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Two experiments were conducted to test the hypothesis that feeding diets which limit the amount of fermentable substrate entering the large intestine would protect pigs against experimental infection with Serpulina hyodysenteriae, the causative agent of swine dysentery. Experiment 1 examined the effect of grain processing (hammer milling vs. steam flaking) and grain type (barley, groats, corn, sorghum and wheat) on indices of fermentation in the large intestine and the incidence of swine dysentery. Experiment 2 examined the role of five diets, steam-flaked corn, steam-flaked sorghum, hammer-milled wheat, extruded wheat and cooked white rice, on these same measures. All diets contained an animal protein supplement and no antibiotics. Pigs fed diets based on steam-flaked corn and steam-flaked sorghum had a lower incidence of disease (11-33%) than pigs fed diets based on other grains (75-100%). Pigs fed the diet based on cooked white rice were fully protected against swine dysentery. Both the soluble non-starch polysaccharide (NSP) concentration and the total NSP concentration of the diets explained a significant proportion of the variation in swine dysentery (R2 = 0.56, P = 0.016, and R2 = 0.71, P = 0.002, respectively), such that pigs eating diets containing <1.0 g/100 g soluble NSP showed reduced disease. However, pigs fed corn, sorghum and steam-flaked sorghum (Experiment 2), which contained only 0.4-0.5 g/100 g soluble NSP, still had a high incidence of disease (>50%). This was attributable to a higher level of resistant starch present in these grains. These data provide evidence that the expression of swine dysentery is associated with an increased concentration of fermentable substrate entering the large intestine.

SPECT brain perfusion imaging has definite value in the evaluation of cerebrovascular disease (particularly acute stroke), dementia, epilepsy, and may have a role in the diagnosis of brain death and head trauma. SPECT with tumor tracers T1-201 and Tc-99m sestamibi shows promise for detecting tumor recurrence.

Unlabelled: An analysis of patients with proven Langerhans' cell histiocytosis (LCH) was undertaken with the aim of evaluating the role of bone scintigraphy in the diagnosis and staging of LCH., Methods: Radiographic skeletal surveys and whole-body bone scintigraphy study results were reviewed for all patients treated at the Mayo Clinic in Rochester, Minnesota during 1965-1994 with histologic proven LCH. All available studies were then reported in a randomized and blinded fashion., Results: Of the 73 patients with the histologic diagnosis, 56 (76%) had a definite lesion reported on radiographs and subsequent biopsy-proven bone involvement. For this population, the sensitivity and specificity of radiographic survey were 100% and 61%, respectively, compared to 91% and 55% for bone scintigraphy. Solitary bone lesions were reported on 21 radiographic surveys and 24 bone scintigrams. For solitary lesions, radiograph sensitivity and specificity were 95% and 73%, respectively, compared to 88% and 77% for bone scintigraphy. Bone scintigraphy receiver operating characteristic curves showed the region of greatest diagnostic accuracy to be skull, facial bones and mandible (88% sensitivity, 52% specificity). Radiation dosimetry to adult reproductive organs was less favorable for radiographic skeletal survey compared to bone scintigraphy., Conclusion: Our results support the use of radiographic skeletal survey in the initial diagnosis of LCH. Bone scintigraphy may have a role in monitoring a patient's progress in which the initial scintigram and radiographic survey show good correlation.

