Biomedical subjects
Publications and source records attributed to J Dressler.
In cases of disputed fatal alcohol intoxication during the absorption (pre-peak) period it is strongly recommended to examine the blood ethanol level not only in blood taken from a peripheral vessel but also simultaneously in blood from at least one central. In the case reported, without such a duplex determination of the blood ethanol concentration it would have been impossible to establish the actual cause of death.
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64 sperm samples are tested for the evidence of Sperm Acid Phosphatase by agarose isoelectrofocusing with modified blotting. Near pI = 5.0, we observed polymorphic fractions of Sperm Acid Phosphatase. The investigated polymorphism is alike the original one from prostata. Polymorphic patterns are stable in sperm stains up to 6 weeks.
In the differential diagnosis of unclear neonatal and infant cholestasis the formerly applied 131-I-Rose Bengal scintigraphy has been widely abandoned in favour of hepatobiliary scintigraphy with 99mTc-labelled IDA derivatives excreted with the bile. Our results in 32 jaundiced children ranging from ages 2 weeks to 32 weeks show a high sensitivity of scintigraphy in proving an occlusion in 92% with a clearly lower specificity of 79%, if based on the demonstration of marked bile in the intestine as the only criterion. Diagnostic accuracy, however, can be further increased in additional criteria such as hepatocellular clearance and patient age are considered. The examination is of equally high importance for post-operative follow-up. Here, scintigraphy is superior to all other imaging procedures in the evaluation of bile flow situations. In 52 examinations of portoenterostomies, the prognostic value can be demonstrated not only with a good coincidence of the scintigraphic data with the bilirubin level, but also with the histological degree of liver fibrosis at the time of operation. Early and late complications of hepatoportojejunostomy can usually be recognised and localised. Since the prognosis of extrahepatic biliary atresia depends on an early operation-presently by means of reconstruction of biliary flow-indications for hepatobiliary scintigraphy must be given more widely and earlier (at the latest in the fourth week of life) in all unclear cases of cholestatic syndrome.
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Lacrimal dacryoscintigraphy facilitates definite diagnosis of obstructions and stenosis of the lacrimal drainage system with little stress to the patient. Together with x-ray dacryocystography it is an important diagnostic tool especially for pre- and postoperative evaluation of the drainage apparatus. Dacryoscintigraphy is the best method for measuring the dynamics of tear drainage especially in the canaliculi. Although it is not a substitute for other methods in general use, it complements them and expands their diagnostic accuracy.
Aside from imaging techniques several (radio-)immunological analyses are used for tumor diagnosis. Oncofetal antigens, for instance the carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP), have become the most important substances for many malignancies. However, nearly all of the so-called tumor markers are not suitable for early diagnosis or screening either because of low sensitivity or low tumor specificity. On the other hand follow-up measurements give a very sensitive index of the success of treatment and may indicate tumor progression when other signs are still not present. In some carcinomas and under some clinical circumstances tumor specific markers are available and mandatory for detection and/or staging: AFP in hepatoma, acid phosphatase in metastasizing carcinoma of the prostate and serum thyreoglobulin in differentiated thyroid cancer.
149 patients with acute (n = 75) myocardial infarction and 74 post-infarctions, angiographically confirmed, were investigated by 201T1 myocardial scintigraphy and subsequent radionuclide ventriculography. Quantitative evaluation of the scintigram showed 201T1 storage defects in 92% in the acute stage in 79% in the later stage. The sensitivity of identification of the posterior wall infarction was consistently markedly less than for anterior wall infarctions and could not be increased by additional application of 99mTc methylene diphosphonate. By the combined application of myocardial scintigraphy and radionuclide ventriculography the functional effects of the infarction can be described non-invasively.
