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Background: Clinico-pathological studies have shown that only three out of four patients with parkinsonism have idiopathic Parkinson's disease. In patients with so-called Parkinson plus syndrome, the degeneration in the brain is more widespread and the variety of neurological signs greater than in Parkinson's disease. The differentiation of these syndromes from Parkinson's disease can be difficult. Single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) can be of value in the differential diagnosis of parkinsonism., Material and Methods: We present three patients with atypical parkinsonism in whom MRI and SPECT with beta-CIT and epidepride was performed in addition to the clinical evaluation., Results: The three patients all had a rapidly developing symmetric akinetic-rigid syndrome that responded poorly to levodopa. MRI showed findings regarded as typical for multiple system atrophy in two patients, but only nonspecific findings in the third patient. SPECT with beta-CIT showed a pronounced bilateral and relatively symmetric reduction in the striatal dopaminergic activity in all patients. SPECT with epidepride showed a clearly reduced striatal D2-receptor binding bilaterally in only one of the patients., Interpretation: In patients with atypical parkinsonism, MRI and SPECT with beta-CIT and epidepride can give valuable support to the clinical diagnosis of a Parkinson plus syndrome.

Ectopic parathyroid adenomas and hyperplastic glands are difficult to locate during surgical exploration. Failure to find and remove them is the most usual cause of surgical failure in the treatment of hyperparathyroidism. Earlier methods of preoperative localization of pathological parathyroid tissue had low sensitivity and were not generally recommended. Recent advances in parathyroid scintigraphy have improved this technique; the sensitivity is now as high as 95% for parathyroid adenomas. In the present study, ectopic parathyroid adenomas and hyperplasia were correctly localized by scintigraphy and were verified surgically in seven patients. Six of the patients had previously undergone ten unsuccessful operations altogether. Preoperative parathyroid scintigraphy might have saved these failed surgical explorations. In a pregnant woman, a mediastinal parathyroid adenoma was correctly localized by preoperative parathyroid scintigraphy. This patient was successfully operated by a sternotomy, and she was the only one of five patients with a mediastinal parathyroid adenoma who escaped unnecessary neck exploration. Preoperative parathyroid scintigraphy may reduce the number of surgical failures in hyperparathyroidism and shorten the operation time by less extensive exploration and thus fewer complications.

In 1896 Henri Becquerel discovered that uranium emitted penetrating rays similar to X-rays. His finding started a series of discoveries that were rewarded with numerous Nobel prizes. Marie and Pierre Curie found that thorium was radioactive too, and discovered and described two new elements, polonium and radium. They also found that radioactive radiation could be separated into alpha, beta and gamma rays. In 1993 their daughter Irene Joliot-Curie and her husband Frederic Joliot managed to produce radioactivity artificially by bombarding atomic nuclei with alpha particles. Enrico Fermi did likewise, but bombarded the nuclei with neutrons. In the cyclotron invented by Ernest Lawrence, radioactive isotopes were produced by proton bombardment. The ability to produce radioisotopes of different elements initiated a variety of tracer studies in biology and medicine. The number of studies increased exponentially when the nuclear reactor in Oak Ridge, US, was opened for radionuclide production in 1946. This article summarises the history of the application of radionuclides in science and medicine internationally and in Norway until now.

Quantification of left to right shunt was carried out in 15 adult patients, mean age 49 years, with a suspected ostium secundum atrial septal defect (ASD II). Radionuclide shunt quantitation correlated well with the results of right heart catheterization (r = 0.85). The radionuclide technique failed in two patients for technical reasons, but revealed no false negative or false positive results when technically satisfactory. The diagnosis was confirmed at operation. It is concluded that the radionuclide technique is a useful and reliable method which can also be used at follow-up after surgery in patients with atrial septal defects of secundum type.

201-Thallium scintigraphy and radionuclide ventriculography with 99m-Technetium are the two most important nuclear imaging techniques in clinical cardiology. The sensitivity and specificity of tomographic Thallium scintigraphy for detection of coronary heart disease is about 90%. Radionuclide ventriculography may be used to describe systolic and diastolic function of the left and right ventricles with results comparable to those of angiographic studies. Both methods are non-invasive and feasible during exercise. These methods provide important information on myocardial ischaemia and cardiac function which may be difficult to obtain by other methods. In county hospitals with no equipment for invasive studies these methods provide important diagnostic and prognostic information. In the university hospitals, however, the techniques are of a more supportive nature and may help the clinician to select appropriate treatment.

This article discusses the reliability of laboratory-based diagnosis of hypothyroidism by means of combined determination of TSH and FT4. Differential diagnoses and supplementary tests are listed, and administrative and analytical errors reviewed. It is concluded that unexpected results should not be accepted without undertaking control analyses and supplementary examinations. Partial selective peripheral resistance to thyroid hormones (persons who have normal TSH and FT4 but need thyroxine therapy) is a very uncommon condition. Patients suspected of this disorder should be referred to their respective regional hospitals, and the results of the study should be published in international journals.