[Spondylolysis and -listhesis. A computed tomographic differential diagnosis of lumbar discopathy]

Spinal CT scans of 680 patients with suspected disc herniation were reviewed to detect lumbar spondylolysis. In this group of patients, 3.23% (n = 22) had pars interarticularis defects at L4 or L5. Disc herniation at the interspace of the pars defect was seen in 27.27% (6/22) of patients with spondylolysis. Using Meyerding's method, which measures the degree of vertebral forward dislocation, grade 2 and grade 3 spondylolisthesis were most often seen. While moderate and severe spondylolisthesis can be already detected via lateral localiser image (scout view), pars defects with only little forward dislocation can be easily underdiagnosed. Sources of diagnostic error are: 1. an atypically posterior disc margin which extends beyond only one vertebral body and presents the appearance of disc herniation, 2. pars defects simulating the adjacent facet joints involve the risk of overlooking spondylolysis, 3. CT sections made through the intervertebral discs and facet joints only, may fail to show up the pars defect 10 or 15 mm above the disc plane.

[Clinical picture of multiple sclerosis in the magnetic resonance tomogram]

We performed magnetic resonance tomography (MRT) on 22 patients with multiple sclerosis (MS) using varying scan sequences. In 21 patients MRT produced abnormal findings demonstrating multiple lesions, giving varying signals. The MRT appearances of MS have the following characteristics: circular configuration and homogeneous structure of individual lesions, multiple foci, with involvement of all parts of the brain, but with preference for the periventricular region and white matter. This constellation of MRT features is characteristic for MS, but is largely independent of the varying clinical symptoms. The appearance of the individual lesions and the distribution pattern of the foci is sufficiently characteristic to support the clinical diagnosis of MS in younger patients.

[Detection of regional hypertrophy in hypertrophic cardiomyopathy with ECG triggered nuclear magnetic resonance tomography--comparison with hypertensive patients and persons with healthy hearts]

Gated magnetic resonance tomography (MRT) was conducted in 40 patients (13 normal volunteers, 9 hypertensives and 18 patients with hypertrophic cardiomyopathy) using a 0.35 Tesla superconducting magnet. Multisectional spin echo imaging (35/400 msec) was obtained in coronal, transversal and sagittal planes. Myocardial wall thickness was measured in different segments and the three groups were compared to each other. 15/18 patients with hypertrophic cardiomyopathy (HCM) had asymmetrical regional thickening involving the septum and the anterior wall, in 8/15 the lateral wall was also hypertrophic. The distribution pattern in 3/15 patients with HCM was symmetric. Involvement of the right ventricle was found in 14/18 patients with HCM. There were significant differences (p less than 0.001) in wall thickness for the septal segment in all three groups and for the ratio septal to posterior wall between the HCM and the hypertensives and the normal volunteers. We conclude that MRT can differentiate HCM from hypertensives and normals, and is superior to echocardiographic imaging in the evaluation of the distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy.

Influence of 0.2 mg ipratropium bromide on mucociliary clearance in patients with chronic bronchitis

14 patients with chronic bronchitis were subdivided into 2 groups of 7 patients. They were given at random 10 puffs of placebo or ipratropium bromide (0.2 mg). The mucociliary clearance rate was measured immediately after ipratropium inhalation (group 1) or 24 h after ipratropium inhalation (group 2). In group 1, the mucociliary clearance after ipratropium bromide was significantly better than after placebo (p less than 0.01). In group 2 there was no difference in the mucociliary clearance rates measured after ipratropium bromide or placebo, but the clearance rate still tended in favour of ipratropium bromide. We conclude that ipratropium bromide should be inhaled in high doses (0.2 mg) by hypersecretory patients with chronic bronchitis to improve mucociliary transport.

