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Biomedical subjects

U Büll

Publications and source records attributed to U Büll.

At least 91 records · Page 5Linked to original sources
PubMed1990

[99mTc-2-methoxy-isobutyl-isonitrile in the diagnosis of coronary heart disease: results of a multicenter study].

A total of 226 patients was studied in a phase-III multicenter trial to compare the results of stress/rest 99mTc-MIBI with 201TI scintigraphy and/or coronary arteriography. The evaluation of planar and SPECT imaging was based on a semiquantitative visual scoring. A congruent diagnosis was generated from all planar 201TI and 99mTc-MIBI scintigrams performed in 36 patients. In 62 of 63 patients, SPECT-studies with 99mTc-MIBI and 201TI led to an identical diagnosis. In one patient a positive result was obtained with 201TI-SPECT whereas 99mTc-MIBI was negative. Segmental agreement for 1509 SPECT segments was 85.7%, for 554 planar segments it was 86.6%. In comparison to coronary arteriography, performed in 180 patients, the overall sensitivity for the correct diagnosis of coronary artery disease (CAD) was 86% for planar MIBI scintigraphy or 92% for MIBI-SPECT. Overall specificity was 100% for planar imaging and 57% for SPECT. The low specificity of MIBI-SPECT was probably due to high prevalence of CAD in this study population. In a subgroup of 43 patients, who underwent coronary angiography, identical results were found with 99mTc-MIBI and 201TI. Only one patient showed a positive scintigraphic result with both 99mTc-MIBI and 201TI without angiographically proven stenosis greater than 50% or prior myocardial infarction. Vessel sensitivities in stenosed coronary arteries (greater than 50% stenosis) were 54% for the LAD and 87% for the RCX/RCA areas with MIBI-SPECT, or 51% or 79% for planar scintigraphy, respectively. Vessel specificities for SPECT were 65% in the LAD or 52% in the RCX/RCA, or 90% or 83% in planar imaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Clinical significance of immunoscintigraphy for the diagnosis and treatment of gastrointestinal malignant tumors].

Eighty-one immunoscintigraphy (IS) studies in 80 patients with gastrointestinal malignancies were re-evaluated retrospectively to analyze accuracy and clinical impact of the IS findings. Selection of patients was based upon complete diagnostic records and a clinical follow-up of at least 6 months. The 3 antibody preparations used (99m-Tc labelled complete anti-CEA antibodies (BW 431/26), 111-In labelled F(ab')2-fragments against CEA (BW 431/31), and a mixture of 131-I labelled F(ab')2-fragments against CEA and CA 19-9 (IMACIS-1] yielded equal diagnostic sensitivities (65%, range 60-78%) except for liver metastases. These were preferably detected by the 131-I labelled compound. Best results were gained in local recurrencies of gastrointestinal cancer (12/15 true positive = 80%). Among these were 3 out of the 4 lesions which had been exclusively recognized by IS. Thus IS should be applied in patients with suggested local recurrencies and inconclusive outcome of routine diagnostic workup. A widespread and frequent use of IS (e.g. screening of metastases) cannot be advocated since diagnostic results were not convincing and the immunologic risks of IS (development of human anti-mouse antibodies) are still under discussion.

Antibodies, Monoclonal↗
PubMed1989

[Reduced myocardial fatty acid utilization in coronary heart disease following symptom limited ergometric stress. Detection of pathologic metabolic patterns using iodine-123-phenylpentadecanoic acid and sequential SPECT].

Regional cardiac free fatty acid metabolism of 41 patients with coronary artery disease (CAD) and of 10 controls with normal coronary arteries was studied by means of I-123 phenylpentadecanoic acid (IPPA), a radioiodinated palmitic acid analog, and sequential single photon emission tomography (SPECT). All patients and controls underwent symptom--limited bicycle exercise, with the tracer being injected at peak stress. More than 99% of left ventricular segment of controls showed homogeneous tracer uptake and release, indicating homogeneous free fatty acid turnover in normal myocardium. Homogeneous postexercise uptake was followed by decreasing segmental activity in 75.1% of normally perfused segments in patients with CAD. Sixty-five percent and 88.6% of segments, assigned to the perfusion bed of 50%-75% and greater than 75% obstructed vessels had decreased IPPA release and/or reduced IPPA uptake. Patients with exercise induced ischemia had focal metabolic abnormalities in jeopardized myocardium for significantly longer time than clinical or electrocardiographic signs of ischemia (p less than 0.01). All patients with CAD and a negative stress test had metabolic abnormalities, but exhibited, compared to ECG--positive patients, less pronounced segmental metabolic aberrations. These findings indicate reduced cardiac utilization and delayed oxidation of IPPA, associated with exercise-induced ischemia in CAD. The metabolic changes suggest a marked sensitivity to ischemia as well as prolonged postischemic abnormalities of cardiac fatty acid metabolism in jeopardized myocardium.

