Showing papers in "Wiener Klinische Wochenschrift in 1991"

Endothelium-derived relaxing and contracting factors.

Abstract: Since the description of the essential role of the endothelium in mediating relaxations due to acetylcholine in mammalian arteries, it has become obvious that endothelial cells release several relaxing and contracting substances. The release is activated by a variety of agents including circulating hormones, autacoids, and products liberated by aggregating platelets, but also by changes in shear stress exerted by the blood. There is strong evidence that the major endothelium-derived relaxing factor (EDRF) is the free radical nitric oxide (NO) formed enzymatically from L-arginine. Endothelium-dependent relaxations caused by EDRF are induced through increases in the activity of soluble guanylate cyclase in the smooth muscle. Other relaxing factors, such as prostacyclin and endothelium-derived hyperpolarizing factor (EDHF) contribute to endothelium-dependent relaxations. Beside the recently described and chemically identified peptide endothelin, at least two other endothelium-derived contracting factors appear to exist. The mechanisms by which endothelium-derived contracting factors activate vascular smooth muscle are not yet clear. In certain clinical situations an impairment of the production of EDRF in face of a maintained or augmented release of contracting factors may contribute to the occurrence of localized vasospasm or generalized increases in peripheral resistance.

Risk factors for coronary heart disease

Abstract: Cardiovascular disease remains the major cause of death in the industrialized world with dyslipidemia, hypertension and cigarette smoking leading a long list of risk factors. Recently, controversy arose from some critical articles expressing concern about the evaluation and interpretation of statistical data of epidemiologic studies. One study using covariance analysis reported an absence of the widely accepted negative association between coronary heart disease (CHD) and high density lipoprotein (HDL) cholesterol. Also criticism was expressed regarding the cost-effectiveness of preventive measures such as the use of lipid lowering drugs on life expectancy. Because of such recent scientific controversy and discussions already taking place in the media, we have summarized in this article recent epidemiologic evidence including a meta-analysis of the major epidemiologic studies on HDL. We have directed particular attention to 3 large epidemiological studies, i.e., the Familial Atherosclerosis Treatment Study (FATS), the Program on the Surgical Control of the Hyperlipidemias (POSCH), and the Cholesterol Lowering Atherosclerosis Study (CLAS), all of which have clearly demonstrated a desirable effect of intensive lipid lowering therapy on coronary lesions.

Clinical syndromes with vasoconstrictor response.

Abstract: Vasospasm implies reversible vasoconstriction that may diminish blood flow to the perfused tissues followed by an ischaemia of varying severity. The exact pathophysiology of the condition remains unknown to this day. Vasospasms are not only present in Raynaud's disease, migraine, Prinzmetal's variant angina, visual field defects and partially in low-tension glaucoma, but may also be involved in the pathogenesis of Crohn's disease. Vasospastic diseases may result from more than one mechanism. It is difficult to determine which of the underlying abnormalities is the most important in vasospastic syndromes of different vascular beds.

The mechanisms and significance of the coupled release of endothelium-derived relaxing factor (EDRF) and prostacyclin (PGI2) from endothelial cells.

Abstract: Endothelium-derived relaxing factor (EDRF) and prostacyclin (PGI2) are co-released from endothelial cells by stimuli acting via membrane-bound receptors or via non-receptor mediated mechanisms. The receptor-mediated release of EDRF and PGI2 is calcium-dependent and seems to be under the negative feedback regulation of protein kinase C. Significant interactions between EDRF and PGI2 or between their respective second messengers within the endothelial cell have not yet been conclusively demonstrated. Furthermore, although EDRF and PGI2 synergize in the inhibition of platelet aggregation, there is little evidence for such synergism in smooth muscle relaxation. These observations indicate that EDRF and PGI2 release may be coupled primarily by their requirement for raised intracellular calcium levels and by their regulation through protein kinase C.

[Influence of an iodine-drinking cure on the antioxidative status of diabetic patients].

