Delayed gastric emptying in patients with chronic renal failure

Forty patients with chronic renal failure (CRF) were enrolled into the study, none of whom had peptic ulcer disease, amyloidosis, a previous abdominal operation, diabetes mellitus or other factors that could influence gastric emptying. Twenty of the 40 patients had been receiving regular haemodialysis (HD) for at least 1 year prior to the study. Twelve of the 40 patients had upper gastrointestinal symptoms/signs (GI Sx). Radionuclide-labelled solid meals were used to calculate gastric emptying time (GET). Twenty-five normal volunteers comprised the control group. Of the 40 patients, 35 (88%) had an abnormal GET. The incidence of an abnormal GET in HD and non-HD patients was 95 and 80%, respectively; the incidence of an abnormal GET in patients with and without upper GI Sx was 83 and 89%, respectively. These differences in the incidence of an abnormal GET among the HD and non-HD patients, as well as in the patients with and without upper GI Sx, were not statistically significant. There were no significant differences between the normal and abnormal GET patients for any of the following clinical parameters and conditions: dialyser-specific proportionality constant x time/urea distribution volume (KT/V), protein catabolic rate (PCR), ferritin, serum blood urea nitrogen, creatinine, calcium ion, phosphate, intact parathyroid hormone, albumin, uric acid, haemoglobin, triglyceride and cholesterol, total dialysis time, creatinine clearance and daily urine protein. We conclude that in Chinese patients with CRF, both dialysed and undialysed, an abnormal GET is common. The pathogenesis seems to be multifactorial. The presence of abdominal symptoms cannot foretell an abnormal GET.

Hepatic artery injection of Yttrium-90-lipiodol: biodistribution in rats with hepatoma

In this study, we analyzed the biodistribution of 90Y-lipiodol in rats with liver tumors (hepatoma) following hepatic arterial injection.

METHODS

Sixteen male Sprague-Dawley rats with liver tumors were killed at 1, 24, 48 and 72 hr (four rats at each time) after injection of approximately 0.1 mCi 90Y-lipiodol through the hepatic artery, respectively. Samples of tumor, liver, spleen, skeletal muscle, lung, kidney, bone, whole blood and testis were obtained and counted to calculate the tissue concentrations (%ID/g).

RESULTS

We found that the radioactivity in the liver tumor was high at 1 and 24 hr and then declined slowly. The biological half-time was 84.1 hr. The radioactivity in normal liver tissue was also high at 1 hr but was significantly lower than that in the tumor. The biological half-time was 38.5 hr. The ratio of tissue concentration between liver tumor and normal liver tissue (T/N ratio) was 3.03 at 1 hr and rose to 6.45 at 72 hr. The radioactivity in the lung was almost as high as in normal liver tissue at 1 hr and declined rapidly with a biological half-time of 25.6 hr. The activity levels of the kidney were moderate at 1 hr and remained at almost the same level throughout the study. A moderate concentration of radioactivity in bone was noted within the first 24 hr. The concentration, however, rose over the ensuing time. The concentration of radioactivity in skeletal muscle, spleen, testis and whole blood was quite low.

CONCLUSION

Following hepatic arterial injection of 90Y-lipiodol, tracer uptake in liver tumor was high and tumor retention was lengthy. Consequently, large radiation doses could be delivered to the tumor. We suggest that 90Y-lipiodol is a potential agent in the treatment of liver malignancy.

Gastric clearance of radiopaque markers in non-ulcer dyspepsia patients

BACKGROUND

The use of radiopaque markers has been proposed as an easy, non-invasive method for measuring gastric emptying. In this study we intended to evaluate the effectiveness of this test in determining the gastric motor function in patients with non-ulcer dyspepsia.

METHODS

Simultaneous recording of scintigraphic solid gastric emptying and gastric clearance of radiopaque markers were conducted in 65 non-ulcer dyspepsia patients.

RESULTS

Forty-two patients (64.4%) showed abnormal gastric clearance of radiopaque markers, and 38 patients (58.5%) showed delayed solid gastric emptying. There was no correlation between delayed solid gastric emptying and abnormal gastric clearance of radiopaque markers (p > 0.05). Although the frequency of abnormal gastric clearance of radiopaque markers was higher than that of delayed solid gastric emptying (64.6% versus 58.5%), it was not statistically significant.

