bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonspecific bowel activity in imaging inflammation with Tc-99m labelled monoclonal anti-NCA-90 Fab’ fragment MN3
Authors: Wolter A. , Munz D. L. , Ivančević V.
Published: March 2018

Aim: Since the Tc-99m labelled monoclonal anti-NCA 90 granulocyte antibody Fab’ fragment MN3 (MN3 Fab’) might be of interest for imaging abdominal inflammation which could be hampered by nonspecific bowel activity, we prospectively investigated the appearance of bowel activity in MN3 Fab’ imaging. Methods: Eighty consecutive patients (age range 12-85 years) referred for suspected nonabdominal, mostly musculoskeletal infection, were included. Abdominal inflammation was excluded clinically and there were no signs of inflammatory bowel disease in the patients’ histories. One, 5, and 24 hours after intravenous injection of up to 1.1 GBq of MN3 Fab’ planar images of the abdomen were performed. Bowel activity was graded visually using a 5-point scale. Results: The one (N = 80), 5 (N = 79), and 24 (N = 52) hour images revealed 46 (10%), 162 (34%), and 173 (55%) accumulating bowel segments, respectively, in 37 (46%), 69 (87%), and 52 (100%) patients. The mean intensity score per accumulating segment was 1.1,1.8 and 2.7 (p = 0), respectively. Relative frequencies of appearance of the small intestine were 38%, 57%, and 21%, ileocaecal region 6%, 53%, and 48%, ascending colon 5%, 67%, and 89%, transverse colon 1%, 9%, and 69%, descending colon 8%,15 %, and 67%, and rectosigmoid 0%, 4%, and 38%, respectively. Follow-up investigations in 13 patients revealed diverging uptake patterns. Conclusion: Nonspecific bowel activity is often present in the early and almost always and more intense, in the delayed images. Early imaging at one hour after administration seems feasible, but a loss in sensitivity has to be considered. Thus, nonspecific bowel activity can be anticipated to be a pitfall in imaging abdominal inflammation with MN3 Fab’.
Antigranulocyte scintigraphy of septic loosening of hip prosthesis: influence of different analyzing methods
Authors: Steiner D. , Puille M. , Khalisi A. , Matter H.-P. , Stürz H. , Bauer R. , Klell R.
Published: March 2018

Aim: Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult because of contemporary visualisation of bone marrow. Therefore, we investigated, whether it is possible to improve the accuracy in diagnosing septic loosening of hip endoprosthesis by changing the analyzing methods. Methods: In 28 patients, the results of a visual interpretation of late scan, a visual interpretation and a quantitative interpretation of time-activity-course were compared. These results were verified by histology respectively microbiology. Results: Histological and microbiological verification found 14 septic loosening and 14 aseptic loosening of the hip protheses. Therefore, sensitivity, specifity, negative and positive predictive value for the visual interpretation of late scan were 0.86,0.57,0.80 and 0.67. For visual and quantitative interpretation of time-activity-course we found 0.86,0.79,0.85 and 0.80 respectively 1,0.93, 1,0.93. For interobserver agreement we found kappa coefficients of 0.28 ± 0.2 for visual interpretation of late scan, 0.48 ±0.17 for visual interpretation and 1.0 ± 0 for quantitative interpretation of time-activity-course. Conclusion: In all investigated values quantitative interpretation of time-activity-course was superior to the other analyzing methods. Therefore, antigranulocyte scintigraphy for septic loosening of hip endoprosthesis should be interpreted quantitativly.
Assessment of left ventricular function and volumes by myocardial perfusion scintigraphy - comparison of two algorithms
Authors: Fischer R. , Saurbier B. , Brink I. , Moser E. , Krause T. , Zajic T.
Published: March 2018

Aim: Left ventricular volume and function can be computed from gated SPECT myocardial perfusion imaging using Emory Cardiac Toolbox (ECT) or Gated SPECT Quantification (GS-Quant). The aim of this study was to compare both programs with respect to their practical application, stability and precision on heart-models as well as in clinical use. Methods: The volumes of five cardiac models were calculated by ECT and GS-Quant. 48 patients (13 female, 35 male) underwent a one day stress-rest protocol and gated SPECT. From these 96 gated SPECT images, left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were estimated by ECT and GS-Quant. For 42 patients LVEF was also determined by echocardiography. Results: For the cardiac models the computed volumes showed high correlation with the model-volumes as well as high correlation between ECT and GS-Quant (r ≥ 0.99). Both programs underestimated the volume by approximately 20-30% independent of the ventricle-size. Calculating LVEF, EDV and ESV, GS-Quant and ECT correlated well to each other and to the LVEF estimated by echocardiography (r ≥ 0.86). LVEF values determined with ECT were about 10% higher than values determined with GS-Quant or echocardiography. The incorrect surfaces calculated by the automatic algorithm of GS-Quant for three examinations could not be corrected manually. 34 of the ECT studies were optimized by the operator. Conclusion: GS-Quant and ECT are two reliable programs in estimating LVEF. Both seem to underestimate the cardiac volume. In practical application GS-Quant was faster and easier to use. ECT allows the user to define the contour of the ventricle and thus is less susceptible to artifacts.
Results of preoperative ultrasound guided fine needle aspiration biopsy of solitary thyroid nodules as compared with the histology
Authors: Wartner U. , Kresnik E. , Gallowitsch H. J. , Heinisch M. , Dinges H. P. , Lind P. , Mikosch P.
Published: March 2018

