[Polyarteritis nodosa under the clinical picture of terminal kidney insufficiency]

In a 24-year-old patient the diagnosis panarteritis nodosa intra vitam was made. A terminal renal insufficiency was the dominating symptom. In addition to this besides fever in the patient were clinical symptoms on the side of the lung, the musculature and the skin. The diagnosis was confirmed by means of skin-muscle-biopsy from the clinically affected area. As was shown by biopsy in the patient who died after a stay in hospital of 9 days, the case in question was a multiple affection of the organs by panarteritis. A success in therapy could not be achieved. In the discussion clinic and diagnosis of this relatively rare disease are briefly explained.

[Synoviorthesis of the knee joint with 32P-chromic phosphate (author's transl)]

32P-CrPO4 in colloid form has been used for radiosynoviorthesis. There were no acute or subacute side reactions observed. The therapy results were equal to those following 90Y colloid application: 60% very good to good results after 6 months. The substance can be kept on stock since it has a relatively long shelf-life. The cost reduction and the simplification of treatment planning have proved to be the most important advantages of 32P-CrPO4.

[Disturbed growth in height in multiple cartilaginous exostoses (author's transl)]

Basing on the hypothesis that reduced body height in patients with multiple cartilaginous exostoses would be mainly accounted for by shorter extremities, not by a shorter trunk, the authors clinically examined 19 exostosis patients in respect of thigh, lower leg, upper and lower arm, as well as height of the seated patient. The dimensions were compared by the method of matched pairs, with 19 volunteers without diseased skeleton, who corresponded with one of the exostosis patients in respect of age, sex and height of seated patient. Results were evaluated according to Wilcoxon's test. This showed a statistically significant reduction in length of the extremities in adults with multiple cartilaginous exostoses.

[Functional and oncologic results after bronchial or blood vessel anastomosis in the resection therapy of bronchogenic carcinoma]

In treatment of bronchogenic carcinoma twelve selected patients had economical resections. To avoid a pneumonectomy, lobectomies or bilobectomies were associated twice with bronchial excision, 8 times with bronchial resection (sleeve resection) and twice with resection and anastomosis of pulmonary artery. Nine patients underwent clinical, radiologic and szintigraphic control. Except one case all patients showed good functional results. The anastomosed lobes were perfused and ventilated proportionally to the number of segments. The quality of life after partial pulmonary resections had deteriorated only to a small extent compared with the preoperative state. These results were emphasized by the only poor result which (after atelectasis of the anastomosed lung) corresponded functionally to a pneumonectomy. --The two cases of anastomosis of pulmonary artery showed a short survival. Both corresponded to a stage II of tumor classification. Of the other patients (all stage I) three are alive more than five years.

[Unrecognized hyperthyroidism in hospital patients. Analysis of clinical symptoms compared to aged euthyroid goiter patients]

During a 14-month period hyperthyroidism has been diagnosed in 39 of 2916 inpatients of a general medical service. Graves' disease was present in only 8 cases. 21 patients had solitary autonomous nodules or multiple autonomous nodules (toxic multinodular goiter). In 10 patients the type of hyperthyroidism could not be established. The referring practitioner suspected hyperthyroidism in all 8 patients with Graves' disease, but in only 5 of the 31 remaining cases. The relative rarity of Graves' disease in inpatients reflects the fact that this form of hyperthyroidism is easily recognized by the practitioner and treated on an out-patient basis. Graves' disease patients and those with autonomous solitary or multiple nodules were of comparable age and had an identical serum free-thyroxin. Thus, neither higher age nor lower thyroxin is responsible for the atypical clinical presentation of autonomous nodules. A comparison with age- and sex-matched carriers of euthyroid goiters identified weight loss, resting pulse rate over 90 and auricular fibrillation as reliable clinical features. A thyroid function test is therefore indicated in every patient with a goiter and one of the three above clinical findings.

