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H Diemer

Publications and source records attributed to H Diemer.

At least 19 recordsLinked to original sources
PubMed2001

Is an increased intestinal permeability a valid predictor of relapse in Crohn disease?

BACKGROUND: An increased intestinal permeability (IP) may be a pathogenetic factor in Crohn disease (CD). Increases in IP could be an indicator of subclinical disease and precede clinical relapses. We examined whether an increased IP is a valid predictor of relapse in CD. METHODS: 27 patients with CD in remission (CDAI <150) and 22 healthy controls ingested 3.7 MBq of 51Cr-EDTA, 20 kBq of 14C-mannitol and 5 g of unlabelled mannitol in 100 ml of distilled water. The percent urine excretion (24 h) of labelled markers was determined. Patients were followed for 1 year or until relapse, defined as CDAI > 150 and > 50 from baseline. RESULTS: Median (25th-75th percentiles). The excretion of 51Cr-EDTA was 1.55% (1.13%-2.53%) for patients and 1.20% (1.11%-1.44%) for controls (P = 0.04). Three of 9 patients with a raised, and 6 of 18 patients with a normal, 51Cr-EDTA excretion relapsed (P = 1.00; Fisher's exact test). Thus, the specificity and sensitivity of the 51Cr-EDTA test as a predictor of relapse was 67% and 33%, respectively. The 51Cr-EDTA/14C-mannitol index was 0.060 (0.037-0.093) for patients and 0.045 (0.038-0.054) for controls (P = 0.06). Four of 12 patients with a raised, and 5 of 15 patients with a normal, index relapsed (P = 1.00; Fisher's exact test). Thus, the specificity and sensitivity of the index test as a predictor of relapse was 56% and 44%, respectively. For controls and patients in remission, who were tested twice, variability of and fluctuations in both the 51Cr-EDTA excretion and the index were greatest for patients. CONCLUSIONS: This study supports previous findings of an increased IP in patients with CD. Although fluctuations in the permeation of markers were pronounced in CD, neither the excretion of 51Cr-EDTA nor the 51Cr-EDTA/14C-mannitol index test were valid predictors of relapse in CD.

Adult↗
PubMed2000

Fifteen minutes bone scintigraphy in patients with clinically suspected scaphoid fracture and normal x-rays.

Occult fractures of the scaphoid bone occur frequently and may lead to non-union. The use of three-phase bone scintigraphy in patients with normal x-rays of the scaphoid after carpal injury is widely advocated.In this study, 40 patients with negative radiographs but clinically suspected scaphoid fracture, all had rapid bone scintigraphy with images taken 15 min after intravenous injection of 99 m-Technetium Hydroxymethylene diphosphonate. The scan was performed approximately 2 weeks after the trauma. We found 8 fractures of the scaphoid bone and 13 fractures of other carpal bones. In 5 cases the images were inconclusive. At follow-up 6 months to 2 years later we found no patients with non-union. We find this rapid version of the bone scan useful as a second line investigation for continuing wrist pain following trauma in the presence of normal radiography. This can result in a reduction in both time and costs required for the diagnostic process. If the results are inconclusive we recommend a delayed image. CT or MRI could also be considered. In rare cases a wrist arthroscopy may be considered.

Adolescent↗
PubMed1996

[Preoperative localization of parathyroid adenomas using Tc-99m-sestamibi].

Over an eight month period, ten patients with primary hyperparathyroidism were preoperatively scanned with Tc-99m-Sestamibi in order to locate adenomas. An adenoma was detected in nine patients, of which four were operated and good concordance was found between the scanning and the operative findings. Of the remaining six patients two were inoperable, two refused operation and two died of other causes.

Adenoma↗
PubMed1996

Continuous vectorcardiographic changes in relation to scintigraphic signs of reperfusion in patients with acute myocardial infarction receiving thrombolytic therapy.

