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Differentiation of functionally active mouse T-lymphocytes from functionally inactive bone marrow precursors.

An investigation has been made of the development of various T cell functions in lethally irradiated mice reconstituted with anti-0 treated spleen or bone marrow cells. Evidence is presented to show that both organs contain a post-thymic precursor pool able to regenerate by 15 days limited T cell responses in thymectomized recipients. A prethymic pool also exists in each organ able to regenerate, at a later date, first a suppressor T cell population and probably later, mature functional T cells involved in helper functions and cell mediated lympholysis. The spleen is apparently a better source of precursors of the suppressor cells than bone marrow, while a poorer source of precursors of the other T cell functions. All T cell functions investigated apparently first appear in large cells which undergo a reversion to small cells without necessarily maturing to their full potential reactivity. By following the kinetics of appearance of T cell functions, and the physical parameters of the cells with which these functions are associated, it is shown that PHA responding and Con A responding cells, cytotoxic T cell progenitors, helper T cells for antibody production and helper T cells for cytotoxicity induction can all at some stage of differentiation be separated from one another.

Animals↗

Relationship among function, phenotype, and specificity in primary allospecific T cell populations: identification of phenotypically identical but functionally distinct primary T cell subsets that differ in their recognition of MHC class I and class II allodeterminants.

The goal of the present study was to evaluate the relationship among function, Lyt phenotype, and MHC recognition specificity in primary allospecific T cell populations. By using Lyt-2+ and L3T4+ T cells obtained from the same responder populations, we assessed the ability of T cells of each phenotype to generate cytotoxic effector cells (CTL) and IL 2-secreting helper T cells in response to either class I or class II MHC allodeterminants. It was found that a discordance between Lyt phenotype and MHC recognition specificity does exist in primary allospecific T cells, but only in one T cell subpopulation with limited functional potential: namely, Lyt-2+ T cells with cytotoxic, but not helper, function that recognize class II MHC alloantigens. Target cell lysis by these Lyt-2+ class II-allospecific CTL was inhibited by anti-Ia monoclonal antibodies (mAb), but not anti-Lyt-2 mAb, indicating that they recognized class II MHC determinants as their "restriction" specificity and not as their "nominal" specificity even though they were Lyt-2+. A second allospecific T cell subset with limited functional potential was also identified but whose Lyt phenotype and MHC restriction specificity were not discordant: namely, an L3T4+ T cell subset with helper, but not cytotoxic, function specific for class I MHC allodeterminants presented in the context of self-Ia. Thus, the present study demonstrates that primary allospecific T cell populations contain phenotypically identical subpopulations of helper and effector cells that express fundamentally different MHC recognition specificities. Because the recognition specificities expressed by mature T cells reflect the selection pressures they encountered during their differentiation into functional competence, these findings suggest that functionally distinct but phenotypically identical T cell subsets may be selected independently of one another during ontogeny. Thus, the existence of Lyt-2+ CTL specific for class II allodeterminants can be explained by the hypothesis that the association of Lyt phenotype with MHC recognition specificity results from the process of thymic selection that these Lyt-2+ effector cells avoid.

Animals↗

The helper and suppressor functions of primate T cells elicited by a 185K streptococcal antigen, as compared with the helper function elicited by a 4K streptococcal antigen.

Helper and suppressor functions of human T lymphocytes that act on antibody-forming B cells were elicited by a large 185K streptococcal cell wall antigen. However, a small 4K streptococcal peptide elicited helper but no suppressor function. These differences in the functional activities of the large and small m.w. streptococcal antigens (SA) were confirmed by direct immunisation of rhesus monkeys with the 185K-SA and 4K-SA. Sequential studies have shown that whereas the 185K-SA elicits dose-dependent helper and suppressor activities, the 4K-SA elicits only helper function. Cell-depletion studies with human cells suggest that removal of T8+ cells by killing with OK.T8 and complement leads to a loss of suppressor and a broadening in the concentration of 185K-SA, which elicits helper activity. Because the 4K-SA does not elicit suppression, removal of T8+ cells does not affect this function. However, similar depletion of T4+ cells results in loss of the helper activities, both with the 185K-SA and 4K-SA, and again a broadening in the concentration of the 185K-SA, which elicits suppression. Direct comparison by autoradiography between 125I-labeled 185K-SA and 4K-SA suggests that both antigens can bind directly to monocytes or T8+ VV+ cells. Furthermore, both antigens can induce helper function if T4+ cells are reconstituted with either monocytes or T8+ VV+ cells. Attempts will now be made to sequence the amino acid determinants of the 185K-SA, so as to define the epitopes responsible for the two major regulating functions elicited by this antigen.

