[Difficulties in the differential diagnosis of a non-traumatic, active myositis ossificans during pregnancy (author's transl)]

A 28 year old patient complained of sensory disturbances and pain in the right upper arm during pregnancy. During the 32nd week of her pregnancy, a large painful mass developed in the flexor muscles which, radiographically, showed some calcification. A diagnosis of a parosseous sarcoma was made; biopsy, however, indicated a diagnosis of non-traumatic myositis ossificans. Since the histological appearances of active myositis may be vary difficult to distinguish from a juxtacortical sarcoma, a right brachial angiogram and scintiscan were obtained. The angiographic and scintigraphic findings were erroneously considered to suggest malignancy. Following delivery, the tumour was removed. Futher histology confirmed the diagnosis of localised, non-traumatic myositis ossificans. The value of radiology, biopsy, angiography and scintigraphy are discussed with reference to our experience.

[Asymmetric brain perfusion in the aged?]

Between 1971 and 1975 we performed 1580 dynamic perfusion studies in 1411 patients. The patients were admitted to the nuclear medicine department for brain scanning from the medical, neurological and neurosurgical departments as well as directly by private family physicians. For dynamic brain studies we used the scintillation camera (Searle Radiographics) and a bolus of 99mTc-pertechnetate intravenously injected. The polaroid frames were exposed at 4 second intervals The results of the dynamic brain study were divided into five categories: normal, moderately diminished perfusion of one hemisphere, severe perfusion defect of one hemisphere, focal or multifocal hypervascular areas ("hot areas") and stenosis or occlusion of the carotid artery. In 1009 cases we found a normal perfusion of the tracer material without any side difference between the brain hemispheres. In 68 patients with motoric hemisyndrome of the right side and in 89 patients with hemisyndrome of the left side we were able to demonstrate a diminished perfusion of the contralateral hemisphere. In 65 patients with confirmed primary or metastatic brain tumors we observed a perfusion deficiency in 39 cases and focal "hot" areas in 26 cases. In 24 epileptic patients we found asymmetrical perfusion of the brain. In 109 patients without any neurological signs or symptoms we registered a "false positive" dynamic perfusion study with an asymmetrical initial transition of the injected tracer material. The left hemisphere showed a diminished perfusion in 86 cases, the right in 23 cases. The asymmetrical brain perfusion was not observed in patients under the age of twenty years. The incidence of "false positive" dynamic brain studies was found to be dependent on the age of the investigeted patients with a maximum of asymmetrical brain perfusion scans in the age group between 61 and 70 years. At present time we are not able to explain the reason of the "false positive" results. Because of this reason the investigation will be continued together with the neurologists and radiologists to find out a possible correlation between our study, the EEG-curves and results of the morphological brain investigations such as pneumoencephalography or ACT-scans.

[The 57Co-excretion and absorption test in the diagnosis of iron deficiency anemia]

1971 Sorbie et al. described a simple 57Co-excretion test (16) as an aid in the diagnosis of iron deficiency anemia. The authors found that renal excretion of a tracer dosis of 0,5 muCi 57CoCl2 was significantly elevated in patients with iron deficiency anemia (31% of the administered dose in 24 hours' urine) as compared with the controls (18%). Between 1972-1974 we performed the 57Co-excretion test in 29 patients with different kind of anemia and in 10 healthy volunteers. The test was modified by measurement of the serum activity 1, 2, 3, 7, 11 and 24 hours after the oral administration of the test dosis. In all anemias as well as in the control group we found the maximum of serum activity three hours after the oral administration of the tracer. The three hours serum activity was elevated only in patients with iron deficiency anemia (5,53%/1 serum) as compared with the control group (1,92%/1) and renal, tumor and infectious anemia (1,20%/1). p less than 0,001. The 57Co excretion was moderately elevated in most of the patients with iron dificiency anemia (average 31,5% 57Co-activity in 24 hours' urine) in comparison to the healthy controls (average 25,30%). Contrary to the results obtained by Sorbie et al. we found a wide range of fluctuation of the Co-excretion test in each group of patients with a poor statistical significance of p greater than 0,005.

Asymmetrische Hirndurchblutung im Alter?

Between 1971 and 1975 we performed 1580 dynamic perfusion studies in 1411 patients. The patients were admitted to the nuclear medicine department for brain scanning from the medical, neurological and neurosurgical departments as well as directly by private family physicians.

