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Resume Introduction Le lymphœdeme (LO) primaire est la consequence d’une insuffisance lymphatique generalement liee a une hypoplasie des vaisseaux et/ou des ganglions lymphatiques. La lymphoscintigraphie (LS) en permet un diagnostic precoce. Objectifs Determiner, chez les enfants ayant un LO primaire unilateral de membre, la frequence d’une atteinte controlaterale infraclinique diagnostiquee par lymphoscintigraphie, et les determinants d’une bilateralisation clinique. Methodes Cette etude retrospective monocentrique a inclus les enfants ayant un LO primaire unilateral ayant consulte au CHRU de Tours entre 2004 et 2014. Les parents ont ete contactes par telephone pour les donnees de suivi. Resultats Parmi les 13 sujets inclus, six (46 %) avaient des anomalies lymphatiques bilaterales sur la LS. Sur un delai de suivi median de 6 ans, une bilateralisation clinique a ete observee, apres 7 ans d’evolution, chez un enfant qui avait une atteinte bilaterale sur la LS initiale. Conclusion Une insuffisance lymphatique infraclinique controlaterale est frequente en cas de LO primaire unilateral de l’enfant, mais la bilateralisation clinique semble rare.

Points essentiels Le principe de la lymphoscintigraphie repose sur le transport physiologique vers les vaisseaux et les ganglions lymphatiques de petites particules radioactives injectees dans le tissu interstitiel. La lymphoscintigraphie etudie directement le systeme lymphatique ; les autres methodes d’exploration du lymphœdeme : echographie, tomodensitometrie (TDM) et imagerie par resonance magnetique (IRM), etudient les consequences de la maladie lymphatique sur les tissus. La technique scintigraphique doit etre bien standardisee pour rendre l’examen reproductible. L’analyse porte sur l’aspect des vaisseaux et ganglions lymphatiques ainsi que de l’interstitium. L’interpretation repose essentiellement sur des donnees visuelles et qualitatives. De multiples anomalies peuvent etre visualisees. Elles ne permettent pas de differencier formellement le lymphœdeme primaire et secondaire. C’est la confrontation des donnees cliniques et scintigraphiques qui permet le diagnostic. L’examen informe sur la composante lymphatique de l’œdeme, sur la physiopathologie du lymphœdeme et contribue a sa prise en charge. L’imagerie hybride est une nouvelle technique d’imagerie du lymphœdeme. D’utilisation recente, elle combine les donnees fonctionnelles de la scintigraphie et celles anatomiques de la tomodensitometrie et devrait apporter une nouvelle dimension a l’imagerie du lymphœdeme.

International audience; Lymphoscintigraphy is a physiological method for the assessment of the lymphatic system. Routinely used for the localisation of sentinel nodes, it is not commonly performed to explore lymphoedema. We report the practical interest of lymphoscintigraphy in the study of limb lymphedoema from a population of 100 patients investigated during an 18-month period. After recalling the pathophysiology of lymphoedema and describing our acquisition and interpretation protocol, we present the practical interest of lymphoscintigraphy from the analysis of response to questions raised by the requesting physician. In our experience, lymphoscintigraphy was useful for the diagnosis of lymphoedema in clinically doubtful cases, the discussion of oedema pathophysiology, for the identification of the lymphatic component in lymphovenous oedema, and for the management of lymphoedema. The quality of information provided by lymphoscintigraphy depends on the rigour of the protocol, the overall data analysis and the integration of clinical data.

