3,5,3’-Triiodothyroacetic Acid (TRIAC) Effects on Pituitary Thyroid Regulation and on Peripheral Tissue Parameters

The effects of TRIAC on peripheral thyroid hormones, TSH incretion and peripheral tissue parameters were investigated in 13 mildly obese patients (group I) and 10 volunteers of normal body weight (group II). TRIAC was administered 3x1 mg daily over a period of 8 days to both groups. In group I (on a 400 kcal low caloric diet) bTSH and fT4 decreased significantly whereas TT4 decreased only insignificantly. TT3 and fT3 rose significantly due to the cross-reactivity of the employed antibody. The peripheral tissue parameters cholesterol, ankle jerk and systolic time interval did not reveal any changes suggesting an increase in metabolic rate. The increase in heart frequency was not significant either. The significant rise in sex-hormone binding globulin was most probably associated with the weight reduction of 3.1 ± 1.2 kg per week. In group II (on normal diet) bTSH and fT4 decreased significantly whereas TT4 decreased only insignificantly. As in group I, TT3 and fT3 rose significantly. Also in group II TRIAC did not cause alterations in the peripheral tissue parameters. In contrast to the obese group the volunteers in group II showed no significant rise in sex-hormone binding globulin and no reduction of body weight. Side effects such as nervousness, tremor or palpitations were not observed. Thus, TRIAC does not induce an increase in peripheral metabolic rate, not even under a TSH-suppressive dose as high as 3 x 1 mg per day.

The EANM practice guidelines for bone scintigraphy

PURPOSE

The radionuclide bone scan is the cornerstone of skeletal nuclear medicine imaging. Bone scintigraphy is a highly sensitive diagnostic nuclear medicine imaging technique that uses a radiotracer to evaluate the distribution of active bone formation in the skeleton related to malignant and benign disease, as well as physiological processes.

METHODS

The European Association of Nuclear Medicine (EANM) has written and approved these guidelines to promote the use of nuclear medicine procedures of high quality.

CONCLUSION

The present guidelines offer assistance to nuclear medicine practitioners in optimizing the diagnostic procedure and interpreting bone scintigraphy. These guidelines describe the protocols that are currently accepted and used routinely, but do not include all existing procedures. They should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary.

Hypervolemic haemodilution and completed stroke: how important is the application time for its effect?

In 75 patients with completed stroke hypervolemic haemodilution was performed for 1 day with 500 ml 6% HES 200.000/0.6-0.66 (Elohäst) to test the acute influence of application time for haemorheological changes. The patients were divided into 3 groups randomly selected: group A received the infusion for 2 hours, group B for 4 hours and group C for 6 hours. Haematocrit (HCT), whole blood viscosity (VI-VB), blood elasticity (EL-VB) and plasma viscosity (VI-PL) were determined before onset of infusion, after 6 and 18 hours subsequently. The values obtained were compared with the onset results. In all groups and parameters after 6 hours there was a significant decrease. After 18 hours group A showed a significant higher value of HCT and increasing trends for VI-VB and EL-VB. In group B after 18 hours a significant decrease of VI-VB could be observed. In group C all values remained significantly below the onset. The results show, that one important haemorheological argument for an effective form of haemodilution should also be a long application time. This might be one of the reasons, why in some studies with hypervolemic haemodilution no positive results could be obtained.

32nd International Austrian Winter Symposium : Zell am See, the Netherlands. 20-23 January 2016

A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CT

W Langsteger, A Rezaee, W Loidl, HS Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M Beheshti

A2 F18 Choline PET – CT: an accurate diagnostic tool for the detection of parathyroid adenoma?

L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W Langsteger

A3 [18F]Fluoro-DOPA-PET/CT in the primary diagnosis of medullary thyroid carcinoma

A Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M Hartenbach

A4 Variations of clinical PET/MR operations: An international survey on the clinical utilization of PET/MRI

T Beyer, K Herrmann, J Czernin

A5 Standard Dixon-based attenuation correction in combined PET/MRI: Reproducibility and the possibility of Lean body mass estimation

I Rausch, P Rust, MD DiFranco, M Lassen, A Stadlbauer, ME Mayerhöfer, M Hartenbach, M Hacker, T Beyer

A6 High resolution digital FDG PET/MRI imaging for assessment of ACL graft viability

K Binzel, R Magnussen, W Wei, MU Knopp, DC Flanigan, C Kaeding, MV Knopp

A7 Using pre-existing hematotoxicity as predictor for severe side effects and number of treatment cycles of Xofigo therapy

A Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A Haug

A8 QDOSE – comprehensive software solution for internal dose assessment

Wencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas Kluge

A9 Clinical impact of Time-of-Flight on next-generation digital PET imaging of Yttrium-90 radioactivity following liver radioembolization

CL Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, MV Knopp

A10 Snakes in patients! Lessons learned from programming active contours for automated organ segmentation

M Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, RP Baum, B Knäusl, D Georg

A11 Influence of a genetic polymorphism on brain uptake of the dual ABCB1/ABCG2 substrate [11C]tariquidar

M Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O Langer

A12 Outcome prediction of temporal lobe epilepsy surgery from P-glycoprotein activity. Pooled analysis of (R)-[11C]-verapamil PET data from two European centres

M Bauer, M Feldmann, R Karch, W Wadsak, M Zeitlinger, MJ Koepp, M-C Asselin, E Pataraia, O Langer

A13 In-vitro and in-vivo characterization of [18F]FE@SNAP and derivatives for the visualization of the melanin concentrating hormone receptor 1

M Zeilinger, C Philippe, M Dumanic, F Pichler, J Pilz, M Hacker, W Wadsak, M Mitterhauser

A14 Reducing time in quality control leads to higher specific radioactivity of short-lived radiotracers

L Nics, B Steiner, M Hacker, M Mitterhauser, W Wadsak

A15 In vitro 11C-erlotinib binding experiments in cancer cell lines with epidermal growth factor receptor mutations

A Traxl, Thomas Wanek, Kushtrim Kryeziu, Severin Mairinger, Johann Stanek, Walter Berger, Claudia Kuntner, Oliver Langer

A16 7-[11C]methyl-6-bromopurine, a PET tracer to measure brain Mrp1 function: radiosynthesis and first PET evaluation in mice

S Mairinger, T Wanek, A Traxl, M Krohn, J Stanek, T Filip, M Sauberer, C Kuntner, J Pahnke, O Langer

A17 18F labeled azidoglucose derivatives as “click” agents for pretargeted PET imaging

