Scintigraphic evaluation of myocardial uptake of thallium 201 and technetium 99m pyrophosphate utilizing a rat model of chronic doxorubicin cardiotoxicity

To evaluate the usefulness of myocardial scintigraphy as a monitoring tool for chronic doxorubicin (DXR) cardiotoxicity, a rat model was used to investigate the relationship between the myocardial uptake of thallium 201 (Tl) or rechnetium 99m pyrophosphate (99mTc-PPi) and histological changes of the heart. Although there was no significant difference in myocardial Tl uptake between control and DXR-treated rats at an early phase after Tl injection, late-phase Tl uptake was significantly higher in the DXR-treated rats than in the control rats, indicating a slow wash-out of Tl from the myocardium. The wash-out rate calculated from scintigraphic examination of DXR-treated rats was significantly decreased with increasing degree of cardiomyopathy. Since the Tl wash-out rate was sharply decreased even in animals with minimal histological changes, it may be a possible monitoring tool for the early detection of chronic DXR cardiotoxicity. On the other hand, myocardial 99mTc-PPi images could be obtained only in rats with severe myocardial changes and hence would not useful for early detection.

Adsorption removal of benzalkonium chloride by granular activated carbon for medical waste water treatment

The adsorption removal of benzalkonium chloride disinfectant by granular activated carbon is discussed. The adsorption isotherm of benzalkonium chloride was expressed by the Freundlich equation. A significant correlation was found between the amount of benzalkonium chloride adsorbed in less than 1000 ppm of equilibrium concentration and the micropore volume of activated carbon. As for the adsorption rate, a change in intraparticle diffusiveness was found with increasing adsorption ratio. No significant correlation between the values of intraparticle diffusiveness and the properties of activated carbon was found. It was concluded that the micropore volume of activated carbon was the dominant factor in the adsorption removal of benzalkonium chloride by granular activated carbon.

[A case of a gastric cancer patient with high serum pepsinogen levels at relapse]

A rare case of a 68-year-old female cancer patient with an extremely high serum level of pepsinogens (PG) at relapse is presented. She had stage 3 Borrmann 3 type gastric cancer which was a poorly differentiated adenocarcinoma. Her postoperative serum PG levels had been within normal limits (23.0 ng/ml for PG-I and 3.2 ng/ml for PG-II), but at the time of the peritoneal relapse they were 5,630 ng/ml and 3,380 ng/ml, respectively. After was chemotherapy initiated, her serum PG levels decreased in parallel with an improvement of her clinical status. Immunohistochemical examination with monoclonal antibodies revealed PG-I and PG-II production in the primary and the metastatic lesions.

[Prevention of vitamin K deficiency in the early neonatal period--prophylactic oral administration of VK to the mother]

We studied the effect of vitamin K(MK-4) on the prevention of vitamin K deficiency in the early neonatal period. MK-4 (20 mg/day) was given orally for 1-7 days to 183 pregnant women at 37-39 weeks gestation. In the MK-4 treated group, there were no cases of melena neonatorum but there were 9 cases in the untreated group (9/757, 1.2%). To investigate the influence of MK-4 administration on liver function and the VK dependent coagulation system, maternal and umbilical venous blood were taken to measure T-Bil, GOT, GPT, gamma-GTP, LDH, and II, VII, X activity and HPT. There was no significant difference between these values in MK-treated and untreated groups. MK-4 concentrations were measured in the maternal and umbilical venous blood of 68 subjects. The level of MK-4 in umbilical venous blood was less than 0.1 ng/ml in 17 of 21 subjects not treated with MK-4 but it was over 0.1 ng/ml in 30 of 47 MK-4 treated subjects. However, no MK-4 was detected in 6 of 8 subjects who were treated for 1 day. The level of MK-4 in maternal blood was less than 0.1 ng/ml in 12 of 21 untreated subjects but it was 0.19-92.6 ng/ml in all of the 47 MK-4 treated subjects. The mean MK-4 concentration in cord blood as a percentage of that in maternal blood was 17.9%. These findings indicate that MK-4 is effectively transported from maternal to fetal blood through the placenta and its administration to pregnant women is useful in preventing melena neonatorum.

