Search

The results in the use of Gallium-scintigraphy for diagnosis of osteomyelitis are reported. The examined cases all had individual problems and the Gallium-67 promised additional information about the nature of the underlying bone process. Because of the different mechanisms for Gallium to accumulate in pathological bone processes it is necessary to know exactly the individual problem of the case to keep the rate of wrong positive results low. Despite of such efforts one should be cautious in using this method in the diagnosis of chronic osteomyelitis.

Lingual goitre was found in two adolescents suffering from mild dysphagia. Since there were typical changes in lingual sonomorphology, sonographic evaluation was easy to perform. Lingual thyroid was less echogenic than normal thyroid tissue. Ultrasound may support the decision of the initial treatment and is useful to guide further therapy.

This case report describes a 65-year old man with symptomatic abdominal and pelvic splenosis. 50 Years ago he has had splenectomy after a road traffic accident. Ultrasound and CT revealed a bulky mass in the iliac fossa and multifocal intraabdominal nodules suggesting peritoneal carcinomatosis. Scintigraphy with Tc-99m-labelled heat damaged red blood cells led to definitive diagnosis. RBC-scintigraphy is a specific, easy performable diagnostic tool. It is cost-effective and can avoid other diagnostic procedures or explorative surgery.

The activation of the idiotypic network seems to be a beneficial approach to the immunological therapy of ovarian cancer. In a retrospective study 62 patients with ovarian carcinoma (of which 57 could be evaluated) received 1 mg of 131J-F(Ab)2 OC 125 MAb one to five times after radical surgery and polychemotherapy. In twenty-eight patients (49%) a remarkable anti-idiotypic antibody (Ab2) response arose. The anti-idiotypic antibody (Ab2) plasma levels increased with increasing number of F(Ab)2 OC 125 MAb applications. The twenty patients (35%) who developed Ab2-concentrations > 10,000 U/ml had a significantly higher survival rate than the patients who showed weak (Ab2-concentrations < 10,000 U/ml) or no immunological response to 131J-F(Ab)2 OC 125 MAb treatment (p < 0.05).

ZusammenfassungBei 31 Patienten, bei denen ein histologisch gesicherter Parenchymikterus bestand, wurde die hepatobiliäre Funktionsszintigraphie mit 99mTc-Diaethyl-IDA durchgeführt. Die Aufschlüsselung der Befunde erfolgte nach morphologischen (Darstellung von Leber, D. choledochus, Gallengangssystem, Gallenblase und Niere) sowie funktionellen (Tmax, Halbwertszeit der Gallenexkretion, Zeitpunkt des Erscheinens von Testaktivität in D. choledochus, Gallenblase und Darm) Kriterien. Dabei gelang die Darstellung der Leber in 90,3%, des D. choledochus in 7 1% und der Gallenblase in 72,4%. Das Ausscheidungsmuster des Tracers ließ in 9,5% einen Gallespeichertyp und in 90,5% einen Galleausscheidungstyp erkennen. Die intrahepatischen Gallengänge waren in 22,6% (D. hepaticus sinister) bzw. 6,5% (D. hepaticus dexter) zu beurteilen. Eine über 15 Min. p.i. hinausgehende Nierendarstellung war in 35,5% festzustellen. In allen Fällen ließ sich eine Galleausscheidung in den Darm erkennen, die zwar verzögert einsetzte, sich aber mit dem Normbereich überschnitt. Die Erscheinungszeit für D. choledochus (18,4 Min.) und Gallenblase (39,5 Min.) war ebenfalls verzögert. Die Leberfunktionskurve ergab für Tmax (14,3 Min.) und die HWZ der Exkretionsphase (> 30 Min.) gegenüber Lebergesunden verzögerte Werte. Die für den Parenchymikterus zur Abgrenzung gegen den Gallengangsverschluß differentialdiagnostisch bedeutsamen Kriterien sind Ausscheidung des Radiopharmakons in den Darm, Darstellung normal weiter Gallengänge und Füllung der Gallenblase.

After a brief review of the literature concerning scintigraphy of the spleen, its vascular system is described. The presence of numerous anastomoses makes it likely that occlusion of the splenic vein will usually not lead it any parenchymal damage. In five patients with angiographically confirmed spenic vein thrombosis it was shown that radio-colloid scans always demonstrate an enlarged spleen. Poor colloid uptake was thought to be due to a venous reflex mechanism leading to a reduction in the arterial blood supply. The statement found in the literature, that the spleen cannot be shown scintigraphically if the vein is thrombosed, has not been confirmed by us. We tend to the view that the apparent absence of a splenic scan was due to geometric causes.

