Sequential treatment of anemia in ulcerative colitis with intravenous iron and erythropoietin.

BACKGROUND: Intravenous iron and erythropoietin have been shown to be effective in Crohn's disease-associated anemia. The aim of this study was to test the sequential treatment of anemia in ulcerative colitis with intravenous iron in the first phase and erythropoietin in the second. PATIENTS AND METHODS: Twenty patients with ulcerative colitis-associated anemia (hemoglobin < or = 10.5 g/dl) entered this open-label trial. In the first phase all patients received intravenous iron saccharate for 8 weeks. A response was defined as an increase in hemoglobin > or = 2.0 g/dl; a final hemoglobin >10.5 g/dl was regarded as full response, < or = 10.5 g/dl as partial response. A hemoglobin increase < 2.0 g/dl was regarded as nonresponse. In the second phase (n = 4) erythropoietin was initiated in patients without response. Patients with partial response were continued on iron saccharate for another 8 weeks. RESULTS: During the first phase the hemoglobin increased from 8.3 to 11.9 g/dl (mean hemoglobin difference 3.6+/-2.3 g/dl, p < 0.001). Fifteen patients (75%) showed a full response (mean hemoglobin difference 4.5+/-1.5 g/dl), 1 (5%) a partial response (hemoglobin difference 2.1 g/dl) and 4 no response (mean hemoglobin difference 0.4+/-1.8 g/dl) with a need for blood transfusions in a single patient. In the second study phase erythropoietin was highly effective in previous nonresponders (mean hemoglobin difference 3.3+/-1.9 g/dl). The single patient with partial response had a minor hemoglobin increase (hemoglobin difference 1.0 g/dl). CONCLUSION: Most patients with ulcerative colitis-associated anemia improve on intravenous iron alone. Erythropoietin is effective in those who do not respond.

Renography before heart transplantation in patients with cardiomyopathy.

UNLABELLED: In patients with ischemic cardiomyopathy (CM), abnormal renograms may result not only from circulatory failure (which should reverse after transplantation) but also from intrinsic renal disease (which contraindicates heart transplantation). Here, the outcome of heart transplantation was related to preoperative renograms, and the differentiating and prognostic value of renography was analyzed. METHODS: The study population consisted of 50 patients with ischemic CM expecting heart transplantation. Anatomical renal pathology was excluded in all patients. Dynamic renal scintigraphy was performed with 99mTc-mercaptoacetyltriglycine. Background-subtracted renograms were inspected visually and characterized numerically. Mean parenchymal transit time (mPTT), renal tracer content at 15 min (RTC15) and retention index (RI) were determined. The parametric renogram values were related to a normal reference group of 64 patients. The preoperative renograms were matched with the postoperative outcome. RESULTS: Three characteristic types of symmetrical findings in the kidneys were found: no pathological findings, mildly delayed peak and excretion phase and severely delayed peak and excretion phase. Pathological renograms were observed in 36 of 50 (72%) patients. The mean parametric renogram values in ischemic CM were as follows: Group A (normal kidney function), mPTT = 142+/-26.6 sec, RTC15 = 22.3%+/-4.6% and RI = 24.7+/-11.9; Group B (mild dysfunction), mPTT = 210+/-44.0 sec, RTC15 = 42.6%+/-10.3% and RI = 101.4+/-50.5; Group C (severe dysfunction), mPTT = 320+/-94.2 sec, RTC15 = 79.6%+/-15.9% and RI = 347.7+/-194.7; and reference patients (normal kidney function), mPTT = 137+/-31.1 sec, RTC15 = 22.8%+/-3.8% and RI = 24.6+/-7.9. Postoperative serum creatinine levels were <1.5 mg/dl in all Group A patients, between 1.5 and 2.5 mg/dl in 78% of Group B patients and >2.5 mg/dl in 75% of Group C patients. CONCLUSION: Renography revealed abnormal kidney function when structural pathology was excluded. The renographic abnormalities in ischemic CM did not reflect simply the circulatory failure. The numerical grading of renograms allowed patient stratification, suggestive of possible renal insufficiency after cardiac transplantation and immunosuppressive therapy. With further experience, renography may become a useful tool for predicting postoperative outcome in ischemic CM.

A case of parathyroid carcinoma visualized on Tc-99m-sestamibi scintigraphy.