Study on digestibility and energy availability of daily food intake in Japanese (Part 3. Cereals)

Four male Japanese were fed a semisynthetic diet including egg and soy powder as protein source for seven days (Basal-diet period), and in the following seven days 200 g of polished rice, wheat flour and buckwheat flour added at the expense of part of the corn starch and sugar in the basal diets (Test-diet period). Urine and feces were collected throughout both periods and the contents of nitrogen, fat and energy in these excreta were determined. Digestibility of protein (N), fat and carbohydrate (by difference) was calculated. The protein digestibilities of the polished rice (in the form of cooked grains), wheat flour (in the form of cooked powder) and buckwheat flour were 89.6 +/- 5.0%, 93.4 +/- 2.9% and 85.1 +/- 2.5%, respectively. The fat digestibilities of the polished rice, wheat flour and buckwheat flour were 93.6 +/- 1.8%, 70.8 +/- 13.5% and 103.1 +/- 8.4%, respectively showing relatively large variation (This results may be caused by an errors in measurement). The carbohydrate digestibility was close to 100%. The net energy availabilities of the polished rice, wheat flour and buckwheat flour were 100.6 +/- 1.4%, 96.5 +/- 1.1% and 96.0 +/- 1.1%, respectively.

A method for computing the derivative of noisy time-activity curves and its application to radioisotope dynamic analysis

A method for computing the slope or the derivative of time-activity curves containing statistical fluctuations is described. The algorithm presented employs digital differentiation as a digital filter. In designing an effective differentiating filter the Chebyshev-type min-max method and Remez exchange algorithm are used to minimise the weighted Chebyshev error. The validity of this method has been investigated using computer-based Monte Carlo simulation. Renogram curve analysis is presented as an example of an application of this method to radioisotope dynamic analysis. The ratio of the bilateral slopes of the renogram's second segments estimated using this method correlated well with the renal plasma flow ratio (r = 0.97, n = 16). The functional images of the slope of the renogram's second segments have been constructed and ascertained to be clinically useful. This method is considered to provide a powerful tool for extraction of quantitative information both in research and in routine nuclear medicine clinical work, and may be useful in various other fields.

[The role of gallium-67 citrate scintigraphy in gastro-intestinal malignant lymphoma]

To evaluate the clinical usefulness of gallium-67 scintigraphy in the detection of the gastrointestinal (GI) non-Hodgkin's lymphoma (NHL) and in the assessment of the therapeutic effects, gallium-67 scintigraphy was reviewed on 24 cases (25 lesions; stomach in 20, ileum in 2, and terminal ileum and/or cecum in 3). Twenty-three out of the 25 lesions (92.0%) were detected by gallium-67 scintigraphy, while barium study could detect all of the 25 lesions. The sizes of the gallium-67 negative 2 lesions were the smallest of all (2.5 and 3.0 cm). The tumor size was considered to the most important factor in the detection by gallium-67 scintigraphy, while the histological classification and the location of the tumor were not related to its detectability. Findings in follow-up gallium-67 scintigraphy after therapy on 10 cases were correlated well with the therapeutic effects. These data suggest that gallium-67 scintigraphy is useful for the detection of GI involvement of NHL and for the assessment of therapeutic effects.

Validity of microsphere model in cerebral blood flow measurement using N-isopropyl-p-(I-123) iodoamphetamine

A microsphere model is sometimes used when calculating cerebral blood flow (CBF) using N-isopropyl-p-[I-123]iodoamphetamine (IMP), and is based on the assumption that there is essentially no washout of IMP. The validity of a microsphere model was investigated by comparison with the values of CBF obtained by means of a model which takes into consideration the diffusion of IMP from brain tissue to blood (nonmicrosphere model). When calculating CBF by the latter model, the look-up table method was used with expression of the double integral in the model equation by the recursion relations, a method which is useful for obtaining pixel-by-pixel values. The average rate constants for diffusion from brain to blood of gray and white matter were 0.021 and 0.0016 min-1, respectively. The values of CBF obtained by applying a microsphere model to the data acquired from 0 to 3.2 min after IMP injection were overestimated by approximately 23% compared with those values obtained using a nonmicrosphere model. This is considered to be due to the effect of the IMP activity in the vascular space. Values obtained using the data acquired from 3.2 to 6.4 min were underestimated by approximately 15%. When the values of CBF obtained by a microsphere model were interpolated, they became nearly equal to those obtained using a nonmicrosphere model at about 4 to 5 min after injection. This is suggested to be the reason why the underestimation due to diffusion from brain to blood is cancelled out by the overestimation due to the IMP in the vascular space. Our preliminary results suggest that it is necessary to take the diffusion of IMP from brain tissue to blood into account for the quantification of CBF using IMP.

