[99mTc tin colloid scintigraphy in the diagnosis of acute rejection reactions in kidney transplants]

Quantitative measurements of 99MTc-tin colloid uptake in renal transplants permits differentiation of acute rejection from other causes of deteriorating renal function, such as acute tubular necrosis, cyclosporin A nephrotoxicity or chronic rejection. 144 99mTc-tin colloid scintigrams were performed on 71 renal transplants; the results were compared with clinical, biochemical and histological findings. Sensitivity of colloid scintigraphy is 97.4% and specificity is 80%. Compared with other isotope methods, this has the advantage that it does not depend on comparison with repeated examinations.

Adenylate cyclase stimulation and [3H]thymidine incorporation in human thyroid tissues and thyrocyte cultures: the effect of IgG preparation from patients with different thyroid disorders

Primary cell cultures of normal and adenomatous human thyroid tissues were incubated with TSH or ammonium sulphate precipited IGG fractions (1 mg/ml) of sera from patients with different thyroid diseases (Graves' disease: active n = 7 in remission n = 12; thyroid autonomy n = 39; simple euthyroid goitre n = 15) and were compared to controls (n = 26). [3H]thymidine incorporation in primary thyrocyte cultures demonstrated a typical bell shape curve after incubation with EGF and TSH with a maximal effect at 10-100 microIU/ml. This effect, however, was inconsistent and positive only in 2 of 7 primary cultures. Only TSH positive cultures were used for IgG studies. 16-28% of IGG fractions from sera of thyroid patients caused high (more than X + 5 SD of controls) stimulation of [3H]thymidine incorporation. Dose response curves of IgG fractions of 19 additional patients (Graves' disease in remission n = 15; thyroid autonomy n = 4) showed an increase in [3H]thymidine incorporation at 0.1 mg protein/ml for 10 patients and at low concentrations of 10-5 mg/ml for 5 patients. There was a good correlation (r = 0.72) (P less than 0.0001) between positive findings in TSH-binding inhibition (TBII) and AC-stimulation (TSI) IGG fractions but none between stimulation of [3H]thymidine incorporation and any other thyroid specific immunoglobulin nor thyroid function nor any other available data. Immunoglobulins stimulating [3H]thymidine incorporation differ therefore from TBII and TSI. The growth effect of these immunoglobulins, however, has yet to be determined.

LT4-monopreparation versus LT4-LT3-compound preparation in the treatment of diffuse endemic goitre

Fifty-four patients with diffuse non-toxic goitre were observed before and under therapy either with 125 micrograms LT4 (group A) or 75 micrograms LT4 + 15 micrograms LT3 (group B) in a prospective double blind study, using 1-, 3- and 6-months controls. Changes in goitre size have been estimated by ultrasonic scanning. Both treatment forms provided a significant reduction of goitre size, even after 1 month of therapy: a 20%-decrease in group A and 16% in group B. The 6-month reduction was about 30% in group A and 27% in group B. Between the 2 groups there were no differences in the reduction of volume. The suppression of the TSH-response to TRH was identical in both groups, too. In group A there was a predominant increase of the TT4- and FT4-serum levels, both reaching the hyperthyroid range. In group B there was a predominant increase of the TT3- and FT3-serum levels and a slight increase of the FT4-levels. The TT3- and FT3-serum levels also exceeded the upper normal range. As the blood samples were drawn about 2 h after medication, acute hormone resorption influenced these data. In the 3-month controls only there was a significant correlation between the reduction of the thyroid volume and the suppression of TSH-release. In the 6-month controls we found a weak correlation of the reduction of volume and the decrease of the pertechnetate uptake value.(ABSTRACT TRUNCATED AT 250 WORDS)

[Computed tomographic determination of thyroid iodine concentration in an endemic goiter area]

