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Biomedical subjects

D Emrich

Publications and source records attributed to D Emrich.

At least 55 records · Page 3Linked to original sources
PubMed1990

Intravenous streptokinase in acute myocardial infarction (I.S.A.M.): assessment of left ventricular function 1 and 7 months after infarction by radionuclide ventriculography.

I.S.A.M. was a prospective, placebo-controlled, double-blind multicentre trial of high-dose short-term intravenous streptokinase in acute myocardial infarction (AMI) within 6 h of the onset of symptoms. Determination of left ventricular ejection fraction (LVEF) by radionuclide ventriculography was performed 1 and 7 months after AMI in a subset of 192 patients at rest and, in 140 of them, also during exercise. Regional myocardial function was analysed in all 145 patients with neither a history of a previous myocardial infarction nor revascularization procedures or reinfarction within the 7-month follow-up period. One month after AMI, mean LVEF was higher in the streptokinase group in patients with anterior AMI (50 +/- 15% vs 42 +/- 16%, P = 0.013). This difference was more marked in the subgroup treated within 3 h (53 +/- 14% vs 42 +/- 15%, P = 0.004), whereas patients treated 3-6 h after the onset of symptoms did not differ from respective controls (41 +/- 16% vs 41 +/- 18%). In patients with inferior AMI, the difference in mean LVEF was small (57 +/- 11% vs 55 +/- 12%, P = 0.47). After anterior AMI benefit due to streptokinase therapy was preserved up to 7 months (52 +/- 14% vs 44 +/- 17%, P = 0.013). During exercise, the increase of mean LVEF was greater in the streptokinase group at both dates, especially 7 months after AMI (4.1 +/- 6.1% vs 1.2 +/- 6.3%, P = 0.015). In streptokinase-treated patients with anterior AMI, regional LVEF at rest was higher at both dates compared with controls, within the infarct zone as well as in remote myocardium. No treatment-control differences were demonstrable in patients with inferior AMI. During exercise, regional contractile reserve was better in the streptokinase group within the infarct zone as well as in remote myocardium, irrespective of the site of infarction. Thus, intravenous streptokinase within 3 h after the onset of AMI preserves global left ventricular function in anterior AMI over a period of at least 7 months. Intravenous streptokinase improves regional myocardial function within the infarct zone as well as in remote areas. In inferior AMI investigation solely at rest may underestimate the benefit of streptokinase therapy.

Aged↗
PubMed1990

Immunoscintigraphy with 111In antimyosin Fab.

Monoclonal 111In antimyosin Fab is a marker for myocytes which have lost their membrane integrity. Because of the slow blood pool clearance of the radiopharmaceutical, imaging is usually started 24-48 h after intravenous injection of 74 MBq of the tracer. This long postinjection interval restricts its utilization in the primary diagnosis of acute myocardial infarction. However, antimyosin may help to differentiate between necrotic and viable myocardium in the subacute stage of incomplete myocardial infarction. Serial endomyocardial biopsy for early detection of transplant rejection after heart transplantation may be partially replaced or supplemented by antimyosin scintigraphy. The compound may facilitate the diagnosis of myocarditis. Other potential indications may be prognostic assessment of dilated cardiomyopathy, monitoring cardiotoxic side-effects of chemotherapeutics, recognition of cardiac contusion as well as diagnosis of rhabdo- and leiomyosarcoma. In specific clinical situations 111In antimyosin Fab immunoscintigraphy may provide valuable diagnostic information.

Antibodies, Monoclonal↗
PubMed1990

[The risk of recurrence following the thyrostatic treatment of immunogenic and nonimmunogenic hyperthyroidism].

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogenic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p less than 0.001 and 83%, p less than 0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

Adolescent↗
PubMed1989

TSH binding-inhibiting antibodies in hyperthyroidism: relationship to clinical signs and hormone levels.

