抗人肝癌铁蛋白抗体对原发性肝癌的放射免疫显像

应用^131I标记的抗人肝癌铁蛋白抗体对16例原发性肝癌作放射免疫显像分析，其阳性离为81．3％（13／16）。其中经肝动脉插管注射者8例，阳性率为100％（8／8）。注射后当天断层摄影（SPECT）即可获得阳性显像，以第4－6天最为清晰，有3例追踪到第20天仍可获阳性显像。其3、5和8天时肝癌与正常肝部位的中位放射强度比值分别为1．4、1．6和1．8，最高可达2．9。经外周静脉注射者8例，阳性率为62．％％（5／8），低于经肝动脉插管注射者。比值分别为1．2、1．3和1．4，最高为1．8。     

^99Tc—ccM4（鼠／人嵌合抗体）胃癌放射免疫显像研究

采用＾９９ｍＴｃ－ｃｃＭ４ ＭｃＡｂ对１０例胃癌病人，４例非胃癌病人进行放射免疫显像研究，观察了血清ＴＡＧ－７２抗原量，抗体注入量，组织类型和细胞反应性对ＲⅡ阳性检出率的影响。注入＾９９ｍＴｃ－ｃｃＭ４后，胃癌阳性率６０％，肝转移癌阳性率５０％，全部良性病变均显示阴性。     

放射性核素显像在心脏再同步化治疗中的应用

近年来心力衰竭的治疗取得了重大进展,心脏再同步化治疗是新的治疗手段之一,而其疗效与心脏运动是否同步显著相关.目前,放射性核素门控心血池显像和门控心肌灌注显像均可检测心脏运动同步性,本文就其在心脏再同步化治疗中的应用情况予以综述.     

放射性核素显像以伴心脏损害的风湿病的检测意义

目的 探讨某些活动期风湿病患者左心室功能改变、心肌损害以及放射性核素显像检测风湿病患者心脏损害的临床应用价值。方法 用放射性核素显像平衡法门电路心血池扫描及心肌断层显像测定２０例正常人和２０例系统性红斑列多发性肌炎（ＰＭ）,６例结节性动脉炎（ＰＡＮ）,５例风湿热患者左心室收缩和舒张功能改变、心肌损害情况。结果 活动期风湿病病人的左室射血分数（ＬＶＥＦ）,高峰射血率（ＰＥＲ）,高峰充盈率（ＰＦＲ）,     

核素显像评估心脏失同步及在心脏再同步化治疗中的应用进展

核素显像位相分析技术能够进行心脏机械收缩失同步分析,能用于指导心脏再同步化治疗(CRT)、预测CRT疗效。目前有2种方法:1核素门控心血池显像;2核素门控单光子发射型计算机断层心肌灌注显像(GSMPI)。尤其是GSMPI可通过一次检查,"一站式"评估心室收缩失同步、定位心脏最迟收缩部位、识别疤痕心肌的部位、范围,且方法客观,重复性好。     

99mTc-SZ-51用于犬静脉血栓模型放射免疫显像的研究

目的 :观察 99m Tc标记抗活化血小板单抗 (99m Tc- SZ- 5 1)在犬血栓模型的体内代谢分布情况 ,以及检测静脉血栓的能力。方法 :制作犬静脉血栓模型 2 4h后注射 99m Tc- SZ- 5 1370 MBq,分别测定血液半清除时间 (T1 /2 ) ,不同时间的血栓 /血液和血栓 /肌肉比值以及血栓部位与对侧相应部位 (T/ NT)比值。结果 :99m Tc- SZ- 5 1的血液半清除时间分别为 ,快相 (15 .2 8± 9.2 5 ) m in,慢相 (7.76± 2 .2 5 ) h,肾脏摄取量显著高于其他脏器 ;4h血栓 /血液和血栓 /肌肉比值分别为 4.0和 6 6 .5 ,10 h达到 7.2和 16 3.3;注射显像剂后 1h活体显像 ,可见股静脉血栓局部有明显放射性聚集 ,4～ 6 h血栓显像更清晰。ROI定量分析显示 ,T/ NT比值在注射显像剂后 1h即可达到 1.5 2 ,4h达到最高点 2 .6 5。结论 :99m Tc- SZ- 5 1具有较快的血液清除率和较高的 T/ NT比值 ,活体显像可获得满意的显像效果 ,血栓最佳显像时间为 4～ 6 h。     

心脏交感神经显像的临床应用和研究进展

交感神经系统在调节心血管功能方面起着关键作用,其功能异常是多种心血管疾病发生和发展的重要机制。应用放射性核素心脏交感神经显像,可无创性评估心脏交感神经支配的功能状态和病理改变,在疾病诊断、危险分层、预后评估和疗效评价等方面都具有重要的作用。现综述心脏交感神经显像技术在心力衰竭、缺血性心脏病和心脏移植等方面的临床应用研究,以及研发新型显像药物对该技术普及推广的意义。     

