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A Phase 2 multicenter trial of 123I-IBF, (S)-5-iodo-7-N-[(1-ethyl-2- pyrrolidinyl)methyl]carboxamido-2,3-dihydrobenzofuran, was conducted to evaluate its clinical efficacy and safety in 158 patients with Parkinson's disease (PD) or Parkinson syndromes (PS). SPECT data were acquired at two hours (2H-SPECT), after intravenous injection of 123I-IBF (167 MBq). Additional SPECT scan at three hours (3H-SPECT) and dynamic SPECT scan at most until one hour were performed when possible. No severe side effects due to 123I-IBF injection were observed. The sensitivity, specificity and accuracy for discriminating PS from PD using the striatal specific binding count-to-frontal cortex count ratio (St/Fc-1) in 3H-SPECT were 72.7%, 81.0% and 78.1% in 64 clinically definite cases (i.e., typical cases), respectively. The putamen-to-caudate ratios were significantly lower in striatonigral degeneration compared with those in PD. The contralateral-to-ipsilateral ratios against the symptomatic side of tremor and/or rigidity in the patients with PD (HoehnYahr I) were significantly higher than the left-to-right ratios in the normal controls. St/Fc-1 in 3H-SPECT was significantly lower in the patients showing a poor response to levodopa than in those showing a good response. The dopamine D2 receptor binding potential (k3/k4), obtained by dynamic SPECT based on compartment model analysis, correlated well with the striatal specific binding count-to-occipital cortex count ratio. These results suggest that 123I-IBF is a promising agent for differential diagnosis and pathophysiological evaluation of PD and PS.

The phase III clinical trial of strontium-89 chloride agent (SMS.2P) was performed in 90 patients with painful bone metastases secondary to prostate (53), breast (18) and other types of cancer (19). Some patients experienced a transient increase in pain or nausea and vomiting. However both symptoms subsided and serious side effects were not observed in any of the patients. As reported, we confirmed some abnormal changes in peripheral blood picture. A decrease in the number of white blood cells and platelets was considered to be partly a result of bone marrow suppression due to 89Sr irradiation. Pain was substantially improved after 89Sr therapy in 58% of the patients and there was some alleviation in 12%. The release from pain was accompanied by an improved quality of life for these patients including sleep patterns and morbidity. Some patients were able to resume their former life styles. Most of the improved patients experienced pain relief from days to one week following 89Sr therapy and in half cases, this remained effective for 2 or 3 months. There were even cases in which the pain relief continued over an observation period of time of clinical study.

Single photon emission computed tomography (SPECT) using 123I-Iomanzenil (IMZ), a tracer which binds specifically to central-type benzodiazepine receptors, was performed in patients with cerebrovascular diseases (CVD) to determine the clinical signicigance of IMZ SPECT studies in evaluating the pathophysiology of CVD. IMZ SPECT images obtained three hours after administration of the tracer were compared with the images of cerebral blood flow (CBF) studies in 206 cases. In regions with decreased CBF, the uptake of IMZ was relatively preserved in patients with cerebral thrombosis in comparison with cerebral embolism, and in those with perforator branch infarction in comparison with cortical infarction. The uptake of IMZ decreased as a function of both the severity of the decrease in the CBF and the duration of illness in regions with a significantly decreased perfusion reserve. These results suggest that decreased IMZ binding in ischemic stroke reflects the neuronal damage caused by the cerebral ischemia. On the other hand, in patients with intracerebral hemorrhage, the cortical uptake of IMZ was relatively well-preserved in regions with decreased CBF, and the decrease in the uptake of IMZ was more profound as a function of the decrease in the CBF, especially in cases of putaminal hemorrhage. These results also suggest that the decreased cortical CBF is a remote effect caused by a neuronal disconnection, and neuronal damage may occur in regions with severely impaired CBF.