CONCLUSIONS

On the basis of the results of our study, gastric clearance of radiopaque markers may be used as an easy, non-invasive screening test for the purpose of detecting gastric motor dysfunction. However, this test is not superior to scintigraphic gastric emptying studies.

A door-to-door survey of Parkinson's disease in a Chinese population in Kinmen

BACKGROUND

Most published studies have shown lower prevalence rates of Parkinson's disease (PD) in Asian and black African than in Western countries, leading to the hypothesis that Asians and blacks might be protected from PD.

OBJECTIVE

To investigate the prevalence of PD in a Chinese population.

DESIGN

Community-based survey.

SETTING

Registered residents 50 years of age or older (N = 5061) on the islet of Kinmen located off the southeastern coast of China [corrected].

METHOD

Single-phase door-to-door survey by neurologists. All participants were administered a questionnaire and received motor examinations of the Unified Parkinson's Disease Rating Scale.

RESULTS

The participation rate was 96% (N = 3915) among 4158 contacted individuals. Twenty-three cases of PD were identified, including three cases with dementia. The crude prevalence rate of PD was 587 (95% confidence interval (CI), 373 to 884) per 100,000 persons 50 years of age or older. Assuming no case of PD among individuals under 50 years of age, the prevalence rate was 119 (95% CI, 80 to 169) per 100,000 for the total population.

CONCLUSIONS

The prevalence rates of PD in Kinmen were much higher than those reported from mainland China, but slightly lower than those reported from more developed countries. The present findings suggest that, instead of genetic factors, differences in case-ascertainment, life expectancy, and the length of survival with PD may be more important contributors to the variations in observed PD prevalence rates.

Discrepant pattern of solid and liquid gastric emptying in Chinese patients with type II diabetes mellitus

While abnormal gastric emptying has been widely reported in patients with diabetes, its clinical relevance is still uncertain. We conducted scintigraphic gastric emptying studies in patients with Type II diabetes mellitus who had symptoms suggestive of delayed gastric emptying in an attempt to evaluate the incidence of abnormal gastric emptying and to assess the clinical parameters of the different patterns of gastric emptying. Seventy male diabetic patients were included in the study. The patients were divided into four groups according to the results of liquid and solid gastric emptying: group 1, normal liquid and solid emptying (n = 22); group 2, normal liquid but delayed solid emptying (n = 30); group 3, delayed liquid but normal solid emptying (n = 7); group 4, delayed liquid and solid gastric emptying (n = 11). To assess clinical significance, we compared duration of disease, status of blood sugar control, presence or absence of vascular complications and of peripheral neuropathy among the four groups. Of the 70 patients, 18 (25.7%) showed delayed liquid gastric emptying and 41 (58.6%) delayed solid gastric emptying. There were no significant differences in the clinical parameters of the four groups, except that patients with good sugar control were likely to have normal liquid gastric emptying. Based on the results of this study, delayed solid gastric emptying is more common than liquid gastric emptying in symptomatic Type II diabetes mellitus patients. Of the different patterns of gastric emptying, delayed liquid gastric emptying with normal solid gastric emptying is the most unusual. For Type II diabetic patients with symptoms suggestive of delayed gastric emptying, both liquid and solid gastric emptying studies should be performed.

Investigations on the mechanism of tetrahydro-9-aminoacridine-induced presynaptic inhibition in the rat amygdala

