99m-Tc HMDP bone scintigraphic findings of gouty arthropathy of both hands: extending soft tissue uptake adjacent to the joints.

The 99mTc hydroxy methylene diphosphonate scintigraphic findings of both hands are correlated to the radiographic findings in a patient with a 30-year history of gouty arthropathy. Scintigraphic differentiation of the type of arthritis on the basis of uptake pattern is difficult. However, the findings of rheumatoid arthritis are confined to the joints and usually the involvement is symmetrical.

Malunion of a femoral fracture mimicking osteomyelitis in three phase bone imaging.

A case of greatly increased blood flow in the region of a fracture with malunion of the left femur, both in the flow and immediate blood pool studies during three phase bone imaging, is presented. The sluggish left femoral artery flow resulted from the greatly increased regional perfusion and is similar to the findings in acute osteomyelitis. The sluggish left femoral artery flow and greatly increased regional perfusion of the site is probably best explained as a regional "neurovascular flush" resulting from the pain caused by the malunion of the fracture and/or hyperemia in the area of the malunion responding to inflammation.

Followup of ureterosigmoidostomy diversion for bladder exstrophy--behavioral biofeedback as an alternative treatment for fecal-urinary incontinence: a case report.

A total of 6 children underwent primary ureterosigmoidostomy diversion between 1972 and 1979. Despite preoperative testing of rectal competence all 6 children now experience rectal leakage. Behavioral biofeedback has been used in a 7-year-old boy who had learned to isolate and to contract the perineal muscles appropriately by 12 months of followup.

Scott's inflatable penile prosthesis: evaluation of mechanical survival in the series 700 model.

The series 700 penile prosthesis was implanted in 131 patients. Actuarial analysis revealed survival of the cylinders to be 98 per cent at 1 year and 92 per cent at 36 months. The only additional failures were leaks in the reinforced tubing in 9 cases.

Penile prosthesis: review of current models, mechanical reliability, and product cost.

A fifty-year experience with the modern penile implant has led urologists to conclusions as to the reliability, applicability, and cost of these devices. Product evolution has led to a more physiologic erection. However, with increased sophistication, further potential for failure must be considered.

Incidental vertebral lesions identified during technetium-99m sulfur colloid liver-spleen imaging.

Three vertebral lesions, two compression fractures, and one metastasis in two patients, were incidentally demonstrated during Tc-99m sulfur colloid liver-spleen studies. Although the scintigraphic photon-deficient area could not be differentiated due to the metastasis and the compression fracture, the abnormal radiocolloid findings of vertebrae may lead to further studies using Tc-99m diphosphonate, Ga-67, radiographic studies, and/or biopsy.

Urinary incontinence in the elderly. Ways to relieve it without surgery.

Few studies of incontinence have been done on the elderly as a specific population, although epidemiologic reports reveal that incontinence is a debilitating condition that affects 15% to 30% of the elderly population of the United States. In diagnosing the problem, we use the simplest procedure that can supply the required information. However, if the diagnosis is uncertain or the treatment being considered is risky, urodynamic testing is necessary.

Ring-like uptake pattern of a skeletal imaging agent in a huge renal cell carcinoma.

A case of huge renal cell carcinoma with localization of a skeletal imaging agent is presented. Two unusual scintigraphic findings of bone agent localization in the tumor were observed: a ring-like configuration, and low-intensity uptake. The large ring-like appearance of the extraosseous radioactivity may reflect a bulky tumor with central necrosis and a less active calcification process.

Massive splenic metastases with localization of a skeletal imaging agent.

A 70 year old man with squamous cell carcinoma of the lung underwent Tc-99m sulfur colloid liver-spleen scintigraphy and abdominal CT studies; both studies showed multiple large lesions in the massively enlarged spleen, with a cystic appearance being noted on the CT examination. Two consecutive Tc-99m HMDP bone scintigrams demonstrated mild, diffuse radioactivity in the region of the spleen, indicating extraosseous localization of the bone imaging agent in the spleen and suggesting solid tumor masses rather than cysts. At autopsy, the huge spleen weighing 2,200 gm contained multiple, large, metastatic masses.

Biofeedback for the treatment of anal incontinence in a child with ureterosigmoidostomy.

The case of a 7-year-old boy born with exstrophy of the bladder is presented. Biofeedback and behavioral therapy were employed in the treatment of anal incontinence, which occurred following ureterosigmoidostomy diversion. After 19 treatment and follow-up sessions over a period of 12 months, there was significant decrease in fecal/urinary incontinence.

Simultaneous demonstration of pleural effusion and ascites by technetium-99m sulfur colloid liver-spleen scintigraphy.

