Optimal thyroid scintigraphy requires an understanding of 1) the embryology, anatomy, and physiology of the thyroid gland; and 2) the properties of the 2 common imaging agents, technetium-99m pertechnetate (Tc-99m) and radioiodine (1-123). The normal gland has a characteristic scintigraphic pattern with these tracers and its uptake can be quantified with 1-123. Thyroid diseases often produce characteristic abnormal patterns. These abnormal patterns could be described as diffuse or focal, homogeneous or heterogeneous, increased or decreased. "Extrathyroidal" localization can be seen with esophageal activity, ectopic tissue, thyroglossal duct cyst, and substernal goiter. Thyroid scintigraphy of neonates, as a follow up to abnormal blood screening, demonstrates typical etiologic patterns. The first step in evaluating a patient with suspected thyroid disease is correlating the normal or abnormal scintigraphic pattern with available biochemical data, clinical history, and physical examination. By integrating the interpretive and technical "pearls" and "pitfalls" outlined in this article, the radiologist can be more confident in establishing a proper diagnosis.

Optimal parathyroid scintigraphy requires an understanding of (a) the embryologic, anatomic, and physiologic features of the parathyroid glands and (b) the properties of the two common imaging agents, technetium-99m sestamibi and Tc-99m tetrofosmin. Normal parathyroid glands are too small to be visualized, but parathyroid disease often produces visibly enlarged glands. Enlarged parathyroid glands may be found near the thyroid gland or outside their expected locations. Characteristic abnormal scintigraphic patterns may be described as focal or multifocal, usual or ectopic in location, and associated with a normal or abnormal thyroid gland. Patients who are referred for parathyroid imaging should have an abnormal biochemical profile. The first step in evaluating images of a patient suspected to have parathyroid disease is correlating the normal or abnormal scintigraphic patterns with the clinical and surgical history. By integrating the interpretative and technical pearls and pitfalls of parathyroid scintigraphy, the radiologist can be more confident in establishing a correct diagnosis and can precisely guide the surgeon to a single parathyroid adenoma, multiple parathyroid adenomas, or multigland hyperplasia.

SEVEN years ago I described some experiences of this subject,' and in thle sudden week of mobilization in August, 1914, I had arranged to see patients, operated on in 1912 and 1913, for tlle purpose of tilis paper. Military work shelved it until six moinths ago, but.I am dealing lhere mainly with those cases. They group themselves into tlhree clhiof types. CLASSIFICATION. 1. Affecting caecum and ascending colon only, the "cesspool caecum." This may be the mobile caecum alone, or combined with an appendix lying behind the caecum, colon, or terminal ileum, adherent to the posterior abdominal wall, either in iliac fossa, or internal to it, behind the end of tlle mesentery, and constituting Sir Arbuthnot Lane's " controlling appendix." 2. Affecting proximal colon-that is, as far as the centre of the transverse colon. 3. Where the whole colon lhas slipped down, sometimes alone, sometimes accomplanied to some extent by stomach,

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