Abstract: The influence of a 4 week course of balneotherapeutic treatment in Bad Hall on different blood parameters and on the activity of the antioxidative enzymes glutathione peroxidase (GSH-Px), catalase and superoxide dismutase (SOD) was examined in diabetics. The patients were divided into 2 groups. One group underwent an iodine-balneotherapeutic programme (therapeutic exercises, baths, packages, inhalations), the other group additionally received an iodine brine drinking cure. At the end of the cure, the cholesterol, triglyceride and glucose levels had fallen to normal values in both groups due to the diabetic diet and, if required, drug therapy. Erythrocyte SOD was also reduced in both groups. Plasma catalase and plasma GSH-Px were significantly raised only in the group drinking iodine brine, while erythrocyte GSH-Px and the amount of the lipid peroxidation product malonyl dialdehyde were unchanged. The observed improvements in the parameters are considered unspecific cure effects, which lead to a desirable normalisation and homogenisation. Only the enhancement of plasma GSH-Px activity can be interpreted as an iodine specific cure effect.

Dopamine receptor classification, neuroanatomical distribution and in vivo imaging.

Abstract: The classification of dopamine receptors and their neuroanatomical distribution is reviewed, including the newly discovered D3, D4 and D5 subtypes. In vivo imaging techniques and methods for quantification are briefly described and PET and SPECT studies of D2 receptors in schizophrenia, under neuroleptic treatment, in aging, Parkinson's disease, Huntington's disease, tardive dyskinesia and multisystem atrophies are reviewed and compared with our own results. A short description is given of imaging studies of D1 receptors.

Serendipity--its basis and importance.

Abstract: Horace Walpole (1717-1797) coined the term serendipity in 1754 in allusion to an ancient oriental legend of the "Three Princes of Serendip". Since about one century this term has been discussed in literary history; for almost 50 years medical writers have made use of it. Today, serendipity is understood as the ability to make discoveries not purposely searched for - the greater the knowledge, the more likely the discovery.

Efficacy and safety of fluoxetine versus clomipramine in ambulatory patients with a depressive syndrome in a clinical trial with private practitioners

Abstract: 8 general practitioners and 7 specialists in the field of psychiatry and neurology participated in this study evaluating the results of fluoxetine treatment in outpatients with depression in respect to safety and efficacy. They were familiarized with the requisite instruments by video rater training. The study was designed as a randomised double-blind parallel study involving 139 patients, comparing the effects of a daily dosage of 20 mg fluoxetine, 40 mg fluoxetine and 50 mg clomipramine. The number of patients treated in each group was 45, 46, and 48, respectively and altogether 125 completed the four-week study (five visits). A comparison of overall efficacy ratings showed significant antidepressant efficacy in all three treatment groups. On day 14 of the study (visit 4), patients receiving 40 mg fluoxetine showed significantly (p less than 0.05) better global improvement than patients receiving clomipramine. Treatment was well tolerated by all patients. The frequency of adverse events in response to fluoxetine was lower than under clomipramine treatment. On comparing treatment by psychiatrist and general practitioner no significant differences were found regarding age, sex, number of previous episodes and duration of the recent episode and outcome. Severe depression tended to be treated by psychiatrists; general practitioners prescribed additional medication less frequently.

13-Hydroxyoctadecadienoic acid (13-HODE) metabolism and endothelial cell adhesion molecule expression: effect on platelet vessel wall adhesion.

Abstract: Endothelial cells synthesize two important fatty acid metabolites, PGI2, which is synthesized from arachidonic acid via the cyclooxygenase pathway, and 13-HODE, which is synthesized from linoleic acid via the lipoxygenase pathway PGI2 is synthesized following cell activation or injury while 13-HODE is synthesized in the unstimulated cell While the role of PGI2 in platelet vessel wall interactions has been studied extensively, the role of 13-HODE in platelet vessel wall interactions is just now being understood The present evidence suggests that 13-HODE is continuously synthesized in "resting" vessel wall cells and is in close juxtaposition with the ubiquous integrin adhesion molecule, the vitronectin receptor The observation that the endothelial cell is not adhesive when 13-HODE and the vitronectin receptor are in close association and becomes adhesive when these two moieties dissociate and the vitronectin receptor relocates on the surface of the cell, provides further evidence that 13-HODE may induce conformational changes in the vitronectin receptor to reduce its ability to recognize its adhesive ligands The additional observations that 13-HODE levels in both human and animal vessel walls are inversely related with vessel wall adhesivity, and that this adhesivity can be altered by altering 13-HODE synthesis, provides evidence that 13-HODE down-regulates the thrombogenecity of the injured vessel wall surface