D Svatunek, C Denk, M Wilkovitsch, T Wanek, T Filip, C Kuntner-Hannes, J Fröhlich, H Mikula

A18 Bioorthogonal tools for PET imaging: development of radiolabeled 1,2,4,5-Tetrazines

C Denk, D Svatunek, T Wanek, S Mairinger, J Stanek, T Filip, J Fröhlich, H Mikula, C Kuntner-Hannes

A19 Preclinical evaluation of [18F]FE@SUPPY- a new PET-tracer for oncology

T Balber, J Singer, J Fazekas, C Rami-Mark, N Berroterán-Infante, E Jensen-Jarolim, W Wadsak, M Hacker, H Viernstein, M Mitterhauser

A20 Investigation of Small [18F]-Fluoroalkylazides for Rapid Radiolabeling and In Vivo Click Chemistry

C Denk, D Svatunek, B Sohr, H Mikula, J Fröhlich, T Wanek, C Kuntner-Hannes, T Filip

A21 Microfluidic 68Ga-radiolabeling of PSMA-HBED-CC using a flow-through reactor

S Pfaff, C Philippe, M Mitterhauser, M Hartenbach, M Hacker, W Wadsak

A22 Influence of 24-nor-ursodeoxycholic acid on hepatic disposition of [18F]ciprofloxacin measured with positron emission tomography

T Wanek, E Halilbasic, M Visentin, S Mairinger, B Stieger, C Kuntner, M Trauner, O Langer

A23 Automated 18F-flumazenil production using chemically resistant disposable cassettes

P Lam, M Aistleitner, R Eichinger, C Artner

A24 Similarities and differences in the synthesis and quality control of 177Lu-DOTA-TATE, 177Lu -HA-DOTA-TATE and 177Lu-DOTA-PSMA (PSMA-617)

H Eidherr, C Vraka, A Haug, M Mitterhauser, L Nics, M Hartenbach, M Hacker, W Wadsak

A25 68Ga- and 177Lu-labelling of PSMA-617

H Kvaternik, R Müller, D Hausberger, C Zink, RM Aigner

A26 Radiolabelling of liposomes with 67Ga and biodistribution studies after administration by an aerosol inhalation system

U Cossío, M Asensio, A Montes, S Akhtar, Y te Welscher, R van Nostrum, V Gómez-Vallejo, J Llop

A27 Fully automated quantification of DaTscan SPECT: Integration of age and gender differences

F VandeVyver, T Barclay, N Lippens, M Troch

A28 Lesion-to-background ratio in co-registered 18F-FET PET/MR imaging – is it a valuable tool to differentiate between low grade and high grade brain tumor?

L Hehenwarter, B Egger, J Holzmannhofer, M Rodrigues-Radischat, C Pirich

A29 [11C]-methionine PET in gliomas - a retrospective data analysis of 166 patients

N Pötsch, I Rausch, D Wilhelm, M Weber, J Furtner, G Karanikas, A Wöhrer, M Mitterhauser, M Hacker, T Traub-Weidinger

A30 18F-Fluorocholine versus 18F-Fluorodeoxyglucose for PET/CT imaging in patients with relapsed or progressive multiple myeloma: a pilot study

T Cassou-Mounat, S Balogova, V Nataf, M Calzada, V Huchet, K Kerrou, J-Y Devaux, M Mohty, L Garderet, J-N Talbot

A31 Prognostic benefit of additional SPECT/CT in sentinel lymph node mapping of breast cancer patients

S Stanzel, G Pregartner, T Schwarz, V Bjelic-Radisic, B Liegl-Atzwanger, R Aigner

A32 Evaluation of diagnostic value of TOF-18F-FDG PET/CT in patients with suspected pancreatic cancer

S Stanzel, F Quehenberger, RM Aigner

A33 New quantification method for diagnosis of primary hyperpatahyroidism lesions and differential diagnosis vs thyropid nodular disease in dynamic scintigraphy

A Koljević Marković, Milica Janković, V Miler Jerković, M Paskaš, G Pupić, R Džodić, D Popović

A34 A rare case of diffuse pancreatic involvement in patient with merkel cell carcinoma detected by 18F-FDG

MC Fornito, D Familiari

A35 TSH-stimulated 18F-FDG PET/CT in the diagnosis of recurrent/metastatic radioiodine-negative differentiated thyroid carcinomas in patients with various thyroglobuline levels

P Koranda, H Polzerová, I Metelková, L Henzlová, R Formánek, E Buriánková, M Kamínek

A36 Breast Dose from lactation following I131 treatment

WH Thomson, C Lewis

A37 A new concept for performing SeHCAT studies with the gamma camera

WH Thomson, J O’Brien, G James, A Notghi

A38 Whole body F-18-FDG-PET and tuberculosis: sensitivity compared to x-ray-CT

H Huber, I Stelzmüller, R Wunn, M Mandl, F Fellner, B Lamprecht, M Gabriel

A39 Emerging role 18F-FDG PET-CT in the diagnosis and follow-up of the infection in heartware ventricular assist system (HVAD)

MC Fornito, G Leonardi

A40 Validation of Poisson resampling software

WH Thomson, J O’Brien, G James

A41 Protection of PET nuclear medicine personnel: problems in satisfying dose limit requirements

J Hudzietzová, J Sabol, M Fülöp

Imaging of bone metastases in prostate cancer: an update

Assessing bone metastases is often beyond the scope of plain - film radiography, and nuclear imaging in particular with bone scintigraphy has proved the mainstay for detection of bony disease for over 40 years. Bone scanning with 99mTechnetium - labeled diphosphonates relies on the detection of pathological osteoblastic response elicited from malignant cells. This technique offers the advantage of whole body examination, low cost, availability and high sensitivity. However, it suffers from relative low specificity. The addition of single-photon emission computed tomography (SPECT) to bone scintigraphy has markedly improved the diagnostic benefit. Although the accuracy of SPECT is significantly higher than that of planar scintigraphy, there is still room for improvement of anatomic localization and morphological characterization, a limitation that has currently been mainly overcome with the upcoming of combined SPECT-CT (computed tomography). Positron emission tomography (PET), a modality with higher spatial resolution than that of SPECT can be particularly helpful in detecting small lesions. Moreover, PET imaging using various specific radiotracers has the advantage of detecting malignant disease in both bone and soft tissues. It is highly sensitive mainly in detecting early bone marrow as well as for diagnosing lytic bony metastases and can be also reliably used to monitor therapy response. In this review, we present the current role of SPECT and PET in the imaging of skeletal metastases from prostate cancer.

Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading

AIM

The aim of this paper was to compare the diagnostic performance of positron emission tomography/computed tomography (PET/CT) with fluorocholine (18F) (FCH) or fluoride(18F) (FNa) for the detection of bone metastasis in patients with prostate cancer complaining from osteoarticular pain, taking into account whether they were referred for initial staging or recurrence localization. The initial hypothesis was that FCH site-based specificity would be superior to that of F Na, with no loss in sensitivity.

METHODS

Forty-two patients were enrolled in this prospective study, underwent both PET/CTs and were then followed-up for at least 6 months. The standard of truth (SOT) about the presence/absence and location of bone metastasis could be determined in 40 patients, by 2 independent medical assessors, blinded to the results of both PET/CTs. The comparison was performed according to the guideline of the European Medicines Agency, i.e. based on the results of blind reading with SOT as reference.

RESULTS

Bone extension was present in 22 patients and absent in 18. Patient-based performance for FCH vs. FNa was 91% vs. 91% for sensitivity, 89% vs. 83% for specificity and 90% vs. 88% for accuracy (no significant difference). Of 360 skeletal sites, 68 were malignant and 292 non-invaded. There was no significant difference in site-based performance in the group of patients referred at initial staging, but in the group of patients referred for suspicion of recurrence, FCH was significantly more specific than FNa (96% vs. 91%, P=0.033 with Obuchowski's correction) while sensitivity was the same, 89%.

CONCLUSION

Both radiopharmaceuticals, based on a very different metabolic approach, showed good diagnostic performance. If FCH is available, it should be preferred in patients after initial treatment.

[18F-fluorodeoxyglucose positron emission tomography in colorectal cancer: value in primary staging and follow-up]

Positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) is a encouraging imaging technique allowing a highly sensitive whole-body search for malignant foci detected by their increased glucose metabolism compared with benign tissues. Several studies are now available that indicate its added value for diagnosis and staging of colorectal cancer. In all, patient management seems to be changed in 20-30% of patients who undergo Fluorodeoxyglucose positron emission tomography in addition to standard staging procedures. Fluorodeoxyglucose positron emission tomography is also useful in monitoring radiation therapy and chemotherapy. Regarding preoperative staging of primary colorectal cancer the literature is very limited.

[F-18 fluorodeoxyglucose positron emission tomography in colorectal carcinoma]

Whole-body positron emission tomography (PET) with the radiolabeled glucose analog F-18-fluorodeoxyglucose (F-18-FDG) is a sensitive diagnostic tool that images tumors based on increased uptake of glucose. Several recent publications have shown that F-18-fluorodeoxyglucose-positron emission tomography is more sensitive than computed-tomography (CT) in detecting colorectal cancer. In patients with increasing CEA (carcinoembryonic antigen) and no evidence of recurrent disease on CT F-18-fluorodeoxyglucose-positron emission tomography often detects recurrent cancer. In all, patient management seems to be changed in about 25% of patients who undergo F-18-fluorodeoxyglucose-positron emission tomography in addition to standard staging procedure. Limited reports to date on both chemotherapy and radiotherapy support the role of F-18-fluorodexyglucose-positron emission tomography in assessing treatment response. Also regarding preoperative staging of primary colorectal cancer the literature is very limited.

[The value of F-18 fluorodeoxyglucose in positron emission tomography diagnosis of breast carcinoma]

Fluorodeoxyglucose-positron emission tomography (F-18-FDG-PET) has become an important issue in the diagnosis of malignant tumors within the last years. In breast cancer PET has been established in the diagnosis of the primary tumor as well as in recurrences with a sensitivity of 90% and a specificity of 75%-100%; additional a sensitivity of more than 90% and a specificity of about 75% is also seen in axillary lymph nodes detection. With our own results we were able to prove sensitivity of positron emission tomography in diagnosing the primary lesion, locoregional lymph nodes and the staging of metastases. Furthermore, positron emission tomography seems to be superior to conventional imaging modalities in staging primary and recurrent breast cancer, distant metastases and lymph nodes outside the axilla.

Subclinical hyperthyroidism as a risk factor for atrial fibrillation

OBJECTIVES

Atrial fibrillation is a well-known manifestation of hyperthyroidism. We studied whether subclinical hyperthyroidism with low serum thyrotropin concentrations and free thyroid hormone concentrations within the normal range in clinically euthyroid persons is a risk factor for subsequent atrial fibrillation.

METHODS

We studied 23,638 persons. The subjects were classified according to their serum thyrotropin concentrations: group 1 comprised those with normal values of serum thyrotropin concentration (>0.4-5.0 mU/L) and free tri-iodothyronine and free thyroxine concentrations were within the normal range (22,300 subjects), group 2 comprised those with both low serum thyrotropin values (</=0.03 mU/L) and elevated free tri-iodothyronine and free thyroxine concentrations (725 subjects), and group 3 comprised those with low values of serum thyrotropin (<0.4 mU/L) and free triiodothyronine and free thyroxine concentrations were within the normal range (613 subjects).

RESULTS

Atrial fibrillation was present in 513 persons (2.3%) in group 1 with normal values for serum thyrotropin, 100 (13.8%) in group 2 with overt hyperthyroidism, and 78 (12.7%) in group 3 with subclinical hyperthyroidism. The prevalence of atrial fibrillation in patients with low serum thyrotropin concentrations (<0.4 mU/L) was 13.3% compared with 2.3% in patients with normal values for serum thyrotropin (P <.01). The relative risk of atrial fibrillation in subjects with low serum thyrotropin and normal free tri-iodothyronine and free thyroxine concentrations, compared with those with normal concentrations of serum thyrotropin, was 5.2 (95% CI 2.1-8.7, P <.01).

CONCLUSION

A low serum thyrotropin concentration is associated with a >5-fold higher likelihood for the presence of atrial fibrillation with no significant difference between subclinical and overt hyperthyroidism.

