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Biomedical subjects

B Nowak

Publications and source records attributed to B Nowak.

At least 19 recordsLinked to original sources

A defect in bone marrow derived dendritic cell maturation in the nonobesediabetic mouse.

The pathogenesis of diabetes in the nonobese diabetic (NOD) mouse is characterized by a selective destruction of the insulin-producing beta-cells in the islets of Langerhans mediated by autoreactive T cells. The function of T cells is controlled by dendritic cells (DC), which are not only the most potent activators of naïve T cells, but also contribute significantly to the establishment of central and peripheral tolerance. In this study, we demonstrate that the NOD mouse (H2: K(d), Ag(7), E*, D(b)) shows selective phenotypic and functional abnormalities in DC derived from bone marrow progeny cells in response to GM-CSF (DC(NOD)). NOD DC, in contrast to CBA DC, have very low levels of intracellular I-A molecules and cell surface expression of MHC class II, CD80, CD86 and CD40 but normal beta 2-microglobulin expression. Incubation with the strong inflammatory stimulus of LPS and IFN-gamma does not increase class II MHC, CD80 or CD86, but upregulates the level of CD40. The genetic defect observed in the DC(NOD) does not map to the MHC, because the DC from the MHC congenic NOD.H2(h4) mouse (H2: K(k), A(k), E(k), D(k)) shares the cell surface phenotype of the DC(NOD). DC from these NOD.H2(h4) also fail to present HEL or the appropriate HEL-peptide to an antigen-specific T cell hybridoma. However all the DC irrespective of origin were able to produce TNF-alpha, IL-6, low levels of IL-12(p70) and NO in response to LPS plus IFN-gamma. A gene or genes specific to the NOD strain, but outside the MHC region, therefore must regulate the differentiation of DC in response to GM-CSF. This defect may contribute to the complex genetic aetiology of the multifactorial autoimmune phenotype of the NOD strain.

Animals↗

High-performance liquid chromatography method for the determination and quantitation of arabinosylguanine triphosphate and fludarabine triphosphate in human cells.

A gradient anion-exchange high-performance liquid chromatographic assay was developed for the simultaneous determination and quantitation of the cytotoxic triphosphates of arabinosylguanine (ara-GTP) and fludarabine (F-ara-ATP). The method was validated with respect to selectivity, recovery, linearity, precision, and accuracy using authentic standards. To test this assay in a more complex biological matrix, perchloric acid extracts of circulating human leukemia cells spiked with known concentrations of ara-GTP and F-ara-ATP were examined. Finally, to assess the clinical utility of our method, perchloric acid extracts of circulating human leukemia cells isolated from patients treated with fludarabine and nelarabine were analyzed. The range of quantitation was 0.0125-10 nmol for the ara- and native NTPs in cellular extracts. This assay should be helpful in establishing the mechanistic rationales for drug scheduling and combinations of nelarabine and fludarabine, and for correlating the therapeutic efficacy and levels of the cytotoxic triphosphates in target cells.

Arabinonucleotides↗

Auxiliary rat liver transplantation with portal vein arterialization in acute hepatic failure.

BACKGROUND: The aim of our work was to study the effect of the portal vein arterialization of an auxiliary liver graft on survival, liver function, and regeneration of the native liver suffering from surgically induced acute liver failure (ALF). METHODS: In Lewis rats (control group: n=10), ALF was induced by resection of about 85% of liver tissue. The auxiliary liver graft (reduced size of 30%) was transplanted into the right upper quadrant of the abdomen (trial group: n=12). The portal vein was arterialized via the renal artery. The infrahepatic vena cava was anastomosed end-to-side, and the bile duct was implanted into the duodenum. RESULTS: Survival rate over a 3-month period was 10/12 in the trial group vs. 2/10 in the controls. In the trial group, the prothrombin time rose up to 38+/-2 sec on day 1 after surgery (control group: 66+/-6 sec); on day 5 after surgery, it returned to values of 30+/-1 sec. On day 1 after surgery, serum albumin fell to 25+/-1 g/L (preoperative value: 32+/-1 g/L). Within 3 weeks, it returned to normal. The hepatobiliary scan on day 7 after surgery showed normal uptake in the liver graft, whereas the uptake of the native liver was distinctly reduced. After 3 months, the transplanted liver had atrophied (0.6% of body weight), the native liver hypertrophied (2.5% of body weight), with a normal total weight for both livers of 3.1% of body weight. CONCLUSIONS: Thus, auxiliary liver transplantation with arterialized portal vein allows maintenance of liver function at the time of ALF and regeneration of the native liver.