Iomazenil (IMZ) is a partial inverse agonist of central-type benzodiazepine receptors (BZR) which binds specifically to BZR with high affinity. The safety and clinical effectiveness of 123I-IMZ SPECT in the diagnosis of brain diseases were evaluated in 655 patients with various brain diseases, such as epilepsy, cerebrovascular diseases, degenerative diseases and mental disorders relating to BZR. This was a Phase 3 study conducted as a multicenter trial at 52 collaborating institutions. There was no significant adverse reactions in the clinical symptoms or abnormal laboratory test values. The investigators judged 123I-IMZ SPECT to be effective in 95% of 638 analyzed cases. The injected dose did not correlate with the image quality or the clinical effectiveness of 123I-IMZ SPECT, suggesting that these items depend largely on the characteristics of the apparatus used, the disease or pathology of the patients, rather than the dose. We conclude that 123I-IMZ imaging is safe and provides effective information based on BZR binding which is useful in the diagnosis of various brain diseases.

Iomazenil (IMZ) is a partial inverse agonist of central-type benzodiazepine receptors (BZR) which binds specifically to BZR with high affinity. A multi-center Phase 3 clinical study was performed to evaluate the clinical usefulness of 123I-IMZ-SPECT in the diagnosis of brain disorders in 169 patients with degenerative neurological diseases and 37 patients with mental disorders such as neurotic, stress-related and somatoform disorders. In dementia, the decrease in activity in late images, obtained three hours after administration of 123I-IMZ, correlated negatively with the dementia score. In Parkinson's disease and spinocerebellar degeneration. 123I-IMZ showed a more profound decrease in uptake in late images than seen in the cerebral blood flow (CBF) images, and this decrease was in proportion to the duration and severity of the illness. In mental disorders, the ratio of the late to early image counts showed a negative correlation with Hamilton's anxiety scale in all regions in the brain cortices. In panic disorders, the ratio of the cerebral count to the cerebellar count in the late images correlated negatively with the severity of the attack in the frontal, temporal and parietal cortices. These results suggest that 123I-IMZ-SPECT enables us to evaluate the neuronal damage in degenerative diseases and the decrease in the BZR binding potential in mental disorders.

A phase 2 study of 123I-Iomazenil (IMZ) was performed to evaluate its clinical usefulness in SPECT imaging of central-type benzodiazepine receptors (BZR). A total of 246 patients with various central nervous system disorders [82 with epilepsy, 94 with cerebrovascular disease (CVD), 47 with degenerative disorders, 14 with mental disorders relating to BZR and 9 with other diseases] were intravenously injected with 111-222 MBq of IMZ. Early and late images were obtained 15 min and 180 min after injection as the mid-scan time, respectively. In comparison with regional cerebral blood flow (rCBF) images, the uptake of IMZ in the late images, which reflect the regional distribution of BZR, was relatively preserved compared to the uptake of CBF tracers in most of the patients with CVD. In the area of hyperperfusion in the subacute phase of cerebral infarction, however, the defects of IMZ uptake were accompanied by increased uptake of the CBF tracers. On the other hand, late IMZ uptake in most of the patients with the other diseases was decreased more significantly than the uptake of the CBF tracers, suggesting that cortical neuronal damage is more prominent than rCBF in these diseases compared to the vascular perfusional state. No adverse reactions were recognized relating to the IMZ administration. These results suggest that IMZ may provide us with valuable information for assessing pathophysiological state in the brain, which are difficult to achieve with other imaging modalities.

A phase 2 clinical study of 123I-iomazenil (IMZ) was performed to evaluate its clinical usefulness as central-type benzodiazepine receptor imaging agent in 81 cases with epilepsy, 82 cases with cerebrovascular diseases (CVD), 35 cases with degenerative disorders and 14 cases with mental disorders. In epilepsy, IMZ SPECT images for detection of epileptic foci showed relatively high specificity compared with EEG recording in not only interictal but also ictal state, in spite of the fact that IMZ SPECT images was performed during interictally. It was surmised that IMZ SPECT provides valuable clinical information for detection of epileptic foci which are hard to be diagnosed by EEG. The frequency of abnormal findings by IMZ late images was higher than that by interictal blood flow images and comparable to that by ictal blood flow images. In patients with CVD, different observations were obtained between IMZ late images and blood flow images; for example, in regions of hemodynamic cerebral ischemia, postischemic reperfusion and other pathological perfusion, IMZ late images seemed to reflect the degree of cortical neuronal loss. In patients with degenerative disorders, the binding potential (calculated by a simple quantitative method for IMZ) and other parameters correlated with the dementia score. While the number of examined cases with mental disorders was limited, the frequency of abnormal findings with IMZ imaging was higher than that with morphological imaging.

