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Biomedical subjects

W C Klingensmith

Publications and source records attributed to W C Klingensmith.

At least 55 records · Page 3Linked to original sources
PubMed1981

Complementary role of Tc-99m-diethyl-IDA and ultrasound in large and small duct biliary tract obstruction.

Fifty-one patients underwent both radionuclide and ultrasound studies of the hepatobiliary system. Eleven patients had large bile duct obstruction, six had intrahepatic diffuse small duct obstruction, and 37 had no obstruction. In all 11 patients with large duct obstruction, the radionuclide images were abnormal, but in nine of these studies the level of obstruction could not be determined. Ultrasound was abnormal in nine studies (with correct identification of level), normal in one, and technically inadequate in one, ultrasound scans were also abnormal in six patients without obstruction. In small duct obstruction, the radionuclide scan was abnormal in all six, but in five patients it could not differentiate small from large duct obstruction. In all six patients, ultrasound showed no large duct obstruction, thus allowing identification of the level of obstruction in patients whose radionuclide scans were equivocal. A cost analysis indicated that in suspected large duct obstruction, the best strategy is ultrasound first, followed by radionuclide imaging in all positive or technically inadequate ultrasound studies. In suspected small duct obstruction, the best strategy is radionuclide scanning first followed by ultrasound in all Tc-99m-diethyl-IDA studies equivocal as to level of obstruction.

Cholestasis, Intrahepatic↗
PubMed1981

Clinical comparison of diisopropyl-IDA Tc 99m and diethyl-IDA Tc 99m for evaluation of the hepatobiliary system.

Thirty-one patients with a wide range of hepatobiliary function and clinical diagnoses were studied with both diisopropyl-IDA Tc 99m and diethyl-IDA Tc 99m. Images were similar except for an increased liver-to-kidney ratio with diisopropyl-IDA Tc 99m (p less than 0.01) and a tendency toward an increased liver-to-background ratio at five minutes with diisopropyl-IDA Tc 99m (p greater than 0.05). Quantification of the relative hepatocyte extraction efficiency indicated a 16% higher extraction efficiency for diisopropyl-IDA Tc 99m (p greater than 0.05). Cumulative three-hour urine collections following injection demonstrated no significant difference in renal excretion in patients with normal total serum bilirubin levels. Both radiopharmaceuticals demonstrated increasing renal excretion with increasing total serum bilirubin levels; however, renal excretion of diisopropyl-IDA Tc 99m increased more slowly than excretion of diethyl-IDA Tc 99m (p less than 0.01). We conclude that, while the overall differences between these two radiopharmaceuticals are small, diisopropyl-IDA Tc 99m is superior because of a lower renal excretion rate in patients with decreased hepatocyte function.

Bile Duct Diseases↗
PubMed1981

Single-composite image display of information from tomographic myocardial perfusion studies.

Tomography has the general advantage of improving spatial resolution in a direction perpendicular to the tomographic sections. However, visualizing the size, shape, and relative position of a lesion depicted in multiple tomograms can be difficult. The authors have developed computer software which permits the single-composite display of information contained in multiple tomographic sections from a thallium-201 myocardial perfusion study. The display also allows identification of left ventricular myocardial areas as normal, reversibly ischemic, or irreversibly ischemic and quantitates the per cent of myocardium in each category.

Coronary Circulation↗
PubMed1981

The normal fasting and postprandial diisopropyl-IDA Tc 99m hepatobiliary study.

Diisopropyl-IDA Tc 99m imaging studies were performed in 11 normal subjects in both the fasting and postprandial states. In 5- to 60-minute analog images obtained in both fasting and postprandial studies, the cardiac blood pool was almost never seen, renal pelvic radioactivity was commonly seen, the extrahepatic biliary tract was always seen, and the left hepatic duct was always more prominent than the right hepatic duct. The biliary tract was visualized by ten minutes in nine of 11 fasting studies and 10 of 11 postprandial studies. The gallbladder was visualized in all eleven fasting studies, but in only four postprandial studies. The gallbladder was visualized in all eleven fasting studies, but in only four postprandial studies (p less than 0.05). The zero- to sixty-minute digital data indicated a greater hepatocyte clearance, an earlier time of peak parenchymal radioactivity, and a faster parenchymal washout in the postprandial studies compared with fasting studies (p less than 0.05). Approximately nine percent of the injected dose was recovered in the urine during the first three hours in fasting and postprandial studies. The normal diisopropyl-IDA Tc 99m study in the fasting and postprandial states is defined; significant differences exist between the two states.

Adult↗
PubMed1981

Effect of growth hormone on metaphyseal uptake of 99mTc-methylene diphosphonate.

