Biomedical subjects
Publications and source records attributed to W Börner.
A 61-year-old white female with ulcerative carcinoma of the sigmoid exhibited an abscess-like pattern on a white blood cell scan using 111In-oxine-labeled 'pure' granulocytes. Constant 111In activity could be seen in the tumor 0.5, 3, and 20 h after the reinjection of the labeled cells. The absence of an abscess was proven by surgery and histological investigation.
The optimal diagnostic procedure before surgery in thyrotoxicosis and thyroid malignancies is a combination of scintigraphy, sonography and fine-needle-aspiration biopsy. In diffuse toxic goiters the differentiation of immunogenic and non immunogenic thyrotoxicosis is predominant. In toxic nodular goiters the sonographic localisation in relation to the thyroid capsule is necessary to prevent recurrent autonomies. Malignomas should be subclassified (fine-needle-aspiration biopsy, calcitonin) to differentiate between carcinomas with necessary aggressive or conservative surgical treatment. After thyroidectomy in differentiated carcinomas a high I-131-uptake requires once more surgical resection to decrease radiation exposure during I-131-therapy.
111In-oxine "pure" granulocyte scanning allows an exact localisation of infiltrated bowel in Crohn's disease and ulcerative colitis. Fecal excretion of labeled granulocytes yields a good parameter of disease activity. In comparison to 111In-oxine "mixed" leukocyte scanning, this method is more specific in assessing disease activity and more sensitive in localising diseased bowel. Radiation exposure to blood cells is not as high as in "mixed" leukocyte scanning. Pure granulocytes were isolated by discontinuous density gradient centrifugation of an isolated "mixed" leukocyte fraction.
The absorption profile of the distal forearm, which depends on bone mineralisation, was measured using a high resolution microcomputer-controlled transverse rotational scanner with a tightly collimated I-125 photon source and a scintillation counter. Reconstruction of the anatomical structures within the measured area occurred in two stages. Subsequently the linear attenuation coefficient for soft tissues, compacta and spongiosa was obtained by a "least-square" algorithm. The absorption coefficient of the compacta and spongiosa provided a measure of bone mineralisation. Correlation between the reconstructed images and the calculated results and measurements was tested by calculation. Ten measurements of a model and of in vivo bones resulted in a coefficient of variation of 1.8% and 3.3% for the compacta and 2.5% and 3.8% for the spongiosa. Relative deviation from the standard varied from +1.3% to -1.0%, depending on mineral content. This new, technically simple procedure for the separate determination of the compacta and spongiosa in the distal radius is useful for the early recognition of changes in bone mineralisation which are usually apparent first in the spongiosa.
Measurements of thyroidal suppressibility by thyroid hormones belong to the diagnostic program in nuclear medicine for more than 30 years. Suppression tests are used in follow-up of antithyroidal treatment to predict remission or relapse of hyperthyroidism. Recently, the number of publications dealing with suppression tests has been increasing. Apparently, non-suppressibility of the thyroid after antithyroidal treatment for about 1 year corresponds to a rate of relapse of about 70% whereas in the case of a positive suppression test, the relapse rate amounts to about 20% only. The diagnostic procedures described in the literature are different with respect to radiopharmaceuticals, activity doses, thyroid hormone suppression and, above all, to the time of uptake measurements. After a critical discussion of the literature, a modern diagnostic procedure for the suppression test is proposed using 123I or 99mTc and a computer-assisted gamma camera.
Patients with Crohn's disease (n = 22), ulcerative colitis (n = 5), inactive Whipple's disease (n = 1), irritable bowel syndrome (n = 2), arthritis (n = 1) and Yersinia infections (n = 2) were examined with 111In-oxine labelled "mixed" leukocyte preparations (n = 12) or with 111In-oxine labelled "pure" granulocyte preparations (n = 21). Compared with barium enemas of the gut and colonoscopy, performed within of one week in 31 patients there was a correct location of infiltrated bowel segments in 24 patients (78%). The scan diagnosed more infiltrated segments in 4 patients (13%). In 3 patients it failed to diagnose one inflamed segment. In 24 patients the faecal 111In-excretion was expressed as percentage of the reinjected 111In-activity. All patients with non inflammatory bowel diseases and patients with inactive inflammatory bowel diseases excreted less than 2% of the reinjected 111In-activity. All but one female patient with active bowel disease excreted more than 2%. In 24 patients the correlation of ESR, CDAI and A.I. was available. There was a good correlation between ESR (r = 0.77, P less than 0.001), A.I. (r = 0.61, p less than 0.001) and the %-faecal faecal excretion. The 111In-labelling of white blood cells, especially of granulocytes, seems to be a reliable alternative method to localize infiltrated bowel segments and to assess disease activity in patients with inflammatory bowel diseases, compared to usually performed radiological, endoscopical and clinical methods.
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The place of ultrasound in the diagnosis of thyroid nodules was assessed in 384 patients by comparing its findings with those obtained on palpation, scintigraphy, fine-needle cytology and (in 45 cases) histology. Further diagnosis of scintigraphically "cold" nodules is the main indication for ultrasound examination in goitre-endemic areas. In 13 of 69 cases of a cold nodule with complex or echo-poor echo image proved it to be malignant, while in 74 with cold nodules but with a normal or increased echo pattern there was no malignant tumour. Thus, if the echo pattern is "complex" or "echo-poor" urgency of surgical intervention is strengthened, while with echo-normal or echo-rich nodules or cysts indications for operation are relative. In future, a combination of scintigraphy, ultrasound and cytology (ultrasound-guided small-needle biopsy) will give the highest rate of diagnostic accuracy in the differentiation of malignant from benign thyroid lesions.
