Biomedical subjects
R Bennink
Publications and source records attributed to R Bennink.
Evaluation of small-bowel transit for solid and liquid test meal in healthy men and women.
Evaluation of severe functional gastrointestinal motility disorders requires an investigation of the entire gastrointestinal tract. This should be possible with a single radionuclide imaging study. The purpose of this study was (1) to define normal values of small-bowel transit in men and women and (2) to assess a possible difference between gender or test meal, since it has been shown that women have slower gastric emptying than men, and gastric emptying of solids is slower than liquids. A standard gastric-emptying test for a solid (technetium-99m sulphur colloid, 230 Kcal) and liquid (indium-111 DTPA water) test meal was performed in 12 healthy male and 12 healthy female volunteers. After 135 min, the volunteer was placed in the supine position for static imaging of the abdomen every 15 min for 6 h. Decay and crossover-corrected geometric mean gastric-emptying data were fit to a modified power exponential function to determine the 10% stomach emptying time for solids and liquids separately. An ROI was drawn around the caecum and ascending colon to determine the arrival time of at least 10% of the solid and liquid test meal. Ten percent small-bowel transit time (10% SBTT) and orocaecal transit time (OCTT) were calculated. The OCTT for males and females, respectively for solids and liquids, are 294.6 +/- 18.8; 301.3 +/- 24.5; 294.6 +/- 18.8 and 301.3 +/- 24.5 min. The 10% SBTT for males and females, respectively for solids and liquids, are 280.3 +/- 18.4; 280.6 +/- 24.0; 288.2 +/- 18.9 and 297.4 +/- 24.4 (mean +/- SEM) min. We observed a simultaneous transfer of solids and liquids from the terminal ileum to caecum (correlation coefficient 0.90). There is no statistically significant difference in SBTT between gender or solids and liquids. In contrast to the gastric-emptying time, the SBTT of solids and liquids were not significantly different nor was a gender difference found. Determination of the OCTT seems to be the simplest and most accurate approach to measure SBTT. Since ileocaecal transfer occurs as a bolus phenomenon, a 111In-labelled test meal can also be used for the determination of colon transit in a single imaging study protocol.
Validation of the lactose-[13C]ureide breath test for determination of orocecal transit time by scintigraphy.
UNLABELLED: The breath test using oral administration of a 13C-labeled substrate, lactose-ureide (LU), to measure orocecal transit time (OCTT) was validated against 99mTc-scintigraphy. Although LU is not absorbed in the human small intestine, colonic bacteria readily metabolize LU, producing 13C-labeled CO2. The time at which 13CO2 appears in breath corresponds to the OCTT. METHODS: Twenty-two healthy volunteers ingested a meal labeled with 99mTc and 13C-LU. Scintigraphy was performed over 8 h at time intervals of 10 or 15 min. OCTT with scintigraphy was defined as the time at which at least 10% of the label had entered the colon. Breath samples were obtained every 10-15 min for 10 h and measured by isotope ratio mass spectrometry. OCTT was defined as the time of first significant increase above baseline. The results were compared using correlation and Altman-Bland statistics. RESULTS: OCTT results from scintigraphy (mean OCTT = 283+/-53 min) and breath test (mean OCTT = 292+/-58 min) correlated well (r = 0.94). Altman-Bland statistics showed close agreement between scintigraphy and breath test. No significant difference between male and female subjects was observed. CONCLUSION: The breath test using 13C-LU is a valid alternative to scintigraphy techniques for measuring OCTT.
Comparison of total and compartmental gastric emptying and antral motility between healthy men and women.
There is increasing evidence of gender-related differences in gastric emptying. The purpose of this study was first, to confirm the difference in gastric emptying for both solid and liquid test meals between healthy men and women, and secondly, to investigate the origin of this difference by studying regional gastric emptying and antral motility. A standard gastric emptying test with additional compartmental (proximal and distal) evaluation and dynamic imaging of the antrum was performed in 20 healthy women studied during the first 10 days of the menstrual cycle, and in 31 healthy age-matched men. In concordance with previous reports, women had a longer half-emptying time for solids as compared to men (86. 2+/-5.1 vs 52.2+/-2.9 min, P<0.05). In our observations this seemed to be related to a significantly prolonged lag phase and a significant decrease in terminal slope. Dynamical antral scintigraphy did not show a significant difference. The distribution of the test meal within the stomach (proximal vs distal) showed more early proximal retention in women as compared to men. The terminal slope of the distal stomach was significantly lower in women. We did not observe a significant difference in gastric emptying of the liquid test meal between men and women. Gastric emptying of solids is significantly slower in healthy women as compared to men. These findings emphasise the importance of using different normal values for clinical and research purposes in gastric emptying scintigraphy in men and women. The difference could not be explained by antral motility alone. Increased proximal retention and a lower terminal emptying rate in women are observations to be further investigated.
Tc-99m tetrofosmin uptake in pulmonary tuberculosis with Pott's disease.
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Pulmonary tumor microembolism.
Pulmonary tumor embolism is an often missed antemortem diagnosis in patients with cancer and respiratory failure. Although rare, this complication is an important cause of additional morbidity. Referred for radionuclide pulmonary perfusion and ventilation scintigraphy, a typical pattern of multiple subsegmental peripheral defects on perfusion lung scanning without matching ventilation defects, suggesting a high probability of pulmonary thromboembolism, often leads to false conclusions. We present a case of bilateral multiple subsegmental mismatched defects in lung ventilation perfusion scintigraphy, where autopsy confirmed the diagnosis of pulmonary tumor embolism, secondary to an undifferentiated ductal type adenocarcinoma of the pancreas. Pulmonary tumor embolism is an entity to keep in mind in patients treated for carcinoma presenting with (sub) acute dyspnea.
Serum tissue polypeptide antigen (TPA): monoclonal or polyclonal radio-immunometric assay for the follow-up of bladder cancer.
Tissue polypeptide antigen (TPA) is a serological tumor marker, measuring cytokeratin 8, 18 and 19, used in the follow-up of non squamous epithelium- and derived neoplasms. It has been demonstrated that TPA is reliable in the monitoring of the efficacy of a curative or palliative treatment of bladder cancer. Recently, a monoclonal antibody-based assay for TPA (TPA-M) has been developed, which seems to be equivalent to the polyclonal-based assay. The aim of the study was to assess the superiority of the monoclonal to the polyclonal test in patients with bladder carcinoma. The value of tissue polypeptide antigen was therefore measured both with TPA and TPA-M IRMA. A correlation coefficient of 0.96 was obtained. Precision testing showed a lower overall variability of TPA-M. Since both tests correlate well and TPA-M testing is more precise, faster and easy to perform, we conclude a superiority of TPA-M and advise the monoclonal test as best suited for clinical use in the follow-up of bladder cancer patients with poorly differentiated superficial, locally advanced or systemic disease after curative or palliative therapy.