Animals↗

The Functional Status Index: reliability and validity of a self-report functional disability measure.

Practical, reliable and valid functional assessment instruments are needed to assist health providers in planning a patient's discharge from hospital and determining the need for rehabilitation or longterm care. In addition, such instruments can be used in clinical and epidemiological research. Several methods of assessing functional performance are available. Patient self-report offers many advantages: cost, speed of obtaining assessments and the potential for assessing a wide range of complex functional dimensions. Criticisms of this approach center around the degree to which the data are a reliable and valid reflection of patient function. We developed a Functional Status Index (FSI) and assessed its validity in 47 patients with hip fracture by comparing it to the results of objective functional performance tests. Our results indicate that patient self-report of function, if conducted with a structured, standardized format, yields data with considerable reliability and validity.

Aged↗

[The function W = (a--b e-ct)n, a generalization of the classical growth functions (author's transl)].

The generalization of Bertalanffy's function of length and mass growth and the extension of the Gompertz function to 4 parameters as exercised by the author (Sager 1979 b, a) leads to the equation W = (a--b e-ct)n with positive values of n, and b in the first case and negative ones for n and b in the second case. It is shown that with the range of values for n the above expression comprises all classical functions of organic growth, namely the logistic or Verhulst function (1838), the Mitscherlich function (1919), and the Pütter-Bertalanffy functions (1920, 1934) of length and mass development. Moreover, the limiting case n leads to +/- infinity leads to the Gompertz-function (1825), as can be verified by the increase ansatz of the universal expression. Beside graphs examples are given showing the evaluation of the parameters a, b, c and n in the case of free choice as well as c, d and n for the transformed notation W = W0 [(1--de-ct)/(1--d)]n with a given initial value W0 leaving three parameters for choice.

Animals↗

Mechanism involved in the systemic suppression of antigen-presenting cell function by UV irradiation. Keratinocyte-derived IL-10 modulates antigen-presenting cell function of splenic adherent cells.

Exposure to UV radiation suppresses tumor rejection and delayed-in-time hypersensitivity reactions and depresses splenic APC function. Because almost all of the UV radiation is absorbed in the upper layers of the skin, it appears unlikely the direct irradiation of APC can account for the impaired ability of splenic adherent cells to present Ag after total-body UV exposure. Because UV-irradiated keratinocytes release IL-10, and in light of the well-documented effects of IL-10 on Ag presentation, we tested the hypothesis that keratinocyte-derived IL-10 is responsible for the systemic impairment of APC function following UV exposure. Injecting supernatants from UV-irradiated keratinocytes suppressed the ability of splenic adherent cells to present Ag. Treating the supernatants with anti-IL-10 mAb neutralized the suppressive effect. Similarly, when splenic adherent cells were isolated from mice exposed to UV radiation, APC function was suppressed. Injecting the UV-irradiated animals with anti-IL-10 restored APC function. In addition, spleen cells from UV-irradiated mice did not efficiently present Ag to Th1 clones, and injecting anti-IL-10 after UV exposure restored APC function. The reverse was observed when spleen cells from UV-irradiated mice were used to present Ag to Th2 clones; in which case, UV exposure enhances APC function, and anti-IL-10 reverses this effect. These findings suggest that UV-induced, keratinocyte-derived IL-10 can modulate splenic APC function.

Animals↗

Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap.