A retrospective study of 101 patients with histologically confirmed cirrhosis of the liver and portal hypertension was carried out in order to evaluate the accepted scintigraphic criteria. In only 20% were all the essential criteria present. The absence of generally accepted important scintigraphic signs does not exclude the diagnosis of cirrhosis of the liver. Specificity of liver scintigraphy in cirrhosis of the liver is fairly low, but sensitivity of the method is almost 100%.

ZusammenfassungDie Schilddrüsenhormonwerte von Patienten mit einem autonomen Adenom der Schilddrüse wurden einer eingehenden statistischen Analyse unterzogen. Dabei konnten folgende Aussagen gesichert werden: Es besteht eine signifikante Korrelation zwischen dem szintigraphischen Bild, der Größe des Adenoms, den Hormonspiegeln im Serum und dem Delta-TSH. Bei Patienten mit szintigraphisch kompensiertem autonomem Adenom liegen die Hormonspiegel durchweg im euthyreoten, bei Patienten mit szintigraphisch dekompensiertem autonomem Adenom teils im euthyreoten, teils im hyperthyreoten Bereich. Dekompensierte autonome Adenome weisen stets einen negativen TRH-Test auf, bei kompensierten autonomen Adenomen kann dieser sowohl positiv als auch negativ ausfallen. Der TRH-Test erlaubt somit nicht die Abgrenzung zwischen kompensierten und dekompensierten autonomen Adenomen.

Thirty-nine (LEW x BN)F1 kidneys were transplanted to LEW rats. Twenty-four untreated recipients survived for a mean time of 16.1 +/- 1.7 days (group 1). Fifteen recipients received 4 ml of antilymphocytic serum per rat (group 3). In the last group 10 recipients survived for more than 4 months. The spleen cells of these permanently surviving 10 rats were obtained by splenectomy and used in a graft-versus-host assay, and this assay showed that the reactivity of these cells was normal. Following splenectomy the animals were given an (LEW x BN)F1 skin allograft, followed 18 days by a second. After another 18 days (LEW x Buf)F1 "third party" skin allografts were transplanted to the same animals. Animals of group 2 rejected their first grafts with a mean survival time of 12.2 +/- 1.2 days, whereas the second grafts were rejected normally as were the third party grafts. Attempts were made to detect lymphocytotoxic antibodies and haemagglutinins before and after the transplantation of skin grafts and none could be found up to day 53. The sera of group 2 inhibited allorosette formation by 38%. This serum-blocking factor was donor specific. It is probable that the survival of the kidney transplants following antilymphocytic serum treatment was brought about by the development of blocking antibodies.

Aktives Enhancement mit spenderspezifischem Antigen ist bei der klinischen Kadaver-Organtransplantation nicht praktikabel. Deshalb wurde der Versuch gemacht, ein aktives Enhancement von orthotopen Hundeleberallotransplantaten mit polyspezifischem Antigen zu erzielen. Die 17 Tiere der Kontrollgruppe uberlebten durchschnittlich 6,9 ± 1,5 Tage. 6 Empfanger (Gruppe 3) erhielten 750 mg/kg polyspezifisches halblosliches (PSEA 20) Antigen, welches aus 20 Milzen hergestellt wurde, zusammen mit 10 mg/kg Prednisolon 15, 8 und 1 Tag vor der Transplantation. Die durchschnittliche Uberlebensdauer in dieser Gruppe betrug 10,1 ± 2,0 Tage (P < 0,01, gegen die Kontrollgruppe). Weitere 6 Hunde (Gruppe 4) wurden wie die Tiere de Gruppe 3 vorbehandelt; jedoch wurde das Antigen hier aus 70 Nilzen hergestellt (PSEA 70). Die Uberlebensdauer war sehr unterschiedlich: 3 Tiere uberlebten mehr als 3 Wochen, die anderen 3 starben 1, 7 und 8 Tage nach der Transplantation unter Zeichen der beschleunigten Abstosung. Spender und Empfanger waren in keinem Fall LD-identisch, aber ein nahezu identisches Spender-Empfanger-Paar zeigte einen besseren Enhancement-Effekt. Die Empfanger mit der beschleunigten Abstosung zeigten ungewohnlich hohe Lymphocytotoxin-und Hamagglutinin-Prasenz, langer uberlebende Tiere niedrige Antikorper-Titer. Bei allen Empfangern mit starker Rejektion war die Leukocyten-Migration inhibiert. Rosetten-bildende Lymphocyten waren nach dreimaliger Antigenapplikation vermehrt im Blut nachweisbar und blieben danach konstant.