A Phase 1 clinical study of 123I-iomazenil (IMZ), a new radiopharmaceutical developed for evaluation of central-type benzodiazepine receptor (BZR) with SPECT, was performed to examine its safety and biodistribution in six healthy volunteers. The brain uptake of 123I-IMZ reached a maximum value of 11.7 +/- 1.6% of the injected dose at 10-20 min after i.v. administration, and then decreased slowly. The regional tracer distribution immediately after injection (0-10 min) was considered to be a reflection of the cerebral blood flow. From 2 to 3 hours post-injection, washout of the radioactivity from the deep gray matter was observed, resulting in the distribution reflecting the reported distribution of BZR. No significant accumulation was seen in any organ other than the brain. The estimated absorbed dose of 123I-IMZ calculated by the MIRD method was comparable to that of 123I-N-isopropyl-p-iodoamphetamine. Neither adverse reactions nor abnormal clinical laboratory findings due to the drug administration were observed. These results suggest that 123I-IMZ is a safe and promising agent for evaluating the function of central-type BZR.

The clinical usefulness of scintigraphy with thallium-201 (201Tl) chloride injection was evaluated in 79 patients with suspected bone, soft tissue or mediastinal tumors. No abnormal changes of subjective or objective signs and clinical test values were observed post injection. It is considered that 201Tl chloride is a safe radiopharmaceutical. In comparison with benign tumors, malignant tumors showed longer retention or more increased uptake of the 201Tl in the lesions on delayed images. The results suggested that the evaluation of changes of 201Tl uptake might be useful to some extent to differentiate malignant tumor from benign tumor. It is considered that 201Tl scintigraphy is useful for evaluating the location and extent of tumor and differentiating malignant from benign tumor.

Forty-eight patients with suspected brain tumor were studied to evaluate the clinical efficacy of Thallium-201 (201Tl) SPECT. 201Tl scintigrams showed abnormal accumulation in 24/26 (92.3%) and 9/14 (64.3%) of patients with malignant and benign tumors, respectively. 201Tl tended to be retained more prominently in malignant brain tumors than in benign ones. The lesion-to-normal ratios (L/N ratios) of 201Tl demonstrated significant correlation with those of 18F-FDG (n = 5, r = 0.90, p = 0.044). L/N ratios were higher in patients with recurrent tumors than those with necrotic lesions (3.33 +/- 0.81 and 1.73 +/- 0.81, respectively, p = 0.0123). The positive predictive value of L/N ratiosor = 2.5 for diagnosing as recurrence and L/N ratios2.5 as necrosis were 83.3% and 100%, respectively. These results suggest that 201Tl scintigraphy may be useful to determine the malignancy of brain tumors and to differentiate recurrence from necrosis after therapeutic procedures.

Clinical utility for detection of hyperfunctioning parathyroid glands in patients with primary and secondary hyperparathyroidism (PHPT, SHPT) using 201TlCl and 99mTcO4-images was estimated in 50 patients including 18 PHPT and 32 SHPT (male; n = 31, female; n = 19, 51.5 +/- 11.1 yr). Detection of 94 hyperfunctioning parathyroid glands in 34 cases were achieved correctly by 201TlCl and 99mTcO4- images in agreement with surgical findings. Detectability of hyperfunctioning parathyroid glands was 100% in more than 1.0 g, 62.0% in more than 0.5 g and 41.5% in less than 0.5 g respectively. Ectopic parathyroid glands in two cases and a metastasis to pretracheal lymph node in one case were clearly demonstrated. Our results show that parathyroid scintigraphy using 201TlCl and 99mTcO4- as well as 131I or 123I is useful and safe method for preoperative detection of hyperfunctioning parathyroid glands.

A phase 2 clinical study of 99mTc-mercapto acetyl glycylglycylglycine (99mTc-MAG3) injectable, a new dynamic renal imaging agent, was performed in 110 patients with renal and/or urinary disorders to evaluate the safety, efficacy and optimal dose of this agent. Neither adverse reactions nor abnormal laboratory findings due to intravenous administration of 99mTc-MAG3 were observed. The investigators evaluated the clinical efficacy of 99mTc-MAG3 was to be effective in 96 of 97 cases. Among the doses of 92.5 MBq, 185 MBq, 370 MBq and 555 MBq, the dose of 92.5 MBq was not large enough to provide adequate-quality blood flow images or reliable information for evaluation of the renal blood flow. It was concluded that the optimal dose range of 99mTc-MAG3 was 185-555 MBq with 370 MBq as the standard dose. Also, we surmise that 555 MBq is especially recommendable when detailed blood flow information is required. These results indicate that 99mTc-MAG3 injectable is useful for the diagnosis of renal and urinary disorders.

