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Biomedical subjects

B Hesse

Publications and source records attributed to B Hesse.

At least 73 records · Page 4Linked to original sources

Local cooling prolongs oesophageal transit in humans.

The influence of local cooling on oesophageal transit was studied in eight healthy volunteers by oesophageal radionuclide transit. Compared with lukewarm (18 degrees C) water a significantly prolonged mean transit time (MTT) was found after ingestion of cold liquid (4 degrees C) and a slightly shorter MTT with 50 degrees C. The effect was of short duration lasting less than 2 min. The effect of atropine, morphine and naloxone, on the influence of local cooling was evaluated. Morphine (7 x 5 mg i.v.) abolished the effect of cooling on MTT. Naloxone (1 x 6 mg i.v.) reduced the effect of cooling, but the difference between 4 degrees C and 19 degrees C was significant still. Atropine (1 mg i.v.) had no effect on the increase in MTT at 4 degrees C. It is concluded that in humans local cooling increases oesophageal MTT. Local warming shortened MTT slightly. The abolishment of the influence of cooling by morphine suggests that opioids may be involved.

Adult↗

Pulmonary uptake in indium-111-antimyosin Fab fragment imaging following human cardiac transplantation.

UNLABELLED: Recent studies suggest that cardiac uptake of 111In-labeled antimyosin monoclonal antibody may be estimated semiquantitatively by calculating a heart-to-lung activity ratio, with pulmonary uptake serving as a reference region. METHODS: We obtained 96 111In-antimyosin scintigraphs to monitor rejection occurrence after heart transplantation in 26 patients. RESULTS: On five scintigraphs, the count rate density in ROIs over the lungs was markedly higher (mean 53% higher) than that in the immediately preceding and following scintigraphs, whereas the activity in the heart was essentially unchanged. Four of these scintigraphs coincided with ongoing pulmonary infection and the fifth with an occurrence of a high anti-CMV titer. CONCLUSION: The mechanism of apparent nonspecific antimyosin accumulation in the lungs is uncertain, although increased capillary permeability may be one possibility. Attention should be given to activity in the lungs if this activity is used as a reference in studies of 111In-antimyosin uptake in the heart.

Antibodies, Monoclonal↗

[Bone scintigraphy in assessment of risk of complications after medial femoral neck fractures].

The value of visually evaluated bone scintigraphy in predicting postoperative non-union and avascular necrosis was examined in a prospective, consecutive series of patients with intracapsular fracture of the femoral neck. 49 patients had scintigraphy carried out preoperatively, and 37 postoperatively. In 18 scintigraphy was done preoperatively as well as postoperatively. The patients were followed clinically and radiographically for at least two years after operation. In the preoperative group 19 patients had been excluded at follow up and 13 patients in the postoperative group. The results indicate a high correlation between a reduced uptake of isotope in preoperative scintigraphy and development of late complications in these patients. It is concluded that visually evaluated preoperative planar scintigraphy is of value in selecting those patients with intracapsular femoral neck fractures, who are at risk of developing late complications.

Aged↗

In vivo demonstration of focal fibrinolytic activity in abdominal aortic aneurysms.

Disseminated intravascular coagulation in association with arterial aneurysm has been reported in several cases. Reports have suggested a continuous deposition of fibrin and/or platelets at the site of the aneurysm followed by fibrinolysis as responsible for this disorder. To further investigate this theory we studied the in vivo binding of an indium-111-labelled monoclonal antibody against human tissue plasminogen activator (t-PA), a proteolytic enzyme involved in the fibrinolysis. Six patients admitted to the hospital for elective resection of an abdominal aortic aneurysm with a mural thrombus were examined. One day before the operation the antibody was injected intravenously. Scintigrams acquired just prior to operation and tissue samples obtained at the operation revealed an increased t-PA accumulation in the wall of the aneurysm. The study demonstrates in vivo, focally increased fibrinolytic activity in the aneurysm, explaining the coagulopathy observed in these patients.

Aged↗

[Differential diagnosis in acute chest pain and suspected myocardial infarction. A pilot study].