Animals↗

Diagnosis and staging of head and neck cancer: a comparison of modern imaging modalities (positron emission tomography, computed tomography, color-coded duplex sonography) with panendoscopic and histopathologic findings.

OBJECTIVE: To compare the clinical value of positron emission tomography (PET) using fludeoxyglucose F 18, computed tomography (CT), color-coded duplex sonography (CCDS), and panendoscopy in the detection and staging of head and neck cancer. DESIGN: Prospective nonrandomized controlled study. SETTING: Medical school. PATIENTS: Convenience sample of 50 patients with suspected primary or recurrent head and neck cancer. INTERVENTION: Biopsy, tumor surgery. MAIN OUTCOME MEASURES: Information of diagnostic procedures compared with histopathologic features. RESULTS: Both PET and panendoscopy had a sensitivity of 95% and 100% for detection of primary tumor or recurrent carcinomas, respectively. Specificity for PET and panendoscopy was 92% and 85% in primary tumors and 100% and 80% in recurrent carcinoma, respectively. Sensitivity of CCDS and CT was 74% and 68% in primary tumors and 67% and 63% in recurrent carcinomas, respectively. Specificity was 75% and 69% in primary tumors and 100% and 80% in recurrent neoplasms. When assessing neck nodes, all imaging procedures exhibited identical sensitivity (84%). Specificity was 90%, 96%, and 88% in PET, CT, and CCDS, respectively. In recurrent lymph node metastases, sensitivity was 100%, 67%, and 67% and specificity was 87%, 91%, and 87% for PET, CT, and CCDS, respectively. CONCLUSIONS: Positron emission tomography was the most reliable imaging procedure in the detection of primary tumor and recurrent carcinomas localized in the head and neck region. Owing to its limited anatomical depiction, it cannot as yet replace other diagnostic procedures in preoperative planning but does contribute valuable complementary diagnostic information. Computed tomograpy may have difficulties in identifying recurrent carcinomas. For routine diagnosis of nodal spread in the neck, CCDS is recommended. Panendoscopy is a valuable diagnostic procedure that can provide key information in cases of superficial mucosal tumor involvement. Arch Otolaryngol Head Neck Surg. 2000;126:1457-1461

Biopsy↗

Relationship of lead and cadmium to essential elements in hair, teeth, and nails of environmentally exposed people.

The aim of this investigation was to evaluate the environmental exposure to Pb and Cd during 1990-1997 of inhabitants of Katowice District, which is an area of high environmental exposure to lead and cadmium, as well as exposure to Fe, Zn, Cu, Mn, Ni, Cr, Ca, Na, and K, on the basis of concentrations in hair, teeth, and nails. This investigation was to explain if accumulation of Pb and Cd can affect the concentration of such essential metals as Fe, Zn, Cu, and Ca. Inhabitants of the Beskid area constituted a control group. Analysis of the aforementioned elements was carried out on 624 hair samples, 785-tooth- samples, and 338 nail samples taking into consideration sex, age (<15, 16-30, >30 years), and type of teeth (incisor, canine, molar, premolar). Concentrations of elements in the media investigated were determined using atomic absorption spectroscopy. The results were calculated using the Statistica program. The major statistical analysis focuses on determining analysis of variance by MANOVA/ANOVA, Rao R (P<0.05), Spjotvolla-Stoline'a test, and cluster analysis (1-Pearson r). The investigation revealed that among the media investigated, Pb concentration in hair is an environmental marker of exposure to this metal in the human organism and depends on sex and age. It was also observed that an increase in Pb concentration in hair causes a decrease in Fe and Ca concentrations and changes the ratios of essential metals: Fe/Cu, Fe/Zn, and Ca/Zn. It is concluded that not only in blood but also in the hair, lead significantly influences Ca and Fe. Analysis of nail samples of people living in Katowice District indicated that an increasing concentration of Pb decreases concentrations of copper and zinc. Increased accumulation of such metals as Ni, Cr, and Mn in teeth was observed for samples taken from inhabitants of Katowice District.