Epidemiology of thyroid diseases in iodine sufficiency

Epidemiology of thyroid diseases in iodine-sufficient areas (ISA) deals with sporadic goiter, thyroid autoimmune diseases, and thyroid cancer. A comparison between the different studies performed is difficult because methods have changed over time and selection criteria and definitions such as prevalence or incidence were not used consistently by some authors. Sporadic goiter: in ISA, autoimmune processes play a major role in the development of sporadic goiter. In adults, sporadic diffuse goiter is most frequent in young women (16%), perhaps due to additional relative iodine deficiency especially in pregnancy, and declines with age (<10%). Sporadic nodular goiter increases from 5% in young women to 9% in older women. Autoimmune thyroid disease (AITD): thyroid autoantibodies (TAb) and histopathological lymphocytic infiltration of the thyroid is much more common in ISA (4.6% in women; 1.1% in men) than in iodine-deficient areas (IDA). The prevalence and incidence of hypothyroidism and hyperthyroidism varies, depending on whether overt and subclinical forms are included and whether newly or previously diagnosed dysfunction is considered. In an overview of the literature, the prevalence is 2 in 1000 for overt and 6 in 1000 for subclinical hyperthyroidism in ISA. The values for hypothyroidism are 5 in 1000 and 15 in 1000, respectively. Change from IDA to ISA: in former IDA, the percentage of hyperthyroidism increases up to 4 years after salt iodination. Whereas this effect is transient for Plummer's disease, a change from IDA to ISA seems to lead to a permanent increase in overt and subclinical Graves' disease. Thyroid cancer: most studies demonstrate that the histopathological types of thyroid cancer are different in IDA and ISA. There is a tendency toward an increase in differentiated and decrease of anaplastic cancer. The ratio of papillary to follicular thyroid cancer ranges from 6.5:1 to 3.4:1 in areas with high iodine intake, decreases 3.7:1 to 1.6:1 in areas with moderate iodine intake, and ranges from 1.7:1 to 0.19:1 in IDA.

[Pseudohyperthyroxinemia in endemic sprue--reversibility with a gluten-free diet]

HISTORY

An increased concentration of free T3 (fT3) with normal TSH was repeatedly measured in a 58-year-old man with diarrhoea. Hyperthyroidism was diagnosed and he was treated with thyrostatic drugs.

INVESTIGATIONS

Referred to our clinic, fT4 concentration, determined by routine ELISA, was found to be raised to 33.9 pmol/l, while fT3 and TSH levels were within normal limits. But the equilibrium-dialysis method gave a normal serum level also for fT4. Gastroscopy suggested coeliac disease, confirmed histologically.

TREATMENT AND COURSE

The symptoms quickly improved on a gluten-free diet and the fT4 level returned to normal values even on routine measurement.

CONCLUSION

The raised fT4 level with non-suppressed TSH was only revealed as a false finding by special non-routine laboratory methods. The reversibility and the close time relationship of the reported laboratory data with the clinical manifestations of the concomitant coeliac disease strongly suggested that changes in serum in the course of the latter disease played a role in these misleading laboratory results. An interference of coeliac disease with some laboratory tests has been previously described.

[Thyroid gland surgery in pregnancy]

Thyroid carcinoma is more frequent in younger women, but direct correlation with pregnancy is not proven. Preoperative management of suspect nodules reveals clear indications for immediate intervention. Out on 1471 thyroid operations, 340 female were in the group between 20 and 40 years. 53 carcinoma, i.e. 3.6%, in this subgroup had a potential concomittance of pregnancy and thyroid tumor. Although risk of obortion is very low in non-abdominal surgery, operations should be delayed post-partum except in cases of proven carcinoma.

[Iodine and thyroid hormone metabolism in pregnancy]

The influence of pregnancy on thyroid function as well as important interactions of pregnancy and thyroid disorders are of high clinical importance. During the last decade knowledge of these issues greatly influenced clinical aspects and basic science. Because of the increasing frequency of thyroid disorders during pregnancy, knowledge of these issues is important in order to diagnose, treat and manage all patients exposed to these problems.

Thyrotropin and thyroglobulin as an index of optimal iodine intake: correlation with iodine excretion of 39,913 euthyroid patients

The recommendations for the dietary allowance of iodine are 150 micrograms per day for adolescents and adults. Thyrotropin (TSH) and thyroglobulin (Tg) can be used as surveillance indicators for assessing iodine deficiency disorders. We compared the relation between TSH and Tg, free triiodothyronine, and thyroxine serum levels with urinary iodine excretion in 2311 untreated euthyroid patients using our modified cericarsenite method. An adequate iodine intake may be assumed when TSH and Tg values are at the lower end of the normal range. Patients were grouped according to urinary iodine excretion and goiter size. In the group with an iodine excretion between 201 and 300 micrograms of iodine per gram of creatinine, the lowest TSH values and even low Tg levels could be shown. We conclude that an iodine intake of approximately 250 micrograms/day is associated with the lowest TSH stimulation to thyrocytes. In the groups separated according to thyroid size, significantly higher Tg levels were found in the patients with uninodular and multinodular goiter as a result of longstanding iodine deficiency, whereas actual urinary iodine excretion did not differ significantly. Additionally, iodine excretion of 39,913 euthyroid patients between 1984 was 1996 was examined. In Austria iodized salt (10 mg KI/kg) was introduced by law in 1963 and increased to 20 mg KI/kg salt in 1990. An initial increase of iodine excretion until 1993 was followed by a decrease in 1994 and 1995 without further changes in 1996. These results show that iodine intake has improved since 1984; however, in 1996 iodine excretion in one-third of the investigated patients was under 100 micrograms per gram of creatinine and more than 80% had less than 200 micrograms per gram of creatinine.

Ossifying fibromyxoid tumor misdiagnosed as follicular neoplasia. A case report

BACKGROUND

Fine needle aspiration of an ossifying fibromyxoid tumor (OFMT) at a prethyroidal location is initially misinterpreted as follicular neoplasia. Though the histopathologic criteria have been analyzed in detail, no experience with the cytologic features of OFMT is reported in the literature.

CASE

A 50-year-old male presented clinically with a recurrent goiter. Aspiration cytology (Giemsa stained) was characterized by a predominant fine fibrillary, pink matrix and moderate cellularity. The nuclei were eccentrically located, round to oval and slightly plemorphic, with fine chromatin. Focally, mild nuclear crowding and a few rosettelike structures were present.

CONCLUSION

The cytologic features were consistent with a soft tissue tumor of probably neurogenic origin, like OFMT. Differential diagnosis in this particular location not only included follicular thyroid neoplasms but also neurofibroma, neuroma, chondroma and, less likely, neuroepithelial tumors. However, since some diagnostic criteria of OFMT, like the nodular growth pattern and mature bone, can be found only histologically, the diagnostic value of aspiration cytology seems to be limited.

Technetium-99m-tetrofosmin whole-body scintigraphy in the follow-up of differentiated thyroid carcinoma

The purpose of this study was to evaluate prospectively the reliability of the new nonspecific tumor-searching tracer tetrofosmin in the postoperative follow-up of differentiated thyroid carcinoma (DTC) during TSH suppressive thyroid hormone treatment.

METHODS

Whole-body scintigraphy was performed in 114 patients under TSH suppressive L-T4 treatment 20 min after intravenous injection of 370 MBq 99mTc-tetrofosmin by means of a dual-head gamma camera followed by three-dimensional SPECT in case of suspicious tracer uptake. The results of serum thyroglobulin, ultrasonography of the neck, 131I whole-body scintigraphy, chest radiograph, transmission CT or MRI, and bone scintigraphy were also available.

RESULTS

A group of 68 patients without thyroid remnants who were tumor free and had no history of metastases or tumor recurrence showed a negative 99mTc-tetrofosmin whole-body scan. Another 24 patients (papillary carcinoma pT1NOMO) were also in complete remission, but had sonographically proven remnants (echonormal). Sixteen of them (67%) exhibited 99mTc-tetrofosmin accumulation in the thyroid bed, which corresponded excellently to the localization of the remnant. The third group comprises seven cases of local recurrence confirmed by histopathology after reoperation or by cytology after fine-needle aspiration where tetrofosmin scintigraphy clearly revealed relapse of malignancy in all cases. A total of 17 patients had distant metastases (11 pulmonary, 3 bone, 2 bone and pulmonary, 1 bone and soft tissue) discovered by different modalities, resulting in 44 lesions to be evaluated. Of the 23 radioiodine negative metastases, 17 were detected by tetrofosmin (74%), whereas all 21 radioiodine accumulating lesions also showed tetrofosmin positive scans. The overall sensitivity of 99mTc-tetrofosmin in detecting distant metastatic lesions was 86%. Four additional cases with radioiodine-negative disseminated lung metastases showed diffuse pulmonary tetrofosmin uptake.

CONCLUSION

Technetium-99m-tetrofosmin is a promising tracer to detect malignant recurrence and distant metastases in the follow-up of DTC without the necessity of thyroid hormone withdrawal.

[Management of suspected malignant nodular goiter in pregnancy]

Guidelines for the management of thyroid nodules supposed to be malignant during pregnancy have not yet been established. We recommend performance of fine needle biopsy in thyroid nodules having developed during pregnancy, and in preexisting thyroid nodules suspicious of being malignant, respectively. According to literature, surgical intervention in case of papillary carcinoma can be postponed to a timepoint soon after delivery. Regarding the management of follicular or medullary cancer, sufficient data are not available. In threatening cases, i.e. in case of rapid growth of the nodule(s) or suspected high malignancy, surgery can be done at any time. Nevertheless, pregnancy itself neither seems to promote growth of thyroid cancer nor to have any impact on the dignity of cancer.

[Point mutations of the thyrotropin receptor gene in autonomously functioning thyroid gland nodules: correlation with clinical findings and morphology]

Seventeen autonomously functioning thyroid nodules (AFTN) were analyzed for the most frequent mutations of the thyrotropin (TSH) receptor gene at codons 619, 631, 632 and 633. DNA was extracted from formalin-fixed, paraffin-embedded samples from both nodules and surrounding tissue after micro- or macrodissection. A fragment of the TSH receptor gene (bp 1762-1976) encoding the third cytoplasmic loop and the sixth transmembranous domain was amplified by PCR. Screening for mutations at codons 619, 631, 632 and 633 was performed by restriction enzyme analysis using Asp 718, Hph I, Taq I and EcoR I, respectively. For verification, cases with a mutated restriction site were cloned and sequenced. Mutations were found in 3 AFTNs (18%): in 2 cases at codon 632 and in 1 case at codon 631. The 2 cases with a mutation at codon 632 harbored additional mutations at codon 599 and 640, respectively, detected by sequencing. Normal thyroid tissue outside the AFTNs did not harbor mutant TSH-receptor. Mutations occurred in patients with clinical and subclinical hyperthyroidism. Mutations were associated both with total (2 cases) and partial (1 case) suppression of the surrounding thyroid tissue as noted on the scinti scan. AFTNs with TSH-receptor mutation occurred as single nodules. All 3 nodules with mutations were classified histologically as nodular hyperplasia according to the criteria of the WHO. Although the number of cases is small, our data suggest that AFTNs are clinically and morphologically heterogenous. Since the most common TSH-receptor mutations occur only in a small subset of AFTNs other molecular genetic alterations may be involved in the development of AFTNs.

Evaluation of the Abbott IMx ultrasensitive II hTSH immunometric assay in three European centres: a comparison with established commercial immunometric assays for thyrotropin

The Abbott Ultrasensitive II hTSH assay was evaluated in three European centres and its performance compared with its predecessor and with commercially available kits. A total of 408 individuals was included in the study (140 euthyroid, 116 hyperthyroid and 86 hypothyroid subjects, as well as 26 patients with non-thyroidal illness and 30 patients with thyroid cancer). The kit was evaluated for (im)precision and analytical and functional sensitivity according to ECCLS-Guidelines. The analytical sensitivity lay between 0.004 and 0.013 mU/1, the mean value being 0.008 mU/1, results being from 12 runs. The functional sensitivity gave a coefficient of variation below 20% at a concentration of 0.05 mU/1 under routine conditions. Inter-assay precision was less than 7% at 0.25 mU/l (range 5.3-6.8%), less than 6% at 6 mU/l (range 4.0-5.2%) and less than 9% at 30 mU/l (range 6.5 - 8.7%). Intra-assay (im)precision was not calculated as the Abbott IMx is designed to run on singlicate determinations.

Intraoperative radiation therapy in advanced thyroid cancer

An intraoperative radiation therapy (IORT)-protocol was designed for poorly differentiated non-anaplastic thyroid carcinoma. Out of 155 cases of differentiated thyroid tumours, 12 showed marked vascular/capsular invasion. Five entered the study (three primarily local invasive tumours, two local recurring). IORT was administered after tumour surgery (4-10 GY) and combined with post-operative percutaneous irradiation. The tumour control rate in the thyroid bed was achieved in all five patients, 1/5 developed mediastinal nodes and 1/5 with primary mediastinal tumour extension showed tumour progression. No specific complications occurred.

Ossifying fibromyxoid tumour of the neck clinically mimicking a primary neoplasm of the thyroid gland

We present a 50-year-old male patient with an ossifying fibromyxoid tumour (OFMT) of the prethyroidal soft parts infiltrating the thyroid gland in coincidence with recurrent goitre, 20 years after strumectomy. The tumour, initially misdiagnosed as thyroid carcinoma and malignant schwannoma respectively, was histologically composed of typical solid cell-formations and shelly-like mature bone at the periphery. In addition, in the tissue adjacent to the tumour some foreign body granulomas with suture material and small proliferating nerves were present as a residual of the preceding strumectomy. We regard this finding as an indication of nerve sheat origin of OFMT. Follow up of 3 years after total thyroidectomy and local irradiation shows the patient free of recurrent and metastatic disease.

