Genetic polymorphism of Alpha-2-HS glycoprotein in Lombardy (Italy)

Summary 2HS-subtypes have been analysed in samples from 700 unrelated individuals from the Brescia area (Italy) by the isoelectric focusing technique and immunofixation. The observed allele frequencies were: 2HS*1= 0.7472; 2HS*2 = 0.2507; 2HS*V = 0.0021.     

‘Hot’ and ‘cold’ lesions detected by gallium-67 scintigraphy in a pyogenic liver abscess

Most pyogenic liver abscesses appear to be not in a ⁶⁷Ga-citrate study; rarely, a warm or cold area may also be seen. We present a patient with a pyogenic liver abscess that had both cold and hot areas in the ⁶⁷Ga-citrate study. This striking finding is probably related to the different stages of evolution of the abscess.     

Local Administration of NF-κ B Decoy Oligonucleotides to Prevent Restenosis after Balloon Angioplasty: An Experimental Study in New Zealand White Rabbits

Purpose To evaluate the efficacy of NF- B oligonucleotides (ODN) administered by local administration with the channeled balloon catheter to prevent restenosis after balloon angioplasty in restenotic iliac arteries of New Zealand white rabbits.Materials and Methods In vitro, 8000 rabbit vascular smooth muscle cells (rVSMC) where transfected with a liposomal carrier (TfX50) with 100 ng of decoy and scrambled ODN. Inhibition of proliferation was measured using a MTT assay after 24 hours in comparison to control. In vivo, 22 male New Zealand White rabbits were fed a 1% cholesterol diet and received denudation of both common iliac arteries with a 3 mm balloon catheter to induce an arterial stenosis. Four weeks after stenosis induction, local application of NF- B in two different concentrations (1 g: n=14; 10 g: n=8) was performed randomly on one common iliac artery. Scrambled oligonucleotides without specific binding capacities were injected into the contralateral side. The channeled balloon catheter allows simultaneous balloon dilation (8 atm) of the stenosis and local application of a drug solution (2 atm). Four weeks after local drug delivery the animals were killed and the vessels were excised and computerized morphometric measurements were performed.Results NF- B decoy ODN but not scrambled ODN inhibited proliferation of rVSMC in vitro. Following local ODN application in the animals, no acute vascular complications were seen. NF- B ODN resulted in a statistically non significant reduction of neointimal area compared to the control group. The neointimal area was 0.97 mm² using 1 g NF- B ODN compared to 0.98 mm² in the control group. The higher dose resulted in a neointimal area of 0.97 mm² compared to 1.07mm² at the control side.Conclusions Local drug delivery of NF- B ODN using the channeled balloon catheter could not reduce neointimal hyperplasia in stenostic rabbit iliac arteries. Application modalities have to be improved to enhance the effect of the local application to prevent restenosis after balloon angioplasty.     

Disco-vertebral destructive lesions (So-called Andersson Lesions) associated with ankylosing spondylitis

Radiological examination of 31 patients with established ankylosing spondylitis revealed 58 disco-vertebral destructive lesions. Careful assessment of their radiological features permitted differentiation into two main types, (1) inflammatory and (2) non-inflammatory. The inflammatory type may represent either an active inflammatory process or a late sequel to such a lesion. In this series 44 lesions were included in this category, with a marked predilection for the lumbar spine. Moreover, all were observed within the first decade following the onset of the disease.The non-inflammatory type reflects an attempt of a stress fracture in the diseased spinal column to repair by connective tissue, causing a pseudoarthrosis. Eleven such lesions were obseved in this series all occurring more than 12 years after the onset of the disease. In a much smaller group of three cases-here termed the ambivalent type — differentiation between the inflammatory and non-inflammatory types could not be established on radiological grounds alone. It is of interest that all three cases occurred within the first year after the onset of the disease.It is suggested that the term Andersson lesion should be used to include all disco-vertebral destructive lesions related to ankylosing spondylitis—be they of inflammatory or non-inflammatory pathogenesis —as the better known term Romanus lesion includes all types of circumscribed marginal destructive lesions of vertebral bodies without involvement of the disc in ankylosing spondylitis.     