Aim: The goal of this study was to assess the accuracy and limitations of ultrasound guided fine-needle aspiration biopsy (ug-FNAB) of solitary thyroid nodules. Methods: The ug-FNAB results of 538 patients with solitary thyroid nodules, who afterwards underwent thyroid surgery, were compared retrospectively with the histology. Patients with multinodular goiter were excluded from the study. Ug-FNAB was performed on growing and/or hypoechoic and/or hypofunctional nodules. The ug-FNAB results were grouped as follows: group 1: malignant (n = 44); group 2: malignancy cannot be ruled out (n = 173); group 3: non-malignant (n = 296), group 4: inadequate (n = 25). Results: When the cytological results of group 1 and group 2 were interpreted os being malignant and those of group 3 as being benign, sensitivity, specificity and accuracy of ug-FNAB were 96.7%, 65.8% and 69.5% respectively. The 62 thyroid carcinomas (TO biopsied presented in 59 cases a suspicious or malignant cytology (95.2%). The smallest TC diagnosed by ug-FNAB had a diameter of 0.5cm and 36.4% of all papillary TC ≤ 1 cm displayed stage pT4. The histology verified a TC in 18 cases out of the 173 ug-FNABs in group 2. Non-malignant ug-FNABs were confirmed by histology in 294 patients (99.3%) in group 3. In 4.65% of the ug-FNABs inadequate material was aspirated. Conclusion: Nodules with non-suspicious ug-FNAB results can be safely followed-up by sonography, as the cytological diagnoses were verified in more than 99% by histology. Papillary TC can be diagnosed with ug-FNAB very accurately. As stage pT4 was present in more than one third of patients with papillary TC ≤ T cm, ug-FNAB is also recommended for thyroid nodules 0.5-1 cm in diameter located adjacent to the thyroid capsule. However, microfollicular proliferations remain the limitation of ug-FNAB, as the cytology cannot distinguish between benign adenoma and follicular TC.
Early change of thyroid hormone concentration after 131I treatment in patients with solitary toxic adenoma
Authors: Fidler V. , Zaletel K. , Gaberšček S. , Hojker S. , Pirnat E.
Published: March 2018

Aim: In spite of extensive use of 131I for treatment of hyperthyroidism, the results of early outcome are variable. In our prospective clinical study we tested whether 131I induced necrosis causing clinical aggravation of hyperthyroidism and increasing the free thyroid hormone concentration in the serum of patients with solitary toxic adenoma not pretreated with antithyroid drugs. Patients and methods: 30 consecutive patients were treated with 925 MBq 131I. Serum concentration of thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), thyroglobulin (Tg), and interleukin-6 (IL-6) were measured before and after application of 131I. Results: After application of 131I no clinical worsening was observed. FT4 and fT3 concentration did not change significantly within the first five days, whereas both of them significantly decreased after 12 days (p <0.0001). Slight and clinically irrelevant increase in the level of the two thyroid hormones was observed in 9 patients. Furthermore, we observed a prolonged increase in Tg concentration and a transient increase in IL-6 concentration. Conclusion: Neither evidence of any clinical aggravation of hyperthyroidism nor any significant increase in thyroid hormone concentration by 131I induced necrosis of thyroid cells was found. Therefore, the application of 131I may be considered as a safe and effective treatment for patients with hyperthyroidism due to toxic adenoma.
Concept and validation of a simple model of the intrathyroidal iodine kinetics
Authors: Bormuth F.-J. , Braun S. , Zimny M. , Schroth H.-J. , Rink Th.
Published: March 2018

Aim of this study is the introduction and validation of a simple model of the intrathyroidal iodine kinetics, designed for optimizing radioiodine therapy planning and dose measurement in a routine clinical setting. Methods: The new model defines the intrathyroidal iodine kinetics as balance of the thyroidal iodine intake and -excretion, characterized by the two exponential equations At = A0 * (1-exp(-λ1t)) and At = A0 * (exp(-λ2t) -1), respectively. A0 describes the theoretically maximum iodine uptake when the thyroidal iodine excretion is ignored, λ1 and λ2 represent the constants characterizing the iodine intake and excretion, respectively. The thyroidal iodine content at the time t equals the sum of both functions, which is At = A0 * (exp(-λ2t)-exp(-λ1t)). In 25 patients with autonomous goiter / nodules (n = 18), Graves’ disease (n = 5), or endemic euthyroid goiter (n = 2), the iodine uptake in the thyroid during the radioiodine therapy as fraction of the applied activity was determined daily, with the remaining body covered by a lead shield. On average, 7.2 measurements were performed per patient (minimum 4, maximum 13). With these uptake values, individual regression curves were fitted using the above equation, and the difference between the actual measurements and the corresponding values of the regression curves was determined.

Results: The average deviation of the 179 uptake values from the calculated points of the respective regression curves was only 1.4%. There was no significant difference between the three disease groups. The distribution of the relative deviations during the individual courses was constant, systematic errors were not detected. Conclusion: Our results suggest that the intrathyroidal iodine kinetics can be precisely described with the model At = A0 * (exp(-λ2t)-exp(-λ1t)). With only three measurements, the trend of the curve can be calculated, which allows to determine the total radioiodine storage in the thyroid.
Where does subclinical hypothyroidism start?
Authors: Wunderlich G. , Grüning Th. , Koch R. , Döge H. , Kotzerke J. , Zöphel K.
Published: March 2018

The upper limit of the TSH reference range is currently under discussion. In its recent guidelines, the National Academy of Clinical Biochemistry (NACB) recommended the use of ~2.5 mIU/L, rather than ~4 mIU/L, due to the fact that reference populations, on which the definition of the reference range is based, contain persons undergoing an initial phase of autoimmune thyroid disease. This will skew the upper reference limit of TSH. Ultrasonography, in addition to measurement of thyroid autoantibodies, should be used to exclude these persons. Objective: The present study investigates whether the NACB recommendation also applies for a region of mild iodine deficiency. Methods: According to NACB criteria, a reference population (713 persons) was defined out of a total study population of 1442. The TSH reference range was calculated in this reference group and in further subgroups by percentiles. The results were compared with the total study population and the NACB recommendation. All assays used were provided by BRAHMS Diagnostica AG, Hennigsdorf, Germany. Results: As expected, all median TSH values, excluding the median of the group with a hypoechogenic thyroid were close to 1.2 mIU/L. The 97.5th percentile in the reference population was 3.35 mIU/L. However, there was no difference compared to the total study population. Conclusion: The upper reference limit for TSH based on a reference population according to NACB criteria came down to 3.35 mIU/L, but not to ~2.5 mIU/L. Interestingly, there is no difference compared to the total study population.
Scintigraphic results in patients with lung transplants
Authors: Sandrock D. , Aurisch R. , Richter W.-St. , Ewert R. , Munz D. L. , Humplik B. I.
Published: March 2018