Resume Introduction Le lymphœdeme de membre resulte d’une incompetence du systeme lymphatique. Qu’il soit primitif ou acquis, la prise en charge est le drainage lymphatique manuel et la contention. L’efficacite de ce traitement varie beaucoup selon les malades, sans caractere previsible. Buts de l’etude Chercher des criteres cliniques ou paracliniques permettant de prevoir la reponse au traitement physique combine (drainage lymphatique et bandage multicouches) pratique en hospitalisation. Malades et methodes L’etude retrospective a porte sur 45 malades, tous hospitalises une semaine dans l’unite de lymphologie du service de Dermatologie du CHU de Tours pour traitement intensif d’un lymphœdeme de membre. Tous ces malades avaient eu une lymphoscintigraphie du membre lymphœdemateux en debut d’hospitalisation. Pour evaluer l’efficacite des drainages, nous avons etudie la perte de volume du membre atteint. Resultats Deux criteres se sont averes predictifs d’une resistance au traitement combine : l’existence d’une insuffisance veineuse et une activite ganglionnaire a la lymphoscintigraphie a 4 heures. Ces deux criteres etaient lies entre eux de facon tres significative. Conclusion L’insuffisance veineuse semble etre un facteur de resistance au traitement physique combine. Pour optimiser les resultats de ce traitement, il convient donc de la depister et de la traiter, en particulier chez tous les patients ayant une activite ganglionnaire sur les cliches tardifs de lymphoscintigraphie.

Resume Introduction La lipoido-proteinose est une maladie tres rare, hereditaire autosomique recessive, dont le gene en cause (ECM1) a ete mis en evidence recemment. Certaines mutations sont associees a une severite accrue de la maladie cutaneo-muqueuse. Observation Une malade, âgee de 38 ans, avait une atteinte cutaneo-muqueuse clinique et histologique caracteristique de la maladie d’Urbach-Wiethe. L’examen neurologique trouvait des vertiges, une ataxie, un ralentissement psychomoteur leger, et la malade signalait des troubles mnesiques et un episode de paralysie brachio-faciale gauche spontanement resolutive en une semaine. La tomodensitometrie et l’imagerie par resonance magnetique cerebrale etaient normales. La scintigraphie de perfusion cerebrale montrait une hypoperfusion des regions frontale anterieure bilaterale, temporale antero-interne droite (qui inclut l’amygdale) et du noyau thalamique gauche. Discussion L’absence d’argument pour une autre cause nous a fait considerer les signes neurologiques comme des manifestations de lipoido-proteinose. Cette observation et les donnees recentes de la litterature incitent a realiser un examen neurologique et neuropsychologique attentif chez les personnes atteintes de maladie d’Urbach-Wiethe.

Lymphedema results from impaired lymphatic transport with increased limb volume. Primary and secondary forms can be distinguished. Secondary lymphedema of the upper limb is the most frequent in France. A 2-cm difference on any segment of the limb confirms the diagnosis of lymphedema. Calculated lymphedema volume using the formula for a truncated cone is required to assess the efficacy of treatment and to monitor follow-up. Primary lymphedema is sporadic but rarely familial. Lymphoscintigraphy is useful in the primary form to evaluate precisely lymphatic function of the two limbs. Erysipelas is the main complication,but psychological or functional discomfort may occur throughout the course of lymphedema. Lipedema is the main differential diagnosis, defined as an abnormal accumulation of fat from hip to ankle and occurs almost exclusively in obese women.

Lipoid proteinosis is a rare autosomal recessive disease that has recently been shown to result from mutations in the ECM1 gene. Some cases are associated with a more severe mucocutaneous phenotype.We report the case of a 38-year-old woman who had clinical and histological skin features typical of Urbach-Wiethe disease. Physical examination revealed neurological abnormalities including dizziness, ataxia, slight psychomotor retardation and amnesic impairment. The patient reported sudden left brachiofacial paralysis one month earlier that regressed spontaneously after one week. CT scan and MRI were normal. Cerebral scintigraphy displayed bilateral hypoperfusion of the frontal areas, of the anterior and internal right temporal lobe (which includes amygdala), and of the left thalamic core.We considered these abnormalities as neurological features of lipoid proteinosis in the absence of evidence of any other cause. Our observation as well as other recent reports suggests the need for neurological and neuropsychological investigations in patients with Urbach-Wiethe disease.

