bluuebunny/crossref_metadata_2025 huggingface dataset:
Leitvenenschädigung durch Verödungsbehandlung?
Authors: Pawlak J. , Marshall M.
Published: March 2018

Ziel: Die Haupthypothese, ob es nach Verödungsbehandlung häufiger zur Leitveneninsuffizienz kommt, als es dem Spontanverlauf der primären Varikose entspricht, sollte geklärt werden. Weiter sollte geprüft werden, ob eine Verödungstherapie rascher und ausgeprägter zur Dilatation der Vena femoralis communis führt oder komplikationsträchtiger ist als die operative Varizenausschaltung oder die rein konservative Behandlung, und ob eine intensive, ausgedehnte Sklerotherapie mehr Komplikationen aufweist als eine begrenzte (Nebenhypothesen). Methodik: In einer retrospektiven Analyse einer Zufallsstichprobe wurden 198 Patienten durch einen externen Untersucher rekrutiert und in folgende, gut vergleichbare, gleich große Gruppen eingeteilt: Patienten nur mit Verödungstherapie (a), Patienten nach Varizenoperation (b), Kontrollgruppe nur mit Kompressionstherapie und Allgemeinmaßnahmen (c). Der Beobachtungszeitraum betrug mindestens 12, im Mittel 46 Monate. Ergebnisse: Nach Sklerosierungsbehandlung trat weder eine Klappeninsuffizienz im Bereich der Leitvenen noch eine Dilatation der Vena femoralis communis rascher oder häufiger auf als in den Vergleichsgruppen mit operativer oder rein konservativer Therapie. Die Anzahl bedeutsamer Komplikationen war gering; bei operativer Behandlung waren die Komplikationen häufiger und schwerwiegender. In der Kontrollgruppe kam es in zwei Fällen zu Beinvenenthrombose mit Lungenembolie. Es ergab sich ein guter Effekt der varizenausschaltenden Maßnahmen: Die Patienten waren in >80% der Fälle mit dem Ergebnis zufrieden. Schlussfolgerung: Verödungs- und operative Behandlung von Varizen sind ausreichend sicher und effektiv. Wichtig für die Indikationsstellung zu den geeigneten Therapiemaßnahmen und zur Verlaufsbeurteilung ist eine adäquate morphologische und funktionelle Primärdiagnostik mit entsprechenden Verlaufskontrollen.
Intravaskuläres Lymphom unter dem klinischen Bild einer therapieresistenten Thrombophlebitis
Authors: Meyer zu Vilsendorf E. , Bosse U. , Mentzel T. , Griefingholt H.
Published: March 2018

Wir berichten über eine 63-jährige Patientin, die nach einmonatiger erfolgloser antibiotischer Therapie aufgrund eines Erysipels rechts mit der Verdachtsdiagnose einer therapieresistenten Thrombophlebitis in einer phlebologischen Praxis vorgestellt wurde. Klinisch imponierte ein derbes rotes, schmerzhaftes und brennendes Areal im Bereich der rechten Wade sowie mehrere bis 3 cm große derbe, leicht druckschmerzhafte Areale des linken Beines mit Betonung des Unterschenkels. Hinweise für eine tiefe Beinvenenthrombose oder eine Thrombophlebitis fanden sich nicht. Histologie: In der konventionellen histologischen Untersuchung fand sich zunächst das Bild eines hochmalignen, intravaskulären Tumorgeschehens. Mit Hilfe immunhistochemischer Färbungen wurde ein intravaskuläres (angiotropes) T-Zell-Lymphom (maligne Angioendotheliomatose) gesichert. Schlussfolgerung: Der Fall unterstreicht die Notwendigkeit der frühzeitigen histologischen Untersuchung auch vermeintlich harmloser Hautveränderungen.
Das Lipödem an Armen und Beinen
Authors: Cornely M.
Published: March 2018

Geschätzt werden 3,5 Millionen PatientInnen, die an einer angeborenen Fettverteilungsstö-rung der Beine und Arme leiden. Da diese Fettverteilungsstörungen aufgrund einer lym -phologischen Hochvolumeninsuffizienz und einer strukturellen Drainageschwäche schmerzhaft ist, hat sich der Begriff Lipo-hyperplasia dolorosa zur Bezeichnung des Krankheitsbildes Lipödem durchgesetzt. Auch in Bezug auf die therapeutischen Optionen erlebte dieses lymphologische Krankheitsbild in den letzten 15 Jahren einen Paradigmenwechsel: Lipohyperplasia dolorosa ist heilbar. In einer vierteiligen Serie wird über Grundlagen und Erfolge der operativen Lymphologie berichtet werden.
Ätiologie und Epidemiologie des primären Lymphödems
Authors: Kröll A. , Neuhüttler S. , Brenner E.
Published: March 2018

Eine beträchtliche Zahl Patientinnen und Patienten mit einem Lymphödem leiden an einer genetisch bedingten Form, dem primären Lymphödem. Fundierte epidemiologische Daten sind allerdings spärlich. Die vorliegende Übersichtsarbeit fasst den derzeitigen Stand des Wissens über die vielfältigen genetischen Ursachen und Grundlagen zusammen. Die Zusammenstellung umfasst folgende Erkrankungen und Syndrome: Klippel-Trenaunay, Nonne-Milroy, Waver und Sotos, Lissenzephalie vom Norman-Roberts-Typ, Buschke-Ollendorff, Noonan, Aagenaes, Meige, Lymphödem-Distichiasis, Yellow-Nail, Lymphödem und Ptosis, Hypotrichose-Lymphödem-Teleangiektasie, Kanzaki-Krankheit, Lymphödem-Mikrozephalie (-Chorioretinopathie), unilaterale Gigantomastie, Hennekam, rezessives kongenitales Lymphödem, Aarskog-Scott, OLEDAID, Lymphödem-Hypoparathyreoidismus, Campomelie vom Cumming-Typ sowie Swyer.
Vermeintlich venöse Beschwerden
Authors: Kendler M. , Haas E.
Published: March 2018

In der phlebologischen Praxis sind vermeintlich venöse Symptome wie schweres Bein, Schwellungs-, Müdigkeitsund Spannungsgefühl ohne erkennbare organische Ursache (Schweres-Bein-Syndrom) häufig. Oftmals findet sich bei den Patienten eine psychosomatische Auffälligkeit und ihre Lebensqualität ist reduziert. Die Diskrepanz zwischen Symptomen und Befunden führt nur selten zu einer geeigneten Therapie.