Aim: We addressed the feasibility of scintigraphy in the postoperative monitoring of lung transplants. Method: 37 patients (22 women, 15 men, 37 ± 15 years) in good clinical condition were examined after lung transplantation. Scintigraphic procedures for assessing ventilation (133Xe), perfusion (99mTc micro-spheres) and aerosol-inhalation (99mTc aerosol) were performed for all patients. The findings were compared with those of established diagnostic modalities. Results: All lung transplants showed homogeneous ventilation but with a non-physiologic difference of over 20% between both pulmonary lobes in one-third of the cases. There was a difference between the impairement of perfusion and ventilation in the presence of an impaired Euler-Liljestrand reflex in 14/37 (38%) patients. Furthermore, bronchoscopy and aerosol-inhalation scans often did not correlate, e. g. a bronchoscopically evident stenosis was not necessarily associated with an increased activity, and vice versa. Although peripheral mucociliary clearance was preserved after transplantation, stasis in central airways resulted in significantly impaired global clearance. Conclusion: Ventilation and perfusion scintigraphy reveal in a significant number of lung recipients pathologic findings and therefore can be recommended for postoperative monitoring. From a clinical point of view aerosol-inhalation scintigraphy (clearance) is not of any additional value.
Radioisotope albumin flux measurement of microvascular lung permeability: an independent parameter in acute respiratory failure?
Authors: Benzing A. , Nitzsche E. U. , Moenting Schulte , Reinhardt M. J. , Geiger K. , Moser E. , Hoegerle S.
Published: March 2018

Aim: To evaluate the extent to which single measurements of microvascular lung permeability may be relevant as an additional parameter in a heterogenous clinical patient collective with Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). Methods: In 36 patients with pneumonia (13), non pneumogenic sepsis (9) or trauma (14) meeting the consensus conference criteria of ALI or ARDS double-isotope protein flux measurements (51Cr erythrocytes as intravascular tracer, Tc-99m human albumin as diffusible tracer) of microvascular lung permeability were performed using the Normalized Slope Index (NSI). The examination was to determine whether there is a relationship between the clinical diagnosis of ALI/ARDS, impaired permeability and clinical parameters, that is the underlying disease, oxygenation, duration of mechanical ventilation and mean pulmonary-artery pressure (PAP). Results: At the time of study, 25 patients presented with increased permeability (NSI > 1 × 10-3 min1) indicating an exudative stage of disease, and 11 patients with normal permeability. The permeability impairment correlated with the underlying disease (p >0.05). With respect to survival, there was a negative correlation to PAP (p <0.01). Apart from that no correlations between the individual parameters were found. Especially no correlation was found between permeability impairment and oxygenation, duration of disease or PAP. Conclusion: In ALI and ARDS, pulmonary capillary permeability is a diagnostic parameter which is independent from clinical variables. Permeability measurement makes a stage classification (exudative versus non exudative phase) of ALI/ARDS possible based on a measurable pathophysiological correlate.
A Stochastic Approach to Tracer Kinetics
Authors: Spaventi Š. , Knešaurek K.
Published: March 2018

The single compartment well-mixed model (SCWMM) which has been used in almost all dynamic studies in nuclear medicine is, in fact, strictly accurate only in the case of a steady state obtained by means of constant administration of long-lived isotopes. That is the reason why SCWMM is not a good predictor of the behaviour of short-lived isotopes and why the distribution and transport of short- and long-lived isotopes in various situations has not yet been discussed in general terms. The aim of this paper is to do that by means of a more general stochastic approach. This more general approach takes into account the distribution and transport of tracer in the system, not requiring a hypothesis of good mixing and providing a possibility of making corrections due to decay in the case of short-lived isotopes studies.
Pharmacology of Radioiodinated Hexadecenoic Acid – A Myocardial Imaging Agent
Authors: Zhang J. , Ji Q.-M. , Wang Y.-C. , Xie D.-F. , Hua R.-L. , He W.-Y. , Shi X.-C. , Li Y.-J. , Jiang C.-J. , Dang G.-F. , Zheng H.-L. , Yang Y.-F. , Sun Q.-X.
Published: March 2018

123I- and 131I-labeled hexadecenoic acid (IHDA, radiochemical purity over 92%, dissolved in 6% bovine serum albumin solution) was investigated in vivo. ICR mice were administered IHDA via the tail vein. Maximum myocardial uptake (27.3 ± 5.1%) was reached about 0.5 min after the injection. The ratio of uptake in the heart to that in the lungs was 2.3, to that in liver 1.5 and to that in other organs 2.4 to 6.4. The dog myocardium was visualized distinctly within 3-5 min with a gamma camera after i.v. 131I-IHDA, and not interfered with by activities in the lungs, liver and other organs. The low blood levels at 20 min had little effect on the quality of the heart images.
Weiterentwicklung der quantitativen Auswertung der Myokardszintigraphie mit 201Tl
Authors: Meindl S. , Adam W. , Pfannenstiel P.
Published: March 2018

Beschrieben wird eine Weiterentwicklung der rechnergestützten quantitativen Auswertung der Thalliumstudie unter Belastung und in Ruhe mit Schwerpunkten auf der Erhöhung der örtlichen Auflösung beim Abtasten der myokardialen Aktivitätsverteilung, Verbesserung der Backgroundsubtraktion und Anwendung optimaler Filteralgorithmen.
Nicht-invasive Bestimmung von Druck- und Volumen- parametern der linksventrikulären Funktion
Authors: Strauß E. , Erdle J. , Schümichen C.
Published: March 2018