Pelvimetry by digital radiography and its dosimetry

Sonography is firmly established in obstetrics as the method of choice for the localization of fetus and placenta. However, for the determination of pelvic dimensions sonography does not suffice. Thus, for a few strictly selected indications conventional x-ray pelvimetry is used. This has the disadvantage of the relatively high radiation dose for the fetus and the maternal gonads. Since the introduction of digital radiography, there is the alternative of digital pelvimetry. We performed dosimetry comparing digital and conventional radiography with the new high amplifying screens (Quanta III, Dupont) using an ionization dosimeter and a wax phantom. The radiation dose of digital radiography was 24 mu Gy. This corresponds to about 15% of a comparable conventional exposure (177 mu Gy). A further advantage of digital radiography is a standardized and rapid exposure technique; furthermore pelvic dimensions can be measured directly. The disadvantages are the poorer spacial resolution and poor image quality in obese patients. Digital radiography because of its lower radiation dose is suitable for pelvimetry for special indications.

Pulmonary deposition of aerosols by different mechanical devices

With a new method for easy labeling of beta 2-agonists we measured intra- and extrapulmonary aerosol deposition after the administration of a bolus from a metered-dose inhaler at residual volume (RV) inhaling after a pause of 2 s and after immediate administration into the inspiratory flow at functional residual capacity (FRC). Immediate administration during a slow inspiratory vital capacity maneuver gives the highest intrapulmonary deposition (30-40%). Compressed air and ultrasonic nebulizers with a particle distribution pattern of 2-5 micron aerodynamic mass median diameter (AMMD) allow in normal subjects to achieve an intrapulmonary deposition of 30-60% during standardized tidal breathing at rest, the magnitude of the deposition depending mainly on each subject's larynx geometry. The outlet system leads to different deposition patterns in aerosol generators with the same AMMD. Many commercially available aerosol generators do not fulfill the criteria for any intrapulmonary aerosol deposition. For drug administration into the lungs, condensation aerosol generators ('steam boiler nebulizers') are useless as well as compressed-air, ultrasonic and steam driven nebulizers with a particle size of more than 10 micron AMMD.

[Arterial digital subtraction angiography for visualizing hemodialysis shunts]

Intraarterial application of contrast medium in digital video subtraction angiography was used to visualize chronic haemodialysis arteriovenous shunts. Patient compliance could be enhanced by the use of small volumes of non ionic contrast medium (3 ml/inj.), and the use off thin needles. The diagnostic reliability was excellent for all 25 examinations.

[Suspected herniated disk--differential diagnostic case studies by lumbar CT]

The most common reason a patient is referred for spinal CT examination is to exclude a ruptured intervertebral disc. Besides nerve root entrapment due to herniated disc, a number of unusual or unexpected conditions have been encountered in the course of CT lumbar spine studies. These include spondylolisthesis, spinal dysraphism, Paget's disease, and inflammatory, neoplastic, or metastatic lesions. The application of spinal (small-circle) target imaging includes the risk to overlook soft tissue lesions that extend beyond the reconstruction circle. Therefore, complete (large-circle) circumferential abdominal scanning is recommended in case of a suspected extraspinal cause of sciatica.

[The connections between smoking, mucociliary clearance and airway obstruction]

The connection between smoking habits (pack years, smoker and ex-smoker period), mucociliary clearance (mC) and the obstruction of the respiratory passages was investigated in 17 ex-smokers (7 without bronchitis; 10 with bronchitis) and 48 smokers (13 without bronchitis; 35 with bronchitis). The ex-smokers without chronic bronchitis showed the same clearing behaviour as the healthy non-smokers, but the non-smokers did not have the least obstruction of the respiratory system. The smokers without chronic bronchitis showed a normal lung function, but a worse clearing behaviour than the healthy non- and ex-smokers (p less than 0,01). Compared to volunteers without bronchitic symptoms the ex-smokers and smokers with chronic bronchitis had a bad clearing behaviour (p less than 0,001) and a distinctly obstructive ventilation disorder. Furthermore, it was noticeable that the ex-smokers with persistent bronchitis showed the worst respiratory system obstructions, whilst the smokers with chronic bronchitis had the greatest restriction of the central mC (c-mC) with less respiratory system obstruction than the ex-smokers with chronic bronchitis. The smoking habits (pack years) correlated with the decrease of the mC (p less than 0,01) and the grade of the respiratory system obstruction (p less than 0,001).

