Tumor calcinosis imaged by bone scanning: case report.

The typical symmetric lesions in a patient with tumor calcinosis avidly accumulated bone-seeking compounds. Thus, bone scanning is very helpful in the diagnosis of this rare disease, especially if the calcareous masses are not situated periarticularly.

Liver blood flow and blood volume following chronic phenobarbitone administration.

Mlae rats were ra&ndomly divided into 2 groups one of which received 30 mg/kh phenobarbitone for 4 days i.p. and the other sodium chloride. Liver blood flow was measured 24 hr following the last injection of phenobarbitone or sodium chloride using the radioactive colloidal gold clearance technique. In addition, blood volume, liver weight and extraction of radioactive gold were estimated. Following 4 daily infections of phenobarbitone the body weight and the blood volume of both groups were not significantly different. The liver weight in the phenobarbitone treated groups was 27% higher than that found in the control group. Liver blood flow increased from 22.7 ml/min (92,8 ml/min/kg body weight) to 30.1 ml/min (123.7 ml/min/kg body weight). This increase of 33% was highly significant (p less than 0.005). In contrast, the extraction of radioactive gold was 11% lower in the phenobarbitone treated groups than in the controls. The earlier, semiquanititative finding of increased blood flow using a chronic implanted thermocouple could thus be quantified by the present study.

[Determination of three body compartments in the chest by scintigraphy]. / Die szintigraphische Messung dreier Körperkompartimente im Thoraxbereich.

We adapted a previously described method for the measurement of transthoracic tissue thickness and volumes of blood and interstitial tissue. This non-invasive procedure can be performed safely and by relatively simple means. We used a gamma camera and 99mTc to obtain transmission and emission scintigrams. A computer program written for a personal computer, can recognize the borders of the lung in a fully automatic manner and do the necessary calculations. Clinical studies show significantly higher interstitial volumes of the lung in patients with chronic pulmonary sarcoidosis.

Imaging of inflammatory and infectious lesions after injection of radioiodinated monoclonal anti-granulocytes antibodies.

Successful detection of inflammatory lesions by planar scintigraphy and SPECT after injection of iodine-123 labelled monoclonal antibodies directed against human granulocytes (123I-Mabgc) is demonstrated. This new tracer has been compared with indium-111 labelled white blood cells (111In-WBC) in selected patients with proven infectious lesions. Scans were equally positive in all cases, but the methodical advantages of the new marker were obvious, namely, there is no need for cell separation and the images of inflammatory lesions were better defined. In addition, SPECT could be performed with 123I-Mabgc and allowed a better anatomic localization and a three-dimensional description of the lesions. No adverse reactions have been seen. It is concluded, therefore, that 123I-Mabgc is a promising agent for the detection of acute focal inflammatory lesions which may, with advantages, replace 111In-WBC.

Myocardial 18F-FDG-PET. Experiences with the euglycemic hyperinsulinemic clamp technique.

Myocardial positron emission tomography (PET) with 18F-Fluordeoxyglucose (FDG) is increasingly used for the detection of viable tissue in the infarcted myocardium. Previous studies show that the variable metabolic conditions determine the regional distribution of this tracer and that the inhomogeneities of uptake often observed even in the normal myocardium may relate to substrate availability. The authors tried to stimulate the myocardial FDG uptake by either the technically easier method of glucose loading or by the euglycemic hyperinsulinemic clamp (EHC) technique. In their hands both methods could be considered as equally practicable but differing in some important details in regard to both the study protocol (tracer dose, optimal scanning time) and the reproducibility of results. The EHC allows a quick stabilization of the metabolic environment and resulted in an earlier and markedly increased FDG uptake. However, the important standardization of the method was performed by a computer-controlled system only for the glucose and insulin infusions. Their experiences show that the EHC provides a useful framework for assessing altered cardiac metabolism and possibly describes changes after therapeutic interventions more precisely than the commonly used glucose-loading technique.

Labelled monoclonal antibodies used for the detection of inflammatory processes and and bone marrow metastases.

This review gives a short history of the developments of immunoscintigraphy using radiolabelled monoclonal antibodies and will look at some clinical indications studied in close cooperation with international groups. Examples are presented of infected orthopaedic prostheses and the diagnosis of osteomyelitis in diabetic foot in which the method is considered diagnostically helpful. Furthermore, the accuracy of the bone marrow immunoscintigraphy is discussed in evaluating results of a multi-centre study, clearly demonstrating its diagnostic superiority over bone scanning in metastatic cancer. It is concluded that the future diagnostic trend is going towards more specific agents (antibodies, peptides) and a speedier availability of the diagnostic results in cases of supposed infection.

[Familial deficiency of thyroxine-binding globulin]. / Familiärer Mangel des thyroxinbindenden Globulins.

