Biomedical subjects
Publications and source records attributed to S Gruenewald.
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93 patients with hormone refractory metastatic prostate cancer were entered on a prospective study to measure reduction in pain and changes in quality of life (QoL) after the administration of 150 MegaBequerel (MBq) Strontium-89 (Sr-89). QoL was assessed using a validated instrument, the Functional Living Index - Cancer (FLIC) questionnaire. Pain response was measured using the Radiation Therapy Oncology Group scoring system. Overall there was limited QoL improvement over 3 months following Sr-89. However, in the 53 patients (63%) achieving pain responses, QoL did significantly improve within 6 weeks of receiving Sr-89 compared to patients with stable or worsening bone pain, and this was independent of other parameters that might influence QoL outcomes, such as performance status, baseline PSA and extent of skeletal disease (P = 0.004). PSA 'response' occurred in 30 patients (37%) over 4 months after Sr-89. This did not appear to correlate with clinical improvement. This study supports the presumption that improvement in pain following Sr-89 is accompanied by better QoL. The lack of correlation of PSA response and clinical parameters indicates that in the palliative setting, PSA may not provide a useful surrogate for treatment outcome.
A 48-year-old woman underwent cadaveric renal transplantation for end-stage renal failure secondary to polycystic kidney disease. Nine months after transplantation, intermittent renal dysfunction and severe graft hydronephrosis developed despite the presence of a ureteric stent. A Tc-99m MAG3 scan performed with the patient standing showed complete transplant obstruction. Rapid tracer clearance with progressive bladder filling was present when the patient was imaged in the supine position. Ureteric obstruction is the most common urologic complication of renal transplantation. However, postural ureteric obstruction has been described only rarely. This case indicates that posture may affect ureteric patency and highlights this potential pitfall in the evaluation of intermittent graft dysfunction by diuretic renography.
The aim of the present paper was to assess the utility of Levovist in defining the pathology of liver masses. Levovist is a new ultrasound contrast agent consisting of galactose microparticles, air bubbles and palmitic acid. Prospective studies were performed in patients referred for further evaluation of known liver masses. Levovist was peripherally injected and colour Doppler ultrasound studies were performed. Findings were correlated with clinicopathology and three other imaging modalities: biphasic spiral CT, CT arterial portography and contrast MRI. Twenty-five patients were studied (15 male and 10 female) in the age range 25-74 years. Liver masses ranged from 0.5 to 7 cm in maximum diameter. Thirteen lesions were benign and 12 were malignant (four hepatomas (HCC) and eight metastases). Levovist enhancement occurred in 18 lesions. Of these, six were benign (four focal nodular hyperplasias (FNH) and two haemangiomas). All 12 malignant lesions demonstrated enhancement. The HCC showed a mosaic pattern of central and peripheral enhancement, and the FNH demonstrated a spoke-wheel pattern. It was not possible to distinguish between haemangiomas and malignant lesions. Non-enhancing lesions may well be benign, with all malignancies showing some enhancement. Characteristic enhancement patterns were found for HCC (mosaic) and FNH (spoke-wheel). It was not possible to distinguish between metastases and benign lesions (haemangiomas) when the pattern of enhancement was peripheral.
Low-dose dopamine (LDD) is commonly used after kidney transplantation as a renoprotective agent, although the benefits of dopamine (DA) in this setting are controversial. LDD increases renal blood flow, decreases resistive index (RI) and causes diuresis in normal kidneys. We hypothesised that the vasculature of a denervated renal transplant may not respond to DA in the same way as healthy native kidneys. In a prospective, controlled study, renal blood flow velocity and vascular resistance were measured by Doppler ultrasound in recent kidney transplants (n = 20) over a range of DA doses (0-5 microg/kg/min). Main renal artery velocity was lower in kidneys with acute renal dysfunction than in those with normal function (0.60 +/- 0.31 vs. 0.81 +/- 0.24, respectively, p < 0.05). There was no demonstrable haemodynamic effect of LDD on either RI or main renal artery velocity as measured by Doppler ultrasound. Interestingly, the only significant correlation with mean RI was trough cyclosporin A level (r = 0.57, p < 0.001). Technical or timing factors cannot be used to explain the absence of DA effect, with equivalent doses capable of producing vasodilatation and reduced RI in studies of normal kidneys. In summary, these findings contrast the DA response of healthy native kidneys and may explain studies showing no clinical benefit of LDD in the early post-transplant period. These data suggest an insensitivity of recently implanted kidneys to the vasodilatory effects of LDD, that other factors such as cyclosporin A vasoconstriction may also be important, and question the rationale for routine LDD after kidney transplantation.