OBJECTIVE: To construct a functional disability scale for the rheumatoid hand and to determine if this scale also assesses functional handicap. METHODS: Outpatients and inpatients with rheumatoid arthritis (RA) according to the ACR criteria answered a set of questions on their daily hand activities. Intrarater and interrater reliability were examined. Criterion referenced validity, and convergent and divergent validities were investigated. Factor analysis followed by varimax rotation was performed. Spearman's (rs) correlation coefficients between 2 quantitative variables were examined. The level of significance was p < 0.05. RESULTS: 96 patients with RA were recruited. The provisional scale had 41 questions. The elimination process left 18 hand activity questions with 6 levels of answers. The intrarater and interrater reliabilities of the scale were 0.97 and 0.96, respectively. Correlation of the scale's total score with visual analog scale (VAS) measure of functional handicap (rs = 0.78) showed good criterion referenced validity. The scale had good convergence with Revel's Functional Index (rs = 0.91) and a moderate relation to the Hand Functional Index (HFI) (rs = 0.58). The scale had a moderate, fair, or no relation to age, morning stiffness, pain measures, and hand swelling. The scale had 3 main factors by factor analysis. An English translation of the scale was validated. CONCLUSION: We have developed a practical functional disability scale for rheumatoid hands that also assesses functional handicap. It has 18 hand activity questions and has been validated in a French population.

Adolescent↗

Renal function in experimental chronic hydronephrosis. III. Glomerular and tubular functions in relation to renal pelvic volume.

Studies of renal function comprising determination of exogenous creatinine clearance, urinary osmolality and TmG were performed on 23 dogs, for each kidney separately, after hydronephrosis with partial ureteric obstruction had been produced by ligation of one ureter over an indwelling catheter. A method for determining the volume of the hydronephrotic renal pelvis was developed and the degree of functional reduction was correlated to the degree of pelvic dilatation. In 11 cases the renal blood flow was determined by direct measurement. Statistically significant reductions of the glomerular and tubular functions were noted on the hydronephrotic side. TmG and the urinary osmolality showed the greatest percentual decreases and the TmG/GFR ratio the smallest. The decrease in this ratio was due to greater deterioration of tubular than of glomerular function. The renal blood flow was reduced on the hydronephrotic side in comparison with the intact side, but seemed relatively less affected than the glomerular and tubular functions. Compensation by the intact kidney resulted in masking of the deterioration on the hydronephrotic side; thus for the whole material the mean GFR and urinary osmolality for the two kidneys together remained essentially unchanged. No statistically significant correlation between the degree of functional reduction and the degree of pelvic dilatation was found. Such a correlation could therefore not be used in the individual case as an indication of the functional capacity of a kidney.

Animals↗

[Loss of renal functional reserve following kidney transplantation and in patients with advanced disorders of liver function].

Renal functional reserve capacity was evaluated in healthy controls, kidney transplant recipients and patients with impaired liver function by simultaneous measurements of periodic clearances of inulin, PAH and creatinine every 30 minutes before, during and after infusion of an amino acid (AA) solution. During AA infusion glomerular filtration rate rose in 10 healthy controls to about 35% above basal values (inulin clearance from 107 +/- 6 to 144 +/- 7 ml/min, p less than or equal to 0.0005), renal plasma flow increased by 27% (PAH clearance from 530 +/- 25 to 675 +/- 40 ml/min, p less than or equal to 0.002). 8 renal transplant recipients with good and stable renal function (creatinine clearance above 65 ml/min) showed no rise in GFR and RPF, as did 10 patients with severe impairment of liver function and normal basal kidney function (creatinine clearance above 100 ml/min). The lack of renal functional reserve in kidney transplant recipients might indicate a hyperfiltration of the transplanted kidney. This could affect the longtime prognosis of these patients. The liver seems to play a role in the mediation of the amino acid-induced rise of GFR, supporting the hypothesis of a putative liver hormone regulating GFR after protein ingestion or AA infusion.

Adult↗

The reorganization of sensorimotor function in children after hemispherectomy. A functional MRI and somatosensory evoked potential study.

