Reticuloendothelial system blockade promotes progression from mild to severe acute pancreatitis in the opossum.

OBJECTIVE: To examine the relation between hepatic reticuloendothelial system (RES) dysfunction and the development of acute biliary pancreatitis. In an opossum model, the authors tested the hypothesis that RES blockade can turn the mild pancreatitis seen after pancreatic duct obstruction (PDO) into the severe form. SUMMARY BACKGROUND DATA: Biliary obstruction is considered the decisive event in gallstone pancreatitis. Suppression of the RES occurs during biliary obstruction. METHODS: Eighteen opossums were placed into three groups of six animals each: group A, RES blockade with lambda-carrageenan; group B, PDO; and group C, PDO and RES blockade with carrageenan. The severity of pancreatitis was evaluated by enzyme serum levels and percentage of pancreatic tissue necrosis. RES capacity was measured by dynamic liver scintigraphy, and hepatic blood flow was documented using the hydrogen clearance technique. RESULTS: No changes in hepatic blood flow occurred in groups A to C. RES capacity was suppressed in groups A and C; in group B, RES function remained unchanged. In group A, amylase and lipase levels remained normal, 3 +/- 1.9% of pancreatic tissue were necrotic. The animals in group B developed mild edematous pancreatitis with an increase in amylase and lipase levels and 15 +/- 10% of pancreatic necrosis. In group C, amylase and lipase increased significantly and histology revealed severe necrotizing pancreatitis, with 72 +/- 11% of necrotic areas. CONCLUSIONS: Artificial RES blockade can promote the progression from mild pancreatitis as observed after PDO to the severe necrotizing form of the disease. Thus, RES dysfunction resulting from biliary obstruction might be an important cofactor in the pathogenesis of bile-induced pancreatitis.

Hypoxia decreases exhaled nitric oxide in mountaineers susceptible to high-altitude pulmonary edema.

An exaggerated hypoxic pulmonary vasoconstriction is essential for development of high-altitude pulmonary edema (HAPE). We hypothesized that susceptibility to HAPE may be related to decreased production of nitric oxide (NO), an endogenous modulator of pulmonary vascular resistance, and that a decrease in exhaled NO could be detected during hypoxic exposure. Therefore, we investigated respiratory tract NO excretion by chemiluminescence and pulmonary artery systolic pressure (Ppa,s) by echocardiography in nine HAPE-susceptible mountaineers and nine HAPE-resistant control subjects during normoxia and acute hypoxia (fraction of inspired oxygen [FI(O2)] = 0.12). The subjects performed oral breathing. Nasally excreted NO was separated from respiratory gas by suction via a nasal mask. In HAPE-susceptible subjects, NO excretion in expired gas significantly decreased (p < 0.05) during hypoxia of 2 h in comparison with normoxia (28 +/- 4 versus 21 +/- 2 nl/min, mean +/- SEM). In contrast, the NO excretion rate of control subjects remained unchanged (31 +/- 6 versus 33 +/- 6 nl/ min, NS). Nasal NO excretion did not differ significantly between groups during normoxia (HAPE-susceptible group, 183 +/- 16 nl/ min; control subjects, 297 +/- 55 nl/min, NS) and was not influenced by hypoxia. The changes in Ppa,s with hypoxia correlated with the percent changes in lower respiratory tract NO excretion (R = -0.49, p = 0.04). Our data provide the first evidence of decreased pulmonary NO production in HAPE-susceptible subjects during acute hypoxia that may contribute among other factors to their enhanced hypoxic pulmonary vascular response.

[Mucoepidermoid carcinoma of the submandibular gland after high-dose radioiodine therapy: case report and review of the literature]. / Mukoepidermoid-Karzinom der Glandula Submandibularis nach hochdosierter Radioiodtherapie: Fallpräsentation und Literaturübersicht.

Case report of a 42 year old female, who received 14th-20th year of life six radioiodine therapies with altogether 19.2 GBq131I because of a papillary thyroid carcinoma. 17 years after the last therapy, she developed a histologically proven chronic radiogenic sialadenitis of the left submandibular gland. Further four years later, the right submandibular gland has been extirpated because of a mucoepidermoid carcinoma with infiltration of a regionary lymphatic node. Review of the previous published secondary-malignancies of the salivary glands after high-dose radioiodine therapies.