A multicenter clinical trial of 99mTc-mercaptoacetylglycylglycylglycine (99mTc-MAG3), a new 99mTc-labeled renal scintigraphic and renographic dynamic functional agent, was performed to evaluate its clinical usefulness at 24 hospitals. The study was performed as a phase III clinical trial and total 357 patients with renal or urinary disorders were examined. There was no adverse reactions in all patients therefore administration agent was judged to be safe by the investigators. 99mTc-MAG3 was proved and concluded to have a superior effectiveness by the investigators in all 347 patients, and by the committee composed of eight representative investigators in 346 patients (99.7%). 99mTc-MAG3 gives a good quality of images of renal, perfusion phase and function-excretory phase as well as functional informations in comparison with 123I-OIH. The committee decided that 99mTc-MAG3 had a superior effectiveness than 123I-OIH in 147 out of 153 cases (96.1%). It is concluded that 99mTc-MAG3 is a safe and effective radiopharmaceutical for routine use in diagnosis of renal dynamic function.

A phase 3 clinical study of a newly developed brain perfusion agent, 99mTc-L,L-ethyl cysteinate dimer (99mTc-ECD), was performed in 521 cases of cerebrovascular diseases and impairment of brain function to evaluate the safety, effectiveness and usefulness of the agent as a multi-center study involving 35 institutions in Japan. Out of 510 cases evaluated for the clinical usefulness, valuable information for clinical diagnosis was obtained in 486 cases (95.3%), and 444 cases (87.1%) were judged as "extremely useful" or "useful". Although the positive ratio of abnormalities detected by the agent was as same as that of 99mTc-hexamethylpropyleneamine oxime (99mTc-HM-PAO), the abnormal regions detected by the agent had tendency to be larger in size and to have higher contrast than those detected by 99mTc-HM-PAO. It is concluded that 99mTc-ECD is a safe and useful radiopharmaceutical as a brain perfusion agent for the diagnosis of cerebrovascular diseases and impairment of brain function.

A phase 2 clinical study of a newly developed brain perfusion agent, 99mTc-ECD, was performed in 166 cases of cerebrovascular diseases and impairment of brain function to evaluate effectiveness, usefulness, optimum dose and optimum timing of imaging as a multi-center study involving 10 institutions in Japan. All cases were judged as no problems on safety and any side effects due to the administration of the compound were not observed. Out of 163 cases evaluated for the clinical usefulness, valuable information for clinical diagnosis was obtained in 160 cases (98.3%), and 154 cases (94.5%) were judged as "extremely useful" or "useful". Although SPECT imaging was possible from 5 min after injection, images obtained between 60 and 90 min after injection showed relatively better image quality in many cases. Regarding standard administration dose, 400 to 800 MBq were considered to be appropriate. 99mTc-ECD is considered to be a promising radiopharmaceutical as a brain perfusion agent.

A multi-center trial of beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP) was performed to assess its clinical usefulness in the evaluation of myocardial fatty acid metabolism in 587 patients with various heart diseases. 123I-BMIPP showed relatively decreased uptake compared with 201Tl in the myocardial lesions of 62% of patients with ischemic heart disease (IHD), 39% of those with cardiomyopathy and 32% of those with other heart diseases. In case of myocardial infarction, less uptake of 123I-BMIPP (Type B) than 201Tl was more frequently seen in patients with successful recanalization than in those without recanalization. The patients with matched distribution of the two tracers (Type E) increased in the direct proportion to the interval between the onset of myocardial infarction and the radionuclide studies. The uptake of 123I-BMIPP correlated well with myocardial viability evaluated by 201Tl exercise-redistribution studies. Type B was frequently seen in the areas with 201Tl redistribution, while Type E was seen in the fixed defect areas. In the other heart diseases studied, Type E was observed in approximately 60% of patients with dilated or secondary cardiomyopathies. Type B was seen in about 45% of patients with valvular heart diseases and myocarditis. Various types of mismatch between the two tracers were demonstrated in hypertrophic cardiomyopathy and hypertensive heart disease. It is concluded that 123I-BMIPP is a safe and useful agent for the diagnosis of various heart diseases, since it reflects myocardial fatty acid metabolism.

