Evidence from multicenter networks on the current use and effectiveness of antenatal corticosteroids in low birth weight infants.
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Biomedical subjects
Publications and source records attributed to H Gunkel.
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One month to 16 years old 288 children suffering from recurrent and chronic bronchitis, asthma, cystic fibrosis, malformations and various other lung diseases have been undergone 133Xe-Gas/99mTc-HAM lung scintigraphy. By means of results and taking in consideration scintigraphic findings the strategy of bronchographic indication is laid open being of higher load for the children based on anaesthesia and x-ray. Thus the number of bronchographs could be reduced from 47 (1984) via 33 (1985) to 22 (1986) by means of lung-scintigraphic imaging.
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A total of 117 children with recurrent and chronic bronchitis aged from 2 months to 16 years were subjected to combined ventilation-perfusion scan of the lungs with 133Xe-gas and 99mTc-HAM. It served as a screening before bronchological examination with the aim to get a more exact indication for bronchography which leads to a higher stress in children because of anaesthesia and radioscopy. Due to combined lung scan, the number of bronchological examinations could be reduced from 109 in 1984 to 79 in 1985 and even to 54 in 1986. Among the 117 children suffering from bronchitis, we found normal scans in 16 cases, perfusion defects in 59 cases, combined ventilation-perfusion defects in 41 cases and one case showed a pure ventilation defect. The lung scan should be applied in the framework of bronchopulmonary standard diagnosis.
By means of the radionuclide ventriculography certain contractility parameters of the right heart are presented in 15 patients with chronic obstructive bronchitis without pulmonary hypertension. The results confirm that also without increase of the pulmonary arterial blood pressure the ejection fraction of the right ventricle in rest is decreased in possible dependence upon the size hypoxaemia. The increase of the ejection fraction of the right ventricle under stress is insufficient in 7 out of 15 patients, in which case a connection with the left-ventricular ejection fraction is observed. A characteristic valuation of the right- and left-ventricular ejection fraction for pathophysiology and prognosis of the pulmonary heart disease is discussed. The necessity of further investigations is emphasized.
With the help of the comparison of the results of 95 patients with coronary heart disease who were examined by means of the intracardiac space scintigraphy for the purpose of the subjective subdivision according to the NYHA-classification there is no close correlation between the nuclear-medically obtained functional sizes (EF, maximum ejection and filling rate) and the clinical degree of severity of the disease. Only at the degree of severity 3 and 4 a discrimination is possible. In 64 patients laevocardiographic and coronarographic, respectively, findings were present. The trend to the deterioration of the functional parameters and to the increase of the nuclear-medically recognizable disturbances of the kinetics, respectively, with a more intensive expression of the vascular stenoses is distinctly readable. From the examination in rest in the individual case no statement is possible concerning the findings which are to be expected in the invasive diagnostics. When there are discrepancies between the result of the intracardiac space scintigraphy and the clinical and electrocardiographic preliminary investigations in many cases a clarification becomes possible by the immediately following study under submaximal exercise. On the assumption of a close cooperation with experienced cardiologists the relatively little expensive intracardiac space scintigraphy which does not stress the patient provides an essential evidence for the prognosis and estimation of the functional capacity of the patients with coronary heart disease.
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