Accurate Localization and Surgical Management of Active Lower Gastrointestinal Hemorrhage with Technetium-Labeled Erythrocyte Scintigraphy

Abstract

ObjectiveThere is disagreement over the reliability of technetium Tc 99m (99mTc)-labeled erythrocyte scintigraphy in the localization of active lower gastrointestinal hemorrhage. A previous study at The New York Hospital-Cornell Medical Center that showed a superior sensitivity for localization of scintigraphy versus angiography in surgical patients led the authors to emphasize scintigraphy as the diagnostic test of first choice in the clinical diagnostic algorithm. The authors hypothesized that tagged erythrocyte scintigraphy can be used accurately as the primary diagnostic modality in localizing acute bleeding and guiding surgical intervention. MethodsThe authors conducted a 5-year, retrospective analysis of 224 inpatients who underwent scintigraphic imaging for diagnosis and localization of active lower gastrointestinal bleeding. Using scintigraphy as the primary diagnostic test, with colonoscopy, upper endoscopy, and angiography as adjunctive studies, 99mTc-labeled erythrocyte scans were performed at the clinician's discretion and were reviewed again for study purposes by two nuclear radiologists who were blinded to clinical outcome. Adjunctive diagnostic tests also were ordered for clinical indications. Results

Association between Actinic Keratoses and Potentially Photosensitizing Drugs

“…Despite the generally benign outlook stressed by the authors, mitral-valve prolapse, which affects 2.4 percent of the population, accounts for most cases of severe mitral regurgitation 3 including 90 percent of the cases of ruptured chordae tendineae. 4 Moreover, among adults with native-valve endocarditis, it is the most commonly recognized lesion. 5 2 Although the prevalence of mitral-valve prolapse throughout the world might have been overestimated as a result of the use of nonuniform echocardiographic criteria, as pointed out by Nishimura and McGoon, 2 it is undeniably the most common cause of mitral regurgitation.…”

“…3 Therefore, although mitral-valve prolapse may not be as serious a disease as was previously thought, one of its most serious complications -namely, mitral regurgitationremains a major issue in the care of affected patients. 4 Fortunately, mitral-valve repair, rather than replacement, is now possible in nearly 90 percent of patients with mitral-valve …”

“…Its development is related to the cumulative exposure to ultraviolet radiation from the sun and the sensitivity of people to this radiation. Many drugs have photosensitizing effects, [1][2][3] and some, such as psoralens 4 and fluoroquinolones, 5 augment photocarcinogenesis. We hypothesized that other photosensitizing drugs could also act in this way.…”

“…This is important, because anti-Hu antibodies occur in as many as 15 percent of patients who have small-cell lung cancer without a paraneoplastic syndrome. 4 It would be useful to know the prevalence of anti-Ma2 antibodies in patients with and without testicular cancer and in patients with and without paraneoplastic neurologic disorders. …”

“…Recent information from studies of adults treated with potent antiretroviral agents indicates that immune reconstitution may result in a decrease in CMV viremia and improvement of CMV-specific immunity and CMV disease. 4,5 Although these patients may differ from infants with congenital or perinatal CMV infection, additional information from clinical trials or natural-history studies would be useful in making general recommendations.…”