Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs.

This case-control study is based on an investigation of 27 nonsmoking patients with radiologically verified spontaneous pneumothorax (SP) and ten healthy never-smoker control subjects. The posteroanterior and lateral radiographs of patients and control subjects were normal. They were all submitted to the same clinical, laboratory, and radiologic examinations, including computed tomography (CT) of the lungs, with the aim of detecting any parenchymatous lung changes. Emphysema-like changes (ELCs) were detected on CT in 22 (81 percent) of the 27 patients, and if the ELC cases detected during interventional surgery are added, the frequency increases to 24/27 (89 percent). In 20 patients with unilateral SP, at least one ELC was found in 13 of the 20 SP-affected lungs, but only in five of the 20 lungs that were not diagnosed as having SP (p < 0.05). ELCs were found more frequently in the upper than in the lower lung regions (p < 0.05) and more frequently in the radiologically peripheral than in central regions (p < 0.001). No ELC was detected in the control group on CT. No alpha 1-antitrypsin deficiency was found in the 27 nonsmoking patients with radiologically verified SP who had ELCs despite the absence of these known promoters of emphysema.

Provocation of chest pain in patients with coronary insufficiency using the vasodilator adenosine.

Chest pain provoked by intravenous injection of adenosine was compared with natural angina pectoris in five patients with ischaemic heart disease. In seven healthy subjects a possible myocardial site for provocation of the chest pain was evaluated by analysis of time delays from injection to symptoms. The healthy volunteers were given the maximum tolerable dose of adenosine intravenously, together with 99Technetium-diethylentriaminpentaacetate (99Tcm-DTPA). Chest pain started after 4.1 +/- 2.4 s and reached its maximum 8.4 +/- 4.1 s after maximum left ventricular radioactivity. The patients with a history of typical angina pectoris were given similar doses of intravenous adenosine and the provoked chest pain did not differ in quality from the patients' habitual angina pectoris. The patients did not develop electrocardiographic signs suggesting myocardial ischaemia. Heart rate and blood pressure did not indicate increased myocardial work. In conclusion, the results concur with the hypothesis that adenosine elicits angina pectoris by stimulation of intracardiac adenosine receptors.

Regional lung function of non-smokers with healed spontaneous pneumothorax. A physiologic and emission radiologic study.

This study is based on investigations of 11 nonsmokers with healed spontaneous pneumothorax. Physiologic, scintigraphic and radiologic examinations were performed to determine whether they had any impairment of overall or regional lung function. Posteroanterior and lateral chest radiographic examinations revealed no abnormality. Forced expirographic study was normal, but the residual volume was increased. Ventilation was impaired and perfusion decreased in the apical region of the lungs, also the most common location of spontaneous pneumothorax. Findings are consistent with the presence of regional airway obstruction, which may cause, or at least contribute to, development of this condition.

Uteroplacental blood flow in pregnancy hypertension after the administration of a beta-adrenoceptor blocker, pindolol.

The effect of a beta-adrenoceptor blocker, pindolol, on uteroplacental blood flow was determined in 10 women with pregnancy hypertension using an isotope technique giving a very low radiation dose. 0.5 mCi 113mIn was injected intravenously before and 30 min after 10 mg pindolol was given orally. After the administrations of 113mIn serial scintigrams were recorded for 240 s by a gamma camera on line with a computer, and the placenta was outlined for time-activity analysis of the isotope accumulation curves. From these curves a relative measure of the uteroplacental blood flow could be determined. Pindolol induced a significant fall in mean arterial pressure but there was no reduction of uteroplacental blood flow index.

Acute effect of dihydralazine on uteroplacental blood flow in hypertension during pregnancy.

The uteroplacental blood flow was measured in 12 women with hypertension during pregnancy before and after intravenous injection of dihydralazine. After intravenous administration of 18.5 MBq (0.5 mCi) 113mIn, the gamma radiation emanating from the placenta was recorded with a computer-linked gamma camera during 10-second intervals for 240 s. From time-activity analysis of the isotope curve a uteroplacental blood flow index could be calculated. 30 min after the intravenous injection of dihydralazine, 18.5 MBq 113mIn were again administered, and a second uteroplacental blood flow index was calculated. After dihydralazine administration there was a significant reduction of mean blood pressure (p less than 0.01) and an increase of mean maternal heart rate (p less than 0.01). There was no significant change in uteroplacental blood flow or in uteroplacental vascular resistance.