The bedside determination of extravascular lung water: a non-invasive double indicator technique using 123I-antipyrine, 113mIn-transferrin and external counting

Using the formulae of Fazio and coworkers, we calculated the extravascular lung water per unit of blood volume (ELW/V) and per unit of blood flow (ELW/F) after intravenous injection of 113In-transferrin as the blood label, and 123I-antipyrine as the diffusible, i.e. water label. Time-activity curves were recorded over the right anterior upper chest wall using a mobile detector. The curves were digitalized and fitted to a gamma-variate using a GAMMA-11 computer. Area over height calculations gave the mean transit times (t). Sixteen control subjects, without evidence of cardiac or pulmonary disease, and 10 patients, with clinical and radiological evidence of left heart failure, were examined. In the control group ELW/V was 0.37 plus or minus 0.17 and ELW/F 3.39 plus or minus 1.56 (mean plus or minus 1 SD). In the patients ELW/V was 0.71 plus or minus 0.26 and ELW/F 13.10 plus or minus 5.67. The difference between both ELW/V and ELW/F for the control group and the patient group is statistically significant. Our values for ELW/V both in patients and control subjects are very similar to those obtained by Fazio and coworkers using H2 15O. However, our values for ELW/F differed from those of Fazio; this could be partly due to dependence of this parameter on the cardiac output.

[Sequential cardiac szintigraphy: a methodological contribution to the evaluation of local cardiac dynamics]

A non-invasive technique is described in which the initial passage of a radionuclide is followed through the heart using an tanger camera after intravenous bolus injection. This method allows analysis of the regional and global wall motion of the left ventricle as well as estimation of the regional distribution of stroke volume and ejection fraction. Supplementing radionuclide angiocardiography with gradient scintigraphy permits the diagnosis of left ventricular aneurysms, intracardiac shunts and av-valve insufficiency. Initial comparisons show fair agreement between the radionuclide technique and left ventricular contrast angiography.

[Trend scintigraphy]

Focal changes in activity concentration for given time function. The increase per time interval is calculated for each pixel and arranged into a result matrix. Areas with increasing activity are displayed in a "positive trend scintigramm", those with decreasing activity in a "negative trend scintigram", using a gray scale of color format. Statistical fluctuations are suppressed using this method; the data smoothing over the chosen time period and the fact that several individual pictures are included in the calculations provide displays with increased informational content as compared to serial imaging methods. The clinical interpretation of localized changes in activity concentration during a specific time interval is facilitated. The method is simple, can be adapted to different camera and computer systems, and requires no additional examination procedures on the patient.

[Selective double-isotope coronary scintigraphy with 99mTc- and 111In-HSA-microspheres]

A small fraction of a commercially available kit for the preparation of human serum albumin (HSA)-microspheres is labeled with 111In or 99mTc. The regional coronary blood flow is determined after selective injection of these labeled microspheres at rest and during rapid atrial pacing using a double-isotope coronary scintigraphy with a gamma camera.

[Characterization of gastric emptying by determination of transit time]

Gastric emptying of a solid test meal labelled with 99mTc-sulphur colloid has been studied in 18 healthy men using a gamma camera with on-line computer. Mean transit time (MTT) was determined by fitting the time-activity histogram to a gamma variate, and the half-time of emptying (T1/2) was calculated by exponential fitting of the down-slope of the C(t) curve. Mean transit times showed a smaller coefficient of variance than T1/2, and this difference was statistically significant (p less than 0.005). This result suggests that MTT may be a more suitable parameter for definition of normal values and for the separation of normal from pathological patterns of emptying.

[Role of renal function and calcemia in demonstration of kidneys in 99mTc-diphosphonate skeletal scintigrams (author's transl)]

Normally, in 99mTc-diphosphonate-skeletal scintigrams the kidneys are delineated with the same intensity as the lumbar spine; This is not the case in patients with reduced renal function. In a series of 20 patients with varying degrees of renal insufficiency, a continuous decrease in the renal intensity with increasing serum creatinine was seen: clearly recognizable decreased renal intensity in patients with serum creatinine over 2 mg%, and no visualization of the kidneys in patients with serum creatinine over 8 mg%. This effect is intensified through a simultaneously existing hypercalcemia has the opposite effect, i.e., the intensity decrease is partially prevented. In patients with normal renal function a hypercalcemia even leads to an increased renal intensity. As a further cause for excessive renal intensity, an increased parenchymal transit time was found in the radionephrography in 5 out of 11 patients with normal serum creatinine in whom the increased renal intensity in the skeletal scintigram was a chance finding.