A family with congenital athyropexinemia is reported. By reconstruction of the family tree over seven generations, a heterozygous woman born in 1842 was identified as the first carrier of the anomaly who introduced the disorder into two family branches by marrying twice. 24 descendants examined included 6 heterozygous females and 8 hemizygous males. All were euthyroid. The mode of inheritance was obviously linked to the X-chromosome. An interesting fact was that in one family thyroxine binding globulin was absent or measured only in traces in hemizygous patients.

[Evaluation and documentation of tomographic images and further data using the Apple-Macintosh PC]. / Auswertung und Dokumentation von tomographischen Bildern und weiteren Daten mit Apple-Macintosh-PC.

Use of the personal microcomputer for the analysis of clinical cardial PET studies acquired at the Paul Scherrer Institute in Villigen, Switzerland. At present this is the only PET facility in Switzerland. As the local computers were not usually available for image analysis, it was necessary to find a convenient way to visualize and analyze the PET images in our department in the Cantonal Hospital, Aarau (distance to Villigen some 30 km). The personal microcomputer is, as other authors have already shown, in fact capable of handling the acquired images (128 by 128 pixels) easily. We use a Macintosh IIcx (16 MHz Motorola 68030 CPU) as image analysis workstation. In spring 1990 we implemented a software which could read the original Siemens matrix file directly into the Macintosh PC. As the handling of this software was somewhat clumsy, we now use a very powerful software ("Explorer", UCLA), which is specially designed for PET analysis. Analysis of PET data on the personal computer saves both time and money as we are able to use a standard PC periphery, which is less expensive than specially designed medical units.

Immunoscintigraphic localization of inflammatory lesions: pharmacokinetics and estimated absorbed radiation dose in man.

Five patients with inflammatory lesions received anti-granulocytes murine monoclonal antibody (Mabgc) infused over 5 to 15 min at doses between 3.4 and 5.4 mCi 123I (120 micrograms antibody). Clearance of 123I from blood pool closely fits a biexponential mathematical model with the two effective half-lives 0.73 h and 9.3 h. The spontaneous release of 123I was found to be relatively low in the blood pool. The cumulative urinary excretion of the 123I label over 120 h was in the range of 63% of the totally administered dose and is assumed to represent only a low molecular compound or 123I alone as iodide. Analysis of the label in spleen, liver and red marrow showed that the concentration of label in these tissues remains more or less constant over a period of 20 h after infusion. With data of liver, spleen, red marrow and whole body activity over a period of 24 h, an estimated radiation dose was calculated. Compared with 111In labelled leucocytes, especially in spleen, the absorbed dose is lower by a factor of ten per examination.

Immunoscintigraphic localization of inflammatory lesions: concept, radiolabelling and in vitro testing of a granulocyte specific antibody.

Current nuclear medicine techniques for the localization of inflammatory processes are based on injection of 111In labelled autologous granulocytes which need to be isolated and radiolabelled in vitro before reinjection. A new technique is presented here that obviates the need for cell isolation by the direct intravenous injection of a granulocyte specific 123I labelled monoclonal antibody. In this publication the basic parameters of the antibody granulocyte interaction are described. Antibody binding does not inhibit vital functions of the granulocytes, such as chemotaxis and superoxide generation. Scatchard analysis of binding data reveals an apparent affinity of the antibody for granulocytes of 6.8 X 10(9) l/mol and approximately 7.1 X 10(4) binding sites per cell. Due to the high specificity of the antibody, the only expected interference is from CEA producing tumors.

Immunoscintigraphic localization of inflammatory lesions: clinical experience.

This clinical study was based on the experimental results reported in the two preceding papers, showing that the highly selective affinity of the 123I-anti-CEA monoclonal antibody 47 (123I-Mabgc) for human granulocytes makes this compound suitable for the immunoscintigraphic detection of inflammatory lesions. Forty five patients with suspected infections have been studied after infusion of 4 mCi (148 MBq) 123I-Mabgc corresponding to 120 micrograms labeled protein. No adverse reactions have been seen. Because of the high number of labeled cells, the quality of the images was excellent. SPECT was performed in 15 cases in order to define the extent of the lesion. Infectious foci were usually seen 3-5 h postinjection, but the unimpaired function of the granulocytes guarantees diagnostically relevant examinations over a much longer period of time. Scans were read as being negative if no pathological accumulation of activity was detected after 24 h. The new scanning method is technically easy to perform and provides distinct advantages over other techniques necessitating in vitro labeling of the white blood cells. Therefore, recommended indications are acute infections of unknown origin or extent, especially recurrent episodes of osteomyelitis and infections of joint prostheses.

[Determination of regional rate of glucose metabolism in lumbar muscles in patients with generalized tendomyopathy using dynamic 18F-FDG PET]. / Bestimmung der regionalen Glukose-Metabolisierungsrate der Lumbalmuskulatur bei Patienten mit generalisierter Tendomyopathie (GTM) mittels dynamischer 18F-FDG PET.