TSH binding-inhibiting antibody (TBIAb) activity was measured in 809 European patients with different forms of hyperthyroidism. Distribution of these TBIAb was skewed, with a peak in the range of normal controls, and an ill defined, not clearly separated peak at higher levels of TSH displacement. There was no unequivocal separation of two possible subgroups of hyperthyroidism (immunogenic and non-immunogenic). TBIAb distributions of patients with and without endocrine ophthalmopathy (EO) overlapped considerably. Although patients with Graves' disease, arbitrarily defined by the presence of endocrine ophthalmopathy or diffuse nuclide uptake by thyroid scanning, had mostly elevated TBIAb activity, 24.3% had values within the range of normal controls (mean + 2SD). Patients with diffuse thyroid uptake had significantly higher TBIAb levels than patients with nodular scan findings. In Graves' disease, TBIAb activity was positively correlated with the severity of endocrine ophthalmopathy, the size of the thyroid, and the serum levels of total and free triiodothyronine. There was no influence of age, sex, pretreatment, or regional iodine supply. These results suggest (1) that the clinical manifestations of Graves' disease are statistically related to TBIAb activity and (2) that separation of immunogenic and non-immunogenic forms of hyperthyroidism by means of TBIAb determination is unsatisfactory. The almost continuous distribution of TBIAb points to insufficient sensitivity of the present technique and raises doubts as to whether TBIAb values can be reliably classified as 'positive' or 'negative'.

Age Factors↗
PubMed1989

Treatment of endemic goitre due to iodine deficiency with iodine, levothyroxine or both: results of a multicentre trial.

Preliminary clinical studies and recent in vitro investigations suggest that iodine administration may be an effective alternative in the treatment of the diffuse euthyroid goitre of iodine deficiency. Therefore a 12-month multicentre study was initiated in which 166 patients were randomly assigned to take either 150 micrograms levothyroxine day-1 (group A, n = 61), 400 micrograms iodine day-1 (group B, n = 50), or a combination of 75 micrograms levothyroxine and 200 micrograms iodine day-1 (group C, n = 55) for 8 months with follow-up examinations at 4 and 8 months as well as 4 months after cessation of treatment. Initially, thyroid volume, as determined by ultrasound, was not significantly different in the three groups. In all three groups, during treatment a significant and comparable mean decrease in goitre size was documented (-32.1% in group A, -37.3% in group B, -38.7% in group C). After cessation of treatment in group A mean thyroid volume again increased to near the baseline value (-12.0% compared to the initial investigation), while the therapeutic effect was sustained in group B (-32.5%). In group C, only a slight rebound effect was observed (-26.3% vs baseline volume). Total thyroxine (T4) increased sharply and significantly in group A from 7.8 +/- 1.9 to 10.9 +/- 2.8 micrograms dl-1 after 8 months (P less than 0.001), but only slightly, although significantly in group B (from 7.8 +/- 1.5 micrograms dl-1 to 8.9 +/- 1.6 micrograms dl-1; P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Does the stomach balloon modify the function of the esophagus and lower esophageal sphincter, stomach emptying and release of gastrointestinal peptides?].

The Willmen gastric bubble has been used as an adjunct to weight loss in morbidly obese patients. 35 patients with morbid obesity were studied with routine manometry, esophageal 24-h-pH-measurement, and gastric emptying studies before and 4 weeks after bubble placement. During emptying studies blood samples were taken to measure gastrin, PP, CCK, VIP, neurotensin and insulin. No patient developed heartburn or regurgitation after bubble placement. Esophageal motility and LES function remained unchanged. There was no important pathological gastroesophageal reflux before and after gastric bubble. The gastric emptying time of solid food was unchanged by gastric bubble placement and the emptying time of liquids was accelerated up to normal. In patients with fasting gastrin levels less than 20 pg/ml at the beginning of the first test we found no differences in gastrin release before and after bubble insertion. In patients with primary high fasting values gastrin release was significantly increased. CCK, VIP, neurotensin and insulin levels were unchanged. With PP we measured significantly raised fasting levels after gastric bubble. We conclude that esophageal and LES functions are not altered by Willmen gastric bubble placement and that primary retardation of fluids is changed to normal. Bubble induced gastric tension increases fasting PP. In case of high fasting gastrin the bubble leads to an extremely high food response without any clinical signs.

Adult↗
PubMed1989

[Results of the definitive treatment of autonomy in iodine deficiency goiter].