Of the wide range of radiopharmaceuticals which accumulate in acutely myocardial tissue and subsequently enable its scintigraphic detection compounds of 99mtechnetium phosphate have proven clinically practicable in numerous investigations. As opposed to the similarly non-invasive method of myocardial scintigraphy with ionic tracers (201thallium scintigraphy), infarct detection through positive delineation is possible, at the earliest, six to twelve hours faster the onset of pain and meaningful for those in whom the classical ECG and enzyme changes are equivocally diagnostic and for patients with delayed hospital admissions. After approximately one week the concentration of activity in the necrotic zone and, in turn, its detectability, declines. Persistent activity is indicative of extensive infarction and poor prognosis. The sensitivity of the infarct scintigram, which is primarily carried out with 99mTc-pyrophosphate or 99mTc-methylendiphosphonate, is about 86% with small and sudbendocardial infarcts more frequently eluding detection. The method corresponds with electrocardiographic assessment of localization. The combination with 201thallium scintigraphy is useful in differentiating remote from acute infarction and in detection of right ventricular involvement associated with inferior infarction. In spite of a good correlation between the experimentally-determined infarct weight and scintigraphic findings, clinical investigations employing conventional methods of measurement (scintillation camera) have not been able to yield an early and accurate quantification of the appearance may occur, for example, in unstable angina pectoris. Thus, a negative infarct scintigram carried out at the optimal time of uptake assumes its most useful role in ruling out acute myocardial infraction in the presence of otherwise equivocal clinical findings.
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There has been clinical evidence that a perfusion defect on a stress image fills in over time. The diagnostic value of initial and 120 min post exercise redistribution thallium-201 myocardial images (RMI) was determined in 120 pts. with suspected coronary heart disease (CAD), all of whom had coronary arteriography. Significant (greater than or equal to 75%) lesions were present in 88 pts. 30 pts. without CAD showed a normal tracer uptake immediately after exercise. Scintigrams taken 120 min after exercise revealed a decrease of 201-Tl concentration in every area of the myocardium. 80 pts. with CAD showed an area of decreased tracer uptake in the initial scans. 120 min RMI in 51 pts. revealed a segnificant increase (p greater than 0.01) of countrate time ratio in previous underperfused area. In 37 pts. persistent defects were present, in every case the defect correlated with the site of a myocardial infarction as determined by the finding of an akinetic area in the left ventricular angiogram. Thus RMI following a single dose of 201 Tl can differentiate between scar- and exercise-induced transient ischemia.
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ECG triggered scintiphotography has established itself as a reliable, reproducible, noninvasive method for the determination of ventricular volumes, left ventricular ejection fraction, and regional ventricular wall motion. It can be used with sufficient precision and accuracy in severely ill patients who are not suitable for invasive diagnostic procedures. The method is useful for follow-up investigations of known heart disease. In comparison with left ventricular cineangiocardiography a correlation coefficient of r=0.78 could be found for enddiastolic voluumes, of r=0.92 for endystolic volumes, and of r=0.91 for ejection fraction. The sensitivity of the method for recognition of disturbances of regional ventricular wall motion is 94%, the specificity 86%. In comparison with left ventricular cineangiocardiography the resulting accuracy is 90%.
A new scintigraphic method, the radionuclide dacryography, to evaluate lacrimal drainage and its disorders is described. A drop of 99mTc-pertechnetate is dropped onto the eyes and the transport of the nuclide is registered by a scintillation camera. By this method it is easy to verify, under physiological conditions, suspected obstructions of the lacrimal drainage system and to determine its localization. The absorbed radiation dose using radionuclide dacryography is very low as compared to radiological methods.
201Thallium scintigraphy serves as a non-invasive method for visualizing regional perfusion, viability and configuration of the myocardium. Serial scans performed after injection during ergometric exercise allow to differentiate between irreversible cell damage, i.e. myocardial infarction or scar, and transient, reversible ischemia in patients with coronary heart disease. ECG-gated blood pool scans are an ideal adjunct as they represent the functional results of the pathologically altered myocardium. This method permits quantitative determination of the enddiastolic volume, endsystolic volume and left ventricular ejection fraction. Furthermore, regional and global wall motion may be judged qualitatively. Results of both methods show an excellent correlation with those obtained by invasive catheterization and cineangiocardiography. The clinical value is based on screening and follow up of a broad variety of cardiac diseases.
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