Die mit der getriggerten Herzbinnenraumszintigraphie gewonnenen Volumenparameter der Herzfunktion wurden durch die Ventrikelabmessungen und den unblutig nach Riva-Rocci gemessenen arteriellen Mitteldruck ergänzt. Daraus abgeleitet wurde die systolische Leistung als lastabhängiger Parameter der Kontraktilität und die Gesamtleistung des linken Ventrikels, die in Beziehung zur Volumenleistung gesetzt, Auskunft über den relativen Wirkungsgrad der Herzaktion gibt. An drei Patientenkollektiven mit unterschiedlicher Leistungsfähigkeit des linken Ventrikels konnte gezeigt werden, daß unter Einbeziehung der Ventrikelgeometrie und des arteriellen Mitteldruckes die Kontraktilität des Myokards sowohl quantitativ als auch qualitativ besser beurteilt werden kann und sinnvolle Angaben zur Arbeitsökonomie des Herzens gemacht werden können.
The Influence of Elevated Iodide Supply on the Autonomously Functioning Thyroid Gland
Authors: Kutzim H. , Wellner U. , Waters W.
Published: March 2018

A pharmacokinetic two-compartment model of iodine metabolism has been established on the basis of data from the literature and our own experimental investigations. By this model it is possible to estimate the effects either of prolonged elevation of iodide supply or of a single administration of a high dose of inorganic iodide in the presence of autonomously functioning thyroid tissue. Prolonged elevation of iodide supply in regions of iodine deficiency will cause manifest hyperthyroidism in many cases of thyroidal autonomy (cases with facultative hyperthyroidism). The administration of a single high dose of iodide, as it is proposed for the situation of an accident in a nuclear power station (100 mg Nal) in order to reduce the radiation burden to the surrounding population, carries almost no risk in cases of thyroid autonomy.
Osteoporose bei Typ-1-und Typ-2-Diabetes mellitus
Authors: Scharla S.
Published: March 2018

Diabetes mellitus und Osteoporose sind häufige Erkrankungen. Deshalb gibt es viele Patienten, die an beiden Krankheiten gleichzeitg leiden. Darüber hinaus stellt jedoch sowohl der Typ-1-als auch der Typ-2-Diabetes mellitus jeweils eine prädisponierende Erkrankung dar, die das Risiko für Osteoporose und Frakturen erhöht. Dabei ist das Risiko bei Typ-1-Diabetes mellitus stärker ausgeprägt, während bei Diabetes mellitus Typ 2 vor allem Patienten mit längerer Krankheitsdauer, schlechter Stoffwechsellage, Insulinpflichtigkeit und vaskulären Folgeschäden frakturgefährdet sind. Die Knochendichte ist bei Typ-1-Diabetes mellitus erniedrigt, während insbesondere adipöse Typ-2-Diabetes-Patienten auch höhere Knochendichtewerte aufweisen können. Das Fraktur-risiko wird nicht nur durch Veränderungen der Knochendichte und der Knochenarchitektur erhöht, sondern auch durch veränderte Knochenmaterialeigenschaften (veränderte Kollagen-Quervernetzung). Pathogenetische Faktoren sind Hyperglykämie, hormonelle Veränderungen, und der Einfluss von oralen Antidiabetika. Während Inkretine und DPP-4-Hemmer das Frakturrisiko zu senken scheinen, sind Glitazone mit höherem Risiko assoziiert. Auch SGLT-2-Hemmer könnten bei eingeschränkter Nierenfunktion mit einem höheren Frakturrisiko behaftet sein. Die Therapie der Osteoporose bei Diabetes mellitus unterscheidet sich nicht vom Vorgehen bei primärer Osteoporose. Die Effizienz von antiresorptiven Medikamenten wird nicht durch Diabetes mellitus beeinflusst.
Clinical Results of Immunoscintigraphy in a Variety of Malignant Tumors with Special Reference to Immunohistochemistry
Authors: Bockisch A. , Oehr P. , Knoblich A. , Hartlapp J. , Biltz H. , Jaeger N. , Bellmann O. , Vogel J. , Björklund B. , Taylor-Papadimitriou J. , Winkler C. , Biersack H. J.
Published: March 2018

Radioimmunoscintigraphy was performed in 52 patients with a variety of malignant tumors (colorectal, melanoma, lung, testicular, ovarian, bladder, carcinoid). Respective antibodies or their F(ab’)2 fragments against CEA (n = 23), melanoma antigen 225.28 S (n = 18), TPA (n = 4), ßHCG (n = 5) and HMFG2 (n = 2) were selected by immunohistochemistry of the primary tumor. Most patients were suspected of recurrence or of hitherto unknown distant or local metastases. Overall accuracy was 61 % (32/52). False negatives amounted to 33% (17/52). Useful additional clinical information – not available by CT, ultrasonics or serum levels of tumor markers – was obtained in 17 out of 52 patients (= 33%). From these results it seems obvious that antibodies used for radioimmunoscintigraphy should be selected on the basis of immunohistochemistry.
Comparison in Rabbits of Chole-Scintigraphic Properties of Several 99mTc-IDA Derivatives
Authors: Liniecki J. , Durski K. , Elzbieta Mikiciuk-Olasik , Kapuscinski J.
Published: March 2018

Pathways and kinetics of excretion were compared to four 99mTc-IDA derivatives in healthy rabbits of both sexes. Assessment of differences between the compounds was based upon: plasma clearance, characteristics of time-activity curves measured scintigraphically over the liver (time of the peak Tmax; time for decline of activity to half the peak value - T50%), and hepatocytic mean transit time (MTT) as derived after deconvolution of the hepatic time-activity curve. Hepatocyte transit time was short and similar to 99mTc-complexes of Mebrofenin, 2,4-diethyl IDA (HEPIDA) and 3-iodo-2,6- diethylphenylcarbamoylmethyliminodiacetic acid (JODIDA); it was evidently longer for 99mTc-p-butyl-IDA (BIDA). 99mTc-HEPIDA displayed significant urinary elimination; the remaining three compounds were excreted practically completely via the biliary route. It is concluded that optimal parameters were displayed by 99mTc-Mebrofenin and 99mTc-JODIDA.
Serum-Thyreoglobulin in der Metastasendiagnostik des differenzierten Schilddrüsenkarzinoms
Authors: Schneider C. , Tempel M.-Th. , Müller-Gärtner H.-W.
Published: March 2018

