ROC analysis in radioimmunoassay: An application to the interpretation of thyroglobulin measurement in the follow-up of thyroid carcinoma

This study is an application of the ROC technique to the determination of threshold values (TV) for the interpretation of serum thyroglobulin (Tg) measurements in the follow-up of differentiated thyroid cancer. Serum Tg was assayed using the Henning kit in 1466 samples from 245 individuals. A local or distant recurrence was assessed by clinical examination, radiological and scintigraphic investigations, and was present in 23 patients. The measurements were divided into four groups: 1) measurements performed less than 6 months after thyroidectomy; 2) measurements performed more than 6 months after thyroidectomy; 3) measurements performed during the suppression of pituitary secretion; 4) measurements performed during withdrawal of the substitutive therapy. An ROC curve was calculated for each group and for each curve three TVs were determined: TV1, TV2, and TV3 corresponding to a high sensitivity, a high specificity and a high sum of sensitivity and specificity respectively. TV1 is 3.12 g/l in the four groups. TV2 is 44 g/l, 19 g/l and 30 g/l, in the first, second, third and fourth groups respectively. TV3 is 35 g/l in the first group, 3.12 g/l in both the second and third groups and 30 g/l in the fourth group. When the classical method allows the determination of only one threshold value, the ROC technique allows us to determine threshold values adapted to both the patient clinical status and the chosen sensitivity or specificity.     

Gray-scale three-dimensional sonography of thyroid nodules: feasibility of the method and preliminary studies

The aim of the study was differential evaluation of new and classical sonographic features of benign thyroid nodules and thyroid cancer with three-dimensional gray-scale sonography and evaluation of the effectiveness of the thin-slice surface rendered images in comparison with multiplanar reformation (MPR) presentation. Fifty-four thyroid nodules were interactively evaluated with thin-slice smooth surface rendering: shape in the c-plane (parallel to the probe) and evaluation of echogenicity, margins and calcification/microcalcification-like echogenic foci in the a-plane (plane of the probe). Evaluation of the level of agreement in readers interpretation and between sonographic techniques was performed using the statistic. Surface rendering permitted visualization of the shape of the nodule in the c-plane in all cases, in contrast to only up to 48% of cases in MPR evaluation. Lobulated nodule shape in the c-plane was 82–100% sensitive and 47–53% specific in diagnosis of carcinoma. Surface rendered images showed more calcification/microcalcification-like echogenic foci than MPR ones. The level of agreement between the observers in the evaluation of features of thyroid nodules and the agreement between features of thyroid nodules on MPR and surface-rendered images showed at least moderate reproducibility (0.41). Three-dimensional thin-slice surface rendering sonography appears to be a feasible and effective method for thyroid nodule evaluation.     

Positron CT imaging of an impending stroke

Summary We present PET findings of a case of a transient ischemic attack which later progressed to cerebral infarction. Cerebral blood flow at the stroke focus in the right parietal cortex measured after a TIA attack and before stroke was as low as 24 ml/100 g/min with some increase in oxygen extraction fraction and blood volume. The condition was compatible with misery perfusion. This case may be an example suggestive that the misery perfusion sign is a warning of impending stroke and its poor prognosis if left without appropriate treatments.     

Nachvergütung an Psychotherapeuten/Anspruch auf Aufhebung bestandskräftiger Honorarbescheide

Abstrakt 1. Aus dem Grundsatz der Honorarverteilungsgerechtigkeit und dem objektiv-rechtlichen Gehalt des x85 Abs. 4 SGB V ergibt sich hinsichtlich der Rücknahmeentscheidung bestandskräftiger Honorarverteilungsbescheide, soweit die Rechtswidrigkeit auf einer Verteilungsungerechtigkeit der Arztgruppen zueinander beruht, eine Vorprägung des Ermessens nach x44 Abs. 2 S. 2 SGB X in Richtung einer Rücknahmeversagung.2. Für Honorarnachvergütungsansprüche gilt die 4jährige Frist des x44 Abs. 4 SGB X. (Leitsätze des Bearbeiters)     

Verteilungsmuster und funktionelle Bezüge der nachWernicke benannten Encephalopathie

Zusammenfassung Die Wernicke'sche Encephalopathie als eine der Folgen des chronischen Alkoholismus wird hinsichtlich ihrer Auswirkungen auf die Verkehrstauglichkeit besprochen. Anhand von 33 Fällen werden die neurologischen Symptome aufgezeigt, und es wird auf die möglichen Persönlichkeitsdefekte bei thalamischen Schädigungen und abortiven Krankheitsformen hingewiesen.