Diese Übersichtsarbeit versucht, die Problematik von vermeintlich venösen Beschwerden aufzuzeigen und mittels einer Pilotstudie die tatsächliche Möglichkeit der Lebensqualitätsmessung bei Personen mit Schweres-Bein-Syndrom darzustellen.
Multiple basal cell carcinoma in lymphoedema
Authors: Wollmer I. , Wenzel J. , Rabe E. , Pannier F. , Hamm K.
Published: March 2018

Basal cell carcinoma is the most common malignant skin tumour, but rarely appears in more than one location. For these multiple basal cell carcinoma (MBCC), lymphoedema seems to be a predisposing factor. We report the case of a patient with secondary lymphoedema, presenting with a 3-year-history of ulcerations and papules on her lymphoedematous leg. Histology confirmed the clinical diagnosis of MBCC in all lesions.

Pathophysiologically, a strong risk factor for the development of MBCC in lymphoedema seems to be the local failure of immunosurveillance. In obstructive lymphoedema, an impairment of lymphocyte and Langerhans cell trafficking was observed, resulting in ineffective phagocytosis of foreign antigens. Consequently, lymphoedema is an immunologically vulnerable area, facilitating the development of MBCC. Nevertheless, other risk factors such as actinic skin damage and somatic mutations might also play a role in the development of MBCC in lymphoedema. Despite its rare occurrence, MBCC has to be taken into consideration in all suspicious skin lesions. Whenever in doubt, skin biopsy should be performed.
Determinants of pressure exerted by medical compression stockings
Authors: Lun B. , Uhl J. F. , Bringer Y. , Blättler W.
Published: March 2018

Objective: The force exerted on a limb by a medical compression stocking (MCS) is given by the properties of the yarn and the technique of knitting. The pressure determined by the manufacturer should be the one acting on the leg provided the stocking fits the leg shape. However, the interface pressure is governed by additional factors which act simultaneously in a poorly defined manner. We sorted out the different material- and patient-related components and assessed their relative role combining in vitro with in situ techniques. Design and method: The force exerted by the stockings was measured with the Zwick and Hosy dynamometers and the pressure exerted on the leg with the SIGaT instrument placed underneath the stockings at various sites. Leg circumference was determined with the Perometer and local radius calculated from computer tomographic slices and assessed with templates. Stockings exerting ankle pressures between 10 and 40 mmHg were tested. Subjects serving in the various experiments were selected from a pool of 28 healthy volunteers. Results: All stockings exerted the predefined pressure when measured at the stocking/leg-interface (in situ) and on the dynamometer (in vitro) provided the local leg curvature was taken into account. The stockings showed slightly different elastic properties (pressure amplitude difference upon leg movement 2–6mmHg). The interface pressure varied significantly when measured at different angular positions on the same circumference (range of change +40%; –20%). The differences were strongly correlated with the local radius (range of variation along the calf circumference 35–125 mm). The differences of local radii got smaller with higher interface pressures. Leg movements provoked simultaneous increases and decreases of interface pressure of up to 15 mmHg depending on the site of measurement. Leg circumference varied only slightly with movements pointing in either direction: 0.25 cm at the ankle (range +0.4; –0.4) and 0.33 cm at the calf (range +1.05; –1.45), respectively. The compressibility of the underlying tissue had no effect on the interface pressure. Conclusions: The interface pressure can be assessed reliably in vitro and in situ. It shows complex, quantitatively important non-uniform local variations both when measured along a given leg circumference at rest and when monitored at one particular site during movements. The changes reflect the discontinuity of the leg configuration and further alterations of the silhouette occurring with every muscle activation. Clearly, a massage effect of stockings is documented which does not necessarily reflect a global effect exerted on the leg.
Tumor-induzierte Thrombophilie
Authors: Goerge T. , Schneider St. W.
Published: March 2018

Bereits im späten 19. Jahrhundert wurde von Armand Trousseau die klinische Beobachtung beschrieben, dass Tumorpatienten gehäuft thromboembolische Ereignisse erleiden. Allerdings sind die molekularen Mechanismen, die für die Tumor-induzierte Thrombose verantwortlich sind, noch weitgehend unbekannt. Obwohl es einige molekulare Konzepte zur Aktivierung des Gerinnungssystems bei Tumorpatienten gibt, sind die genauen Mechanismen Gegenstand intensiver Forschung. Das Verständnis und die Zusammenhänge dieses Wechselspiels könnten neue therapeutische Optionen eröffnen. Zunehmend wird klar, dass Tumorpatienten, die eine Aktivierung des Gerinnungssystems (z. B. aufgrund einer Thromboembolie) aufweisen, eine verstärkte Tumorprogression zeigen. Daher korreliert eine Aktivierung des Gerinnungssystems mit einer verstärkten Metastasierung und schlechten Prognose unabhängig von weiteren thrombotischen Ereignissen. Um die Mechanismen der Tumor-induzierten Thrombophilie besser zu verstehen, ist es notwendig, Studien zu initiieren, die diese Zusammenhänge und ihre therapeutischen Optionen untersuchen.
Thrombosis as a complication of the Klippel-Trénaunay syndrome and other vascular malformations
Authors: Geyer A. , Benedix F. , Strölin A. , Lichte V.
Published: March 2018

