technetium-tc-99m-pyrophosphate and Burns--Electric

The surface thermal burn associated with high voltage (HV) electrical injuries represents only the tip of the iceberg. Occult muscle damage may not become apparent for 5 to 10 days. In this study, the efficacy of Technetium-99m (Tc) pyrophosphate scanning was investigated. Early scanning (within 3 days of injury) of 19 limbs in 15 patients demonstrated a sensitivity of 75 per cent, with a specificity of 100 per cent. The predictive value of a positive test, however, was 100 per cent. Compared to a control group of 17 patients treated without Tc scan, the scan was not associated with reduced hospital length of stay or with decrease in the number of surgical procedures.

Topics: Arm Injuries; Burns, Electric; Humans; Leg Injuries; Length of Stay; Muscle, Skeletal; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate; Thumb

This study investigates whether (99m)Tc pyrophosphate (PYP) imaging provides a quantitative non-invasive assessment of the extent of electroporation injury, and of the effect of poloxamer in vivo on electroporated skeletal muscle.. High-voltage electrical shock was used to produce electroporation injury in an anesthetized rat's hind limb. In each experiment, the injured limb was treated intravenously by either poloxamer-188, dextran, or saline, and subsequently imaged with (99m)Tc PYP. The radiotracer's temporal behavior among the experimental groups was compared using curve fitting of time-activity curves from the dynamic image data.. The washout kinetics of (99m)Tc PYP changed in proportion to the electric current magnitude that produced electroporation. Also, (99m)Tc PYP washout from electroporated muscle differed between poloxamer-188 treatment and saline treatment. Finally, 10-kDa dextran treatment of electroporated muscle altered (99m)Tc PYP washout less than poloxamer-188 treatment.. Behavior of (99m)Tc PYP in electroporated muscle appears to be an indicator of the amount of electroporation injury. Compared to saline, intravenous polaxamer-188 treatment reduced the amount of (99m)Tc PYP uptake. Coupled to results showing poloxamer-188 seals ruptured cellular membranes, lessens the extent of electroporation injury and improves cell viability, (99m)Tc PYP imaging appears to be a useful in vivo monitoring tool for the extent of electroporation injury.

Topics: Animals; Burns, Electric; Electroporation; Lower Extremity; Muscle, Skeletal; Poloxamer; Radionuclide Imaging; Radiopharmaceuticals; Rats; Surface-Active Agents; Technetium Tc 99m Pyrophosphate

Extensive extremity injuries often require difficult decisions regarding the necessity for amputation or radical debridement. During the past decade, we have used technetium-99 pyrophosphate (PyP) scanning as an adjunct in this setting. This study was performed to assess the accuracy of PyP scan in predicting the need for amputation in relation to clinical, operative, and pathologic findings.. Review of our computerized registry identified 11 patients (10 men, age 36.1 +/- 14.9 years) admitted from 1990 to 1999 who underwent PyP scan. Using operative and pathologic findings, accuracy of the PyP scan was graded as supporting or refuting the clinical assessment of the need for amputation.. Eight patients suffered high-voltage electrical injuries, one had severe frostbite, and two suffered soft-tissue infections. In most cases, PyP scan showed clear demarcation of viable and nonviable tissue, verifying the need for amputation (positive); those that demonstrated viable distal tissues confirmed at operation were considered negative. PyP scan had a sensitivity of 94%, a specificity of 100%, and an accuracy of 96% in this setting.. Technetium-99 PyP scanning is a useful adjunct in predicting the need for amputation in extremities damaged by electrical injury, frostbite, or invasive infection. In addition, by providing an objective "picture" of extremity perfusion, PyP scans can be helpful in convincing patients of the need for amputation.

Topics: Adolescent; Adult; Amputation, Surgical; Arm; Burns; Burns, Electric; Cell Survival; Child; Female; Humans; Leg; Male; Middle Aged; Radiopharmaceuticals; Soft Tissue Infections; Technetium Tc 99m Pyrophosphate

Six patients with soft tissue injury secondary to different etiologic factors are presented. The degree and extent of tissue necrosis was precisely identified by scintigraphy. In two of these, radionuclide imaging helped to establish accurately the level of amputation that resulted in appropriate wound healing.

Topics: Adult; Burns, Electric; Child Abuse; Child, Preschool; Diabetic Neuropathies; Diphosphates; Humans; Male; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

High-voltage electrical injuries, though uncommon, are not rare and make up approximately 3% of hospital admissions for burns. Our review of a seven-year experience including treatment of 60 patients indicates that the mortality for hospitalized patients is low, but the complication rate is significant. Sepsis or wound infection occurred in one third and neurologic impairment in one fourth of the patients. Despite this, most patients are able to return to gainful employment.

Topics: Accidents, Occupational; Burns, Electric; Diphosphates; Follow-Up Studies; Humans; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Burns, Electric; Diagnosis, Differential; Diphosphates; False Positive Reactions; Heart; Humans; Male; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Burns, Electric; Child, Preschool; Diphosphates; Humans; Male; Muscles; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A prospective study was undertaken to determine the incidence of possible myocardial damage following electrical injury. Sixteen patients with non-flash electrical injuries were assessed utilizing serial electrocardiograms (ECG), creatine kinase (CK) and MB creatinine kinase (MB-CK) determinations, technetium 99m stannous pyrophosphate scans, and 24-hour Holter monitors. Results showed that five patients (31%) had abnormal ECG, nine patients (56%) had elevations of the MB-CK isoenzyme, and one patient had a transiently abnormal Holter monitoring. No patient had an abnormal technetium pyrophosphate cardiac scan. Of the nine patients with elevated MB-CK levels, only two had abnormal ECG. None of the patients had clinical evidence of cardiac dysfunction. These results indicate a poor correlation of elevated MB-CK levels with ECG abnormalities, and demonstrate a relatively low incidence of myocardial damage in association with electrical injuries.

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Burns, Electric; Child; Creatine Kinase; Electrocardiography; Heart; Humans; Isoenzymes; Male; Monitoring, Physiologic; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Adult; Brain Diseases; Burns, Electric; Cardiovascular Diseases; Digestive System Diseases; Diphosphates; Diphosphonates; Female; Humans; Leukemia, Erythroblastic, Acute; Lung Diseases; Male; Middle Aged; Polyphosphates; Radionuclide Imaging; Splenic Diseases; Technetium; Technetium Compounds; Technetium Tc 99m Pyrophosphate; Urologic Diseases