The use of gallium-67 in pulmonary disorders.

Imaging of the chest cage with gallium-67 (67Ga) citrate is relatively easier to perform and interpret than imaging of the abdomen, because normally pulmonary concentration is low after 48 hr and physiologic accumulation in bones and breast can be recognized by its distribution. Modern scintillation detectors, particularly large field cameras with multiple pulse-height analyzers, give substantially better gallium images than those available in the past. Because of the nonspecific affinity of gallium through neoplastic and inflammatory processes, its value in the differential diagnosis of pulmonary diseases is limited. However, based on the literature and our own observations in over 1100 patients with established diagnosis of a variety of pulmonary diseases, we feel that the judicious use of 67Ga in selected patients is helpful in answering specific questions. These include preoperative evaluation of hilar and mediastinal involvement in pulmonary neoplasms, differential diagnosis of pulmonary infarctions and bacterial pneumonias, evaluation of pulmonary infiltrates regarding infectious etiology, follow-up of sarcoidosis on corticosteroid treatment, assessment of inflammatory activity in interstitial fibrosis and, in selected cases, early detection of neoplastic and inflammatory diseases before radiography becomes abnormal, such as diffuse carcinomatosis and Pneumocystis carinii infection. Potential large-scale application of pulmonary gallium imaging could be found in the screening of subjects exposed occupationally to noxious dust and in long-term serial follow-up of pulmonary tuberculosis patients for treatment response and reactivation. However, it remains to be seen whether gallium imaging statistically provides essential additional information in these indications when compared to cheaper conventional techniques.

Scintigraphic documentation of lymph drainage of cutaneous tumours.

A method of lymphoscintigraphy is described which provides additional diagnostic information, of particular value prior to surgery for the removal of cutaneous tumours. The technique demonstrates the individual physiology of the lymphatic drainage system from a particular region of the skin. However, it is not the aim of the method to diagnose possible lymph node metastases.

Influence of fluid removal rate during hemodialysis on left ventricular performance and exercise tolerance in patients with coronary artery disease.

The effect of hemodialysis (HD) on left ventricular (LV) function and exercise tolerance were measured at rest and during exercise using gated equilibrium radionuclide ventriculography in seven patients with confirmed coronary artery disease (CAD). To separate the effects of fluid removal rate on LV function in CAD, we investigated the same patients with identical overall volume loss of 4 liters during two different treatment times (4 hr and 2 hr). HD significantly increased resting LV ejection fraction (EF) from 55.7 +/- 8% to 64.7 +/- 8% (P less than 0.01) during the 4 hr HD and from 58.1 +/- 9 to 68.1 +/- 10 (P less than 0.05) during the 2 hr HD. Indicating ischemia, EF decreased at pre- and postdialysis peak exercise without differences between both treatments. HD also resulted in an improved segmental wall motion score. Exercise duration as well as S-T segment depression and angina score improved during HD, whereas heart rate, blood pressure and double product remained unchanged. We conclude that HD improves global and regional resting LV function and exercise tolerance in patients with CAD. The degree of interdialytic hydration and not the degree of fluid removal per time affects LV performance in CAD. Since LV function is the major prognostic factor in CAD, those patients require volume restriction and/or shorter interdialytic phases.

[Results of quantitative radionucleid investigations in acute testicular disease (author's transl)]. / Ergebnisse einer quantitativen Radionukliddiagnostik bei akuten Hodenerkrankungen.

All publications dealing with tortion of the testis stress the difficulty of diagnosis and the frequency of errors. This has suggested to us the need to develop a radio-isotope testiculogram corresponding to the radioisotope nephrogram used for renal functional diagnosis. The substance for the timeactivity curve is 99mTc pertechnitate which is taken up by the tubular epithelium of the testis and epididymis. A scan at 20 minutes proved highly diagnostic and produced a small amount of radiation only. Six quantitative parameters described the shape of the curve. These have been determined for the normal and related to age and point of measurement. It is then possible to differentiate partial and total tortion from acute epididymoorchitis. It is no longer necessary to subject every patient with acute testicular disease to surgery. With partial tortion, a conservative operation with fixation of the testis can be recommended instead of semicastration.