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Summary Wernicke's encephalopathy, as one of the sequelae of chronic alcoholism, is discussed with regard to its effects on driving ability. The neurological symptoms are presented with reference to 33 cases and the possible personality defects with thalamic lesions and abortive types of disease are emphasized.

Als Vortrag gehalten auf der Jahrestagung der Deutschen Gesellschaft für Verkehrsmedizin in Heidelberg (21.-22.5.1977)     

A comparison of the structure and function of the terminal lleum in crohn's disease using radiology,the “dicopac” schilling test and [14C] G.C.A. Breath test

Twenty patients with Crohn's disease were studied. Thirteen had radiological evidence of involvement of the terminal ileum. None had significant bacterial overgrowth of the small bowel contents and none had had resection of the terminal ileum. In all patients a [¹⁴C] glycocholic acid ([¹⁴C] G.C.A.) breath test and a Dicopac Schilling test were performed to assess terminal ileal function. The data showed poor correlation between the radiological appearance of the terminal ileum and the results of the functional tests. There was also poor correlation between the results of the [¹⁴C] G.C.A. breath test and the Dicopac Schilling test. Without terminal ileal histology, any assessment of the extent of Crohn's disease of the terminal ileum and of its effect on terminal ileal function, must include the [¹⁴C] G.C.A. breath test as well as radiology and the Dicopac Schilling test. The limitations of the [¹⁴C] G.C.A. breath test as a test of terminal ileal function in Crohn's disease are discussed.     

A new approach to computer-aided comparison of skull and photograph

A computer-based method developed for the purpose of checking the results of identification performed with the traditional method of video-superprojection (developed by Helmer and Grüner) is demonstrated; it does not require any special programs in addition to those necessary for digitising the video pictures. The method is suitable for filtering out false-positive cases. A great advantage is that the phase of computer evaluation can be separated from the job performed in the video studio, both in time and space. The process can be reconstructed, which means it can be checked. The results can be easily documented and interpreted for lay people.     

In vitro and in vivo characterisation of nor-β-CIT: a potential radioligand for visualisation of the serotonin transporter in the brain

Radiolabelled 2-Cabomethoxy-3-(4-iodophenyl)tropane (-CIT) has been used in clinical studies for the imaging of dopamine and serotonin transporters with single-photon emission tomography (SPET). 2-Carbomethoxy-3-(4-iodophenyl)nortropane (nor--CIT) is a des-methyl analogue of -CIT, which in vitro has tenfold higher affinity (IC₅₀=0.36 nM) to the serotonin transporter than -CIT (IC₅₀=4.2 nM). Nor--CIT may thus be a useful radioligand for imaging of the serotonin transporter. In the present study iodine-125 and carbon-11 labelled nor--CIT were prepared for in vitro autoradiographic studies on post-mortem human brain cryosections and for in vivo positron emission tomography (PET) studies in Cynomolgus monkeys. Whole hemisphere autoradiography with [¹²⁵I]nor--CIT demonstrated high binding in the striatum, the thalamus and cortical regions of the human brain. Addition of a high concentration (1 M) of citalopram inhibited binding in the thalamus and the neocortex, but not in the striatum. In PET studies with [¹¹C]nor--CIT there was rapid uptake of radioactivity in the monkey brain (6% of injected dose at 15 min) and high accumulation of radioactivity in the striatum, thalamus and neocortex. Thalamus to cerebellum and cortex to cerebellum ratios were 2.5 and 1.8 at 60 min, respectively. The ratios obtained with [¹¹C]nor--CIT were 20%–40% higher than those previously obtained with [¹¹C]-CIT. Radioactivity in the thalamus and the neocortex but not in the striatum was displaceable with citalopram (5 mg/kg). In conclusion, nor--CIT binds to the serotonin transporter in the primate brain in vitro and in vivo and has potential for PET and SPET imaging of the serotonin transporter in human brain.     