Objective evaluation of dextromethorphan and glaucine as antitussive agents

Twenty-four inpatients affected by chronic cough completed a single-dose double-blind cross-over study of placebo, glaucine 30 mg and dextromethorphan 30 mg. The study was carried out using a balanced incomplete block design, each patient receiving two of the three experimental treatments. Objective evaluation of cough was ensured by means of a writing cough recorder. Coughs after dextromethorphan and glaucine were fewer than coughs after placebo: however only glaucine was significantly different from placebo in reducing coughs. Treatments were well tolerated: clinical results included a reduction in pulse rate after both dextromethorphan and glaucine , and a large number of patients reporting side effects after dextromethorphan administration.

Effects of ketotifen on cholinergic induced airway obstruction

By repeated inhalant carbachol provocation tests on 13 normal and 13 asthmatic subjects, we investigated the effect of ketotifen (as compared with placebo) on the cholinergic responsiveness of the airways. In normal subjects, ketotifen reduced the slope of the linear regression lines, calculated from the airway resistance vs. the intra-pulmonary deposited amount of carbachol (reactivity). By adding a single dose of 80 mg of propranolol the bronchial reactivity was increased. Neither placebo nor ketotifen pretreatment altered the response to propranolol. In asthmatic subjects, the reactivity of the airways to carbachol was reduced after 7 days of ketotifen treatment. Propranolol increased the pre-challenge airway resistance values, and ketotifen did not reduce this bronchoconstrictive action. We could not observe any influence of ketotifen on the potentiation of the carbachol-induced bronchoconstriction. We conclude that ketotifen on the potentiation of the carbachol-induced bronchoconstriction. We conclude that ketotifen reduces the bronchial reactivity as assessed by carbachol inhalation in normal and in asthmatic subjects.

[Diagnosis of intracardial and paracardial space-occupying masses: comparison between two-dimensional echocardiography and computed tomography]

The validity of two-dimensional echocardiography (2-D echo) and computed tomography (CT) in the detection of intra- and paracardial tumors and thrombi was compared in 32 patients: 7 endocardial myxomas, 1 left ventricular fibroma, 2 paracardial cysts, 1 paracardial tumor, and 21 thrombi. In 16 cases intraoperative findings served as a control. The 2-D echo is easier to handle and free of radiation of contrast media. CT can visualize cardiac tumors independently of their location, whereas 2-D echo sometimes insufficiently images paracardial and right ventricular structures. It must be considered an advantage that 2-D echo detects mobile tumors such as those attached to valves, which the CT will not show. The tissue involved is more likely to be characterized by CT, although results are unreliable. However, in all cases tumors could be differentiated from thrombi by means of additional diagnostic criteria, such as the pattern of wall motion or valve motion. 2-D echo and CT therefore appear to be complementary methods rather than competitive ones. Invasive diagnostic procedures are required only to answer particular questions, e.g., concerning the coronary arteries.

[Ventilation scintigraphy of the lung with 99mTc-DTPA or with 99mTc-sulfur colloid?]

Ventilation scintigraphy of the lung, obtained with sufficiently small 99mTc-labelled aerosol particles, provides an image of ventilation distribution that is acceptable in clinical routine. Whether 99mTc-DTPA or 99mTc-sulfur colloid is more suitable as a carrier was studied in 6 smokers and 8 non-smokers with chronic obstructive pulmonary disease. 99mTc-sulfur colloid was not absorbed by the bronchial mucosa and therefore appears to be an almost ideal agent. In contrast, 99mTc-DTPA was absorbed by the bronchial mucosa in all smoking patients more rapidly and inhomogenously than in non-smokers. The quantitative and qualitative comparison of the two dorsal ventilation scans taken both immediately after inhalation and 20 min later, showed in all 6 smoking patients after 20 min significant differences which influenced the diagnosis result. 99mTC-DTPA is therefore not recommended for use in ventilation lung scintigraphy, especially in smoking patients.