Prostaglandin E1 in therapy of peripheral arterial occlusive disease

Abstract: The intraarterial and intravenous infusion of prostaglandin E1 (PGE1) today is well established in the therapy of peripheral arterial occlusive disease. This review summarizes the results of pharmacological-clinical studies and the influence of PGE1 on the pathomechanism of ischaemia due to its antithrombotic, leukocyte and endothelial stabilizing properties. Clinical data available on continuous and intermittent infusion for both modes of administration are critically appraised, taking into account more recent data on active metabolites.

Sequelae after infection with Trichinella spiralis: a prospective cohort study.

Abstract: It is still a matter of debate whether or not infection with Trichinella spiralis is followed by long lasting sequelae. A common source epidemic of trichinosis which occurred in Bitburg, FRG, in October 1982 gave us the opportunity of performing a controlled cohort study (171 patients and 51 controls). 145 patients and 44 controls completed the 3 year follow-up. Complaints persisted in 36% of patients aged less than 30 years and in 100% of patients aged greater than 50 years. Complaints in order of frequency were: muscular complaints 84%, ocular complaints 63%, cardiac complaints 48%, cephalgia 43%, neurological complaints 35%, gastrointestinal complaints 18%, m fatigue and weakness 18%, oedema 12% and fever less than 1%. IgG antibodies to T. spiralis were still present in all but 5 patients 3 years after infection. IgM antibodies were either low or absent. In our patients the frequency and pattern of complaints and the correlation to the specific antibody response provide evidence that trichinosis causes long-lasting disease. Yet, from our data we were unable to draw conclusions as to the causative pathophysiological mechanisms.

Methanol metabolism in chronic alcoholism

Abstract: Serum methanol concentrations (SMC) exceeding 10 mg/l are highly suggestive of long-term alcohol intoxication and can be considered as marker for chronic alcohol abuse. Endogenously formed or consumed methanol is almost exclusively metabolized by alcohol dehydrogenase. As long as blood alcohol concentrations exceed 0.2-0.5 g/l methanol cannot be metabolized and accumulates. In a prospective study on 78 patients admitted for alcohol detoxification, elevated SMC up to 78 mg/l were found, with a mean SMC of 29.4 mg/l. No correlation was demonstrated between SMC and severity of the alcohol withdrawal syndrome. Further clinical, forensic and biochemical aspects of methanol metabolism are discussed.

[Nicotine--drug addiction--AIDS. Drug use habits of Vienna addicts].

Abstract: In Austria it is illegal to sell tobacco to young adolescents. A diverse sample of 358 narcotic addicts was investigated at the Psychiatric University Clinic of Vienna. Data were obtained from on site confidential interviews and a HIV-test was conducted. The individual drug use history was recorded and, interestingly, tobacco addiction was the first stage in starting a drug career. Furthermore, a strong correlation was observed between onset of heroin use and HIV-1 infection. It is concluded that in Austria not only the availability nicotine and alcohol to young adolescents should be prohibited, but also their use should be punishable. Easy access to nicotine as in public restaurants or from automatic distributors, has to be withdrawn. Tobacco advertisements may drive vulnerable young adolescents to early nicotine abuse and this may be followed by addition to other drugs and diseases causing death, including AIDS. Socioeconomic data, as well as the methadone data are presented. 180 out of the 358 patients were on methadone maintenance. Methadone treatment offers a first step toward social rehabilitation for drug addicts who have been living as criminals on the fringe of society. Physicians have a clear responsibility to lead the effort on all fronts against tobacco, especially in view of the HIV epidemic.

The pharmacological basis of receptor binding.