Purpose: In a blinded fashion, radiolabeled B72.3 was investigated in operative cases of recurrent colorectal cancer to determine if diagnostic accuracy would be improved to ultimately maximize curability and minimize interventional morbidities., Methods: Study patients underwent conventional evaluation including history, physical examination, abdominal/pelvic computed tomographic scan (CT), colon examination, and carcinoembryonic antigen (CEA) determination, with select magnetic resonance imaging and ultrasonographic imaging as indicated. Murine monoclonal antibody B72.3 was labeled with indium-111 (111In-CYT-103 provided by Cytogen) and scans obtained at 48 hours and, selectively, at 72 and 96 hours. Unlike previous studies, the operating surgeon was blinded to 111In-CYT-103 abdominal scan results until surgical exploration was complete., Results: Of 15 study patients (10 male; 5 female), average age was 57 years, and average CEA was 10 ng/ml (with eight elevated CEA levels). A single patient did not undergo surgery because of presence of pulmonary metastases identified on CT scan but not identified on a 111In-CYT-103 scan. Laparotomies included resection and intraoperative radiation (10), resection alone (1), and biopsy only (3). CT and 111In-CYT-103 scans were compared with operative findings. CT scans had an accuracy and positive predictive value of 47 and 100 percent, respectively, whereas those of 111In-CYT-103 scan were 60 and 82 percent, respectively. Contribution of the scan to diagnosis and management was graded by the surgeon as no effect (67 percent), beneficial effect (13 percent), or negative effect (20 percent)., Conclusions: 111In-CYT-103 was more accurate compared with CT scan, but when value of the scan was examined with respect to its potential contribution to patient management, it was beneficial in only 13 percent of patients. Further refinements may enhance the value of antibody imaging techniques.

The economic impact of proliferative enteritis (PE) on an 'average' pig farm was calculated using the AUSPIG decision support system. Inputs were modelled on actual cases of PE, in which affected herds suffered from depressed growth rate, decreased feed efficiency and stock losses. The costs associated with non-haemorrhagic PE and proliferative haemorrhagic enteropathy ranged from $15/sow/yr to $141/sow/yr, respectively, depending on the clinical severity of the disease, incidence of infection and the type of medication strategy used to treat and control the disease.

The occurrence of extramedullary hematopoiesis in the pleura is rare and is usually asymptomatic. It is generally diagnosed on postmortem examination. Herein we describe a 61-year-old woman with agnogenic myeloid metaplasia who sought medical assessment because of progressive dyspnea. Thoracentesis yielded sanguineous fluid with 10% myeloblasts. A 99mTc bone marrow scan demonstrated increased tracer activity throughout both lungs, an outcome consistent with extramedullary hematopoiesis. Fine-needle aspiration and video-assisted thoracoscopy were considered but deferred because of the potential risk of profuse bleeding. Treatment with low-dose external beam irradiation to the left posterior pleura was successful. To date, no hemothorax has recurred.

Single-photon emission computed tomography is a well established functional imaging technique in epilepsy that aids precise noninvasive localization of the seizure focus required for surgical intervention in refractory seizures. Electroencephalography with video monitoring of seizures precedes more invasive evaluation, such as cortical or depth electrodes. Positron emission tomography studies in temporal lobe epilepsy are moderately sensitive, demonstrating ipsilateral hypometabolism. Ictal single photon emission computed tomography studies in temporal lobe epilepsy demonstrate transient intense hyperemia in the anterior temporal lobe structures. Peri-ictal images show persisting mesial temporal hyperperfusion with lateral hypoperfusion developing over the next 2 to 5 minutes to be replaced by significant hypoperfusion in the postictal phase. Interictal single photon emission computed tomography with ipsilateral hypoperfusion, suffers from reduced sensitivity and accuracy, whereas ictal and, to a lesser extent, peri-ictal and postictal single photon emission computed tomography are highly sensitive and accurate in localizing temporal lobe epilepsy. New iodinated neuroreceptor single photon emission computed tomography imaging agents hold promise in localizing the seizure focus (focally reduced uptake) without ictal injection, and also may elucidate underlying mechanisms inherent to epilepsy.

An In-111 WBC study showed intense periarticular uptake in both knees of a patient being investigated to exclude joint infection before total knee replacement surgery for advanced osteoarthritis. Infection was subsequently excluded. Patients with synovitis secondary to active osteoarthritis can have intense synovial uptake of labeled WBCs. This should be considered as a cause of false-positive scans in the investigation of septic arthritis with labeled WBCs.