Angina Pectoris↗
PubMed1988

Nuclear imaging in loosening of hip-joint endoprostheses.

In 28 patients with surgically proved loosening of hip-joint endoprostheses and 42 patients without loosening between 2 and 12 years after implantation and without clinical or radiological signs of loosening we performed clinical evaluation, and radiographs, a three-phase bone scan, and a 111indium-labeled leukocyte scan (ILLS). The sensitivity of radiographs in the group with loosening of hip-joint endoprostheses in the femoral as well as in the acetabular component was only about 50%, while the specificity was almost 100%. With a combination of radiographs and ILLS we reached a sensitivity in the acetabular component of 100% and in the femoral component of 88%, but specificities of only 57% in the acetabular component and 40% in the femoral component were found. We found that the ILLS is a very helpful method of examination to detect loosening of hip-joint arthroplasties in doubtful cases.

Hip Joint↗
PubMed1988

[Significance of basal TSH and free T3 as compared with an extended in vitro diagnosis in the understanding of functional disorders of the thyroid].

Data of 411 untreated patients undergoing thyroid investigations were stored in a data base system. Three combinations of thyroidal hormone parameters were compared with respect to their clinical value. In patients with concordant basal TSH (bTSH) and free T3 (fT3)-values (e.g. bTSH normal and fT3 normal, bTSH decreased and fT3 increased) it could be demonstrated that the predictive value of the combined evaluation of basal TSH (supersensitive) and free T3 alone (97% in normal thyroid function, 98% in thyrotoxicosis, and 97% in hypothyroidism) was sufficient. Additional determinations of T4 parameters did not increase predictive value (e.g. TT4: 95% in thyrotoxicosis). Thus, thyroid disorders may currently be diagnosed by the combined evaluation of basal TSH and free T3, saving costs without loss of diagnostic efficacy.

Clinical Laboratory Techniques↗
PubMed1987

Combined evaluation of first pass radionuclide angiography and equilibrium radionuclide ventriculography in the diagnosis of coronary artery disease. II. Results during exercise.

Results of 203 patients who underwent first pass radionuclide angiography (FP) and quantitative equilibrium radionuclide ventriculography (qERNV) were stored in a data base system and evaluated statistically. Eighty eight of these patients also underwent exercise equilibrium radionuclide ventriculography (E-qERNV). In patients with coronary artery disease (CAD) without previous myocardial infarction (MI), evaluation of global and regional ejection fraction (gEF, rEF) at rest revealed a poor sensitivity of 64%, the specificity was about 71% (qERNV). FP at rest revealed similar values of sensitivity (69%) and specificity (83%). Additional assessment of stress induced changes of gEF, significantly (P less than 0.05) improved sensitivity of qERNV in CAD patients without a history of previous MI to 84% (specificity 86%). In patients with one previous MI, however, similar values of sensitivity were found (R-FP: 87%, R-qERNV: 84%, E-qERNV: 93%). In patients with several MI's, sensitivity was above 90% at rest and during exercise (R-FP: 96%, R-qERNV: 93%, E-qERNV: 100%).

Coronary Disease↗
PubMed1987

[Radioimmunoscintigraphy using SPECT: methodology, problems and clinical experiences].

Radioimmunoscintigraphy (RIS) with 111In-and 131I-labelled monoclonal antibodies (MAbs) against CEA and/or CA 19-9 was performed in 83 patients with various gastrointestinal carcinomas. A total of 276 body regions could be examined. The results of planar scintigraphy and SPECT were compared intraindividually. Using 111In-labelled MAbs the sensitivity of RIS was significantly improved by SPECT (88.9 vs. 52.4% with planar scintigraphy, p less than 0.01). For 131I-labelled MAbs the effect was smaller (83.9 vs. 65.6% with planar scintigraphy, n.s.). This finding can be explained by different kinetics and biodistribution of the used MAb preparations. 111In-labelled MAbs with long whole-body retention and rapid blood clearance reveal ideal qualities for SPECT; on the other hand, the short whole-body retention of 131I-labelled MAbs leads to small count rates and therefore long counting times that make delayed SPECT unsuitable in clinical practice.

Antibodies, Monoclonal↗
PubMed1986

Comparison of 75SeHCAT retention half-life and fecal content of individual bile acids in patients with chronic diarrheal disorders.