We determined the CT density of the thyroid gland in 60 patients with normal thyroids and 176 patients with various thyroid disorders. The density was 75 +/- 6.2 H.U. in normal thyroids, which was markedly higher than in goiters (66 +/- 6.0 H.U.), while there was a considerable further decrease in patients with immunogenic hyperthyroidism, the density being 48.5 +/- 7.9 H.U. The thyroids of patients with nonimmunogenic hyperthyroidism differed from these by virtue of a significantly greater density, 79.8 +/- 12.5 H.U. The clinical importance of CT investigation of the thyroid is its ability to distinguish rapidly between immunogenic hyperthyroidism without ocular symptoms and the (mostly iodine induced) non-immunogenic form. There is a linear correlation between CT density and iodine concentration in the thyroid tissue; this was determined in surgical specimens from 17 patients. Iodine concentration in the thyroid, as well as the iodine content of the whole gland, can thus be calculated from the measured CT density at any time by estimating the volume of the gland with ultrasound and combining this value with the measured iodine concentration. The results correlate well with those found using the x-ray fluorescence method.

[Pre- and postnatal diagnostic imaging of congenital urinary tract disorders]

The prenatal diagnosis of urinary tract obstruction was made in 10 neonates. These findings were confirmed postnatally by sonography, urography, voiding cystourethrography, and scintigraphy. There were 8 neonates with unilateral obstruction of the ureter, and 2 with urethral valves and reflux. Nephrectomy because of hydronephrosis was necessary in 2 instances. The prenatal diagnosis of a urinary tract obstruction is of great importance, because the neonate may be operated upon without delay. Thus the diseased kidney can be saved. Diuretic radionuclide urography is helpful in differentiating between dilated obstructed and dilated nonobstructed kidneys.

[Radicality principles in operations on malignant thyroid tumors]

Different concepts are required by different tumors: anaplastic carcinomas rarely are accessible to curative surgery, but tumor reduction gives sense in combined concepts. In follicular carcinomas general ("near"-) total thyroidectomy + radioiodine + hormonal suppressive therapy is recommended, with respect to the high incidence of distant metastases even in low 1 degree Tu-stages. Papillary carcinomas allow a stage related procedure with exceptions from total thyroidectomy: no reintervention for "occult" carcinomas and-in patients under 40 years of age-hemithyroidectomy for intrathyroid tumors without regional metastases. In C-Cell-carcinomas total thyroidectomy has to be accompanied by lymph-node dissections of various extent, depending on familiary or sporadic type and tumor-stage.

Thyroid function after surgery for autonomous and non-autonomous nodular endemic goitre--effect of iodide-substitution

The aim of this study was to evaluate the influence of postoperative iodide-substitution on the function of thyroid remnants of different quality and quantity in order to define the appropriate prophylaxis (iodide or thyroid hormone) to prevent recurrent goitre. In a prospective, randomized clinical trial, the following patients were examined: group I: simple, non-autonomous nodular goitre, bilateral thyroidectomy (n = 40); group II: simple, non-autonomous nodular goitre, "selective" (unilateral) thyroidectomy (n = 40); group III: autonomous nodular goitre, bilateral thyroidectomy (n = 40); group IV: autonomous nodular goitre, "selective" (unilateral) thyroidectomy (n = 35). The following parameters were measured 6 and 12 weeks postoperatively. Serum-total-T4, -T3, -TSH, TRH-test, 99mTc-Thyroid-Uptake (TcTU). Six weeks postoperatively the 4 groups were separately randomized into controls and treatment groups, who received 200 micrograms iodide/day orally. Six weeks postoperatively, patients in group I had lower T4 levels and both basal and stimulated TSH were higher than in the other groups, however no significant differences were observed in T3, T4/T3 ratio and TcTU. Twelve weeks postoperatively patients from groups I, II and III, who had been treated with iodide, had lower T3 and TcTU values but higher T4 and T4/T3 than the appropriate controls. Basal and stimulated TSH showed no differences between controls and iodide-treated patients in these groups. In group IV, T4 and T3 showed a tendency to elevation (n.s.), and basal and stimulated TSH as well as TcTU were lower in patients with iodide.(ABSTRACT TRUNCATED AT 250 WORDS)

Low T3 syndrome in patients following major surgery

Time sequence and specificity of thyroid hormones and biochemical parameters were investigated in patients following major surgery. Serum concentration of triiodothyronine decreases significantly following operation, with a biphasic regression. There is a reciprocal change in serum reverse triiodothyronine levels, but serum thyroxine levels show no significant change after operation. The significant decrease in serum concentration of alpha-2-macroglobulin and antithrombin III during and after surgery is the result of consumption of these inhibitors because the reciprocal change in serum concentration of elastase-like protease has been recognized. According to the change of curvilinear regression of serum triiodothyronine levels, 14 patients were grouped into 3. The patients for whom the curvilinear regression resembled a polynomial of degree 3 and 2 had a good prognosis, but the remaining 4 with no significant curvilinear regression had major complications and 2 died. It is meaningful that the postoperative change of triiodothyronine levels relates to the clinical outcome, to some degree.

Increased serum concentration of free L-triiodothyronine in patients treated with L-thyroxine

This study demonstrates that in spite of measured normal concentrations of carrier proteins one cannot deduce in all cases a normal fT3 from a normal level of TT3 when l-thyroxine given for diagnostic or therapeutic purposes is present in excess. The displacement of l-triiodothyronine from its binding sites is shown in 35 patients with non-toxic goitre who received an oral dose of 200 micrograms l-thyroxine/die for two weeks. Apart from a significant increase of TT4 (from 7.85 to 14.21 micrograms/dl equal + 81%) and of fT4 (from 1.58 to 3.7 ng/dl equal + 134%) there is only a slight increase in TT3 from 148 to 158 ng/dl (equal + 10%) after 14 days of treatment. By contrast fT3 rises clearly from 4.97 to 8.07 pg/ml equal + 63% (normal range: 2.8-5.6 pg/ml). Compared with the increase of TT3 (+ 10%) the free T3 rises by a factor of 6.3 (63%/10%). On account of higher affinity of l-thyroxine to binding proteins the free T4 is influenced to a lesser degree. Compared with the increase of TT4 (+ 81%) free T4 rises by a factor of 1.6 (134%/81%). It is supposed that the serum concentration of free T3 can be increased despite a normal concentration of TT3 when l-thyroxine is present in excess. Therefore, for laboratory work fT3 should be assigned a higher validity than TT3 when patients are treated with comparatively high doses of l-thyroxine.

Increased Serum Concentration of Free L-Triiodothyronine in Patients Treated with L-Thyroxine

This study demonstrates that in spite of measured normal concentrations of carrier proteins one cannot deduce in all cases a normal fT3 from a normal level of TT3 when 1-thyroxine given for diagnostic or therapeutic purposes is present in excess. The displacement of 1-triiodothyronine from its binding sites is shown in 35 patients with non-toxic goitre who received an oral dose of 200 μg 1-thyroxine/die for two weeks. Apart from a significant increase of TT4 (from 7.85 to 14.21 μg/dl ≙ + 81 %) and of fT4 (from 1.58 to 3.7 ng/dl ≙ + 134%) there is only a slight increase in TT3 from 148 to 158 ng/dl (≙ + 10%) after 14 days of treatment. By contrast fT3 rises clearly from 4.97 to 8.07 pg/ml ≙ + 63% (normal range: 2.8-5.6 pg/ml). Compared with the increase of TT3 (+ 10%) the free T3 rises by a factor of 6.3 (63 %/10%). On account of higher affinity of 1-thyroxine to binding proteins the free T4 is influenced to a lesser degree. Compared with the increase of TT4 (+ 81 %) free T4 rises by a factor of 1.6 (134%/81 %). It is supposed that the serum concentration of free T3 can be increased despite a normal concentration of TT3 when 1-thyroxine is present in excess. Therefore, for laboratory work fT3 should be assigned a higher validity than TT3 when patients are treated with comparatively high doses of 1-thyroxine.

Home traction in the management of congenital dislocation of the hip

A form of axial fraction has been devised for the premanipulative management of a child with congenital dislocation of the hip. This set-up makes it possible to maintain a child in his own home while gently pulling the head of the femur down to the level of the acetabulum. Home traction has proven to be a simple, extremely safe method of management of congenital dislocation of the hip, with an exceptionally low incidence of avascular necrosis. It requires only that adequate instruction and supervision are available to the family. It helps to reduce the stress on the child inherent with hospitalization and on the parents with dividing their time and energy between the hospitalized child and their family at home. Home traction and is as effective as hospital traction and is far more acceptable to he parents and child.

The foot-ground pressure distribution following triple arthrodesis

The present is a long-term follow-up study of patients who underwent triple arthrodesis for a variety of pathologic alterations. Utilizing a new method for both the qualitative and quantitative measurement of foot-ground pressure patterns, these patterns were recorded in forty control feet and twenty-six operated feet. In the patient group, less equal distribution of body weight between both feet was observed in comparison to the control group. In the latter, the main load underneath the foot was distributed underneath the forefoot and heel, while in the patient group, this load distribution had persistently shifted to the midfoot and heel, thus producing a completely different foot-ground pressure pattern. Furthermore, under the forefoot, the main load was located under the medial two rays in the control group, shifting towards the lateral rays in the patient group. The talo-navicular joint had the highest rate of non-union, but no positive correlation between that finding and persistent pain was found. Feet affected by neurological disorders often became pain-free following surgery, but none of the patients showed such post-traumatic relief.

[Early recognition of potential hyperthyroidism in endemic goitre areas (author's transl)]

Equal amounts of autonomous thyroid tissue were found with the same frequency before and after 40 years of age in eumetabolic patients in endemic goitre areas. A tentative diagnosis of thyroid autonomy can be made already in euthroid patients with an 80% accuracy by combined estimation of an equivalent of free thyroxine and iodine uptake. The equivalent is taken from determination of thyroid pertechnetate uptake by quantitative scan evaluation. Proof of autonomy is established by the suppression test which in a prolonged fractionated form also permits estimation of the amount of functioning autonomous tissue. There is a linear correlation of technetium thyroid uptake after suppression and the volume of autonomous thyroid tissue. As free thyroxine increases after iodine intake of sufficient amount and duration in proportion with the volume of autonomous tissue, prognosis appears possible: patients with autonomous thyroid tissue above a "critical" volume can be expected to develop hyperthyroidism in case of sufficient iodine uptake. Iodine salt prophylaxis however does not induce hyperthyroidism in patients below 50 years of age provided that the daily additional iodine intake does not exceed 100 micrograms.

[Diagnostic value of clinical methods in the staging of abdominal Hodgkin's disease (author's transl)]

Explorative laparotomies were carried out on 68 patients with Hodgkin's disease in the University Hospital of Marburg from 1969 through 1978. These laparotomies were preceded by clinical examination, abdominal sonography in 27 cases, lymphography in 55 cases, scintigraphy of liver and spleen in 58 cases, and radiographic examinations of the intestinal tract in 18 cases. Sonography revealed a greater accuracy (90%) for splenic involvement than scintigraphy (74%); the results of sonography and scintigraphy of the liver were comparable. For the detection of para-aortal lymphomas ultrasound and lymphography can be regarded as complementary methods. Our results are compared with findings in the literature on abdominal sonography (n = 50), scintigraphy of liver and spleen (n = 185), and lymphography (n = 465) carried out before explorative laparotomy for lymphogranulomatosis. There was a better correlation for the systemic symptoms of the 68 patients with the clinical stage than with the pathologic stage. The importance of diagnosing different groups, e.g. in stage III, is stressed.

[Studies on the reliability of the 99mTc-uptake as a measure of thyroidal stimulation (author's transl)]

In 44 patients with stimulated goitre the trapping kinetics of 131I-iodide and 99mTc-pertechnetate are analyzed having corrected for different size of the thyroid and different physical properties of the tracers under use. Unidirectional iodide clearance (UDCL) is chosen as reliable estimator of thyroidal stimulation. UDCL shows strong correlation to iodide uptake tests and the correlation to pertechnetate uptake tests is sufficiently strong for semiquantitative evaluation of thyroidal stimulation. Under the conditions of clinical routine work the reproducibility of pertechnetate uptake tests exceeds that of iodide, thus, pertechnetate uptakes are more suitable for evaluation of regulation tests, i.e. suppression test and stimulation test with TSH. 99mTc-thyroid-uptake (TcTU) 20 min after injection is a useful parameter of thyroidal stimulation for clinical routine work as it combines excellent reproducibility with strong correlation to unidirectional iodide clearance as the relevant parameter of thyroidal stimulation.