[Impact of pretreatment variables on the outcome of standardized 131I therapy with 150 Gray in Graves' disease]. / Einfluss prätherapeutischer Variablen auf die Wirkung einer standardisierten 131J-Therapie mit 150 Gray beim Morbus Basedow.

AIM: We examined the impact of several pretreatment variables on thyroid size and function in 61 patients with Graves' disease one year after a standardized [131]I treatment with 150 Gray. METHODS: FT3, FT4, and TSH serum concentrations were determined before and 1.5, 3, 6, and 12 months after therapy. Thyroid size was measured by ultrasound and scintigraphy before and one year after therapy. RESULTS: One year after therapy, 30% of the patients had latent or manifest hyperthyroidism, 24% were euthyroid, and 46% had developed latent or manifest hypothyroidism. Age and initial thyroid volume were major predictors of post-therapeutical thyroid function. Thus, persistent hyperthyroidism was observed in 70% of the patients age 50 years and older with a thyroid size of more than 50 ml. With few exception, thyroid size markedly decreased after therapy. Initial thyroid size and age were also major predictors of posttherapeutical thyroid volume. Thyroid size normalized in all patients younger than 50 years of age, independent from initial thyroid size. CONCLUSION: Radioiodine treatment with 150 Gray causes a considerable decrease in thyroid size in most patients with Graves' disease. Age and initial thyroid volume are important determinants of thyroid function and size after therapy and should be considered in dose calculation.

[99m-Tc-MIBI for recurrent and metastatic differentiated thyroid carcinoma]. / 99mTc-MIBI zur Rezidiv- und Metastasensuche bei differenzierten Schilddrüsenkarzinomen.

AIM: The aim of the study has been the examination of the diagnostic value of 99mTc-MIBI scintigraphy for the detection of local tumor or metastases following total thyroidectomy and 131I ablation therapy in differentiated thyroid carcinoma. METHODS: MIBI-scintigraphy has been indicated in 85 patients because of ascending thyroglobulin values or suspected local recurrencies by ultrasonography. The results have been compared to cytology or histology or ultrasonography, computed tomography, X-ray and radioiodine scanning. RESULTS: MIBI scintigraphy was found positive in 32 of 40 metastases. Only 18 metastases have been seen by radioiodine. MIBI scintigraphy was most effective in detecting local tumor recurrencies and lymph node metastases (94%). The specificity of MIBI and radioiodine was similar (100%). In inflammatory enlarged lymph nodes no MIBI uptake was found, so it is possible to differentiate reactive lymph node enlargement from metastatic disease. CONCLUSION: In conclusion scintigraphy with 99mTc-MIBI is advisable in suspected local recurrencies and negative radioiodine scan. It is favourable that withdrawing TSH-suppressive hormone medication is not necessary.

[Osteomyelitis during the growth period. Diagnostic imaging]. / Osteomyelitis im Wachstumsalter. Bildgebende Diagnostik.

In acute osteomyelitis of childhood a rapid diagnosis and initiation of antibiotic therapy is necessary in order to prevent late sequelae. Thus, diagnostic imaging plays a crucial role. If acute osteomyelitis is suspected in a child, imaging starts with conventional radiography in order to exclude other differential diagnoses. This is followed by sonography for the purpose of diagnosing a subperiosteal abscess or joint fluid from which the causative organism could be isolated. If the diagnosis is unclear, the next step should be either MRI or 99mTc-MDP bone scan, depending on the possibility of clinical localization and the site of the suspected lesion. MRI is superior to bone scan in depicting the exact anatomy, which is extremely important in spinal osteomyelitis and preoperatively. The bone scan can show the whole skeleton in one examination and should be favored if there is no definite localization or in suspected multifocal osteomyelitis. Rarely scintigraphy with labeled white blood cells is indicated. The 67Ga scan, however, should not be used in children because of the high level of radiation exposure. The different imaging modalities are described in detail and an imaging diagnostic workup is outlined.

Imaging in osteomyelitis in the growing skeleton.