Evaluation of the Cobas Core system for use in routine diagnosis of thyroid disorders

The aim of this clinical study was to evaluate the TSH, FT4, FT3, T3, and T4 assays designed for use on the Cobas Core Immunoassay Analyzer. Performance of these enzyme immunoassays (EIAs) was compared with well established and routinely used radioimmunoassays (RIA) or immunoradiometric assay (IRMA). In the first part of the study, the between-run and within-run data as well as the linearity of the Cobas Core assays was carried out, showing a very high precision; most coefficients of variation (CVs) were below 8%. In the second part of the study, serum samples from patients with different thyroid diseases were evaluated, and the results compared with those obtained by RIA or by IRMA. All results were highly comparable with the clinical aspects of all investigated thyroid disorders, and the data of TSH, FT4, T3 and T4 were completely in concordance with those assessed by RIA or IRMA methods; however, only the FT3 assays had a moderately correlation. In contrast to RIA methods, Cobas Core EIAs provided precise results in patients with thyroid hormone transport protein anomalies or T4/T3 autoantibodies; moreover, elevated serum concentrations of thyroxine binding globulin (TBG) did not affect measurement of total thyroid hormone concentrations.

Changes in thyroid hormone parameters after acute myocardial infarction

Abnormalities in circulating thyroid hormone levels are very common in systemic nonthyroidal illnesses, such as acute myocardial infarction. In this study, thyroid parameters were determined in a series of 16 consecutive infarction patients treated by thrombolysis. Blood samples were taken before therapy as well as 2, 4, 6, 8, 12 and 72 h following admission. Total and free serum thyroxin and triiodothyronine decreased and reverse T3 increased significantly showing no major variations up to 72 h, whereas thyroid-stimulating hormone values remained almost unchanged during the observation period. Subjects with CK-MB levels of more than 150 ng/ml (n = 10) revealed similar changes in thyroid parameters in comparison to those with lower values (n = 6; NS). Thus, although hormone modifications very often occur following acute infarction, thyroid status may not serve as a marker for the extent of left ventricular dysfunction in the early phase of myocardial infarction.

Familial dysalbuminaemic hyperthyroxinaemia and inherited partial TBG deficiency: first report

BACKGROUND

Abnormalities of the serum thyroid hormone binding proteins are not uncommon but, when properly assessed, they do not present diagnostic difficulties. In contrast, the presence of two inherited defects of thyroid hormone transport, of the type presented in the family described here, may cause a major problem in diagnosis and has not been described previously.

METHODS

All conventional thyroid function tests were carried out. In addition, thyroid hormone binding to serum proteins was assessed by agarose gel electrophoresis, and thyroxine binding globulin by immunoassays and by immunodiffusion. The affinity of TBG for thyroxine and its maximal binding capacity were assessed by Scatchard analysis.

RESULTS

Tests carried out on 22 members of the family revealed familial dysalbuminaemic hyperthyroxinaemia in 10 family subjects. All five living siblings of the propositus had familial dysalbuminaemic hyperthyroxinaemia and two tested transmitted this trait to their children and grandchildren. This was not the case with the propositus. Partial thyroxine binding globulin deficiency only, inherited presumably from the propositus' mother, was found in two family members. Both thyroxine binding globulin deficiency and familial dysalbuminaemic hyperthyroxinaemia were detected in the propositus and in his male nephew, masking the typical laboratory abnormalities associated with each of these defects.

CONCLUSIONS

Coexistence of two inherited defects of thyroid hormone transport proteins produce atypical thyroid function test abnormalities, which can be misinterpreted as thyroid hormone dysfunction.

Coexistence of papillary and medullary carcinoma of the thyroid gland-mixed or collision tumour? Clinicopathological analysis of three cases

We present three thyroid carcinomas displaying medullary and papillary components. In two cases the papillary component was characterized by typical papillae with a fibrovascular core; in one a follicular variant of papillary carcinoma was found. The papillary component was dominant in two and the medullary in one case. One tumour showed clear-cut borders between the two components, the others displayed an intermingled pattern. Both tumour components were seen in lymph node metastases with immunostaining with antibodies to calcitonin, chromogranin A, carcinoembryonic antigen, other neuroendocrine markers and thyroglobulin. At least two of our cases are true mixed carcinomas probably arising from a common stem cell.

Postpartum thyroiditis and familial dysalbuminemic hyperthyroxinemia

Familial dysalbuminemic hyperthyroxinemia (FDH) is a syndrome associated with euthyroidism and increased binding of T4 to serum albumin. The combined occurrence of FDH and postpartum hyperthyroidism due to Graves' disease has only been reported in one patient. We now describe the first case of FDH and thyrotoxicosis due to postpartum silent thyroiditis. In a 19-yr-old woman, FDH, suspected on the basis of strikingly elevated analog free T4 (fT4) and total T4 values, but normal two-step fT4 and serum TSH values, was confirmed by [125I]T4 agarose-gel electrophoresis. When FDH and thyrotoxicosis, characterized by markedly elevated analog fT4, total T4, and two-step fT4 values and undetectable TSH values, coexist, the differential diagnosis may be confusing.

The effect of treatment with levothyroxine or iodine on thyroid size and thyroid growth stimulating immunoglobulins in endemic goitre patients

OBJECTIVE

We assessed the effect of levothyroxine or iodine on thyroid size and on thyroid growth stimulating immunoglobulins in endemic goitre patients.

DESIGN

Levothyroxine or iodine was given orally in an open randomized prospective study (100 and 200 micrograms respectively).

PATIENTS

Thirty-seven euthyroid patients with diffuse iodine deficiency goitres and thyroid growth stimulating immunoglobulins were studied.

MEASUREMENTS

Thyroid size, thyroid growth stimulating immunoglobulins (mitosis arrest assay), basal TSH, free T3, free T4, thyroid anti-microsomal antibodies, antithyroglobulin antibodies, anti-TSH receptor antibodies and urinary iodine excretion were measured.

RESULTS

Thyroid size decreased significantly in both groups, in the levothyroxine group more than in the iodine treated group. Thyroid growth stimulating immunoglobulins levels also decreased significantly in both groups. Between groups there was no statistically significant difference. A statistically significant correlation between thyroid growth stimulating immunoglobulins reduction profiles and goitre size reduction could not be established. TSH levels became suppressed in the levothyroxine group while the T4 values rose; in the iodine treated group TSH levels stayed constant as did T4. None of the patients developed thyroid microsomal or thyroglobulin auto-antibodies and/or hyperthyroidism during the treatment.

