans; Male; Middle Aged; Orchitis; Pain; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testicular Hydrocele

Topics: Adolescent; Aged; Child; Humans; Male; Pain; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Testicular Diseases

The incremental value of clinical assessment, exercise electrocardiography (ECG) and biplane radionuclide ventriculography (RVG) in the prediction of coronary artery disease (CAD) was assessed in 105 men without myocardial infarction who were undergoing coronary angiography for investigation of chest pain. Independent clinical assessment of chest pain was made prospectively by 2 physicians. Graded supine bicycle exercise testing was symptom-limited. Right anterior oblique ECG-gated first-pass RVG and left anterior oblique ECG-gated equilibrium RVG were performed at rest and exercise. Regional wall motion abnormalities were defined by agreement of 2 of 3 blinded observers. A combined strongly positive exercise ECG response was defined as greater than or equal to 2 mm ST depression or 1.0 to 1.9 mm ST depression with exercise-induced chest pain. A multivariate logistic regression model for the preexercise prediction of CAD was derived from the clinical data and selected 2 variables: chest pain class and cholesterol level. A second model assessed the incremental value of the exercise test in prediction of CAD and found 2 exercise variables that improved prediction: RVG wall motion abnormalities, and a combined strongly positive ECG response. Applying the derived predictive models, 37 of the 58 patients (64%) with preexercise probabilities of 10 to 90% crossed either below the 10% probability threshold or above the 90% threshold and 28 (48%) also moved across the 5 and 95% thresholds. Supine exercise testing with ECG and biplane RVG together, but neither test alone, effectively adds to clinical prediction of CAD. It is most useful in men with atypical chest pain and when the ECG and RVG results are concordant.

Topics: Adult; Cholesterol; Coronary Angiography; Coronary Disease; Electrocardiography; Exercise Test; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Pain; Probability; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thorax

Out of 270 children with gastrointestinal symptoms, the indications for technitium scanning were: gastrointestinal tract bleeding (165 patients), abdominal pain (99 patients) and a history of intussusception (6 patients). Thirty children had abnormal findings, while the remaining 240 patients had "normal" scans. Four of the 30 children with positive scans were not explored, while the others underwent laparotomy. Of the 26 operated patients, 12 (46%) had a Meckel's diverticulum. Nine patients (34%) had other pathologic lesions that were detected by the scan. Five had true "false positives" as no pathologic lesions were found. Of the 240 children with negative scans, 19 were eventually explored because of persistent symptoms or clinical findings. Two of these had a Meckel's diverticulum. Eleven had a negative exploration while six had other surgical lesions. Technitium scan should reliably detect around 80%-90% of Meckel's diverticula. It will also accurately exclude the diagnosis of Meckel's diverticulum in over 90% of patients.

Topics: Abdomen; Adolescent; Child; Child, Preschool; Evaluation Studies as Topic; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Infant; Infant, Newborn; Intussusception; Male; Meckel Diverticulum; Pain; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium