[Fluorosis following the uncontrolled administration of sodium fluorophosphate].
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Biomedical subjects
Publications and source records attributed to T Schaub.
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Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for urinary calculi. 117 patients were studied prospectively with 99mTc mercaptoacetyltriglycine (MAG3) before and after ESWL. 79 (66%) of the 119 kidneys treated had abnormal findings. Of these 63/119 (53%) had abnormal scans. 41 (65%) had focal lesions with a delayed intrarenal transport. The remaining 22 had a diffuse delay of intrarenal transport. A loss of relative renal function of 3% and more compared to the pretreatment values was observed in 50/119 (42%) patients. 99mTc MAG3 should be done routinely together with radiologic tests (CT or MRI) before and after ESWL to select the patients at risk for post ESWL hypertension.
The biosynthesis of leukotrienes (LT) C4 and B4 is followed by an export of these mediators into the extracellular space. This transport was characterized using plasma membrane vesicles prepared from mastocytoma cells and identified as an ATP-dependent primary active process. The apparent Km-values were 110 nM for LTC4 and 48 microM for ATP. The transport rate was highest for LTC4, whereas LTD4, LTE4, and N-acetyl-LTE4 were transported with relative rates of 31, 12 and 8%, respectively, at a concentration of 10 nM. LTB4 transport was also dependent on ATP. LTC4 transport was inhibited by LTD4 receptor antagonists (IC50 = 1.0 microM for MK-571 and 1.3 microM for LY245769) and by the inhibitor of leukotriene biosynthesis MK-886 (IC50 = 1.8 microM). The ATP-dependent export carrier for leukotrienes in leukotriene-synthesizing cells represents a novel member of the family of ATP-dependent exit pumps.
In an experimental study on pigs, 28 stone-free kidneys were treated with a second generation lithotripter. Histologically, acute bleeding was seen after ESWL in 23 (82%) of the 28 treated kidneys. CT studies before and after contrast were correct in 20/28 (74%) cases. It was shown that extracorporeal shock waves cause renal bleeding that is only partially detected by computed tomography. It can be concluded that the CT findings seen in a high percentage of renal stone patients after ESWL represent bleeding. The incidence of renal bleeding after ESWL and thus the possible risk of hypertension has obviously been underestimated so far in clinical studies.
In a pig model, 13 kidneys were treated with a second generation lithotripter and examined by CT immediately and three weeks after ESWL. 9 (69%) acute traumatic lesions were seen in CT without, and 10 (77%) in CT with contrast in the 13 treated kidneys. After 3 weeks only 1 residual lesion persisted in CT contrast studies. On the histopathologic specimens residuals of bleeding were found in 3 (23%) of the 13 kidneys treated, which could not be seen in CT studies. CT is accurate in monitoring acute traumatic renal lesions after ESWL, but appears less reliable in chronic ones. Three weeks after ESWL traumatic renal lesions show marked regression.
The influence of moderate ambient ozone exposure on spirometric lung function and bronchial responsiveness was analyzed in 13 healthy adult nonsmokers and 11 asymptomatic smokers. The study was divided into an initial investigation at low atmospheric ozone concentrations of about 80 (range 68-102) micrograms/m3 and a subsequent similar testing at moderately elevated ozone concentrations above 140 (range 145-205) micrograms/m3. Overall there was a slight but significant impairment in forced expiratory volumes (p less than 0.002) at elevated compared with low ozone concentrations. Furthermore, a significant increase in bronchial responsiveness was shown, with a decrease in threshold dose for inhaled metacholine to produce a 50% fall in specific airway conductance (p less than 0.02). In both smokers and nonsmokers there was a similar change in lung function at ambient ozone concentrations, with more pronounced bronchial irritation in the smokers group. It is concluded that even moderately elevated ambient ozone concentrations can induce slight but significant ventilatory obstruction and an obvious increase in bronchial responsiveness in healthy adults. Although the minor impairment of lung function did not cause manifest acute respiratory problems, it still reduced maximal physical ventilation capacity. The results further support the assumption that air pollution may act as a primary trigger in the development of obstructive airway disease.
The liver is the major organ which eliminates leukotriene C4 (LTC4) and other cysteinyl leukotrienes from the blood circulation into bile. Transport of LTC4 was studied using inside-out vesicles enriched in canalicular and sinusoidal membranes from rat liver. The incubation of canalicular membrane vesicles with [3H]LTC4 in the presence of ATP resulted in an uptake of LTC4 into vesicles. The initial rate of ATP-stimulated LTC4 uptake was about 40-fold higher in canalicular than in sinusoidal membrane vesicles. When liver plasma membrane vesicles were incubated in the absence of ATP, an apparent transient uptake of LTC4 was observed which was temperature-dependent and not affected by the osmolarity. This indicates that LTC4 was bound to proteins on the surface of plasma membrane vesicles. Two proteins with relative molecular weights of 17,000 and 25,000 were detected by direct photoaffinity labeling as major LTC4-binding proteins. One protein (Mr 25,000) was ascribed to subunit 1 (Ya) of glutathione S-transferase which was associated with the membrane. LTD4, LTE4, N-acetyl-LTE4, and omega-carboxy-N-acetyl-LTE4 were also transported into liver plasma membrane vesicles in an ATP-dependent manner with initial rates relative to LTC4 (1.0) of 0.46, 0.11, 0.35, and 0.22, respectively. Mutual competition between the cysteinyl leukotrienes and S-(2,4-dinitrophenyl)-glutathione for uptake indicated that they are transported by a common carrier. Apparent Km values of the transport system for LTC4, LTD4, and N-acetyl-LTE4 were 0.25, 1.5, and 5.2 microM, respectively. The ATP-dependent transport of LTC4 into vesicles was not inhibited by doxorubicin, daunorubicin, or verapamil, or by the monoclonal antibody C219, suggesting that the transport system differs from P-glycoprotein. Liver plasma membrane vesicles prepared from mutant rats deficient in the hepatobiliary excretion of cysteinyl leukotrienes lacked the ATP-dependent transport of cysteinyl leukotrienes and S-(2,4-dinitrophenyl)-glutathione. These results demonstrate that the ATP-dependent carrier system is responsible for the transport of cysteinyl leukotrienes and glutathione S-conjugates from the hepatocytes into bile.