In order to evaluate the efficacy of, and the risk associated with, the definite treatment of euthyroid goiter with autonomy, the data of 88 patients treated between 1982 and 1986 (50 by subtotal thyroidectomy; 38 by 131I-treatment, mean radiation dose 200 Gy without protection by thyroxine) were analyzed in a retrospective study. The following criteria were used before and after treatment: the results of scintigraphy under suppression qualitatively (in focal autonomy) and quantitatively (global thyroid uptake) (TcUs), the means of FT4I, FT3I and delta TSH after TRH, the improvement of mechanical signs and symptoms and the decrease of thyroid volume. Measured by TcUs and delta TSH, autonomy could be removed completely in 85-90% of all patients. Surgery was slightly more successful (100%) compared to treatment by 131I (75-80%). This was also true for removal of mechanical symptoms and reduction of the goiter. The incidence of manifest hypothyroidism was greater after surgery (16%) than after 131I treatment (3%). At a higher grade of autonomy (TcUs greater than 3.2%) surgery was more effective (95-100%) than treatment with 131I (60-70%) but at a higher risk of hypothyroidism (24 vs 0%). It is imperative to improve the methods of estimating the amount of 131I to be administered in euthyroid goiter with autonomy. Selection of patients with autonomy in euthyroid goiter for definite treatment is difficult, since until now their risk to become hyperthyroid cannot be predicted properly.

Adult↗
PubMed1988

Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage.

A prospective randomized pilot study of subcutaneous low-dose heparin in the prevention of deep-vein thrombosis and pulmonary embolism was carried out in patients admitted to hospital after intracerebral hemorrhage. A high incidence of deep-vein thrombosis and lung embolism was detected by phleboscintigraphy and lung perfusion scintigraphy, respectively. There was no significant reduction of deep-vein thrombosis and pulmonary embolism in the therapy group. Heparin did not increase the risk of rebleeding.

Cerebral Hemorrhage↗
PubMed1988

Significance of gated equilibrium radionuclide ventriculography in quantification and follow up of valvular regurgitation.

In order to evaluate the significance of gated equilibrium radionuclide ventriculography (RNV) for non invasive quantification of valvular regurgitation and follow up, various approaches were tested concerning accuracy and reproducibility. By using in vitro labeling of red blood cells and extending the acquisition time, a clear reduction of dispersion was obtained in patients without valvular insufficiency. Quantification of regurgitation directly from functional images (ventricular amplitude or stroke volume image) was clearly superior compared to the variable region of interest method. Employing functional images, reproducibility between two observers and between two independent measurements was excellent. Correlation to regurgitation values determined by cardiac catheterization was only moderate with all RNV approaches tested. RNV is limited in the absolute quantification of valvular regurgitation due to the variable overlap of right atrium and right ventricle. However, because of its high reproducibility, RNV is a non invasive technique suitable for intraindividual follow up of patients with valvular insufficiency.

Adult↗
PubMed1988

Thyroid autonomy: sensitive detection in vivo and estimation of its functional relevance using quantified high-resolution scintigraphy.

This study is concerned with 236 euthyroid individuals living in an area of iodine deficiency, 227 of whom had endemic goitres. In these subjects, autonomy could be suspected owing to an inhomogeneous activity distribution on the thyroid scintigram or a subnormal TSH response to TRH. They complete a total number of 426 investigated individuals. Previously, in 190 separated controls without evidence of autonomy, the reference ranges for the thyroid 99mTc pertechnetate uptake under suppression (TcUs), a measure for the non-suppressible thyroid iodide clearance, and for suppressibility of circumscribed thyroid regions, had been determined. These two parameters obtained by high-resolution quantified scintigraphy were used for an accurate detection of thyroid autonomy among the 236 individuals. Suppression scintigraphy revealed autonomy in 171 patients. delta TSH after TRH was subnormal in 40% of the subjects with abnormal thyroid suppressibility. Prevalence of abnormal suppression was dependent on three factors: patient age, goitre type and estimated thyroid weight. In the total investigated collective, the prevalence of autonomy was 77% in patients with a goitre weight above 50 g. The individuals with abnormal suppression were grouped into four classes of TcUs. In these classes, free thyroxine index (FT4I) and total triiodothyronine (TT3) increased with increasing TcUs, whereas delta TSH decreased. This finding indicates a continuum of different extents of autonomous thyroid function, whereas in the individual patient, the extent can be determined using the pertechnetate uptake under suppression. In addition, FT4I, TT3 and delta TSH in each of the TcUs classes depended on the individual iodine supply.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Effect of voluntary intake of iodinated salt on prevalence of goitre in children.