The Klippel-Trénaunay syndrome (KTS) is a congenital disorder of vascular malformations characterized by the clinical trias of naevi flammei, varicosis and hypertrophy of the affected limb. According to its clinical development KTS can be diagnosed directly post partum or becomes apparent in the course of the development particularly regarding incomplete forms. The most described symptoms next to swelling are pain and augmented sweating of the affected extremity. Complications of KTS are bleeding from mechanically traumatised vascular malformations or widened vessels, but also thromboembolic events are reported. We report on two patients with KTS and one patient with angiodysplasia, who developed deep vein thromboses in the affected limb at young age. None of the patients suffered from thrombophilia or other predisposing risk factors for thrombosis. KTS and other angiodysplastic disorders seem to be a risk factor for thromboembolic complications even at young age. A comprehensive counceling of the patients concerning the prevention of complications and especially the symptoms of thromboembolic events is important for early diagnosis and immediate therapy.
Surgery of varicosis in retrospect
Authors: Salzmann G.
Published: March 2018

The surgical treatment of varicose veins has been the general accepted state of the art for more than one hundred years. Prof Wolfgang Hach played a decisive role in the development of a scientific basis for the surgical treatment of varicose veins. This article gives a short overview of today's standard, highlighted by personal remarks from the author. More than ten years ago endovascular methods were developed, and a modification of sclerotherapy with foam has been established. The differences of these treatments are shown and discussed subjectively. In conclusion, however, because of the uncertain long-term results, the author still prefers surgical treatment.
Ulcus cruris in differential dermatological diagnosis
Authors: Zabel M.
Published: March 2018

The leg ulcer is mostly caused by vascular or venous diseases. About 1% of the German population suffer from a leg ulcer. 50–80% of the leg ulcers are caused by chronic venous insufficiency. Besides, there are many other diseases which can develop a leg ulcer. If a leg ulcer does not heal over months of therapy there are many other differential diagnosis possible. The ulcer is only a symptom, not a diagnosis.

Following diseases can induce leg ulcer: vasculitis, rheumatoid arthritis, cryoglobulinaemia, livedo vasculitis, polyarthritis nodosa, haematological, neuropathic, infectious and metabolic disorders, necrobiosis lipoidica (diabeticorum), pyoderma gangraenosum, calciphylaxis, arterial hypertension, chemical and physical injuries. The different diseases are discussed. For the diagnosis it is important that a detailed anamnesis, a typical statement, laboratory and histological findings exist. Sometimes the cooperation between several medical disciplines is necessary. Only an exact diagnosis can induce a differentiated therapy and in many cases the leg ulcer heal up. The aim of this paper is a survey of various non venous or vascular reasons for the development of leg ulcer. However the survey is not completed. But the main causes are mentioned.
Konstante Infusion von 15O-markiertem Wasser und Inhalation von 11C-markiertem Kohlenmonoxid als methodische Grundlage zur regionalen Bestimmung des Lungenwassers mittels Positronen-Emissionstomographie
Authors: Schober O. , Hundeshagen H. , Meyer G.-J.
Published: March 2018

Mittels konstanter Infusion von 15O-markiertem Wasser kann der Wasserraum der Lungen tomographisch rekonstruiert werden. Durch nachfolgende Inhalation von 11C-markiertem Kohlenmonoxid gelingt eine Rekonstruktion des Blutverteilungsraumes. Durch Differenzbildung der so erhaltenen Schichten ergibt sich ein quantitatives Bild des extravasalen Lungenwassers. 15O-markierter Sauerstoff wird an einem Zyklotron (MC-36, Scanditronix) kontinuierlich erzeugt und on-line zu 15O-H2O weiterverarbeitet. Nach Verdünnung mit 0,9% Kochsalz-Lösung wird die Aktivität mit einer Pumpe infundiert. Die Infusionsrate beträgt 6 ml/Min. Das Aktivitätsniveau des Infusâtes beträgt 3,7 MBq/Sek. und kann über 40 Min. mit einer Abweichung von weniger als 5% konstant gehalten werden. Sterilität und Pyrogenfreiheit des Infusâtes werden durch bakteriologische Untersuchungen sowie Kaninchen- und Limulus-Tests sichergestellt. Die konstante Infusion von 15O-markiertem Wasser führt nach ca. 8 - 10 Min. zu einem gleichbleibenden Aktivitätsniveau über der Lunge. Die tomographische Rekonstruktion mittels einer Positronenkamera (Model 4200, Cyclotron Corp.) dauert ca. 15 Min. Ein schneller Wechsel der Zyklotron-Parameter sowie weitgehend automatisierte chemische Verfahren gestatten eine schnelle Herstellung von 11C-CO, so daß ca. 40 MBq hiervon 15 Min. nach Beendigung der 15O-H2O Infusion für eine Bolus-Inhalation zur Verfügung stehen. Eine gleichmäßige Markierung des Blutvolumens ist nach 3 ȓ 4 Min. erreicht. Die anschließende tomographische Rekonstruktion dauert ebenfalls 15 Min. Die mittels der Positronen-Kamera in transversalen Schichten bestimmte Intravasalaktivität korreliert linear mit der Aktivität von Blutproben bis zu einer Aktivitätskonzentration von 100 kBq/ml.
Obstructive Uropathy: Frusemide Test and Analysis of Renographic Curve Patterns
Authors: Ackermann D. , Noelpp U. , Roesler H. , Probst P.
Published: March 2018