Recent studies indicate that Tc-99m-Sestamibi (MIBI, DuPont Pharma) is a useful tracer for detecting parathyroid adenomas. We present a patient with focal Tc-99m-MIBI uptake in parathyroid carcinoma which has only been described once before (1). Tc-99m-MIBI scintigraphy may be considered for diagnosing pathological parathyroid tissue. But presently the histopathological examination only allows the differentiation between adenoma and carcinoma.

First experiences with technetium-99m furifosmin as tumour-seeking agent in breast cancer and recurrent ovarian cancer.

Recent in vitro studies suggest that technetium-99m furifosmin may have tumour-seeking properties. We analysed the diagnostic value of 99mTc-furifosmin scintigraphy in nine patients with documented carcinoma of the breast and in eight patients with continued recurrent ovarian cancer. In the breast, 99mTc-furifosmin failed to visualize the primary malignant tumour and the associated malignant lymph nodes in all patients. In contrast, multiple sites of increased tracer uptake were demonstrated in one patient with acute benign inflammatory breast disease. In four of eight patients with recurrent ovarian cancer, 99mTc-furifosmin scintigraphy demonstrated early (5 min p.i.) localized increased uptake corresponding to adhesions to the bowel as diagnosed by computed tomography, but failed to reveal further abnormalities in all patients. The present study demonstrates that furifosmin is of no value in the imaging of breast cancer and recurrent ovarian cancer. These results do not continue the pattern observed in cell culture studies and are quite in contrast to the findings of mammoscintigraphy using 99mTc-methoxyisobutylisonitrile and 99mTc-tetrofosmin.

Intravenous iron and erythropoietin for anemia associated with Crohn disease. A randomized, controlled trial.

BACKGROUND: Anemia often complicates Crohn disease and affects quality of life. OBJECTIVE: To evaluate the efficacy of intravenous iron alone and in combination with erythropoietin for the treatment of anemia associated with Crohn disease. DESIGN: Double-blind, randomized, placebo-controlled trial with a subsequent open-label phase. SETTING: University-based gastroenterology outpatient clinic. PATIENTS: 40 patients with Crohn disease and a hemoglobin concentration of 10.5 g/dL or less. INTERVENTION: All patients received intravenous iron saccharate for 16 weeks. During the blinded phase of the trial, they received either erythropoietin or placebo. During the open phase, the erythropoietin dose was increased in non-responders who had received erythropoietin and erythropoietin therapy was initiated in nonresponders who had received placebo. MEASUREMENTS: Response was defined as an increase in hemoglobin concentration of 2 g/dL or more. RESULTS: 15 of 20 patients in the placebo group (75% [95% CI, 51% to 91%]) and 18 of 19 patients in the erythropoietin group (95% [CI, 74% to 100%]) responded to intravenous iron (P = 0.20). The erythropoietin group had a higher cumulative response rate (P = 0.036) and a more pronounced mean increase in hemoglobin concentration (4.9 g/dL in the erythropoietin group compared with 3.3 g/dL in the placebo group, a difference of 1.6 g/dL [CI, 0.6 g/dL to 2.5 g/dL]; P = 0.004). In the open phase, all 6 previous nonresponders had a response. Hematologic response was associated with improved quality of life (P = 0.03). CONCLUSIONS: Most patients who have anemia associated with Crohn disease respond to intravenous iron alone. Erythropoietin has additional effects on hemoglobin concentrations.

99Tcm-tetrofosmin scintigraphy in Hodgkin's disease.

The aim of this study was to assess the suitability of 99Tcm-tetrofosmin (tetrofosmin) scintigraphy as a diagnostic modality in patients with Hodgkin's disease. Fourteen untreated patients with biopsy proven Hodgkin's disease (clinical stage Ia-IVb) were investigated. Post-treatment investigations were also done in 7 of the 14 patients. Focal pathological tetrofosmin uptake was seen in 42 site in the pre-treatment studies. Computed tomography identified 36 pathological regions. The tumour-to-background ratio ranged from 1.44 to 2.17 (mean 1.63). Follow-up studies demonstrated a response to treatment, in that there was a reduction in, or complete disappearance of, localized tetrofosmin uptake in regions previously pathological, and a decrease in tumour-to-background ratios. Tetrofosmin appears suitable for the localization of lymphomatous lesions, especially supradiaphragmatic ones, and for the follow-up of therapeutic response.