Limb lymphedema results from incompetence of the lymphatic system, and treatment of both primary and secondary forms involves manual lymphatic drainage and support. The effectiveness of treatment varies from patient to patient and can be unpredictable.To investigate clinical and paraclinical criteria able to predict responses to combined physical treatment (lymphatic drainage and multilayered support) during hospitalization.A retrospective study was performed in 45 patients admitted for one week's intensive treatment of limb lymphedema in the Lymphology Unit of the Department of Dermatology of the University Hospital of Tours. Lymphoscintigraphy was performed for all patients on admission. Loss of volume in affected limbs was studied to evaluate the effectiveness of treatment.Two criteria were predictive of resistance to combined treatment, i.e. venous insufficiency and continuing lymph node evidence of scintigraphic activity four hours after lymphoscintigraphy. The two factors were significantly related.Failure of combined physical treatment for lymphedema appears to be related to venous insufficiency. It is therefore essential to investigate and treat venous insufficiency, particularly in patients with continuing evidence of scintigraphic activity in lymph nodes.

The objectives of this work were a) to assess the feasibility of lymphoscintigraphy in very young children, and b) to assess its usefulness in understanding the underlying pathophysiology.Forty-one children (age range 3 months-16 years) with primary lymphedema of the lower and/or upper limbs underwent lymphosinctigraphy using 99mTC-labeled colloid (Nanocis or Nanocol) injected subcutaneous at the foot and/or hand level. Recording time, which depended on the child's age, included at least static images during the thirty minutes following injection and four hours later.Abnormal activity of the lymph collectors, nodes, and interstitial space were analyzed according to age (or2 years). Abnormal findings were classed as simple hypoplasia (n=18) or other type of lymph disease: diffuse lymphatic dysplasia (n=6), mixed vascular dysmorphism (n=5), amniotic bride disease (n=1), and hypoplasia revealed by occurrence of a minor factor (n=11). These observations demonstrate the role of lymphoscintigraphy in the diagnosis and prognostic evaluation of lymphedema in children.Lymphoscintigraphy is a useful technique for very young children with lymphedema providing further information contributing to overall exploration.

We report the case of a woman who presented a single liver lesion with no evidence of specific findings at Doppler US, CT, nuclear studies and MRI to suggest angiomyolipoma. The final diagnosis was confirmed at anatomopathology and immunohistochemistry which demonstrated positive anti-HMB 45 aspect.

Patients with respiratory pathologies in the forms of tracheitis, rhino-sinusitis, and asthma sometimes have symptoms of gastro-oesophageal reflux, that should be taken into consideration in order to treat the co-factors associated with the etiopathology. However, these patients, because of their respiratory handicaps, are frequently unwilling to submit themselves to traumatic investigations. Oesophageal scintigraphy, because of its perfect tolerance and reliability, seems to be an examination that is adapted to the situation to resolve this dilemma.

Introduction et but de l’etude Dans une situation de repas successifs (petit dejeuner/dejeuner par exemple), une elevation precoce ( Materiel et methods Neuf sujets sains ont ingere un petit dejeuner (07h30) contenant 25 g de lipides marques par du [1-13C] palmitate et un dejeuner (pour 6 des 9 sujets) contenant 44 g de lipides (3 temoins n’ingeraient pas de dejeuner). Le lendemain, un petit dejeuner marque par 123I-LIPIODOL® etait ingere par les 9 sujets. Pour 3 d’entre eux, un dejeuner etait ingere. L’enrichissement en [1- 13C] palmitate etait mesure dans les TG plasmatiques et les TG des CM (CM-TG). Le parcours du LIPIODOL® etait suivi in vivo par scintigraphie centree sur l’estomac, l’intestin grele et le canal thoracique. Resultats Apres le petit dejeuner, l’enrichissement en [1-13C] palmitate etait maximal a 150 et 210 min pour les TG plasmatiques et TG des CM (CM-TG) respectivement, diminuait ensuite puis reaugmentait rapidement (50 min apres le dejeuner pour les TG plasmatiques et 30 min pour les CM-TG). La scintigraphie montrait que les lipides ingeres au petit dejeuner etaient en partie retenue dans l’estomac et l’intestin grele au moment du dejeuner (respectivement 13±3,92% et 71±18.2% de la radioactivite totale a l’ingestion, m±SD). Pour les 3 temoins qui ont ingere un dejeuner, une diminution des activites dans l’estomac (–6, 7 %) et dans l’intestin (–22,4 %) ainsi qu’une augmentation de l’activite dans le canal thoracique (+8,4%) etaient observees. Conclusions L’elevation des TG plasmatiques et CM-TG qui suit le dejeuner est associee a une vidange gastrique et intestinale incomplete des lipides ingeres au petit dejeuner. L’ingestion du dejeuner mobilise les lipides du petit dejeuner presents dans le secteur intestinal, par acceleration de la vidange intestinale et du flux du canal thoracique. La vidange intestinale est un element important de la regulation des flux d’entree plasmatique des CM lors de repas successifs.