The diagnostic accuracy of serum thyroglobulin (S-TG) determination as measured under endogenous thyrotropin(TSH)stimulation (ETS) has been investigated in 372 patients with completed therapy for differentiated thyroid cancer. In 51 of these (13.7%) S-TG could be detected by means of the IRMA-technique. In 34 S-TG determination was additionally performed during suppressive thyroxine therapy (SSH): S-TG in SSH was significantly lower as compared with S-TG in ETS (p <0.001). In seven cases with proven metastases S-TG values were pushed below the minimal detection level by SSH. Tumor manifestations with suppressive S-TG were significantly smaller (x͂ = 5 ccm, range 1-25 ccm) than those with non-suppressible S-TG (x͂ = 90 ccm, range 11-125 ccm, p <0.005) and displayed a papillary histology. There was a moderate correlation between S-TG concentration and tumor volume (r = 0.71 ; p <0.001). 21 % (n = 66) of patients with undetectable S-TG in ETS showed 131l-uptake in the thyroid region; 2% (n = 7) had proven metastases. Sensitivity of S-TG determination for the detection of metastases amounted to 82.5% in ETS and 53.3% in SST, specificity was 94.6% in ETS and 99.7% in SST. It is concluded that small metastases of papillary thyroid carcinomas may escape S-TG screening more readily than follicular carcinoma metastases when S-TG concentrations are measured during thyroxine treatment.
First Experiments on Radioimmunodetection with b-12-Monoclonal Antibody Fragments against Breast Cancer Antigen
Authors: Andres R. , Stähli C. , Zenklusen H. R. , Fridrich R.
Published: March 2018

In 14 patients with breast cancer the results of radioimmunoscintigraphy with 123l-labeled b-12 monoclonal antibody fragments were correct in more than two thirds of the patients.
Konzepte pädiatrischer Studien
Authors: Weber H.-J.
Published: March 2018

Arzneimittelentwicklung und -informationen für Kinder gelten als unzureichend. Die Ursachen werden in mangelnden Anreizen und besonderen Herausforderungen gesehen, klinische Prüfungen bei Kindern mit dem Ziel des notwendigen Erkenntnisgewinns zu etablieren. Der Verband Forschender Arzneimittelhersteller (VfA) hat in einem Positionspapier ein Bündel von Maßnahmen vorgeschlagen, um die Situation für Kinder zu verbessern und nicht die Bedenken, sondern die Möglichkeiten klinischer Forschung bei Kindern in den Vordergrund zu stellen. Maßgeblich sind Überlegungen zum Schutz von Minderjährigen auf dem Boden der EU-Direktive, Aspek-te wissenschaftlicher, regulatorischer und administrativer Rahmenbedingungen zur Machbarkeit pädiatrischer Studien sowie Anreizsysteme entsprechend der Kinderinitiative der amerikanischen Food and Drug Administration nach dem FDA-Erneuerungsgesetz. Es ist Zeit, ernst zu machen und die Kinder am therapeutischen Fortschritt einer innovativen Arzneimittelentwicklung zu beteiligen.
Positionierungsstrategien für die transkranielle Magnetstimulation
Authors: Spitzer M. , Herwig U. , Schönfeldt-Lecuona C.
Published: March 2018

Die transkranielle Magnetstimulation (TMS) hat sich in den letzten Jahren aufgrund ihrer guten zeitlichen und zufriedenstellenden räumlichen Auflösung sowie der guten Verträglichkeit und Sicherheit und ihrer einfachen Praktikabilität als Forschungsinstrument in den Neurowissenschaften etabliert. Ein grundlegendes Problem bleibt jedoch die optimale Positionierung der Spule zur gezielten und fokussierten Stimulation. Die initial verwendeten Methoden zur Spulenpositionierung (in Anlehnung an das EEG-10-20-System, orientiert am Motorkortex oder an Landmarken) sind mittlerweile durch exaktere, aber auch kostenintensivere stereotaktische Positionierungsmethoden ergänzt worden. Diese neuen Techniken bedienen sich der Bildgebung, insbesondere der Magnetresonanztomographie. Rahmenlose optisch gesteuerte Neuronavigationssysteme können als komfortable und präzise Methode zur Spulenpositionierung angesehen werden. Unser Beitrag stellt verschiedene TMS-Positionierungsstrategien und -methoden vor.
Frontale Dysfunktion und TMS
Authors: Giesel F. , Eschweiler G. , Schönknecht P. , Essig M. , Schröder J. , Hempel A.
Published: March 2018

Methoden der funktionellen Bildgebung wurden eingesetzt, um die den psychiatrischen Erkrankungen zugrunde liegenden Störungen neurobiologischer Prozesse zu beschreiben. Mit Verfahren wie der transkraniellen Magnetstimulation (TMS) besteht die Möglichkeit, zerebrale Netzwerke selektiv zu modulieren. Die Kombination von TMS und funktioneller Bildgebung bietet dabei zahlreiche Vorteile, wie die Beschreibung der Effekte einer fokalen Intervention auf die durch die Krankheit betroffenen funktionellen Netzwerke und die Auswahl bestimmter Patienten, die von einer therapeutischen TMS des Kortex profitieren könnten. Der Einfluss weiterer möglicher Moderatorvariablen auf die Aktivierungsmuster wird diskutiert.
Gemeinsamkeiten und Unterschiede der therapeutischen transkraniellen Magnetstimulation und der Elektrokrampftherapie
Authors: Plewnia C. , Wild B. , Eschweiler G. W.
Published: March 2018