OBJECTIVES: Changes in the electrical activity of the heart reflecting the infarct process can be recorded by continuous vector-ECG, a method which is now clinically available for cardiac supervision. Shifts of the ST-segment and QRS-vector reflect ischaemia and necrosis of the myocardium. Continuous vector-ECG changes were evaluated against myocardial scintigraphy in 18 patients with acute myocardial infarction treated with streptokinase in order to study the impact of improved myocardial perfusion. DESIGN: Myocardial perfusion was analysed with 99Tcm-Sestamibi (Cardiolite, DuPont Scandinavia AB, Kista, Sweden) single photon emission computerized tomography (SPECT). Registrations were performed before and after thrombolysis in order to estimate the amount of myocardium with impaired perfusion initially (threatened myocardium) and the degree of perfusion improvement in this myocardial area. X, Y, Z vectors were registered continuously by Frank leads (Ortivus Medical, Täby, Sweden). QRS-vector difference, and the time to plateau phase and the ST-vector magnitude were used as a measurement of ischaemia and size of the myocardial infarction. RESULTS: In seven out of 11 patients treated within 3 h of onset of symptoms, an improvement in myocardial perfusion in the initially hypoperfused areas was achieved in contrast to none of the seven patients treated > 3 h after onset of pain (P < 0.05). In the whole patient material, there was a negative correlation between the time to plateau level for the QRS-vector and the improvement in myocardial perfusion (r = -0.53, P < 0.05). Among patients treated within 3 h, there was a negative correlation between the plateau level for the QRS-vector magnitude compared to the improvement in myocardial perfusion (r = -0.61, P < 0.05) and a negative correlation between the plateau level and the myocardial perfusion level after therapy (r = -0.69, P < 0.05). In these patients, there were also negative correlations between the maximal ST-vector magnitude and the myocardial perfusion both before and after thrombolysis (r = -0.81, P < 0.05 and r = -61, P < 0.05, respectively). CONCLUSION: Patients with marked improvement in myocardial perfusion indicating successful thrombolysis reach their plateau levels of the QRS-change faster and have lower total QRS-vector differences than patients without successful thrombolysis as reflected by myocardial scintigraphy. Patients with a high ST-vector magnitude have low perfusion levels both before and after therapy indicating a pronounced ischaemic damage of the myocardium. Thus, VCG-changes reflect impairment in myocardial perfusion during acute myocardial infarction.

Aged↗
PubMed1995

Blood pressure and myocardial perfusion in hypertensive patients with and without left ventricular hypertrophy.

To evaluate the effect of acute blood pressure (BP) changes on the myocardial perfusion in hypertensives, 10 patients with and 10 patients without left ventricular hypertrophy (LVH) were examined with 99TCm-Sestamibi scintigraphy at rest and after acute pharmacological BP reduction using nifedipine and captopril. Signs of LV ischaemia was quantified as the size of the hypoperfused area defined as isotope uptake below 70% of maximum LV uptake, and LVH was defined as ventricular mass (LVM) > 125 g/m2 BSA by use of echocardiography. Not significant relations between BP and size of the hypoperfused area was found at rest. During BP reduction patients with LVH had negative correlations (r = -0.58) between the size of the hypoperfused area and the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) (r = -0.49) while patients without LVH showed positive correlations (SBP r = 0.60, DBP r = 0.48). The differences in correlation coefficients were significant (P < 0.01) for both. Thus, in hypertensives with LVH, ischaemia may develop at low BP providing a possible mechanism for the observed increased risk of cardiovascular events in some hypertensive patients with low achieved BP during follow-up. Until treatment goals are defined on scientific grounds, BP should not be decreased below 90 mm Hg in subjects with LVH.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

Low nitrogen diets preserve nutritional status but not residual renal function in rats with severe renal failure.

The effects of low nitrogen diets (oral and parenteral) on nutritional status and residual renal function were evaluated in rats with experimentally induced severe renal failure (partial nephrectomy) and compared with the effects of a normal protein diet. Non-uremic rats were used as controls. Muscle protein synthesis was significantly lower in uremic rats fed a normal protein diet than in those fed low protein diets. Values for serum insulin-like growth factor 1 (IGF-1) were significantly lower than for controls in all uremic groups as were the wet and dry weights of skeletal muscle. The glomerular filtration rate was studied after 3 wk of nutritional intervention. Serum creatinine concentration was lower and creatinine clearance greater in uremic rats given the low nitrogen dietary treatments (both oral and parenteral) compared with those fed the normal protein diet. However, the glomerular filtration rate determined with 51Cr-EDTA clearance did not differ between uremic rats with normal and low protein intake. Thus, a low nitrogen diet had positive effects on uremic toxicity and did not compromise nutritional status. The results do not, however, establish a favorable influence on residual renal function and emphasize the need for reliable methods for studying dietary effects on renal function in uremia.

Animals↗
PubMed1993

99Tcm-sestamibi uptake in the leg muscles and in the myocardium in patients with intermittent claudication.