Plain X-rays computed tomographic and magnetic resonance images all yield information on the pathophysiology of diseases with spinal involvement. Descriptions of the following nuclear medicine methods are presented: Bone scanning with 99 m-technetium labeled phosphonate complexes used for the evaluation of skeletal metastases, primary bone tumors, traumatic, degenerative, and postoperative changes as well as in inflammatory conditions. Specific radionuclides used for the localization of inflammatory conditions are radioactive labeled leucocytes. Iodine total body scans used to detect spinal metastases of follicular and papillary thyroid carcinoma. 201-thalliumchloride is used as a tumor-marker with high affinity and sensitivity in malignant thyroid tumors. 131- or 123-iodine-meta-iodobenzylguanidine scans used in the detection of metastases of pheochromocytoma and neuroblastoma. Immunoscintigraphy with radioactive labeled anti-CEA antibodies used for the specific labelling of metastases of gastrointestinal tract tumors, melanoma, breast, and ovarian carcinoma. The value of the various nuclear medicine methods in the diagnostic schedule is illustrated in case reports.
Melorheostosis, Osteopoikilosis and Osteopathia striata Clinical Relevance and Bone Scintigraphy Melorheostosis, Osteopoikilosis and Osteopathia striata are rare conditions. Although there is no casual therapy for any of the three diseases, differential diagnosis is important because concomitant or resulting impairments deserve orthopaedic or medical treatment. The analysis of typical cases with their clinical, roentgenological and radionuclide presentation shows the need of an accurate diagnosis to prevent senseless treatment or lost therapeutic opportunities.
The radiological and scintigraphic findings of 26 patients with histologically proven Ewing's sarcoma were analysed. Three-phase bone scan should be done early in patients presenting with pain and normal radiographs. Perfusion and metabolism of a bone lesion can be assessed by skeletal scintigraphy. Bone metastases are first seen on bone scan. In the follow-up of the patient bone scans at regular intervals are essential to detect bone metastases and tumour recurrence. The scintigraphic findings have to be correlated with radiographs and if these are negative a short-term control is indicated. Three-phase bone scans can assess the tumours response to therapy.
Preoperative and postoperative computer tomographs in 24 patients suffering from idiopathic scolioses who were treated by CD (Cotrel-Dubousset) surgery, showed a mean correction of the rotatory angle in the apex vertebra amounting to 28.5% in relation to the anterior midline of the body, and 23.8% in relation to the sagittal plane. Best results were seen in lumbar curves and in the lumbar curves of double major curves. In thoracic curves only minor corrections were observed. CD instrumentation is the first dorsal procedure that allows a three-dimensional correction of the scoliotic spine.
Radionuclide imaging (99mTc bone scans, 99mTc S colloid scans, 99mTc brain scans and 67gallium scans) and bone radiographs were done in 54 children with histiocytosis X. The results are discussed, compared with the literature and indications for the different nuclear medicine studies are given.
In a 43 year old man with an inguinal abscess a paravertebral soft tissue swelling suggested a gravitation abscess. On CT only a retrocrural fat accumulation was identified.
Tumours originating from the ceruminous glands can be classified into five types: adenomas, adenocarcinomas, adenoid-cystic carcinomas, pleomorphic adenomas and mucoepidermoid carcinomas. The diagnosis is based on histological findings and can be quite difficult if the tumour status has to be determined. Classification into one of the five types of tumours may be facilitated at times by studying the clinical pattern. Three case reports are quoted as examples to illustrate that neoplasias originating from the ceruminous glands can assume considerable proportions and must be considered in differential diagnosis when assessing space-occupying growths in the soft tissue of the neck. Whereas prognosis of adenomas and pleomorphic adenomas can be considered to be good, it must be regarded as likely to be infaust in the case of adenocarcinomas, adenoid-cystic carcinomas and mucoepidermoid carcinomas. The use of cytostatics resulted in a marked reduction of the tumour in one of the described cases of adenocarcinoma.
The difficulties arising in diagnosing osteoidosteoma are demonstrated by means of 30 surgically treated cases and the results are compared with those available from the literature. The value of bone scintigraphy and of tomography within the framework of a diagnostic concept is underlined. Diagnosis is confirmed and treatment is effected by the successful surgical removal of the nidus.
The unfavourable prognosis of malignant synoviomas makes it essential to arrive at an early diagnosis. The early clinical symptoms and radiological appearances may be minimal and sometimes absent. It is therefore advisable to obtain bone scintigrams with perfusion and early images as well as the radiographs. The local extent of the tumour can be evaluated by ultrasound and CT. Angiography is required only if the relationship to the vessels cannot otherwise be ascertained, or if intra-arterial therapy is being considered. The final diagnosis depends on a biopsy. For subsequent observation, both scintigrams and radiographs should be obtained. It is essential to perform a three-phase scintigram. This improves the recognition of recurrences and of soft tissue or bone metastases. Most bone metastases are visible on scintigraphy, but a normal scintigram in the presence of an osteolytic lesion on a radiograph may be obtained. Pulmonary metastases can only be demonstrated radiologically.
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