Urine excretion of inhaled technetium-99m-DTPA: an alternative method to assess lung epithelial transport.

Technetium-99m DTPA clearance (99mTc-DTPA) clearance measured by a gamma camera or a scintillation probe not only reflects epithelial transport, but is also influenced by an unknown amount of mucociliary clearance depending on particle size and aerosol deposition. This is confirmed by factor analysis of dynamic inhalation studies. Assessment of epithelial absorption by urinary excretion of inhaled 99mTc-DTPA is largely independent of aerosol lung deposition. Twenty-four-hour excretion reflects the amount of aerosol cleared by absorption, while two-hour excretion is a quantitative measure of the aerosol absorption rate from the epithelium into blood. Urinary 99mTc-DTPA excretion of two aerosols with different particle size correlated significantly (p less than 0.001) with analysis of lung clearance curves. A very similar regression in the form of a cumulative exponential function was found with both aerosols. Two-hour urine values of nonsmokers differed significantly from those of smokers or patients with active interstitial or infectious lung disease. This alternative procedure is suited as a bedside test and holds promise for patient monitoring and follow-up.

Assessment of activity in Sarcoidosis. Sensitivity and specificity of 67Gallium scintigraphy, serum ACE levels, chest roentgenography, and blood lymphocyte subpopulations.

The value of different factors are examined to assess activity in 60 patients with biopsy-proven sarcoidosis. In patients with active sarcoidosis (n = 35), 67Gallium scans proved to be the most sensitive method (94 percent sensitivity), followed by serum angiotensin I converting enzyme (S-ACE) levels, chest x-ray films, and lymphocyte assays. In patients with peripheral pulmonary lesions, chest x-ray films failed in 32 percent of cases to document activity (68 percent sensitivity) whereas 67Ga scans and S-ACE levels remained to give reliable results. Despite poor specificity, negative 67Ga scans together with normal ACE levels have a high predictive value for exclusion of active sarcoidosis. In patients with peripheral pulmonary lesions, chest roentgenography is of doubtful value for staging lung involvement and assessment of activity including monitoring and control of therapy.

Immunoreactive trypsin, alpha-amylase and lipase in serum--is there an age-dependence?

A strong age-dependence of IR trypsin was found in 424 healthy controls suggesting the need for age-matched reference values. A possible relation of other exocrine pancreatic enzymes like alpha-amylase and lipase to age was investigated in 185 apparently healthy persons undergoing a preventive health check. Only alpha-amylase showed a weak correlation with age, but not lipase. Both enzymes correlated with IR trypsin. Whilst alpha-amylase and lipase activities were within the normal range, approximately 25% of IR-trypsin concentrations were above age-matched control values. It is suggested that these apparently healthy persons already have disease of the exocrine pancreas, and IR trypsin is a more sensitive diagnostic tool for screening than alpha-amylase or lipase.

[Single-photon emission tomography (SPECT) using 123I-amphetamine in cerebral ischemic circulatory disorders]. / Die Single-Photon-Emissionstomographie (SPECT) mit 123J-Amphetamin bei zerebralen ischämischen Durchblutungsstörungen.

The uptake of 123I-amphetamine (IMP) in brain mainly corresponds to regional perfusion. Distribution of IMP can be visualized in tomographic slices by single-photon emission computed tomography (SPECT). For better evaluation and comparison in follow-up studies, right/left ratios were computed and an asymmetry index calculated. The most sensitive asymmetry index was achieved by 120 average circumferential profiles. In 52 patients with stroke and 16 controls the respective sensitivities of IMP-SPECT, computed tomography (CT), static and dynamic brain scanning and angiography were evaluated. In patients with TIA and PRIND the IMP-SPECT had the highest sensitivity of all non-invasive methods. In patients with completed stroke, the sensitivity of IMP-SPECT was comparable with that of CT (90 vs. 93%). There was a significant correlation between the IMP asymmetry index and the clinical and social score (p less than 0.001). The IMP asymmetry index was significantly correlated to the size of the CT lesion (p less than 0.001). In most patients, the size of the IMP lesion was larger than that of CT. In a prospective study, 28 patients with completed stroke were examined. 14 patients underwent surgical treatment (6 endarterectomies, 5 EIA, 3 combined operations), 14 patients had medical treatment only. Both groups were reexamined after 10 and 6.5 months, respectively. In both groups, neither the IMP asymmetry index nor the size of the CT lesion were changed, but the clinical and social scores improved (p less than 0.01). The outcome in both groups was the same. A positive effect of surgery could not be demonstrated.

