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A retrospective study was conducted into technetium-99m sestamibi imaging of primary hyperparathyroidism to determine the accuracy of identification and localization of parathyroid pathology. Of 56 patients studied, 48 had full preoperative scan data, operative data and pathological results analysed. Overall scan accuracy was 96 per cent. For single gland pathology (adenoma) imaging had a sensitivity of 97 per cent, a specificity of 100 per cent and a positive predictive value of 100 per cent. For single gland disease the side was correctly identified in 100 per cent of cases and the site in 94 per cent, but the respective values were only 82 and 79 per cent for multiple gland pathology. Technetium-99m sestamibi imaging is highly sensitive and accurate for primary hyperparathyroidism, with sufficient positive predictive value and accuracy in single gland disease to allow scan-directed unilateral neck exploration.

The concept of the P3 index and its use in separating acute pancreatitis from other causes of hyperamylasaemia is described. The mean P3 index of 12 healthy volunteers was 94.8 per cent. All 69 patients with acute pancreatitis had a P3 index below 80 per cent with a mean value of 67.9 per cent. The P3 index is abnormal longer than the raised serum amylase, which increases diagnostic accuracy. Causes of hyperamylasaemia other than acute pancreatitis have been studied and most patients have a P3 index above 80 per cent, although certain false positive values have been obtained. No patient with acute pancreatitis has had a P3 index above 80 per cent on admission. Five cases of acute pancreatitis have been studied in whom the P3 index remained abnormal; all had continuing pancreatic disease, usually with pseudocyst formation. The test has proved most valuable in identifying those patients at risk of developing subsequent problems. To date, the test cannot be relied upon to help in deciding upon the severity of an attack of acute pancreatitis.