Scintigraphic evidence of ascites has been observed in Tc-99m sulfur colloid studies of the liver and spleen, in Tc-99m HIDA hepatobiliary scans, in Ga-67 citrate scans, and in Tc-99m phosphonate bone images. Pleural effusion has been demonstrated in Tc-99m phosphonate bone scintigraphy. The case of a 48-year-old man whose Tc-99m sulfur colloid liver-spleen scintigram simultaneously demonstrated a right pleural effusion and ascites is presented.

Diagnostic imaging in mediastinal thyroid tumor.

Various diagnostic imagings in nine patients with mediastinal goiters were presented. The clinical manifestations of these patients were various, from totally asymptomatic to severe dyspnea. Six of the nine patients underwent surgical intervention, three were follicular adenomas and three were nodular goiters.

Intermittent catheterization: evaluation of complete dryness and independence in children with myelomeningocele.

We studied 46 children in active followup who have been managed by nonsterile intermittent catheterization to achieve continence. All patients were given maximum therapeutic doses of supplemental medication to improve dryness. Of the patients 33 per cent were noncompliant and, therefore, wet, 30 per cent were wet despite full compliance with the program, and only 24 per cent were completely dry and wearing regular underclothing.

The inflatable penile prosthesis, reoperation and patient satisfaction: a comparison of statistics obtained from patient record review with statistics obtained from intensive followup search.

Of 179 patients who received the inflatable penile prosthesis 43 per cent have required reoperation, 60 per cent of which were performed for mechanical failure. An attempt to evaluate the adequacy of chart review in assessing current function and patient satisfaction was made by comparing reports obtained by chart review to those obtained by direct patient interview. Results showed that if chart review alone was used malfunction would have been underestimated by 13 per cent and patient satisfaction overestimated by 21 per cent.

The inflatable penile prosthesis: failure of the rear tip extender in reducing the incidence of cylinder leakage.

Of 184 patients who have received an inflatable penile prosthesis at our institution since 1974, 43 per cent have undergone reoperation, the majority of which were owing to cylinder leakage. Comparison by life-table analysis of cylinders placed before and after introduction of the rear tip extender does not show an improvement in cylinder survival to date.

Pyogenic liver abscess presenting as a "warm" lesion in Ga-67 scintigram. A potential pitfall in interpretation.

In the Ga-67 scintigram, most pyogenic liver abscesses appear to be areas of high radiotracer concentration; rarely photon-deficient lesions may also occur. We present a 58-year-old man with sepsis and hepatic abscess, demonstrated by a Tc-99m BIDA study and a computerized tomogram of the body, showing homogenous radiogallium uptake throughout the liver in the Ga-67 images. To avoid missing such a "warm" lesion, it is emphasized that abdominal Ga-67 scintigrams for localization of a focal inflammatory lesion should be done along with Tc-99m sulfur colloid or Tc-99m BIDA scintigraphy.

Adult polycystic disease of kidneys: a potential cause of false-positive 67Ga images.

A 56-year-old man with adult polycystic disease of the kidneys complicated by renal failure, hypertension, and bacteremia underwent bilateral nephrectomy because the enlarged kidneys compromised his gastrointestinal function and respiratory capacity. A scan using 99mTc-methylene diphosphonate demonstrated nonfunctioning kidneys, bilaterally. An unusual radioactivity pattern in the bowel in 67Ga scintigraphy was due to extreme renal enlargement and should be kept in mind to avoid misinterpretation.

The diagnosis and surgical management of vasculogenic impotence.

Thirty-two patients have been treated for organic impotence at our institution during a 16-month period. Of these patients 5 were found to have penile vascular insufficiency and underwent a femorocavernosal bypass with an autogenous saphenous vein graft. Initial results were excellent but late failures occurred.

Aggressive management of bilateral renal cell carcinoma.

We review 4 cases of bilateral renal cell carcinoma. Treatment included extracorporeal surgery with subsequent autotransplantation in 2 patients and radical nephrectomy combined with contralateral partial nephrectomy in the remaining 2 patients. Absence of recurrence as well as length of patient survival supports this aggressive therapy.

The management of vesicoureteral reflux in the pediatric neurogenic bladder.

An integrated method of management has been used in 29 children with neurogenic bladders and vesicoureteral reflux. Radiological followup reveals that resolution or improvement of reflux occurred in 48 per cent of the renal units managed by close observation only, 48 per cent managed by intermittent catheterization, 75 per cent managed by vesicostomies and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy.

Correlation of antibody-coated bacteria with intravenous pyelogram in children with refluxing and nonrefluxing units.

A fluorescent technique for detecting immune globulins on the surface of urinary bacteria has been used to differentiate upper from lower urinary tract infections. In an attempt to correlate positive fluorescence with deteriorative changes on the intravenous pyelogram, a total of 79 pediatric patients was studied. Twenty-three had ileal conduits with freely refluxing urine.