49 patients with clinically proven uropathy and 14 others suffering from nephropathy underwent quantitative 131I-OIHA renography, combined with a frusemide provocation test. In significant obstruction, diuresis reaction was typically less than 5% (predictive value of a positive test 76%). The renographic curves, derived from the renal cortex and from the pyelon were diverging, with the pelvic curve showing a continuous rise (predictive value of a positive test for the curve pattern analysis 92%). Non-obstructive dilatation of the urinary system was characterized by a high diuresis index (> 15%) (predictive value 82%). The curve pattern was plateau-like before and showed a converging course of cortical and pelvic activity spontaneously, at least after diuresis provocation (predictive value 75%). Nephropathy alone could exceptionally mimick both significant obstruction and non-obstructive dilatation. Qualitative renographic curve analysis combined with diuresis provocation renders a higher diagnostic yield regarding the dynamic state of questionable uropathy than either test alone.
The Influence of Cycle Length on the Radionuclide Left Ventricular Volume Curve Acquired with a Scintillation Camera and ECG-Triggered Data Processor
Authors: van Gelder A. L. , Dormehl Irene
Published: March 2018

This study was designed to evaluate the effect of cycle length on the parameters of left ventricular function such as left ventricular ejection fraction (LVEF), ejection rates and ejection times. Radionuclide (in vivo 99mTc-labelled red blood cells) volume curves were obtained from ten chacma baboons. Transoesophageal atrial pacing of the baboon hearts was controlled by a microcomputer. A sequence of four beats was generated during arrhythmic pacing, consisting of two beats of equal cycle lengths, followed by a beat 15% shorter and a subsequent beat after a compensatory pause. Triggering impulses were sent to the data processor coincident with one of these beats until sufficient counts were obtained, before advancing to the next beat. Global LVEFs were found to be influenced by the preceding cycle length, increasing on a previous long cycle and decreasing on a previous short cycle and were even found to be influenced one normal beat on from the unrepresentative cycle. Similar trends were found for ejection times and rates. Discarding specific unrepresentative cycle lengths in order to correct for arrhythmia without attention to the previous cycle and even to the following cycle is therefore inappropriate.
67Gallium Kinetics in the Blood of Patients with Malignant Tumors
Authors: Maiga M. K. , Koeppe P. , Keller F.
Published: March 2018

67GaIlium was injected into 60 patients with malignant tumors and into 42 patients in whom malignant tumors had been excluded by clinical investigation. 67Ga kinetics in blood were evaluated by non-linear least square regression computer analysis according to an open 2-compartment model where elimination proceeds from the peripheral compartment. Parameters of 67Ga kinetics in tumor patients showed a bimodal distribution, as was also the case in patients without tumors. No difference could be demonstrated between kinetic parameters of tumor patients and patients without tumors. In 4 patients, 67Ga kinetics could be evaluated before and after treatment of their malignant tumors, but a decrease in the volume of distribution was the single alteration of kinetic parameters occurring after treatment. This decrease may be explained by a smaller peripheral compartment resulting from the loss of tumor mass after treatment. Nevertheless, we conclude that the evaluation of 67Ga kinetics in blood will provide only limited information about the presence, size and growth rate of malignant tumors in man.
Zur Osteotropie von Rhenium- und Yttrium-Komplexen
Authors: Becker M. , Grimm W. , Kutzner J.
Published: March 2018

Tierexperimentelle Untersuchungen zur Ermittlung des Verteilungsmusters an Ratten ergaben für Strontium als Chlorid (85Sr, 89Sr) sowie Yttrium als Zitratkomplex (90Y) eine hohe Knochenaffinität. Keine Knochenaffinität und schnelle Elimination ließ sich bei Rhenium (186Re) als Perrhenat sowie als Rhenium-Kolloid und Re-Methylendiphosphonat nachweisen.
SPECT myocardial perfusion imaging
Authors: Koehli M. , Monbaron D. , Prior J. O. , Calcagni M. L. , Fivaz-Arbane M. , Stauffer J. C. , Gaillard R. C. , Bischof Delaloye A. , Ruiz J.
Published: March 2018

Aim: To determine the long-term prognostic value of SPECT myocardial perfusion imaging (MPI) for the occurrence of cardiovascular events in diabetic patients. Patients, methods: SPECT MPI of 210 consecutive Caucasian diabetic patients were analysed using Kaplan-Meier event-free survival curves and independent predictors were determined by Cox multivariate analyses. Results: Follow-up was complete in 200 (95%) patients with a median period of 3.0 years (0.8-5.0). The population was composed of 114 (57%) men, age 65 ±10 years, 181 (90.5%) type 2 diabetes mellitus, 50 (25%) with a history of coronary artery disease (CAD) and 98 (49%) presenting chest pain prior to MPI. The prevalence of abnormal MPI was 58%. Patients with a normal MPI had neither cardiac death, nor myocardial infarction, independently of a history of coronary artery disease or chest pain. Among the independent predictors of cardiac death and myocardial infarction, the strongest was abnormal MPI (p <0.0001), followed by history of CAD (Hazard Ratio (HR)=15.9; p=0.0001), diabetic retinopathy (HR=10.0; p=0.001) and inability to exercise (HR=7.7; p=0.02). Patients with normal MPI had a low revascularisation rate of 2.4% during the followup period. Compared to normal MPI, cardiovascular events increased 5.2 fold for reversible defects, 8.5 fold for fixed defects and 20.1 fold for the association of both defects. Conclusion: Diabetic patients with normal MPI had an excellent prognosis independently of history of CAD. On the opposite, an abnormal MPI led to a >5-fold increase in cardiovascular events. This emphasizes the value of SPECT MPI in predicting and risk-stratifying cardiovascular events in diabetic patients.
A DICOM based PACS for nuclear medicine
Authors: Reiners Chr. , Laßmann M.
Published: March 2018

The installation of a Radiology Information System (RIS) connected to a Hospital Information System (HIS) and a Picture Archiving and Communications System (PACS) seems mandatory for a nuclear medicine department in order to guarantee a high patient throughput. With these systems a fast transmission of reports, images to the in- and out-patients’ wards and private practitioners is realized. Therefore, since April 2000, at the department of nuclear medicine of the university of Würzburg a completely DICOM based PACS has been implemented in addition to the RIS.