Lung scintigraphy gives the clinician valuable tools in the diagnosis or management of major pulmonary disorders. The imaging test agents used allow the imaging of pulmonary perfusion and ventilation.

The first successful pneumonectomy was reported in 1933 by Graham and Singer [1]. Since 1955, many studies have focused on morbidity due to respiratory insufficiency after pneumonectomy or even lobectomy. More recently, the development of lung transplantations has increased the necessity for precise pre-operative measurement of pulmonary function. Many techniques have been reported to be useful for such a purpose. Some, such as bronchospirometry, bronchoscopic respiratory gas sampling, temporary unilateral pulmonary arterial occlusion, and intraoperative pulmonary artery pressure measurement [2] have been abandoned now. These techniques are invasive and, in fact, well correlated with non-aggressive tests. Pre-operative measurement of pulmonary function nowadays requires at least spirometry, possibly associated with DLCO and exercise tests. Ventilation and/or perfusion scans complete these basic tests when necessary.

A technetium-99m labelled red blood cell scintigraphy was performed in 51 patients with an unexplained gastro intestinal bleeding. Static images were acquired on the injection day then at 24 hours. Forty one patients had a positive scintigraphy. In 13 patients with a positive scintigraphy, on the injection day (5 cases) and later (8 cases), no intestinal bleeding was identified in spite of further investigations guided by scintigraphy. In 24 patients, with a positive scintigraphy on the injection day (20 cases) and later (4 cases), an intestinal lesion was identified and treated; data were confirmed in 19 cases: there were 15 colon lesions, localized on caecum in 10 cases and 4 small bowel lesions. Clinical value and limitations of the investigation are discussed. The scintigraphic localization is usually accurate if the abnormal focus activity is noticed on the injection day. It helps to guide further investigations of the bleeding site. This non invasive method should be performed more quickly to help to localize intestinal bleeding which poses a diagnostic problem.

Condensed image processing (CIP), a computerized technique of scintiscans that generates a vertical distribution of activity as a function of time in a single image, was applied to isotopic lymphoscintigrams of four patients with leg lymphedema. By "condensing" information gained from multiple images into a single image, CIP better evaluates ascending progression of radiolabeled colloid in peripheral lymph and better localizes stagnant areas. In "high lymph flow failure," CIP also depicts radioactive "bursts" suggestive of increased lymphatic truncal contractility. This data processing method improves interpretation of dynamic scintiscan recordings and seems ideally suited for evaluation of peripheral lymph kinetics.