Abstract: Radiolabeled ligands can be used to characterize recognition sites of natural receptors. Verification of a receptor-specific binding of a radioligand requires a series of in vitro approaches, as saturation, competition, and kinetic (association and dissociation) experiments. Success of ligand binding depends on may factors involving the radio-pharmaceutical used as the radioligand, methods for separating bound and free ligand, proper use of the non-specific binding marker, and proper analysis of the binding data. A major theoretical constraint is the very short time available for separating bound an free radioligand, since a considerable fraction of radioligand can dissociate from the receptor binding sites during this process, in particular if the receptor affinity of the radioligand is low. Saturable, steady-state binding data can be analyzed utilizing standard binding isotherms and non-linear regression analysis as well as Scatchard plots. Competition experiments with unlabeled drugs are the most important in determining pharmacology of binding. Each method is subject to potential artifacts. Estimation of association is straightforward in order to assess the time necessary to achieve binding equilibrium.

[Ineffectiveness of diltiazem in Duchenne muscular dystrophy: a placebo-controlled double-blind study].

Abstract: In a randomized double-blind study the clinical efficacy of the calcium channel blocker, diltiazem was compared to that of a placebo on the clinical course of Duchenne's dystrophy (DMD) over a 12-month period. Altogether 30 patients, mostly in an advanced state of the disease, were evaluated. The 17 patients in the diltiazem group received 90-360 mg diltiazem per day according to their body weight; the 13 patients of the placebo group received the equivalent amount of a placebo. No significant difference was detected between the two groups regarding muscular power, muscle state, muscular functional ability (Vignos), serum myoglobin and serum creative phosphokinase.

Inverse relationship between diastolic blood pressure and urinary excretion of potassium in girls aged 8 to 9 years--a preliminary communication.

Abstract: In order to investigate the association of urinary excretion of sodium and potassium with blood pressure, 72 prepubertal healthy children between 8 and 9 years were investigated in a cross sectional study. We determined anthropometric data, diastolic (DBP), and systolic blood pressure (SBP) and urinary excretion of sodium and potassium in 24-hour urine samples. No relationship was found between urinary sodium or potassium excretion and systolic or diastolic blood pressure, neither with regard to simple, nor multiple regression analysis. However, on simple linear and multiple regression analysis a significant inverse association between the excretion of potassium and diastolic blood pressure (r = -0.53; p less than 0.01 and r = -0.60; p less than 0.001) was observed in girls. From our data we conclude that in normal weight, healthy children urinary excretions of sodium and potassium are not associated with systolic blood pressure. However, a high 24-hour urinary excretion of potassium might be associated with lower diastolic blood pressure in prepubertal girls.

Low density lipoprotein receptors: preliminary results on "in vivo" study.

Abstract: Plasmatic levels of low density lipoproteins (LDL) are regulated by the receptor pathway and most LDL receptor are located in the liver. A receptor defect due to genetic mutations of the LDL receptor gene is the cause of familial hypercholesterolemia (F. H.), a disease characterized by high cholesterol levels and premature atherosclerosis. Injection of autologous radiolabelled LDL, followed by hepatic scintiscanning, can be used to obtain "in vivo" quantification of hepatic receptor activity, both in normal and hypercholesterolemic patients. In this study we observed no hepatic increase of radioactivity in patients affected by F. H., confirming the liver receptor defect. Scintigraphy is a non-invasive technique which can be used to diagnose this disease and to monitor the efficacy of hypolipidemic therapy.

Metabolism of intravenously administered prostaglandin E1 in patients with peripheral arterial occlusive disease

Abstract: Using high performance liquid chromatography and radioimmunoassay we have investigated the stability of prostaglandin (PG) E1 and its metabolite 13,14-dihydro-PGE1 in human plasma as well as the initial metabolism of PGE1 infused intravenously (80 micrograms/patient/hour) in patients with peripheral arterial occlusive disease. 13,14-dihydro-PGE1 degraded like PGE1 in human plasma at 37 degrees C with a half-life of several hours. During infusion of PGE1 higher plasma concentrations of the major metabolite 15-keto-13,14-dihydro-PGE1 and lower plasma levels of PGE1 and 13,14-dihydro-PGE1 were observed. The metabolite 13,14-dihydro-PGE1 is of interest, since in contrast to 15-keto-13,14-dihydro-PGE1 it is biologically active. The biosynthesis of 13,14-dihydro-PGE1 could contribute to the therapeutic efficacy of PGE1 administered intravenously in patients with peripheral arterial occlusive disease.