The role of gallium 67 imaging in non-Hodgkin's lymphoma of the gastrointestinal tract

To evaluate the clinical usefulness of gallium 67 imaging in the detection of gastrointestinal (GI) non-Hodgkin's lymphoma (NHL) and in the assessment of the therapeutic effects, images were reviewed in 24 cases (25 lesions: stomach, 20; ileum, 2; and terminal ileum and or cecum, 3) and were compared using barium studies and, in 16 cases, computerized tomography (CT). In all, 23 (92.0%) of the 25 lesions were detected by 67Ga citrate imaging, the barium studies detected all 25, and CT detected 15 of 16 lesions (93.8%). The two lesions not identified by imaging and the one not found by CT were the smallest of all. In 2 (8.7%) of the 23 lesions positively identified by 67Ga-citrate imaging, both CT and imaging revealed the extent of the tumor more accurately than did the barium studies. In all but one of the patients, a close correlation existed between the imaging results and the therapeutic effects. These data suggest that 67Ga imaging is useful in conjunction with CT and barium studies for the detection of GI NHL and for the assessment of both the spatial extent of disease and the therapeutic effects, although a lack of 67Ga uptake after therapy does not always indicate a good therapeutic effect.

Methods for measuring the renal uptake rate of 99mTc-dimercaptosuccinic acid (DMSA): a comparative study

A comparative study of the renal uptake rate of 99mTc-dimercaptosuccinic acid (DMSA) was performed using a phantom study and clinical data from 100 patients (200 kidneys) with a variety of renal diseases. The measurement methods for renal uptake rate studied here include a posterior-view method, a conjugate-view method, and a method using single photon emission computed tomography (SPECT). The renal uptake rates obtained by the posterior-view method significantly (P less than 0.001) depended on kidney depth correction. With the SPECT method, the cut-off level for delineating the kidney was changed according to the background count ratio using the results of the phantom study. The renal uptake rates obtained by the SPECT method correlated significantly (P less than 0.001) with those obtained by other methods, and there were no significant differences as compared with those obtained by the conjugate-view method. An analysis of error with the above methods indicated that the error relating to the sensitivity to body thickness was smallest for the SPECT method and greatest for the posterior-view method. In terms of measurement of renal uptake rate only, the conjugate-view method is considered the most useful because it needs no kidney depth correction and requires very little additional effort or examination time.

Study on digestibility and energy availability of daily food intake by the Japanese. Part 2. Horse mackerel and milk

Four male Japanese students were fed a semisynthetic diet including rice and whole egg as protein for seven days (basal-diet period), and in the following seven days milk and then, for seven days, horse mackerel were added at the expense of part of the corn starch and sugar in the basal diet (test-diet period). Urine and feces were collected throughout all periods and the contents of protein, fat and energy in these extra were determined. The results obtained were as follows: 1) Digestibility of protein was 97.3 +/- 4.1% for milk and 96.8 +/- 2.8% for horse mackerel. 2) Digestibility of fat was 96.7 +/- 1.9% for milk and 98.6 +/- 2.6% for horse mackerel. 3) The ratio of the total available energy to intake energy (Net Energy Availability) was 92.5 +/- 2.9% for milk and 88.4 +/- 5.2% for horse mackerel.

[Evaluation of a modified latex agglutination inhibitory reaction method for the quantitation of urinary estriol in pregnant women]

This study evaluated a modified latex agglutination inhibitory reaction method for the quantitation of urinary estriol in women during normal and abnormal pregnancy. The urinary levels of estriol in pregnant women measured by this method correlated with urinary and serum levels measured by radioimmunoassay. The urinary level of estriol rose during pregnancy and reached a peak at the time of delivery, after which it returned to the control level in a few days. In contrast, the urinary level of estriol in women with abnormal pregnancy did not rise during pregnancy. This method is useful to detect impaired function of the placenta in pregnant women.

[Evaluation of serum pepsinogen I and II of patients with gastric cancer]

Serum pepsinogen levels were examined by immunoradiometric assay method for evaluating its clinical usefulness in gastric cancer. In patients with gastric cancer, serum PG-I tended to decrease but PG-II stayed normal level, resulting in low PG-I/PG-II ratio. Combination of PG-I and PG-I/PG-II discriminated 53.7% of gastric cancer, 70.6% of scirrhous type gastric cancer, and 66.7-100% of those arisen in the upper portion of the stomach, but 13.7% of normal subjects. As the aged normal subjects tended to show decreased PG-I/PG-II ratio (about 30% of the normal subjects aged over 40 years were discriminated as abnormal), the usefulness for detection of gastric cancer seems to be limited, but some types of gastric cancer such as scirrhous type or one arisen in the upper portion may be discriminated by this method. It is also suggested that this method may detect the recurrence of the cancer in some patients.