With this system a DICOM based workflow is realized throughout the department of nuclear medicine for reporting and archiving.

The PACS is connected to six gamma-cameras, a PET scanner, a bone densitometry system and an ultrasound device. The volume of image data archived per month is 4 GByte. Patient demographics are provided to the modalities via DICOM-Worklist. With these PACS components a department specific archive purely based on DICOM can be realized. During the installation process problems occurred mainly because of the complex DICOM standard for nuclear medicine. Related to that is the problem that most of the software implementations still contain bugs or are not adapted to the needs of a nuclear medicine department (particularly for PET).

A communication software for the distribution of nuclear medicine reports and images based on techniques used for the worldwide web is currently tested.
Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan
Authors: Shung-Shung S. , Yu-Chien S. , Mei-Due Y. , Hwei-Chung W. , Kao A.
Published: March 2018

Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.
Methods and clinical applications in nuclear cardiology: a position statement
Authors: Schäfers M.
Published: March 2018

Nuclear cardiological procedures have paved the way for non-invasive diagnostics of various partial functions of the heart. Many of these functions cannot be visualised for diagnosis by any other method (e. g. innervation). These techniques supplement morphological diagnosis with regard to treatment planning and monitoring. Furthermore, they possess considerable prognostic relevance, an increasingly important issue in clinical medicine today, not least in view of the cost-benefit ratio.

Our current understanding shows that effective, targeted nuclear cardiology diagnosis – in particular for high-risk patients – can contribute toward cost savings while improving the quality of diagnostic and therapeutic measures.

In the future, nuclear cardiology will have to withstand mounting competition from other imaging techniques (magnetic resonance imaging, electron beam tomography, multislice computed tomography). The continuing development of these methods increasingly enables measurement of functional aspects of the heart. Nuclear radiology methods will probably develop in the direction of molecular imaging.
Tc-99m ciprofloxacin in clinically selected patients suspected for peripherial osteomyelitis, spondylodiscitis and fever of unknown origin: preliminary results
Authors: Heinisch M. , Mikosch P. , Kresnik E. , Kumnig G. , Gomez I. , Lind P. , Gallowitsch H.-J.
Published: March 2018

Aim: Retrospective evaluation of Tc-99m ciprofloxacin (infecton) scintigraphy consecutively performed in a series of patients clinically suspected for peripheral osteomyelitis (OM), spondylodiscitis (SD) and fever of unknown origin (FUO). Methods: A total of 20 patients clinically suspected for OM (n = 12), SD (n = 3) and FUO (n = 5) were included in our retrospective analysis. The additional criterion was a positive 3-phase bone scan for OM, or a 2-phase bone scan in case of SD. Planar whole body scans and static acquisitions were performed 1 and 4 h after application of 370 MBq Tc-99m ciprofloxacin. In 10 patients with suspected OM, additional immunoscintigraphy using Tc-99m labelled monoclonal antibodies (Mab BW 250/183) was performed and the correlation of infecton to bloodpool and antigranulocyte scintigraphy was analysed. Results: OM: Bacterial infection was confirmed in 8 of 15 lesions. Infecton demonstrated true positive (TP) results in 7 of 8, true negative (TN) results in 2 of 7, false positive (FP) results in 5 of 7 patients and one false negative (FN) result. A strong correlation could be demonstrated between T/NT ratios of infecton and bloodpool Tc-99m medronate imaging (r = 0.84, 0.88) and between infecton and BW 250/183 (r = 0.92, 0.90). Using a threshold of 2.0 for T/NT ratio, only TP results could be observed whereas a T/NT in the range of 1.0-2.0 could not discriminate between septic and aseptic inflammation. Concordant results with Mab BW 250/183 could only be observed in 5 of 10 patients (4 TP, 1 TN) by showing 4 FP and 1 FN lesions with IF. Conclusion: Non-specific uptake of infecton can be observed in a variety of clinical situations with moderate uptake, by showing a strong correlation with blood-pool imaging. Nevertheless, intense uptake may be specific for septic inflammation.
Recent Developments in the Field of 123I-Radiopharmaceuticals
Authors: Knust E. J. , Machulla H.-J.
Published: March 2018

Due to its advantageous nuclear physical properties iodine-123 is an excellent label for radiopharmaceuticals very well suited for measurements by γ-cameras and single-photon emission tomography. The development of 123I-radiopharmaceuticals should be based on a clear biochemical concept, reliable labelling procedures and careful pharmacokinetic studies in order to evaluate the physiological behaviour of the radioiodinated compounds being analogues of metabolic substrates. The development of 123I-labelled fatty acids and biogenic amines clearly proved the successful use of 123I for labelling compounds applied in medical diagnosis.
The Influence of Substituents in 99mTc-Benzylidenediphosphonate Complexes on their Organ Distribution in Rats
Authors: Kristen P. , Garnier-Moiroux A. , Winkel K. , Eisenhut M.
Published: March 2018

The biodistribution of a series of new 99mTc-benzylidenediphosphonate complexes (99mTc-BDP) in rats was found to vary considerably with substituents in the alpha (X) and para (R) position of the BDP ligands. From the in vivo behaviour of the 99mTc-BDP complexes the following conclusions could be drawn: 1. the blood clearance was accelerated by X = NH2; 2. the kidney uptake was decreased by X = OH; 3. the bone uptake was enhanced by X = OH and R = OH; and 4. R = C1 retarded the blood clearance, increased the kidney and lowered the bone uptake. A subcutaneously transplantable osteosarcoma was tested with 99mTc-BDP complexes as a bone lesion model. Although rapidly growing the osteosarcoma accumulated less activity than the femur diaphysis. The small amount of binding sites in the tumor tissue for osteotropic radiopharmaceuticals was attributed to the formation of necroses.
Die normale Schilddrüse im Szintigramm
Authors: Geiselmann Th. , Feine U.
Published: March 2018