CONCLUSIONS

Levothyroxine as well as iodine was effective in reducing thyroid size as well as thyroid growth stimulating immunoglobulins levels in endemic goitre patients. Since in both groups TSH levels were not related to thyroid size reduction, other factors than TSH suppression must be responsible for the observed thyroid size reduction. Iodine itself by virtue of its antiproliferative action on thyrocytes may have had a direct action on the goitre reduction during iodine treatment; however, the levothyroxine dose, containing less iodine, had a similar effect. A complicated picture hence emerges with regard to factors involved in the shrinkage of iodine deficiency goitre during thyroxine or iodine therapy. These findings indicate that TSH and thyroid growth promoting immunoglobulins are not the only influences on the size of endemic goitres, although it cannot be excluded that these two factors contribute to influence the pathogenetic process.

Expression of various MHC class II molecules and of intracellular adhesion molecule-1 (ICAM-1) on focal clusters of dendritic cells in iodine deficiency goitres

Thyroid sections from 18 consecutive euthyroid patients undergoing surgery for iodine deficiency goitre were investigated by means of immunohistochemistry and immunofluorescence, evaluating the expression of MHC class II antigens (HLA-DR, -DP, -DQ, and RFD1) and intercellular adhesion molecule-1 on the formerly described clusters of dendritic cells, as well as on thyrocytes. Eleven of 18 iodine deficiency goitres contained clusters of dendritic cells. These clusters appeared to express only HLA-DR in two cases; in nine of 12 cases they showed a differential expression of class II molecules in the following frequency: HLA-DR > DQ and/or -DP > RFD1. These dendritic cells also were ICAM-1+. In four of 18 iodine deficiency goitres, thyroid epithelial cells showed MHC class II expression in several combinations, but were ICAM-1-. In normal thyroids and in nodular goitres from inhabitants of the endemic area not having an actual iodine deficiency, only sparse clusters of dendritic cells were found; these cells were only HLA-DR+. Follicle lining cells were negative for the MHC class II molecules. In normal thyroids from an area with sufficient iodine supply, no clusters of dendritic cells were seen. The few dendritic cells observed were lying isolated in the interstitium and only positive for HLA-DR and ICAM-1; epithelial cells were negative for the studied markers. These data show clusters of dendritic cells in thyroids of inhabitants of an endemic area. When goitre is accompanied by iodine deficiency at the moment of operation, there appears to be activation of these dendritic cells and of thyroid epithelial cells.

[Hemorheologic effects of ginkgo biloba extract EGb 761. Dose-dependent effect of EGb 761 on microcirculation and viscoelasticity of blood]

METHOD

In a randomized open clinical trial involving 42 patients with pathological visco-elasticity values, the effect of a single intravenous injection of 50, 100, 150 or 200 mg of the Ginkgo biloba extract EGb 761, commercially available as Tebonin p.i. on the microcirculation of the skin (Doppler flowmetry) and the visco-elasticity of whole blood was investigated.

RESULTS

A dose-dependent significant increase in the microcirculation was found. In the case of visco-elasticity, this dose-dependence was less marked. The present study thus confirms the positive effect of EGb 761 on the microcirculation and whole-blood visco-elasticity in patients with pathological visco-elasticity values, already found in earlier studies, and shows it to be dependent on the dose employed.

The impact of geographical, clinical, dietary and radiation-induced features in epidemiology of thyroid cancer

Cancer of the thyroid accounts for less than 1% of all cancers recognised each year, but the incidence is rising. Much of the early work of the epidemiology and aetiology of thyroid cancer was based on the assumption that thyroid cancer can be treated as an entity. The recognition that two distinct types of endocrine cell occur within the thyroid has made it clear that any discussion of the aetiology and epidemiology of thyroid malignancies must take into account the histological classification of these tumours. Moreover, there are difficult problems to be considered when comparing thyroid cancer incidence across tumour registries, because of a lack of standardisation or morbidity data collection, difficulties in histological diagnosis, varying rates of diagnosis of occult papillary carcinoma, and prevalence and techniques of autopsies. So far only a relatively small proportion of thyroid cancer cases can be explained with adequate certainty as regards epidemiology and aetiology. As in cancer in general, the aetiology and epidemiology of thyroid cancer in detail remains unknown in the majority of cases.

Involvement of the immune system in iodine deficient goiter

Iodine deficient goiters were studied by immunohistochemistry and showed extensive presence and typical arrangement of dendritic cells, known to have excellent antigen presenting capacity. These cells were positive for all MHC-class II epitopes and for ICAM-1. Epithelial follicle lining cells were also seen to be class II positive but lacked ICAM-1. Thyroglobulin seemed not to be iodinated at the C-terminal hormogenic site, as shown by reactions with monoclonal antibodies. Iodine therapy, as well as thyroxine therapy were effective in reducing thyroid size. Both forms of therapy were found to decrease the pretreatment levels of circulating thyroid growth stimulating immunoglobulins (TGI).

[Modification of blood viscosity and elasticity. Principle therapeutic approach in relation to its pathophysiology]

Exercising a therapeutic influence on the viscoelastic properties of whole blood is a very complex matter. In general, apart from hemodilution, the modification of such factors as erythrocyte aggregation, red cell rigidity or plasma viscosity, all of which may be influenced more or less independently of one another, are possible approaches. The present article discusses the basic possibilities of influencing the viscoelasticity of blood for therapeutic purposes, with attention being paid in particular to the pathogenesis of hyperviscosemia.

Differentiation of lymph-node metastases by anti-CEA immunoscintigraphy in a patient with follicular thyroid and breast cancer

Supraclavicular lymph node metastases appeared in a female patient six years after thyroidectomy, radioiodine therapy and external radiation for a follicular thyroid carcinoma and four years after mastectomy and lymphadenectomy for an invasive ductal breast cancer. It was not possible either by conventional imaging methods or by serological methods, to assign the metastases to one of the two primary tumors. Anti-CEA immunoscintigraphy and SPECT of the cervicothoracic region showed a circumscribed pathological uptake of 99mTc-labeled anti-CEA antibodies in the area of the supraclavicular lymph nodes. The preoperative suspicion of lymph-node infiltration by CEA-expressing breast cancer cells was confirmed histologically after surgical removal of the lymph nodes.