~（99m）Tc－ccM4（鼠／人嵌合抗体）胃癌放射免疫显像研究

采用~（９９ｍ）Ｔｃ－ｃｃＭ４ＭｃＡｂ对１０例胃癌病人，４例非胃癌病人进行放射免应显象（ＲＩＩ）研究，观察了血清ＴＡＧ－７２抗原量、抗体注入量、组织类型和细胞反应性对ＲＩＩ阳性检出率的影响。注入（９９ｍ）Ｔｃ－ｃｃＭ４（５５５～１４８０ＭＢｑ／０．５～１．５ｍｇ）后，胃癌阳性率６０％，肝转移癌阳性率５０％，全部良性病变均显示阴性。最佳显象时间为注入抗体后８ｈ。给予一定量抗体后，增加抗体用量并不能提高ＲＩＩ的阳性率。血清ＴＡＧ－７２抗原含量与ＲＩＩ肿瘤阳性检出率明显相关。     

Subendocardial Myocardial Infarction

Abstract: Subendocardial myocardial infarction. N. Bayley, D. Hunt, C. Penington and J. G. Sloman, Aust. N.Z. J. Med., 1982, 12, pp. 166–169.
Sixty–one consecutive patients with acute subendocardial myocardial infarction (SEAMI) and 223 consecutive patients with transmural infarction (TMI) seen in a coronary care unit were followed for one year. All patients were less than 70 years of age. The patients with SEAMI had a higher frequency of previous infarction (34% vs 21%, p< 0–025), less cardiac failure (44% vs 65%, p<0005), and were more often free from arrhythmias (61 % vs 31%, p<0001) than patients with TMI. Hospital mortality was less in patients with SEAMI (0% vs 8%, p < 0 05) but total mortality to one year was similar (15% vs 17%). Amongst patients with SEAMI, two died within two weeks of infarction but all other deaths occurred at least six weeks after infarction.
Patients with SEAMI and a history of previous infarction had a higher one year mortality than patients without such a history (29% vs 7%, p < 0 05). Coronary angiography with a view to coronary artery surgery should be considered in the former group.     

Myocardial Viability Detected by Myocardial Contrast Echocardiography—Prognostic Value in Patients after Myocardial Infarction

Objective: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a predictor of cardiac events and death in patients with acute myocardial infarction (AMI). Methods: Eighty‐six patients underwent primary percutaneous coronary angioplasty for AMI. Segmental perfusion was estimated by MCE in real time at mean 5 days after PCI using low MI (0.3) after 0.3–0.5 ml bolus injection of intravenous Optison. MCE was scored semiquantitatively as: (1) normal perfusion (homogenous contrast effect), (2) partial perfusion (patchy myocardial contrast enhancement), (3) lack of perfusion (no visible contrast effect). A contrast score index (CSI) was calculated as the sum of MCE scores in each segment divided by the total number of segments. The patients were followed up for cardiac events and death. Results: A CSI of >1.68 was taken to be a predictor of cardiac events and death. Death occurred only in patients with CSI >1.68. Patients with CSI >1.68 had a significantly (P = 0.03) higher incidence of cardiac death or cardiac events (75%) compared to those with CSI <1.68 (27%). The absence of residual perfusion within the infarct zone was an independent predictor of death and cardiac events (P = 0.02). Conclusions: The absence of residual myocardial viability in the infarct zone supplied by an infarct‐related artery is a powerful predictor of cardiac events in patients after AMI. (Echocardiography 2010;27:430‐434)     

Classification of Myocardial Infarction: Frequency and Features of Type 2 Myocardial Infarction

Background

The classification of myocardial infarction into 5 types was introduced in 2007 as an important component of the universal definition. In contrast to the plaque rupture–related type 1 myocardial infarction, type 2 myocardial infarction is considered to be caused by an imbalance between demand and supply of oxygen in the myocardium. However, no specific criteria for type 2 myocardial infarction have been established.

Methods

We prospectively studied unselected hospital patients who had cardiac troponin I measured on clinical indication. The diagnosis and classification of myocardial infarction were established, and the frequency and features of type 2 myocardial infarction were investigated by use of novel developed criteria.

Results

From January 2010 to January 2011, a total of 7230 consecutive patients who had cardiac troponin I measured were evaluated, and 4499 patients qualified for inclusion. The diagnosis of myocardial infarction was established in 553 patients, of whom 386 (72%) had a type 1 myocardial infarction and 144 (26%) had a type 2 myocardial infarction. Patients in the group with type 2 myocardial infarction were older and more likely to be female, and had more comorbidities. The proportion of patients without significant coronary artery disease was higher in those with type 2 myocardial infarction (45%) than in those with type 1 myocardial infarction (12%) (P < .001). Tachyarrhythmias, anemia, and respiratory failure were the most prevalent mechanisms causing type 2 myocardial infarction.

Conclusions

In a cohort of patients with myocardial infarction who were admitted consecutively through 1 year, the category of type 2 myocardial infarction comprised one fourth when diagnosed by the use of newly developed criteria. Approximately half of patients with type 2 myocardial infarction had no significant coronary artery disease.     