The binding parameters of radiolabelled monoclonal F (ab′)2 and Fab′ fragments relative to immunoglobulin G in reactions with surface-bound antigens

The binding parameters of iodine-125-labelled intact monoclonal immunoglobulin G (IgG), F(ab)₂ and Fab fragments were compared. The study was carried out with the two monoclonal antibodies (MoAbs) K13 and K16 specific for human Ig light chains K and , respectively. When testing the ¹²⁵I-MoAbs against monodisperse polymer particles coated with the specific antigens, the K_a for the F(ab)₂ fragments were similar to that for IgG, while the K_a for the Fab fragments were reduced to 10%–20% of that for IgG. The number N of effective target sites revealed with Fab was higher than with F(ab)₂ and IgG, presumably because less surface area is occupied by the small Fab molecules. The immunoreactive fraction F ranged according to IgG > F(ab)₂ > Fab. The explanation of the moderate difference between the K_a of the monoclonal Fab and the divalent IgG and F(ab)₂ was that the divalent molecules were not divalently attached to the particles. When testing the same antibody preparations against human lymphoma cells producing Ig with light chains K or , the binding results were less reliable than when particles were utilised, presumably due to antigen shedding. Different MoAbs vary in their loss of immunoreactivity due to enzymatic degradation and the radiolabelling procedure. The preparation of the radiolabelled fragments should therefore be optimized for each MoAb, and evaluation is necessary before injection. Artificial targets with a low leakage of antigen, like the monodisperse polymer particles here applied, are recommended for the in vitro evaluation of the immunoreactivity of labelled MoAb preparations.     

ACL graft can replicate the normal ligament’s tension curve

The anatomical femoral insertion of the normal anterior cruciate ligament (ACL) lies on the deep portion of the lateral wall of the intercondylar fossa. Following the deep bone–cartilage border, it stretches from 11 oclock high in the notch all the way down to its lowest border at 8 oclock. The tension curve of the normal ACL during passive flexion–extension shows a characteristic pattern with two tension peaks, one in full extension and the other in deep flexion. Low tension in mid-flexion is measured between those two peaks. Standard ACL reconstructions use a femoral insertion at 11 oclock, which results in non-physiological tension curves with one peak in full extension only. The hypothesis was that it is possible to reproduce the typical tension curve of the normal ACL by placing the femoral tunnel into the low part of the normal ACL footprint. In a controlled laboratory study, three different femoral tunnel positions at 9, 10 and 11 oclock were tested in four cadaver knees while using the identical standard tibial tunnel each time. The tension curve was measured during passive flexion–extension with a custom-made tension measurement device, using an artificial Dacron graft. The tension curve of grafts in the 9 oclock tunnels showed the characteristic pattern of the normal ACLs tension curve with tension peaks in extension as well as in deep flexion. The tunnels in the 10 and 11 oclock positions failed to reproduce the normal ACLs tension curve with high-tension values in extension only. Clinical relevance: If an ACL graft is placed low within the normal femoral footprint, the physiological tension curve of the normal ACL can be reproduced.     

A pattern of post-traumatic demineralization of bone simulating permeative neoplastic replacement: A potential source of misinterpretation

Long bones with a prominent endosteal trabecular pattern, particularly the herringbone configuration, when immobilized, will demineralize in a striking spotty pattern which may simulate neoplastic permeative replacement of bone. The recognition of this phenomenon will obviate needless concern and investigation.     

Non-invasive assessment of distribution volume ratios and binding potential: tissue heterogeneity and interindividually averaged time-activity curves

Due to the stochastic nature of radioactive decay, any measurement of radioactivity concentration requires spatial averaging. In pharmacokinetic analysis of time-activity curves (TAC), such averaging over heterogeneous tissues may introduce a systematic error (heterogeneity error) but may also improve the accuracy and precision of parameter estimation. In addition to spatial averaging (inevitable due to limited scanner resolution and intended in ROI analysis), interindividual averaging may theoretically be beneficial, too. The aim of this study was to investigate the effect of such averaging on the binding potential (BP) calculated with Logans non-invasive graphical analysis and the simplified reference tissue method (SRTM) proposed by Lammertsma and Hume, on the basis of simulated and measured positron emission tomography data {[¹¹C]d-threo-methylphenidate (dMP) and [¹¹C]raclopride (RAC) PET}. dMP was not quantified with SRTM since the low k ₂ (washout rate constant from the first tissue compartment) introduced a high noise sensitivity. Even for considerably different shapes of TAC (dMP PET in parkinsonian patients and healthy controls, [¹¹C]raclopride in patients with and without haloperidol medication) and a high variance in the rate constants (e.g. simulated standard deviation of K ₁=25%), the BP obtained from average TAC was close to the mean BP (error <5%). However, unfavourably distributed parameters, especially a correlated large variance in two or more parameters, may lead to larger errors. In Monte Carlo simulations, interindividual averaging before quantification reduced the variance from the SRTM (beyond a critical signal to noise ratio) and the bias in Logans method. Interindividual averaging may further increase accuracy when there is an error term in the reference tissue assumption E=DV ₂–DV (DV ₂ = distribution volume of the first tissue compartment, DV = distribution volume of the reference tissue). This can be explained by the fact that the distribution volume ratio (DVR=DV/DV) obtained from averaged TAC is an approximation for DV/DV rather than for DVR/n. We conclude that Logans non-invasive method and SRTM are suitable for heterogeneous tissues and that discussion of group differences in PET studies generally should include qualitative and quantitative assessment of interindividually averaged TAC.     

