technetium-tc-99m-exametazime and Colonic-Neoplasms

Abdominal lavage is a common surgical practice, but few studies have been conducted to assess its efficacy at removing cells from the abdominal cavity, particularly during laparoscopic surgery.. After three 12-mm trocars were inserted into six female 30-kg pigs at the umbilicus left and right iliac fossae, the abdomen was insufflated with carbon dioxide. The pelvis of each pigs was injected with 6 million radiolabeled LIM 1215 cells. Then the abdominal cavity was irrigated with either 500 ml 0.9% saline, 500 ml 10% betadine solution, or 1 L 0.9% saline. A maximum of 5 L of solution was used for each animal. The lavage fluid was suctioned into separate containers after each aliquot, and each container was measured for radioactivity.. Significantly greater numbers of cells were removed by lavage by the first to third lavage cycle; however, after four lavage cycles, relatively few cells were removed by each further cycle. No difference was observed between 500-ml and 1-L aliquots. Additionally, the mechanical efficacy of 0.9% saline and 10% betadine solution appeared similar.. These findings suggest that optimal lavage consists of four irrigation/suction cycles utilizing 500-ml aliquots.

Topics: Abdomen; Animals; Ascitic Fluid; Carbon Dioxide; Cell Count; Cell Survival; Colonic Neoplasms; Female; Humans; Injections, Intraperitoneal; Insufflation; Neoplasm Transplantation; Pelvis; Peritoneal Lavage; Peritoneum; Radionuclide Imaging; Radiopharmaceuticals; Swine; Technetium Tc 99m Exametazime; Tumor Cells, Cultured; Umbilicus

Port-site recurrences have delayed the uptake of laparoscopic colectomy, but the etiology of these is incompletely understood. These studies were designed to investigate variables such as the size of the tumor inoculum and the volume and pressure of the insufflated gas during operative laparoscopy that might affect the deposition of these cells in relation to trocars and port sites.. Radiolabeled human colon cancer cells were injected into the peritoneal cavity of pigs. Three trocars were inserted, and the abdomen was insufflated with carbon dioxide. The movement of cells within the abdomen was traced on a gamma camera. After 2 h, the trocars were removed and the port sites excised. Two studies were performed. In the first study, tumor inocula were varied from 1.5 x 10(5) to 120 x 10(5). In the second study, insufflation pressure was varied, with pressures 0, 4, 8 and 12 mmHg were studied.. When larger tumor inocula were injected, the contamination of both trocars (p = 0.005, Kendall's rank correlation) and trocar sites (p = 0.04, Kendall's rank correlation) increased. The deposition of cells on a trocar site was linked to contamination of its trocar (p = 0.03, chi-square), but the contamination of trocars did not always result in trocar-site contamination (p = 0.5, chi-square). Increased volumes of gas insufflation caused increased intraabdominal movement of tumour cells (p = 0.01, Kendall's rank correlation), although this did not lead to greater contamination of trocars or port sites (p = 0.82, Kendall's rank correlation). Decreased insufflation pressures resulted in increased contamination of trocars and port sites (p = 0.01, Kendall's rank correlation).. If clinical situations parallel this study, strategies such as increasing insufflation pressure, reducing episodes of desufflation and gas leaks, and using frequent intraabdominal lavage may help to reduce the numbers of viable tumor cells displaced to port sites during laparoscopic surgery for intraabdominal malignancy. This may reduce the rate of port-site metastases.

Topics: Abdominal Wall; Animals; Carbon Dioxide; Catheterization; Cell Survival; Colonic Neoplasms; Disease Models, Animal; Equipment Contamination; Female; Humans; Injections, Intraperitoneal; Insufflation; Laparoscopy; Neoplasm Seeding; Pelvis; Peritoneal Cavity; Pressure; Radionuclide Imaging; Surgical Instruments; Swine; Technetium Tc 99m Exametazime; Tumor Cells, Cultured

A 5-year-old Arabian horse was admitted with a 5-day history of undulant pyrexia of unknown origin, inappetence, obtundation, and acute collapse. Physical examination results were unremarkable except for a grade II/VI left-sided systolic cardiac murmur and abdominal splinting. Mild chronic inflammatory changes were evident on clinicopathologic evaluation. Echocardiography revealed moderate aortic insufficiency. A solitary soft tissue opacity was found on thoracic radiography but not on ultrasonography. Palliative treatment was ineffective. Nuclear scintigraphy with WBC labeled with technetium Tc 99m hexamethylpropyleneamine oxime did not identify abnormalities, but a second nuclear scan with technetium Tc 99m hydroxymethylene diphosphate identified polyostotic disease. Examination of a biopsy specimen from an affected rib revealed disseminated adenocarcinoma. The horse was euthanatized. Necropsy and histologic examination revealed a colonic adenocarcinoma with osseous metaplasia that had disseminated to multiple parenchymal organs, muscle, and bone.

Topics: Adenocarcinoma; Animals; Bone Neoplasms; Colonic Neoplasms; Diagnosis, Differential; Horse Diseases; Horses; Male; Palliative Care; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Barium Sulfate; Colonic Neoplasms; Diagnosis, Differential; Enema; Enteritis; False Positive Reactions; Humans; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Exametazime; Yersinia Infections