Es werden quantitative Angaben zur Größe der normalen Schilddrüse gemacht: rechter und linker Lappen weisen im Szintigramm eine unterschiedliche Höhe, Breite und Fläche auf, die daraus berechneten Gewichte variieren in Abhängigkeit vom Korrekturfaktor. Dystopes Schilddrüsengewebe findet sich in der Mittellinie, jodspeicherndes Gewebe im lateralen Halsbereich ist dagegen karzinomverdächtig.
A Comparison of the Cyclic Anhydride and Mixed Anhydride Methods for 111In-DTPA Chelation to Monoclonal Antibodies
Authors: Srivastava S. C. , Fawwaz R. A. , Giacomini P. , Ferrone S. , Richards P. , Hardy M. , Alderson P. O. , Wang T. S. T.
Published: March 2018

The cyclic anhydride (CA) and the mixed anhydride (MA) of DTPA were synthesized and used to chelate 111In to an antimelanoma monoclonal antibody. The CA and MA methods showed mean labeling efficiencies of 25.7 and 20.5%, respectively (p = NS). The binding efficiency of labeled antibody to human melanoma cells in tissue culture also was similar (x̄ = 52 and 50%, respectively, p = NS), as was tumor uptake in nude mice at 96 hrs post-injection (16%-CA vs 12%-MA). The method required less complicated chemical syntheses, much less preparation time, and the product was stable over a much longer period. The results suggest that the CA method is preferable for bifunctional chelate labeling of monoclonal antibodies with 111In-DTPA.
Zur Ursache der gekreuzten zerebellaren Diaschisis bei zerebrovaskulärer Erkrankung
Authors: Hartmann A. , Friedrich G. , Fröscher M. , Reichmann K. , Reske S. N. , Knopp R. , Biersack H. J.
Published: March 2018

Bei 31 Patienten mit Apoplexie (n = 30) bzw. PRIND (n = 1) wurde eine Hirn-SPECT mit 123J-markierten Amphetaminen durchgeführt. Hierbei fand sich bei 14 (= 45%) Patienten eine gekreuzte zerebellare Diaschisis. In allen Fällen lag eine zwischen 1 Woche und 7 Jahren bestehende Hemiplegie vor. Demgegenüber bestand bei den Patienten ohne gekreuzte zerebellare Diaschisis mit einer Ausnahme keine Hemiplegie. Das Phänomen einer solchen Diaschisis ist am ehesten darauf zurückzuführen, daß bei Hirninfarkt bzw. -blutung die kontralaterale Körperhälfte gelähmt ist und damit die entsprechende Kleinhirnhemisphäre weniger periphere Reize über spino-zerebellare Bahnen erhält.
Quantitative Radioisotope Measurement of Duodenogastric Reflux in Patients with Ulcer or Gastrectomized for Ulcer
Authors: Pääkkönen M. , Aukee S. , Korhonen K. , Pääkkönen A. , Länsimies E. , Hyödynmaa S.
Published: March 2018

In this work the duodenogastric reflux was quantified as the amount of radioactivity entering the stomach after an i.v. administration of 99mmTc-HIDA in ulcer patients and in patients who had undergone BI gastrectomy. The results were compared with visual evidence of gastric activity in the gamma camera images and biochemical determination of gastric bile reflux. The method is useful in quantifying the reflux if the activity is above the background activity. It allows the determination of an upper limit for the reflux when the reflux is evident visually. Only two or three images are needed for the quantitation. No correlation was found between biochemical measurement of fasting bile reflux in the stomach and radioisotopic quantification.
Der Suppressionstest zur Verlaufskontrolle der thyreostatischen Therapie: Renaissance eines nuklearmedizinischen In-vivo-Verfahrens?
Authors: Becker W. , Börner w. , Reiners Chr.
Published: March 2018

Suppressionstests, die die Supprimierbarkeit der thyreoidalen Jodidbzw. Technetium-Anraffung nach ausreichender Zufuhr von Schilddrüsenhormonen prüfen, gehören seit über 30 Jahren zum Repertoir der nuklearmedizinischen Schilddrüsendiagnostik. Sie werden im Verlaufe der thyreostatischen Therapie dazu verwendet, eine Remission der Hyperthyreose bzw. eine Rezidivgefährdung vorherzusagen. Die Durchsicht der in jüngster Zeit zunehmenden Zahl der Publikationen ergibt, daß bei negativem Suppressionstest am Ende einer ca. einjährigen antithyreoidalen Therapie in rund 70% der Fälle mit einem Rezidiv gerechnet werden muß; bei positivem Suppressionstest beträgt die Rezidivrate nur rund 20%. Die von verschiedenen Arbeitsgruppen vorgeschlagenen Untersuchungsverfahren unterscheiden sich nach Art und Dosis des verwendeten Radiopharmakons, Form und Dauer der Schilddrüsenhormon-Suppression und vor allem durch den Zeitpunkt der Speichermessung. Nach kritischer Würdigung der Literatur wird ein dem heutigen Stand der Technik entsprechendes diagnostisches Vorgehen unter Verwendung von 123J bzw. 99mTc und der computerunterstützten Gammakamera vorgeschlagen.
Investigation of the Parameters Related to the Formation of 99mTc-Pyrophosphate Complexes Using Gel Chromatography Column Scanning
Authors: Al-Janabi M. A. A. , Al-Azzawi H. M. , Abdel-Azeez M. A. A. , Al-Hissoni M. H. S. , Jassim M. N. , Shafiq Y. F.
Published: March 2018

Using gel chromatography two different 99mTc-PPi complexes (complex I and II) were observed under various pH-values. In neutral medium complex II was the main product while in acidic or alkaline media complexes