In acute osteomyelitis of childhood a rapid diagnosis and initiation of antibiotic therapy is necessary in order to prevent late sequelae. Thus, diagnostic imaging plays a crucial role. If acute osteomyelitis is suspected in a child, imaging starts with conventional radiography in order to exclude other differential diagnoses. This is followed by sonography for the purpose of diagnosing a subperiosteal abscess or joint fluid from which the causative organism could be isolated. If the diagnosis is unclear, the next step should be either MRI or 99m Tc-MDP bone scan, depending on the possibility of clinical localization and the site of the suspected lesion. MRI is superior to bone scan in depicting the exact anatomy, which is extremely important in spinal osteomyelitis and preoperatively. The bone scan can show the whole skeleton in one examination and should be favored if there is no definite localization or in suspected multifocal osteomyelitis. Rarely scintigraphy with labeled white blood cells is indicated. The 67 Ga scan, however, should not be used in children because of the high level of radiation exposure. The different imaging modalities are described in detail and an imaging diagnostic workup is outlined.

[Semiquantitative 99mTc-HMPAO SPECT in dementia of the Alzheimer type: influence of the selection of reconstruction filter and reference region]. / Semiquantitative 99mTc-HMPAO-SPECT bei Demenz vom Alzheimer-Typ: Auswirkungen der Wahl von Rekonstruktions-filter und Referenzregion.

AIM: The aim of the study was to clarify, whether the selection of the reference-region and/or the reconstruction-filter influences the result of the semiquantitative analysis of a 99mTc-HMPAO-SPECT that was conducted to diagnose the dementia of the Alzheimer type (DAT). METHODS: A group of 19 DAT-patients according to the criteria of NINCDS-ADRDA and DSM-III-R was examined together with a comparison group (n = 14) with normal cerebral perfusion. Three reference-regions (cerebellum, whole slice, occipital cortex) and four reconstruction-filters (Hanning fc = 0.7 and 1.0 Nyquist; Butterworth (n = 8); fc = 0.5 and 0.9 Nyquist) were applied to twelve standardized regions of interest (per patient) respectively. The data was evaluated through a ROC-analysis. RESULTS: It has been showed, that the bilateral parieto-temporal perfusion reduction as a characteristic of DAT depends on the filters and reference-regions used. The most secure separation of both groups of patients was obtained through a Butterworth-filter (n = 8; fc = 0.5) in combination with the cerebellum as reference-region. CONCLUSION: The selection of the reference-region and the reconstruction-filter has an important influence on the results of a semiquantitative analysis. Therefore standardisation in dependency on the actual questioning is necessary.

[Methodical evaluation of immunoluminometric determination of thyroid peroxidase in serum]. / Methodische Untersuchung zur immunoluminometrischen Bestimmung von Thyreoperoxidase im Serum.

With the identification of thyroid peroxidase (TPO) as the specific autoantigen in autoimmune diseases of the thyroid, the development of a commercial assay for detection of TPO in human serum became possible. The diagnostic value of this TPO assay was evaluated in 194 patients with various thyroidal diseases. The assay appeared to be easily affected by specific and/or unspecific interferences such as TPO-auto-antibodies in the patient's blood samples. To analyze these effectors every sample was checked in a parallel recovery test. In most of the cases with elevated anti-TPO levels an exact determination of TPO could not be estimated correctly. Whenever a correct measurement of TPO was possible, to none of the different examined groups of thyroid diseases a correlation of TPO-levels could be demonstrated. Moreover, the value of TPO determination as a tool in the follow-up of differentiated thyroid carcinoma was not provable. For the time being our studies do not suggest TPO measurements being helpful in thyroidal diagnosis.

Bifunctional NHS-BAT ester for antibody conjugation and stable technetium-99m labeling: conjugation chemistry, immunoreactivity and kit formulation.