Tetrahydro-9-aminoacridine, a centrally acting anticholinesterase, has been reported to improve clinical conditions of certain patients with Alzheimer's disease. A previous study from our laboratory suggested that tetrahydro-9-aminoacridine presynaptically inhibited synaptic transmission. In the present study, the mechanism responsible for presynaptic inhibition mediated by tetrahydro-9-aminoacridine was studied in the rat amygdalar slice preparation using intracellular recording techniques. Bath application of tetrahydro-9-aminoacridine reversibly suppressed the excitatory postsynaptic potential. Tetrahydro-9-aminoacridine's inhibitory action was unaffected by the pretreatment of slices with baclofen (5 microM), suggesting that it did not act by eliciting the release of GABA, which binds presynaptic GABAB receptors to inhibit glutamate release. The synaptic depressant effect of tetrahydro-9-aminoacridine was blocked in the presence of 4-aminopyridine. The action of 4-aminopyridine could be reversed by reducing extracellular Ca2+ concentrations from a control level of 2.5 to 0.5 mM, suggesting that tetrahydro-9-aminoacridine inhibits excitatory postsynaptic potentials by acting directly at the terminals to decrease a Ca2+ influx. The L-type Ca2+ channel blocker nifedipine (50 microM) had no effect on tetrahydro-9-aminoacridine-induced presynaptic inhibition. However, the depressant effect of tetrahydro-9-aminoacridine was partially occluded in slices pretreated with the N-type Ca2+ channel blocker omega-conotoxin GVIA (1 microM). It is concluded that a reduction in omega-conotoxin GVIA-sensitive Ca2+ currents contributes to tetrahydro-9-aminoacridine-mediated presynaptic inhibition. After exposure to bicuculline, a GABAA receptor antagonist, afferent stimulation evoked epileptiform bursts. Occasionally, spontaneous bursts similar in waveform to synaptically triggered bursts also occurred in disinhibited slices. Application of tetrahydro-9-aminoacridine reversibly reduced the burst duration in a concentration-dependent manner. These results suggest that tetrahydro-9-aminoacridine possesses anticonvulsant activity against disinhibited bursts.

A comparative study of 99Tcm-d,l-HMPAO and 99Tcm-d,l-CBPAO as leukocyte-labelling agents

An attempt was made to use 99Tcm-d,l-cyclobutylpropylene amine oxime (99Tcm-d,l-CBPAO) to label leukocytes. The radiochemical purity of 99Tcm-d,l-CBPAO, labelling efficiency of leukocytes, cell viability of labelled leukocytes and stability of 99Tcm-d,l-CBPAO-labelled leukocytes were calculated. In comparison with the commercial cell-labelling agent 99Tcm-d,l-hexamethylpropylene amine oxime (99Tcm-d,l-HMPAO), (1) the radiochemical purity of 99Tcm-d,l-CBPAO was higher than that of 99Tcm-d,l-HMPAO immediately after and 1, 2, 4, 6, 8 and 24 h after 99Tcm labelling; (2) the labelling efficiency of 99Tcm-d,l-CBPAO-labelled leukocytes was lower than that of 99Tcm-d,l-HMPAO; (3) the viability of labelled white blood cells was high for both agents; and (4) the stability of 99Tcm-d,l-CBPAO-labelled leukocytes was better than that of 99Tcm-d,l-HMPAO after 1, 2, 4, 6, 8 and 24 h. In conclusion, although the labelling efficiency of 99Tcm-d,l-CBPAO is lower, it is more stable than 99Tcm-d,l-HMPAO and provides greater stability of 99Tcm-d,l-CBPAO-labelled leukocytes. Therefore, 99Tcm-d,l-CBPAO has the potential to replace 99Tcm-d,l-HMPAO as a commercial leukocyte-labelling agent.

Biodistribution of rhenium-188 Lipiodol infused via the hepatic artery of rats with hepatic tumours

The purpose of this study was to analyse the biodistribution of rhenium-188 Lipiodol in rats with hepatic tumours following intrahepatic arterial injection to assess the potential of 188Re-Lipiodol as a radiopharmaceutical for the treatment of hepatic tumours in humans. Twelve male rats with hepatic tumours were killed at 1h, 24h and 48h after injection of approximately 7.4MBq of 188Re-Lipiodol via the hepatic artery. Samples of various organs were obtained and counted to calculate the tissue concentration. Radioactivity in the hepatic tumours was very high throughout this study, with a biological half-life of 122.9h. Radioactivity in the normal liver tissue was also high, but was significantly lower than in the tumour. The biological half-life in the normal liver tissue was 31.7h. The ratio of tumour concentration to the normal liver tissue concentration was 5.15 at 1h and rose to 7.7 at 24h and 10.84 at 48h. The level of radioactivity in the lung was high at 1h, and declined rapidly over time. The level of radioactivity in the kidney was moderate throughout the study. The radiation concentrations in muscle, spleen, testis, bone and whole blood were insignificant. We conclude that 188Re-Lipiodol should be considered as a potential radiopharmaceutical for the intra-arterial treatment of hepatic tumours.

