[Diagnosis of adrenal tumors and adrenal hyperplasias].
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Biomedical subjects
Publications and source records attributed to H Kiefer.
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2-Amino-4-nitrophenol was tritiated in an acid-catalyzed hydrogen exchange reaction. Radioactive 2-azido-4-nitrophenol with a specific radioactivity up to 21 mCi/mmol was synthesized from 2-amino-4-nitrophenol by diazotization and azide coupling. The photochemical properties of the uncoupler, 2-azido-4-nitrophenol, were studied as free solute and as ligand bound to uncoupler binding sites in bovine serum albumin and mitochondria. Based on product analyses, irradiation of free or bound 2-azido-4-nitrophenolate with visible light results in the formation of nitrene intermediates with a singlet to triplet ratio of 6:1 to 9:1. 2-Azido-4-nitrophenolate and bovine serum albumin form a strong 1:1 complex (KD = 0.7 micron) which can be converted into a photoproduct with a covalent bond between the label and the protein. The acid dissociation constant of the protein-bound 2-amino-4-nitrophenol moiety is strongly pH dependent. Photoaffinity labeling of mitochondria by 2-azido-4-nitrophenolate follows a pattern expected from equilibrium binding studies using normal and lipid-depleted particles: polypeptides were found to bear 90-95% of the radioactive label, and 5-10% of the latter was bound to phospholipids. Two polypeptides (approximately 56 000 and 31 000 daltons) were associated with 60% of the label, indicating a high degree of specific photochemical labeling.
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Real-Time-Sonography and pharmacoangiography with vasodilating drugs was performed in 63 patients with suspected pancreatic disease. Confirmation of the pancreatic lesion could be obtained in 41 cases by the symptomatology, pancreatic function test, autopsy, operation, laparoscopy with fine-needle-biopsy and by the roentgenologic visualization of pancreatic calcifications. Considering the relatively advanced disease of pancreatic carcinoma in our six patients the sonographic diagnosis was correct in all of them and with pharmacoangiography we failed on one case. In chronic pancreatitis correct diagnostic results with pharmacoangiography could be obtained in 8 of 18 cases and with sonography in 14 of 18 patients. In this study sonography showed certain advantages in comparison with angiography, but both methods were complementary and a better result in the differential diagnosis between chronic pancreatitis and pancreatic carcinoma could be achieved.
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Pancreatic angiography was performed in 246 patients using various vasodilating drugs. A pancreatographic effect could be found in 79% of all cases; Tolazolin was particularly efficient, since the effect could be found in 91% of the cases receiving the drug. The diagnostic value of different parameters was assessed in patients with chronic pancreatitis and in patients with carcinoma of the pancreas, in particular concerning the presence or absence of the pancreatographic effect, and the structure, width and contours of this organ. Evaluating the pancreatographic effect and vascular changes a correct diagnosis could be obtained in 69% of all cases with chronic pancreatitis and in 78% of all cases with carcinoma of the pancreas. The pancreatographic effect was diagnostically essential in 26% of all cases, and turned out to be rather useful in patients with chronic pancreatitis, whereas its diagnostic value was less in patients with carcinoma. The diagnostic value of angiography can be improved by the superselective technique and by applying the vasodilator Tolazolin, which is well tolerated and gives an excellent pancreatographic effect.
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Using an MR-film-screen combination for mammography, only 8% of the usual radiation dose was found to be necessary. This corresponds with an average skin dose of 0.55 R per exposure. The new technique resulted in visible improvement of contrast. Some loss of detail affected in particular the recognition of macrocalcification. As the sole method for the early diagnosis of occult carcinomas of the breast, it will therefore be necessary to improve image quality. The system is suitable for control examinations and investigation of special problems. The use of the MR system with non-screen film in two planes is discussed in relation to dose reduction.
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In forty patients suspected clinically of having an endocrine cause for hypertension, an adrenal cortical adenoma was confirmed histologically in five. Hyperaldosteronism with enlarged or normal adrenals was demonstrated in three patients. The diagnosis in a further eight patients with an abnormal hormone pattern and/or an abnormal venogram has not yet been confirmed. Adrenal glands show considerable variation in their size, shape and localisation on venography.
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