Bedeutung des Alkohols in der Embryofetalperiode und beim Neugeborenen

Zusammenfassung Es wird über Alkoholbefunde bei einem Neugeborenen berichtet, welches von der Mutter im Rausch geboren wurde. Aufgrund von zwei Blutentnahmen wurde für den Zeitpunkt der Geburt eine BAK von ca. 2 beim Kind ermittelt. Das Neugeborene zeigte das typische Bild einer Alkoholembryopathie.Aus der gynäkologisch-geburtshilflichen Literatur werden mehrere Anwendungsbereiche des Äthanols referiert, wobei Blutalkoholkonzentrationen zwischen 1 und 2 bei Mutter und Frucht als therapeutische Spiegel angesehen werden. Für die forensische Praxis bedeuten diese Befunde, daß BAK-Werten unter 2 bei Neugeborenen ohne zusätzliche Komplikationen allein keine todesursächliche Bedeutung zukommt.Herrn Prof. Dr. Erich Fritz zum 80. Geburtstag gewidmet     

Zur ACP-Typendifferenzierung aus Blutflecken

Zusammenfassung Serien von frisch angelegten Blutspuren auf Glas und auf Baumwolle — alle sechs Phänotypen der sauren Erythrocytenphosphatase (acP) — werden verschiedenen Lagerungsbedingungen ausgesetzt: 37°C, hohe Luftfeuchtigkeit; 20°C, Raumtemperatur; 4°C, Kühlschrank; –20°C, Tiefkühlschrank. Die elektrophoretische Darstellung erfolgt parallel mit Hilfe der Cellogel-Elektrophorese sowie mit Hilfe der Agarose-Dünnschicht-Elektrophorese. Die Darstellung der Isoenzyme erfolgt mit Hilfe des fluorogenen Substrats 4-Methyl-Umbelliferylphosphat.Die wichtigsten Ergebnisse sind: Es werden zur acP-Typendifferenzierung nur Bruchteile eines Blutstropfens verwendet. Die Verwendung der Cellogel-Technik ermöglicht a) geringen Spurensubstanzverbrauch, b) sichere Typendifferenzierung, c) längere Nachweisgrenzen (im Vergleich zur Agarose-Technik). Spuren auf Glas lassen sich länger nachweisen als Stoffspuren. Die ungefähren zeitlichen Nachweisgrenzen sind: Bei feuchtwarmer Lagerung 0,5 Wochen, bei Raumtemperaturlagerung 4 bis 6 Wochen, bei Kühlschranklagerung 10 bis 12 Wochen, bei Tiefkühlschranklagerung 13 Wochen.Die Methode der acP-Typendifferenzierung aus Blutspuren unter Verwendung der Cellogel-Technik und des fluorogenen Substrats wird als praktikable und reproduzierbare Methode empfohlen.     

201Tl in the scintigraphic evaluation of the “cold” thyroid areas

²⁰¹Tl-chloride, which has a metabolic behaviour similar to that of potassium and cesium, has been used in 68 patients for the evaluation of thyroid nodules previously recognized as cold on ¹³¹I or ^99mTc scans.All patients were re-examined with gamma-camcra and/or sequential scintigraphic recordings during 60 min after i.v. administration of thallium. In some cases, simultaneous imaging and integral digital plot with ¹³¹I or ^99mTc and ²⁰¹Tl were performed.In all 12 malignant nodules, ²⁰¹Tl has showed a high uptake, while it did not concentrate in 47 benign nodules (cystic or macrofollicular adenomas); thallium uptake was nevertheless found in 10 solid neoformations in which histological pictures were negative for malignancy or atypical lesions.The computerized study of the ²⁰¹Tl intranodular concentration, with the analysis of its dynamic function curves, seems to offer further possibility in differentiating and in a more objective evaluation of the cold areas on the thyroid scan.     

Virtopsy

Zusammenfassung Computed-tomography-Verfahren sind während der letzen 10 Jahre weiterentwickelt worden und haben verschiedene Anwendungen im rechtsmedizinischen Fachgebiet gefunden. Die neueste Entwicklung besteht in der multislice computed tomography, kombiniert mit photogrammetry-based surface optical scanning und Image-rendering-Techniken. Diese Kombination kann für die 3-dimensionale Darstellung von Verletzungsmustern zum Vergleich mit infrage kommenden Tatwaffen sowie zum Screening nach pathologischen Befunden in lebenden oder verstorbenen Personen eingesetzt werden. Es handelt sich um ein minimal-invasives Verfahren, mit dem forensisch relevante Bilder erfasst werden können, die auch im Gerichtssaal vorgeführt werden können. Die rasche Weiterentwicklung der Imaging-Technnik könnte in der Zukunft eine Alternative zur konventionellen Obduktionen darstellen.     