[Thallium scintigraphy of the myocardium. Uniform research protocols of the Austrian Society for Nuclear Medicine]. / Die Thalliumszintigraphie des Myokards. Einheitliches Untersuchungsprotokoll der Osterreichischen Gesellschaft für Nuklearmedizin.

A uniform protocol for thallium scintigraphy of the myocardium has been issued in Austria to avoid difficulties in interpreting results and to avoid repeated examinations to save expenses and radiation burden. From the beginning of 1995 this protocol will be used in the Austrian departments of Nuclear Medicine, differences from this protocol have to be mentioned separately. In this protocol the procedure of examination, bicycle and pharmacological stress testing and vasodilatation, acquisition techniques for planar and SPECT imaging, data processing and quality control of devices are defined.

The effect of mobilisation of patients during treatment of thromboembolic disorders with low-molecular-weight heparin.

OBJECTIVE: To elucidate the risk of pulmonary embolism (PE) in patients with deep vein thrombosis (DVT) who are kept walking with compression bandages. EXPERIMENTAL DESIGN: Perfusion/ventilation scanning of the lungs was performed at admission and after 10 days of treatment. SETTING: General community hospital. PATIENTS: A total of 631 consecutive patients were studied (upper limit of the thrombi: iliofemoral vein, n=212; femoral or popliteal vein, n=302; lower leg, n=117). The patients received different dose regimens of low-molecular-weight heparin (dalteparin) subcutaneously. RESULTS: The study revealed that the prevalence of PE at baseline was between 45.1% and 51% (95% CI 38.2-55.2 and 45.2-56.8% respectively) in patients with proximal DVT, and 31.9% (95% CI 23.6-41.2%) in those with DVT restricted to the lower leg. The majority of these cases of PE were completely asymptomatic. The incidence of a new PE, revealed by a second lung scan on day 10 after admission, was 7.0% (95% CI 3.9-11.4%) in patients with iliofemoral DVT, 5.5% (95% CI 3.2-8.7%) in those with femoropopliteal DVT and 2.7% (95% CI 0.6-7.6%) in those with lower-leg DVT. These incidence rates for new PEs were significantly lower than the rates previously reported (p<0.01). The fatality rate was also lower compared with the literature: one patient suffered a fatal PE (0.2%; 95% CI 0-0.9%), four patients died from malignant tumours, and one from pneumonia. The frequency of malignant tumours was greater in this study than in the literature (23% in patients with iliofemoral DVT, 14% in those with femoropopliteal DVT and 9% in those with DVT of the lower leg). CONCLUSION: Mobile patients with DVT do not need bed-rest. Low-molecular-weight heparin s.c., compression bandages and walking exercises make home-treatment of DVT feasible.

[Measurements of radiocesium incorporation in 250 deceased patients who died within a year following Chernobyl]. / Radiocäsiuminkorporationsmessungen an 250 innerhalb eines Jahres nach Tschernobyl Verstorbenen.

Two months after the nuclear accident of Chernobyl, postmortem measurement of radiocaesium (137 Cs and 134 Cs) were started in different organs to study incorporation, organ distribution, and kinetics. 250 corpses were examined between July 1986 to August 1987 in the Department of pathology, St. Pölten. Highest concentrations were found in skeletal muscles, with a median value of 2.3 pCi/g wet weight (80-90% of the total incorporated dose), followed by liver, lung, spleen, kidneys, thyroid gland, heart, blood and brain, with values between 0.8 and 1.3 pCi/g. No caesium was detectable in fatty tissue. During the observation period an increase in caesium concentration was observed in almost all organs. The concentration almost doubled within 10 months in skeletal muscles. Only the lung demonstrated a decrease in the radiocaesium concentration within the first months, which can be explained only by inhalation of radiocaesium. A statistically significantly higher caesium concentration in most organs was found in females as compared with males. A possible explanation is the known lower urinary caesium concentration in women. Statistically significant correlations were found between caesium concentration and nutritional status, presence of malignancy, and the most recent intravital serum creatinine value.