I and II were formed. Our results related to the organ distribution in mice revealed that complex II

is a bone-seeking agent whereas complex I concentrates in the kidneys.
Ergebnisse der Fettsäure-SPECT des Myokards bei der koronaren Herzerkrankung
Authors: Knapp F. F. , Nitsch J. , Kropp J. , Reichmann K. , Winkler C. , Reske S. N.
Published: March 2018

New developments in radiopharmacology of 123l-labeled metabolic tracers and single-photon emission computerized tomography (SPECT) allow now-a-days the assessment of parameters of cardiac energy metabolism in well-defined areas of the heart muscle. This article will present a brief outline of the basic pathophysiological principles used in the application of 123l-labeled phenyl fatty acids for the evaluation of CAD. First clinical results suggest an important application of cardiac fatty acid metabolic imaging to the detection, localisation and conceivable quantitation of myocardial ischemia, myocardial infarction and assessment of tissue viability. In addition to the diagnostic applications in CAD, cardiac fatty acid metabolic imaging may provide new perspectives to pathophysiological investigations of the coupling of local flow and substrate utilisation in vivo and the effect of therapeutic interventions.
Comparison of Renal Size as Determined by Scintigraphy and Radiography
Authors: Gyftaki E. , Pontifex G. , Binopoulos D. , Kesse-Elias M. , Mavrikakis M.
Published: March 2018

The values for the apparent size of the kidneys as determined by scintigraphy and radiography were compared on 100 normal adult subjects. The values for both the long and short axes, and for the area calculated therefrom, were corrected for the radiographic magnification of images. The results of the two methods agree reasonably well but scintigraphy must be considered to be the more reliable method as it provides a more accurate estimate of the short axis of the kidney.
Investigation of Distortions in Gamma Camera Scintigraphic Pictures
Authors: Toiwinski J. , Mackiewicz H. , Siwicki H. , Tarkowski W. , Jasinski W. K.
Published: March 2018

Pictures of a homogenous volume source of activity registered in the memory of the analyser, show large differences in counts from channel to channel which result in picture distortions.

The aim of this investigation was to develop a simple measuring test to define the degree of distortion caused by the uneven response of the scintillation camera detector.

The effect of three parameters on the degree and kind of distortion in pictures obtained from a 1600-channel analyser was investigated. These parameters were: the time period between camera tunings, the activity of the source, and the number of collected data.

Measurements were made with a scintillation camera Nuclear-Chicago Pho/Gamma II combined with a 1600-channel analyser.
The Diverging Collimator
Authors: Muehllehner G.
Published: March 2018

The diverging collimator makes it possible to increase the field of view of a radioisotope imaging camera. The larger field of view is obtained by sacrificing efficiency per unit area of the field of view while preserving the resolution of the system. This situation is analogous to that of the scanner, where the efficiency per unit area is inversely proportional to the total area scanned.

Efficiency and resolution of diverging collimators can be calculated quite accurately as is evidenced by the good agreement between calculated and measured values. The problem of septum penetration, however, needs to be further investigated for both parallel-hole as well as diverging collimators, so that the influence of the shape and arrangement of the holes upon septum penetration is taken into account.
Thyroxinbindende Beta-Globuline während einer subakuten Thyreoiditis
Authors: Bekier A.
Published: March 2018

Im experimentellen Teil der Arbeit wird mittels Papierelektrophorese im Veronal-Natrium-Puffer bei pH 8,6 der Einfluß von wasserlöslichem Thyreoglobulin auf die 125J-Thyroxin-Verteilung unter den Serum-Protein-Fraktionen untersucht.

Das Thyreoglobulin führt ähnlich wie das 125 J-Thyroxin zur Verlagerung des Aktivitäts-Maximums auf die Albumine. Eine kompetitive Verdrängung des 125 J-Thyroxins auf die Beta- oder Gamma-Globuline konnte nicht beobachtet werden.

Der Einfluß der Autoimmun-Antikörper und die möglichen Ursachen der abnormalen Aktivitätsverteilung unter den Protein-Fraktionen des Serums werden diskutiert.
A Simplified Procedure for the Preparation of 131I-Labelled Sulfobromophthalein. Its Applications to Liver Scanning
Authors: Tubis Manuel , Viranuvatti Vikit , Limwongse Kasem , Suwanik Romsai
Published: March 2018

A method of preparing 131I-labelled sulfobromophthalein is described. The method is simple and inexpensive. The labelled compound is of particular value where 99mTc-labelled preparations for liver scanning are too expensive or not readily available. It has been used as a liver scanning agent with satisfactory-results, revealing both morphological as well as functional abnormalities in various liver conditions in the same manner as 131I-labelled Rose Bengal.

Its use in liver scanning has been extended to the visualization of the liver abscess cavity after intracavitary injection. The method has been used to observe the changes in size and configuration of the abscess cavity during its course of healing under medical treatment. Another extension of the work is the intraductal administration of the labelled compound viaa T-tube to demonstrate the dilatation of the biliary tract in cases of advanced opisthorchiasis.

The application of the labelled compound to liver scanning is illustrated.
The Value of 67Ga Scanning in the Evaluation of Liver Involvement in Hodgkin’s Disease: Comparison with 99mTc-Sulfur Colloid
Authors: Larson Steven , Schall Gerald , Johnston S.
Published: March 2018

A patient with documented Hodgkin’s disease was evaluated by a whole-body scan performed with 67Ga citrate and a liver scan performed with 99mTc sulfur colloid. The gallium study showed two areas of abnormal, positive concentration within the liver, whereas the liver scan showed only one negative defect. 67Ga scanning may be a more sensitive indicator of hepatic involvement in Hodgkin’s disease than the colloid scan, and appears useful in confirming a diagnosis of malignancy in the presence of a negative defect on the liver scan.
Zur Aktivitätsbeurteilung der fibrösen Knochendysplasie mittels Szintigraphie und Thermographie
Authors: Czitober H , Meixner M , Strassl R , Umek H
Published: March 2018

Bei fünf Patienten mit verifizierter fibröser Knochendysplasie verschiedener Lokalisation wurden röntgenologische, szintigraphische und thermographische Befunde miteinander verglichen.