After a brief review of the classical methodology and results of lymphoscintigraphy, the technique is considered in terms of an original kinetic study approach. Immediately after distal subcutaneous injection of a technetium colloid (rhenium sulfocolloid), 40 1-min serial images of the limbs are recorded followed 4 h after injection by recording of static images. The main abnormalities detected by scintigraphy concern the lymphatic vessels, nodes and interstitium. They reveal the presence of lymphedema and provide information about its mechanism, indicating, particularly in the case of primary lymphedema, whether there is predominant hyperplasia or hypoplasia in vessels or nodes. Synoptic study of the initial dynamic recording based on simple examination of serial images is difficult. Complementary data provided by activity curves determined from manually selected regions of interest (ROI'S) are of limited value since the ROI'S correspond to superimposed spatial structures. Two data-processing techniques--the condensed image (CI) and factorial analysis (FA)--were therefore applied to dynamic scintigraphic recordings in order to study lymphatic progress of the radiotracer in the legs. A complete dynamic series is described in two IC, one for each leg. The CI, obtained by mounting the 40 serial images in vertical strips 1 pixel in width, describes the spatial distribution of radioactivity along the leg during recording. Factorial analysis provides automatic extraction of pure kinetic components or factors from the dynamic series despite their spatial superposition. The factors are described by factorial curves and factorial images representing the spatial identity of the factor. Three-factor FA was applied successively to each leg.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to investigate the mechanism of uptake of meta-iodobenzylguanidine (mIBG) by the adrenal glands, autoradiographic and pharmacologic studies were performed in mice and dogs receiving radioiodinated mIBG. In mice, on macroautoradiography of whole body sections 48 h after 125I-mIBG, most of the radioactivity was focused in the adrenal glands. On microautoradiography, silver grains were exclusively located in the adrenal medulla. Tissue counting after phenoxybenzamine, cocaine, and desipramine treatment resulted in 45%, 35%, and 0% inhibition of mIBG uptake, respectively. Tissue counting and scintigraphic studies demonstrated a more than 50% mIBG release from the adrenal glands after reserpine. These data indicate the high affinity of mIBG for adrenal medulla and suggest that the mIBG and catecholamine uptake mechanisms are only partially the same.

This report describes the use of lymphscintigraphy in a patient with traumatic chylous ascites. Radioactivity "leakage" near the origin of the thoracic duct and accumulation into the peritoneal cavity were delineated.

The effects of intermittent pneumatic compression (IPC) in 12 patients with lower or upper limb lymphedema were studied using a computer-based technique (factorial analysis) of dynamic lymphoscintigraphy. After subcutaneous injection of radiocolloid into the first interdigital web space of the arm or leg, scintigraphic recordings consisted of 40 consecutive one-minute frames of both lower extremities or an edematous upper extremity. Pneumatic compression by Euroduc (6 patients) or by Lymphapress (6 patients) was applied during the final 20 minutes of the recording. A three factors factorial analysis (FA) was performed successively for each extremity. FA allowed "uncontaminated" curves to be displayed distinct from neighboring structures and corresponded to dynamic tracer activity in the interstitium, at the injection site, and within lymphatic vessels. Based on the results of lymphatic vascular factorial analysis, a beneficial effect of IPC was detected in 18 of 22 limbs examined. FA processing suggested that IPC facilitated radiocolloid transport in the proximal portion of the limb and also propelled tracer from the injection site toward the lymphatics. The effect of IPC was evident as soon as external compression therapy began and was similar with either mechanical unit. Residual tracer activity in peripheral lymphatics 20 minutes after application of IPC was higher in the edematous as compared with the normal limbs. FA processing is a new and potentially valuable method to evaluate the effects of external pneumatic compression in the management of peripheral lymphedema.

Nine sera with falsely elevated results in a TSH radioimmunoassay were studied. Sera dilution and gel filtration showed that the immunoreactive TSH was different from the standard and labeled TSH. It coeluted with the immunoglobulin fraction of the serum. Rabbit serum decreased or emphasized the artifact according to the dose. Falsely elevated results appeared only in radioimmunoassays using a double antibody method for the separation of free and bound labeled hormone. FSH, LH, and beta HCG radioimmunoassays using the double antibody method underwent the same disturbance as the TSH assay in these patients. Our results suggest that the artifact may be due to the presence in certain human sera of anti-rabbit IgG antibodies, interfering in the radioimmunoassay by inhibition of the binding of first and second antibodies.