Cerebral circulation and metabolism in adults' moyamoya disease--PET study

Regional cerebral blood flow (rCBF), oxygen extraction fraction (rOEF), cerebral metabolic rate for oxygen (rCMRO2) and cerebral blood volume (rCBV) in nine cases of moyamoya disease in adults were studied with positron emission CT (PET) scan, using 15O steady-state methods. Three cases showed ischaemic symptoms and the other six cases showed haemorrhagic symptoms. PET scan was performed during the chronic stage. Control data were obtained from eight normal volunteers. Regional cerebral blood flow and other physiological parameters in cerebral gray matter, white matter and basal ganglia were compared with normal controls. All nine cases of Moyamoya disease showed decreased rCBF, though not significant, in cerebral gray matter, white matter and basal ganglia. Reduction of rCBF was significant in the cerebral cortex of six haemorrhagic cases. This significant decrease was considered to be due to diaschisis and also brain atrophy caused by the cerebral haemorrhage. There was a significant increase in rCBV in white matter of the both ischaemic and haemorrhagic cases. The calculated value of CBF/CBV is considered to be an index of perfusion pressure. This value was significantly decreased in all three regions, though rOEF was not significantly increased in moyamoya disease. Hence the cerebral circulation in adults with moyamoya disease appears to be characterized by a mild decrease in perfusion pressure and prolonged circulated time.

[Study on the plasma plasminogen activators in patients with malignant gynecologic tumors]

Increased plasminogen activator (PA) secretion has been observed in malignant cells and tissue and PA is thought to be involved in the processes of tumorigenesis, cancer invasion and metastasis. Recently two types of plasminogen activator--tissue type PA(tPA) and urokinase type PA(uPA)--have been detected in human plasma. In this study, to investigate the relationship between circulating PA and the malignant state, we measured the plasma PA concentrations (PA activity, tPA and uPA antigen) in 69 women with gynecologic malignancies (cervical cancer 50, ovarian cancer 19). These concentrations were compared to those in control groups of 33 women with benign gynecologic tumors (uterine tumor 8, ovarian tumor 25). An enzyme-linked immunoassay for tPA and uPA antigens was performed by the modified method described by Takada et al. (1986). PA activity was measured by the sensitive spectrophotometric assay of Verheijen et al. (1982). The blood samples were taken from an arm vein with a minimum of venous occlusion before treatment. There was no correlation between PA activity or uPA antigen levels and the malignant state. However, in the case of uterine tumors, a significantly higher concentration of tPA antigen (10.5 +/- 5.1 ng/ml) was found in patients with cervical cancer, in stage IV, than in those in the benign group (5.2 +/- 2.0 ng/ml). Moreover the tPA antigen concentration in cervical cancer, stage IV, was higher than in stages 0-III.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transcatheter arterial embolization of hemangiomas in the perioral region]

This paper presents four cases with successful transcatheter arterial embolization (TAE) for oral and perioral hemangiomas. Four TAEs were performed without major complications and the tumors disappeared in one case and decreased in size in the other 3 cases.

A unified design algorithm of two-dimensional digital filters for radioisotope image processing

A unified design algorithm of two-dimensional digital filters for radioisotope image processing based on the Fourier-Bessel transform and the weighted least-squares method is described. The algorithm presented here can treat the various kinds of two-dimensional digital filters in a unified approach. Design examples are presented and several graphs are included to show the relationships between the design parameters as an aid in practical applications. The application of the method in radioisotope image processing is also presented. Several low-pass, Wiener and band-pass filters were designed using the method and applied to some clinical data in nuclear medicine including SPECT images. The digital filter design technique proposed here is considered to provide a powerful tool for extraction of additional qualitative information and improvement of the quality of nuclear medicine images both in research and in routine clinical work.

[Single photon emission computed tomography (SPECT) with N-isopropyl-p-(123I) iodoamphetamine in partial epilepsy--evaluation of delayed image]