[Stimulation of limited sperm motility and mucociliary clearance of the lung with theophyllin-ethylendiamin]

The influence of oral aminophylline (Phyllotemp ret., 2 X 225 mg) on the mucociliary clearance of the lung and on sperm motility was examined in 13 patients with asthenospermia vs. placebo because the anatomic structure of the cilia of the sperm cells and of the respiratory epithelium cells is similar. The mucociliary clearance was measured by means of radioactive tagged (99 mTc) monodisperse particles (erythrocytes from the patients). To attain a reproducible deposition pattern, the particles were inhaled during a slow inspiratory vital capacity maneuvre. The i.v. application of aminophylline (6 mg/kg body weight) to four normal subjects increased the mucociliary clearance in three of the four volunteers vs. placebo. The elimination rate of the particles increased under treatment with aminophylline from 29% +/- 12% to 46% +/- 19%, but only in seven of the 13 patients with asthenospermia. Sperm motility increased in all of the patients from 33% +/- 12% to 54% +/- 14%. No correlation was found between the increase in the mucociliary clearance and the sperm motility. The reasons for this difference will be discussed. Theophylline can be recommended for the treatment of male infertility in cases of asthenospermia.

[Computer tomographic and echocardiographic diagnosis of intracardial space occupying masses]

Nineteen patients suspected of having intracavitary masses were examined by echo-cardiography and computer tomography. One 1 cm. thrombus on the mitral valve could be demonstrated only on the echo-cardiogram and was interpreted as a tumour. Both CT and echo-cardiograms produced occasional false negative findings with cardiac thrombi, which were ultimately diagnosed by the other method or by ventriculography. Differentiation between a thrombus and a tumour depends essentially on its localisation and on the history, and some morphological criteria. Echo-cardiography and densitometric measurements did not assist in the differential diagnosis. CT may be able to differentiate thrombus from tumour if the latter contained fat or has become cystic.

Prenatal toxic effects of STS 557. II. Investigation in rabbits--preliminary results

The synthetic steroid STS 557 (17 alpha-cyanomethyl-17 beta-hydroxy-estra-4, 9-dien-3-one) was tested in gravid rabbits from days 5 to 25 p.c. It was the aim of the experiments to investigate any embryotoxic and/or teratogenic effect of STS 557. The compound did not show any effects on the mothers nor on the fetuses. Levonorgestrel was tested as standard.

Surveillance of pelagic birds for influenza A viruses

Within a 4-year surveillance period for influenza A virus in pelagic birds, 351 influenza A strains were isolated from the trachea or cloaca of 3344 apparently healthy ducks, gulls, swans, terns and geese. The isolated influenza A viruses represent 14 subtypes. Their haemagglutinins (HA) were mainly related to avian HA, but also to the human HA H2 and to the swine HA Hswl. The neuraminidases (NA) were identified as avian, equine and human NA. The isolated influenza A strains include fowl plague-like viruses Havl Neql, strains with the surface antigen Hswl Nav4 and the subtype Hav7 Navl isolated from unconcentrated water samples. A subtype unknown to date, with the antigen formula H2 Nav4, was isolated from ducks. 8.2% of pekin ducks showed dual infections.

Ventilationsszintigraphie der Lunge mit 99mTc-DTPA oder mit 99mTc-Schwefelkolloid?

Die Ventilationsszintigraphie der Lunge, durchgeführt mit genügend kleinen 99mTc-Aerosolpartikeln ergibt für die klinische Routinediagnostik ein ausreichend genaues Abbild der Ventilationsverteilung. Ob 99mTc-DTPA oder 99mTc- Schwefelkolloid als Träger der Aktivität geeignet ist, wurde an 6 rauchenden und 8 nicht-rauchenden Patienten mit chronischer obstruktiver Ventilationsstörung untersucht. Dabei zeigte sich, daß 99mTc-Schwefelkolloid praktisch nicht durch die Bronchialschleimhaut resorbiert wird und somit eine nahezu ideale Substanz darstellt. Im Gegensatz dazu wird bei den rauchenden Patienten 99mTc-DTPA rascher und regional inhomogener resorbiert als bei den nicht-rauchenden Patienten. Ein quantitativer und qualitativer Vergleich der von dorsal aufg.nommenen Ventilationsszintigramme nach 0 und 20 Min. zeigte, daß bei allen 6 rauchenden Patienten, nach 20 Min. wesentliche, die diagnostische Aussage beeinflussende Unterschiede vorhanden waren. Für diese Patienten-Gruppe kann 99mTc-DTPA daher nicht empfohlen werden.