For dynamic brain studies we used the scintillation camera (Searle Radiographics) and a bolus of 99mTc-pertechnetate intravenously injected. The polaroid frames were exposed at 4 second intervals

The results of the dynamic brain study were divided into five categories: normal, moderately diminished perfusion of one hemisphere, severe perfusion defect of one hemisphere, focal or multifocal hypervascular areas (“hot areas”) and stenosis or occlusion of the carotid artery.

In 1009 cases we found a normal perfusion of the tracer material without any side difference between the brain hemispheres.

In 68 patients with motoric hemisyndrome of the right side and in 89 patients with hemisyndrome of the left side we were able to demonstrate a diminished perfusion of the contralateral hemisphere.

In 65 patients with confirmed primary or metastatic brain tumors we observed a perfusion deficiency in 39 cases and focal “hot” areas in 26 cases.

In 24 epileptic patients we found asymmetrical perfusion of the brain.

In 109 patients without any neurological signs or symptoms we registered a “false positive” dynamic perfusion study with an asymmetrical initial transition of the injected tracer material.

The left hemisphere showed a diminished perfusion in 86 cases, the right in 23 cases.

The asymmetrical brain perfusion was not observed in patients under the age of twenty years.

The incidence of “false positive” dynamic brain studies was found to be dependent on the age of the investigeted patients with a maximum of asymmetrical brain perfusion scans in the age group between 61 and 70 years.

At present time we are not able to explain the reason of the “false positive” results. Because of this reason the investigation will be continued together with the neurologists and radiologists to find out a possible correlation between our study, the EEG-curves and results of the morphological brain investigations such as pneumoencephalography or ACT-scans.

Der 57Co-Exkretions- und Resorptionstest in der Diagnose der Eisenmangelanämie

Im Jahre 1971 beschrieben Sorbie und Mitarbeiter (16) den 57Co-Exkretionstest als eine einfache und zuverlässige Methode in der Diagnose der Eisenmangelanämie. Nach oraler Applikation von 0,5 μCi 57Co (20 μmol CoCl2) fanden die Autoren eine renale Ausscheidung der Testdosis von 31% im 24-Stunden-Urin bei Eisenmangelanämien gegenüber 18% bei gesunden Kontrollpersonen.

In den Jahren 1972—1974 führten wir diesen Test bei 29 Patientinnen und Patienten mit verschiedenen Anämien sowie bei 10 gesunden Kontrollpersonen durch. Neben der renalen Ausscheidung von 57Cobalt haben wir zusätzlich die Serumaktivität 1, 2, 3, 7, 11 und 24 Stunden nach der Applikation der Testdosis gemessen. Sowohl bei den gesunden Kontrollpersonen als auch bei allen Anämieformen fanden wir das Aktivitätsmaximum im Serum 3 Stunden p.c., danach nahm die Aktivität langsam ab. Die 3-Stunden-Serumaktivität (57Co-Resorptionstest) war bei den Patienten mit einer Eisenmangelanämie mit durchschnittlich 5,53 %/L Serum gegenüber der Kontrollgruppe (1,92 %/L) signifikant erhöht (p < 0,01). Auch bei den renalen, Tumor- und Infektanämien konnten wir eine „normale” 3-Stunden-Serum-aktivität von durchschnittlich 1,20 %/L feststellen (p < 0,01).

Im Gegensatz zu den Resultaten von Sorbie und Mitarbeiter erwies sich die Messung der 57Co-Ausschei-dung im 24-Stunden-Urin als ein wenig zuverlässiger Test. Bei den Patienten mit einer Eisenmangelanämie konnten wir zwar eine leicht erhöhte renale Ausscheidung von 31,6 % der Dosis gegenüber 25,3 % bei gesunden Kontrollpersonen feststellen. Die Streubreite der einzelnen Meßwerte war jedoch hoch und die statistische Signifikanz der Eisenmangelanämie gegenüber der gesunden Kontrollgruppe mit p > 0,05 schlecht.

[The radionuclide hepato-angiography in the clinical diagnosis (author's transl)]

In 156 patients the dynamic liver perfusion study with 99mTc-sulfur colloid and the scintillation camera was performed. Out of the 81 cases with confirmed diagnosis, the rapid sequential liver study was only in one case to provide an additional information of clinical importance, which could not be demonstrated by static liver imaging. Except for 2 patients with carcinoid metastases of the liver and 3 cases of acute hepatitis, we did not find any significant difference in the activity appearance in the liver between normal subjects and patients with liver metastases and diffuse liver diseases.