Parathyroid scintigraphy: first experiences with technetium (III)-99m-Q12.

We report the preliminary results of a prospective study demonstrating technetium(III)-99m furifosmin (Q12) uptake in histologically proven parathyroid adenomas. Scintigraphy was performed in 12 patients with hyperparathyroidism. Q12 correctly identified the parathyroid adenomas by focal prolonged tracer retention in ten of the 12 patients. In the two patients without localized tracer retention, no parathyroid adenoma could be identified surgically, either. The retention half-times ranged from 0.5 to 1.8 h (mean 1.27) in the parathyroid adenomas and from 0.3 to 1.2 h (mean 1.05) in the thyroid gland. Our preliminary results show that Q12 is a feasible, sensitive tracer for parathyroid scintigraphy. In comparison to sestamibi (MIBI) and tetrofosmin, Q12 displays short retention in the thyroid gland, which would seem rather advantageous. Further evaluation is needed to determine which among Q12, tetrofosmin and MIBI is most sensitive for the detection especially of small parathyroid adenomas, and which tracer properties will best reflect the degree of endocrine activity.

Cholescintigraphy in the evaluation of bile flow after Roux-en-Y hepatico-jejunostomy and hepatico-antrostomy in infants with choledochal cysts.

BACKGROUND: The study tests the hypothesis that stasis of bile in the Roux-en-Y hepatico-jejunostomy (RYJS) loop might facilitate biliary reflux and cause cholangitis, whereas quicker transit times in hepatico-antrostomy (HAST) might prevent cholangitis. MATERIALS AND METHODS: Cholescintigraphy was performed using Tc99m-trimethyl-Br-IDA in seven RYJS patients and in five HAST patients. RESULTS: The time to peak (Tmax) within the RYJS loop occurred between 18 and 50 min postinjection in all patients and the mean transit time (MTT) ranged between 42 and 69 min in 5/7 patients. Prolonged clearance of the tracer from the liver was seen in 2/7 RYJS patients, in whom the MTT was 77 and 240 min, respectively. In the HAST group, the Tmax within the anastomosed antrum occurred between 5 and 33 min postinjection, and the MTT ranged between 42 and 44 min in 2/5 patients. Protracted tracer uptake in the liver in one patient and localised tracer retention in the left hepatic bile ducts in 2/5 patients caused prolonged MTTs. Recurrent cholangitis and diarrhoea occurred in 4/7 RYJS patients, but in none of the HAST patients. Elevated gastrin levels after RYJS contrasted sharply to normal gastrin levels after HAST. CONCLUSION: The findings on cholescintigraphy did not differ significantly between RYJS and HAST and provided no explanation for the distinctly different postoperative clinical course of both surgical methods. Nevertheless, we consider cholescintigraphy to be an efficient and cost-effective diagnostic modality for evaluation of the surgical outcome as regards biliary flow.

Semi-quantitative scintigraphic follow-up studies of cerebral arteriovenous malformations after radiosurgical treatment.

An evaluation of semi-quantitative 99Tcm-red blood cell scintigraphy (RBCS) was undertaken in patients with cerebral arteriovenous malformations (AVM) during follow-up after radiosurgical treatment. Twenty-seven patients were studied with an initial dynamic imaging sequence of 32 frames each lasting 2 s, planar images in four projections beginning 15 min post-injection and single photon emission tomography immediately following the planar imaging. A 2 ml cubital vein blood sample was imaged to obtain an extracorporeal equivalent of the intravascular activity. The counts within the AVM on a planar image were divided by the counts obtained from the image of the blood sample (corrected for the same acquisition time and radioactive decay). This value yielded the 'volume index' (VI), which was proportional to the volume of the AVM. The VI obtained from the first RBCS served as the initial reference value and was set at 100%. The VIs obtained from the follow-up investigations of the same patient in the same projection were expressed as the percentage of the initial VI. We found RBCS identified the AVM in all patients. The VIs obtained from the follow-up studies demonstrated a decrease in blood volume at different time intervals after radiosurgical treatment. RBCS provides a sensitive, relatively non-invasive, semi-quantitative method for measuring the relative volume and follow-up of the degree of obliteration of AVMs after radiosurgical treatment.

Follow-up of osteomyelitis of infants with systemic serum parameters and bone scintigraphy.

