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The clinical, radiologic, histopathologic, and genetic features of a sclerosing bone dysplasia found in three members of a family are described. The bone disorder affected all metaphyseal-diaphyseal regions of all long bones, the skull, and three metacarpals. All affected members also had ichthyosis vulgaris and premature ovarian failure. These features have not been reported before, indicating a new syndrome.

Purpose: To compare the effect of two different informed consent forms on patients' anxiety level prior to intravenous contrast material (IVCM) injection. Material and Methods: Two different informed consent forms were randomly given to 265 consecutive patients referred for either intravenous pyelography or computed tomography requiring IVCM injections. Form 1 had brief information, including only the common risks and risk factors associated with IVCM, while Form 2 had more comprehensive information. Before being presented with the two different informed consent forms, 191 of the 265 patients filled out two other forms evaluating: 1: How they felt in that particular situation/moment (STAI-T); and 2: How they felt independently of the situation or condition at that moment (STAI-S). After the patients were informed, the STAI-T (measuring how they felt in that particular situation) was filled out once more to see if the anxiety level had changed. Results: The anxiety level for 88 patients receiving Form 1 decreased after they were given the informed consent (P=0.033). However, among the 103 patients receiving Form 2, the anxiety level showed a significant increase (P=0.001) compared to the values obtained before Form 2 was given. Conclusion: These results indicate that informed consent, including brief information about the risk factors and potential adverse reactions of IVCM, reduces anxiety level, while detailed information before the procedure increases the anxiety level. C1 Afyon Kocatepe Univ, Sch Med, Dept Radiol, TR-03200 Afyon, Turkey. Afyon Kocatepe Univ, Sch Med, Dept Psychiat, TR-03200 Afyon, Turkey. Suleyman Demirel Univ, Sch Med, Dept Radiol, Isparta, Turkey. Adnan Menderes Univ, Sch Med, Dept Radiol, Denizli, Turkey.

Aim: Investigation of the diagnostic role of technetium-99m methoxyisobutylisonitrile (Tc-99m sestamibi) scintimammography in non-palpable, suspicious breast lesions described as microcalcification, moss and increased density using mammography. Patients, method: 35 women with non-palpable breast lesions were enrolled in the study. Anterior, left and right lateral, ipsilateral posterior oblique images were obtained 15 min after the injection of 740 MBq of Tc-99m sestamibi. All scintigraphic images were evaluated visually and focal increased Tc-99m sestamibi uptake was accepted as malignant lesion. Breast lesions were classified as microcalcification (13 women), mammographic mass (16 women) and increased density (6 women). Excisional biopsy was performed in all of them irrespective of the scintigraphic results. Results: The focally increased Tc-99m sestamibi uptake was seen in 11 breast lesions with malignant lesions and in 4 breast lesions with benign lesions. The diffuse uptake of Tc-99m sestamibi was seen in 18 breast lesions with benign lesions and 2 breast lesions with malignant lesions. There was no false positive result of Tc-99m sestamibi in microcalcification group and there was no false negative result of the mammographic mass and increased density groups. Conclusion: Scintimammography might be a complementary method in decision making for the non-palpable, suspicious breast lesions that were evaluated as microcalcification, mass and increased density mammograpically.

Technetium-99m-tetrofosmin, an agent that is widely used in myocardial imaging, has been reported to accumulate in several types of malignancies, including lung tumors. Yet, there is limited knowledge about its role in imaging infection or inflammatory lesions. The aim of this study was to investigate the role of Tc-99m-tetrofosmin scintigraphy in pulmonary tuberculosis in cases with active and inactive tuberculosis in comparison with radiological and microbiological findings. Methods: Twenty-seven patients with active pulmonary tuberculosis (APTB) and 6 patients with inactive pulmonary tuberculosis (IPTB), proven by sputum smears and cultures, were included in this study. Mean age of the group was 42.6 +/- 13 yr. Nine months after therapy, Tc-99m-tetrofosmin scintigraphy was repeated in 6 patients with APTB to evaluate response to therapy. Ten-minute anterior and posterior chest images were acquired 20 and 60 min after the injection of 370 MBq (10 mCi) Tc-99m-tetrofosmin. The images were evaluated both visually and semiquantitatively by two blinded nuclear medicine physicians. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L) and nonlesion areas (NL). The mean count values of ROIs were obtained and L/NL ratios were calculated. Results: According to the visual evaluations, Tc-99m-tetrofosmin uptake was Grade (+) in 4 (15%) and Grade (+ +) in 23 (85%) patients with APTB. Technetium-99m-tetrofosmin uptake was negative in 5 patients with IPTB. Grade (+) Tc-99m-tetrofosmin uptake was observed in only one inactive case. After therapy, there was no Tc-99m-tetrofosmin uptake in 3 patients, which correlated well with chest radiography and clinical findings. In the other 2 patients, Tc-99m-tetrofosmin uptake was slightly decreased when compared with a previous scan that correlated with radiological and clinical findings. In 1 patient with bilateral lung disease, Tc-99m-tetrofosmin uptake decreased on the right lung lesions, whereas the left lung lesions persisted with no change. The mean early and delayed L/NL ratios of APTB were 1.53 +/- 0.22 and 1.45 +/- 0.21, respectively. Although Tc-99m-tetrofosmin uptake in APTB lesions was more visually marked in early images than that in delayed images, there was no statistically significant difference between these two sets of images. Conclusion: Technetium-99m-tetrofosmin scintigraphy showed increased uptake in APTB lesions related to disease activity. After treatment, Tc-99m-tetrofosmin uptake disappeared or decreased, correlating well with radiological and clinical findings. Technetium-99m-tetrofosmin scintigraphy may have a complementary role in the assessment of APTB as well as in follow-up treatment.