Unlabelled: Several 99mTc-labeled radiopharmaceuticals have been developed for lymphoscintigraphy of the extremities. In the United States, however, these agents are not widely used clinically. This study evaluates the use of smaller particle sizes ( < 0.1 micron) of 99mTc-sulfur colloid (99mTc-SC) for lymphoscintigraphy., Methods: The 99mTc-SC was prepared by kit, and the final preparation was filtered through a sterile 0.1-micron filter. The radiochemical purity (RCP) of the filtered 99mTc-SC was determined before administration. Nineteen patients with suspected lymphedema were injected with 18.5 MBq (500 muCi) filtered 99mTc-SC intradermally in each foot, and whole-body images were obtained immediately and 1, 3, 6 and 24 hr later. Local views over the inguinal or axillary lymph nodes were also obtained every 5 min for the first hour., Results: The average RCP value was 93.4% +/- 4.2% (n = 19), and the RCP difference pre- and postfiltration of the 99mTc-SC preparation was -1.7% +/- 1.4% (n = 40). Evaluation of the particle size with the polycarbonate filter showed that 89.9% +/- 4.5% (n = 28) of particles were less than 50 nm, and the particle size was further determined by electron microscopy to be 38.0 +/- 3.3 nm (n = 202). The mean particle sizes of two peaks measured by laser light scattering techniques were 7.5 and 53.9 nm (major peak). Clinical studies with filtered 99mTc-SC demonstrated similar lymphoscintigrams compared with those obtained with 99mTc antimony sulfide colloid (99mTc-ATC). Filtered 99mTc-SC showed a faster transport rate to the inguinal lymph nodes and lower radiation dosimetry for liver, spleen and whole body compared with 99mTc-ATC., Conclusion: Filtered 99mTc-SC can be easily prepared and is readily available for routine clinical use in lymphoscintigraphic studies.

Objective: To assess the splenic and whole body retention of radiolabeled autologous leukocytes over 24 or 48 h as measures of the severity of colitis., Methods: Eleven patients with colitis underwent standardized clinical, endoscopic, histological, and 111In-labeled leukocyte scintigraphy. A logistic discriminant analysis was used to estimate weighting factors for morphological indices, serum albumen, and stool excretion of 111In over 24 h that predicted the clinical assessment of severity. Subsequently, Spearman rank correlation analysis estimated associations among reductions in spleen and whole body radioactivity and the derived indices of inflammation., Results: The reduction in spleen counts over 24 h correlates significantly with morphological indices (rs = 0.83, p < 0.005) and with serum albumen and stool 111In (functional index, rs = 0.77, p < 0.01). Similarly, the reduction in whole body 111In over 48 h correlates significantly with the combined index (rs = 0.8) and with the morphological and functional index separately (rs = 0.72 and 0.79, respectively)., Conclusion: This pilot study identified weighting factors for morphological and functional indices in assessing severity of colitis; reduction in whole body and splenic retention of radioactivity was sufficient for evaluation of severity of colitis without the need for stool collections.

Background: The ideal method for preoperative localization of abnormal parathyroid glands has yet to be determined. Technetium-99m-sestamibi, previously used for myocardial perfusion studies, has recently been introduced for parathyroid imaging., Methods: From August 1991 to September 1993, 44 patients underwent Tc-99m-sestamibi scanning (45 scans) and surgical exploration for hyperparathyroidism at our institution. These 44 patients form the database for this retrospective study. Twenty-eight patients had persistent hyperparathyroidism, six had recurrent disease, three had prior thyroid operation, and seven underwent first time neck operations. The nature of disease was complex and varied: single gland, 26; primary hyperplasia, 5; multiple endocrine neoplasia type 1, 5; familial, 3; secondary or tertiary, 5. One patient with single gland disease and one patient with multiple endocrine neoplasia type 1 had parathyroid carcinoma. All patients had biochemical confirmation of hyperparathyroidism., Results: Twenty-six (58%) of 45 scans accurately predicted the location(s) of all abnormal gland(s) involved (true positive). Surgical removal of these glands was curative. Sixteen (36%) of 45 scans were false negative because they did not show all abnormal glands involved; however, 7 of these 16 scans did localize at least one abnormal gland. The overall sensitivity of this test was 62% when all abnormal glands were considered but increased to 79% with the demonstration of at least one abnormal gland. These values increased to 80% and 90% (p = 0.03), respectively, in the last 20 patients when the injected dose of Tc-99m-sestamibi was increased from 10 to 15 mCi. Thirty-seven of 44 patients were cured after operation. Six of the seven patients who experienced surgical failure had multigland disease, one of which was malignant. Sestamibi scans correctly identified abnormal cervical glands in 18 (58%) of 31 patients and abnormal mediastinal glands in six (75%) of eight patients., Conclusions: Tc-99m-sestamibi scanning is helpful in the reoperative setting as an adjunct to localizing abnormal parathyroid tissue. A higher percentage of positive tests occurs in patients with mediastinal and single gland disease. A higher dose of Tc-99m-sestamibi (15 mCi) significantly improves test sensitivity.