AIM: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). METHODS: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. RESULTS: CRP was the most effective serum parameter for follow-up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. CONCLUSION: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

Parathyroid scintigraphy: comparison of technetium-99m methoxyisobutylisonitrile and technetium-99m tetrofosmin studies.

We report the preliminary results of a prospective study demonstrating tetrofosmin uptake in surgically and histologically proven parathyroid adenomas. In ten patients with primary chronic hyperparathyroidism, parathyroid imaging was performed using (1) technetium-99m methoxyisobutylisonitrile (MIBI) and (2) 99mTc-1, 2-bis(bis(2-ethoxyethyl)phosphino)ethane (tetrofosmin) within a time interval of 3-5 days. Both tracers correctly identified the parathyroid adenomas by focal prolonged tracer retention. On visual inspection image contrast was generally higher with MIBI than with tetrofosmin in all the patients studied. Tetrofosmin showed a slower elimination from the parathyroid adenomas than MIBI in six of the ten cases. Our preliminary results show that tetrofosmin, like MIBI, as a feasible, sensitive tracer for parathyroid scintigraphy. For routine use, the rapid kit preparation without heating and the lower radiation dose to the patient make tetrofosmin an alternative tracer for parathyroid scintigraphy. Further evaluation is needed to determine which of the two tracers is the more sensitive for the detection of parathyroid adenomas, and which tracer properties better reflect the degree of endocrine activity.

Dynamic and static scintigraphic evaluation of cerebral arteriovenous malformations to evaluate radiosurgical treatment.

The radiobiologic changes induced by cobalt-60 gamma irradiation in cerebral arteriovenous malformations (AVMs) is a torpid process. Complete obliteration may take 1 or 2 years or even longer. Neuroradiological modalities like magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) do not provide sufficient information to comprehend this process. Digital subtraction angiography represents an invasive method and is therefore most often performed when complete obliteration is expected. The purpose of this study was to investigate the value of blood pool scintigraphy and functional imaging, such as single photon emission computed tomography (SPECT), to gain more knowledge about the volumetric changes of AVMs treated by radiosurgery. Twenty consecutive candidates for Gamma Knife treatment were selected for comparative MRI/ MRA and scintigraphic studies. All lesions ranging from 0.6 to 18.6 cm3 could be identified on blood pool and SPECT images. Seven patients had repetitive examinations at 3-month intervals to compare the relative volumetric change of the lesion. In 5 cases, a marked decrease in blood pooling was noticed after 3 months, and in 2 patients no significant change was evident. In contrast, MRI/MRA scans done at the same time did not similarly indicate progressive obliteration changes. This preliminary result indicates that scintigraphic evaluation using the blood pool technique is a very sensitive method to describe the relative volumetric change of radiosurgically treated AVMs.

Results of three-phase bone scintigraphy and radiography in 20 cases of neonatal osteomyelitis.

Neonatal osteomyelitis, a rare, potentially crippling disease, requires early diagnosis and effective therapy. This study of 20 neonates analysed the diagnostic value of three-phase bone scintigraphy (motivated by its controversial role), plain radiography and local clinical signs in neonatal osteomyelitis and complicating septic arthritis. The sensitivities for detecting focal skeletal involvement were as follows: bone scintigraphy 90%, radiography 65%, clinical local signs 20%. Reliable scintigraphic signs were localized hyperperfusion (phase I), vasodilation (phase II) and hot or cold lesions on 3-h images. Radionuclide angiography definitely increased the validity of bone scintigraphy. During follow-up, the reduction or normalization in focal hyperperfusion was the first and most sensitive sign of an adequate response to antibiotic treatment; persistence (or recurrence) of focal hyperperfusion, increasing relative uptake ratios and the appearance of new foci of bone involvement indicated escape from antibiotic therapy. Radiography revealed no pathological signs in 35% of cases, soft tissue changes in 20% and effusion of the hip joint in 45%. Local clinical signs were not a reliable predictor of scintigraphic or radiographic findings. We consider bone scintigraphy in neonatal osteomyelitis to be a successful, efficient and cost-effective diagnostic modality, not only for early diagnosis, but also during follow-up.

SPET quality control: a comprehensive test procedure for evaluating the rotation system parameters COR-offset, y-shift and detector tilt.