Die Elektrokrampftherapie (EKT) ist ein etabliertes Verfahren zur Behandlung von therapieresistenten Depressionen, während die transkranielle Magnetstimulation (TMS) über dem präfrontalen Kortex zurzeit als experimentelle Behandlungsform dieser Erkrankung gilt. Beide Therapieverfahren, die EKT und die TMS, induzieren intrakortikal ein elektrisches Feld. Dieses Feld führt zu einer neuronalen Depolarisation unter der Spule und zu Fernwirkungen via Projektionen zum anterioren Cingulum und ventralen Striatum sowie anderen tiefer gelegenen Hirnstrukturen. Ein wesentlicher Unterschied ist das subkonvulsive Prinzip der TMS, während die EKT per definitionem einen generalisierten Krampfanfall induziert und somit eine Narkose und Muskelrelaxation benötigt. Die TMS-induzierten Effekte auf den Hypothalamus und Hirnstamm sind im Vergleich zur EKT wesentlich schwächer ausgeprägt, was eventuell die geringere antidepressive Wirksamkeit begründen könnte. Die TMS verursacht andererseits weder passagere noch anhaltende kognitive Nebenwirkungen, sodass die Akzeptanz der TMS bei den Patienten entsprechend hoch ist. Die TMS ist kostengünstiger und kann ambulant durchgeführt werden. Größere Multicenter-Studien könnten helfen, die antidepressive Wirksamkeit dieser subkonvulsiven Technik zu beweisen und das alte Dogma der EKT-Forschung, nur generalisierte Krampfanfälle seien wirksam, zu überwinden.
Kortikale Exzitabilität – Messung und Modulation
Authors: Eschweiler G. W. , Plewnia C.
Published: March 2018

Mit der transkraniellen Magnetstimulation (TMS) steht eine nichtinvasive Methode zur Verfügung, die kortikale Erregbarkeit sowohl zu messen als auch zu modulieren. Damit stellt diese Technik ein besonders attraktives Forschungsinstrument der biologischen Psychiatrie dar und bietet darüber hinaus möglicherweise neue Therapieoptionen für unterschiedliche zentralnervöse Störungen. Nach einer kurzen Übersicht über die üblicherweise verwendeten Messmethoden der durch die TMS fassbaren Parameter kortikaler Exzitabilität wird der bisherige Kenntnisstand zur physiologischen bzw. pathophysiologischen Bedeutung der Parameter beschrieben. Nachfolgend werden die Möglichkeiten der Modulation kortikaler Erregbarkeit dargestellt. Abschließend werden offene Fragen und Perspektiven der neuropsychiatrischen Forschung mit TMS diskutiert.
Theoretical Considerations Concerning Mathematical Models of Radioisotope Renography
Authors: Doroszewski J. , Klimasara A. , Lawruk B.
Published: March 2018

A mathematical analysis of theoretical models of the radiohippuran renogram is presented. The preliminary considerations are based on a hydrodynamic model and a diffusion model. On the basis of the model assumptions the functions describing radioactivity of the blood, kidneys and urinary bladder are derived. It is demonstrated that by comparing theoretical curves with experimental ones the parameters characterizing some phenomena of hippuran kinetics may be estimated. These parameters are: the clearance of the tracer from the blood, the out-flow of the urine from the kidneys to the urinary bladder, the extravascular diffusion of the tracer and the functional asymmetry of the kidneys.
The Muon as a Tool for Scanning the Interior of the Human Body
Authors: Daniel H.
Published: March 2018

A completely new technique for scanning the interior of the human body is proposed which is based on the following principle: muons from an accelerator pass through two spark chambers and are stopped in the body. The decay electrons leave the body and pass also two spark chambers. The trajectory co-ordinates read out from the spark chambers allow the determination of the point of decay with high precision. The truly three-dimensional picture obtained in this way is truly three-dimensionally displayed on a screen. Several modifications of the basic method are described, the most important ones being the simultaneous recording of the muonic X-rays (equivalent to a chemical analysis) or of the muon precession. The necessary dose is low. The most serious disadvantage is the need of a medium-energy accelerator. Quantitative figures on resolution, efficiency, and dose are given.
Imaging Properties of the Positron Camera
Authors: Krauss O. , Lorenz W. J. , Luig H. , Ostertag H. , Schmidlin P.
Published: March 2018

The imaging properties of a Nuclear Chicago type Pho/Gamma III positron camera were investigated. The positron emitting nuclide 64Cu was used in the experiments. The edge packing effect of the detectors was eliminated by ringshaped lead shields. The resolution, the sensitivity, and the tomographic effect of the positron camera were measured with line phantoms. The best resolution was 8 mm (FWHM). Using tomoscintigrams of a volume phantom with four hot or four cold nodules in different planes the imaging properties of the positron camera for extended activity distributions are discussed. Because of the complex imaging properties of the positron camera the tomography of voluminous activity distributions is only useful if digital evaluation methods are employed.
Funktionsszintigraphische und serienangiographische Untersuchungen der Leber von Hunden mit experimentell erzeugtem Verschlußikterus
Authors: Beduhn D. , Kampmann H.
Published: March 2018

Für eine sichere Differenzierung zwischen extra- und intrahepatischem Verschlußikterus besteht großes klinisches Interesse. Mit den klinisch zur Verfügung stehenden Methoden ist diese Differentialdiagnose häufig nicht möglich. Auch angiographische Untersuchungen der Leberarterien und der Venen des Pfortader-systems können zur Frühdiagnostik nichts beitragen. Dagegen erscheinen funk-tionsszintigraphische Untersuchungen für eine Differenzierung des Verschlußikterus im Frühstadium geeignet.
Lokalisationsszintigraphie für die perkutane Nierenbiopsie
Authors: Mydlíik M. , Pokorná I. , Melničák P. , Mriňák J. , Zimáček J.
Published: March 2018

Die szintigraphische Lokalisation der Nieren für perkutane Nierenbiopsie mit Anwendung von 197Hg Neohydrin, die die Autoren beschreiben, ist sehr genau und wurde bei 37 Patienten mit Erfolg benützt. Die angeführte Methode belastet den Patienten nicht und hat außerdem den Vorteil, daß sie örtlich und zeitlich unabhängig ist von der perkutanen Nierenbiopsie. Autoren diskutieren darüber, ob diese Methode bei Patienten mit Niereninsuffizienz geeignet ist und ver-gleichen die Vor- und Nachteile dieser Methode mit anderen, die für die Nieren-lokalisation für perkutane Nierenbiopsie benützt werden.
Untersuchungen über die diagnostische Aussagekraft des Quotienten aus präkordialer und präpulmonaler Impulszahl von Na131 J bei Herzkranken und Normalpersonen
Authors: Blümchen G. , Lenz F. , Hoffmann G.
Published: March 2018

Dreyfuss et al. berichteten über Untersuchungen an 49 Patienten, von denen 23 einen Herzinfarkt erlitten hatten. Sie verabreichten oral zwischen 50 und 200 μCi Na131 J. Bei den Infarktpatienten waren am 1., 2., 6., 7. Tag nach der Injektion höhere präkordial gemessene Aktivitäten feststellbar (verglichen mit den Aktivitäten über der rechten Lunge), als bei den nicht herzkranken Kontroll-patienten. Die Autoren folgerten daraus, daß der geschädigte Herzmuskelbereich oder das ihn umgebende Gewebe Radiojod anhäuft.