A phase 2 study of beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP), a myocardial imaging agent developed for evaluating myocardial fatty acid metabolism, was performed in 197 patients with various heart diseases. The myocardial distribution of 123I-BMIPP did not change from early to late images in 88% of 91 patients with ischemic heart disease (IHD), while washout and/or fill-in were observed in 45% of 55 patients with hypertrophic cardiomyopathy (HCM). In comparison with 201Tl in 165 patients with various heart diseases, the decrease in uptake was more profound with BMIPP in 56% and with 201Tl in only 4%. 123I-BMIPP showed more severely decreased uptake in 83% of the patients with subacute myocardial infarction (15 to 30 days after the onset) and in 73% of the patients with HCM. High-quality SPECT images were obtained with 123I-BMIPP in 93% of 194 patients analyzed. However, the image quality in cardiomyopathy was inferior to that in IHD. The optimal injection dose range and standard dose of 123I-BMIPP were considered to be 74-148 MBq and 111 MBq, respectively. These findings suggest that 123I-BMIPP myocardial imaging is safe and useful for evaluating myocardial fatty acid metabolism in various heart diseases.

Phase II study of 99mTc-DTPA-galactosyl human serum albumin (99mTc-GSA), a new radiopharmaceutical which binds to the asialoglycoprotein receptors on the hepatocytes, was performed in 81 patients with liver diseases to validate its safety and possibility for the evaluation of hepatic function. None of adverse reactions, abnormal clinical laboratory findings and anti-99mTc-GSA antibody production due to 99mTc-GSA was recognized. Immediately after the injection of 99mTc-GSA, the dynamic data and serial hepatic images were obtained for 60 min. The indices for blood clearance and liver accumulation were calculated based on the counts in the regions of interest on the hearts and livers. In 54 patients with chronic hepatic disorders such as liver cirrhosis, the blood clearance and liver accumulation of 99mTc-GSA were retarded according to the progress of the hepatic disorders. The findings of 99mTc-GSA scintigraphy also reflected the hepatic functions of the patients with large hepatic tumors, obstructive jaundice and acute hepatitis. These results suggest that 99mTc-GSA has the clinical potentials to evaluate the liver functions in the patients with hepatic disorders.

Multicenter Phase III clinical trial on a new myocardial imaging agent, 99mTc-hexakis 2-methoxy isobutyl isonitrile (99mTc-MIBI), was carried out in 464 patients with various cardiac disorders. Both planar and tomographic images provided high-quality regional myocardial perfusion images which correlated well with 201TlCl images. The positive ratios of myocardial infarction and angina pectoris by the agent were as high as that of 201TlCl. In addition, ventricular function and wall motion could be assessed with first-pass and ECG gated studies. There was no serious adverse reaction which were attributed to 99mTc-MIBI in any of patients studied. A transient metallic taste was observed immediately after the injection in approximately 64% of the patients. Based on its safety and efficacy, the clinical usefulness of 99mTc-MIBI was observed in 562 (93.1%) of 604 injections. In conclusion, 99mTc-MIBI was useful as a imaging agent of myocardial blood flow.

Gd-DTPA (Gd) has been shown to provide effective contrast enhancement in MR imaging. However, it is sometimes impossible to evaluate Gd contrast enhancement (C.E.) in high intensity tissues like fat and bone marrow. To solve this problem, color-hybrid images (hybrid images) were generated by the use of an RGB mixing method. A total of 54 lesions, including 30 bone and soft tissue lesions and 24 gynecological lesions, were studied. In most cases, the hybrid images were superior to the original ones in terms of both morphologic and temporal evaluation of Gd C.E. The hybrid images helped to define the localization and extent C.E., by providing better visualization through the use of color display.