Coronary artery bypass grafting (CABG) is one of the major treatment methods of coronary artery disease. CABG is an open-heart surgery that uses cardiopulmonary bypass (CPB). After CPB, it is well known that neurological and neuropsychological complications may occur. The purpose of this study was to evaluate brain perfusion patterns before and after CPB and to locate brain perfusion changes in patients with neurological and neuropsycological complications after CPB. Methods: Twenty-five patients who underwent open-heart surgery (22 CABG, 3 valve replacement) and 5 patients (4 cholecystectomy, 1 periferic vascular surgery) as a control group were included in the study. The Tc-99m-HMPAO injected dose was 925 MBq. Brain perfusion SPECT images were obtained 30-60 min postinjection using a dedicated triple-head brain SPECT camera, Imaging was performed 1 wk before and 4-6 wk after surgery. Technetium-99m-HMPAO brain SPECT slices were evaluated visually and semiquantitatively. Results: None of the patients had severe neurologic complications. Neuropsychological deficits occurred in eight patients after CABG. Cognitive deterioration and depressive mood occurred in five patients. Disorientation, agitation and confusion periods were present in another two patients. Frontal hypoperfusion was found in these patients by visual and semiquantitative evaluations (p = 0.0277) and left parietal hypoperfusion was also present semiquantitatively (p = 0.0277). Visual hallucinations occurred in one patient. Computed tomography of these patients was normal. No perfusion abnormalities were observed in the patient with visual hallucinations and in patients without symptoms after open-heart surgery nor in the control group. Brain SPECT was repeated in two symptomatic patients 5 mo after CABG. Frontal hypoperfusion became normal, and these patients' symptoms disappeared. Conclusion: The results of this study indicate that regional cortical hypoperfusion may occur in patients with neuropsychological complications after CABG. Technetium-99m-HMPAO brain SPECT is a useful method to locate and determine brain perfusion changes after CABG.

To investigate the role of sublingual nitrate plus 99Tcm-tetrofosmin infusion in the detection of severely ischaemic but viable myocardium, we selected 25 patients with coronary artery disease who had at least one fixed segmental defect during conventional stress-redistribution (ST-RD) 201T1 single photon emission tomographic (SPET) imaging. Reinjection (RI) and 24 h late redistribution (LRD) imaging were also performed. Within a week of 201T1 imaging, one-day rest-stress (R-ST) 99Tcm-tetrofosmin SPET was performed with the same stress levels. The following day, 99Tcm-tetrofosmin was infused over 1 h immediately after sublingual nitrate administration and SPET images (N + Inf) were acquired. Of 100 fixed defects on R-ST 99Tcm-tetrofosmin imaging, 15 were reversible on N + Inf 99Tcm-tetrofosmin imaging. There was 91% concordance between ST-RD/RI/LRD 201T1 and R-ST/N + Inf 99Tcm-tetrofosmin imaging regarding reversibility. We conclude that N + Inf 99Tcm-tetrofosmin imaging may be clinically useful in the detection of severely ischaemic but viable myocardium. © 1996 Chapman and Hall ltd.

Indium-111 octreotide uptake has been reported in various somatostatin receptor positive tumors, granulomas and autoimmune diseases in which activated leucocytes may play a role, subcutaneous cavernous hemangioma and angiofibroma. We present Indium-111 octreotide uptake in a surgical abdominal scar tissue 1.5 and 6 months after surgery in a patient who had been treated for recurrent carcinoid tumor in the rectosigmoid junction. Indium-111 octreotide uptake in a surgical scar may be related to the binding to somatostatin receptors in the activated lymphocytes and fibroblasts that is previously reported.