[Infections in the neutropenic phase following bone marrow transplantation: comparison of laminar airflow isolation with conventional isolation].

Abstract: From May 1978 to September 1989 45 patients underwent 25 allogeneic and 21 autologous bone marrow transplantations (BMT) and 1 peripheral stem cell transplantation for the following indications: severe aplastic anemia (n = 4), hematological malignancies (n = 28), malignant solid tumours (n = 12) and sideroblastic anemia (n = 1). The first group of 20 patients was isolated in a conventional hospital room, while management of the aplastic phase in the second group of 25 patients was performed in a laminar air flow (LAF) unit. All patients received total decontamination. In a retrospective analysis the number of positive blood cultures during the neutropenic period was 85% in the first group, as compared with 40% in the second group, and the number of febrile episodes was 85% versus 64%, respectively. Despite the fact that the septic morbidity was lower in the LAF group, mortality during the neutropenic period (15% in group I versus 16% in group II) was unaffected and survival rate (45% in group I versus 36% in group II) did not improve. We conclude that LAF protection will only have a positive impact on survival rate if the incidence of non-infectious complications of BMT, such as organ toxicity or graft-versus-host disease, is likewise reduced.

[The significance of Karl Landsteiner's works for syphilis research].

Abstract: On January 7th 1905, more than five months before the detection of T. pallidum, Karl Landsteiner began his work on syphilis research together with notable members of the Viennese School of Medicine, namely Ernest Finger, Rudolf Muller, Viktor Mucha, Otto Potzl and others. Extensive animal experiments led to the formulation of the Finger-Landsteiner Law and provided the basic facts for the Jadasson-Lewandowsky Law. Attempts of active or passive immunization were unsuccessful and, indeed, were still a failure in 1990 after implementation of the latest tools of modern research, including gene technology. Dark-field microscopy was introduced for the detection of T. pallidum by Landsteiner and Mucha. These authors noted that serum of syphilitic patients inhibited the movements of T. pallidum and, thus, observed the basic principle underlying the T. pallidum immobilization test (= TPI = Nelson-Mayer test). Finally, Landsteiner, Muller and Potzl discovered that it was not an antibody specific to T. pallidum that reacted in the Wassermann reaction, but "autotoxic" substances, which they called reagines. During the 1970's and 1980's it was discovered that these reagines are autoantibodies directed against parts of the inner envelope of the mitochondria.

Therapeutic approaches to Lambert-Eaton myasthenic syndrome in the intra-individual comparison.

Abstract: A patient with Lambert-Eaton myasthenic syndrome was clinically treated several times over a period of 9 months. During at least 3 weeks each time, the patient received prednisone, then underwent 9 plasmaphereses, and was given guanidine-hydrochloride (HCl) and 3,4-diaminopyridine (3,4-DAP). The muscle-power scoring, muscle function tests and the electrophysiological parameters showed a superiority of 3,4-DAP over the other pharmacological therapies. Good results were also obtained with plasmapheresis. Corticoid medication proved to be less effective. No improvement was seen with guanidine-HCl. For comparative judgement, two months after beginning the last therapy, the patient and the attending physician were questioned with regard to subjective therapeutic success. The answers largely match the objective results. Both favour 3,4-DAP. In contrast to the patient's opinion, the physician sees a distinct effect of plasmapheresis. All in all, the administration of 3,4-DAP may be seen as an effective and acceptable therapy in Lambert-Eaton myasthenic syndrome.

[Analysis of polycyclic aromatic hydrocarbons in lipid-containing biological matrices--study of contamination of breast milk by benzo(a)pyrene along transit routes through Tyrol].

Abstract: 41 samples of human milk from the region of Tyrol were investigated with regard to benzo(a)pyrene content. A complicated analytical preparatory method had to be worked out. The percentage recovery of benzo(a)pyrene was 85-90. Analysis was carried out by means of capillary gas chromatography and flame ionization detection or mass spectrometry. The limit of benzo(a)pyrene detection is 0.1-1 microgram/kg (single ion monitoring). None of the investigated samples of milk showed the presence of benzo(a)pyrene.

A citation analysis of Austrian medical research and Wiener klinische Wochenschrift.