Generalized tendomyopathy (GTM), or fibromyalgia (FM), is a disease characterized by wide-spread pain in the musculoskeletal system which usually begins at a single site, e.g., as low-back pain or cervical syndrome, and develops into generalized pain over months or years. The disorder affects primarily women, beginning around the age of 35 and reaching its peak during or after the menopause. Its etiology is still unknown. Secondary forms are observed particularly in rheumatoid arthritis. In order to get more information on FM we determined the local metabolic rate of glucose in vivo in the skeletal muscle (lumbar region) with dynamic 18F-FDG positron emission tomography (PET). 2 healthy volunteers and 6 female patients with FM reaching in age from 31 to 53 years were scanned. As 18F-FDG PET scanning is a metabolic tool, it is crucial to observe standardized conditions of metabolic steady-state. We used, therefore, the hyperinsulinemic euglycemic insulin clamp technique to stimulate the myogenic glucose uptake under stable plasma-glucose levels. The local metabolic rates of glucose utilization were estimated with a non-linear least squares fit on the 3 compartment 18F-FDG-model. A lumped constant of 0.67 was assumed. Under glucose clamp conditions patients with FM showed a significantly (p < 0.001) lower metabolic rate of glucose (4.3 +/- 1.1) mumol/100 g tissue/min compared with normal volunteers (8.5 +/- 2.3 mumol/100 g/min). Due to a significantly (p < 0.005) increased glucose backflow from tissue into the vascular space (k2 in the kinetic model) the rate of phosphorylation was markedly reduced in patients with FM.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental approach to the correlation of hemodynamic changes with increases in urinary lactate dehydrogenase as a new parameter reflecting serious renal tissue damages.

From previous investigations with nephroptotic patients increased urinary LDH was assumed to be a reliable marker indicating a renal tissue defect due to the organs descent in erect position. Animal experiments now allowed correlation of this enzymatic activity with controlled changes of anatomical and physiological parameters. Changes of the renal hemodynamics or urinary flow induced in acute experiments in dogs simulated kidney displacement in nephroptotic patients. Both ureters were cannulated for separate urine collection and one kidney was manipulated. The renal arterial or venous flow was reduced or the ureter was occluded under electromagnetic blood-flow control. Arterial constriction alone (30%/15 min) selectively caused a drastic decrease (approximately 80%) of Xenon wash-out (= nutrient-flow) in the renal cortex. Under the same conditions radio-labeled microspheres injected intracardially showed a centralization of the renal capillary blood flow from the outer cortex to the juxtamedullary zone. Urinary LDH activities increased up to 800% immediately after arterial constriction. In accordance with total LDH activity the percentage distribution of isoenzymes changed: LDH-I increased and the LDH-V decreased. Neither constriction of the renal vein nor ureteral occlusion had similar effects. In long-term experiments backward fixation of one kidney in rats would reflect the effects of kidney displacement over years in nephroptotic patients: animals were unilaterally nephrectomized and the remaining kidney was dislocated backwards (approximately 2,5 vertebrae) and fixed to the lateral pelvic wall. "Ptotic" rats showed during the following examinations a constant increase of urinary LDH up to 50% by 26 weeks postoperatively. In accordance with increased LDH the isotope nephrogram was pathological and arteriographies showed a stretched and narrowed renal artery. In a number of rats "ptotic" fixation was not effective enough. All these animals showed normal LDH, isotope nephrograms and arteriographies. Both animal experiments documented that reduced flow/hypoxia is essentially responsible for the tissue damage in the kidney manifested by increased release of urinary LDH.

Diagnostic relevance of urinary lactate dehydrogenase determination in nephroptosis and for the indication to nephropexy.

Previously reported experiments with animals suggested that reduced renal arterial flow might be the actual cause for the pathogenicity of nephroptosis. Clinical studies now give evidence that measurements of urinary LDH may be a criterion equal to the isotope nephrogram (ING) in considering this disease. Patients with a "mobile" kidney verified by i.v. pyelography were examined by an ING and a 1-day test for urinary LDH. In accordance with periodic kidney displacement total urinary LDH activities were measured in a 8-h urine volume in the supine position and a 8-h urine volume in the erect position of the patients. Evaluations were all expressed as percentage increase of LDH activity of the patient in the erect versus supine position and correlated with his ING-pattern. Among 45 nephroptotic individuals 34 showed, in accordance with a pathological ING, a mean LDH increase of more than a 100%. Eleven individuals had normal INGs and less than 20% increase equal to a group of 16 normal controls. We postulated a 30% increase as the upper limit between normal and pathological urinary LDH. The percentage distribution of isoenzymes was also altered within the pathological LDH range: LDH-I, which increases in normal controls, now decreased in nephroptotic patients. LDH-IV and V, which decrease in controls, now increased. Homomeric isoenzymes obviously show reciprocal behavior. The degree of kidney descent in cm does not correlate with percentage increase of urinary LDH, i.e. it is not a criterion for pathogenicity. Biopsies taken during nephropexy revealed that from an anamnestic duration of 50 weeks onwards the kidney is significantly affected and tissue damages become evident. If patients were re-investigated after nephropexy they showed normal i.v. pyelograms and normal LDH and no longer had clinical symptoms.