Patterns of radioiodine uptake by the lactating breast

Breast uptake of radioiodine, if not suspected, may be misinterpreted as thyroid cancer metastasis to the lung. To characterize the patterns of radioiodine breast uptake, we retrospectively studied 20 radioiodine scans that were performed within 1 week of cessation of breast feeding. Four patterns of uptake were identified: full, focal, crescent and irregular. The uptake was asymmetric in 60% (left>right in 45%, right>left in 15%), symmetric in 25% and unilateral in 15% of cases. A characteristic full bilateral uptake was present in 40% of cases. In three cases with the irregular pattern, caused in part by external contamination with radioactive milk, the uptake closely mimicked lung metastases. Delayed images, obtained in one case, showed an apparent radioiodine shift from the breast to the thyroid, suggesting that the presence of breast uptake can modulate radioiodine uptake by thyroid tissue. In a case of unilateral breast uptake, a history of mastitis was obtained, which to our knowledge has not been previously reported. Breast uptake of radioiodine may take several scintigraphic patterns that are not always characteristic of the lactating breast and may affect the apparent extent of thyroid remnant/metastasis.     

The influence of orthoses on the proprioception of the ankle joint

The ankle joints of 14 healthy volunteers and 16 patients with unstable ankle joints were tested regarding their functional and proprioceptive capabilities. All of them were active athletes. Three tests were used of the study: single-leg stance test, single-leg jumping course test, angle-reproduction test. The influence of three stabilization devices (lace-on-brace/Mikros, stirrup-brace/ Aircast, taping) on the proprioceptivity of stable and unstable ankle joints was evaluated. The scores of the singleleg jumping course without any stabilizing device (category standard) ranged between 8.06 and 13.68 (10.65±1.29). In the categories Mikros (9.85±0.99), and Aircast (9.99±1.14) as well as with the tape bandage (10.27±0.81) better scores were achieved. The differences standard vs. Mikros and standard vs. Aircast revealed a significant reduction of the scores with orthoses (P<0.01). The error rate in the single-leg stance test was within the range of 0–16 (5.12±2.85) for the category standard. It was lower for the categories Mikros (3.65±2.65) and Aircast (4.17±2.59). The error rate was highest in the group with a tape bandage (5.79±3.53). The differences standard vs Mikros as well as standard vs. Aircast were significant (P<0.01). There was also a significant difference between these categories regarding injured and not injured ankle joints (P<0.01). The angle-reproduction-test showed higher values for the category standard (2.36°±0.97) in comparison to the categories Mikros (1.46°±0.72), Aircast (1.62°±0.91) and taping (1.84°±0.41). In the category standard the reproduction error was lower testing not injured ankle joints (2.30°±1.04) than testing the group of unstable ankle joints (2.44°±0.81), whereas in all other categories the reproduction error was higher in the group of not injured joints. The differences in all measurements between standard vs. Mikros and standard vs. Aircast were significant (P<0.01). The results of the three tests showed a highly significant difference between injured and not injured ankle joints (P<0.01).     

Radioimmunoassay of serum thyroglobulin

A radioimmunoassay technique using a double antibody procedure for human serum thyroglobulin (HTg) is described. Only antigen labeling with iodine-125 is performed extemporaneously, the other reagents being purchased commercially. Quality criteria were: sensitivity (2 g/l), interassay reproducibility (coefficient of variance, C.V.=11%) and specificity are comparable with those of previously published techniques. Normal limits for serum HTg concentrations were established on the basis of 65 assays (33.0±21.20 g/l). In 69 subjects exhibiting goiters and cold nodules, the values observed were considerably higher and more dispersed (81±57 g/l); the same observation was made for the cases of Basedow's disease studied. Patients who had undergone thyroid ablation for thyroid cancer exhibited a low or nondemonstrable HTg concentration, except for seven subjects showing osseous and/or pulmonary functionally active metastases of a differentiated cancer whose HTg levels were significantly higher (300–400 g/l). These results concur with several previous reports in emphasizing the interest of assaying serum HTg during the surveillance of differentiated cancers of the thyroid.     

Location of the “zero zone” and its role in the pathogenesis of cervical spondylosis

Summary Significant correlation between the location of the zero zone and spondylosis was found in the cervical spine. The possible role of the zero zone in the development of spondylosis is suggested and the deleterious effect of counteracting forces as compared with a unidirectional traction is stressed.

