Histopathological and bacteriological examinations were performed on 178 brains from Sardinian sheep which were showing neurological signs. The sheep represented the total number of sheep with neurological syndromes submitted for diagnostic investigations over a three-year period in Sardinia. Scrapie was detected in 57 cases, cerebrocortical necrosis in 25, intoxication by a typical Mediterranean plant (Cistus species) was suspected in 25, coenurosis was detected in 11 cases, Listeria monocytogenes in eight cases and focal symmetrical encephalomalacia in six cases. Non-suppurative inflammatory changes were observed in three of the brains and suppurative changes were noted in two. Lesions restricted to the spinal cord were found in three cases. In the remaining 38 cases there were no significant neuropathological changes.
Scintigraphy using indium-111-oxine-labeled white blood cells was used as a complementary diagnostic study in the differential diagnosis of 20 intracerebral cystic lesions for which computerized tomography scanning did not exclude abscess. To lower the rate of false-positive findings with scintiscanning, three criteria of positivity were tested in the 20 lesions. The most stringent criterion yielded 100% sensitivity, 94% specificity, and 96% diagnostic accuracy. The clinical and surgical implications of these results are discussed.
Simultaneous measurements of the clearance rate of chromium-51 ethylene diamine tetra-acetic acid (51Cr-EDTA) and technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA) were performed in 54 patients with a range of function between 9 and 176 ml/min. Using multiple blood samples the two clearance values correlated well (r = 0.97, SEE 8.6 ml/min) and DTPA clearance was higher by 2.9%. For each radiopharmaceutical the plasma clearance rates obtained using multiple blood samples were compared with those obtained with simplified methods, i.e., the 60-180 min two-sample method of Russell and the mono-exponential method with the Brochner-Mortensen correction. For both radiopharmaceuticals the clearance values correlated well with the Russell method (r = 0.99, SEE = 4.1 ml/min for EDTA; r = 0.99, SEE 4.9 ml/min for DTPA) and the mono-exponential method (r = 0.99, SEE 3.6 ml/min for EDTA; r = 0.99, SEE 3.9 ml/min for DTPA). The mean plasma clearance obtained using multiple blood samples did not differ significantly from that obtained with the Russell method, either in patients with a glomerular filtration rate (GFR)< 30 ml/min or in patients with GFR > or = 30 ml/min. The mean plasma clearance obtained using multiple blood samples differed significantly from that obtained with the mono-exponential method because of the great difference observed in patients with GFR > or = 30 ml/min. It is concluded that the Russell two-sample method after injection of 99mTc-DTPA is accurate enough for routine clinical use.
Cranial and spinal infections are severe events that require timely diagnosis and treatment. Physical and neurological examination, laboratory tests and radiological imaging may be insufficient for assessing cranial and spinal septic lesions. This study aimed to evaluate the accuracy of indium-111 white blood cell (WBC) scan in assessing the presence of leucocytes in intracranial and spinal lesions, and in the diagnosis, management and follow-up of primary, post-traumatic and post-surgical infections. One hundred and twenty-four subjects were included in the study (48 with post-traumatic or post-surgical lesions, 73 with primary cerebral lesions, and 3 with spinal lesions). All patients underwent a diagnostic work-up including planar scans with 111In-labelled WBCs, at 4 and 24 h post tracer injection. All subjects underwent surgical treatment. Patients who did not recover from the infection as suggested by clinical evolution underwent further treatment (up to three times) and further WBC scans (up to four times). WBC scintigraphy correctly identified all the areas of leucocyte accumulation, as confirmed after surgery. WBC scintigraphy also correctly excluded the presence of leucocytes in all other lesions, as demonstrated at surgery. The results of this study confirm the accuracy of WBC scan for the assessment of patients with cranial and spinal lesions, in whom the demonstration of leucocyte accumulation can ease the diagnosis of infection, and indicate that the method is also accurate for the follow-up and management of neurosurgical patients.
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