Children who have suffered extensive unilateral brain injury early in life may show a remarkable degree of residual sensorimotor function. It is generally believed that this reflects the high capacity of the immature brain for cerebral reorganization. In this study, we investigated 17 patients who had undergone hemispherectomy for relief from seizures; eight of the patients had congenital brain damage and nine had sustained their initial insult at the age of 1 year or older. Sensorimotor functions of the hand were investigated using functional MRI (fMRI) during a passive movement task, somatosensory evoked potentials (SEPs) arising from electrical and vibration stimulation, and behavioural tests including grip strength, double simultaneous stimulation and joint position sense. On fMRI, two of the eight patients studied with this technique (one with congenital damage and one with damage acquired at the age of 3 years) showed activation in the sensorimotor cortex of the remaining hemisphere with passive movement of the hemiplegic hand. The location of the ipsilateral brain activation was similar to that found on movement of the normal contralateral hand, although the latter was greater in spatial extent. In one of these patients, a greater role was demonstrated for the ipsilateral secondary sensorimotor area (compared with the ipsilateral primary sensorimotor area) for movement of the hemiplegic hand than for movement of the normal hand. Median nerve stimulation of the hemiplegic hand showed reproducible early-latency ipsilateral SEP components in the remaining sensorimotor cortex in 10 of the 17 patients (five with congenital and five with acquired disease). Five of the patients who demonstrated ipsilateral electrical SEPs also showed ipsilateral vibration SEPs (two with congenital and three with acquired disease). The behavioural tests revealed residual sensorimotor function in 14 of the patients; however, not all of the patients who exhibited ipsilateral SEP or fMRI responses had residual sensorimotor function in the hemiplegic hand. Ipsilateral sensorimotor responses were demonstrated both in patients with congenital disease and those with acquired disease, suggesting that factors additional to aetiology and age at injury may influence the degree of residual sensorimotor function and cerebral reorganization.

Adolescent↗

The DEFIANT study of left ventricular function and exercise performance after acute myocardial infarction. Doppler Flow and Echocardiology in Functional Cardiac Insufficiency: Assessment of Nisoldipine Therapy Study Group.

The DEFIANT-I study (Doppler Flow and Echocardiography in Functional cardiac Insufficiency: Assessment of Nisoldipine Therapy) was a multicenter, multinational double-blind randomized study of the effects of the new calcium channel blocking drug nisoldipine on left ventricular (LV) size and function after acute myocardial infarction. Randomization to placebo or to long-acting nisoldipine core coat (20 mg once daily) was performed in 135 eligible patients with mild to moderate systolic LV dysfunction (LV ejection fraction < or = 50%) 20 days (range 7-35) after infarction, with serial clinical, echocardiographic, and Doppler cardiographic measurements during a 4 week follow-up period. At the end of the follow-up period, exercise capacity was determined by bicycle ergometry. Nisoldipine improved indices of diastolic LV function. Early diastolic transmitral blood flow velocity increased, with an increase in peak E wave of 0.06 m/sec (95% confidence intervals [CI], 0.01, 0.11) and an increase in time velocity integral of 1.2 cm (95% CI, 0.16, 2.27). Isovolumic relaxation time was reduced by 14.7 msec (95% CI, -22.5, -6.9), a change not explained by the very small (and not significant) changes in systemic arterial pressure, heart rate, or cardiac output. There was no change in systolic and diastolic LV volume, nor in LV ejection fraction. Exercise capacity was greater by 12 watts (95% CI, 0.8, 23.3) in patients receiving nisoldipine, while the incidence of > or = 1 mm ST-segment depression (relative occurrence 0.54, 95% CI, 0.30-0.97) and the incidence of angina pectoris (relative occurrence 0.67, 95% CI, 0.42-1.08) during exercise testing tended to be lower in this group. Although the relations were not exact, peak exercise workload 7 weeks after infarction correlated with resting measurements of diastolic LV function. Exercise workload was inversely related to peak late diastolic transmitral blood flow velocity (A wave, slope, -86.6; 95% CI, -120.9, -52.2) and directly to the E/A ratio (slope, 20.5, 95% CI, 6.0, 35.1). The relations between exercise workload and peak late diastolic flow velocity remained significant after correction for age, sex, resting heart rate, and usage of beta-blocking drugs or nisoldipine. Exercise capacity was not related to measurements of systolic LV function (LV end-diastolic and end-systolic volume, LV ejection fraction, stroke volume, cardiac index). In summary, the calcium channel blocker nisoldipine improved measurements of diastolic LV function in patients recovering from acute myocardial infarction. Exercise capacity was higher in patients receiving the drug, and there was less exercise induced ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)

Double-Blind Method↗

Differential recovery of volitional motor function, lateralized cognitive function, dopamine agonist-induced rotation and dopaminergic parameters in monkeys made hemi-parkinsonian by intracarotid MPTP infusion.