Measurement of the retention of 23-75Se-25-homotaurocholic acid (SeHCAT) has been suggested as a new test for ileal function. We investigated 31 patients with chronic diarrhea, 10 with ileal Crohn's disease and 21 with diarrhea but without ileal disease. The whole-body retention half-life of 1 mu Ci SeHCAT was determined and compared to the fecal content of total and individual bile acids. Patients with ileal disease had increased primary fecal bile acids (chenodeoxycholic acid: mean 6.95 mg/g dry weight, range 3.15-10.6 mg/g; cholic acid: mean 18.15 mg/g, range 10.3-33.9 mg/g) and a short SeHCAT retention (mean 11.9 h, range 2-24 h), whereas patients with intact ileum had normal fecal bile acids and a SeHCAT retention of 85.9 h (range 28-216 h). SeHCAT retention half-life differentiated well between patients with ileal disease and patients with normal ileum, thus indicating the SeHCAT test as a valid investigation method for detection of primary bile acid malabsorption in patients with chronic diarrhea and ileal dysfunction.

Adolescent↗
PubMed1986

[Results of SPECT thallium-201 of the myocardium in the diagnosis of coronary disease and the follow-up of percutaneous transluminal coronary angioplasty].

Sensitivity and specificity of 201Thallium-SPECT in rest-exercise studies were evaluated in 129 patients in comparison to coronary morphology. In addition, the results of 70 patients, examined before and after dilatation of coronary stenoses by PTCA were obtained. In this group, quantification of SPECT images was tested. Sensitivity in detection of CAD was 93%, specificity 84%. False negatives were most frequently found in the posterior wall. After PTCA 73% of the segments improved. With quantification, an increase of vitality by 11.6% and a decrease of the redistribution factor by a value of 8 was documented. 201Thallium-SPECT of the myocardium was found to be very useful to both evaluate CAD and follow-up interventional procedures. A quantification of slice-images is useful to objectively reveal therapeutic success.

Angiography↗
PubMed1986

Three-dimensional ROI-based quantification of stress/rest 201Tl myocardial SPECT: presentation of a method.

A semiautomated method for three-dimensional quantification of stress/rest 201Tl myocardial SPECT of the left ventricle (LV) is introduced. A total of 33 ringsegment-shaped regions of interest (ROIs) are distributed over 6 oblique (short axis cuts) double-slices (thickness 1.3 cm) from LV apex to base, commencing with 1 ROI for the apex up to 8 ROIs for the base (1-4-4-8-8-8). Within the last two double slices an additional adjacent ROI is automatically placed in the upper right quadrant to observe lung TI-uptake. Correspondence of slices for exercise and rest is achieved by adjusting the long axis outlines rebuilt from summed profiles of 15 oblique slices of each examination. Calculated numeric arrays of the extracted parameters (vitality, washout and redistribution) are displayed in a target-like two-dimensional polar fashion.

Coronary Disease↗
PubMed1985

[Comparison between cimetidine-pirenzepine and antacids for the prevention of stress hemorrhage in intensive care patients. A controlled clinical study on 125 patients].

In a controlled clinical trial, the efficacy of an intravenous combination of cimetidine and pirenzepine (group A: 62 patients) was compared with that of an intragastric administration of a magnesium-aluminium-hydroxide concentrate (group B: 58 patients) in preventing visible and occult upper gastrointestinal tract bleeding in intensive-care patients. It was found that both forms of therapy had the same favourable effect on the extent and incidence rate of visible and occult gastric bleeding. The antacid was more effective than the cimetidine-pirenzepine combination in raising the pH level to 4 or higher (P less than 0.05). Intensive-care patients should, therefore, be treated with the antacid whenever possible, since it is equally effective as the cimetidine-pirenzepine combination in preventing bleeding from the upper gastrointestinal tract, whereas it is superior in elevating the gastric pH. Besides, the use of the antacid is also less costly.

Adult↗
PubMed1985

Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels.

To quantitate visual findings in lymphoscintigraphy with 99mTc-labeled stannous sulfur colloids, a numeric index of transport kinetics was designed by combining visual assessment of five criteria: temporal and spatial distribution of the radionuclide, appearance time of lymph nodes, and graded visualization of lymph nodes and vessels. For assessment, scores were used ranging from 0 to 9. Thus, the resulting transport index (TI) ranged from 0 (normal) to 45 (pathological). TI in healthy extremities was less than 10. Lymphoscintigraphy was performed routinely in healthy lower extremities to ensure normal drainage before transplantation. In 122 investigations of upper and lower extremities, TI was found to be very sensitive (97.4%). Specificity was 90.3%. An interobserver study in 179 investigations revealed a high correlation (r = 0.96). A total of 23 patients underwent autologous lymphatic transplantation. The average decrease of TI was 5.9: 31.1 before and 25.2 after transplantation. This decrease of TI was correlated with a marked decrease of the volumes of the extremities (from 3423 ml to 2580 ml). Changes in TI and volume were significant (p less than 0.05). This method of evaluation has proved to be very sensitive, reproducible, and able to measure the transport capacity of only two or three transplanted lymph collectors.