Agreement between emergency physician diagnosis and radiologist reports in patients discharged from an emergency department with community-acquired pneumonia

To evaluate the level of concurrence between radiologist reports and the diagnosis of community-acquired pneumonia (CAP) in patients discharged from an emergency department (ED), a retrospective chart audit of patients discharged with a diagnosis of pneumonia or possible pneumonia from the ED during a 2-year period was conducted. Emergency physician (EP) and radiology report (RR) diagnoses were categorized as pneumonia, possible pneumonia, non-pneumonia and normal, and categories from each were compared. 815 charts were analyzed. Of 671 EP diagnoses of pneumonia, 304 (45.3%) RRs reported pneumonia and 82 (12.2%), possible pneumonia. Of 815 EP diagnoses of pneumonia or possible pneumonia, 426 (52.3%) RRs were in agreement, while 216(26.5%) were of diagnoses other than pneumonia and 173 (21.1%) were read as normal. EPs and radiologists frequently disagree on whether a patient has pneumonia or not. Perhaps it is time to revisit the gold standard status of plain chest X-ray.Presented at the 9th International Conference of Emergency Medicine, Edinburgh, Scotland, 17–21 June, 2002.     

γ-Glutamyltransferase test as a new tool for identification of seminal stains

Summary A simple qualitative method for identification of seminal stains based on a high activity of -glutamyltransferase (-GTP) in human semen is described. It employs the release of -naphthylamine from N--glutamyl--naphthylamide by the -GTP action; -naphthylamine couples with Fast Garnet GBC salt to produce a strong brownish-red color. The data on its simplicity, specificity, and stability show that the present method is suitable for medicolegal examination of seminal stains as a preliminary test.     

Proportional anatomical stereotactic atlas for visual interpretation of brain SPET perfusion images

A semi-automatic method was developed to determine the anterior (AC) and posterior (PC) commissures on brain single-photon emission tomographic (SPET) perfusion images, and then to draw the proportional anatomical Talairach's grid on each axial SPET image. First, the AC-PC line was defined on SPET images from the linear regression of four internal landmarks (frontal pole of the brain, inferior limit of the anterior corpus callosum, sub-thalamic point and occipital pole). Second, the SPET position of AC and PC points on the AC-PC line was automatically determined from measurements made on hard copies of magnetic resonance (MR) images of the patients. Finally, a proportional Talairach's grid was automatically drawn on each axial SPET image. To assess the accuracy of localization of AC and PC points, co-registered technetium-99m hexamethylpropylene amine oxime SPET and MR images from 11 subjects were used. The mean displacements between estimated points on SPET and true points on MRI (x=sagittal, y=frontal and z=axial displacement) were calculated. The mean displacements (in mm) were x=–1.4±1.8, y=–1.7±3.3 and z=–1.1±2.5 for AC, and x=–1.8±1.8, y=0.3±3.2 and =–1.3±2.7 for PC. These displacements represented an error of less than 5 mm at the anterior or posterior pole of the brain or at the vertex. Intra- and inter-observer comparisons did not reveal significant differences in mean displacements. Thus, this semi-automatic method results in reproducible and accurate stereotactic localization of SPET perfusion abnormalities. This method can be used routinely for repeat follow-up studies in the same subject as well as in different individuals without requiring SPET MRI co-registration.     