[Renal blood flow, diuresis and isotope nephrogram in experimental stenosis of the renal artery (author's transl)]

After experimental stenosis of the renal artery of the dog, the isotope nephrogram shows a prolongation of the transit-time, when the renal blood flow is reduced to 40--70%. This finding was most significant in low diuresis (0,05--0,2 ml/min), sporadic in moderate diuresis (0,2--2,0 ml/min), no longer demonstrable in forced diuresis (greater than 2,0 ml/min). The diuretic effect of X-ray contrast medium (70% Na-Meglumin-Jotalamat, 0,5 ml/kg i.v.) normalizes a pathologic ING in low diuresis.

[New diagnostic examinations in patients with urinary calculi, taking into consideration primary hyperparathyroidism]

The serum levels of total calcium and anorganic phosphate have been the leading parameters in the diagnosis of primary hyperparathyroidism. In addition to these, it is now possible to measure ionized calcium (Ca++) by an ion-selective electrode and parathormone (PTH) by C- and N-terminal radioimmunoassays (RIA). Whereas Ca++ determination and C-terminal PTH RIA represent a diagnostic progress, this can not be claimed for the N-terminal PTH RIA in peripheral venous blood especially in border-line cases.

Magnetic microspheres prepared by redox polymerization used in a cell separation based on gangliosides

A facile method is described for making magnetic microspheres that bind specifically to cell surfaces, in order to separate cells magnetophoretically. Control over the sizes of the spheres is effected by using their magnetic cores as part of a redox polymerization system. The use of the microspheres is demonstrated with a separation involving C-1300 neuroblastoma cells, 10% of which express the ganglioside GM1 in their membranes. The GM1-containing cells were separated with better than 99% purity, while the deficient cells were obtained at least 98% pure. The separation, which was carried out under sterile conditions, required only 6 minutes.

[Diseases of the small intestine from the surgical aspect (author's transl)]

Among 37,857 operations in a general surgical department (1965-1975), 205 interventions on the small intestine were necessary- enterotomies, oversuturing, amputations and resections. The operations are evaluated with regard to etiology, clinical aspects and operative technique.

Disparity between clinical and immune responses in a controlled trial of azathioprine in rheumatoid arthritis

Drugs that interfere with the immune response in vitro, such as azathioprine (AZ), have been used extensively since 1964 in clinical therapeutic trials of autoimmune diseases. However, few adequately controlled studies are available concerning the concurrent effect of AZ on the immune and clinical responses to treatment of rheumatoid arthritis (RA). Thirty patients suffering from classical seropositive RA received AZ (1.5 - 2.0 mg/kg/day) and placebo in a controlled clinical cross-over study for two 12-week periods. Other treatments were kept constant throughout the entire 6 months. In terms of the clinical responses of joint count and grip strength patients receiving AZ improved markedly, in contrast to the placebo group. After 2 months, joint scanning revealed no progress of the disease in patients undergoing AZ treatment. Corresponding with the remarkably beneficial clinical effect of AZ, a significant drop in immunoglobulins was observed. However, since AZ failed to suppress in vivo specific antibody synthesis in RA, the question remains as to whether this drug actually does interfere with the autoimmunogenesis of the disease.

Protein synthesis in vitro by cryopreserved Plasmodium falciparum

Plasmodium falciparum-parasitized erythrocytes obtained from infected owl monkeys (Aotus trivirgatus) and stored in the frozen state retain both the capacity to incorporate 14C isoleucine into protein and to infect animals. The cryopreservation method involves the use of glycerol and the reconstitution of isotonicity after thawing. Animals have been infected from material held for up to 273 days and protein synthesis has been demonstrated in vitro for up to 180 days after freezing. The specificity of protein synthesis as an activity of the parasites was shown by the inactivity of control uninfected erythrocytes stored by the same method. Additional evidence for the specificity of the reaction was obtained from inhibition studies with chloroquine; a 7 X 10(-5) M concentration of the drug resulted in 50% inhibition of the initial rate of protein synthesis.