Clinical trial of a new antigonadotropic substance, 2,6-cis-diphenylhexamethylcyclotetrasiloxane, in cancer of the prostate. A pilot study.

An organic siloxane compound, 2,6-cis-diphenylhexamethylcyclotetrasiloxane, (Cisobitan) has been shown to possess antigonadotropic properties. In this study it has been tried in prostatic cancer. 9 patients received the drug in the dose of 4-5 mg/kg body weight. General condition and subjective response, cytologic changes and semiquantitative scintigraphic changes of metastases were recorded, as well as common laboratory data. In this limited trial, Cisobitan was not adequate for tumour palliation. In a few instances subsequent oestrogen treatment was more effective. No side effects of Cisobitan were noted for periods up to 6 months. Further studies may be of value, perhaps using a higher dose.

Contrast enhancement with time in gliomas. Stereotactic computer tomography following contrast medium infusion.

Dynamic enhancement of astrocytomas has been investigated with CT following infusion of contrast medium. The areas of measurement corresponded with obtained stereotactic biopsies. The resulting types of enhancement are discussed in terms of a 3-compartment model. Great differences exist in the degree of enhancement of astrocytomas of grade I to II and those of grade III to IV. In the latter tumours a dynamic response appears to occur, distinctly different from that in infarctions.

Contrast enhancement of cranial lesions in computed tomography.

The time course of enhancement in apparently normal brain tissue, edema and focal lesions during 30 to 60 min after intravenous injection of vascular contrast medium was evaluated in a series of 41 patients with different intracranial lesions. The attenuation of apparently normal unenhanced brain tissue varied with the level of the scan, mainly an effect of beam hardening. Different types of enhancement response are discussed in terms of a 3-compartment model. The differential diagnostic potential of contrast enhancement in the early phase needs further evaluation using instruments with short scanning time, while the late phase of enhancement must be recorded with the use of a reliable head fixation to provide reproducibility of repeat measurements.

Stereotactic biopsies and computer tomography in gliomas.

This study was carried out in order to obtain data on the relation between tumour structures seen in computer tomograms and the corresponding histopathology and cytology. Nine consecutive patients were studied, and stereotactic biopsies were obtained from sites determined on contrast enhanced computer tomograms. Biopsies were obtained from tumour areas with high and low contrast uptake and from the low attenuating areas surrounding the tumours. The results indicated a close correlation between the microscopical morphology of gliomas and the pattern of the computer tomogram. Biopsy samples from low-uptake central areas contained tumour tissues, necrotic tissue, and in one case a cyst. Biopsies from high-uptake areas typically contained tumour tissue, whereas biopsies from low-uptake surrounding areas contained oedematous non-tumour tissue. For tumour diagnosis biopsies should be obtained from both low and high attenuating tumour areas.

Stereotactic computer tomography for biopsy of gliomas.

A technique is introduced enabling automatic transfer of coordinates obtained at computer tomography into a stereotactic system previously applied in biopsies of brain lesions. Four to five biopsies from different parts of gliomas were taken to compare the structures demonstrated on computer tomography with the microscopic appearances. Of 45 biopsies in 13 patients, 36 were predicted correctly. This also served as an attempt to classify gliomas on the basis of their appearance in the CT image.

Splenic injury due to indirect torsion.

A patient with subcapsular rupture of the spleen in association with indirect torsion trauma is reported. The spleen was surrounded by bands and adherent organs. The injury was considered to have been caused by a stretched band. In patients with hemoperitoneum, celiac angiography is advocated for diagnosis when immediate surgery is not indicated.

Rejection of isolated pancreatic allografts in patients with with diabetes.

Four patients with diabetes mellitus of juvenile onset but without uremia have been treated with segmental transplantation of the body and tail of pancreas. The indications were hyperlabile diabetes or progressive loss of vision. The grafts were procured from cadaveric donors four to 16 minutes after circulary arrest and were subsequently stored in the cold for approximately four hours. In one patient, the pancreatic duct was ligated, while in the other three, drainage was attained by suturing the transected end of the pancreas into a jejunal Roux-en-Y loop. Three of the grafts failed within six weeks as a result of irreversible refection, and one graft failed because of the early onset of venous thrombosis. The first sign of graft rejection was an increase in the postprandial blood sugar level, an increase in the fasting blood sugar level occurring several days later. Neither hyperamylasemia nor fever was observed. Radioisotope scans and angiograms were of great value in establishing the diagnosis of graft rejection. All of the patients survived after graft removal.