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Die Stelle der Nullzone und ihre Rolle in der Pathogenese der zervikalen Spondylose

Zusammenfassung Die Ergebnisse der dynamischen Studien scheinen darauf hinzuweisen, daß ein Zusammenhang zwischen den häufigsten Stellen der Nullzone und der Spondylose besteht. Es scheint, daß das Bindegewebssystem der Halswirbelsäule auf die Überlastung durch entgegengesetzte Zugkomponenten sehr empfindlich ist und durch diese stärker beschädigt wird als durch eine Traktion, die nur in einer Richtung ausgeübt wird.

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Localisation de la zone zero et son rôle dans la pathogenie de la spondylose cervicale

Résumé Il semble y avoir une corrélation entre la zone zéro et le développement d'une spondylose cervicale et que la détérioration discale se fasse spécialement au niveau des mouvements intervertébraux bidirectionnels opposés.

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From the annual congress of the European Society of Neuroradiology (Geilo, September 1975)     

Enlargement of the pancreas in non-alcoholic cirrhosis: a computed tomography and pathological investigation

To evaluate the effect of hepatic dysfunction on pancreatic morphology, the antero-posterior width of the pancreas was measured by CT in 50 non-alcoholic cirrhotic patients without pancreatic disease and 221 age-and sex-matched normal controls. In addition, we reviewed the histology of the pancreas from 13 autopsies of the cirrhotics and 13 controls. The mean width of the pancreatic head in the cirrhotics was 2.94 0.34 cm (mean SD), which was significantly larger than that in the controls (2.17 0.32 cm) (P < 0.001). The width of the pancreatic body in the cirrhotics was also significantly greater than in the controls (1.95 0.24 cm versus 1.50 0.30 cm) (P < 0.001). Histological investigation revealed that lipomatosis and fibrosis increased with age in the controls, while they were seldom observed in the cirrhotics. And enlargement of acinar cells or of the islets of Langerhans was often seen in the cirrhotics. These data suggested that advanced liver dysfunction provoked pancreatic growth, probably through a trophic effect. Offprint requests to: T. Muranaka     

Morphological detection of X- and Y-chromosomes in smears and paraffin-embedded tissues using a non-isotopic in situ hybridization technique (NISH)

Pharyngeal smears and paraffin-embedded tissue specimens (skeletal muscle, kidney) obtained from 10 male and 10 female individuals were evaluated using non-isotopic in situ hybridization (NISH) with commercial X- and Y-specific biotinylated probes which recognize the pericentromeric regions DXZ1 and DYZ1/DYZ3 of the X- and Y-chromosome, respectively. The results provide evidence that the morphological sex determination of a single cell can be performed by critical application of this staining method leading to one nuclear signal in male cells using the Y-specific probe whereas female cells are negative. In situ hybridization of female tissues with an X-specific probe results regularly in 2 signals whereas male cells show only one spot in the nucleus.     

Untersuchungen zum dünnschichtchromatographischen Nachweis eines neuartigen Tranquilizers aus der Trioxazin-Reihe (Versuchspräparat Nr. 518 der Firma Knoll AG.)

Summary The tranquilizer-substance Trioxazine is described and investigations were made for detecting the substance and its metabolites in the urine after intake. It was found, that the unchanged tranquilizer as well as 3 metabolites were excreted. The substance could easily be extracted out of urine with chloroforme after acidifying with hydro-chloric acid. The extract was separated on silica-gel GF₂₅₄-thinlayer-plate in the solvent CHCl₃-n-Heptan-Ethanol (111). For the detection of the substances on the plate it was found, that spraying them with a modified reagent ofSonnenschein, consisting of Cer(IV)sulphate, trichloraceticacid and conc. sulfuric. acid give red spots. An amount of 5 g of Trioxazine can thus be detected. Trioxazine also reacts with conc. nitric acid to a deep red colour.

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Vorgetragen auf der Tagung der Deutschen Gesellschaft für Gerichtliche und Soziale Medizin in Freiburg i. Br. im Oktober 1966.     

Positive 131Cesium scanning in parathyroid adenoma

In a case of primary hyperparathyroidism, a palpable nodule, at the base of the right lobe of the thyroid, proved cool during ^99mTc scanning, but hot when scanned with radiocesium. The uptake of this tracer was higher than the uptake of ⁷⁵Se-selenomethionine after suppression with T₃.The authors discuss the possibility of cases of false-positive radiocesium uptake in extrathyroid nodules, and in particular, the use of this tracer for the detection of parathyroid adenoma by scanning.