Adolescent↗

27Al NMR study in UNiAl.

The ternary compound UNiAl exhibiting an antiferromagnetic order below T(N) = 19.3 K has been studied in the paramagnetic state using the 27Al NMR technique and different magnetically oriented samples. The quadrupole coupling constant e2qQ/h = 1.56 MHz is temperature independent. The dominant, longitudinal component of the Knight shift with respect to the hexagonal c axis, Kparallel, is positive and increases upon lowering the temperature down to 50 K. Much smaller in magnitude, the transverse component, Kperpendicular, is also positive and only slightly temperature dependent. The plots of the Knight shift vs magnetic susceptibility Kparallel(chi parallel) and Kperpendicular (chi perpendicular) form the same line, which implies that the transferred hyperfine field of 9.2 kOe/microB for 27Al nuclei should be considered isotropic.

Aluminum↗

27Al NMR study in ZrNiAl.

We have studied the microscopic properties of the hexagonal ZrNiAl, a model compound for a wide family of intermetallic compounds crystallizing in this type of structure, by using 27Al NMR spectroscopy. We have investigated the lineshape of static and MAS NMR spectra as a function of magnetic field strength (4.7-9.4 T) and temperature (5-300 K). Our data indicate that the 27Al NMR spectra result from a combined effect of quadrupole and anisotropic shift interactions. The 27Al nuclei are in an environment characterized by the quadrupole coupling constant e2qQ/h of 3.3 MHz, asymmetry parameter etaQ of 0.42, isotropic shift delta(iso) of 393 ppm, shift anisotropy delta(anis) = delta(zz) - (delta(xx) + delta(yy))/2 of 150 ppm, and asymmetry factor etaS of 0.5. They are found to be temperature independent. The spin-lattice relaxation rate measured at 7.05 T is proportional to the temperature with T1T = 135 s K. The mechanisms responsible for observed values of delta(iso), delta(anis), T1T, and the enhanced Korringa constant are discussed.

Aluminum↗

Antimicrobial and cytotoxic activity of hypochlorous acid: interactions with taurine and nitrite.

OBJECTIVE: HOCl, a major bactericidal product of neutrophil MPO-halide system reacts with taurine to form taurine chloramine (TauCl), a less toxic anti-inflammatory mediator. Recently, it has been reported that HOCl may also react with nitrite (NO2-), a major end-product of nitric oxide (NO) metabolism, to form very active oxidant, nitryl chloride (NO2Cl). The present study was conducted to elucidate the effect of nitrite on bactericidal and some immunoregulatory properties of HOCl and TauCl. MATERIALS: TauCl was prepared from NaOCl and taurine. The reaction was carried out at pH 5.0 and pH 7.4, in the presence or absence of nitrite. All reactions were monitored by UV absorption spectra. METHODS: Bactericidal activity of HOCl and TauCl in the presence of nitrite was tested by incubation of E. coli with the compounds and determined by the pour-plate method. To test the effect of the compounds on activity of inflammatory cells, murine peritoneal neutrophils (PMN) and macrophages were used. The cells were activated in vitro with either LPS, IFN-gamma or zymosan and the production of following mediators was measured: reactive oxygen species using luminol-dependent chemiluminescence; nitric oxide by Griess reaction; TNF-alpha using capture ELISA. In addition, we tested the effect of HOCl and TauCl on activity of myeloperoxidase (MPO). RESULTS: At physiological pH nitrite reacts with HOCl but not with TauCl. This reaction was abolished in the presence of taurine. Nitrite prevented HOCl-mediated bacterial killing, inhibition of MPO activity, cellular cytotoxicity and inhibition of TNF-alpha production. Nitrite did not affect any activity of TauCl. CONCLUSION: We have shown that nitrite may react in vitro with HOCl but not with TauCl, to form new biologically active product(s). We did not confirm the hypothesis that a product of HOCl reaction with nitrite is more toxic than HOCl. To the contrary, we found that nitrite diminished bactericidal and immunoregulatory properties of HOCl. In vivo, nitrite will also compete with taurine for reaction with PMN-released HOCl. Nevertheless, due to high concentration of taurine in PMN cytosol, formation of TauCl will be a major regulatory mechanism of MPO-halide-system.