[T3- and T4-antibodies in serum: screening and specific determination methods]. / Uber T3- und T4-Antikörper im Serum, ihre orientierende und spezifische Bestimmung.

Endogenous antibodies against T3 or T4 may falsify the radioimmunological determination of T3 and T4. Depending on the method of separation increased or decreased values will result. The clinical aspects are at variance with these radioimmunologically measured values. The TSH value is frequently elevated and the TRH test mostly positive. The determination of unspecific binding capacity allows the selection of suspect sera. In cases of increased binding capacity the diagnosis will be established by a precipitation reaction with human-anti-Ig-G and quantified with radio-T3 or radio-T4.

[User-oriented programs for semi-automated evaluation of radio in vitro tests]. / Anwendungsorientierte Programme zur halbautomatischen Auswertung von Radio-in-vitro Tests

Most of the programmes for the evaluation of radio in vitro tests proceed from the anticipation that the best method should give an approximation of standard values by a curve as perfect as possible. According to our experiences this demand, however, is not decisive for a good standard curve, as in principle all standard values can be incorrect. The application of relatively simple linearising transformations and an additional curve (recovery of a normal serum) guarantees the necessary precision in the programme described. After a short description of the contents of the system, the programme for the assessment of CPBA - methods is shown, by help of which the sample changer - calculator-system determines the absolute concentration of the substance to be measured. This makes the starting point for the more complex RIA programme which methodologically takes into consideration the special problems of these tests.

[Free thyroid hormones in pregnancy]. / Freie Schilddrüsenhormone in der Schwangerschaft.

The following parameters were measured in 95 euthyroid subjects and in 55 healthy pregnant women: TT4, TT3, rT3, RT3-Uptake, TSH, FT4 and FT3. In addition, FT4-index, TT4/TBG, FT3-index, TT3/TBG and the balance of free hormone indices were calculated. The results of FT4 and FT3 measurement indicated an euthyroid status in late pregnancy. Though the FT4 and FT3 levels were significantly lower than those of the euthyroid subjects, they did not fall outside the normal range.

[Intravenous or oral 131I treatment of hyperthyroidism and thyroid cancer?]. / Intravenöse oder orale 131J-Behandlung von Hyperthyreosen und Schilddrüsenkarzinomen?

The purpose of this study was to determine differences in 131I biokinetics after oral or intravenous treatment of hyperthyroidism (0.81 GBq) or differentiated thyroid cancer (1.85 GBq) following thyroidectomy. 20 patients with differentiated carcinoma and 20 patients with hyperthyroidism were studied. In each group 10 patients were treated perorally and 10 patients intravenously. The integrated whole-body activities during therapy were significantly lower, by an average 23% (cancer) and 45% (hyperthyroidism) than after oral application. It is most likely that these differences between oral and intravenous application are due to the higher serum activity after intravenous therapy. It is concluded that a higher activity dose of 131I must be given orally to achieve the same target dose as after intravenous application.

[75-Se-labeled bile acid analog absorption in various gastrointestinal diseases using a whole body counter]. / Untersuchungen zur Resorption von 75Se-markiertem Gallensäureanalog bei verschiedenen gastrointestinalen Erkrankungen mit dem Ganzkörperzähler.

AIM: It is possible to detect disturbances of bile acid absorption using a whole body counter after administration of Se-75 labelled bile acid analogues. We scrutinized the benefit of a modification of the test method. METHODS: We investigated 77 patients with different forms of a gastrointestinal disease. After application of Se 75 homotaurocholic acid we measured patient-activity up to 7 days later including whole-body profile scans in the first 6 h. RESULTS: The fractional retention after 7 days was between 20 and 67%. In cases of impaired absorption it was below 12%. Patients with liver diseases and after cholecystectomy (without bile acid resorption disturbance) showed normal values. Patients with Crohn's disease of the ileum or with intestinal ileac by-pass or with colestyramine treatment or with disturbance of vitamin B12-absorption or with cystic fibrosis showed a disturbance of bile acid absorption. The normal whole-body half-life was more than 2.8 days. The 24 and 72 h values were 62 and 31% in cases with normal absorption. Smaller values are signs of bile acid malabsorption. Impulse rates measured with the whole body counter are of an order of magnitude that allows to reduce the usually administered dose of 37 kBq to 9.25 kBq. CONCLUSION: This is an efficient method to detect disturbances of bile acid absorption. The usually administered activity of 37 kBq can be reduced to 9.25 kBq.