The clinical applicability of direct FT4 determinations by the radioimmunoassays ImmoPhase, GammaCoat, Liquisol, Amerlex and LisoPhase is tested in comparison to the FT4 index and the T4/TBG ratio. Part I of this study deals with technical aspects concerning quality control as well as with in-vitro experiments concerning storage of samples and interference of drugs. The precision of FT4-RIAs is satisfactory; inter-assay coefficients of variation are generally lower than 10% for medium hormone concentrations. Because of a change of the standard curve calibration by the manufacturer of the Liquisol kit, the inter-assay variability (17%) of this assay is unacceptably high. The comparison of working ranges shows that the sensitivity of all FT4 assays is sufficient. However, the upper limits of working ranges of the Liquisol and LisoPhase kits are too low. Storing the samples in form of serum yields lower values for any FT4 parameter than storing as whole blood. This unexpected observation is true for room temperature as well as for refrigeration at 4 degrees C. To be sure, the values of indirect FT4 parameters from serum and whole blood coincide somewhat better especially when the samples are stored in the refrigerator. Repeated thawing and refreezing does not influence the results of FT4-RIAs significantly. In vitro testing of drug interferences by addition of therapeutic doses of primidone, phenobarbital, phenytoin and acetylsalicylic acid yields significant effects only for the last quoted pharmaceutical. While the FT4 levels of the Liquisol and LisoPhase assays rise with the acetylsalicylic acid dose according to expectations, the values of the Amerlex and GammaCoat assays decrease. With regard to handling of the tests, there are no special technical problems for all FT4-RIAs tested.
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The echographic appearance of 19 histologically confirmed malignant thyroid tumours has been analyzed. The value of information by ultrasonography is compared to scintigraphy and fine-needle aspiration biopsy. All patients demonstrated a sonographic pattern of relatively low amplitude, sparse and disordered echoes. Extended thyroid tumours (T2-3) exhibited a serrated marginal border as a sign of the infiltration to the surrounding thyroid tissue. The clinically important separation of solid and cystic nodules can always be made with certainty. Provided that a subtile examination technique is used, ultrasonography can be of great value in choosing the adequate therapy in scintigraphic cold nodules. Diagnostic ultrasound also yields information concerning the reliable and reproducible classification and accurate location of circumscribed thyroid lesions. In all cases, however, the ultrasound pattern did not provide reliable clues as to their histology. A successful differentiation between benign and malignant solid nodules can be obtained only by cytology and histology. Ultrasonography, scintigraphy and aspiration biopsy, therefore, are complementary methods.
In 26 adolescents between 13--15 years of age living in a region with increased fluoride concentration in drinking water (3 ppm = 3 mg NaF/l) bone density-measurements by an I-125 profile scanner as well as measurements of thyroid function by means of numerous in vitro tests (T3U, T4, FT4-Index, RIA-T3, rT3, hTg, TSH, thyroglobulin and microsomal thyroid antibodies) have been done. Comparing 19 adolescents of same age from a region with low fluoride concentration in the drinking water (0,1--0,2 ppm) the study showed no influence of fluoride content of drinking water on skeleton mineralization and on thyroid function. There was found only--not depending on fluoride concentration--an increased bone density in females that was interpreted as a physiological difference between males and females.
26 women were treated for osteoporosis with 40 mg of sodium fluoride twice a day (equivalent 36 mg of fluorine) for a longer period. Mostly by reason of incompatibility, a reduction to half of the dose was necessary in six of these patients. The control of plasma fluoride concentration indicated that only 10 patients took their medicine regularly. Before treatment as well as three and six months after beginning of treatment the patients were examined. In these examinations bone density was measured across the middle phalanx of the middle finger with a I-125-profile scanner. Size and function of the thyroid gland were evaluated by clinical aspects and with in vivo- and in vitro-methods for thyroid diagnostic. The program includes also a check up with a 12 canal-serum-autoanalyzer. In 10 patients with warranted regular intake of the drug the increase of bone density was significant after three months already. In all 26 patients a considerable increase of the alkaline phosphatase after three months was evident. Under the influence of sodium fluoride no change was seen in function and size of thyroid gland. This result verifies the efficiency of sodium fluoride in osteoporosis-therapy without any measurable influence on thyroid function.
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Gastric emptying of a standard semifluid test-meal, labeled with 99mTc-DTPA, was studied by functional scintigraphy in 88 subjects (normals, patients with duodenal and gastric ulcer before and after selective proximal vagotomy with and without pyloroplasty). Gastric emptying curves were analysed by the method of principal components. Patients after selective proximal vagotomy with pyloroplasty showed an rapid initial emptying, whereas this was a rare finding in patients after selective proximal vagotomy without pyloroplasty. The method of principal components is well suited for mathematical analysis of gastric emptying; nevertheless the results are difficult to interpret. The method has advantages when looking at larger collectives and allows a separation into groups with different gastric emptying.
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