Animals↗

Diagnosis of myocardial viability by dual-head coincidence gamma camera fluorine-18 fluorodeoxyglucose positron emission tomography with and without non-uniform attenuation correction.

This study assessed a dual-head coincidence gamma camera (hybrid PET) equipped with single-photon transmission for myocardial fluorine-18 fluorodeoxyglucose (FDG) imaging by comparing this technique with conventional positron emission tomography (PET) using a dedicated ring PET scanner. Twenty-one patients were studied with dedicated FDG ring PET and FDG hybrid PET for evaluation of myocardial glucose metabolism, as well as technetium-99m tetrofosmin single-photon emission tomography (SPET) to estimate myocardial perfusion. All patients underwent transmitted attenuation correction using germanium-68 rod sources for ring PET and caesium-137 point sources for hybrid PET. Ring PET and hybrid PET emission scans were started 61+/-12 and 98+/-15 min, respectively, after administration of 154+/-31 MBq FDG. Attenuation-corrected images were reconstructed iteratively for ring PET and hybrid PET (ac-hybrid PET), and non-attenuation-corrected images for hybrid PET (non-ac-hybrid PET) only. Tracer distribution was analysed semiquantitatively using a volumetric vector sampling method dividing the left ventricular wall into 13 segments. FDG distribution in non-ac-hybrid PET and ring PET correlated with r=0.36 (P<0.0001), and in ac-hybrid PET and ring PET with r=0.79 (P<0.0001). Non-ac-hybrid PET significantly overestimated FDG uptake in the apical and supra-apical segments, and underestimated FDG uptake in the remaining segments, with the exception of one lateral segment. Ac-hybrid PET significantly overestimated FDG uptake in the apical segment, and underestimated FDG uptake in only three posteroseptal segments. A three-grade score was used to classify diagnosis of viability by FDG PET in 136 segments with reduced perfusion as assessed by SPET. Compared with ring PET, non-ac-hybrid PET showed concordant diagnoses in 80 segments (59%) and ac-hybrid PET in 101 segments (74%) (P<0.001). Agreement between ring PET and non-ac-hybrid PET was best in the basal lateral wall and in the apical-septal segment (80%-100%), and lowest in the apical, supra-apical and posteroseptal segments (41%-55%). Ac-hybrid PET showed highest agreement in the lateral wall (89%-100%), and lowest agreement in the apical and the basal septal segments (59%-67%). In conclusion, non-uniform attenuation correction with singles transmission significantly improves the diagnostic accuracy of myocardial dual-head gamma camera coincidence imaging with FDG. However, results equivalent to those obtained with ring PET cannot yet be attained, even if attenuation correction is applied. New rebinning algorithms for three-dimensional data may further improve the performance of ac-hybrid PET and should be evaluated in future studies.

Adult↗

Benign versus malignant osseous lesions in the lumbar vertebrae: differentiation by means of bone SPET.

Bone scanning is a well-accepted and frequently performed diagnostic procedure with a high sensitivity, especially when single-photon emission tomography (SPET) acquisitions are added. However, the differentiation of benign from malignant osseous lesions often poses difficulty. The purpose of this study was to find out whether the particular localisation of an intraosseous lesion in a lumbar vertebra is an indicator of its aetiology. Bone scintigraphy including planar whole-body scans as well as SPET imaging of the lumbar spine was performed in 109 patients. The diagnoses of osseous lesions in the lumbar vertebrae were made strictly on the basis of the findings of magnetic resonance imaging, computed tomography or plain radiography. Sixteen patients had to be excluded from the study because they did not undergo adequate radiological examination. To determine the particular localisation of vertebral lesions in the bone scan, two experienced nuclear medicine physicians examined the studies independently while blinded to the radiological results. Four anatomical regions were differentiated within the vertebra: the vertebral body, the pedicle, the facet joints and the spinous process. Clopper-Pearson analysis, which takes into account the number of examinations, yielded the following probability intervals for the malignancy of intraosseous lesions in the lumbar spine: vertebral body 36.8%-57.3%, pedicle 87.7%-100%, facet joints 0.8%-21.4% and spinous process 18.7%-81.3%. It was concluded that lesions affecting the pedicle are a strong indicator for malignancy, whereas involvement of the facet joints is usually related to benign disease. Lesions affecting the vertebral body or the spinous process do not show a clear tendency towards either malignancy or benignity. In contrast to other studies, a significant probability of malignancy (35.6%) was observed in lesions affecting exclusively the vertebral body.