[Isotopic cisternography in detection of CSF Rhinorrhea (author's transl)]

The radioisotope cisternogram has proven itself to be a valuable diagnostic procedure during the evaluation of patients with cerebrospinal fluid (CSF) rhinorrhea. If it is not possible to define the origin of such a leak, extensive intracranial explorations may be required, which may or may not result in successful correction of the defect. As a functional examination with limited risk to the patient and minimal radiation exposure, the isotopic cisternogram can either establish a diagnosis of CSF rhinorrhea or eliminate cerebrospinal fluid as a cause for rhinorrhea. When occurring, CSF leaks can be shown by demonstrating a "path" from the cranial fossage into the nasal cavity. The present technique utilizes tampons placed in each nostril. A positive diagnosis of CSF rhinorrhea is made by finding a tampon impregnated with at least twice the radioactivity of a control tampon from the opposite nostril (in the presence of an intact septum). Conclusions indicate that a positive anterior fossa cisternogram may be the only evidence for hidden site of CSF leakage, especially when other signs are lacking.

Mean transit time of solid test meals in gastric emptying

Gastric emptying of a test meal labelled with 99Tcm-sulphur colloid has been studied in 9 healthy volunteers using a gamma-camera with on-line computer. Mean transit time (MTT) was determined by fitting the time-activity histogram to a gamma-variate, and the half-time of emptying (T1/2) was calculated by exponential fitting of the down-slope of the time-activity curve. MTT showed a smaller coefficient of variance than T1/2. This result suggests that MTT may be a more suitable parameter for definition of normal values and for the separation of normal from pathological patterns of emptying.

Changes of circulating thyroxine, triiodothyronine and reverse triiodothyronine after radiographic contrast agents

Thyroid function was studied for 42 days in 58 patients, 28 of whome had euthyroid goiter, after urography (diatrizoic acid), cholangiography (ioglycamic acid), and cholecystography (Naiopanoate). After urography and cholangiography short-lived increases of the serum thyroxine occurred in a few patients, but the mean thyroxine and triiodothyronine concentration did not change. By contrast, 7 days after oral cholecystography serum thyroxine had risen consistently by 22% with a concomittant rise of the free thyroxine, while triiodothyronine declined by 15%. The thyroxine metabolite 3,3',5'-triiodo-1-thyronine (reverse T3) rose by 50% and serum thyrotropin concentration doubled. After 42 days thryoxine and triiodothyronine had returned to baseline, and none of the 58 patients developed clinical hyperthyroidism. In patients with severe myxoedema kept on a constant replacement dose with 1-thyroxine NA-iopanoate produced similar changes with the exception of the rise of the serum thyroxine. The primary event after Na-iopanoate seems to be a fall of the serum triiodothyronine, which in turn augments thyrotropin and indirectly thyroxine secretion. the marked and sometimes sustained rose of serum thyroxine after cholecystography may lead to the erroneous diagnosis of hyperthyroidism.

[Congenital liver cysts. Case report and review of the literature]

A study is presented of four female patients with congenital solitary liver cyst. The largest cyst had a volume of 4 liters. One of the patients studied had a neoplasm which was possibly the result of secondary malignant degeneration of the cyst. Congenital cystic degeneration may develop in the entire biliary tract. The clinical symptoms depend on the size, localization and number of cysts. Characteristic signs and symptoms caused by displacement of the intestinal organs begin to appear as a rule in late adulthood. The cysts rarely impair liver function. Hemorrhage into the cysts, rupture of the cystic wall, infection or secondary malignant degeneration of the cysts, torsion and strangulation are infrequent. Solitary cysts of the liver are not accompanied by cysts in other organs as is the case in polycystic liver disease. Diagnostic procedures, differential, diagnosis and therapeutic measures are discussed, and reference is made to non-congenital cystic formations in the liver.

[Radioiodine treatment in Basedow's disease]

Radioiodine (131I) is the standard treatment for hyperthyroidism with Graves' disease because of ease of performance, relatively low cost and minimal complications. The patient must be followed up regularly at 1-2 year intervals although the risk of "early myxedema" (less than 3%) and the cumulative myxedema rate (less than 2% per year) are now minimized thanks to smaller single doses of radioiodine and to an individualized scheme for dose calculation. For patients in poor condition, 131I should be combined with thyrostatic therapy for at least 2 1/2 months.