IN STUDIES of the behavior of patients with organic brain disease the phenomena of reduplication for place, person, and time have been observed. Reduplication for place may be defined as the confabulation of the existence of two or more places with almost identical attributes, although only one exists in reality. Reduplication for person is the confabulation that there are two or more persons with almost identical attributes, although only one exists in reality. Reduplication for time is the confabulation that a present experience has also been experienced at some time in the past.In 1903 Pick1 described reduplication for place and person and termed it "reduplicative paramnesia." As an example, he cited the case of a patient with a diagnosis of senile dementia who, while in Pick's clinic in Prague, said that she had been in another clinic in another city, although the two clinics were exactly alike and a professor of the same name headed each clinic. Without referring to Pick's concept, Henry Head 2 described a similar case. A soldier with a bullet wound in the frontal region "thought that there were two towns of Boulogne, one of which, on the homeward journey from the front, lay near Newcastle; the other one, in France, was reached after you had crossed the sea." Head stated that the man appeared to be rational in all other respects, except that he wrote letters to his mother while recognizing the fact that she had been dead for many years. Recently there has been renewed interest in reduplicative phenomena, and instances of reduplication for place have been reported by

Cholescintigraphy with 99m-Tc labeled iminodiacetic acid (IDA) derivatives has proved to be extremely reliable in the evaluation of suspected acute cholecystitis. The major diagnostic feature of the study is the presence (cystic duct patency) or absence (cystic duct obstruction) of gallbladder visualization. Secondary findings include degree and rate of liver uptake, visualization and caliber of the intrahepatic and common bile ducts, and the presence of intestinal activity as well as rapidity of biliary tract-to-bowel transit of the radiotracer. Various combinations of these secondary parameters result in a spectrum of cholescintigraphic patterns which can assist in determining the cause of the patient's acute clinical problem.

Renal oncocytoma is an apparently benign neoplasm that is being reported with increasing frequency. It is important to differentiate it from renal-cell carcinoma prior to surgery. Angiographic, CT, and ultrasound studies may suggest the diagnosis but are not pathognomonic. In 4 cases, 99mTc-glucoheptonate imaging of the renal tubules was performed; one patient was also scanned in 131I-orthoidohippurate. There was no evidence of radionuclide uptake by the tumor. Reasons for the lack of success in differentiating renal oncocytoma from renal-cell carcinoma are discussed.

Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of 99mTc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The 99mTc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.

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