Adult↗

[Where should the implantable ECG event recorder be placed?].

Aim of our study was the comparison of bipolar ECG quality (with a 4 cm lead distance) at different sites within the anterior thorax to find the preferable implantation site for an ECG event recorder (ECG-ER). In 70 patients a bipolar ECG with a short electrode distance and in the vertical position was registered at the following sites: left and right subclavicular, left and right parasternal (4th-5th ICR), left and right anterior axilla (4th-5th ICR), at the heart apex and subxiphoidal. Then it was compared to the standard lead II. In 34 patients, an additional comparison between vertical and horizontal ECG registration was performed at the above mentioned sites. During implantation of an ECG-ER in 5 patients, ECG signals were compared with electrodes placed towards the skin or towards the muscle. The best ECG quality (greatest QRS amplitude, visible P-wave and pacemaker spike, measurable QT period and bundle-branch block) and the best agreement with standard lead II was found in 67% left parasternal, significant less often (p < 0.001) right parasternal (14.3%), left subclavicular (7.1%), apical (5.7%), and subxiphoidal (4.3%). In a vertical electrode position a significantly higher QRS amplitude and a more often visible P wave was found in comparison to a horizontal electrode position. In all cases, there was good agreement between bipolar surface ECG at the implantation site and ECG-ER stored signals. When the ECG-ER is positioned with electrodes towards the muscle, significant noise-signal occurred in all 5 patients. Only in 3 patients was a P wave visible, but with a slightly greater QRS amplitude than in ECG-ERs positioned with electrodes towards the skin. From these results, it is recommended to implant ECG-ERs vertically with electrodes towards the skin and in the parasternal position.

Adult↗

[Hidden intracardiac conduction disturbances and their spontaneous course in patients with progressive muscular dystrophy].

In patients with progressive muscular dystrophy (PMD) invasive electrophysiologic studies can detect hidden intracardiac conduction disturbances. The aim of this study was a long-term follow-up of these patients. Twelve consecutive patients (9 m, 3 f, age 28 +/- 4 yrs) without cardiac symptoms and with normal echocardiographic findings were included in the study. They suffered from different stages of PMD type Erb (n = 4), Becker-Kiener (n = 4), Duchenne (n = 2) and Landouzy-Déjerine (n = 2). At the beginning of the study all patients underwent an invasive electrophysiologic study (EPS). The follow-up of 5.5 yrs included regular clinical visits, ECGs, and Holter recordings (every 3 months) as well as an echocardiography every 6 months. In 4 patients the EPS revealed a hidden interatrial conduction disturbance (AHRS-ACS 120 +/- 18 ms), and in 10 pts an infrahisian conduction disturbance was found (HV max. 156 +/- 4 ms). Conduction defects were seen independently from the type of PMD and the stage of the disease. During the follow-up the initially hidden interatrial conduction disturbance became evident in the surface ECG in 2 of 4 pts. One of them developed paroxysmal atrial fibrillation. Five of 10 pts with an initially hidden infrahisian conduction disturbance developed an AV block grade I-III and in one case additionally a bundle branch block. Four of these pts--whose PMD showed progression or who developed congestive cardiomyopathy--needed pacemaker implantation because of a first-degree AV block + bifascicular bundle branch block (n = 1), a Mobitz II second-degree AV block (n = 1) or a third-degree AV block (n = 2). None of the pts with normal findings at the EPS showed abnormal p-waves, an AV block, or an intraventricular conduction disturbance during the follow-up. We conclude that intracardiac conduction disturbances, especially infrahisian defects including high-degree AV blocks, are a common finding in pts with PMD. Therefore a regular cardiological screening including an ECG and a Holter recording is reasonable in these patients.

Adolescent↗

Heat-aggregated immunoglobulins increase in vivo immunogenicity of mouse hapten (TNP)-derivatized macrophages by upregulation of interleukin-12 secretion and expression of B7-1 and B7-2 costimulatory molecules.

