Serum lipoprotein lipid and apoprotein levels as indicators of the severity of angiographically assessed coronary artery disease.

Serum lipoprotein cholesterol and triglycerides and apoproteins A-I, A-II and B were determined in 71 consecutive male subjects undergoing coronary angiography because of severe angina pectoris. Among the factors studied, apoprotein B, apoprotein B/A-I ratio, VLDL- and LDL cholesterol showed the most consistent association with the severity of coronary artery disease as assessed by angiography whereas serum HDL cholesterol and apoproteins A-I and A-II showed no correlation. Subjects with stenosis of the left main coronary artery had higher serum HDL cholesterol and apoprotein A-I and B levels than the others. In this series which comprised males with severe angina pectoris, derived from a population with high prevalence of coronary heart disease, LDL was the best indicator of the severity of coronary artery disease.

An evaluation of different imaging chains in clinical chest radiography.

Six imaging techniques in clinical chest radiography have been evaluated: four film-screen combinations in the conventional grid technique and two combinations in the air gap technique. Five parameters characterising the quality of a chest radiograph were evaluated by three radiologists and one chest physician by using a nominal grading scale from -2 to +2 compared with the standard technique. The quality parameters judged were: the visibility of peripheral lung vessels, lung parenchyme, the pulmonary hilum, and lung structure behind the heart shadow, as well as the visibility of miscellaneous findings of clinical interest. The air gap technique was shown to be superior to the ordinary grid technique. The diagnostic quality of chest radiography does not necessarily deteriorate with the screen speed. However, statistically significant differences were noticed, even between techniques which had equal speed and physical resolution.

Visual detection and physical characteristics of roentgenographic systems. Investigations on chest imaging chains.

The relationship between physical characteristics (physical resolution, large object contrast and radiographic mottle) and visual detection parameters was evaluated in a water phantom. To measure visual observer performance a minified Snellen E-plate made of gold (three contrast zones) and a high contrast lead bar test pattern were investigated. A trial to test four types of equipment chains for chest radiography was further done with the E-plate technique by simulating a clinical radiography with an Alderson thorax phantom. The observer performance of the high contrast lead bar test pattern showed a good linear correlation to the physical parameters. However, none of the physical system-related parameters fully predicted the visual detectability when the equipment chains were investigated with the E-plate technique. In Alderson phantom studies the rare-earth screens and the air gap technique considerably reduced the radiation dose compared with that of the ordinary grid technique chest radiography, without impairing visual detectability significantly. The RP- and spotfilm techniques showed relatively poor properties of visual detectability.

Screening for postoperative pulmonary embolism on the basis of clinical symptomatology, routine electrocardiography and plain chest radiography.

The incidence of pulmonary embolism (PE) and the usefulness of various screening methods for its detection were studied in 108 patients undergoing elective hip surgery. Twenty patients had PE as shown by perfusion-ventilation lung scintigraphy. Six of them had symptoms of embolism. Clinical symptoms of PE, highly suggestive electrocardiographic (ECG) signs and signs in chest radiographs showed high specificity but low sensitivity with regard to PE. If the non-specific ECG signs and the symptoms and signs of deep vein thrombosis in the calves had also been taken into account, it would have been possible to identify 95% of the patients with PE. The use of all these screening tests revealed a suspicion of PE in two thirds of the patients. The simplest way to screen for postoperative PE seems to be to use a combination of the symptoms and signs of both PE and deep vein thrombosis, and to identify any tachycardia. This method gave a sensitivity of 85%.

Physical characteristics of four roentgenographic chains proposed for chest radiography.

Four types of roentgenographic chains have been studied in the present work: the ordinary grid technique with 1 screen-film combinations, the air gap technique with 8 screen-film combinations, the roentgen photofluorography (RP technique) and the spotfilm technique. To study resolution and contrast properties a gold plate was radiographed in a 20 cm thick water phantom and the equivalent passband and the inherent subject contrast were calculated. The effect of motion unsharpness on resolution was examined theoretically. The RMS nose and the speed of each technique were evaluated. The air gap technique proved to be a good alternative to the ordinary grid technique. Rare earth screens decrease the radiation dose to at least one third of that of a medium-speed film/calcium tungstate screen combination without noticeably impairing resolution, contrast or noise properties, but reducing motion unsharpness considerably. Differences between various screen-film combinations of equal speed were not very marked. The RP technique proved to be poorest in almost all respects. The spotfilm technique seems worth developing for chest radiography.