[Volume replacement with 2 equivalent molecular weight dextrans: effect on erythrocyte elongation in vitro]

The influence of 2 dextranes with the identical molecular weight of 70,000 Dalton for erythrocytes' elongation was investigated in-vitro in 12 healthy male subjects. An increasing dosage between 0.5 and 10 mg/ml Dextran (trade name: Dextran 70 "Ebewe") and Dextran B (weight-equivalent) was added and the elongation index of erythrocytes at shear-rate 50/sec was determined under fluid conditions. Dextran B showed a stronger reduction of elongation index than Dextran A with an elevation of difference up to the highest dosage. The results show that although the molecular weight is identical, differences in hemorheological properties could observed. This should be taken into consideration for volume substitution therapy.

[Iodine supplementation in the province of Styria]

As far back as 1898 the Austrian Nobel price winner Wagner von Jauregg was the first to recommend iodination of salt as prophylaxis against endemic goitre (prevalence 48%) and cretinism (greater than 10%). In 1923 he achieved in a voluntary iodine supplementation of 5 mg KJ/kg table salt, which only lasted for a number of years. It was in 1963 when finally a mandatory iodized salt prophylaxis was introduced at the rate of 10 mg KJ/kg. In this study the effect of 25 years of iodine supplementation is investigated: Endemic cretinism, hypothyroidism, and goitre in newborns disappeared generally and endemic goitre in pupils was significantly reduced. However, due to epidemiological studies at elementary and secondary schools and army recruitment examinations we still found out endemic goitre grade I (according to WHO) mainly in female juveniles. Examinations were done by palpation, ultrasonography and urinary iodine excretion. In the above as well as in the urine of newborns and in mother's milk the iodine content was significantly lower than in iodine rich countries. Consequently a higher iodination of salt at the rate of 20 mg KJ/kg was recommended by the Austrian Society of Nuclear Medicine in 1985. This suggestion was taken up by the Austrian authorities and it will finally be instituted by law in May 1990 for the benefit of coming generations.

Localization of mediastinal parathyroid adenoma by T1-201 scintiscan and SPECT

A 64-year-old female patient was admitted to our department for fatigue, pain in the right upper abdomen, obstipation, and meteorism. The laboratory findings showed total calcium and ionized calcium elevated, phosphate close to lower limit, and parathyroid hormone increased. T1-201/Tc-99m subtraction scintiscan of the neck and upper mediastinal region did not give any evidence of isolated enhanced uptake suggesting the presence of parathyroid adenoma. After further increases in calcium and parathyroid hormone level T1-201 whole-body scan and single photon emission computed tomography of the thoracic region were performed. These revealed a circumscribed T1-201 uptake in the mediastinum immediately cranial ventral to the heart base. The postcontrast transmission computed tomography of this area confirmed the finding of the T1-201 scintigraphy with a 4 x 3 x 2 cm tumor. After sternotomy and surgical removal of the mediastinal parathyroid adenoma (chief cell adenoma), calcium and parathyroid hormone levels returned to normal values.

Immunoscintigraphy of inflammatory processes with a technetium-99m-labeled monoclonal antigranulocyte antibody (MAb BW 250/183)

Antigranulocyte immunoscintigraphy with a technetium-99m- (99mTc) labeled monoclonal antigranulocyte antibody (MAb BW 250/183) was performed in 34 in-patients of the departments of accident surgery and internal medicine in order to prove or exclude inflammatory processes. After labeling with 99mTc, 555 MBq, 99mTc-MAb (0.5 mg antibody) were slowly injected intravenously over a period of 5 min. A whole-body scan was done 4-6 hr postinjection, and planar or SPECT images were performed 6, 18, and 24 hr postinjection. Leukocyte immunoscintigraphy proved inflammatory suppurating processes in 20 cases (true-positive) and excluded them in 11 cases (true-negative). The findings were false-positive in two patients (hematoma without signs of infection, pseudoarthrosis) and false-negative in one patient (encapsulated lung abscess with pleural fibrosis). Anti-idiotypic human anti-mouse antibodies (HAMA) were found only in one out of 20 patients. According to our experiences, immunoscintigraphy with 99mTc-MAb BW 250/183 has a sensitivity of 95%, and is, therefore, well suited for the identification of leukocytic inflammations.

The effect of D- versus L-propranolol in the treatment of hyperthyroidism

The purpose of this study is to determine whether there is a difference in treatment of hyperthyroidism using either the D- or L-isomer of propranolol. Two groups of 20 patients with overt hyperthyroidism received either 120 mg L- or D-propranolol each for a period of 5 days. In the D-propranolol administered group there was a significant decrease in TT3 and fT3 plasma levels and in the ratio of TT3 to TT4; however, a significant increase occurred in rT3 values up to day 5. On the other hand, L-propranolol treatment resulted in a less pronounced decrease in TT4 and TT3 values, while all other thyroid hormone levels remained unchanged as, above all, did the T3/T4 ratio. The well known effect of D,L-propranolol upon peripheral conversion of T4 to T3 is thus not due to the beta-blocking action of L-propranolol but is mainly conditioned by the D-isomer which has no beta-blocking action itself.

Lipoma of the liver: computed tomographic, ultrasonographic, and cytologic findings

A hepatic lesion, manifest for several years in a 59-year-old female patient, was diagnosed as lipoma in the pre-contrast scan because of its attenuation value (-87 Hounsfield units (HU)); in addition, diagnosis was confirmed by aspiration cytology. In this case report the great merit of transmission computed tomography (TCT) is demonstrated, and ultrasound patterns and possible histogenetic origin of this neoplasm are discussed. The lipomatous liver tumors described in the literature with attenuation values of less than -60 HU are merely mixed tumors with lipomatous amounts of various sizes, whereas in true lipomas attenuation values from -80 to -120 HU have been measured.

[Erythrocyte elongation with 10% dextran 40,000: comparison of 2 substances]

A dosage-effect-study with two 10% dextrans 40,000 was carried out in 12 venous blood samples of healthy men aged from 21 to 45 years. Dextran A (trade name: Dextran 40,000 "Ebewe") and Dextran B (trade name: "Rheomacrodex") were added in dosages of 0.5 to 10 mg/ml whole blood and the elongation-index of erythrocytes at shearrate 50/sec was determined. From 1 mg up to 10 mg/ml the elongation-index in Dextran B showed a stronger decrease than in Dextran A. Under the highest dosage the difference was about 20%. So it was possible to show that in spite of identical molecular weight there are different effects on deformability of erythrocytes. This should be taken into account for parenteral treatment.