In fourteen patients with portal hypertension and bleeding from oesophageal varices, mesentericocaval anastomoses using a dacron-velour prosthesis ("H-shunt") were carried out. Evaluation of the haemodynamics showed: 1. Comparison of 13 pre- and post-operative angiograms showed an haemodynamicically effective shunt in 12 and a stenosed shunt in one. 2. The aim of relieving the portal circulation while maintaining antegrade portal flow was achieved in six patients. 3. In six patients, the portal vein was not seen in a splenic or mesenteric portogram despite an open shunt. Functionally, this corresponds to a porto-caval anastomosis. 4. Pressure reduction in the portal circulation can be so marked as to obtain retrograde portal flow from the hepatic artery. 5. If the portal blood flow through the liver disappears, the hepatic artery may obtain additional flow from the superior mesenteric artery (reversed flow in the gastroduodenal artery). 6. Increased arterial flow to the liver is made possible by a reduction in intrahepatic resistance. The role of collaterals, either arterio-portal shunts or shunts between the sinusoids, is discussed. 7. The hepato-fugal collateral circulation was reversed in twelve patients.

The arterial and portal components of total liver blood flow were determined quantitatively in 31 patients by means of a new, non-invasive method. Sequential hepato-splenic scintigraphy has been employed, using a scintillation camera linked to a computer system. In normals, the proportion of portal flow was 71%, whereas in patients with portal hypertension it averaged 21%. Our experience indicates that the procedure can be of considerable value in the pre-operative diagnosis and postoperative follow-up of portal hypertension.

ZusammenfassungEs wurden insgesamt 159 Patienten, davon 139 mit Malignom und Verdacht auf Lebermetastasen sowie 20 mit primären Lebertumoren, die in den Jahren 1969 bis 1978 zu Sektion gelangten, untersucht. Das Intervall zwischen Szintigraphie und Autopsie betrug zwischen 3 Tagen und 1 Jahr. 78 Patienten wurden mit dem Scanner und 81 Patienten mit der Gammakamera untersucht. Testpräparat war 99mTc-Sulfurkolloid. 62 Patienten hatten Lebermetastasen, davon wurden 80,6% richtig-positiv diagnostiziert. 77 Patienten wiesen keinen metastatischen Befall der Leber auf, davon hatten 72,7% auch ein unauffälliges Szintigramm. Betrug der Zeitraum zwischen Szintigraphie und Autopsie weniger als 15 Wochen, so war in 80,7% der Patienten mit Verdacht auf Lebermetastasen die korrekte Diagnose zu stellen. Patienten mit primären Lebertumoren (n = 20) konnten in 90% richtig-positiv diagnostiziert werden. Hinsichtlich der Nachweiswahrscheinlichkeit von Leberprozessen ließ sich bei Verwendung eines Scanners bzw. einer Gammakamera kein wesentlicher Unterschied feststellen.

Hepato-biliary functional scintigraphy was performed on 51 patients with normal livers after in the injection of 99mTc diethyle-IDA. The results were analysed according the morphological criteria (demonstration of the bile duct, intra-hepatic ducts, gall bladder and renal tract) and functional criteria (T max, half-time biliary excretion values, development of activity in the bile duct, in the gall bladder and in the gut). Demonstration of the bile duct and gall bladder was successful in all cases if the examination was carried out after an appropriate interval following food. 84.3% of patients showed a gall bladder excretary pattern of the tracer and 15.7% a gall bladder storage pattern. Correspondingly, bile appeared in the duodenum at 16.5 +/- 6.5 minutes (excretion) or 79.3 +/- 49.5 minutes (storage). The left hepatic duct was shown in 58.8%, the right hepatic duct in only 58.8%. Sixty minutes after the injection no activity could be determined in the bile ducts beyond the liver parenchyma. The gall bladder could be identified after 26.6 +/- 24.4 minutes, occasionally it was much later, up to 110 minutes. The liver function curve showed a Tmax level of 6.8 +/- 2.7 minutes and half value time of 15.8 +/- 6.7 minutes. At 5 minutes after injection the renal pelvis could be identified in 19.6%, but in no case was this still present beyond 15 minutes. Duodeno-gastric reflux was not demonstrated.