Regulation of plasminogen activator inhibitor activity by plasmin in endothelial cells

The fibrinolytic activity in endothelial cells was regulated by balance of plasminogen activators and plasminogen activator inhibitors. Plasmin can specifically inhibit the biosynthesis of tissue-type plasminogen activator (t-PA), but not plasminogen activator inhibitor, type 1 (PAI-1) in endothelial cells. The PAI activity in the conditioned medium of endothelial cells was low and remained constant in 24 hours. However, the PAI activity in the conditioned medium of the plasmin-pretreated cells increased linearly in 24 hours. Pretreatment with protein kinase C inhibitors, H-7 or staurosporine, partially suppressed the PAI activity induced by plasmin. Pretreatment of endothelial cells with a G-protein inhibitor pertussis toxin resulted in an inhibition of the plasmin-induced PAI activity. The phospholipase A2 inhibitor mepacrine specifically eliminated the effect of plasmin stimulation on PAI activity. Cyclooxygenase and lipoxygenase inhibitors also partially inhibited the plasmin-stimulated PAI activity in endothelial cells. All these inhibitors did not affect the biosynthesis of the PAI-1 antigen in the presence or absence of plasmin. The results indicate that plasmin increased the PAI activity of endothelial cells via pathways in which protein kinase C, G protein, and phospholipase A2 may be involved.

Evaluation of alveolar integrity in patients with non-insulin dependent diabetes mellitus using Tc-99m DTPA and HMPAO radioaerosol inhalation lung scintigraphies

The alveolar integrity (AI) in 17 patients of non-insulin dependent diabetes mellitus (NIDDM) who had normal findings in the chest x-ray and pulmonary function test was measured by Tc-99m DTPA and HMPAO radioaerosol inhalation lung scintigraphies (DTPA and HMPAO). The degree of AI damage in NIDDM was presented as the slopes (%/min) of the time-activity curves from the dynamic of both lung imagings using DTPA and HMPAO. The AI of NIDDM patients was compared with the AI of 23 normal controls. The results show that (1) the slopes of DTPA were larger than those of HMPAO in any portion of either of the lungs for both of the study groups, and that (2) the slopes of DTPA and HMPAO were larger in NIDDM than those in normal controls over any portion of the lungs. The results suggest that (1) at least two different clearance mechanisms for aerosol particles in the lungs are at work; and (2) the AI damage in NIDDM developed in both the hydrophilic and lipophilic parts of the alveoli. In conclusion, the AI damage which appeared as larger slopes of DTPA/HMPAO in our study may be early findings of lung complications in NIDDM patients, which are different from the traditional studies such as chest x-ray or pulmonary function test.

Acute disseminated encephalomyelitis in middle-aged or elderly patients

Acute disseminated encephalomyelitis (ADEM) in middle-aged or elderly adults is rarely reported. We present here three ADEM patients of these age groups, who manifested behavioral changes, mutism or psychosis. Single clinical episodes, widespread encephalopathic disturbances and magnetic resonance imaging (MRI) findings favored the diagnosis of ADEM. However, no obvious preceding infections could be discovered. Two of them had traveled to mainland China prior to admission to psychiatric wards. All three patients had fair-to-good recovery after steroid treatment. A review of the literature showed that clinical and neuroimage findings of ADEM in the elderly group did not differ from those in the younger group. However, ADEM has rarely been reported in older age groups, probably due to: (1) differences between the elderly and young people in susceptibility or immune response to infectious agents, and (2) lack of a sensitive tool to examine patients prior to the wide-spread use of MRI. We suggest ADEM as one of the possible etiologies of acute or subacute onset of psychosis in adult patients, especially in those with a history of traveling.

Fluoride in drinking water and the bone mineral density of women in Taiwan

BACKGROUND

The current evidence on effect of fluoridation in drinking water on bone is inconsistent. This study was undertaken to assess the effect of fluoride concentration in drinking water on bone mineral density (BMD) in Taiwanese women.

METHODS

The study subjects included 248 women aged > or = 40 years who reside in naturally fluoridated and adjacent areas. The individual fluoride concentration of the drinking water and the BMD of the subjects' lumbar spines were assessed.