Abstract: Criteria for the prediction of Nobel prize winners based on citation and predictor prizes are presented. The position of Austrian medical research and the role of the "Wiener klinische Wochenschrift" are compared to international standards.

Outpatient percutaneous transluminal angioplasty: preconditions and results.

Abstract: The present study considers whether percutaneous transluminal angioplasty (PTA) using a balloon catheter may also be performed on an outpatient basis. The prerequisites for the choice of an out-patient procedure were location of the flow obstruction above the knee joint, exclusive catheter recanalisation, absence of any complications during and after the intervention, radiological and vascular surgical standby, patient compliance and adequate social environment. In our 36 patients, 12 PTAs were performed in the pelvic region, 23 in the area of the femoral artery and one in the area of the popliteal artery. The primary success rate in the pelvic region was 100%, that in the femoropopliteal region 91.7%. The cumulative patency rate after an average follow-up period of 4 months was 89% (one early recurrence within 24 hours, 2 late recurrences after 3 and 5 months, respectively). In order to prevent early recurrence, thrombocyte aggregation inhibitors were given in combination with heparin at standard dosage. Two patients had to be hospitalized for monitoring after an aspiration embolectomy in the one case and a major haematoma in the other case. The advantages of a PTA intervention performed on an out-patient basis were the reduced time lag between diagnosis and therapy, full mobility of the patient and minimisation of hospitalization costs. Our results justify the choice of an outpatient schedule for the performance of balloon catheter recanalization in a carefully selected patient population.

Complications of two series of 1000 each heart catheterization studies in childhood

Abstract: Two series of 1,000 consecutive cardiac catheterizations in neonates, infants and older children were prospectively investigated with respect to catheter-induced complications. These were categorized into arrhythmias, vascular complications, catheter and contrast perforations, central nervous (CNS) complications, clinical deterioration and catheter-related death. Comparing series 1 and 2, the number of arrhythmias decreased from 7.6% to 5.0%, acute vascular complications decreased from 2.1% to 1.4%, the number of patients showing clinical deterioration from 2.6% to 0.6% and CNS complications from 0.4% to 0.1%, whereas catheter or contrast perforations-remained virtually constant at 0.4% and 0.5% respectively. Catheter-induced mortality decreased from 2.0% to 0.7%. The group of neonates showed the greatest reduction in serious complications and catheter-induced mortality (31.3% to 12.4% and 11.0% to 4.4%, respectively). Increasing experience of the investigators, introduction of two-dimensional echocardiography as a supplementary investigation or even catheter substitute, use of percutaneous catheterization and sheath techniques, introduction of E-type prostaglandins and increased use of intubation and anaesthesia for catheterization all played an important role in the improvement shown in this investigation. Complications are still mainly seen in the group of neonates and cyanotic patients.

Heart transplantation in childhood

Abstract: This report presents 5 children, in whom a heart transplantation was performed at the II. Chirurgische Universitatsklinik of Vienna. At the time of transplantation the age of the children was 2, 3, 6, 10, and 14 years. The preoperative diagnosis was dilative cardiomyopathy in two patients, hypertrophic cardiomyopathy, right ventricular decompensation after atrial repair of TGA and a tumor of the heart in the other patients. Three children are alive and well. One child suffered from severe postoperative complications and 1 child died because of rejection of the heart. Indication, follow-up, complications of the therapy and the position of heart transplantation in children are discussed.

[Contact eczema and epicutaneous tests--distribution of allergens and changes in the spectrum in Vienna].

Abstract: Thousands of contact antigens have been defined. It is, however, remarkable that only a small group of substances (15 to 20) have proved to be frequent or otherwise important causes of allergic contact dermatitis. In agreement with reports from comparable centres, metals are high up on the "hitlist" of frequent allergens (nickel 24%, cobalt 9%, chromates 6%), followed by ingredients of cosmetics and toiletries (fragrances 16%, balsam of Peru 10%, Kathon 5%), whilst already way back are topical medicines (neomycin 4%, parabens 3%, lanolin 2%, benzocaine 1%) and rubber additives (thiuram-mix 2% and carba-mix 1%). Almost all other substances lie below the 1% limit. There was only one remarkable exception in comparison with the results of most other European studies, namely thiomersal, which is widely distributed as a preservative in vaccines in Austria and climbed to second place, with a sensitization rate of 18%. Although the phenylborate mercurials (historic sensitizations due to topical antiseptics) still reached a surprisingly high incidence of 6%, there were hardly any cases of cross-sensitization with thiomersal. A comparison with the international literature illustrates Austria-specific trends and a change in the spectrum over the past years. Interpretation of patch testing requires great specialist knowledge and experience.