Das Röntgenbild zeigt häufig einseitig lokalisierte, charakteristische Knochenveränderungen, die mit einer Asymmetrie des betreffenden Skelettabschnittes einhergehen.

Diesem Befund entspricht im Szintigramm eine deutlich erhöhte Aktivitätsanreicherung, die thermographisch mit einer erhöhten Wärmeabstrahlung korreliert.

Ein Stillstand des Knochenumbaues, wie er für das Erwachsenenalter gefordert wird, konnte von uns nicht beobachtet werden.

Während eine Aussage über Stillstand oder Progredienz der Erkrankung röntgenologisch nur retrospektiv getroffen werden kann, bieten sich Szintigraphie und Thermographie als unspezifische Parameter zur Erfassung der Aktivität des Prozesses an.
Scintigraphic Cholecystography — the Problem of Contrast Media Selection and Labelling
Authors: Strohal P. , Huljev D. , Filjak K. , Cvrtila D. , Spaventi Š.
Published: March 2018

La possibilité d’obtenir „Biligraphine“ marquée par 131I d’une activité hautement spécifique a été examinée en vue d’obtenir une préparation convenable pour le diagnostic scintigraphique du tract hépato-biliaire avec l’emploi d’un volume réduit du moyen de contraste.

Les résultats ont montré que la meilleure contribution de la réaction est obtenue quand le matériel est traité pendant 11 heures à une température de 150—180° C. Après cette période environ 90% de 131I est entré dans le Biligraphine. Le reste de l’iodide radioactif libre s’élimine por un échangeur d’ions.

Nous pouvons conclure que la méthode de l’échange homogène offre de bonnes possibilités pour le marquage des moyens de contraste et qu’elle est réalisable par un procédé relativement simple.
Peripheral Metabolism of Thyroxine and Triiodothyronine in Endemic Goitre
Authors: Gonticas Spyros , Ikkos Denis , Alevizaki Calliopi
Published: March 2018

Le métabolisme périphérique de la triiodothyronine (T3) et de la thyroxine (T4) a été déterminé simultanément en Grèce chez des personnes affectées d’un goitre non toxique. La comparaison avec des résultats d’une groupe de contrôle montre que chez les goitreux, le métabolisme T4 était normal tandis que le métabolisme T3 était accéléré surtout par un agrandissement de l’espace de distribution du T3. On suppose que le mécanisme de compensation pour les réserves de l’iode diminuées dans le goitre endémique consiste en une augmentation de la production et de l’utilisation du T3.
Development of Barium-135m Radiopharmaceutical for Skeletal Imaging
Authors: Syed Ibrahim , Hosain Fazle , Wagner Henry
Published: March 2018

L’étude décrit une investigation systématique à fin de développer un composé de 135mBa utilisable pour la scintigraphic osseuse. L’isotope a été produit dans un réacteur à flux élevé. La période de 1,2 jours et l’énergie des photons de 268 kev sont particulièrement favorables pour l’enrégistrement par un scanner rectiligne ou une gammacaméra. Le composé consiste en 135mBa en HCl à une activité spécifique de plus de 5mCi/mg Ba, neutralisé à un pH de 6,5 et rendu isotonique. Un facteur de sûreté de plus de 1000 pour la LDj de la substance traceur a été conservé. La dose de radiation dans le squelette était de 1,2 rad par mCi. Pour l’intestin, elle peut arriver à 4 rad par mCi. La dose traceur injectée quitte rapidement la voie sanguine et se trouve fixée à environ 60% dans le squelette tandis que 40% sont excretés de préférence par les selles. Après l’administration de laxatifs, on a obtenu des scintigraphies satisfaisantes 1 à 2 jours après administration. Le plus grand désavantage est la Pertubation par la radioactivité gastro-intestinale.
Die Durchblutungsmessung durch 133Xe-Inhalation zur Überwachung transplantierter Nieren
Authors: Schmitz-Feuerhake I. , Wonigeit K. , Coburg A. J. , Falkenreck-Herbst I.
Published: March 2018

Die Ergebnisse von Durchblutungsmessungen an transplantierten Nieren mit der katheterlosen 133Xe-Inhalationsmethode über einen Beobachtungszeitraum von 2½ Jahren werden vorgestellt und diskutiert. Den über der Niere aufgenommenen 133Xe-Auswaschkurven werden zwei Informationen entnommen: 1. Die Zeitkonstante der ersten Komponente, aus der die spezifische Nierenrindendurchblutung errechnet wird, 2. das Gewicht der ersten Komponente in der Gesamtkurve als Maß für den Anteil des funktionierenden Rindengewebes. Das anhand der Meßwerte ermittelte Durchblutungsverhalten entspricht den mit anderen aufwendigeren Techniken gewonnenen Ergebnissen: langsamer Anstieg in der frühen postoperativen Phase bis zur Erreichung des Optimalwerts bei guter Nierenfunktion nach 10 bis 14 Tagen; dabei liegen die Durchblutungswerte bei gut funktionierenden Allotransplantaten 20 bis 30% unter denen bei Nierengesunden; ra pider Abfall der Durchblutung in der Frühphase der akuten Abstoßungskrise. Die Methode eignet sich zur Früherkennung von akuten Abstoßungsreaktionen und ist dabei zugleich ein wichtiges differentialdiagnostisches Hilfsmittel bei jeder akuten Funktionsverschlechterung. In der chronischen Abstoßungsreaktion gibt die Durchblutung ein Maß für den irreversiblen obliterativen Gefäßschaden.