A comparison of double contrast barium meal and endoscopy.

The diagnostic value of double contrast barium meal and endoscopy was assessed in a material of 100 patients with upper abdominal symptoms. Although endoscopy turned out to be more sensitive in revealing pathologic conditions of the stomach, barium meal is by no means obsolete, provided that due attention is paid to the examination technique.

The effect of bronchography on pulmonary ventilation.

Using a gamma camera and the Xenon-133 washout method the reduction in lung function during unilateral bronchography was assessed in eleven patients. A considerable reduction in the washout rate was observed in the lung examined with bronchography both absolutely and compared with the opposite lung. Some improvement occurred after coughing out the contrast medium. It is concluded that the ventilatory function of the lungs is considerably impaired during bronchography and this should be borne in mind when referring patients with reduced lung function for this examination.

Lymphographic diagnosis of malignant lymphoma in the course of Sjögren's syndrome.

Three patients with Sjögren's syndrome complicated by malignant lymphoma are presented. During the benign stage, two showed non-specific hyperplastic lymph node patterns on lymphography. When the disease had become malignant, all cases revealed generalized involvement of the retroperitoneal lymph nodes. The lymphographic pattern was that of a malignant lymphoma: enlarged nodes, with a foamy, linear or reticular appearance but mostly preserved marginal sinuses. On lymphographic follow-up, the node alterations were consistent with the histological findings and the clinical status, including the therapeutic response.

Lymphography in the assessment of mycosis fungoides.

Extracutaneous manifestations of mycosis fungoides imply a bad prognosis and are a major cause of death. Benign dermatopathic lymphadenopathy is associated with mycosis fungoides and often precedes lymphomatous infiltration. In this study, 10 patients in the early stages of mycosis fungoides underwent clinical and lymphographical examinations. In one the lymphoma was already present in lymph nodes. Six had signs of dermatopathic adenopathy which was verified by lymph node biopsy in 5. In one of these the disease later progressed to a malignant lymphoma. The frequent occurrence of lymph node involvement justifies the use of lymphography collaterally with staging laparotomy to determine the presence of pathologic retroperitoneal lymph nodes.

Regional myocardial perfusion abnormalities on xenon-133 imaging in patients with angina pectoris and normal coronary arteries.

With use of semiselective xenon-133 injections and gamma camera recording, myocardial scintigrams were obtained in a series of 20 patients with angina pectoris, abnormal exercise electrocardiograms and normal coronary arteries. Ten patients (Group I) exhibited localized perfusion defects and the other 10 (Group II) a hjemogenous uptake of the tracer. Group I was characterized by more past myocardial infarctions and, most significantly, by male preponderance (P less than 0.001). Computer analysis of regional xenon-133 washout curves revealed that every patient in Group I had a reduced flow rate in the area of the perfusion defect (P less than 0.001). A comparison of this group with 26 patients with similarly abnormal scintigrams but coronary arterial obstruction revealed that myocardial perfusion was 16 to 18 percent greater in the group with normal coronary arteries. In three patients of this group, myocardial perfusion rates were not augmented by atrial pacing in contrast to the response in patients with coronary arterial obstruction. The data demonstrated localized perfusion abnormalities in half of the patients with angina pectoris and normal coronary arteries and constitute evidence that a metabolic disorder is not the sole mechanism for ischemia in this syndrome.

Double contrast X-ray examination of stomach.

A comparison was made between three double contrast methods and the conventional method of X-ray examination of the stomach. 106 patets received ordinary barium sulphate together with effervescent granules. 119 patients were examined with a special barium sulphate preparation containing dissolved carbon dioxide (Baritop). The third group, 100 patients, received Baritop and effervescent granules, and 100 patients a conventional barium meal. The films were analyzed as to the quality of mucosal pattern demonstration, mucosal affinity of the contrast medium, and the degree of dilatation of the stomach and duo8num. In addition, the degree of interference by gas bubbles was estimated. The best results were obtained with the contrast medium containing carbon dioxide (Baritop).

Radiologically detected collaterals and regional myocardial flow responses to ischaemia in ischaemic heart disease.