There is still controversy regarding the frequency and extent of spontaneous functional recovery in primate models of parkinsonism, perhaps in part stemming from the variety of ways in which recovery has been assessed. The present study examined functional recovery in monkeys made unilaterally parkinsonian by intracarotid infusion of MPTP. Monkeys were evaluated prior to lesioning and for at least 1 year after lesioning on a battery of tests including a rating of spontaneous behaviors, a learned reaction time/movement time task, tests of lateralized neglect or inattention (i.e. lateralized reward retrieval task, extinction with double simultaneous stimulation, and response to a target moving from one hemispace to the other), and rotational asymmetry in response to a dopamine agonist. Some animals also received 6-[18F]Fluoro-L-Dopa (F-DOPA) position emission tomography (PET) scans before MPTP, when symptomatic, and when showing signs of functional recovery. These animals were sacrificed for post mortem neurochemical assessment following the last PET scan. Results showed that estimates of functional recovery in hemi-parkinsonian monkeys may depend upon the behavioral assay used. Even in behavioral tasks that were sensitive to recovery effects, the degree of functional recovery shown by an animal on one such task did not predict recovery on another. This may in part be due to the inherent difficulty in designing behavioral tests to assess basal ganglia functioning, when there is no consensus concerning which aspects of behavior the normal basal ganglia actually control.(ABSTRACT TRUNCATED AT 250 WORDS)

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗

Preserved verbal memory function in left medial temporal pathology involves reorganisation of function to right medial temporal lobe.

The left hippocampus and related structures mediate verbal memory function. The mechanism underlying preserved verbal memory function in patients with left hippocampal damage is unknown. Temporal lobe epilepsy, a common disease, is frequently the consequence of a characteristic hippocampal pathology termed hippocampal sclerosis, which may also affect the amygdala. In this setting, mapping the sites of memory function is a vital component of planning for surgical treatment for epilepsy. Using event-related functional magnetic resonance imaging, we studied 24 right-handed nonamnesic patients with left hippocampal sclerosis and 12 normal controls, performing a verbal encoding task. The patients were subdivided into two groups according to presence or absence of additional left amygdala pathology. Analysis of the data employed a two-level random-effects design, examining the main effects of subsequent memory in each group, as well as the differences between the groups. Additional effects of emotionality of the remembered words were also examined. Verbal memory encoding involved activation of left hippocampus in normals, but was associated with reorganisation to right hippocampus and parahippocampal gyrus in the patients. The additional presence of left amygdala sclerosis resulted in reorganisation for encoding of emotional verbal material to right amygdala. Retained verbal memory function in the presence of left medial temporal lobe pathology is mediated by recruitment of a parallel system in the right hemisphere consistent with adaptive functional reorganisation. The findings indicate a high degree of plasticity in medial temporal lobe structures.

Amygdala↗

Criteria of functional operability in patients with bronchial carcinoma: preoperative assessment of risk and prediction of postoperative function.

In this prospective study of 433 patients undergoing surgery for bronchial carcinoma 3 main factors influencing the operative risk were identified: (1) extent of resection, (2) pulmonary function and (3) age. The 30-day mortality rate was 8.3% in the whole group which comprised a high percentage of patients over 70 years of age (27%) and with a disturbed pulmonary function (45%). The value of various functional criteria proposed in the extensive literature is assessed and compared with the results of the study in which the use of FEV1 and quantitative regional analysis by perfusion scanning and 'regions of interest' proved to be highly efficient, allowing, in addition, the prediction of postoperative lung function even in sleeve resections. A new formula for estimation of the additional loss of function in the early postoperative phase after lobectomies is proposed along with a flow sheet for routine preoperative evaluation of pulmonary function.

Age Factors↗

The infant lung function model: a mechanical analogue to test infant lung function equipment.