In half of the patients admitted with chest pain on suspicion of an acute myocardial infarction (AMI), this diagnosis is not confirmed (non-AMI). Both AMI and non-AMI patients have a mortality which exceeds the mortality of the background population in the years following discharge based on a high incidence of cardiac death. As a pilot investigation, a comprehensive investigation programme was tested in 32 consecutive non-AMI patients. The possible organic causes of acute chest pain were thus illustrated systematically in each individual patient. In ten of the patients, a definitive diagnosis was established within the first 24 hours of admission and no further investigation was thus performed. The remaining 22 patients participated in the planned investigation programme. In 30 of the patients (94%) a probable organic cause for the chest pain was found. This investigation demonstrates that the investigation programme is employable and it suggests that the cause of chest pain in non-AMI patients usually can be placed in one of the three main groups: 1) IHS, 2) oesophageal disease and 3) physiurgic conditions.

Adult↗

Prediction of late complications of femoral neck fractures by scintigraphy.

A prospective study was undertaken to determine the value of scintigraphy in predicting nonunion or necrosis of the femoral head following femoral neck fractures. Scintigraphy was carried out in 49 patients before operation and in 37 one week after operation; in 18 it was done before and after operation. The uptake of isotope was estimated visually as either normal or reduced compared to the opposite side. All the patients were followed up for at least 2 years. The results indicate that pre-operative bone scintigraphy is useful in elderly patients to predict nonunion and necrosis, and therefore is recommended to select those patients who will benefit from primary arthroplasty instead of fixation of the fracture.

Aged↗

Esophageal scintigraphy: reproducibility and normal ranges.

Esophageal scintigraphy has been rather widely used, but much debated as a simple screening method of esophageal dysfunction. However, reports of normal ranges, age dependence and reproducibility are very limited. We studied 60 healthy subjects with a mean age of 43 yr (26, 19, 15 subjects aged 20-39, 40-59, and 60-79 yr) to establish normal ranges and variations of esophageal mean transit time and residual activity measured by a radionuclide method using [99mTc] pertechnetate labeled water. Mean transit time was calculated by Zierler's formula. The median values and 95% percentiles of single measurements of MTT and residual activity in the supine position were 6.1 (3.2-11.5) sec and 11.5 (3.0-50)%, respectively. The coefficients of variation (CV) were 20%-35% for mean transit time and 85%-120% for residual activity in the sitting and supine positions. When double measurements were used, the CVs were reduced to 10% for MTT and 40% for residual activity in the supine position. The values did not change with age except for a higher frequency of spikes in subjects over 40 yr. The study has demonstrated that mean transit time for radiolabeled water in the esophagus of healthy subjects, measured by double determinations, has rather low, age-independent, interobserver and intersubject variabilities. In contrast, measurements of residual activity shows unacceptably high variations.

Adult↗

Monoclonal antibodies that block adhesion of B cell progenitors to bone marrow stroma in vitro prevent B cell differentiation in vivo.

B cell differentiation requires adhesion of B cell progenitors to bone marrow (BM) or fetal liver stroma. We show that B lymphoid cells can adhere to the BM stroma cell line CS 1.3, in vitro. Two monoclonal antibodies, SAB-1 and SAB-2, inhibited the adhesion of a B220+ progenitor B cell line but did not interfere with the binding of cytoplasmic mu chain-positive pre-B cells or mature B cells to the BM stromal cell line. Injection of both SAB-1 and SAB-2 antibodies into pregnant mice reduced by 90% the number of B220+n B lineage cells in the livers of their embryos. Livers from such embryos also were virtually devoid of cells able to give rise to B cell colonies in soft agar cultures (CFU-preB). Either antibody separately had no effect. Flow cytometry analysis show that SAB-1 is present on CS 1.3 stroma cells and on a pre-B cell line while SAB-2 is present on pro-B and pre-B cell lines, but not on CS 1.3 stromal cells. SAB-1 and SAB-2 react with different molecules and neither antibody seems to recognize CD44, and adhesion molecule that may also participate in B cell differentiation. Proteinase K and trypsin can digest both SAB-1 and SAB-2 antigens from viable cells suggesting that both are cell surface proteins. We propose that antibodies SAB-1 and SAB-2 probably recognize novel cell-cell adhesion molecules, and that these molecules are involved in the interactions between B cell progenitors and stroma cells.

Animals↗

Detection of deep venous thrombosis with indium 111-labelled monoclonal antibody against tissue plasminogen activator.

The administration of a radiolabelled monoclonal antibody against tissue plasminogen activator allows detection of areas with increased fibrinolytic activity, i.e. those with an active thrombotic lesion. Eight patients with phlebographically verified deep venous thrombosis were examined. At the time of immunoscintigraphy study they were examined receiving anticoagulant therapy. Some 75-85 MBq indium 111-labelled antibody were injected, and scintigrams were obtained after 30 min and after 24 h. The precise site of the thrombus could not be visualized after 30 min due to high background activity, whereas after 24 h it was detectable in all patients. The thrombus/background ratios achieved are twice as high as those observed in a human antifibrin antibody study. These preliminary data suggest a high sensitivity of our t-PA-specific antibody for the detection of active deep venous thrombosis in man, and our antibody seems to offer theoretical advantages over both platelet and fibrin-specific antibodies.

Antibodies, Monoclonal↗

EA-1, a novel adhesion molecule involved in the homing of progenitor T lymphocytes to the thymus.

The mouse progenitor T lymphocyte (pro-T) cell line FTF1 binds in vitro to thymus blood vessels, the thymic capsule, and liver from newborn mice. A mAb, EA-1, raised against an embryonic mouse endothelial cell line, blocked adhesion. The antibody also interfered with pro-T cell adhesion to a thymus-derived mouse endothelial cell line; it had no effect on the adhesion of mature T lymphocytes and myeloid cells. The antigen recognized by EA-1 is located on the vascular endothelium of various mouse tissues and absent on pro-T cells. EA-1 antibody precipitates molecules with apparent molecular weights of 110,000, 140,000, 160,000, and 200,000. Immunoclearing and binding-inhibition studies with antibodies against known adhesion molecules suggest that the EA-1 antigen is a novel adhesion molecule involved in colonization of the embryonic thymus by T cell progenitors.

Animals↗

Fallacy in direct cystourethrography.

Voiding cystourethrography is widely used in children to detect vesicoureteral reflux disease. A case of radionuclide voiding cystourethrography is reported, where the initial location of the catheter tip in an open ureter ostium might have lead to erroneous interpretation. Recommendations for catheter technique and control of imaging in voiding cystourethrography are given.

Child↗

Oesophageal transit in patients with autonomic dysfunction. The effect of treatment with fludrocortisone.

Oesophageal function was examined by radionuclide transit measurements in 15 patients with severe autonomic deficiency and orthostatic hypothension and 23 healthy volunteers. Seven of the patients were re-examined after treatment for 3 weeks with fludrocortisone acetate (Florinef). Six patients and five control subjects were evaluated before and after i.v. administration of atropine. The mean transit time (MTT) was prolonged (P less than 0.007) and the residual activity increased (P = 0.038) in the patients compared with the control group. Prolonged MTT was associated with oesophageal symptoms. Treatment of orthostatic hypotension with fludrocortisone acetate significantly reduced MTT. Atropine increased MTT and residual activity. The increase in heart rate after atropine was correlated in the patients with MTT before treatment. The results demonstrate the frequent presence of impaired oesophageal function in patients with severe autonomic dysfunction, irrespective of aetiology. The impairment seems to be closely related to parasympathetic insufficiency. The improvement after fludrocortisone may suggest an influence of ion balance on oesophageal function in these patients.

Adult↗

Prognosis and diagnostic work-up in patients admitted for, but without, myocardial infarction--the value of nuclear medicine examinations.