By employing 133 Xenon injections and a gamma camera recording of the initial uptake and subsequent disappearance of the tracer, regional myocardial perfusion rates were determined in 38 patients with ischaemic heart disease. Areas supplied by collaterals and areas devoid of them were analyzed separately. In addition to determining basal flow rates, the regional perfusion was studied by repeated 133Xenon scintigrams during pacing-induced ischaemia. The data were grouped and analyzed according to the visual assessment of collateral response as observed in the angiograms performed under the same circumstances. Eleven patients who did not have collaterals on their angiograms were excluded, as were three patients in whom the collaterals were supplying segments distal to only subtotal obstructions leaving 24 patients to the study proper. Angiographic appraisal disclosed two different responses to ischaemia: ten patients exhibited an increase in the collateral pattern (responders) and 14 patients showed no change or reduction in the collaterals (nonresponders). The prepacing grading of the collaterals was similar in the subgroups. Under basal conditions the regional myocardial flow rates in areas supplied by collaterals or devoid of them were roughly similar. Upon ischaemia the greatest regional flow increment occurred in the responders. The data demonstrate a reasonable agreement between the visual assessment of collateral response to ischaemia and a change in the regional perfusion. The data further indicate that similar collateral patterns observed by routine coronary angiography are not functionally equipotent.

Myocardial imaging using selective intracoronary injection of Thallium-201.

After selective coronary arteriography 150 muCi of Thallium-201 was injected into each coronary artery. Scintigraphy of the myocardium was performed about half an hour after the injection. In a series of ten patients the myocardium was clearly visualized in the gamma images. No adverse effects were noted.

Lymphographic changes caused by lymph node metastases in carcinoma of the suprarenal glands.

In the literature reviewed, only two articles were found describing lymphographical changes caused by metastases of malignant adrenal tumours. A patient with anaplastic carcinoma of the suprarenal gland is presented here. In this patient, postoperative retroperitoneal lymphography with control films was of vital importance for the planning of post-operative treatment and follow-up.

Analysis of coronary collaterals in ischaemic heart disease by angiography during pacing induced ischaemia.

Studies were made using ordinary selective coronary angiography and angiography during ischaemia produced by right atrial pacing, on a series of 41 patients with ischaemic heart disease, to examine the response of the collaterals to the ischaemia stimulus. Regional myocardial perfusion was determined under the same circumstances by measuring regional 133Xenon washout curves. No collaterals were found in 8 patients, none of whom demonstrated collaterals when angiography was repeated during ischaemia. Eleven of the 33 patients with prepacing collaterals (33%) responded to ischaemia with an increase in the collaterals, 16 patients (49%) showed no change, 5 patients (15%) showed a decrease in the collaterals, and one patient exhibited a bidirectional change. Regional myocardial perfusion responses closely paralleled the angiographic changes, yielding suggestive evidence that the collaterals were intimately involved in the enhancement of the flow. Despite different collateral and flow responses to ischaemia, the data on exercise tolerance, left ventricular end-diastolic pressure, ejection fraction, prevalence of left ventricular asynergy, and the topographic relation between synergy and collaterals, were largely similar. The data show that in some patients the collateral circulation reacts to ischaemia by enhancement, but the functional significance of this response is obscure.

Reduction of motion unsharpness in coronary angiography using rare-earth oxysulfide intensifying screens and green-sensitive X-ray film.

During cardiac cycle the coronary arteries move rapidly; the maximum velocity can exceed 400 mm/s. To eliminate the motion unsharpness, exposure times under ten milliseconds are necessary. Using new rare-earth oxysulfide intensifying screens and fast green sensitive X-ray film the exposure times can be reduced to as little as 2 milliseconds. Thus the motion unsharpness can be almost completely eliminated, producing enhanced resolution and better diagnostic accuracy.

Regional renal blood flow in hypertensive patients.

Renal blood flow measurements in three regions of each kidney were carried out in eighteen hypertensive patients using the radioactive Xenon-133 washout technique in conjunction with renal angiography. It was found that the regional differences were generally small but differences existed in four patients significant in spite of normal angiographic findings. The reduction in blood flow in the two kidneys was generally of the same degree which implies a uniform response to the elevated blood pressure.

Further studies of Lp(a) lipoprotein/pre- beta1-lipoprotein in patients with coronary heart disease.

The present study of 100 patients (46 of whom were included in a previous study) with suspected or proven coronary heart disease (CHD) confirms that Lp(a) lipoprotein and pre-beta1-lipoprotein are closely related, if not identical, and that Lp(a) lipoprotein/pre-beta-lipoprotein occurs more frequently in patients with CHD than in healthy people. Analysis of this lipoprotein component may have predictive value with respect to CHD.