To facilitate international multicentre studies and quality control of infant pulmonary function measurements, the European Respiratory Society-American Thoracic Society (ERS-ATS) working group for infant lung function testing aims to develop specifications for standardized infant lung function equipment and software. However, a standardized test device is also needed to test whether existing infant lung function equipment is able to meet these requirements. The authors have built a "mechanical model baby" consisting of a linear pump which can reproduce prerecorded tidal flow waveforms with a precision of 0.5% (full stroke), enabling the simulation of tidal and forced flow patterns. This linear pump can be connected to a series of copper lung volumes (range 50-300 mL) with known time constants, so that lung volumes can be reproduced with a precision of +/-1% at frequencies 10-120bpm. Five airflow resistors were built using sinter material. When assessed using flows 0-300 mL.s(-1) all resistors showed a quasilinear pressure/ flow relationship, with slopes 1.0-5.6 kPa.L(-1).s. These resistances could be reproduced with a precision of +/-2.5%. The infant lung model can also be used to assess frequency responses of infant lung function equipment, since the pump is capable of delivering low amplitude volumes up to 20 Hz in a pseudorandom noise manner. In summary, based on error estimations, this infant lung model is able to test whether or not infant lung function equipment meets the requirements suggested by the European Respiratory Society-American Thoracic Society standardization group, that is: flow measurements within +/-2.5%, volume and resistance measurements within +/-5%, frequency response: magnitude attenuation <+/-10% and phase shift <+/-3 degrees at 10 Hz.

Airway Resistance↗

[The present and future of the pulmonary function tests. The relationship between respiratory and non-respiratory function].

Pulmonary function is classified as respiratory and non-respiratory function. Respiratory pulmonary function involves exchange of O2 and CO2 gas at alveolar units in the lung and non-respiratory pulmonary function concerns metabolism of enzymes, hormones, surfactants vaso-active substances and immunological factors in the lung. The purpose of this study was to examine the relationship between respiratory and non-respiratory function using our newly developed expired NO gas continuous analytic method and the calculation method of ventilatory energy of the lung. Furthermore, we analyzed the relationship between arterial blood O2 pressure (PaO2) and mitochondrial function.

Humans↗

[Alteration of the longitudinal function of the left ventricle in hypertensives with systolic function of normal appearance].

UNLABELLED: Left ventricular (LV) transverse function is often used by the echocardiography to evaluate the systolic function in arterial hypertension (HTN). It would be interesting to know whether the LV long axis systolic dysfunction may precede the abnormalities of the transverse function in hypertension (HTN). For that purpose we evaluated by echo 36 patients (24 males, 12 females) with LV concentric hypertrophic (Lvmi > 134 g/m2 for men and > 110 g/m2 for women). All subjects were free of coronary heart disease and heart failure. According to the dimensions of the LV wall chickness (WTh) the HTN were subdivided in two groups: Group 1: Wth (12-14 mm) and Group 2: WTh (> 14 mm). The patients were compared to 30 healthy persons (control group) matched for age and LV systolic function (Fractional Shortening). METHODS: LV long axis shortening was measured at the septal and lateral sides of the mitral annulus using M-mode from the apical four chamber view. RESULTS: Compared to control group, septal long axis shortening fell significantly (p < 0.05) in proportion to the degree of the wall thickness: control group: 21 +/- 2 mm. Group 1: 16 +/- 1 mm and Group 2: 14 +/- 1 mm. Lateral shortening was reduced only in the Group 2 (15 +/- 2 vs 20 +/- 2 mm) (p < 0.05). LV wall thickness correlated significantly (p < 0.05) to septal and lateral shortening respectively (r = -0.51) and (r = -0.48). CONCLUSIONS: 1. Significant impairment of LV long axis function occurs in arterial hypertension with concentric hypertrophy even with normal transverse systolic function. 2. This alteration seems to be related to the dimensions of the LV wall thickness. 3. The prognostic implication of this disorder should be investigated further.

Adult↗

[Prediction of postoperative pulmonary function in the patient undergoing pneumonectomy using combined pulmonary function test and ventilation/perfusion scintiphotography].

A method to predict postoperative lung function following pneumonectomy has been used in 11 patients. Preoperative unilateral lung function can be predicted by combining the preoperative information on lung volumes obtained by spirometry with the distributional information obtained from ventilation and perfusion scintigrams in order to estimate lung function after pneumonectomy. There was a high degree of correlation between predicted and measured lung function for both FEV1 (r = 0.81, p less than 0.050, and FVC (r = 0.81, p less than 0.05). The postoperative FEV1 and FVC were within 200 ml of the predicted value in most of the patients. A more accurate and easy prediction of postoperative lung function is obtained using unilateral perfusion rather than ventilation scintigrams. We suggest that the combined the results of simple spirometric data and a quantitative right-vs-left perfusion lung scan using radioactive Tc-99m provides a simple non-invasive and accurate method for the pre-operative functional evaluation of the high risk patient.

Adult↗