Distributions of pulmonary blood flow per unit lung volume were measured with subjects in the prone, supine, and sitting positions by means of radionuclide-computed tomography of intravenously administered 99mTc-labeled macroaggregates of human serum albumin. The blood flow was greater in the direction of gravity in all 31 subjects except one with severe mitral valve stenosis. With the subject in a sitting position, four different types of distribution were distinguished. One type had a three-zonal blood flow distribution as previously reported by West and co-workers (J. Appl. Physiol. 19: 713–724, 1964). Pulmonary arterial pressure and venous pressure estimated from this model showed reasonable agreement with pulmonary arterial pressure and capillary wedge pressure measured by Swan-Ganz catheter in 17 supine patients and in 2 sitting patients. The method makes possible noninvasive assessment of pulmonary vascular pressures.

In order to clarify intrarenal dynamic processes related to regional distribution in patients with unilateral renal disease, two radioactive tracers, 133Xe and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) were introduced into a renal artery and intrarenal blood flow and urine flow aspects were observed by scintillation camera. Cortical blood flow decreased and medullary blood flow relatively increased with the advance of renal damage. Urine flow curve from normal cortex showed two phasic patterns. One early phase might correspond to the appearance of the tracer through the proximal tubule and a second phase might correspond to the appearance of the tracer through the loop of Henle to the distal tubule. Under mannitol diuresis, two phasic urine flow curves from the cortex became obscured and the peak time of pelvic curve shifted to the earlier period. These studies were considered to be useful in evaluating unilateral renal function and might offer a good insight for intrarenal physiology concerning blood flow as well as urine flow.

In one case of untreated Hashimoto's disease, serum thyroxine (T4) value by radioimmunoassay (RIA) was significantly lower than that by competitive protein binding analysis (CPBA). The discrepancy was found to be due to the presence of antithyroxine autoantibody in the serum. This phenomenon was considered to be of practical importance in interpreting the T4 value by RIA in cases with autoimmune thyroid diseases. The patient was 59-year-old woman with a 30-year history of goiter. A diagnosis of Hashimoto's thyroiditis had been established by open biopsy of the thyroid ten years ago. The patient was judged to be euthyroid on the basis of clinical and laboratory evaluation (mean serum T4 by CPBA (Tetrasorb and Tetratab kit), 5.0 mug/100 ml; serum T3, 165 ng/100 ml; T3 resin uptake, 31.8%; and serum TSH, 2.0 muU/ml). TBG binding capacity was 24 mug/100 ml. Anti-thyroglobulin antibodies (anti-Tg), once positive ten years before, was negative at this time. But the mean T4 in the serum measured by T4 RIA and RIA-Mat T4 kit were 1.7 and 2.9 mug/100 ml, respectively. Recovery of the T4 added to the patient's serum evaluated by RIA-Mat T4 kit, was 71.2%, although the recovery using a control serum was 108%. Binding of 125I-T4 to the serum or fractions of the serum was studied by using polyethylene glycol (PEG) method, column chromatography, and double antibody precipitation. The results were as follows: 1) The binding of 125I-T4 to the patient's serum was detected by using RIA kit system without addition of anti-T4 serum. 2) On Sephadex G-200 chromatography of 125I-T4 incubated with the serum or the rabbit anti-T4 antibody in the presence of ANS, an early radioactive peak was observed by using the patient's serum as in the case of the anti-T4 antibody. When the serum after thermal inactivation of TBG, was incubated with 125I-T4, and was applied to the Sephadex G-200 column, a radioactive peak was observed in the area where 7S fraction was detected by protein peak. 3) The binding of 125I-T4 to the patient's IgG was 9.0% by using double antibody method when the binding to a control IgG was 0.5%. 4) The binding of 125I-T4 to IgG fractions was also proved by PEG method. 5) The binding of 125I-T4 was competitively inhibited by the addition of unlabeled T4. The affinity constant was 1.9 X 10(8) L/mol and its binding capacity was 0.8 mug/100 ml serum. From these data this T4 binding IgG was considered to be anti-T4 autoantibody. The cross reaction with T3 was approximately 8.3%. MIT and DIT did not displace labeled T4 when tested in amounts varying from 0.1 to 100 ng/assay. By using the paper electrophoresis, the binding of 125IT4 to the serum or IgG was not detectable. Therefore this method was considered unsuitable for detecting such anti-T4 antibody. As we couldn't find any significant binding of 125I-T4 to sera in 37 other patients with Hashimoto's disease by using the PEG method, the incidence of this phenomenon was considered to be low...

