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A dissociation between thyroid concentrating and organification, measured respectively by sodium pertechnetate Tc 99m imaging and the 24-hour radioactive iodine scan, was found in seven of 204 patients examined by combined isotope studies. Histologic diagnoses of adenomatous goiter, follicular adenoma, or thyroid carcinoma (mixed papillary and follicular) indicated that no unique morphologic correlates could be predicted in patients with discordant images. The combined use of sodium pertechnetate Tc 99m and radioactive iodine studies were found to be a useful tool for obtaining serial characterization of functional change following thyroid injury in a patient with de Quervain thyroiditis. ( JAMA 228:866-869, 1974)

Polymicrobial bacteremia increased from 6% in 1970 to 13% in 1975 in patients with bloodstream infections. This type of serious infection most commonly complicated genitourinary (27%) and gastrointestinal (26%) conditions, frequently followed invasive procedures (68%), was more common in hospitalized patients (73%), and was often associated with malignancies (25%) or immunosuppressive or cancer chemotherapy (34%). Although polymicrobial endocarditis was more commonly encountered in recent years, this infection accounted for only 4.5% of patients with multiple organism bacteremias. Gram-negative aerobic bacteria were isolated from 62% and anaerobic bacteria in 39% of patients with polymicrobial bacteremia compared with 37% and 14%, respectively, in patients with monomicrobial bacteremia. In the 88 patients with polymicrobial bacteremia, the mortality was 44.5%, compared with 18.0% in patients with monomicrobial bacteremia.

Cryptococcosis is a disseminated infection of man and animals that involves many organs, especially the central nervous system. Isolated bone involvement may cause lytic bone lesions. Diagnosis may be made by pathologic sections and culture of specimens obtained through surgical biopsy. When Cryptococcus is recovered from bone, care must be taken to study other organ systems, especially the central nervous system. Isolated bone disease without meningitis is very uncommom. Intense medical therapy is necessary for treatment of meningitis; isolated osteomyelitis may respond to surgical drainage alone.

Technetium 99m, in the pertechnetate form, was evaluated as an agent for brain scanning. 99m Tc has a physical half-life of six hours and no particulate radiation emission; large doses (10 to 15 mc) were administered without excessive patient irradiation. The scanning speed was increased and a single view of the brain recorded in five minutes. Because pertechnetate is cleared slowly from the blood, the normal intracranial vascular structures, not seen with chlormerodrin Hg 197 and chlormerodrin Hg 203, are depicted on the scan. In our study of 625 patients, 54 of 65 patients with proved intracranial neoplasia had positive results from brain scans. Forty-one patients with a variety of nonneoplastic intracranial diseases had positive scans. 99m Tc, in the pertechnetate form, was found to be as nonspecific as chlormerodrin Hg 197 and chlormerodrin Hg 203 in outlining intracranial disease.

HEPATIC injury in the form of intrahepatic cholestasis due to allergic drug sensitivity has been reported for many drugs.1The prototype most extensively studied is that of cholestatic jaundice caused by chlorpromazine. This report describes a case of cholestatic hepatitis due to sodium oxacillin (Prostaphlin) and documented by liver biopsy. As far as we know, no such case has been reported so far due to this agent or to other natural or semisynthetic penicillins. The antibiotics erythromycin estolate2,3and triacetyloleandomycin,4however, have caused this reaction. Report of a Case A 65-year-old white woman presented herself in the emergency room of Henry Ford Hospital on Feb 3, 1964, with cellulitis of the right leg. She was started on a regimen of sodium oxacillin, 2 gm daily, administered orally. She returned to the clinic on Feb 6; no improvement was found, and she was admitted to the hospital. The

This book represents the published proceedings of a symposium held in April 1967. Ordinarily readers tend to shy away from symposia because there is probably no area of current medical publications where the range of quality is so extreme. However, this work is not only good but it is very good. The editors gathered together leading authorities in pulmonary radiology and related sciences who deserve the high esteem in which their colleagues hold them. The volume is dedicated to the late Felix Fleischner, whom Dr. Leo Rigler refers to in his introduction as "the epitome of what we would like to see the radiologist be—that is the happy blend of teacher, scholar, investigator, with a keen analytical mind and a heavy clinical orientation." The assembled papers in this book represent the high quality of work which Dr. Fleischner inspired in his own students. At the onset it is clear that