In der vorliegenden Arbeit wurde die Aussagekraft dieser Methode überprüft.

Es wurde bei 9 Infarktpatienten, bei 9 herzgesunden Studenten, bei 7 Patienten mit Koronarinsuffizienz und bei 17 herzgesunden Patienten (diese Patienten litten vorwiegend unter peripher arterieller Verschlußkrankheit) 20 mCi Na131J intravenös injiziert.

Danach wurde die Anhäufung von Na131J präkordial und über der rechten Thoraxhälfte über mehrere Tage verfolgt.

Im Vergleich mit den Normalpersonen fanden wir bei den Infarktpatienten keine erhöhte präkordiale Aktivität. Der Quotient aus präkordialer und präpulmonaler Impulsrate (bis zur 35. Stunde nach der Injektion statistisch untersucht) eignet sich nicht für eine Differenzierung von Infarktpatienten und Herzgesunden.

Es wird diskutiert, wieweit geringe methodische Unterschiede für die unterschiedlichen Resultate verantwortlich gemacht werden können.
Der Einfluß von pH auf das freie Serum-Thyroxin und seine physiologische Bedeutung
Authors: Bekier A.
Published: March 2018

Das freie, biochemisch wirksame Serum-Thyroxin bleibt im dynamischen Gleichgewicht mit dem proteingebundenen Thyroxin, welches als Reservoir wirkt. Der Thyroxin-Spiegel im Blut bleibt konstant unabhängig vom Tages/Nacht-Rhythmus, körperlichen und psychischen Belastungen. Meßbare Veränderungen des freien Serum-Thyroxins sowie der thyroxinbindenden Präalbumine konnten dagegen bei verschiedenen Stress-Situationen festgestellt werden.

Mittels Gleichgewichts-Dialyse (Equilibrium Dialysis) wird der Einfluß der Wasserstoffionenkonzentration auf die dialysierbare Thyroxin-Fraktion des Serums untersucht. Bei pH Verschiebung der Pufferlösung in saurer Richtung konnte eine Zunahme der dialysierbaren Thyroxin-Fraktion beobachtet werden.

Die elektrophoretischen Untersuchungen im Veronal-Natrium-Puffer pH 8,6 und 7,0 zeigten eine nicht signifikante Zunahme der Thyroxin-Bindung durch die Albumin-Fraktion im pH 7,0.

Die beobachteten Auswirkungen der Wasserstoffionenkonzentration auf die thyroxinbindenden Proteine des Serums und das freie Serum-Thyroxin stimmen überein mit den Literaturangaben.

Die Zusammenhänge zwischen dem pH des Serums, der Bindungskapazität der thyroxinbindenden Proteine sowie dem freien Serum-Thyroxin deuten auf eine physiologisch-regulatorische Rolle der Wasserstoffionenkonzentration.
A Comparison of Serum Thyroxine [T4(D)], RT3U Ratio and T4-RT3 Index with Radioiodine Uptake in the TSH Stimulation Test
Authors: Höschl R. , Gimlette T. M. D.
Published: March 2018

A total of 236 TSH stimulation tests were performed using 10 units of TSH intramuscularly. 4 hour uptake of 132I, serum thyroxine [T4(D)], T3 binding coefficient [RT3U ratio] and free thyroxine index [T4-RT3 index] were estimated before and 18 hours after TSH.

In 88 tests classified by radioiodine uptake change as positive serum thyroxine increased significantly in only 63.7%, T4-RT3 index in 61.5%.

Out of 108 tests classified as negative by radioiodine uptake, serum thyroxine increased significantly in 14.8% and T4-RT3 index in 13.0%.

The RT3U ratio procedure used was the least reliable parameter in testing thyroid response to TSH stimulation, T4RT3 index was no better than T4(D) alone.

The change in serum thyroxine levels in response to TSH stimulation is in our opinion unreliable for the evaluation of TSH tests, and correlates poorly with changes in radioiodine uptake (r = 0.37), for reasons which are discussed.
Studies on the Relationship between 67Ga-Citrate Accumulation and Calcium Metabolism in Tumor Cells
Authors: Anghileri Leopoldo
Published: March 2018

L’incorporation in vivo du citrate de gallium (67Ga) et du chlorure de calcium (45Ca) dans les cellules de la tumeur ascitique d’Ehrlich a été étudiée par la technique des “ghost cells”. Les résultats indiquent qu’à peu près 50% du 67Ga intracellulaire est incorporé par le matérial cellulaire résiduel qui ist formé principalement par des phospholipides, protéines et acides nucléiques. La relation existant entre les deux incorporations (du 67Ga et du 45Ca) est discutée.
Renogram Modification Caused by Furosemide
Authors: Camargo Edwaldo
Published: March 2018

Parmi 22 individus normaux et 21 individus portant seulement ou à la fois de la nephropatie, de l’uropathie et de l’hypertension arterielle, l’auteur a analysé statistiquement l’action de la furosemide sur le fluxe plasmatique de chaque rein (FPRD et FPRG) et sur les paramètres de temps du rénogramme, ci-dessus: Tmax, T1/2, T5 et Tex.