RESULTS

Women aged 46-65 years living in areas which have fluoride levels < 0.6 mg/l (mean = 0.18 mg/l; n = 130) had slightly lower bone densities than women living in areas with levels > or = 0.6 mg/l (mean 0.98 mg/l, n = 118). Only the age groups 46-50 and 61-65 years proved to be statistically significant. After controlling for age and body mass index, the BMD of those who had a dose > or = 1.0 mg/l is notably higher than the reference group (< or = 0.6 mg/l). After stratification by menopausal status, fluoride appeared to have no association with bone density in postmenopausal women.

CONCLUSIONS

The BMD of the subjects from the area with a fluoride dose > 1 mg/l were significantly higher than those from the reference group (fluoride < 0.6 mg/l) for premenopausal women. There is no significant association between BMD and fluoride for postmenopausal women in Taiwan.

Performance on a smell screening test (the MODSIT): a study of 510 predominantly illiterate Chinese subjects

The 12-item Modular Smell Identification Test (MODSIT) was administered to 239 male and 271 female Chinese subjects whose age ranged from 50 to 92 years (68.3 +/- 10.9) and whose education ranged from 0 to 20 years (2.5 +/- 4.3). Every participant was examined by a physician and was found to be free of dementia, stroke, and Parkinson's disease. Different from the standard procedures, only one-third of each odor pad was used for each subject, the four odor choices were presented orally for the majority of subjects, and they were not forced to make a selection when they could not detect or identify the odor. The average level of performance was 46% correct. The score was negatively associated with age, positively associated with education and with performance on a dementia screening test, and corroborated with subjects' report of smell deterioration in recent years. Nonsmokers and women performed better than smokers and men. The 12-item MODSIT had an internal consistency reliability of 0.73 and a 7-month retest stability of 0.57 with different examiners. The MODSIT is satisfactory for group studies, even when administered with suboptimal procedures such as those used in the present study.

Delayed gastric emptying does not predispose to Helicobacter pylori infection in non-ulcer dyspepsia patients

Non-ulcer dyspepsia is a common disorder in clinical practice. The pathogenesis and predisposing factors that lead to the development of Helicobacter pylori infection are still unclear. The aim of the present study was to evaluate the prevalence of H. pylori infection in non-ulcer dyspepsia patients with delayed gastric emptying and those with normal gastric emptying, and to determine if delayed gastric emptying predisposes to H. pylori infection. A total of 70 patients (29 males, 41 females) aged 18-59 years (mean +/- S.D. 40.5 +/- 11.2 years) took part in the study. A solid-phase scintigraphic gastric emptying study and 14C urea breath test were performed on each patient. There was no statistically significant difference in age between those patients with and without delayed gastric emptying (40.8 +/- 11.9 vs 40.4 +/- 10.5 years), or between those with and without H. pylori infection (40.5 +/- 12.6 vs 40.5 +/- 9.8 years). Of the 70 patients, 45 (64.3%) had delayed gastric emptying and 25 (35.7%) had normal gastric emptying. The overall incidence of H. pylori infection was 58.6%. The incidence of H. pylori infection among patients with delayed gastric emptying was 60% (27/45 patients) and among patients with normal gastric emptying 56% (14/25) patients). The incidence of H. pylori infection in the two groups was not significantly different. The incidence of H. pylori infection in the non-ulcer dyspepsia patients in this study was similar to that of age-matched asymptomatic volunteers in Taiwan. In conclusion, based on the results of this study, delayed gastric emptying does not lead to a predisposition to H. pylori infection in non-ulcer dyspepsia patients.

Delayed gastric emptying and Helicobacter pylori infection in patients with chronic renal failure

Forty patients with chronic renal failure (CRF) were enrolled in this study. Twelve of the 40 patients had upper gastrointestinal symptoms or signs (GI Sx). Twenty of the 40 patients had been receiving regular haemodialysis (HD) for at least 1 year prior to the study. Radionuclide-labelled solid meals were used to calculate gastric emptying times (GETs). The carbon-14 urea breath test (14C4-UBT) was used to diagnose Helicobacter pylori (HP) infection. Among the 40 patients, 35 (88%) had an abnormal GET and 22 (55%) had a positive 14C-UBT for HP infection. There were no statistically significant differences in the incidence of abnormal GET among patients with HP infection and patients without HP infection. There were also no significant differences in the incidence of HP infection among patients with abnormal and normal GETs. In addition, the incidences of abnormal GET in patients with and without upper GI Sx were 83% and 89% respectively. The incidences of HP infection in patients with and without upper GI Sx were 58% and 54%, respectively. The incidences of abnormal GET in HD and non-HD patients were 95% and 80%, respectively. The incidences of HP infection in HD and non-HD patients were 45% and 65%, respectively. The differences in the incidences of abnormal GET and HP infection among HD and non-HD patients, as well as among patients with and without upper GI Sx, were not statistically significant.

