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Biomedical subjects

H Köhn

Publications and source records attributed to H Köhn.

At least 19 recordsLinked to original sources
PubMed1995

[Thallium scintigraphy of the myocardium. Uniform research protocols of the Austrian Society for Nuclear Medicine].

A uniform protocol for thallium scintigraphy of the myocardium has been issued in Austria to avoid difficulties in interpreting results and to avoid repeated examinations to save expenses and radiation burden. From the beginning of 1995 this protocol will be used in the Austrian departments of Nuclear Medicine, differences from this protocol have to be mentioned separately. In this protocol the procedure of examination, bicycle and pharmacological stress testing and vasodilatation, acquisition techniques for planar and SPECT imaging, data processing and quality control of devices are defined.

Adenosine↗
PubMed1993

99mTc-DTPA aerosol for same-day post-perfusion ventilation imaging: results of a multicentre study.

A multicentre study was performed in an attempt to evaluate a submicronic technetium-99m diethylene triamine penta-acetic acid aerosol generated by a newly developed delivery system, the aerosol production equipment (APE nebulizer), for same-day post-perfusion ventilation imaging in patients with clinically suspected pulmonary embolism. Quantitative comparison between the DTPA aerosol and krypton gas demonstrated a close correlation with respect to regional pulmonary distribution of activity and peripheral lung penetration (n = 14, r = 0.94, P < 0.001 and r = 0.75, P < 0.0025, respectively). In 169 consecutive patients, DTPA aerosol images performed immediately following perfusion (inhalation scan I) were compared to those carried out on the next day (inhalation scan II) with respect to image quality and assessment of perfusion-ventilation matches or mismatches. Agreement between inhalation scans I and II with respect to perfusion defects matched or mismatched to ventilation was found in 166/169 (98%) studies. The image quality of inhalation scan I was equal to that of scan II in 72%; inhalation scan I was superior in 11% of cases, while scan II was superior in 17%. This submicronic 99mTc-labelled DTPA aerosol is well suited for fast same-day post-perfusion ventilation imaging in patients with clinical suspicion of pulmonary embolism.

Aerosols↗
PubMed1993

[Vitronectin in bronchoalveolar lavage--a parameter of disease activity in sarcoidosis].

Vitronectin is a multifunctional glycoprotein which is involved in several of the processes of inflammation and repair. In previous studies we demonstrated that increased concentrations of vitronectin can be detected in bronchoalveolar lavage fluids (BAL) of patients with interstitial lung disease (e.g. sarcoidosis). The outcome of sarcoidosis is generally favorable, however, some patients progress to pulmonary fibrosis. There is a need for markers indicating early fibrotic changes in the lung in patients with sarcoidosis. The present study was designed to evaluate the potential of BAL-vitronectin measurements for the assessment of disease activity in subjects with sarcoidosis. BAL-vitronectin concentrations were determined in 19 patients with biopsy proven sarcoidosis and sequential analysis of BAL-vitronectin levels were performed in 11 patients before and after therapy. Patients with active sarcoidosis had higher BAL-vitronectin concentrations (1.56 +/- 0.89 microgram/ml) than patients with inactive disease (0.68 +/- 0.33 microgram/ml; p < 0.01). Patients with active sarcoidosis received high-dose glucocorticoid treatment for four weeks followed by low-dose glucocorticoid therapy for eleven months. After high-dose medication BAL-vitronectin concentrations fell significantly (1.08 +/- 0.9 microgram/ml; p < 0.01). A further decrease in vitronectin levels resulted when therapy was continued for a year (0.75 +/- 0.48 micrograms/ml). Clinical deterioration correlated with an increase in BAL-vitronectin concentrations. Thus, measurement of BAL-vitronectin levels might be a useful marker for assessing disease activity and response to therapy in patients with sarcoidosis, but does not provide prognostic information.

Adult↗
PubMed1993

[Contribution of nuclear medicine to management of pulmonary complications in patients with acquired immune deficiency].