Antigen-antibody complexes (IC) can up or down regulate immune responses by induction of immunoregulatory cells. We have studied the effect of mouse heat-aggregated immunoglobulin (Ig) (HA) which have many biological activities similar to IC on immunogenicity of TNP-substituted macrophages (TNP-Mphi). Our results show that: (1) mouse oil-induced peritoneal macrophages treated with HA produce in vitro significantly higher levels of interleukin (IL-1beta), tumor necrosis factor (TNF)-alpha, IL-6, IL-10 and particularly IL-12 and express more B7-1 and B7-2 and ICAM-1 cell surface costimulatory molecules than Mphi treated with monomeric Ig (MM); (2) Mphi derivatized with TNP, treated or not with MM, induce in vivo antigen-specific unresponsiveness. In contrast TNP-Mphi treated with HA induce significant contact sensitivity reaction even when injected into previously tolerized recipient animals. Treatment of recipients with anti-IL-12 Ab prevents immunization by TNP-Mphi-HA. These results indicate that bypass of tolerance by treatment of TNP-Mphi with HA is a result of an increased production of IL-12 by these cells and an enhanced expression of costimulatory molecules important in T cell-Mphi interactions. We suggest that a similar overcoming of tolerance through the action of IC may be responsible for the generation of autoantibodies of heterologous specificity in pathological conditions in which such complexes are formed.

Animals↗

How can we identify the best implantation site for an ECG event recorder?

The aim of this study was to show how to find the preferable implantation site for an ECG event recorder (ECG-ER). We compared the quality of bipolar ECG recordings (4-cm electrode distance, vertical position) in 65 patients at the following sites: left and right subclavicular, left and right anterior axillary line (4th-5th interspace), left and right of the sternum (4th-5th interspace), heart apex, and subxyphoidal. The results were compared to the standard ECG lead II. In 30 patients, an additional comparison between vertical and horizontal ECG registrations was done using the same sites. ECG signals in five patients were compared positioning the electrodes towards the skin with turning them towards the muscle during ECG-ER implantation. The best ECG quality (defined as highest QRS amplitude, best visible P wave and/or pacemaker spike, best measurable QRS duration, and QT interval) and best agreement with the standard lead II was found in 68% on the left of the sternum, significantly less often (P < 0.001) on the right of the sternum (14.1%), left subclavicular (6.9%), apical (5.5%) and subxyphoidal (4.2%). A significantly higher QRS amplitude was measured and the P wave was more often visible in the vertical electrode position than in the horizontal position. In all five ECG-ER patients, there was a good agreement between the bipolar surface ECG at the implantation site and ECG-ER stored signals. A significant noise signal occurred in all five patients when the ECG-ER was implanted with electrodes towards the muscle. A P wave was visible in only three of those patients, but there was an insignificantly higher QRS amplitude than in ECG-ERs implanted with electrodes towards the skin. From these results, it can be concluded that the best implantation site for an ECG-ER is right or left of the sternum, positioning the electrodes vertically and towards the skin.

Electrocardiography↗

[Results of pretherapeutic lymph node diagnosis in head and neck tumors. Clinical value of 18-FDG positron emission tomography (PET)].