[A comparative study of the kinetics of 131I-bromsulphthalein and 125 I-biligrafin (author's transl)]. / Vergleichsuntersuchungen der Kinetik von 131J-Bromsulphalein und 125J-Biligrafin

The kinetics of 131I-Bromsulphthalein (BSP) and 125I-Biligrafin were compared with one another. 131I-BSP is taken by the liver ten times faster than 125I-Biligrafin. The distribution volumes of these two tracers are identical. The maximum transport capacities (Tm) of BSP and Biligrafin are inversely proportional to the elimination constant k of the blood. The Tm of BSP is 8.6 +/- 1.9 mg/min., of biligrafin is 35.8 2.2 mg/min. Biligrafin leaves the liver cells without prior metabolization, which could account the higher Tm of this preparation. In conformity with theoretical considerations, 131I-BSP and 125I-Biligrafin differ in the following important respects: 131-I-BSP leads to a high activity in the liver against a low background activity. With labelled Biligrafin, on the other hand, on account of the slow activity in the liver and the high Tm, a striking contrast is demonstrable between liver and bile duct. This could, perhaps, be of diagnostic value in localizing a bile fistula.

[The influence of dopamine on the regional blood volume in liver, abdomen, chest and extremities (author's transl)]. / Der Einfluss von Dopamin auf die regionalen Blutvolumina in Leber, Abdomen, Thorax und Extremitäten.

The influence was studied of 3 and 6 gamma/kg/min. dopamine on the blood volume in the liver, abdomen, chest, arms and legs in ten volunteers with healthy livers, and a comparison was made between the effect of dopamine and the blood volume changes caused in these body regions by inflatable whole-leg boots at a pressure of 40 mm Hg. Regional blood volumes and any induced changes were studied by means of 99 m Tc labelled autologous erythrocytes. A gamma camera with a pinhole collimator and a small computer was used, the field of vision of the camera being 148 cm in diameter. Changes in regional activity reflect changes in the regional blood volume. 1. Whole-leg compression at 40 mm Hg led to an increase in the blood volume of the liver, abdomen and chest, but to a reduction in the legs, while no significant change was observed in the arm blood volume. 2. On infusion of 3 gamma/kg/min. dopamine for 15 minutes no significant change occurred in the blood volume of the liver and abdomen. The chest blood volume increased, while the blood volume of the upper and the lower extremities showed a statistically significant decrease. 3. On infusion of 6 gamma/kg/min. dopamine for 10 minutes no significant change occurred in the blood volume of the liver, while the chest blood volume continued to rise and that of the upper and lower limbs continued to fall. 4. Ten minutes after the end of the infusion there was no significant change in liver and abdominal blood volume as compared with the last value measured during infusion of 6 gamma/kg/min. dopamine. By that time the chest blood volume had already fallen and the blood volume of the arms and legs increased. The possible action mechanisms via dopamine-specific and other catecholamine receptors are discussed in this paper.

[The simultaneous investigation of liver and kidney function in the presence of dopamine (author's transl)]. / Simultane Untersuchung von Funktionsparametern der Leber und Niere unter dem Einfluss von Dopamin

The effect of dopamine on liver function and on renal blood flow and the glomerular filtration rate was studied in 13 patients suffering from liver cirrhosis. Hence, the BSP retention and 131I BSP clearance was determined and also the clearance of 99mTc DTPA and of 125I hippuran in decreasing concentrations, as well as under steady state conditions. Methodological problems arising from the application of the slope clearance technique in cirrhotic patients are discussed. Dopamine did not affect the BSP clearance and BSP retention, but a significant increase in renal plasma flow was observed. The glomerular filtration rate was not significant altered.

[Pulmonary embolism in leg and pelvic vein thrombosis. Results of a prospective study - diagnosis, frequency, nuclearmedical and clinical appearance (author's transl)]. / Lungenembolic bei Bein-Beckenvenenthrombose Ergebnisse einer prospektiven studie.