The availability of iodinated salt containing 20 mg of iodine as iodate/kg salt consumed on a voluntary basis enabled us to investigate its effect on goitre prevalence and iodine excretion in urine in a longitudinal, prospective, randomized study over 4 years. With this salt, under the assumption of a consumption of 5 g salt per day and person, an additional intake of 100 micrograms of iodine can be achieved. The study was performed on initially 334 children (168 boys, 166 girls) at the age of 10 years living in an area of iodine deficiency. After 4 years, 286 children still participated in the study. Initially, goitre prevalence as assessed by palpation was found to be 30.5% (37.4% in girls and 23.8% in boys). Neck circumference was found to be significantly higher in children with goitre compared with those without (30.2 +/- 1.4 vs 29.4 +/- 1.4 cm; P less than 0.001). Iodine excretion in the urine was significantly lower in children with goitre compared with those without (40.4 +/- 16.7 micrograms/g creatinine vs 46.1 +/- 24.9 micrograms/g creatinine; x +/- SD; P less than 0.05). The children were randomly assigned to two different groups: group A (N = 146) was asked to use iodinated salt, group B (N = 188) non-iodinated salt. Over the 4 years, a continuous increase in iodine excretion in urine could be demonstrated in group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1987

Intensive short-term chemotherapy in patients with advanced breast cancer.

Aiming at a high complete remission rate with an intensive induction regimen, 27 patients with advanced breast cancer were given three cycles of VAC chemotherapy consisting of vindesine 3 mg/m2 i.v. on days 1 and 12, adriamycin 40 mg/m2 i.v. on days 1 and 12, and cyclophosphamide 200 mg/m2 p.o. on days 3-6 and 14-17 together with medroxyprogesterone acetate (MPA) 1,500 mg p.o. daily during the induction phase and 1,000 mg p.o. thereafter until relapse. These VAC double cycles were repeated twice with 3-weekly intervals for a total induction period of 15 weeks. In responders, including no change, the chemotherapy was discontinued thereafter, and the patients were observed until relapse with a maintenance therapy of MPA 1,000 mg p.o. daily. A complete remission (CR) was achieved in 8 (29.6%) and a partial remission (PR) in 13 (48.2%) of the 27 patients (CR + PR 77.8%). A no change (NC) status was found in 6 patients (22.2%). There were no nonresponders. The median duration of the CR was 20 (5-42) months with two patients still in CR at 33 and 36 months, of the PR 8.3 (4-13.5) months, and of the NC 6.7 (2-13) months. The treatment was tolerated without life-threatening toxicity or interval prolongation by all patients. No dose-limiting cardiac toxicity was observed in these patients regularly controlled by left ventricular ejection fraction (LVEF). The high response rate of this intensive induction regimen warrants further investigation. Complete remission was achieved only in patients without previous chemotherapy, with marked tumor regression after the first chemotherapy cycle and when there was no extensive bone involvement.

Adult↗
PubMed1987

Physiological aspects of the thyroid trapping function and its suppression in iodine deficiency using 99mTc pertechnetate.

In an area of iodine deficiency, we investigated 190 individuals with and without euthyroid endemic goitre, who had a normal TSH response after TRH and an entirely homogeneous thyroid scintigram before and under suppression. In these subjects, the thyroid uptake of 99mTc pertechnetate, as a measure of the iodide trapping function, was determined before (TcUb) and under suppression (TcUs), using quantitatively evaluated scintigraphy. In this control group of individuals, without evidence of autonomy, the reference ranges of TcUb and TcUs were determined. The upper limit of the reference range for TcUb was 7.4% of the tracer activity injected, and for TcUs 1.6%. The reference range of TcUs is to be used to detect accurately thyroid autonomy in vivo. In addition, factors affecting the thyroid trapping function were investigated. With decreased iodine supply, trapping before suppression was increased, compensating for iodine deficiency. The effect of TSH on the trapping function was secondary, indicating that, to a considerable degree, the follicular cells adapt their iodide trapping to the iodine supply. The trapping before and under suppression increased with the estimated thyroid weight. delta TSH after TRH stimulation measured before suppression correlated inversely with the trapping under suppression. The two latter observations suggest that there is a continuum between low and increased levels of the TSH-independent thyroid function, even among these selected individuals without primary evidence of autonomous tissue. A correlation of the trapping function with sex, oestrogen treatment, and goitre type was not demonstrable. Age was found to have a small influence. Except for iodine contamination, the factors affecting the pertechnetate uptake of the thyroid, can be neglected under routine conditions.

Adolescent↗