Les résultats montrent que le diurétique réduit fort les paramètres de temp étudiés, sans modifier le fluxe plasmatique de chaque rein. Ils montrent aussi que le médicament ne modifie ni le rythme du fournissement du traceur à la cellule ni le “chemin” parcouru par lui. La montée de la velocitée de transport cellulaire du radiopharmaceutique sous l’action diurétique pourrait être expliquée par le gradient de concentration intra-cellulaire et intraluminal du traceur: il y a des conditions pour le dévelopement du troisième segment du rénogramme quand la valeur minimal de cet gradient est atteinte.

La réduction des paramètres de temps, qui peut atteindre des valeurs équivalants ou inférieures a celles que présentent les individus normaux, ne permet pas d’obtenir des rénogrammes chez les malades qui se servent du medicament ou l’on risque d’interpréter comme normal une courbe qui serait pathologique. Cette erreur dévient plus probable si l’involvement cellulaire n’a pas été suffisant pour additioner des altérations morphologiques à celles de la durée de la mesure.

L’auteur propose un critérium clinique pour évaluer la gravidité des altérations souffertes par les cellules tubulaires: dans le cas d’un rénogramme anormal, on le repète sous l’action de la furosémide pour vérifier si les altérations disparaissent ou demeurent.
Some Experiences with the Preparation of 99mTc-DTPA
Authors: Tertoolen J. F. W.
Published: March 2018

The behaviour of 99mTc after preparation of Tc-DTPA is studied. Blood incubation tests suggest a good chemical stability of Tc-DTPA. Tc-proteins and a pertechnetate-like compound are formed during in vitro incubation of freshly prepared 99mTc-DTPA with blood by a radiochemical impurity.
Die Myokarddurchblutung bei berufstätigen Koronarkranken
Authors: Heeger H. , Aldor E. , Kahn P.
Published: March 2018

Bei 89 Patienten mit koronarer Herzkrankheit wurde im Rahmen der Koronarangiographie die Durchblutung der linken und (oder) der rechten Koronararterie mit der 133Xe-Auswaschmethode bestimmt. Statistisch ergab sich zwischen den Flow-Werten der LCA und der RCA ein hochsignifikanter Unterschied, zwischen den Durchblutungswerten von berufstätigen koronarkranken Arbeitern und Angestellten aber keiner. Interessant ist die signifikant bessere Durchblutung sowohl der rechten als auch der linken Koronararterie von weiblichen gegenüber männlichen Berufstätigen.
Änderung der Durchblutung und Durchblutungsverteilung nach normo und hypothermer Ischämie der Nieren
Authors: Heinze H. G. , Eisenberger F. , Chaussy Ch. , Wirth H. , Pfeifer K. J.
Published: March 2018

Es wurde in Experimenten an 22 Bastard-Hunden der Mechanismus überprüft, der zu einer permanenten bzw. reversiblen Nierenparenchymschädigung nach normo- und hypothermischer Ischämie führt. Zu diesem Zweck wurden die Durchblutung und die Durchblutungs-Verteilung mit 133Xenon, die Gefäßveränderungen angiographisch und die Parenchymfunktion mit 131J-Hippuran untersucht.

Nach normothermer Ischämie tritt eine kurzfristige reaktive Hyperämie auf, die allerdings die entstandene Tubuluszellschädigung mit Ausscheidungsinsuffizienz nicht zu kompensieren vermag.

Nach hypothermer Ischämie ist zwar die Durchblutung wahrscheinlich als Folge einer kältebedingten Vasokonstriktion vorübergehend eingeschränkt, die Tubuluszellfunktion ist jedoch aufgrund der protektiven Wirkung der Unterkühlung erhalten. Die Bedeutung dieser Befunde für die Entstehung einer sog. Schockniere (akute Tubulusnekrose) und für die konservative Nierenchirurgie in Hypothermie wird diskutiert und die Anwendung durchblutungsfördernder Maßnahmen angeregt.
Reversible, dosisabhängige zentrale Schlafapnoe unter Natriumoxybat
Authors: Jafarpour Amir-Arsalan , Young Peter , Boentert Matthias
Published: March 2018

Wir berichten über einen Patienten mit Narkolepsie und Kataplexie, bei dem sich unter Natriumoxybat dosisabhängig eine zentrale Atemregulationsstörung mit Cheyne-Stokes-Atemmuster entwickelte, die sich nach schrittweiser Dosisreduktion wieder vollständig zurückbildete.
Evaluation of patients with liver metastases from colorectal cancer for locally ablative treatment with laser induced thermotherapy
Authors: Denecke T. , Hildebrandt B. , Rühl R. , Miersch A. , Nicolaou A. , Ruf J. , Plotkin M. , Hänninen E. L. , Stroszczynski C. , Gutberlet M. , Langrehr J. , Riess H. , Ricke J. , Amthauer H.
Published: March 2018

Purpose: Before locally ablative treatment of colorectal liver metastases, patients have to be carefully evaluated to decide whether this is the adequate therapy. In this study we determined the value of FDG-PET in comparison to conventional staging procedures. Patients, methods: In 68 consecutive patients referred for laser induced thermotherapy (LITT) of liver metastases from colorectal cancer, pretherapeutic staging with conventional imaging (thoracic and abdominal CT, liver MRI, chest X-ray) and FDG-PET was performed. The examinations were analysed separately and blinded. Based on the staging information, therapeutic decisions were made by an interdisciplinary review board according to a standardized algorithm. The results were compared between conventional imaging and FDG-PET, and were validated by clinical follow up data and histopathology, respectively. Results: On FDG-PET 210 lesions were interpreted as tumour manifestations. 48 of these were not seen on conventional imaging (true positive, n=46). In contrast, 24 lesions were visualized by conventional imaging only (true positive, n=12). Compared to conventional imaging, discrepant findings on FDG-PET led to treatment modifications in 25 patients (37%); these were correct in 20/25 patients. According to the actual treatment course, the inadequate treatment modifications in the remaining 5 patients were avoided by further diagnostic procedures (i.e. biopsies). Conclusion: In the evaluation of patients with known liver metastases from colorectal cancer before LITT, FDG-PET depicts relevant findings subsidiary to conventional imaging and thus is of high value for therapeutic decision making.