Thirty eight patients with partial seizures in the interictal phase were studied using single photon emission computed tomography performed 30 min. (early image) and 4-4.5 hrs. (delayed image) after an injection of 111 MBq (3 mCi) N-isopropyl-p(123I) iodoamphetamine (IMP). Five types of distribution changes were observed on IMP-SPECT between the early and delayed images. Eight patients, Type 1, exhibited an unchanged distribution of IMP between the early and delayed images. Fifteen patients, Type 2, showed a smaller area of low uptake on the IMP-SPECT (delayed image) compared to that on the IMP-SPECT (early image)-redistribution. The Type 3 patients exhibited an initial uptake area on the IMP-SPECT (early image) which later became a lower uptake area on the IMP-SPECT (delayed image)-reversed redistribution. This type was further classified into three categories according to the initial uptake pattern including (a) Type 3A, 3 patients with increased uptake area, (b) Type 3B, 6 patients with normal uptake area, and (c) Type 3C, 6 patients with decreased uptake area. With Type 2, the epileptic findings on the present interictal electroencephalography (EEG) were shown in 11 of 15 patients. However, we could not find any other remarkable correlation among these 5 types and the clinical factors (the types of seizures, the X-CT findings, the present interictal EEG data, the present frequency of seizures, and the intervals from the last seizure). In 2 patients with Type 3B who suffered from simple partial seizures, a region of the normal distribution on the IMP-SPECT (early image) became a lower uptake area on the IMP-SPECT (delayed image), corresponding topologically to the ictal symptoms. In this experience, we determined that the IMP-SPECT (delayed image) could be useful in patients with the epileptic lesions unable to be detected on the IMP-SPECT (early image).

[Prognostic significance of histopathological classification in patients with carcinoma of the uterine cervix]

In a retrospective study of 724 patients with histologically proven carcinoma of the uterine cervix from 1980 through 1986, the histological classification and clinical stage (FIGO) were investigated for their prognostic value. The clinical stage was very important in relation to prognosis. The histological type of the squamous cell carcinoma (keratinizing, large cell non-keratinizing, small cell non-keratinizing) did not have any value in predicting survival, but small cell non-keratinizing tumor showed a less favorable prognosis than other tumors when surgery was employed. As to survival, there was no difference between adenocarcinoma and squamous cell carcinoma when compared in all patients, but adenocarcinoma had a worse prognosis than squamous cell carcinoma when surgery was employed. The pelvic lymphnode status at operation was correlated with the clinical stage. Adenocarcinoma had more positive nodes than squamous cell carcinoma. There was no significant difference in the frequency of pelvic node involvement among cell types of squamous cell carcinoma. The present histopathological classification of the uterine cervical carcinoma was of little prognostic value in predicting patient outcome.

A unified computer program for assessment of attenuation correction and data acquisition methods in single photon emission computed tomography (SPECT)

A computer based simulation program was developed to assess the usefulness of various attenuation correction algorithms and data acquisition methods in single photon emission computed tomography (SPECT) in a unified approach. The program analytically calculated projection ray sums from a mathematical model with various distributions of activities and either uniform or non uniform attenuation coefficients by using the line integrals including the effect of attenuation. Data acquisition starting at arbitrary angles, various acquisition angles, including a 180 degree scan and a non circular orbit of a gamma camera, including an elliptical orbit can readily be taken into consideration in our simulation program. To simulate non circular orbit data acquisition, the resolution dependence on the object distance from the collimator surface was incorporated into the simulation. This computer based simulation program allows various combinations of attenuation correction algorithms such as hybrid methods, and data acquisition methods can be evaluated under a large number of study conditions. The usefulness of this computer based simulation program is shown with several representative examples.

[Visualization of epileptic lesions using single photon emission computed tomography (SPECT) with N-isopropyl-p-(123I) iodoamphetamine after intravenous loading of bemegride--report of a case]

Single photon emission computed tomography (SPECT) was performed 30 minutes and 4 hours after injection of 111 MBq (3 mCi) N-isopropyl-p-(123I) iodoamphetamine (IMP) which was injected 5 minutes after the completion of intravenous bemegride loading. A 31-year-old female with simple partial seizures evolving to complex partial seizures evolving to generalized tonic-clonic convulsive seizures with a history of hospitalization, suffering from low-grade fever, generalized convulsive seizures, and impaired consciousness at the age of 27 years was studied. Angiographic examinations, X-CT, MRI, CSF examinations, and interictal neurological examinations were normal. She suffered from clonic convulsions in her right shoulder and arm, and hallucinations and dysmnesia which were characteristic of temporal lobe epilepsy. More recently she suffered from impaired consciousness once or twice a month. While the controlled IMP-SPECT study was normal, the IMP-SPECT study examined after the activation by intravenous bemegride loading showed the pattern of a regional increased uptake of IMP in the epileptic lesions corresponding with the epileptic symptoms, and a surrounding border of decreased uptake which might be the inhibition of surrounding neuronal activity and metabolism. In conclusion, the bemegride loading IMP-SPECT study could be a potential diagnostic method in patients with seizures whose epileptic lesions were not determined by the conventional methods or in whom the surgical interventions were considered, by reason of its capability to demonstrate positively the epileptic lesions.