Vergleich der nach Essen-Möller berechneten Vaterschaftswahrscheinlichkeit einschließlich „Zuordnung“ mit anthropologischen Resultaten bei Einmannfällen

Zusammenfassung Nach der Formel von Essen-Möller berechnete Vaterschaftswahrscheinlichkeiten von 909 Vätern und 909 Nichtvätern, ausgedrückt als lg Y/X, verteilen sich in einer aus 2 Normalverteilungen zusammengesetzten Kurve. Der überlagernde Anteil von 5% der Fälle wird auf eine Beimengung echter bzw. falscher Terzetten mit einem populationsfremden Mann zurückgeführt. Der Mittelwert von Nichtvätern liegt bei einem höheren lg Y/X-Wert als der von Vätern. Die Zuordnungswahrscheinlichkeiten von Vätern, ausgedrückt als lg(1–Z)/Z, sind ebenfalls normal verteilt, während Nichtväter und — in geringerem Maß — serologisch nichtausgeschlossene Männer aus Ein- und Mehrmannsachen (n=910) eine nach niederen Z-Werten hin schiefe Verteilung zeigten. Serostatistische und anthropologische Urteile gehen, wie an 331 Einmannfällen gezeigt werden konnte, weitgehend parallel. In 7 Fällen kam es zum Widerspruch zwischen der serostatistischen Vaterschaftswahrscheinlichkeit (W90%) und dem anthropologischen Ergebnis (Vaterschaft sehr unwahrscheinlich bis praktisch ausgeschlossen). Bei 5 von diesen handelte es sich jedoch im eigentlichen Sinn um Mehrmannfälle.Unter Anwendung der Grundsätze des Feststellungsparagraphen des neuen Unehelichengesetzes der BRD wären 254 von 331 bei Einmannfällen beteiligte Männer aufgrund des serostatistischen Resultats (W80%) und weitere 61 aufgrund des anthropologischen als Erzeuger zu verurteilen. In 16 Fällen müßte die Klage abgewiesen werden, weil aufgrund des anthropologischen Befundes an der Vaterschaft des beteiligten Mannes ernsthaft zu zweifeln ist.

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Evaluation of probability of paternity as determined by the essen-möller formula in a given mother-child constellation

Summary Using the formula of Essen-Möller, the probability of paternity was evaluated in 909 fathers and in 909 non-fathers. The lg Y/X of these groups yield two identical curves of gaussian distribution. 5% of the total number of cases is believed to result from an admixure of true or false trios with a man outside of the normal population. Non-fathers show a higher mean value of lg Y/X than fathers. The classification possibility of fathers, expressed as lg(1–Z)/Z shows a normal distribution curve; non-fathers, however, and to a smaller extent also serologically non-excluded individuals involved in single or multiple-men cases (n=910), show an oblique curve. Evaluation of the serological and anthropological data in 331 single-man cases indicates a significant correlation. In 7 cases there was a discrepancy between the serological evaluation of paternity (W90%) and the anthropological results (paternity very unlikely or practically excluded). Five of these were multiple-men cases, however. According to the new illegitimacy law of the German Federal Republic, 254 men out of 331 single-man paternity cases should be found guilty on the grounds of serostatistical data (W80%) and an additional 61 should be found guilty of paternity on the basis of anthropological findings. 16 cases should be dismissed on the basis of serious doubt cast by the anthropological data.

     

Positron emission tomography imaging of adrenal masses: <Superscript>18</Superscript>F-fluorodeoxyglucose and the 11β-hydroxylase tracer <Superscript>11</Superscript>C-metomidate

Purpose ¹¹C-metomidate (MTO), a marker of 11-hydroxylase, has been suggested as a novel positron emission tomography (PET) tracer for adrenocortical imaging. Up to now, experience with this very new tracer is limited. The aims of this study were (1) to evaluate this novel tracer, (2) to point out possible advantages in comparison with ¹⁸F-fluorodeoxyglucose (FDG) and (3) to investigate in vivo the expression of 11-hydroxylase in patients with primary aldosteronism.Methods Sixteen patients with adrenal masses were investigated using both MTO and FDG PET imaging. All patients except one were operated on. Five patients had non-functioning adrenal masses, while 11 had functioning tumours(Cushings syndrome, n=4; Conns syndrome, n=5; phaeochromocytoma, n=2). Thirteen patients had benign disease, whereas in three cases the adrenal mass was malignant (adrenocortical cancer, n=1; malignant phaeochromocytoma, n=1; adrenal metastasis of renal cancer, n=1).Results MTO imaging clearly distinguished cortical from non-cortical adrenal masses (median standardised uptake values of 18.6 and 1.9, respectively, p<0.01). MTO uptake was slightly lower in patients with Cushings syndrome than in those with Conns syndrome, but the difference did not reach statistical significance. The expression of 11-hydroxylase was not suppressed in the contralateral gland of patients with Conns syndrome, whereas in Cushings syndrome this was clearly the case. The single patient with adrenocortical carcinoma had MTO uptake in the lower range.Conclusion MTO could not definitely distinguish between benign and malignant disease. FDG PET, however, identified clearly all three study patients with malignant adrenal lesions. We conclude: (1) MTO is an excellent imaging tool to distinguish adrenocortical and non-cortical lesions; (2) the in vivo expression of 11-hydroxylase is lower in Cushings syndrome than in Conns syndrome, and there is no suppression of the contralateral gland in primary aldosteronism; (3) for the purpose of discriminating between benign and malignant lesions, FDG is the tracer of choice.     

Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n=88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n=100, group 1), and controls with ESRD but no prior thrombectomy procedures (n=117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n=23), 10% (n=9) and 16% (n=14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p=0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n=49), 10% (n=12) and 4% (n=5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR=1.5), although this failed to reach statistical significance (p=0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension. Patients with ESRD are more likely to have pulmonary hypertension.     

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.     

Stability of α-[11C]methyl-l-tryptophan brain trapping in healthy male volunteers

Purpose The purpose of this study was to assess the reproducibility in healthy volunteers of -[¹¹C]methyl-l-tryptophan ([¹¹C]MT) brain trapping imaging with positron emission tomography (PET), using volumes of interest (VOIs) and voxel-based image analysis.Methods Six right-handed healthy male volunteers (34.3±10.9 years) with a negative family history for psychiatric disorders were scanned twice in the resting condition, 22±17 days apart. An unbiased semiautomatic segmentation of the brain was used to define VOIs. The trapping constant K* (ml g^–1 min^–1) for [¹¹C]MT was calculated for the whole brain and seven brain regions using the graphical method for irreversible tracers. In addition, parametric maps of K* were obtained from dynamic scans using the same method. Comparison of test and retest K* functional images was performed using SPM99. Students paired t statistic was applied for comparisons of [¹¹C]MT brain trapping in a priori selected VOIs.Results [¹¹C]MT brain trapping in VOIs showed a mean variability 2.6±1.8% (0.3–5%) for absolute and 1.5±2.1% (1.4–4.1%) for normalized K*. Intraclass correlations between test and retest conditions were 0.61±0.34 for absolute K* values and 0.73±0.20 for K* values normalized by global mean. SPM99 analysis using a height threshold of p=0.05 (two tailed) and an extent threshold of 100 voxels showed no significant differences between scans.Conclusion Rest measurements in healthy male volunteers of the trapping constant for [¹¹C]MT, using PET, appeared to be stable during an average interval of 3 weeks.     

Immunoelektrophoretische Differenzierung der Proteine faulen Leichenblutes

Zusammenfassung Leichenblute verschiedener Fäulnisgrade wurden immunoelektrophoretisch untersucht. Für die Differenzierung der einzelnen Blutplasmafraktionen wurden Anti-Humanserum vom Kaninchen und die spezifischen Antiseren der Behringwerke gegen die nachstehend aufgeführten Proteine benutzt: Präalbumin, Albumin, ₁-Lipoprotein, ₂-Makroglobulin, ₂-Lipoprotein, ₁-Globulin (Transferrin),-Lipoprotein, Fibrinogen, ₂-A-Globulin, ₂-M-Globulin,- Globulin.Infolge der mangelnden Proportionalität zwischen Fortschritt der Fäulnis und Leichenalter gestattet die Immunoelektrophorese des Leichenblutes keine Todeszeitbestimmung.Albumin und- Globulin widerstehen der Fäulnis am längsten. Es folgen ₂-Makroglobulin, Transferrin und Fibrinogen. Die Proteine, die am reichlichsten im Menschenblut vorhanden sind, lassen sich im faulen Leichenblut auch am längsten nachweisen. Die Proteolyse folgt jedoch nicht nur quantitativen Gesetzen. Die Lipoproteine bilden insofern eine Ausnahme, als sie früher durch die Fäulnis eliminiert werden, als es ihrem Anteil am Gesamtprotein entspricht.Die Eiweißkörper des faulen Leichenblutes weisen im Vergleich zu ihren Homologen frischer Blutproben z. T. Veränderungen der Wanderungsgeschwindigkeit auf. Bei erhaltener Antigenstruktur treten Bruchstücke in Erscheinung, die mit dem Antiserum in ungleichmäßig geschwungenen oder aufgesplitterten Linien präcipitieren.Im Doppeldiffusionstest nachOuchterlony ließen sich im Vergleich zu den frischen Homologen keine Veränderungen der Antigenkomponenten der Proteine des faulen Leichenblutes nachweisen.Mit Unterstützung der Deutschen Forschungsgemeinschaft, der hiermit unser herzlicher Dank ausgesprochen wird.In Anlehnung an einen Vortrag auf der Tagung der Deutschen Gesellschaft für Gerichtliche und Soziale Medizin vom 30. 9. bis 3. 10. 62 in Münster (Westf.).Herrn Professor G.Weyrich zum 65. Geburtstag gewidmet.     