The Prognosis for Patients Referred with Suspected Acute Myocardial Infarction

ABSTRACT. Engby B, Strunge P, Olsen J. (Department of Internal Medicine, Horsens Hospital, Horsens, Denmark.) The prognosis for patients referred with suspected acute myocardial infarction. A follow-up investigation of the prognosis of 381 patients admitted with suspected acute myocardial infarction (AMI) has been carried out in respect of later AMI or death. During hospitalization the patients were divided into groups with particular attention to patients with no demonstrable myocardial infarction but with ischaemic heart disease (non-AMI) and patients with confirmed AMI. All patients were subjected to follow-up for 43 months (range 37–54). The mortality from cardiovascular causes after four years was 26.2% of 130 non-AMI patients and 25.8% of AMI patients. The majority of new infarctions were found in the AMI patients, but with even increase in both groups, 50% occurring within the first 12 months. The groups were studied with regard to earlier manifestations of ischaemic heart disease and heart failure during hospitalization, without any difference being observed. Due to the poor prognosis the question is raised whether non-AMI patients as a group should be offered prophylactic therapy.     

Assessment of Myocardial Viability in Patients With Postischemic Left Ventricular Dysfunction: Role of Myocardial Contrast Echocardiography

The distinction between viable and nonviable dysfunctional left ventricular (LV) segments after acute myocardial infarction is very important, because revascularization increases survival only in patients with viable myocardial tissue. Recent studies have highlighted a mismatch between two highly specific investigations for viability assessment: dobutamine echocardiography, which measures inotropic reserve, and myocardial contrast echocardiography (MCE), which measures microvascular perfusion. Viability and functional reserve are not synonymous. Maintenance of microvascular perfusion, independently of functional reserve, attenuates left ventricular remodelling, reduces the risk of major cardiac events, and increases survival. MCE provides similar perfusion information as myocardial blush, but image quality is much higher. Quantitative analysis of digital data provides more accurate diagnostic MCE information than qualitative analysis of video signal intensity. In a recent study relating MCE findings to histologic data, MCE-derived quantitative data were closely correlated with microvascular density and capillary area, and inversely correlated with collagen content. One of the contrast agents routinely used for MCE is SonoVue, a second generation microbubble contrast agent, which is characterized by high response to ultrasound energy, ease of destruction at high energy, and strong harmonic signal at low energy. Recommendations for the assessment of postischemic LV dysfunction: routine use of MCE, followed by dobutamine echocardiography if perfusion is documented. If MCE is negative, revascularization is not indicated; if both tests are positive, revascularization is strongly recommended; if they are discordant, useful information can be obtained by assessing the extent of ²⁰¹T1 viability. (ECHOCARDIOGRAPHY, Volume 20, Supplement 1, 2003)     

Radioimmunoimaging of colorectal cancer using 99mTc-labeled monoclonal antibody

AIM To determine whether Hb3 and its fragment F(ab')2 have practical value in radioimmunoimaging of colorectal cancer.METHODS Intact Hb3 was purified by hydroxylapatite chromatography. The fragment F(ab')2 was prepared by cold digestion and purified as intact Hb3. Hb3 and its fragment F(ab')2 were labeled with 99mTc by direct labeling method using SnCl2 as reducing agent. The radioactive doses ranged from 15 to 40 mCi. The imaging was accomplished by single photon emission computered tomograph (SPECT) with imaging time ranging from 2.5 to 48 hours. In this study, 10 patients were selected. Among them, 7 were administered with intact Hb3, and 3 with F(ab')2 fragment. All the patients were diagnosed as having colorectal adenocarcinoma.RESULTS After purification, intact Hb3 and its fragment F(ab')2 were fit for radioimmunoimaging. The percentage of labeling of 99mTc to Hb3 or F(ab')2 was 80.6%-91.5%. Among the 10 patients, 3 of 7 patients administered with intact Hb3 had positive scans, the other 4 had negative scans, and 2 of 3 patients administered with F(ab')2 had positive scans, the other 1 had negative scans.CONCLUSION The results showed that both intact Hb3 and its F(ab')2 have some practical value in radioimmunoimaging of colorectal cancer, and the effects of imaging with F(ab')2 was better than that with intact Hb3.     

Myocardial infarction in the diabetic patient

It has long been thought that the symptomatology and prognosis of coronary events in patients with diabetes may differ from those in nondiabetic persons. A review of recent data demonstrates a higher mortality during the acute phase of myocardial infarction for diabetic patients than for their nondiabetic counterparts, possibly related to a higher incidence of congestive heart failure and cardiogenic shock. The clinical course of diabetic patients with infarction and the role of insulin in myocardial adaptation to ischemia are both reviewed. Diabetic patients surviving the acute phase of myocardial infarction have a lower survival in follow-up than nondiabetic survivors, although some improvement in survival has been noted following beta-adrenergic-blocker therapy.