Short-term and long-term monitoring of the serum level of TPA after radical resection of gastrointestinal or lung cancer.

Radically operated tumour patients (gastrointestinal cancer, n = 10; lung cancer, n = 10) were subjected to continuous prospective monitoring of the serum level of tissue polypeptide antigen (TPA) prior to surgical treatment as well as during the subsequent year. The following observations were made: Immediately after radical surgery the serum level of TPA fell temporarily. During the first 2 weeks following this initial decrease, the serum level of TPA rose. In view of the radical surgical treatment the patients had undergone, this finding is interpreted as being not caused directly by the tumour but by tissue repair or proliferation. It is concluded that the first postoperative control of the serum concentration of TPA should be performed not earlier than 4 weeks after tumour resection. If the level of TPA increased after these 4 weeks, the suspicion of a tumour relapse or metastasization was raised. In single cases, a transient rise of serum TPA may not be due directly to the tumour but to other events, e.g. intercurrent infection. In general, the course of the serum level of TPA did not exhibit a marked difference between patients with gastrointestinal and lung cancer.

[Follow-up of patients with differentiated thyroid cancer: determination of serum thyroglobulin in place of routine 131I scintigraphy?]. / Nachsorge bei differenziertem Schilddrüsenkarzinom: Serumthyreoglobulinbestimmung statt routinemässigem 131Jod-Szintigramm?

A comparison was conducted in patients with differentiated thyroid carcinoma still under 131I therapy (n = 18) between 2 mCi-131I scans, posttherapeutic scans and radioimmunologically measurable serum thyroglobulin (TG). All 3 parameters were positive in only 9 cases; among the other 9 patients TG appeared to be the better indicator (ratio 5:1) of residual tumour tissue than the 2 mCi-131I scan. In a second group of patients who had completed 131I therapy the 2 mCi scan and TG were compared (n = 21). Both indices were negative in 15 cases, whereas TG was positive in 6 patients in spite of a negative scan. TG generally remained within the clearly positive range also during T4 therapy. TG was highest in metastatic disease and practically uninfluenced by T4, i.e. by the endogenous TSH level. TG antibodies were found in 15% of cases, generally with low titres only; this did not interfere with TG determination as tumour marker. In summary, TG measurement appears to be superior to 2 mCi-131I scans for follow-up of cases with differentiated thyroid carcinoma.

[The tumor markers CEA, TPA and CA 19-9 and ferritin and osteocalcin in follow-up studies in breast cancer]. / Die Tumormarker CEA, TPA und CA 19-9 sowie Ferritin und Osteocalcin in der Verlaufskontrolle bei Mammakarzinom.

Radioimmunological determinations of the tumour markers CEA, TPA, CA 19-9, ferritin and also osteocalcin were carried out in 250 patients with ablatio mammae for breast cancer over a follow-up period of at least 1 year. Metastases were detected in 49 of the 250 patients. The normal control group comprised 193 healthy persons. CEA proved to be the most valuable tumour marker, but TPA and ferritin were also significantly elevated in metastatic breast cancer. Combined determination of all 3 parameters gave the best results. Additional measurement of CA 19-9 was helpful in only one of the 49 patients with metastases in whom the 3 other parameter were negative throughout. Hence, determination of CA 19-9 appears unnecessary in breast cancer. In progressive disease the markers generally increased and fell again following successful therapy. In a few cases the opposite was found or no changes were observed. Cases with small local recurrence or an additional carcinoma at an early stage did not exhibit increased marker values as compared to patients without metastases. Not infrequently the increase in markers preceded the manifestation of metastases by several months. Very high concentrations of tumour markers signify a poor prognosis. Osteocalcin was elevated in patients with bone metastases, but not soft tissue metastases. In general, however, it paralleled the serum alkaline phosphatase level.