HLA-A and B phenotypes were determined in 38 patients with Cushing's syndrome (29 Cushing's diseases, 9 others etiologies) and compared with those of 591 normal subjects. No significant differences was found in the HLA antigens distribution in the two groups. However the series is too small to definitely support the hypothesis of a lack of correlation with HLA. Indeed, the increased prevalence of B8 antigen in Cushing's disease (28%) as compared to that in the control group (17%), although not statistically significant, emphasizes the need for further typing of HLA-DR, particularly RDw3 which is known to be linked to D8 through desequilibrium and associated with several autoimmune diseases.

Fifty meta-iodobenzylguanidine (MIBG) scintiscans were performed in three groups of medullary thyroid cancer (MTC) patients. Group 1 (n = 11) included treated patients with normal calcitonin levels; Group 2 (n = 24) included patients with elevated calcitonin levels due to sporadic and isolated MTC; Group 3 (n = 15) included patients with elevated calcitonin levels due to familial MTC or multiple endocrine neoplasia Type IIA syndrome (MEN). In Group 1 three pheochromocytoma were depicted by MIBG scintiscan. In Group 2 MTC was seen in a small number of patients (3 of 24). In Group 3, besides adrenal hyperplasia and pheochromocytoma four patients, MIBG scintigraphy showed where MTC had localized and spread in almost half of patients (7 of 15). MIBG uptake occurred in patients with relatively high calcitonin level (greater than 0.6 nmol/l). These data indicate that in patients with familial MTC or MEN syndrome, MIBG scintiscan can be useful not only in detecting associated pheochromocytoma, but also in showing MTC.

During the last 6 years, more than 4,000 tests using 125I fibrinogen have been performed on orthopedic and traumatic patients who were undergoing a thromboembolic treatment by means of subcutaneous heparin. The high accuracy of this method has been confirmed using phlebography. This test still remains a simple, faithful, and non traumatic diagnosis tool in the early detection of thrombosis of the limbs of patients undergoing traumatologic and orthopedic surgery. Moreover, the labeled fibrinogen test is useful in the determination of the efficiency of antithrombotic preventive therapy.

Scintigram imaging is a new means of localization of digestive tract hemorrhage, the radiopharmaceutic agent (technetium-labelled colloidal sulfur or technetium-labelled erythrocytes) accumulating at the bleeding site. The technique used consists of early recording over 80 minutes and then later serial imaging over 24 hours after radioisotope injection. The limitations and advantages of radioisotope investigations are discussed in relation to results in 6 patients with digestive hemorrhage explored by scintigraphy. When technetium-labelled erythrocytes are used the method is a non-invasive, simple and sensitive one for locating site of bleeding during the period of active hemorrhage. It appears to be complementary to arteriography, a more aggressive and less sensitive procedure, and to endoscopy, which explores small intestine and cecum with difficulty and cannot always determine the origin of the bleeding when other lesions exist. Experimental studies in the dog have shown that scintigraphy can detect digestive bleeding of about 0.1 to 0.2 ml/min, and this method of exploration should be used routinely when endoscopy and/or arteriography have not been performed or have given inconclusive results.

Post-traumatic oedema after fractures of the tibia results from several causes which are often associated together. In addition to venous thrombosis, the lymphatic origin of oedema is not inconsiderable. Lymphatic scintigraphy was performed in 32 patients with tibial fractures, either open or closed. All were fixed internally. All had preventive treatment of venous thrombosis by calciparin. The intact leg was also investigated by scintigraphy which was done two to ten days after the trauma. The possible anomalies of scintigraphy are described and discussed. The patients were divided into two groups. Group one developed oedema at three months and group two did not. The anomalies of scintigraphy were significantly higher in group one. It is concluded that early scintigraphy is a safe test for the prediction of residual oedema after tibial fractures. The possible early prevention of oedema of a lymphatic origin is discussed.