Eight children with short stature and GH deficiency were studied with 99mTc-methylene diphosphate before, during (occasionally), and after 4 months of GH therapy. Using digital images of the femoral shaft and distal metaphysis, the percent change in metaphysis-to-shaft, metaphysis-to-background (muscle), and metaphysis-to-injected dose ratios were calculated and compared to percent change in growth velocity over 4 months. The percent change in metaphysis-to-shaft and metaphysis-to-background ratios showed no significant correlation with percent change in growth velocity. The percent change in metaphysis-to-dose ratio demonstrated a significant correlation with change in growth velocity (r = 0.66; P less than 0.05). In addition, five of six patient studies before 4 months (after 1-68 days of GH therapy) demonstrated an increased metaphysis-to-dose ratio compared to baseline. In conclusion, GH therapy in GH-deficient children appears to increase the uptake of 9mmTc-methylene diphosphonate in the metaphysis, shaft, and muscle to a similar extent, and this increase appears to occur in most patients early after initiation of therapy.

Adolescent↗
PubMed1981

99mTc-DTPA renal studies for acute tubular necrosis: specificity of dissociation between perfusion and clearance.

In order to evaluate the usefulness of radionuclide renal studies in differentiating acute tubular necrosis from other causes of decreased renal clearance (e.g., rejection) in renal transplant patients, we assumed that acute tubular necrosis would be common during the first 4 days after cadaveric transplantation (group 1) and uncommon 3 weeks or longer after transplantation (group 2). There were 38 renal studies in 34 patients in group 1 and 62 studies in 27 patients in group 2. Each renal study consisted of both a technetium-99m-DTPA and an iodine-131-hippuran study. Perfusion, clearance, and transit time in the 99mTc-DTPA study, and clearance and transit time in the 131I-hippuran study were visually graded on a 5 point scale without knowledge of the time of study or clinical diagnosis. There were 19 studies in group 1 and 25 studies in group 2 with clearance decreased two or more gradations. Eleven 99mTc-DTPA studies had perfusion 2 or more gradations better than clearance; all 11 were in group 1 (p less than 0.01). Other dissociations within the 99mTc-DTPA and 131I-hippuran studies, or between them, did not distinguish the two groups. Data support the hypothesis that decreased clearance with relatively well preserved perfusion in 99mTc-DTPA studies is common in acute tubular necrosis and uncommon in other causes of decreased renal clearance.

Acute Kidney Injury↗
PubMed1981

Chemical and biological studies of Tc-99m N,N'-bis(mercaptoacetamido)-ethylenediamine: a potential replacement for I-131 iodohippurate.

The tetradentate chelating agent N,N'-bis(benzoylmercaptoacetamido)ethylenediamine was synthesized for evaluation as a potential technetium-99m renal-function radiopharmaceutical. Complexes were prepared using different reducing agents and analyzed by high-performance liquid chromatography. Biological studies were performed in mice, rats, and rabbits and indicated that the new agent is cleared by the kidneys significantly faster than Tc-99m DTPA (p less than 0.01) and slightly slower than I-131 o-iodohippuric acid (p greater than 0.05). There was no evidence of significant renal retention. Renal excretion in all species studied was 70--75% of the injected dose in 30 min; biliary excretion in rats was 7% in animals with normal renal function and 18% in 90 min in the absence of renal function. We conclude that limited clinical trials are warranted.

Animals↗
PubMed1981

Effect of complete biliary-tract obstruction on serial hepatobiliary imaging in an experimental model: concise communication.

In order to determine the effect of biliary obstruction on hepatocyte clearance and bile flow, five dogs were imaged before, and three times a week after, surgical ligation of the common bile duct. THe first postoperative study was performed 3 hr after surgery. Bile flow and duct function were evaluated from analog images; hepatocyte clearance (HC) was estimated in digital images from the ratio of liver to cardiac blood-pool counts at 3 min. Liver function tests were measured serially. 3 hr after surgery the HC index and liver function tests were still normal. Analog images showed no intestinal radioactivity, but accumulation was seen in the distending biliary tract. on the third postoperative day, all liver function tests were abnormal and the HC index was significantly decreased (p less than 0.01). The biliary tract was never seen beyond the first postoperative day. Thus, complete obstruction of the common bile duct does not stop bile flow or cause significant hepatocyte damage in the first few hours. By the third day of obstruction, however, no bile flow is detectible and significant hepatocyte damage has occurred.

Alanine Transaminase↗
PubMed1980

Relative role of Tc-99m-diethyl-IDA and Tc-99m-sulfur colloid in the evaluation of liver function.

Imaging of diffuse liver disease is traditionally done with Tc-99m-sulfur colloid. The advent of Tc-99m-labeled hepatobiliary agents led the authors to reevaluate the role of Tc-99m-sulfur colloid. A total of 95 paired Tc-99m-diethyl-IDA and Tc-99m-sulfur colloid studies were performed in 61 patients (60 paired studies in liver transplant patients and 35 paired studies patients who had not received liver transplants). The following parameters were visually graded on a five-point scale: Tc-99m-diethyl-IDA clearance and time of appearance of appearance of intestinal activity; and Tc-99m-sulfur colloid liver size, bone marrow activity, splenic size, splenic activity, lung activity. Total serum bilirubin levels were used as the standard measure of liver function. The Tc-99m-diethyl-IDA parameters correlated more highly with total serum bilirubin than did the Tc-99m-sulfur colloid parameters in both the transplant and nontransplant groups. In conclusion, Tc-99m-diethyl-IDA appears to be the preferred radiopharmaceutical for evaluation of hepatocellular function, although both agents may be needed in certain clinical situations.