This paper describes a method for SPET quality control that facilitates the determination of COR-offset, parallel y-shift and detector tilt by means of a single, comprehensive test using a special phantom consisting of three point sources. The evaluation of the method was performed by a series of measurements utilizing manually adjusted detector tilts and a simulation of y-shift by moving the phantom. The results show that y-shift and detector tilt are measured with reasonable accuracy, and that y-shift caused by variations in detector tilt can be differentiated from y-shift caused by other factors.

[A new concept in imaging pelvic recurrence of curatively operated rectal carcinoma--image fusion of nuclear magnetic resonance tomography and anti-CEA immunoscintigraphy (SPECT): technique and clinical example]. / Ein neues Konzept der Darstellung pelviner Rezidive nach kurativoperiertem Rektumkarzinom-Bildverschmelzung von Kernspintomographie und Anti-CEA-Immunschichtszintigraphie (SPECT): Technik und klinisches Beispiel.

We present a new technique of image fusion (IF) of magnetic resonance imaging (MRT) and anti-CEA-immunoscintigraphy (Behring 431/26) and single photon emission computed tomography (SPECT). We performed SPECT and MRT within 8 hours on the same day. Glucagon intravenously was used to reduce artefacts due to intestinal motility. Before image fusion we analysed the SPECT and MRT images independently of each other. The MRT and SPECT were connected by a local area network (LAN) to a Gateway computer, which is also used as a picture archive. There a program automatically starts, translates the MRT data from the ACR/NEMA format to the Elscint one and these data are sent for image fusion to the nuclear medicine computer Elscint SP1. By means of a clinical example we present anatomic concordant superimposition and explain the findings and the clinical value of our technique. This system and technique are equally applicable to other digital imaging investigations. By IF, on the basis of the certain evidence of the tracer depot of a pathological lesion diagnosed by MRT and the reliability of the anatomical assignment of a focal lesion diagnosed by SPECT, early detection of local recurrence after surgical treatment of rectal cancer, the correct localisation of recurrent disease and its distinction from non-malignant tissue becomes possible. This enables planning of further therapeutical strategies.

Anemia in Crohn's disease. Importance of inadequate erythropoietin production and iron deficiency.

Intestinal blood loss as well as chronic inflammation are regarded as the most important mechanisms in the pathogenesis of anemia in Crohn's disease. In addition, cytokines such as interleukin-6 can suppress erythropoietin production. This study was performed to investigate the importance of iron status, inflammatory activity, and endogenous erythropoietin concentrations for the development of anemia in Crohn's disease. In 49 consecutive patients with Crohn's disease, hemoglobin, inflammatory activity (Crohn's disease activity index, C-reactive protein, alpha 1-acid glycoprotein), iron status (serum iron, transferrin, transferrin saturation, ferritin), and serum erythropoietin levels were studied. Anemic (Hb < 12.0 g/dl; N = 16) vs nonanemic patients (Hb > or = 12 g/dl; N = 33) showed reduced iron compartments (eg, ferritin 28.7 +/- 12.9 micrograms/liter vs 63.2 +/- 15.0 micrograms/liter, transferrin saturation 6.2 +/- 1.4% vs 11.5 +/- 1.3%, P < 0.01) but no differences in inflammatory activity. An inverse correlation between erythropoietin and hemoglobin concentrations was found (r = -0.62; P < 0.001), but the increase in erythropoietin levels was inadequate to the degree of anemia. There was no correlation between erythropoietin and interleukin-6 serum levels. Four of five anemic patients with hemoglobin below 10.5 g/dl and erythropoietin levels within the normal range were treated with parenteral iron (200 mg iron saccharate in 250 ml NaCl, weekly, intravenously). Two of them additionally received recombinant human erythropoietin (150 units/kg, 3x weekly, subcutaneously). After five weeks all patients had a marked increase in hemoglobin. However, the mean increase in erythropoietin-treated patients was 5.0 g/dl compared to 2.0 g/dl in the patients with iron therapy only.(ABSTRACT TRUNCATED AT 250 WORDS)

Hormonal changes with lower body negative pressure on the 6th day in microgravity in one cosmonaut.