UNLABELLED: Conjugation chemistry and kit formulated binding of the NHS ester of 6-(4'-(4"-carboxyphenoxy)butyl)-2, 10-dimercapto-2,10-dimethyl-4,8-diazaundecane (NHS-BAT ester) to monoclonal antibodies (MAbs) was investigated. The functionalities of the resulting BAT conjugated and 99mTc-labeled MAbs BW 431/26, MAb 425 and bispecific MDX210 (fragment construct) were tested by immunoreactivity and immunoscintigraphy. METHODS: The kinetics and chemistry of the conjugation reaction were monitored by high-performance liquid chromatography, size-exclusion chromatography and positive fast-atom-bombardment mass spectra (FAB-MS). The 99mTc BAT-MAbs were tested with various immunoreactivity assays. The biodistribution of 99mTc-BAT-BW 431/26 in rats was compared with directly labeled BW 431/26. RESULTS: At pH 8.5 and 25 degrees C, the reactivity of the NHS-BAT ester was high with 90% completion after 30 min. The conjugation yield of 19 microM MAb and 228 microM NHS-BAT ester amounted to 30%. Higher NHS-BAT ester concentrations afforded higher BAT-to-MAb ratios. According to FAB-MS, the conjugation competing hydrolysis surprisingly occurred at the NHS ring. Almost quantitative 99mTc labeling was achieved after 5 min at 25 degrees C. Immunoreactivity of the 99mTc-BAT antibodies showed > 90% recovery and proved to be insensitive to BAT-to-MAb ratios of up to 10. The 99mTc-BAT-BW 431/26 showed similar organ distribution but revealed less urinary excretion compared with the directly labeled BW 431/26. Immunoscintigraphy with 99mTc-labeled and BAT-BW 431/26 and BAT-MAb 425 showed the respective biological function in vivo. CONCLUSION: According to straightforward conjugation chemistry, the ease of 99mTc labeling and the application of a simple ultrafiltration technique, the NHS-BAT ester represents a nondestructive, universally applicable biofunctional ligand to introduce stable 99mTc protein binding sites. Kit formulated conjugation/labeling can be performed with little time requirements and laboratory experience.

Dynamic liver scintigraphy: a new way of measuring the function of the reticuloendothelial system of the liver.

The phagocytic function and biokinetics of the hepatic reticuloendothelial system (RES) were evaluated using a 25-nm diameter colloid (Nanocoll) and a scintillation camera technique in opossums with obstruction of the pancreatic duct (group I) and additional obstruction of the common bile duct (group II). The liver net uptake curve was analysed using natural log regression. The regression curves proved to fit very well (r > 0.93) and a parameter R was calculated to describe the curves. In group I there was a slight but significant decrease in the RES function and no morphological change in the pancreas. In group II, RES function was significantly more suppressed than in group I. The opossums developed severe haemorrhagic pancreatitis. The results show that the regression parameter R is well suited to described liver RES function, and suggest that a suppressed liver RES after biliary obstruction could be an important factor in the pathogenesis of biliary pancreatitis.

[The reticuloendothelial system. An overview of function, pathology and recent methods of measurement]. / Das retikuloendotheliale System. Eine Ubersicht über Funktion, Pathologie und neuere Messmethoden.

The Reticuloendothelial System (RES) consists of cells descending from the monocytes which are able to perform phagocytosis of foreign materials and particles. 90% of the RES are located in the liver. The most important function of the RES ist phagocytosis, but it also takes part in cytotoxicity against tumor cells and has a function in the regulation of the immune system. The importance of the RES is obvious in diseases of the bile ducts. An obstruction can lead to a decrease in the function of the RES. Beside a mathematical model there are also a few experimental methods to measure the phagocytic capacity and thus the efficiency of the RES. They are based on a clearance study of the amount of particles absorbed by the RES. This study can e.g. be done with Nanocoll which has been marked with 99mTc. But instead of the bloody clearance, a scintigraphic study using a gamma camera can be performed. With that, the increase time, the liver extraction fraction and the steepness of increase can be determined. Such a test could be of clinical relevance as a parameter for the prognosis of patients with trauma, sepsis or shock. The function of the RES in the pathogenesis of the biliary pancreatitis could also be examined closer with the help of such a test. The requirements a test of the RES should meet are reproducibility, repeatability and practicability.

Fenoterol depot and fenoterol in premature uterine contractions--a multicentric double-blind comparative study.