The effect of coffee on gastric emptying

The effect of coffee on gastric emptying was addressed in a scintigraphic liquid-phase gastric emptying study in patients with non-ulcer dyspepsia. Ninety-three subjects (56 males, 37 females; mean age 40 years, range 17-77 years) diagnosed as having non-ulcer dyspepsia were enrolled in the study. The baseline study was to drink 500 ml of 5% glucose water and the coffee study was to drink 500 ml of 5% glucose water containing 4 g of regular instant coffee. The two studies were performed on separate days. Fifteen of the 93 subjects were chosen at random to undergo repeated coffee studies for evaluation of reproducibility. Overall the 93 subjects showed accelerated gastric emptying, as measured by half emptying time (T1/2) with coffee compared with baseline (35.7 +/- 10.5 vs 45.0 +/- 23.1 min, P < 0.001). However, 68 (73.2%) subjects showed accelerated emptying (-14.8 +/- 19.5 min), while 25 (26.8%) subjects showed delayed emptying (5.9 +/- 4.5 min) after ingestion of coffee. There was no significant difference in the change in gastric emptying with coffee in duplicate measurements from the 15 subjects who had two coffee studies (P = 0.082). We conclude that coffee accelerates liquid-phase gastric emptying in the majority of patients with non-ulcer dyspepsia.

Caudate hemorrhage: clinical features, neuropsychological assessments and radiological findings

The nucleus caudatus is not a common location of spontaneous intracerebral hemorrhage. Twelve patients (8 men and 4 women) aged 38-76 years who had caudate hemorrhage between November 1, 1992 and March 31, 1994 were evaluated. These cases represented 2.1% of intracerebral hemorrhage cases at Neurological Institute, Veterans General Hospital-Taipei, Taiwan. Cerebral angiography was performed on eight patients. Six patients were evaluated by an extensive neuropsychological battery. The most frequent symptoms of caudate hemorrhage were headache and/or vomiting, and decreased consciousness. Clinical features were similar to those of subarachnoid hemorrhage. Angiography showed characteristic moyamoya disease in one patient but did not show an aneurysm or arteriovenous malformation in any patient. The etiology in most patients was hypertension. Neuropsychological assessments showed significant impairment in tasks of short-term and long-term memory and in verbal fluency as well as trends of impairment of orientation rather than of controls. Neurobehavioral symptoms probably resulted from interruption of the cortical-subcortical loops between the caudate nucleus and prefrontal cortex.

Increased accuracy of the carbon-14 D-xylose breath test in detecting small-intestinal bacterial overgrowth by correction with the gastric emptying rate

To date, there is no general agreement as to which test is to be preferred for the diagnosis of small-intestinal bacterial overgrowth. The 1-g carbon-14 D-xylose breath test has been proposed as a very sensitive and specific test for the diagnosis of bacterial overgrowth. However, in patients with severe gastrointestinal motor dysfunction, the lack of consistent delivery of 14C-D-xylose to the region of bacterial contamination may result in a "negative" result. The aim of this study was to determine whether the accuracy of 14C-D-xylose breath test for detecting bacterial overgrowth can be increased by correction with the gastric emptying rate of 14C-D-xylose. Ten culture-positive patients and ten culture-negative controls were included in the study. Small-intestinal aspirates for bacteriological culture were obtained endoscopically. A liquid-phase gastric emptying study was performed simultaneously to assess the amount of 14C-D-xylose that entered the small intestine. The results of the percentage of expired 14CO2 at 30 min were corrected with the amount of 14C-D-xylose that entered the small intestine. There were six patients in the culture-positive group with a 14CO2 concentration above the normal limit. Three out of four patients with initially negative results using the uncorrected method proved to be positive after correction. All these three patients had prolonged gastric emptying of 14C-D-xylose. When compared with cultures of small-intestine aspirates, the sensitivity and specificity of the uncorrected 14C-D-xylose breath test were 60% and 90%, respectively. In contrast, the sensitivity and specificity of the corrected 14C-D-xylose breath test improved to 90% and 100%, respectively. In conclusion, using the gastric emptying rate of 14C-D-xylose as a correcting factor, we found a higher sensitivity and specificity for the 14C-D-xylose breath test in the detection of small-intestinal bacterial overgrowth than were achieved with the conventional method.