A simulation model (AUSPIG) was used to predict the effect of an increase in piglet deaths, and a reduction in growth rate and an increase in feed conversion ratio of grower pigs on the profitability of two herds representative of the Australian pig industry caused by the introduction of transmissible gastroenteritis virus (TGE) into those herds. For each herd, mortality rates for piglets under 1 week of age of 50% and 95% were assumed to represent a 'moderate' and a 'severe' outbreak, respectively. A reduction in net revenue of 70% was predicted to occur in the 6 months after a 'moderate' outbreak of TGE (100% for a 'severe' outbreak). This represents a total loss of between $260 and $330 per breeding sow in the 12 months after infection with the TGE virus. The likely financial impact of an outbreak of TGE on an Australian piggery is substantial and should be considered when addressing quarantine issues.

We performed a retrospective study of 53 consecutive "nonlesional" temporal lobectomy patients to assess the relative utility of MRI versus interictal single-photon emission computed tomography (SPECT) in this patient population. We compared the seizure lateralizing properties of MRI and SPECT using multiple blinded expert reviewers for both SPECT and MRI with a test-retest reviewer paradigm and measurements of hippocampal volume from MRI. The criterion standard for seizure lateralization was satisfactory postoperative seizure control (n = 43). The rate of correct seizure lateralization was significantly greater for MRI than for SPECT (p < or = 0.01), and the rate of incorrect lateralization was significantly less for MRI than for SPECT. The most accurate MRI measure was hippocampal volume measurements, which correctly lateralized the seizures in 86.0% of cases. The correct lateralization rate for SPECT was 45.4%. The MRI and SPECT studies tended to be noncomplementary with respect to seizure lateralization, and SPECT was likely to give an incorrect or indeterminate result in patients who were not lateralized by MRI. Concordant MRI-EEG lateralization was a strong predictor of satisfactory postoperative seizure control, while no relationship between postoperative seizure control and SPECT findings was present.

Tc-99m DTPA scintigraphy of most renal tumors characteristically discloses a vascular mass, without retention of activity on serial images. Two cases, encountered during hypertensive work-up, are presented with vascular renal masses and persistent DTPA uptake. Oncocytoma was confirmed pathologically in both cases. The authors conclude that renal oncocytomas have a relatively distinctive scintigraphic appearance, which may permit accurate preoperative diagnosis.

Parameters of calcium and phosphate metabolism were measured in 27 patients with mild renal failure [glomerular filtration rate (GFR) 40-90 ml/min], 12 patients with moderate renal failure (GFR 20-39 ml/min) and in 12 healthy subjects. GFR was determined by technetium-99m diethylenetriamine penta-acetic acid clearance. Intact parathyroid hormone (PTH) was measured by a sensitive immunochemiluminometric assay and somatomedin-C was determined by radioimmunoassay. Both 1,25-dihydroxyvitamin D [1,25(OH)2D] and vitamin-D-binding protein were measured allowing calculation of the free 1,25(OH)2D index. By linear regression and multivariate analysis, PTH was negatively and independently correlated with GFR, plasma bicarbonate and 25-hydroxyvitamin D [25(OH)D] while free 1,25(OH)2D was positively correlated with GFR. Increased PTH secretion and reductions in 1,25(OH)2D were present in mild renal failure patients before any changes in plasma calcium, phosphate and bicarbonate were noted. Plasma alkaline phosphatase was significantly higher in mild chronic renal failure patients compared to normal subjects, possibly indicating early effects of the secondary hyperparathyroidism on the skeleton. Somatomedin-C did not correlate with the free 1,25(OH)2D index or a measure of 1,25(OH)2D production. It is concluded that the secondary hyperparathyroidism which occurs very early in the onset of chronic renal failure may be due to a reduction in the circulating concentration of 1,25(OH)2D consequent upon the renal failure. Low plasma bicarbonate and 25(OH)D also appear to be determinants of a raised PTH concentration. The compensatory increase in PTH presumably maintains extracellular calcium and phosphate levels constant but with possible deleterious effects on the skeleton.