BACKGROUND: Histological studies demonstrate that there is a high percentage of occult nodal metastasis in head and neck malignomas. Patients with positive lymph nodes have a comparatively worse prognosis. A neck dissection is required in these cases. By demonstrating morphological abnormalities, imaging procedures like ultrasound, computer tomography (CT), and magnetic resonance imaging (MRI) can provide important initial informations about possible malignant alteration of the lymph nodes. Positron emission tomography (PET) allows functional metabolic imaging of a suspected tumor site. The aim of this study was a comparative evaluation of different diagnostic procedures with special emphasis on the value of PET in the pretherapeutic diagnosis of nodal spread in head and neck cancer. PATIENTS AND METHODS: Forty patients (28 male and 12 female) with a suspected malignoma in the head and neck region underwent clinical examination including palpation of the neck sides, ultrasound, CT, and PET to detect a nodal spread of the malignancy. Fifty neck dissections were performed in 28 patients. Lymph node biopsies were performed in the remaining patients. The results of the diagnostic procedures were compared to the histology and the clinical course of the patients. The mean follow-up period was 12.5 months. RESULTS: A nodal metastasis was verified in 35% of all cases. Sensitivity of all imaging procedures including PET was 82%. Palpation had a sensitivity of only 61%. Specificity was 85% for ultrasound, 94% for CT and palpation, and 87% for PET. PET produced false negative results in 13.4% of all cases. Inflammation was detected in these cases. The positive predictive value was marginally better for PET than for ultrasound (77% vs. 75%). It proved to be lower than the values for palpation (86%) and CT (88%). Negative predictive value was 90-91% for all imaging procedures. CONCLUSION: In the primary diagnosis of nodal alterations in the head and neck region, a PET scan has the same diagnostic value as ultrasound or CT. By imaging the metabolism of a suspected nodal metastasis, PET can help to improve the assessment of regions with uncertain anatomic features. To avoid false positive results, acute and chronic inflammatory alterations have to be ruled out before the PET imaging.

Aged↗

Changes in pulmonary blood flow during gaseous and partial liquid ventilation in experimental acute lung injury.

BACKGROUND: It has been proposed that partial liquid ventilation (PLV) causes a compression of the pulmonary vasculature by the dense perfluorocarbons and a subsequent redistribution of pulmonary blood flow from dorsal to better-ventilated middle and ventral lung regions, thereby improving arterial oxygenation in situations of acute lung injury. METHODS: After induction of acute lung injury by repeated lung lavage with saline, 20 pigs were randomly assigned to partial liquid ventilation with two sequential doses of 15 ml/kg perfluorocarbon (PLV group, n = 10) or to continued gaseous ventilation (GV group, n = 10). Single-photon emission computed tomography was used to study regional pulmonary blood flow. Gas exchange, hemodynamics, and pulmonary blood flow were determined in both groups before and after the induction of acute lung injury and at corresponding time points 1 and 2 h after each instillation of perfluorocarbon in the PLV group. RESULTS: During partial liquid ventilation, there were no changes in pulmonary blood flow distribution when compared with values obtained after induction of acute lung injury in the PLV group or to the animals submitted to gaseous ventilation. Arterial oxygenation improved significantly in the PLV group after instillation of the second dose of perfluorocarbon. CONCLUSIONS: In the surfactant washout animal model of acute lung injury, redistribution of pulmonary blood flow does not seem to be a major factor for the observed increase of arterial oxygen tension during partial liquid ventilation.

Animals↗

Diagnostic value of stored electrograms in single-lead VDD systems.

UNLABELLED: Evaluation of the quality of atrial sensing is indispensable to monitor the performance of VDD single-lead systems. In addition to counters, a new VDD system offers storage of intracardiac electrograms (EGMs). The clinical contribution of stored EGMs in a VDD pacemaker was prospectively examined in a multicenter study, and the reliability of its counters was evaluated on the basis of EGM information. METHODS: A VDD system (Pulsar 870, Guidant Co.) was implanted in 46 patients with atrioventricular block. EGM storage was activated upon detection of ventricular tachycardia (VT), recurrent premature ventricular complexes (PVCs), and mode switch ("atrial tachy reaction," ATR). Stored EGMs were retrieved before discharge of the patients from the hospital, and at 6-week, 3-month, and 6-month follow-up. RESULTS: A total of 440 stored EGMs were retrieved and analyzed. Of 30 VT episodes detected, 2 (7%) were confirmed, and all others were attributable to ventricular oversensing. One postmortem interrogation documented VT as the cause of sudden death. Of 175 EGMs stored upon detection of PVCs, 43 episodes (25%) were confirmed and 124 (70%) showed intermittent atrial undersensing with spontaneous AV conduction; in 8 episodes (5%) no abnormality was observed. Of 235 episodes stored upon ATR, 82 (35%) were confirmed and 153 were due to atrial oversensing. CONCLUSIONS: (1). Stored EGMs indicated a high percentage (69%) of event misdiagnosis by the pacemaker. Thus, pacemaker counter information without the availability of stored EGMs should be interpreted with caution. (2). Misclassified events are of high clinical importance since they unmask otherwise unsuspected intermittent under- or oversensing.

Aged↗