The alveolar permeability in patients with diffuse infiltrative lung disease detected by Tc-99m DTPA radioaerosol inhalation lung scintigraphy and the relationships with the pulmonary function test

BACKGROUND

In recent years, there has been growing interest in determining the solute exchange across the pulmonary epithelium for various diseases. Alveolar permeability (AP) in patients with diffuse infiltrative lung disease (ILD) was investigated in an attempt to correlate it with parameters of the Pulmonary Function Test.

METHODS

AP in 21 patients with ILD was measured by Tc-99m DTPA radioaerosol inhalation lung scintigraphy (DTPA). The degree of AP damage in ILD was presented as the slope (%/min) of the time-activity curve of the dynamic lung images. The AP of ILD patients was compared with the AP of 20 normal controls. Comprehensive pulmonary function tests, including forced expiratory volume, flow-volume loop, and diffusion capacity by the single breath CO method, were performed for comparison.

RESULTS

This study showed that there were (1) statistically significant differences among normal controls and patients with ILD and (2) no correlation for the slopes and parameters of pulmonary function tests. The patients were divided into two groups: (A) 8 ILD patients with normal chest X-ray and (B) 13 ILD patients with abnormal chest X-ray findings. There were no significant differences in the results of DTPA for groups (A) and (B).

CONCLUSIONS

When the AP of ILD patients is significantly damaged, however, the severity of the damage is not related to chest X-ray findings. Radionuclide alveolar permeability study is not related to traditional pulmonary function tests. The radionuclide alveolar permeability study should be used as a new method to evaluate lung function.

Comparison of TI-201 and Tc-99m MIBI SPECT imaging in nasopharyngeal carcinoma

Both TI-201 and Tc-99m MIBI uptake in nasopharyngeal carcinoma (NPC) have been reported, yet no comparative study of these two agents using SPECT images has been undertaken for NPC. This study compares the relative effectiveness of TI-201 and Tc-99m MIBI SPECT for detecting NPC. In the patients with NPC, 26 of 32 (81%) showed TI-201 tumor uptake, whereas 24 of 32 (75%) showed Tc-99m MIBI tumor uptake. This preliminary study suggests that both Tc-99m MIBI and TI-201 SPECT imaging can be helpful in detecting NPC, and that sensitivity is slightly higher in TI-201 SPECT imaging.

The relationship of alveolar permeability and pulmonary inflammation in patients with systemic lupus erythematosus

The alveolar epithelium permeability (AP) in 34 patients with systemic lupus erythematosus (SLE) was measured by Tc-99m DTPA radioaerosol inhalation lung scintigraphy. The degree of AP damage in SLE was represented as the slope of the time-activity curve from the dynamic lung imagings. The patients were divided into two subgroups according to the following two criteria. [A] clinical feature: they were separated as stable or flare stage; and [B] chest X-ray findings: they were separated as positive or negative results. Meanwhile, the quantitative Gallium-67 (Ga) lung scan was performed as Ga uptake index (GUI) to evaluate the severity of inflammation in the lungs in SLE. The results show that [1] there were no significant statistical differences in the degree of AP damage between the two subgroups according to clinical features or chest X-ray findings, and [2] no good correlation between the degree of AP damage and inflammation of the lungs was found. In conclusion, the change of AP in SLE may be a mechanism not related to the presentation of clinical features or chest X-ray findings, and the degree of AP damage in SLE is not related to the severity of pulmonary inflammation.

Technetium-99m-pyrophosphate scintigraphic findings of intestinal perforation in dermatomyositis

Gastrointestinal complications are more common in children than in adults and present a serious problem with dermatomyositis. We report on a 66-yr-old man with dermatomyositis who suffered from intestinal perforation. The abdominal plain radiograph revealed only dilatation of the intestinal loops; increased radioactivity, however, was clearly demonstrated in the early 5-min and delayed 3-hr 99mTc-pyrophosphate images.