Opportunistic lung infections and malignancies are life-threatening complications in HIV-positive patients. In 72 HIV-positive patients the role of different non-invasive tests such as lung function tests, blood gas analysis, 67 gallium scanning and epithelial lung clearance with 99m Tc-DTPA for the management of these patients was prospectively studied. For all non-invasive tests the mean values of patients with pulmonary complications (n = 25) differed significantly from those of asymptomatic HIV-positive patients (n = 47) (p < 0.001). In 10 patients presenting with acute Pneumocystis carinii pneumonia, 99m Tc-DTPA clearance rates and 67 gallium uptake differed significantly before and after therapy (4.80 +/- 1.23%/min vs 2.47 +/- 0.72%/min and 2.15 +/- 0.42 vs 1.39 +/- 0.18, respectively). Follow-up after therapy revealed different time courses of these tests for normalization. A significant inverse correlation was found between DLCO and 99m Tc-DTPA lung clearance (r = -0.90, p < 0.001, n = 35). A diffuse homogeneous 67 gallium uptake is not diagnostic for PCP, the same pattern was found in a patient with lymphoid interstitial pneumonitis and in patients with CMV pneumonitis; these patients also had accelerated epithelial lung clearance rates. 67 gallium (6/6) was superior to 99m Tc-labelled immunoglobulin G (3/6) for detection of PCP. The 3 patients with Kaposi sarcoma of the lung had negative 67 gallium scans, but positive 201 thallium scans and increased 99m Tc-DTPA clearance rates.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1993

[Diagnostic value of secretory products of eosinophils and neutrophils in bronchoalveolar lavage in patients with idiopathic lung fibrosis].

Idiopathic pulmonary fibrosis (IPF) is characterized by a chronic inflammatory process in the lower respiratory tract of unknown etiology and poor prognosis. There is evidence that cytotoxic mediators released by neutrophils and eosinophils, such as myeloperoxidase (MPO) and eosinophil cationic protein (ECP) play a central role in the pathogenesis of this disease. The aim of this study was to assess disease activity in patients with IPF by measuring MPO and ECP concentrations in bronchoalveolar lavage (BAL). 14 patients with IPF had significantly higher concentrations of BAL-MPO and ECP (median = 117.2 micrograms/l, range: 4-217 micrograms/l and median = 16 micrograms/l, range: 4-34 micrograms/l, respectively) than patients with sarcoidosis (n = 9) (median = 6.5 micrograms/l, range: 4-12 micrograms/l and median = 7.1 micrograms/l, range: 2-13 micrograms/l, respectively) or pneumonia (n = 13) (median = 10.8 micrograms/l, range: 5-14 micrograms/l and median = 7.6 micrograms/l, range: 3-10 micrograms/l, respectively) (p < 0.01). Follow-up of MPO and ECP concentrations in BAL was performed in 8 patients with IPF before and after 4 weeks high-dose and 12 months low-dose corticosteroid therapy. Changes in MPO and ECP levels paralleled the clinical course and successful treatment resulted in a significant decrease of both MPO and ECP concentrations (p < 0.05), while clinical deterioration or treatment failure was associated with an increase of BAL-MPO and ECP levels. Increased MPO and ECP concentrations in BAL seem to reflect ongoing disease activity and may be useful prognostic markers in the management of patients with IPF.

Adrenal Cortex Hormones↗
PubMed1992

Serum procollagen III peptide levels in subjects with sarcoidosis. A 5-year follow-up study.

In a prospective study, Type III procollagen N-terminal peptide was measured in the sera of 38 subjects with biopsy-proven pulmonary sarcoidosis at 6-month intervals over a period of 5 yr. The subjects were divided into four groups according to their radiologic presentation and clinical course: Group A (n = 10) subjects with sarcoidosis Type I without radiologic progression over 5 yr; Group B (n = 5) subjects with sarcoidosis Type I with radiologic progression to Stage II or III; Group C (n = 9) subjects with sarcoidosis Types II and III without progression over 5 yr; and Group D (n = 14) subjects with sarcoidosis Types II and III with radiologic progression. Lung function tests (FVC, FEV1, and DLCO), chest roentgenograms, and measurements of serum angiotensin converting enzyme (S-ACE) were performed concurrently with the S-PCP-III levels. Significantly higher levels of S-PCP-III were found in group B (Type I, progressive) (18.2 +/- 1.09 ng/ml) and in group D (Type II/III, progressive) (13.9 +/- 1.2 ng/ml) compared with those of Group A (Type I, stable) (9.1 +/- 1.09 ng/ml) and Group C (Type II/III, stable) (7.6 +/- 1.1 ng/ml) or normal volunteers (9.4 +/- 4 ng/ml) (p less than 0.001 for all comparisons). Changes in S-PCP-III levels tended to parallel the clinical course, and steroid treatment resulted in a significant decrease in S-PCP-III concentrations (p less than 0.001). In contrast, serum angiotensin converting enzyme (S-ACE) levels did not correlate with either the clinical course or radiologic changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Frequency of pulmonary embolism in ambulant patients with pelvic vein thrombosis: a prospective study.