Bilirubin↗
PubMed1980

Communication of intrahepatic cavities with bile ducts: demonstration with Tc-99m-diethyl-IDA imaging.

Tc-99m-diethyl-IDA imaging demonstrated intrahepatic bile leaks in two patients. The first patient had an intrahepatic abscess associated with a common bile duct stone; he was successfully treated with common duct lithotomy and antibiotics, but without surgical drainage of the intrahepatic abscess. The second patient had bile leakage into an intrahepatic cavitary hematoma after abdominal trauma.

Adolescent↗
PubMed1980

Clinical comparison of 99mTc-diethyl-IDA and 99mTc-PIPIDA for evaluation of the hepatobiliary system.

Fifteen patients with a wide range of hepatobiliary function were studied with both 99mTc-diethyl-IDA and 99mTc-PIPIDA. In images obtained 5 to 60 minutes after injection, 99mTc-diethyl-IDA was clearly superior with respect to liver/background, hepatic ducts/liver, and small bowel/background ratios. The 99mTc-diethyl-IDA transit time from blood to small intestine averaged 12.2 minutes less than that of 99mTc-PIPIDA. Quantification of relative hepatocyte extraction efficiency indicated that it was 2.15 times higher for 99mTc-diethyl-IDA. Cumulative 3-hour urine collections following injection demonstrated increasing renal excretion of 99mTc-PIPIDA with rising total serum bilirubin levels in a manner quantitatively similar to that determined previously for 99mTc-diethyl-IDA. The authors conclude that 99mTc-diethyl-IDA is superior to 99mTc-PIPIDA for studies of the hepatobiliary system.

Adolescent↗
PubMed1980

Failure of low doses of 131I to ablate residual thyroid tissue following surgery for thyroid cancer.

Thirteen patients received an initial dose of 25-29.9 mCi (9259-1, 106 MB1) of 131I following partial thyroidectomy for papillary, follicular, or mixed carcinoma. Administration of thyroxine (T4) or triiodothyronine (T3) was stopped 3-12 weeks and 1-6 weeks, respectively, before therapy or imaging. Patients remained on normal diets and did not receive thyroid-stimulating hormone (TSH) or diuretics. Follow-up 3 months to 2 years after therapy demonstrated that ablation of thyroid bed activity was successful in only one patient, who still had metastases. This suggests that administration of 25-29.9 mCi of 131I following surgery is unreliable for ablation of residual thyroid bed activity.

Adenocarcinoma↗
PubMed1979

Renal uptake of 99mTc-sulfur colloid in liver transplant patients.

There was renal uptake of 99mTc-sulfur colloid in liver-spleen studies performed on three liver transplant patients. Unlike all previously reported patients, none was in congestive heart failure. The mechanism of this uptake is unknown, but in our three patients it did not correlate with hepatic or renal function.

Adult↗
PubMed1979

A clinical comparison of 99mTc-diethyl-iminodiacetic acid, 99mTc-pyridoxylideneglutamate, and 131I-rose bengal in liver transplant patients.

The relative merits of three radiopharmaceuticals for evaluating liver transplant patients were determined in paired studies. In 86% of studies both 131I-RB and 99mTc-PG gave similar information for differentiation of hepatocellular disease and billary tract obstruction. 99mTc-PG probably demonstrates the biliary tract and small intestine better early after injection (8%); 131I-RB is probably better in showing the colon at 24 hours when intestinal activity is not seen by 1 hour (6%). 99mTc-diethyl-IDA is superior in all respects when compared to 99mTc-PG. The blood retention method (20 min./5 min.) showed that none of the radiopharmaceuticals was a reliable indicator of hepatocyte function when compared to total serum bilirubin.

Biliary Tract Diseases↗
PubMed1979

Multiple regions of absent bone mineral and marrow function in a patient with chronic renal failure.

99mTc-methylene diphosphonate bone mineral and 99mTc-sulfur colloid bone marrow studies were performed on a patient with chronic renal failure. Multiple regions of absent deposition of both radiotracers were noted, involving the right ilium, multiple ribs, and the manubrium. Radiographs of these bones were normal. The findings suggest absent regional perfusion of the involved bones.

Adult↗
PubMed1979

Increased perinephric activity in 99mTc-DTPA studies of renal transplants.

All 99mTc-DTPA studies of renal transplant patients whose grafts infarcted during a three-and-one-half-year period were reviewed. Four patients demonstrated absent renal perfusion and clearance and absent bladder activity. Three of these exhibited increased perinephric 99mTc-DTPA activity and never regained renal function. The fourth patient did not demonstrate increased perinephric activity, and some return of graft function appeared in a subsequent 99mTc-DTPA study. The pathogenesis of increased perinephric activity is unknown, but may signify renal infarction, and its absence may indicate potential renal viability.

Acetates↗