Radio-active plastic microspheres with an average diameter of 15 mu were used in eight dogs to measure renal perfusion and the results compared with time-activity curves before and after constriction of the left renal artery. It was shown that the values obtained for renal blood flow by functional scintigraphy are not accurate, particularly for moderate or low blood flow. The reason for this is primarily the distortion of the intravenously injected radio-active bolus and the consequent deviation from the so-called delta function.

Chest radiographs can reflect increasing pulmonary insufficiency of shock lung. In the early and intermediate stages, there is almost pure interstitial oedema which, in the later stages becomes alveolar-interstitial. In addition one may find evidence of broncho-pneumonia. Respiratory insufficiency is due to abnormalities of perfusion and distribution and is aggravated by disturbance of oxygen diffusion. The latter is due to an increase in the alveolo-capillary diffusion distance in the presence of interstitial oedema. It was not possible to demonstrate quantitatively significant precapillary shunts greater than 25 mu.

A short description of the pharmacology and kinetics of (99m)Tc-diethyl-IDA is given; our experience with this new radiopharmaceutical as a functional test of liver and bile ducts is illustrated by a number of typical examples. The ability to use increased activity together with high resolution "low energy" detectors provides excellent detail recognition in the hepato-biliary system. In addition, sequential scintigraphy with its resulting time-activity curves provides information regarding the function of the hepatocytes. The significance of hepatobiliary scintigraphy is its ability to distinguish between parenchymal and obstructive jaundice.

Focal nodular hyperplasia was diagnosed angiographically in 14 patients and confirmed histologically. Differentiation of this benign lesion from other space-occupying diseases of the liver can be very difficult, since focal nodular hyperplasia produces a variable angiographic appearance. The typical angiogram showing radial vessels in the arterial phase and sharply demarcated foci in the parenchyma phase is found in only one third of patients. Angiographic differential diagnosis includes adenomas and carcinomas of the liver. Resection of the tumours in case of malignant tumours is not indicated. Foci at the margin of the liver, or if they are pedunculated, should be removed in case of spontaneous perforation. Tumours in the centre of the liver should be observed (computer tomography). Oral contraceptives stimulate the growth of these foci. They may diminish in size after stopping these drugs. 70% of cases of focal nodular hyperplasia remain clinically silent and were discovered accidentally or at autopsy.

Lung scanning was performed on five patients with shock lung. It gave no evidence of morphological (pre-capillary) arterio-venous shunts or of increased pulmonary arterial pressure. Nor was there evidence of perfusion-ventilation inequality in the scan. The cause of the progressive pulmonary insufficiency was most likely due to maldistribution of gases in the microscopic region and to diffusion abnormalities.

Using baloon catheters in the inferior vena cava, post-hepatic blocks were produced in experimental animals. Subsequent liver perfusion scintigraphy showed marked reduction in portal flow. The significance of these findings in the diagnosis of the Budd-Chiari syndrome and its differentiation by scintigraphy from an intrahepatic block in cirrhosis of the liver is discussed.

Occurence of severe liver damage including angiosarcoma in polyvinyl chloride production workers necessitates regular control investigations of liver and spleen. Radioisotope techniques with small irradiation doses which give valid results should be used. Investigations of 15 patients with PVC-induced liver disease showed that hepatic perfusion as demonstrated by 99mTc pertechnate does not correlate with the uptake of sulphide colloid in the hepatic reticuloendothelial system. This provides evidence that in VC disease specific damage of the reticuloendothelial system of the liver occurs. Sequential scintigraphy also proved that the liver perfusion quotient can be considered as a measure of portal pressure. In practice this may be used for follow-up controls. Vascularized tumours described in VC disease can also be demonstrated by scintigraphy.

ALS ist eines der konventionellen Immunsuppressiva. Seine Hauptwirkung in vivo ist die Unterdruckung der zellgebundenen Immunantwort. ALS wird innerhalb von Stunden bzw. Tagen nach der Verabreichung vom Organismus eliminiert. Trotzdem konnen nach kurzen Kuren mit ALS die Empfanger von Rattennierenallotransplantaten permanent uberleben. Dabei ist unklar, warum die immunsuppressive Wirkung des ALS nach dessen Eliminierung persistiert.

On the basis of three selected cases (one with clinically occult follicular and two with metastatic papillary carcinoma) the necessity of a comprehensive therapeutic concept even in highly differentiated thyroid cancer is stressed. Thyroid tissue and regional metastases should be eliminated by surgery, followed by radioiodine therapy in any event. Radiation teletherapy should be reserved to patients with invasive tumor growth exceeding the organ capsule, with lymph node metastases, and with massive angioinvasive growth.