We measured volume regulating and stress hormones (AVP, aldosterone, ANP, c-GMP, angiotensin II, PRA, epinephrine, norepinephrine, ACTH, cortisol) in venous blood twice during a lower body negative pressure (LBNP) maneuver in one cosmonaut (31 years, 75 kg, 180 cm) preflight (supine), inflight (6th d in orbit), and on the 4th d (supine) after a 10-d flight. Antecubital blood was taken at the beginning (3 min: "a") and after ceasing (2 min: "b") 40 min LBNP (-15/-30/-35 mm Hg for 15/15/10 min). At the beginning of LBNP, no big changes of resting hormone levels are to be expected. Comparison of "a" values: Inflight, there was a 4-5-fold increase in vasopressin and epinephrine, a slight increase in aldosterone, ANP, norepinephrine, cortisol and ACTH, and a decrease in PRA levels. Postflight, vasopressin was almost as much increased as inflight, and aldosterone and ANP levels were higher than pre- or inflight. PRA, epinephrine, norepinephrine, and cortisol were moderately increased, whereas ACTH and angiotensin II were diminished. Comparison of "b" to "a" values (2 min after LBNP to 3 min intra-LBNP): Preflight, ANP, PRA, and epinephrine rose more than 100%. The inflight response was higher for aldosterone but lower for all other volume active hormones. Postflight, the increase in PRA was pronounced, whereas little change occurred in other hormones. Cortisol and ACTH fell similarly during LBNP under all conditions. In summary, the data provide evidence that not only the endocrine status but also the neuroendocrine responsiveness to stimulation; i.e., the hormone response during cardiovascular load, are altered by the stay in microgravity and readaptation to normal conditions.

[Normal values for free thyroxine, free triiodothyronine, reverse triiodothyronine, thyrotropin, thyroglobulin and thyroxine-binding globulin in umbilical cord blood of healthy mature newborn infants]. / Normwerte für freies Thyroxin, freies Trijodthyronin, reverse Trijodthyronin, Thyreotropin, Thyreoglobulin und Thyroxin-bindendes Globulin im Nabelschnurblut gesunder reifer Neugeborener.

The venous cord blood levels of free thyroxine (fT4), free triiodothyronine (fT3), reverse triiodothyronine (rT3), thyrotropin (TSH), thyroglobulin (TG) and thyroxine binding globulin (TBG) were studied in 56 mature and healthy newborns. Newborns with a gestational age less than 37 or more than 42 weeks, a delivery by forceps or cesarian section, a birth-weight less than 2500 g, a pH-value of the cord-artery blood less than 7.15, an Apgar-value after 1 minute less than 7 were excluded from the study. All mothers were non-smokers. The values of fT4 were 18.66 +/- 4.18 pmol/L, of fT3 were 1.59 +/- 0.75 pmol/L, of fT3 were 2152 +/- 666 pg/ml, of TSH were 7.83 +/- 4.49 mU/ml, of TG were 44.61 +/- 23.84 ng/ml, and of TBG were 25.61 +/- 5.42 micrograms/ml. A weak negative correlation was found between the TG-value and the pH-value of the cord-artery blood (r = -0.27, y = 191.55 - 22.82.x, p less than 0.05), and between the fT4 values and the gestational age (r = -0.34, y = 67.53-1.22.x, p = 0.01). The rT3-values were positively correlated to the gestational age (r = 0.29, y = -4571 + 167.x, p less than 0.03).

Diminished response to furosemide in I-123 Hippuran renal studies of renovascular hypertension caused by unilateral renal artery stenosis.

Dynamic I-123 Hippuran renal studies to measure furosemide response (FR) were performed in three groups of patients: 1) 57 patients with renovascular hypertension due to a poststenotic, ischemic kidney; 2) 23 patients with essential hypertension; and 3) 50 nonhypertensive patients with healthy kidneys (control group). FR was observed as renal parenchymal tracer washout within 10 minutes after the injection of 40 mg of furosemide. The retention index (RI) took into consideration the renal parenchymal tracer content before and 10 minutes after furosemide injection. In the control group, the FR was greater than 50% and the RI was less than 20. Patients with essential hypertension revealed no differences in the amounts of FR and RI compared with the control group. In renovascular hypertension, the FR was diminished and the RI was raised significantly. The values of FR and RI showed a good correlation to the degree of the renal artery stenosis before and after percutaneous transluminal angioplasty. It is concluded that the stimulation of diuresis with furosemide and its quantification represent an important additional step in the evaluation of dynamic I-123 Hippuran studies to detect renal ischemia.