One hundred thirty-nine consecutive patients (average age 70.1 years) who were able to walk with a swollen leg were seen at the clinic where diagnosis of acute deep vein thrombosis (DVT) extending to the pelvis was confirmed by injecting microspheres labeled with technetium 99m into the dorsal foot vein (radionuclide venography). Thirty-nine (28%) of these patients had malignant disease. Perfusion lung scans performed immediately after radionuclide venography were supplemented by inhalation scans (99mTc-labeled diethylenetriamine pentaacetic acid aerosol) in case of perfusion defects. During scintigraphy patterns highly indicative of pulmonary embolism (PE) were found in 80 patients (58%), but only 11 (7.9%) had minor clinical symptoms. All patients were admitted to the ward, were given standard heparin subcutaneously (35,000 to 40,000 units/24 hr) and firm bandages, and were encouraged to walk. After 11 days pulmonary scintigraphy was repeated and revealed no change in 55 of 59 patients without PE and in 40 of 80 patients with PE. Thirty-three patients (23.7%) showed regression of perfusion defects. New PE developed in 11 patients (7.9%, four without and seven with previous PE). Autopsy revealed that one 80-year-old patient with prostatic carcinoma had died of massive PE. When comparing this frequency of newly developed PE during ambulation with the occurrence of PE after bed rest, according to the literature, it is no more dangerous for a mobile patient with proximal DVT to walk wearing a firm bandage than it is for the patient to be in bed. Therefore we recommend treating mobile patients with DVT by use of anticoagulation and firm compression bandages and without immobilization.

Adolescent↗
PubMed1990

Diagnostic modalities for detection of pulmonary embolism in clinical routine: a European survey.

A questionnaire asking for routinely performed modalities to diagnose deep venous thrombosis (DVT) and pulmonary embolism (PE) was sent to 2,500 departments in 23 European countries. Five-hundred-seventy (23%) were received back and evaluated according to hospital size and regional differences. Countries were grouped into: Anglo-Scandinavian (a), German-speaking (g), and Roman (r). Contrast venography is most frequently performed (94%) to diagnose DVT, independent of hospital size and without regional differences. With exception of Doppler ultrasound (71%), noninvasive DVT tests are rarely performed (6-28%). To diagnose PE, pulmonary angiography (PA) and ventilation-perfusion (V-P) scintigraphy are performed in 71%, digital subtraction angiography in only 50%. Frequencies of PE tests strongly depend on hospital size (PA: small hospitals 53-66%, large 83-89%; V-P: small hosp. greater than 80%, large greater than 90%, with 2 exceptions: small German hospitals = 48%, primarily performing only P-scans and large Roman hospitals = 59%, primarily performing PA). Regional differences were also significant (PA: r = 85%, a = 74%, g = 63%, V-P: a = 95%, r = 66%, g = 63%, respectively).

Diagnostic Imaging↗
PubMed1990

Urine excretion of inhaled technetium-99m-DTPA: an alternative method to assess lung epithelial transport.

Technetium-99m DTPA clearance (99mTc-DTPA) clearance measured by a gamma camera or a scintillation probe not only reflects epithelial transport, but is also influenced by an unknown amount of mucociliary clearance depending on particle size and aerosol deposition. This is confirmed by factor analysis of dynamic inhalation studies. Assessment of epithelial absorption by urinary excretion of inhaled 99mTc-DTPA is largely independent of aerosol lung deposition. Twenty-four-hour excretion reflects the amount of aerosol cleared by absorption, while two-hour excretion is a quantitative measure of the aerosol absorption rate from the epithelium into blood. Urinary 99mTc-DTPA excretion of two aerosols with different particle size correlated significantly (p less than 0.001) with analysis of lung clearance curves. A very similar regression in the form of a cumulative exponential function was found with both aerosols. Two-hour urine values of nonsmokers differed significantly from those of smokers or patients with active interstitial or infectious lung disease. This alternative procedure is suited as a bedside test and holds promise for patient monitoring and follow-up.

Administration, Inhalation↗
PubMed1990

[Assessment of different clearance mechanisms of the lung using factor analysis].