A false aneurysm of the left ventricle is an uncommon and usually fatal condition, although sometimes it may be successfully repaired with surgery. This report describes two cases of false left ventricular aneurysms detected by first-pass radionuclide ventriculography. The aneurysmal chamber with a small neck giving a characteristic hourglass configuration to the ventricle was clearly demonstrated in these cases. Contrast ventriculography showed similar findings. Cross-sectional echocardiography revealed the characteristics of the false aneurysm in the second case, but was unsuccessful in the first due to pulmonary emphysema. The first patient unfortunately died of a rupture of the false aneurysm but the second patient was treated successfully with surgery. Because of the marked tendency of false aneurysms to rupture, early and safe diagnosis is desirable. Therefore, when a patient shows signs of a left ventricular aneurysm, radionuclide angiography is recommended to differentiate false and true aneurysms non-invasively.

Gated cardiac blood pool scan and hemodynamic parameters by Swan-Ganz catheter were simultaneously measured in five normal subjects (Group A), five patients with coronary artery disease (CAD) without angina on exercise (Group B) and nine patients with CAD with angina on exercise (Group C) in order to evaluate left ventricular function at rest and during supine bicycle ergometer exercise. Work load was gradually increased every 3 minutes and each data were acquired using a digital computer. There was a fairly good correlation (r = 0.83) between stroke volume by thermodilution method and stroke counts corrected by counts/ml of blood on gated cardiac blood pool scan, which were obtained by subtraction of end-systolic counts (ESC) from end-diastolic counts (EDC) in the region of interest arranged at the left ventricle. Stroke counts obtained by this method are considered to reflect a change in the left ventricular volume during exercise. As to the correlation between pulmonary capillary wedge pressure (PCWP) and stroke work index (SWI) at peak exercise, there was a large increase in SWI (78.9 +/- 17.6 to 112.3 +/- 30.0 g X m/m2) with a small rise in PCWP (10.0 +/- 1.9 to 16.2 +/- 4.0 mmHg) in Group A. In Group B, SWI was increased (57.8 +/- 15.8 to 92.9 +/- 25.2 g X m/m2) with a moderate rise in PCWP (11.8 +/- 3.7 to 20.0 +/- 3.1 mmHg) at peak exercise. In Group C, there was a trivial increase in SWI (74.0 +/- 16.0 to 81.2 +/- 29.3 g X m/m2) despite a marked rise in PCWP (13.1 +/- 3.1 to 33.4 +/- 8.9 mmHg). Similar relationship was present between SWI and EDC. On mild exercise of 25w, however, the rise in PCWP was more prominent rather than the increase in EDC in Group C. This indicates that the left ventricle in Group C is operating on a very steep portion of the diastolic pressure-volume curve.

Serum CA125, CEA, AFP, LDH levels and LDH isoenzymes were analyzed in ovarian tumor patients, who were treated at Kyoto University Hospital. CA125 was positive in 10/16 (62.5%) cases of common epithelial carcinoma, especially 100% positive in serous carcinoma, but was negative in mucinous tumors. CA125 was also negative in patients with germ cell and sex cord stromal tumors. CEA was positive in 13/32 (40.6%) cases of epithelial carcinoma, most frequently elevated in patients with mucinous carcinoma, pseudomyxoma peritonei, and Krukenberg tumor. AFP was positive only in those with endodermal sinus tumors. LDH was elevated in 16/39 (41%) cases of epithelial carcinoma, but was not specific for histological types. In contrast, all 8 cases of dysgerminoma, 1 of immature teratoma and 2 of endodermal sinus tumor showed extremely elevated LDH levels. Moreover, the normal pattern or deviation to H subunit of LDH isoenzymes was seen in such cases of germ cell tumor, while deviation to M subunit was noted in epithelial and metastatic tumor patients. These data indicate that each parameter is useful as a tumor marker for the specific histological type of ovarian tumor; CA125 for non-mucinous epithelial carcinoma, CEA for mucinous tumor and Krukenberg tumor, AFP for yolk sac tumor, LDH and LDH isoenzymes for dysgerminoma and other solid germ cell tumors. In addition, preoperative diagnosis of histological types of ovarian tumors may be possible by combining these tumor markers.