[Inhalation bronchial provocation tests in children: comparative measurements of oscillation, occlusion pressure and plethysmographic resistance]

Examination of the lung function and bronchial provocation tests are useful for confirmation of an airway obstruction. There is a need for measurements independent of child cooperation. The standard method is body plethysmography. Forced oscillation method and interrupted occlusion method were recently introduced. Measurements of airway resistance by body plethysmography (Raw), by forced oscillation (Ros) and by interrupted occlusion method (Rvd) were compared during 78 inhalative bronchial provocation tests. The correlation index between Raw and Ros total was 0,84 and between Raw and Rvd 0,89. There is a good sensitivity and specifity in allergen bronchial provocation testing in all three methods. A bronchial sensitivity is confirmed in body plethysmography by 100% increase of Raw. In the interrupted method a 50% increase of Rvd in children smaller than 165 cm and in forced oscillation method a relative increase of 25% (0,15 kPa/l/s) is sufficient to assess a bronchial sensitivity to tested allergen.

Mucociliary clearance in patients with chronic bronchitis and bronchial carcinoma

We measured the mucociliary clearance rates and lung function data of 40 normal subjects, of 30 smokers with chronic bronchitis and of 64 patients with bronchial carcinoma. The mucociliary clearance rate of cancer patients was significantly lower than that of normal subjects and of patients with chronic bronchitis who smoked the same amount of cigarettes. The fast clearing phase of the central bronchial tree is more delayed than the peripheral mucociliary clearance rate in smokers with and without carcinoma. With our mucociliary clearance measurement we assessed the self-cleaning filter function of about the first 10 generations of the branching bronchial tree where also most bronchial carcinomas develop. The correlation between lung function data (MMEF) and smoking habits is much better (r = 0.73) than with the measured mucociliary clearance rates (r = 0.3), suggesting that inborn errors of mucociliary transport are nearly as important as external lung damage due to smoking and infection in the development of chronic bronchitis and bronchial carcinoma.

[Dynamic computer tomographic for tumours of the facial skeleton (author's transl)]

Serial computer tomography after intravenous bolus injection of contrast provides information concerning the vascularity of tumours in the facial skeleton. In addition the relationship of the tumour to the major vessels and their displacement or compression can be demonstrated. This provides information additional to the ordinary computer tomogram, so that neoplasms of the facial skeleton can be shown at various stages and their extent determined. A requirement for the use of serial CT is a scanner with a short scan time and scan interval.

[A new method for the measurement of regional lung ventilation]

The measurement of regional ventilation with radioactive gases (133Xe, 81Kr) is complicated and expensive. By means of a special device the authors have produced a 99mTc-aerosol with a particle size of less than 2.5 micrometer. If this aerosol is inhaled during a slow inspiratory vital capacity manoeuvre, the distribution of ventilation can also be estimated in patients with obstructive lung diseases. Comparative measurement of ventilation distribution with 133Xe and the 99mTc-aerosol in patients with severe airway obstruction demonstrates the reliability of the aerosol deposition pattern in assessing ventilated volume distribution in the lung 132 measurements in patients with clinical signs of lung emboli demonstrate the clinical applicability of the new device.

[A new method of combined inhalation and perfusion scintigraphy for the diagnosis of pulmonary embolism (author's transl)]

The combined inhalation and perfusion scintigraphy as a specific identification method of thromboembolism of the lung was tried out in 132 patients. A fine aerosol with selected droplet size was produced in a newly developed atomiser device and inhaled by taking a few deep breaths. Perfusion scintigraphy, which was performed immediately after inhalation scintigraphy, was effected with the same radioisotope, 99mTechnetiun. The disadvantages of inhalation scintigraphy, which are inherent in the method itself, were reduced to such an extent that it was possible to distinguish clearly between primary and secondary disturbances of pulmonary perfusion even in obstructive diseases of the respiratory tract, provided perfusion was disturbed in sufficiently large areas, i.e. of segment or lobe size.