Lymphoscintigraphy using epidermal growth factor as tumour-seeking agent in uterine cervical cancer.

Abstract: Fourteen patients suffering from advanced inoperable cervical cancer were investigated by planar scintigraphy after subcutaneous administration of a radiolabelled (I-123) epidermal growth factor (EGF). The objective of the study was to test whether labelled EGF concentrates in lymph node metastases of squamous cell cancer of the cervix uteri. Scintigraphic results were correlated with the gynecological findings, computed tomography (CT), ultrasound (US) and in two patients with histology. A series of scintigrams were performed up to 24 hours post injection. Slight activity in liver and kidneys was found already 30 min after s.c. injection of EGF. Optimal imaging quality for the lymphatics was obtained at 6-8 hours post injection. Accumulation in the pelvic lymph nodes was documented by the region of interest technique (ROI). Lymph nodes of the inguinal and iliac communis region were marked in all cases. Due to this, accumulation of EGF could not be called selective. In 11/14 patients hot spots were correlated to other pelvic lymph nodes. In 4/11 patients with positive EGF-scanning metastatic disease was confirmed by CT scan and/or US examination. 2/11 patients underwent a Probatoria operation. The respective histological reports confirmed our scintigraphic results. In conclusion, labelled EGF did not fulfil our theoretical expectations of excellent accumulation in lymph node metastases and cannot at present be recommended for routine clinical use.

Indirect traumatic diaphragmatic rupture

Abstract: Between 1969 and 1988 51 polytraumatized patients were treated for rupture of the diaphragm due to blunt trauma. In 39 cases the lesion was in the left hemidiaphragm, in 11 cases on the right side and in one case on both sides. Clinical investigation and posterior-anterior chest X-ray were the most important diagnostic procedures. A high percentage of ruptures was only detected intraoperatively during acute laparotomy/thoracotomy. Early or delayed surgery had no influence on the survival of patients. The prognosis depends on the severity of associated injuries, which are the main causes of death in these patients. Language: de

Quantification of human hepatic binding protein (HBP) via 99mTc-galactosyl-neoglycoalbumin (NGA) liver scintigraphy.

Abstract: 99mTc-galactosyl-neoglycoalbumin (99mTc-NGA) was synthesized by covalent coupling of 2-imino-2-methoxyethyl-1-thio-beta-D-galactopyranoside to the primary amino groups of human serum albumin. Injection of 99mTc-NGA (150 MBq; 3.5 mg (= 50 nmol)/ml demonstrated the liver to be the exclusive site of tracer-uptake. Simulation of 99mTc-NGA-kinetics allowed quantification of binding to the hepatic binding protein (HBP). Using this model we studied 250 patients with various liver disease. In alcoholic liver cirrhosis such patients with Child B and Child C stage cirrhosis had a lower HBP-concentration in the liver compared to control individuals (0.85-1.2 mumol/l). The group with the most advanced cirrhosis (Child C stage) had a significantly lower HBP-concentration (0.20-0.45 mumol/l) than Child A patients (0.60-0.85 mumol/l; p less than 0.01) and Child B patients (0.45-0.60 mumol/l; p less than 0.05). In patients with biopsy proven liver fibrosis (0.80-1.22 mumol/l) no difference in receptor concentration to normal individuals was estimated. Patients with recently diagnosed acute viral hepatitis underwent repeated 99mTc-galactosyl-neoglycoalbumin (NGA) scanning of the liver during the course of the disease. Return of liver function tests to normal values was associated with an increased hepatic imaging size as well as increase in HBP-concentration (up to a 3-fold of initial concentration). In patients exhibiting a prolonged course of the disease changes in NGA-kinetic data were borderline and the hepatic image size unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)