In a double-blind randomized study, the effect of a single dose of a fenoterol preparation with delayed release of active substance (designated as fenoterol depot) was compared with a fenoterol product with undelayed release of active substance (designated as fenoterol) in two groups respectively comprising 66 and 65 female patients with premature uterine contractions. The fenoterol depot was administered p.o. in a single total dose of 21 mg at the beginning of an investigation period of 360 minutes and the fenoterol was administered p.o. within 235 minutes in three identical consecutive doses resulting in a total dose of 22.5 mg. The increased uterine activity present at the beginning was markedly lowered by an initial intravenous infusion of Partusisten. After administration of the two oral preparations, the uterine contractions remained at the low level achieved. The fenoterol depot was slightly superior to fenoterol with regard to the reduction of the duration of contractions: the difference in the inhibition of the duration of the contraction between the two preparations was a maximum of 25.7% in favor of fenoterol depot. The frequency of uterine contraction was substantially reduced by both preparations, but to a greater extent by the depot form. The tocolytic efficacy and the tolerance were rated as "good" in 70% and 75% respectively with fenoterol depot and in 69% and in 71% respectively in the case of fenoterol. The maternal pulse rate remained at the level reached at the end of Partusisten infusion with the two preparation, and the blood pressure fluctuated slightly within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

[Observations on the temporal sequence of reported pregnancy risks]. / Beobachtungen zur zeitlichen Aufeinanderfolge befundeter Schwangerschaftsrisiken.

A prospective study was conducted with 383 pregnant women concerning the occurrence in respect of time, the duration, and the mutual interactions of pregnancy risks. 35 per cent of the women with hemorrhages during early pregnancy later had premature labour pain (p less than 0.01). The relative risk of premature labour is greater by the factor 2.2 in pregnant women with hemorrhages during early pregnancy than in women without haemorrhages. There was no difference between the investigated groups in respect of onset and duration of these two risk factors. 54 per cent of the pregnant women in whom circular sature of the cervix according to Shirodkar had been performed, also had premature labour pain (p less than 0.001). After the performance of the Shirodkar suture, premature labour followed in 40% of the pregnant women during the further course of pregnancy, corresponding to a relative risk of 2.3 compared with the group without Shirodkar. Premature labour with subsequent Shirodkar cerclage occurred earlier (21st week) and lasted for a longer time (13 weeks) than with the reverse sequence or if premature labour occurred alone. If cervical insufficiency occurred first, followed by premature labour, the time of birth was definitely much earlier (36 weeks) than with the controls. There was no evident connection between the risks "infections of urinary tract" and "premature labour". On the other hand, 32 per cent of the pregnant women with urinary tract infections suffered an EPH gestosis, corresponding to a relative risk of 2 (p less than 0.001). The results show that clear and specific pointers towards the possible occurrence of other risks can be derived from the presence of certain pregnancy risks based on specific findings.

[Prognostic significance of risk factors in pregnancy. I. Observations of onset and duration of observed pregnancy risks]. / Die prognostische Bedeutung von Risikofaktoren während der Schwangerschaft. I. Beobachtungen zu Beginn und Dauer befundeter Schwangerschaftsrisiken.

In a prospective study 383 from 712 women attending our antenatal clinic were found on examination to have pregnancy risks. These were followed with regard to the time of first occurrence, duration and time of last occurrence, as well as their relation to other risk factors occurring in both history, examination or during labour. The method of delivery, necessity for postpartal intensive pediatric care and the perinatal mortality were considered. Risks included antepartal haemorrhage in the first trimester (median time of onset 11 weeks); in the second trimester: hypotension (20 weeks), cervical incompetence (21 weeks), anaemia (25,5 weeks), premature labour (29 weeks) and uterus size inappropriate to gestational age (34,5 weeks) in the third trimester. Antepartal haemorrhage tends to be episodic (median duration of bleeding one week). The average duration for a cerclage was 16 weeks. The other risk factors were observed to last between 3 and 8 weeks. The onset and duration of risk factors found on examination considered alone do not present a sufficient criterion to enable their gravidity to be judged.

[Prognostic significance of risk factors in pregnancy. II. Risk status at onset of labor]. / Die prognostische Bedeutung von Risikofaktoren während der Schwangerschaft. II. Der Risikostatus am Beginn der Geburt.