A case is presented of a patient with a psychiatric illness and pica who developed a pyogenic liver abscess due to perforation of the duodenum by a pen. This report emphasizes the importance of ultrasound and computed tomography in making a rapid diagnosis. The relative superiority of ultrasound was revealed because an anaesthetic was not required for scanning, and in addition to the liver abscess, the precise location of the perforating foreign body was demonstrated.
Several methods of determining gamma-camera collimators hole alignment and integrity were compared. Four collimators were tested: two new cast collimators and two used foil collimators, one with damage to the protective surface. The most sensitive tests for collimator damage were found to be the collimated x-ray source, COR offset test and collimator hole alignment test.
Gated heart pool scan measuring left ventricular ejection fraction (LVEF) was performed preoperatively in 72 patients presenting for elective repair of abdominal aortic aneurysm. Patients with a positive cardiac history were more likely to have a LVEF of less than or equal to 45 per cent (P less than 0.001). The operative mortality rate was 4 per cent. Each of three patients who died had a LVEF less than or equal to 35 per cent and developed cardiac failure which led to renal failure. Five other patients developed cardiac failure manifested by acute pulmonary oedema during the early postoperative period. There was no statistically significant association between a positive cardiac history and the occurrence of postoperative cardiac failure or death. However, patients with a LVEF of less than or equal to 45 per cent were more likely to develop postoperative cardiac failure (P = 0.004) while patients with a LVEF of less than or equal to 35 per cent had a greater chance of dying (P less than 0.001). No patient died with a LVEF greater than 35 per cent. Preoperative evaluation of LVEF can select patients at high risk of cardiac death from repair of abdominal aortic aneurysm. Such patients could be followed conservatively if they remain asymptomatic and the aneurysm does not enlarge. If operation is considered mandatory, patients with a low LVEF should receive intensive perioperative monitoring with enhancement of ventricular performance.
Four patients with complex abdominal hydatid cysts, one of whom also had pulmonary and pelvic involvement, were treated with up to six 28-day courses of albendazole 400 mg per oral twice daily. As part of a prospective study, serial ultrasound scanning was performed after each 28-day course of albendazole and showed evidence of remission of disease in all four patients. Transient minor abnormalities of liver function were noted during treatment. Ultrasound scanning showed the disappearance of daughter cysts and cystic septation, increase in echogenicity and marked reduction in cyst size. Consolidation of these changes and, in some cases, disappearance of the cysts, were noted with continued therapy. Albendazole seems to be a safe and effective agent in the treatment of recurrent hydatid disease, exerting most of its cysticidal activity within the first 2-3 months of therapy.
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Recovery of diaphragm activity after bilateral diaphragmatic paralysis was monitored in a term infant using a mechanical sector scanner fitted with a 5 MHz transducer. The ratio of diaphragmatic excursion during spontaneous breathing and ventilator assistance was used an objective measure for comparison of diaphragmatic activity during recovery. Ultrasound assessment of diaphragm contraction may be used to study progress in diaphragmatic paralysis.
Patients with extracranial cerebrovascular disease and peripheral vascular disease are at increased risk of ischaemic heart disease with resulting increased risk of early and late mortality following vascular reconstruction. Over a two year period, 67 patients undergoing carotid or aortic surgery were investigated preoperatively with dipyridamole-thallium scan. There were three positive scans in the first 17 patients; two of these patients suffered a postoperative myocardial infarction (one fatal), compared to none of 14 who had a negative scan (p = 0.02). There were seven positive scans in the next 50 patients. Patients with left main trunk or triple vessel disease were recommended to have coronary artery bypass prior to or combined with the vascular reconstruction. There were no deaths or postoperative myocardial infarction in this group, this improvement in morbidity being statistically significant (p = 0.01). Dipyridamole-thallium scanning is an effective screening procedure for coronary artery disease. Patients with a positive scan are at increased risk of postoperative myocardial infarction following vascular reconstruction. Further investigation with coronary arteriography prior to vascular reconstruction is recommended in patients with positive scans. Coronary artery bypass should be performed prior to or combined with the vascular reconstruction in patients with left main trunk or triple vessel disease.