In a prospective study 169 patients with clinically suspected leg/pelvic-vein thrombosis were tested by 131 I fibrinogen uptake-test and radionuclide venography for confirmation of this diagnosis and also by a nuclearmedical lung investigation. In all cases of an abnormal perfusion scan a supplementary ventilation scan was performed. The perfusion scan has a sensitivity for pulmonary embolism of near 1.0 but its specificity is only 0.57. An additional ventilation study (133 Xenon, 81m Krypton) improves the specificity to 0.95. A mismatch of regional ventilation and perfusion is the nuclearmedical substrate of pulmonary embolism. The diagnosis of thrombosis was confirmed in 105 of 169 cases (62%). Thrombosis was located in the lower legs in 56%, in the thigh veins in 23% and in the external iliac veins in 21%. From 105 patients with leg/pelvic-vein thrombosis 60 (57.1%) had pulmonary emboli, from 64 patients with negative tests concerning thrombosis only 3 (4.7%) (p < 0.001). Pulmonary emboli were present in 46% when thrombosis was located in the lower legs, in 67% when thigh veins and in 77% when pelvic veins were involved. The average frequency of 57% emboli found in patients with leg and pelvic vein thrombosis agrees with data from pathologic-anatomical studies. An analysis of these patients with embolism showed that 70% of them were over 70 years old, that 52% of the emboli originated from thigh and pelvis and 43% from the lower leg and that 59% had no clinical signs of embolism. 80.4% of the patients had multiple perfusion defects (up to 9) which correlated in size with the severity of the clinical symptoms and which were about equally distributed in both lungs. Larger perfusion defects occure more frequently with thromboses of the thigh and pelvis than in thromboses of the lower leg. According to the chest x-ray pulmonary emboli were suspected to only 6 of 26 patients with clinical evidence of embolism (23%).

[The effect of dopamine on the renal function in dogs with chronic ligation of the common bile duct (author's transl)]. / Das Verhalten der Nierenfunktion unter Dopamin nach Choledochusligatur beim Hund

The influence of dopamine on glomerular filtration rate (GFR), renal plasma flow (ERPF) and urinary sodium excretion was investigated in dogs before and after a chronic bile duct ligation for a period of 16 days. 1. Dopamine (4 microgram/kg/min.) leads to an increase of GFR, ERPF and urinary sodium excretion. 2. There was no change of GFR and ERPF after bile duct ligation. Urinary sodium excretion was decreased. The decrease was, however, not significant (0.05 less than p less than 0.1). 3. After bile duct ligation dopamine induced increase of GFR and ERPF was of the same order as observed in the preoperative period. Compared with the preoperative values for sodium excretion the dopamine effect was lower (p less than 0.05). The present investigation shows that dopamine is worth trying in cases of obstructive jaundice accompanied by acute renal failure.

Postocclusive reactive hyperemia and postural vasoconstriction in different kinds of leg ulcers--investigations with laser Doppler.

Laser-Doppler fluxmetry was performed in 42 patients with leg ulcers (18 venous, 8 arterial, 12 diabetic-arteriolar and 4 mixed arterio-venous) and in 9 healthy controls. Using a bipolar probe measurement was carried out at the ulcer border and on the dorsum of the foot in the supine and in the sitting position. Reactive hyperemia after three minute arterial occlusion was produced in both body-positions. In every ulcer-group resting and peak fluxes showed a statistically significant increase in the ulcer region as compared to normal skin of the lower leg in the control group, the quotient between peak and resting flux ("reactive hyperemia index" RHI) being significantly lower. The RHI values for four ulcer-patients with a dramatic deterioration worsening eight months later were close to one, while the unchanged and improved cases showed median values above 1,2. Sitting up was followed by a decrease of flux in all ulcer-groups as well as in the control group. On the dorsum of the foot there was an increase of the laser Doppler flux in patients with arterial occlusive disease, i.e. in the group with arterial and mixed ulcers. This study shows that the kind of microcirculatory flow damage is not different in various causes of ulcerations. The reduced reactive hyperemic response compared to the increased resting fluxes (amount of RHI-decrease) might be a useful predictor for healing or non-healing of the ulcer.

[Functional and morphologic studies on the reinnervation of the replanted rabbit external ear]. / Funktionelle und morphologische Untersuchungen zur Reinnervation replantierter Kaninchenohrmuscheln.

Disturbances observed int he thermoregulation of replanted extremities were the stimulus for this experimental study. We chose the auricular conchae of rabbits as an experimental model, as these show--as do the fingers--innervation with the sympathic nervous system and fulfil thermoregulatoric functions. Twenty-five of thirty auricular conchae of rabbits took completely after amputation and replantation. Blood flow measurements with 133 Xenon, thermographic and histologic examinations were performed. Thermography showed dysfunction with temperature provocation even one year after replantation. Histological examinations revealed partly deficient reinnervation in vessels and also in cutaneous appendages.