99Tcm-Sestamibi has now replaced 201Tl as a cardiac imaging agent. In addition to the myocardial uptake there is also a considerable uptake in the striated muscle, which may be used for analyzing the muscular perfusion. Sixteen patients with intermittent claudication were investigated with 99Tcm-Sestamibi-SPECT (single photon emission computerized tomography) in order to visualize coronary ischemic disease. After the registration of the myocardial perfusion they were also studied regarding their leg muscle perfusion. This was done at rest and during standardized stress test using a bicycle ergometer. In 10 of the patients there was an increase in the isotope uptake in the myocardium from work to rest > 10% reflecting pronounced myocardial ischemia, which, however, was symptomatic in only 4 of the patients. The muscular uptake in the myocardium of 99Tcm-Sestamibi in the thigh increased significantly from rest to exercise (P < 0.01), while it remained unchanged in the calf muscle. There were no significant correlations at rest between the ratio of the right and left systolic blood pressure in the ankles and the ratio between the right and left isotope uptake in the calves, but the increase in the isotope uptake from rest to work correlated with the blood pressure ratio at r = 0.79, P < 0.01 (anterior projection) and r = 0.71, P < 0.01 (posterior projection).

Adult↗
PubMed1992

Myocardial reperfusion in thrombolysis A 99Tcm-Sestamibi SPECT study in patients with acute myocardial infarction.

This study presents the outcome of myocardial scintigraphy performed before and after thrombolytic treatment in 16 patients with acute myocardial infarction using 99Tcm-Sestamibi (Cardiolite, Du Pont Scandinavia AB, Kista, Sweden). The patients were given 99Tcm-Sestamibi intravenously as soon as possible after the decision to give thrombolytic treatment. When the patients were in a clinically stable state after the thrombolytic treatment, myocardial perfusion was analysed with the gamma camera using single photon emission computerized tomography (SPECT). A second 99Tcm-Sestamibi tomography was carried out on the second to fourth day after the myocardial infarction. Data reconstruction was done with the 'Bull's eye technique'. Nine patients received thrombolysis < 3 h from the onset of pain. In this group six patients (66%) improved their myocardial perfusion by > 10% after treatment, while all seven patients who received treatment > or = 3 h after the onset of pain improved their myocardial perfusion by < 10%. This study emphasises the importance of early diagnosis and treatment of patients with acute myocardial infarction in order to salvage myocardium.

Aged↗
PubMed1987

Bone scan in the patellofemoral pain syndrome.

Eighty patients who complained of retropatellar pain underwent evaluation by bone scintigraphy, intraosseous pressure determination, radiography, arthroscopy and physical diagnostic tests. The bone scans showed that 48% of the painful knees had an increased uptake compared with 9% for the normal joints. A highly significant correlation was evident between an increased uptake and established chondromalacia. For the diagnosis of a high pressure patella, radiography was only 7% sensitive (6/88), compared with 44% (39/88) for bone scintigraphy and 78% for the clinical "sustained flexion" test. The positive predictive value of a bone scan for detecting a high pressure patella was 0.72 (39/54). The best predictor was a positive sustained flexion test with a predictive value of 0.85 (69/81).

Adolescent↗
PubMed1985

The prognosis of surgically treated congenital hydronephrosis after diagnosis in utero.

Nine patients with a prenatal ultrasonic diagnosis of unilateral ureteropelvic junction obstruction underwent pyeloplasty in early neonatal life. Based on radiological and renographical assessment of the results, immediate postnatal intervention had no demonstrable advantage over those subjects in a control group who underwent an operation after presenting with symptoms. Half of the children in both groups had normal parenchymal function of the hydronephrotic kidney. Because of the operative complications we found it unacceptable to operate on neonates without symptoms and with normal function of the affected kidney. The advantage of prenatal diagnosis lies in the early recognition of the necessity of close surveillance. The primary indications for surgical intervention should be symptoms and impairment of the hydronephrotic kidney function.

Child↗
PubMedDate not supplied

Demonstration of renal mass lesions by early dynamic imaging during bone scintigraphy.

The detection of renal abnormalities during bone scintigraphy using 99Tcm-phosphorous complexes is well documented. Three patients with renal carcinoma visible on early but less well on late images during bone scintigraphy are presented. Early dynamic imaging provides improved lesion detectability and information about renal function.

Adenocarcinoma↗