A group of 383 women with pregnancy risks were screened at the onset of labour. 70% of the EPH-Gestosis, 56% of the urinary tract infections and cervical incompetence, 48% of the anaemias, 38,6% of the premature labour, 11% of the hypotension and 4% of the antepartal haemorrhages were found still to be present at the onset of labour. In those women with EPH-Gestosis at the onset of labour, the risk of cesarean section was markedly higher. When the risks premature contractions and cervical incompetence were recorded, the resulting birth weights were lower and the necessity for intensive paediatric care higher than normal. EPH-Gestosis and urinary tract infections which were still present at the onset of labour were of a longer duration. If the risks premature contractions and cervical incompetence were present at the onset of labour one could imply a shorter period of gestation.

[Partial hydatidiform mole with significantly increased serum HCG levels in the triploidy syndrome]. / Die partielle Blasenmole mit stark erhöhten Serum-HCG-Spiegeln beim Triploidie-Syndrom.

The authors report on a triploid pregnancy with foetal malformations and a sonographically diagnosed partial hydatit mole. The course of this pregnancy was characterised by pre-eclampsia. The fact that in this case, for example, HCG serum levels were very high and persisted post abortum, similar to the concentrations seen in complete hydatit mole, underlines the difficulties in assessing and diagnosing a partial hydatit mole.

Chylothorax in a twin pregnancy of 34 weeks--sonographically diagnosed.

In a twin pregnancy of 34 gestational weeks sonographic follow-up revealed a rapidly spreading hydrothorax in one twin and slight ascites in the other. Analysis of aspirated fluid by intrauterine needle puncture suggested a chylothorax. Pathogenesis of chylothorax is discussed. Differential diagnosis of hydrothorax is presented. Intrauterine puncture is the only method of achieving prenatal diagnosis and therapy.

[Premature birth rate, incidence of cesarean section and perinatal mortality between 1945 and 1980. An analysis of 55,000 births]. / Frühgeburtenrate, Sektiofrequenz und perinatale Mortalität zwischen 1945-1980. Eine Analyse von 55000 Geburten.

56,686 single births between 1945 and 1980 were evaluated in a retrospective study. The results reflect the change which has taken place in obstetrics. Perinatal mortality dropped in a straight line from 48.50/00 to 17.20/00. At the same time, the frequency of Caesarian section increased in non-linear progression from an initial value of 1.9% (1945-1949) to 14.0% (1975-1980). The rate of early births dropped in the first ten years only from 10.6% to 7.3%, followed by an approximately constant value up to 1969. From 1970 onwards, there is a rising tendency (6.7% to 7.7%) which was found in all weight categories. The share of early births in perinatal mortality dropped during the first years only, from 77% to 63%, and has since remained constant. If we compare the periods 1945 to 1959 and 1970 to 1980 with regard to indications for Caesarian section, assuming a birth weight of more than 2500 g, the indication of cessation of labour would rise from the 4th rank to the 1st position, whereas disproportion and asphyxia of the newborn continue to occupy the 2nd and 4th ranks, respectively, despite a relative increase. Meanwhile, the indication "condition after Caesarian section" now occupies the 3rd rank. In newborn weighing less than 2500 g, the prominent indications are early birth, asphyxia, desire to have a child and breech presentation, whereas emergency indications were previously the most important ones.(ABSTRACT TRUNCATED AT 250 WORDS)

[Unexpected risks during labour and delivery following a low risk pregnancy (author's transl)]. / Unvorhergesehene Geburtsrisiken nach risikofreier Schwangerschaft.

Of the maternity patient of the Munich perinatal study from 1975-1977 54.4% were considered to be low risk at the end of the pregnancy. Of these every third patient (17%) developed at least one risk during labour and delivery. These were considered to be consequence risks if they and been present at the onset of labour and delivery or progress risks if they developed during labour and delivery. The progress risks were defined as unpredictable and occurred in 4.7% of the total study. In this group the incidence of spontaneous delivery was only 36.0% compared with 88.5% in the compare group. The perinatal mortality of 6.9% was three times higher than for women who remained low risk during labour and delivery. The commonest unpredictable risks are anomalies of presentation. Acidosis and pyrexia during labour and delivery and emergency risks occur most often in women who start labour and delivery with existing risks. For these so-called progress risks with a high incidence of operative deliveries an operating room must be available at all times in the interest of mother and fetus. The monitoring of the fetus must also be available. Even following a low risk pregnancy monitoring and operation may become necessary.