Effect of adrenergic receptor ligands on metaiodobenzylguanidine uptake and storage in neuroblastoma cells

The effects of adrenergic receptor ligands on uptake and storage of the radiopharmaceutical [¹²⁵I]metaiodobenzylguanidine (MIBG) were studied in the human neuroblastoma cell line SK-N-SH. For uptake studies, cells were incubated for 15 min with varying concentrations of -agonist (clonidine, methoxamine, and xylazine), -antagonist (phentolamine, tolazoline, phenoxybenzamine, yohimbine, and prazosin), -antagonist (proranolol, atenolol), -agonist (isoprenaline and salbutamol), mixed / antagonist (labetalol), or the neuronal blocking agent guanethidine, prior to the addition of [¹²⁵I]MIBG (0.1 M). The incubation was continued for 2 h and specific cell-associated radioactivity was measured. For the storage studies, cells were incubated with [¹²⁵I]MIBG for 2 h, followed by replacement with fresh medium with or without drug (MIBG, clonidine, or yohimbine). Cell-associated radioactivity was measured at various times over the next 20 h. Propanolol reduced [¹²⁵I]MIBG uptake by approximately 30% (P<0.01) at all concentrations tested, most likely due to nonspecific membrane changes. However, incubation with the other -agonists or antagonists failed to elicit significant reductions in uptake. In contrast, all of the -agonists significantly inhibited uptake (P<0.05); guanethidine >xylazine >clonidine=methoxamine. The -antagonists demonstrated a broad range of inhibition (phenoxybenzamine phentolamine prazosin yohimbine=tolazoline)(P<0.05). The mixed ligand, labetalol, inhibited MIBG uptake in a dose-dependent manner with an apparent IC₅₀ of 0.65 M. The retention studies demonstrated that unlabeled MIBG caused profound self-inhibition (P<0.01). Clonidine produced a modest inhibition of retention and yohimbine had no effect. Labetalol, phenoxybenzamine, guanethidine, and propranolol reduced uptake of [¹²⁵I]MIBG by neuroblastoma cells in culture. Although only labetalol has been reported to cause false-negative MIBG scans, our results suggest that these other drugs have the potential to interfere with MIBG imaging and therapy, particularly at high doses. Adrenergic drugs did not alter cytoplasmic retention of [¹²⁵I]MIBG in neuroblastoma cells but may have potential in tumors such as phenochromocytoma, where granular storage of MIBG has been observed. Inhibition of [¹²⁵I]MIBG retention by unlabeled MIBG supports the use of high specific activity radioiodinated MIBG for both diagnosis and therapy.     

Transcatheter Closure of Patent Foramen Ovale in Patients with Platypnea-Orthodeoxia: Results of a Multicentric French Registry

Background Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO).Methods This French multicentric study reports on 78 patients (mean age 67±11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n=36) and an ascending aortic aneurysm (n=11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n=45), Cardioseal (n=13), Sideris (n=11), Das Angel Wings (n=8) and Starflex (n=1). Closure was successful in 76 patients (97%).Results Oxygen saturation increased immediately after occlusion from 84.6±10.7% to 95.1±6.4% (p < 0.001) and dyspnea improved from grade 2.7±0.7 to grade 1±1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15±12 months, there were 7 late deaths related to the underlying disease.Conclusion Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.     

A nationwide system for computer recording of neuroradiologic examinations

Summary For 2 years the system of recording radiologic examinations connected with the computer called SYBAR has been in operation. The examination methods are coded using the Index of Roentgen Examinations of the Swedish National Medical Board (1970), while the diagnoses are coded according to [4]. The positive experience accumulated so far prompted the authors to project and put in operation the system NEUROSYBAR in order to organize a bank of data of neuroradiologic examinations. This system required the widening of two anatomic fields, skull and contents and spine and contents, according to the Index for Roentgen Diagnoses of the American College of Radiology [1]. The NEURO-SYBAR system was adopted by ten radiologic departments in the country. The complete neuroradiologic data from these departments were collected in one computer center in Lodz.