This outstanding contribution to the literature of radiation biology serves as an important bridge between the clinic and basic research radiation biology. As in most multiple author works there is variation of quality and depth of coverage of the material, but in the main the editor has done a very good job. The first chapter on "Physical Considerations" is somewhat brief. That on pathologic effects is good, but in the renal discussion no mention was made of the significant effect hypertension has on sensitizing the kidney to radiation. Also the statement was made that glomerular filtration rate and renal plasma flow were temporarily depressed by as little as 400 rem. This is not borne out by the author's reference. These functions were depressed as long as they were measured (12 months) in their small series. Lionel Cohen's chapter on "Radiation Response and Recovery" is outstanding. This subject is covered in

Lung and heart scanning have been accepted as valuable diagnostic procedures in a variety of diseases. The lung scan is very sensitive in depicting pulmonary perfusion. Since many diseases alter perfusion, the nonspecificity of the test leads to diagnostic confusion. This atlas tries to unscramble some of these problems through careful attention to patterns and specific locations of abnormal perfusion. The book is divided into sections on lung, radioangiocardiography, heart blood pool, and myocardial scanning. The greatest emphasis is placed on the use of the lung scan in cases of pulmonary embolism. The distribution of radioactivity in relation to the segmental anatomy of the lung is stressed. However, there is no mention of the lower lobe medial basal segments. There are many fine illustrations of segmental perfusion defects, but it was often difficult to concur with the authors' specific locations. This was compounded by their use of an anterior anatomic

This small, pamphlet-like volume is the first of a series designed to present radiologic diagnosis in short segments, each of which can be read in two to five minutes. In his presentation, the author illustrates and discusses the use of plain and contrast roentgenogram techniques in the evaluation of common intraabdominal problems. The format is designed for self instruction. For each problem there is an x-ray film reproduction, with a short clinical clue and question on one page, followed by appropriate interpretation and discussion on the back of the page. There are minifications of the roentgenograms on the discussion pages, and the reference numbers frequently are too small to read. The material is organized into a logical progression, and the discussions are concise and succinct. This is a valuable contribution which will be most useful to medical students and nonradiologic house officers and will also serve as a worthwhile review

With the publication of this work, the rapidly growing field of nuclear medicine has its first true textbook. Dr. Wagner has achieved a uniform style and presentation throughout the book, something that has eluded the editors of most multiple author volumes. The basic science as well as clinical aspects of nuclear medicine are handled with suitable depth and clarity. Throughout the book, the presentation of representative cases is quite good, and the discussion of the diagnostic procedures is adequate and objective. The chapter on the diagnostic process is outstanding. Statistics and compartment analysis are, for me, replete with complex equations, but I suppose this is the nature of the discipline. The basic physics and instrumentation sections are excellent and discussed with candid detachment. A minor organization problem concerns the presentation of the more sophisticated metabolic radiotracer procedures, but the difficulty may be due to the emerging stage of these particular

In 1951 Cassen reported the successful imaging of the thyroid gland by means of compounds containing radioactive iodine and a mechanical moving detector. The many technical advances in radioisotope detectors which has occurred since then, as well as our greater knowledge of thyroid pathophysiology, have improved the thyroid scan so that today it is an important diagnostic tool in the evaluation of thyroid disease. The thyroid scan can be used for in vivo determination of thyroid size, location, function, and position. Instrumentation Rectilinear Scanners.— The most common type of radiation detector for thyroid imaging is the rectilinear scanner with a focusing collimator. The patient is given a tracer dose of a compound containing thyroid-seeking radioisotope. The detector moves stepwise over the neck of the patient and records, point by point, the distribution of radioactivity. The data is displayed as dots or dashes on paper or as varying degrees of density