Patients admitted for acute myocardial infarction that is not confirmed (non-AMI) have a prognosis only slightly better than that of patients with confirmed infarction. In a prospective, prognostic study of 158 patients with non-AMI the combination of exercise ECG and transient defects demonstrated at 201thallium scintigraphy identified low- and high-risk groups better than either examination alone. The purpose of a new, still ongoing study of non-AMI patients is to establish a relevant, cost-effective examination programme in order to arrive at a positive diagnosis in each non-AMI patient. Preliminary results of lung perfusion/ventilation scintigraphy suggest a rather low frequency of pulmonary embolism. Preliminary data of oesophageal scintigraphy suggest that about 25% of the non-AMI patients have abnormal mean transit times. The clinical significance of these data are discussed.

Coronary Disease↗

Influence of the renin-angiotensin system on human forearm blood flow.

Although angiotensin II is a potent vasoconstrictor agent in all tissues, including the human forearm, equivocal effects on forearm blood flow (FBF) have been found after angiotensin blockade. In 13 healthy Na(+)-depleted subjects FBF was measured by the 133Xe washout technique; subcutaneous and muscle blood flows were determined separately. FBF was measured during supine rest, after the arm was lowered, and during lower body negative pressure (LBNP). The measurements were repeated during intra-arterial saralasin infusion in six subjects and after intravenous administration of enalapril in seven subjects. FBF decreased and forearm vascular resistance (FVR) increased during arm lowering and LBNP, as the result of local and central adrenergic reflexes, respectively. We observed similar FBF and FVR values after both saralasin and enalapril, except for a decrease in FVR at rest after enalapril. It is concluded that, in the human forearm, angiotensin II is not necessary for sympathetic vasoconstrictor reflexes but may, through a central effect, have some influence on arteriolar tone at rest.

Adult↗

Effects of angiotensin blockade on the splanchnic circulation in normotensive humans.

The effects of angiotensin-converting enzyme inhibition (ACE-I) by enalapril on splanchnic (n = 10) and central hemodynamics (n = 9) were examined in moderately salt-depleted healthy volunteers, at rest and during 15-20 min of lower body negative pressure (LBNP), reducing mean arterial pressure by 10 mmHg. During LBNP before ACE-I, both splanchnic and total peripheral vascular resistances increased. During ACE-I, splanchnic and total peripheral vascular resistances decreased. After enalapril administration, splanchnic vascular resistance did not increase during LBNP. Total peripheral vascular resistance still increased but not to the same extent as during LBNP before ACE-I. The increases in heart rate and plasma norepinephrine during LBNP were attenuated after ACE-I compared with LBNP before ACE-I. The effectiveness of the ACE-I was clearly demonstrated by unchanged and low plasma angiotensin II levels during ACE-I. We conclude that, in normal sodium-depleted humans, acute ACE-I decreases splanchnic vascular resistance at rest and abolishes splanchnic vasoconstriction during LBNP. Furthermore, it may interfere with autonomic nervous system control of the circulation.

Adult↗

Abnormal oesophageal function in patients with non-toxic goiter or enlarged left atrium, demonstrated by radionuclide transit measurements.

In 10 patients with enlarged atrium and in 29 patients with goiters and neck discomfort dynamic oesophageal scintigraphy was performed. The passage of water and capsules, containing 99mTc-pertechnetate, was studied with the patients in the supine and in the sitting positions. As a reference group we examined 35 healthy, age-matched volunteers. Mean transit time (MTT) was calculated, residual activity was expressed as a percentage of maximum activity, and the number of spikes in the curves was defined by visual analysis. Both in patients with enlarged left atrium and in those with large goiters the studies showed significantly prolonged MTT, increased residual activity, and a higher frequency of spikes, compared with healthy volunteers and with patients with small goiters. There was no relationship between symptoms and abnormal scintigraphic results. The passage of capsules was impaired only in cardiac patients. It is concluded that abnormal oesophageal function is often present in patients with enlarged left atrium and in patients with large, but not with small, goiters. Inhibition of oesophageal transit appears to be dependent on mechanical compression, but the nature of oesophageal impairment may vary with the level of compression. The frequent complaints of neck sensations in patients with goiters are probably not of oesophageal origin.

Adult↗