[The place of isotope scanning in the diagnosis of pancreatic diseases (author's transl)]

259 isotope scans of the pancreas, done between 1966 and 1973, were analysed. In 62 cases the results of operation or necropsy findings were also available. In 43 of these 62 patients the scans could be diagnostically evaluated, the others being "negative". Among the 43, agreement with operative or necroptic findings existed in 35. All the malignant pancreatic tumours diagnosed by scanning were no longer operable. The place of isotope scanning is seen in general pancreatic diagnosis, especially on careful combination with clinical, special radiological and biochemical studies.

[A proposal to improve radioactive waste disposal following metabolic radio-iodine therapy]

After metabolic radio-iodine treatments of carcinomas of the thyroid, increased activities of I 131 are secreted from the patient's body by the renal route. The highly radioactive urine represents a serious danger of contamination for the nursing staff and third persons. The ideal conditions for the isolation of treated patients in a department disposing of a sewage disposal system of its own are not fulfilled at our hospital. Collection of radioactive urine of the patients for the purpose of annihilating radioactivity over several half-lifes of I 131 is extremely intricate. For this reason, we developed a filter system by means of which we were able to free the radioactive urine of the first five female patients treated from more than 99% of radioactivity. The contaminated locked filter patterns can be stored as "closed radio-sources" essentially more securely and space saving. The advantages of this system and their practical possibilities of use are discussed.

[Detection of thyreogenic osteopathy with the aid of the modern photon absorption technic]

163 male and female patients with confirmed metabolic status of the thyroid have been investigated with the aid of the 125-J photon absorption technique ("Bone Analyzer"). In the normothyroid group pathologically low values were found in 14.6 percent of cases. Findings which fell below a standard deviation of the normal range were regarded as pathologic. In 42 male and female patients with confirmed thyroid hyperfunction and decompensated autonomous adenomas, mineral content measurements in the radius revealed pathological values in 28.5 percent.

Displacement of anterior cerebral vessels in cerebral dynamic study in cases of chronic subdural hematomas

About 75-80% chronic subdural hematomas give positive results in a brain scan. The typical scintigraphic finding of chronic subdural hematoma is a diffuse widening and increase of the peripheral activity on the anterior view. In the flow studies subdural hematomas lead occasionally to peripheral activity defects. In two cases of chronic subdural hematoma without typical patterns in a perfusion study as well as in static images, we found a displacement of the anterior cerebral vessels as an indircet sign of space occupation.

Die Leistungsfähigkeit der Leberszintigraphie

Mit Hilfe eines Keilphantoms wurde die szintigraphische Nachweismöglichkeit verschieden großer und unterschiedlich gelegener Speicherdefekte untersucht. Bei ungünstiger Lage sind Aussparungen bis 55 mm Durchmesser schlecht erkennbar. Die Aufnahmen mit der Szintillationskamera und 99mTc waren der konventionellen Szintigraphie mit beweglichem Detektor überlegen.

Die Treffsicherheit der klinischen Leberszintigraphie liegt zwischen 80—90%.

Der Einfluß von pH auf das freie Serum-Thyroxin und seine physiologische Bedeutung

Das freie, biochemisch wirksame Serum-Thyroxin bleibt im dynamischen Gleichgewicht mit dem proteingebundenen Thyroxin, welches als Reservoir wirkt. Der Thyroxin-Spiegel im Blut bleibt konstant unabhängig vom Tages/Nacht-Rhythmus, körperlichen und psychischen Belastungen. Meßbare Veränderungen des freien Serum-Thyroxins sowie der thyroxinbindenden Präalbumine konnten dagegen bei verschiedenen Stress-Situationen festgestellt werden.

Mittels Gleichgewichts-Dialyse (Equilibrium Dialysis) wird der Einfluß der Wasserstoffionenkonzentration auf die dialysierbare Thyroxin-Fraktion des Serums untersucht. Bei pH Verschiebung der Pufferlösung in saurer Richtung konnte eine Zunahme der dialysierbaren Thyroxin-Fraktion beobachtet werden.

Die elektrophoretischen Untersuchungen im Veronal-Natrium-Puffer pH 8,6 und 7,0 zeigten eine nicht signifikante Zunahme der Thyroxin-Bindung durch die Albumin-Fraktion im pH 7,0.

Die beobachteten Auswirkungen der Wasserstoffionenkonzentration auf die thyroxinbindenden Proteine des Serums und das freie Serum-Thyroxin stimmen überein mit den Literaturangaben.

Die Zusammenhänge zwischen dem pH des Serums, der Bindungskapazität der thyroxinbindenden Proteine sowie dem freien Serum-Thyroxin deuten auf eine physiologisch-regulatorische Rolle der Wasserstoffionenkonzentration.