Adult↗
PubMed1985

[Amrinone in acute and long-term therapy].

The purpose of this study was to evaluate acute and chronic therapeutic effects of the positive inotropic vasodilating agent amrinone. 50 patients with cardiomyopathy or coronary artery disease and left heart failure participated in the study. Swan-Ganz catheterisation was used in 15 patients; following injection of 1.5 mg/kg amrinone, the mean pulmonary pressure decreased by 26%, the wedge pressure by 27%. Cardiac index rose by 18% (p less than 0.01). 35 patients were examined in the oral study, the avg. dose being 300 mg/day. After 2 and 12 weeks of therapy, exercise tolerance increased by 22% and 13% respectively (p less than 0.05). Cardiac output after maximal workload as determined by equilibrium radionuclide ventriculography increased by 27% and 30% respectively (p less than 0.05). 34 side effects occurred in 23 of 35 patients: nausea, orthostasis, angina pectoris, tachyarrhythmia, hepatotoxicity, thrombocytopenia, hyperuricemia and brown coloring of finger-nails. From the hemodynamic point of view amrinone is intravenously and orally effective. Careful selection of patients and frequent examinations are however necessary.

Administration, Oral↗
PubMed1985

[Effect of body loading on the specific blood radioactivity following 99mTc in-vivo erythrocyte labelling. The effects on determining end-diastolic volume in equilibrium radionuclide ventriculography].

In 40 patients who underwent stress-equilibrium-radionuclide-ventriculography, we examined the stress-induced change of blood radioactivity concentration. A significant (p less than 0.025) increase of blood radioactivity concentration after peak exercise (mean +7.2%) was found. This increase was the result of a significant (p less than 0.025) increase of the hematocrit (mean +4.7%) due to a decrease of the plasma volume. The changes of radioactivity concentration and hematocrit neither show any correlation with peak exercise value, integral exercise or duration of exercise, nor with the increase of heart rate or blood pressure. The increase of end-diastolic volume appears to result largely from a stress-induced increase of blood radioactivity concentration. Thus, radioactivity concentration should be measured before and after exercise when evaluating volume changes caused by stress-equilibrium-radionuclide-ventriculography.

Cardiac Output↗
PubMed1984

[Course of contraction during physiological and ventricular pacemaker stimulation].

Phase imaging of gated radionuclide ventriculography was applied to the identification of cardiac activation patterns in patients with sinus rhythm (n = 14) or with ventricular (VVI)- (n = 28), atrial (AAI)- (n = 3) or AV-sequential (DDD)-pacing (n = 17). In patients with sinus rhythm, AAI- or DDD-pacing, analysis revealed homogeneous distribution of phase across both ventricles. In VVI-pacing a left bundle branch block configuration of the ventricular activation was found in 21 of 28 patients. In 7 of 28 patients phase distribution indicated a simultaneous activation of both ventricles (with or without delimitation of the apex of the right ventricle). This is of clinical importance because artificial spread of excitation and asynchronous contraction during VVI-pacing may be responsible for higher myocardial oxygen demand. Retrograde conduction in VVI-pacing was found in 9 of 28 patients. Phase analysis provides a reliable method for evaluation of pacing-induced activation patterns.

Adult↗
PubMed1984

Evaluation of left ventricular performance by radionuclide ventriculography in patients with atrioventricular versus ventricular demand pacemakers.

In 55 patients with coronary artery disease (n = 37), cardiomyopathy (n = 12), or myocarditis (n = 6) and programmable ventricular or dual-chamber atrioventricular (AV) demand pacemakers, left ventricular (LV) performance was studied by gated radionuclide ventriculography during pacing (60 or 70 to 120 bpm). Twenty-three patients were followed over 4 to 6 months. In 16 patients the findings in ventricular (VVI) and dual-chamber AV (DDD) pacing were compared. In all patients end-diastolic volume (EDV) decreased and cardiac output increased when the pacing rate was changed from 60 or 70 to 120 bpm. For instance, in the patient group with VVI pacemakers, EDV decreased by 7.53% +/- 3.5% (p less than 0.01) and cardiac output increased by 53.5% +/- 19.4% (p less than 0.01). The results were independent of the underlying heart disease. After 4 to 6 months, a reduction of both cardiac output and ejection fraction was found in 6 of the 23 patients. As compared to VVI pacing, a significantly higher cardiac output (2% to 16%) was derived from DDD pacing. The results indicate the dependence of LV performance on the pacing rate and the benefit of DDD pacing. Since gated radionuclide ventriculography provides the means to determine the effect of different pacing modes on LV performance, an optimal pacing mode may be found for each individual.

Adult↗