Infra-red colour thermography has been used to visualize skin temperatures in two athletes standing and running in an outdoor environment at 20 degrees C and in a climatic chamber at 11 degrees C. Temperature distributions and changes have been recorded on film and analysed. Mean skin temperatures determined by this method have been compared with skin temperatures obtained with a probe thermocouple. During running, skin temperatures were higher over muscles than over other structures and the distribution differed dramatically from that observed before exercise. Regional mean skin temperatures obtained by thermography differed by up to 4 degrees C from those obtained with the thermocouple probe. Overall mean skin temperatures obtained by both methods agreed to within 1-5 degrees C.

To refine the functional guidelines for operability for lung resection, we prospectively studied 55 consecutive patients with suspected lung malignancy thought to be surgically resectable. Lung function and exercise capacity were measured preoperatively and at 3 and 12 months postoperatively. Preoperative pulmonary scintigraphy was used to calculate the contribution to overall function by the affected lung or lobe and to predict postoperative lung function. Pneumonectomy was performed in 18 patients, lobectomy in 29, and thoracotomy without resection in six. No surgery was attempted in two patients who were considered functionally inoperable. Cardiopulmonary complications developed in 16 patients within 30 days of surgery, including three deaths. The predictions of postoperative function correlated well with the measured values at 3 months. For FEV1, r = 0.51 in pneumonectomy (p less than 0.05) and 0.89 in lobectomy (p less than 0.001). Predicted postoperative FEV1 (FEV1-ppo), diffusing capacity (DLCO), predicted postoperative DLCO (DLCO-ppo) and exercise-induced arterial O2 desaturation (delta SaO2) were predictive of postoperative complications including death and respiratory failure. In patients who underwent pneumonectomy, the best predictor of death was FEV1-ppo. The predictions were enhanced by expressing the value as a percentage of the predicted normal value (% pred) rather than in absolute units. For the entire surgical group a FEV1-ppo greater than or equal to 40% pred was associated with no postoperative mortality (n = 47), whereas a value less than 40% pred was associated with a 50% mortality (n = 6), suggesting that resection is feasible when FEV1-ppo is greater than or equal to 40% pred.(ABSTRACT TRUNCATED AT 250 WORDS)

Fertility estimates were calculated using own children data from the Mexican migrant town of Guadalupe, Michoacan. In this town, 75 percent of families have a member working in the United States, and wives are often regularly separated from their migrant husbands. Simulations by Menken (1979) and Bongaarts and Potter (1979) suggest that fertility among these women should be depressed. Our results confirmed this hypothesis, showing that the seasonal absence of migrant husbands disrupted both the level and timing of fertility. However, the effect was greater for legal than for illegal migrants, a pattern that stemmed from social factors as well as physical separation. A logistic regression analysis showed that reductions in birth probabilities are greater the longer a couple is separated, and that these reductions are in the range expected from prior simulations.

The effects of dimethyl sulfoxide (DMSO) infusion on cerebral blood flow (CBF) and systemic hemodynamics were studied in a canine model of myocardial ischemia. Immediately after ligation, cardiac output dropped from 2.09 +/- 0.11 (SEM) in the control group and 1.79 +/- 0.13 in the DMSO group to 1.07 +/- 0.21 and 1.0 +/- 0.08 L/min, respectively; there were no significant differences for 2 h. By the third hour and thereafter, the DMSO group had a significantly (p less than .05) higher cardiac output (1.65 +/- 0.08 L/min) than the control group (1.15 +/- 0.10 L/min). The cardiac output increase at 3 h was accompanied by significantly (p less than .05) lower systemic vascular resistance (SVR) in the DMSO group (5315 +/- 248 dyne X sec/cm5) as compared to the control group (7892 +/- 442 dyne X sec/cm5). There were no significant differences in heart rate, mean arterial pressure, pulmonary artery wedge pressure, or cerebral or pulmonary resistances in the control as compared to the DMSO group. Higher CBF values were noted at one hour and thereafter in the DMSO as compared to the control group (p less than .05). Low-dose DMSO given as an iv bolus improved cardiac output and CBF and lowered SVR in this canine model of experimental myocardial ischemia.