Measurement of epithelial clearance over the lungs is always influenced by mucociliary transport since the lung is a 3-dimensional organ where ciliated and respiratory epithelia overlap. Factor analysis provides factor images and time-activity curves of extracted physiological factors corresponding to specific structures, even if these structures overlap. In 16 inhalation studies of 99m Tc-DTPA aerosol, factor analysis always extracted 2 factors with opposite temporal behavior, one corresponding to epithelial and one to mucociliary transport. Clearance rates measured over the lungs were significantly lower than epithelial transport-related factor curve values (1.35%/min vs 2.2%/min), but were identical with the clearance rates of the sum of both factors plus factor background. Factor analysis allows quantitative assessment of epithelial transport without interference of other clearance mechanisms and should be evaluated further in different pulmonary disorders.

Aerosols↗
PubMed1990

[Plasma membrane separation. A therapeutic possibility in thyrotoxic crisis].

A case of thyroid storm is presented, successfully treated with a combination of antithyroidal drugs and plasma exchange. A 280% separation removed 447 micrograms T4 and 12 micrograms T3. During separation, the elevated T4 and T3 values returned to normal. Basic concepts of plasma membrane separation investigated by plasma and whole body counting after administration of 131I-T4, as well as radioimmunoassay measurement of thyroid hormones in plasma and separate are discussed.

Aged↗
PubMed1988

[High dosage ketoconazole therapy in the treatment of advanced prostatic cancer].

This paper reports on oral high-dose ketoconazole treatment (3 x 400 mg/die) in 38 patients with advanced (pT3-4NXMOGIII - n = 9), metastasizing (Ml - n = 23) prostatic cancers that had been treated previously (n = 23) or untreated (n = 15). The primary response rate was 66% with 37% remissions. After 1 year, the response rate was 40% with 8% remissions and 8% progressive tumours. There was drop-out rate of 34% because of adverse experience and a very high rate of side-effects for 74%. During treatment there was a significant reduction in testosterone, cortisol and acid phosphatase blood levels. There was a transient rise in liver enzymes (gamma-GT, GOT, GPT, LDH and bilirubin) above the limit. There was no change registered in the renal parameters (BUN, creatinine) or in the calcium and phosphorus blood levels. There was no difference in the response rate between patients who had been treated previously and those with no treatment. There was also no difference in the outcome of tumours that had metastasized and those that had not.

Aged↗
PubMed1987

Incidence and clinical feature of pulmonary embolism in patients with deep vein thrombosis: a prospective study.

In 169 patients with suspected deep vein thrombosis (DVT), the incidence and clinical feature of pulmonary embolism (PE) was prospectively studied by means of noninvasive thrombosis tests (uptake tests, radionuclide venography) and combined ventilation (133Xe, 81mKr) and perfusion (99mTc microspheres) lung scanning. DVT was detected in 62% of patients (105/169). The incidence of PE in patients with confirmed DVT was 57% (60/105), a figure which is in excellent agreement with data from autopsy studies. Concerning the thrombotic source of emboli, the incidence of PE was 46% in patients with DVT confined to the calf but increased to 67% if the thigh, and to 77% if the pelvic veins were involved as well. Fifty-nine percent of PE were clinically silent, 19% had "minor signs", and 22% "major signs". The size of the perfusion defects correlated significantly with clinical symptoms. Only 23% of clinically symptomatic patients had a pathological chest X-ray. Incidence of both DVT and PE increased with advancing age, but in old patients the incidence of PE rose disproportionately.

Adult↗
PubMed1987

Thoracic imaging with gallium-67.

In the past, gallium-67 imaging has undergone several ups and downs related to its clinical importance. After a period of initial enthusiasm, its role and indications are now established. At present, there are two fields of clinical interest for 67Ga-imaging: (1) mediastinal staging in bronchogenic carcinoma and the staging of malignant lymphoma; (2) assessment of activity in interstitial lung diseases, especially sarcoidosis and inflammatory lung disorders. The advantage of 67Ga-imaging is that it is highly sensitive for the detection of neoplastic and inflammatory processes, independent of anatomical barriers. Particularly with the challenge of AIDS, 67Ga-imaging will gain increasing importance in the future. The low specificity of gallium for detecting underlying disorders precludes its use as a primary diagnostic tool. Therefore, and because of the cost and radiation load, the indications for application will have to be selected very carefully.

Adenocarcinoma↗