A breath-test has been developed for the detection of gastric infection with Campylobacter pylori. Urea that is labelled with carbon 14 is administered to a fasting patient and the patient's breath is sampled for radioactivity over the following 30 minutes. If C. pylori is present in the patient's stomach, urease activity causes hydrolysis of the urea and the 14C is absorbed as carbon dioxide. This carbon dioxide enters the patient's bicarbonate pool and eventually is excreted in the breath. The results are expressed as a percentage of the administered dose/mmol carbon dioxide x kg body weight. Sixty-three patients who were undergoing endoscopy were studied. The radioactivity in exhaled breath which was sampled within five minutes of 14C-urea administration was attributed to the presence of urease enzyme in mouth organisms and was discounted. The time-radioactivity curves for breath samples from five to 30 minutes after the administration of 14C-urea gave an excellent separation between subjects with negative results of the examination of gastric-biopsy samples and patients with microbiological and histological evidence of infection with C. pylori. The area under the time-radioactivity curve at between five and 30 minutes after the administration of 14C-urea in 24 patients with negative microbiological results was 6.9 +/- 4.4 area units; in 35 of 39 patients with positive microbiological results, this area was greater than 40 area units. Measured against the results of the microbiological examination of gastric-biopsy samples, the sensitivity of breath-testing was 90% and the specificity was 100%. Measured against the results of histological examination for the presence of C. pylori infection, breath-testing had a sensitivity of 94% and a specificity of 93%. A positive breath-test result also correlated well (P = 0.0001) with the serological antibody test-result. The role of non-invasive tests--enzyme-linked immunosorbent assays and 14C-urea breath-testing--in the management of gastritis and peptic ulcer disease is discussed. We consider that the 14C-urea breath-test has an important role in the noninvasive confirmation of gastric infection with C. pylori and in the follow-up of patients after treatment.

Gallium lung scanning is widely used to evaluate pulmonary inflammation in patients with interstitial lung disease but has not previously been reported in crocidolite-exposed workers. In order to characterize the pulmonary inflammation caused by crocidolite inhalation, GLS and BAL findings were related to chest x-ray film changes graded according to the ILO classification of roentgenograms of pneumoconioses. In individuals with roentgenographic evidence of asbestosis (CXR greater than or equal to 1/0, n = 15), 13 had a positive GLS and 13 had an abnormal BAL. In asbestos-exposed individuals with equivocal chest x-ray film changes (CXR 0/1, n = 12), six had a positive GLS and six had BAL changes (both GLS and BAL abnormal in three). In individuals with a normal chest x-ray film (CXR 0/0 n = 8), two had a positive GLS and two BAL changes (both abnormal in 1). These data demonstrate that most subjects with crocidolite-induced asbestosis have an abnormal GLS and BAL. In addition, many individuals with asbestos exposure and equivocal or no chest x-ray film changes have an abnormal GLS and/or BAL, suggesting the presence of active subclinical pulmonary inflammation in these individuals.

The case of a young man who presented with lead poisoning is reported. This did not resolve with prolonged treatment and he had several unusual and unexplained bacteraemias. Probable sources of self-administered lead and bacteria were demonstrated and psychiatric assessment showed that the patient had a personality disorder which was consistent with a diagnosis of factitious disorder. Psychiatric management led to the termination of the self-inflicted illnesses and enabled the patient to cope with his personal and social problems.

The method of planar imaging utilizing Bremsstrahlung radiation in patients treated with intraarticular Yttrium-90 for joint synovitis is described, illustrated and discussed.

Disposable plastic two-piece suits were compared with conventional cotton suits, gowns, and plastic aprons by nurses in a burns unit. The plastic suits allowed fewer micro-organisms to be dispersed into the environment than the other garments but were less comfortable.