[Phytochrome-dependent ion-transport in pea seedlings]

Five to 6 day old dark-adapted dwarf and tall pea seedlings grown in water culture were illuminated for ten minutes with red light and/or ten minutes with far-red light, and 90 to 170 minutes later their roots were immersed in a 0.2 mM K(+) solution containing labeled (86)Rb(+). After two hours uptake the fresh-weights and radioactivities of the shoot organs were determined. It was found that red light inhibits K(+)uptake into internodes and promotes uptake into the plumula. The red-light effect on K(+)transport precedes the red-light induced growth inhibition of internodes and growth promotion of leaves and is abolished by far-red light given immediately after red. The red-light effect on K(+)transport is independent of the concentration of K(+) given to the roots in the range between 0.2 to 125 mM.

[Phytochrome dependent variation of grouth and ion uptake of leaves and internodes of etiolated pea (pisum sativum) seedlings]

Inhibition of internodial growth of pea seedlings by light is compensated for by increased growth of leaves. At a given time the sum of fresh weight of internodes plus the product of fresh weight of leaves times a certain factor is constant in darkness or with different periods of light. This correlation may reflect a competition of internodes and leaves for materials delivered at a lightindependent rate from the cotyledons. This hypothesis was tested by immersing roots of pea seedlings into (86)Rb labelled K-solutions for one day in darkness, removing the plants from the solutions, exposing the seedlings to near or far red light and measuring the radioactivity and fresh weights of leaves and internodes separately. Radioactivity and fresh-weight were both dependent on phytochrome; i.e. inhibition of ion uptake and of growth in internodes and promotion of both processes in leaves by near red light as compared to dark or far red controls are mediated by phytochrome.Short time experiments of ion uptake by the roots show that K transport into the shoot organs is promoted by light after a lag phase of somewhat more than one hour. This interval corresponds well to the lag phase of the light induced growth inhibition of internodes.Seedlings deprived of cotyledons and roots grow well in water but exhibit no difference in growth rate of leaves and internodes in light and darkness. Light dependence is restored if the seedlings are submersed in approximately 3% sucrose solutions. This result seems to indicate that the influence of light on growth rates of leaves and internodes is dependent on the uptake of material by the cell. It seems possible that in the etiolated pea seedling light promotes growth of leaves by promoting uptake and hampers growth of internodes by inhibiting uptake of essential growth material delivered from the cotyledons.

[Effect of 2-chloro-9-fluorenolo-9-carbonic acid on stem elongation of peas in light and darkness]

Fluorenole in small amounts promotes, in high concentrations inhibits growth of normal peas. With given amounts of fluorenole the relative inhibition of growth is constant for all gibberellin-concentrations. A competitive effect of fluorenole against gibberellin is therefore excluded.Growth of peas in light is inhibited less by fluorenole than in darkness. On the other hand cycocel inhibits growth of peas in light much more than in darkness. Growth seems to depend in darkness and light on two differently effective and independent processes, one of which is cycocel-sensitive, i.e. gibberellin-dependent, and the other fluorenole- and light-sensitive.

[Dependence of the gibberellin production of normal peas on the phytochrom-system]

Gibberellin bioassays of normal pea seedlings grown for the first 3 days after soaking of seeds in near red light and for the following 4 days under different light conditions had the following results: 1. The gibberellin content is the higher, the longer the plants grow under near red light. This light may be given continuously or intermittently (2.5 min/hour). The gibberellin depressing effect of uninterrupted darkness depends on when the dark period is given in the last 4 days before harvest. It is concluded that the gibberellinproduction has a lag-phase of about one day after light exposure. 2. Intermittent far red light results in a low gibberellin content even when every far red flash is preceded by a near red flash. On the other hand, near red light has the effect of a high gibberellin content even when a far red flash precedes every near red flash. Near red light cancels the effect of far red light and vice versa. The results prove that light influences the gibberellin content via the phytochrome-system.

[Changes in gibberellin-like substances of lettuce seeds after light exposure]

The contents of gibberellin-like substances in lettuce seeds were determined. In darkness the seeds contain only small amounts of gibberellin-like substances, but upon illumination with near red light there is a sharp increase in the gibberellin content within one hour. It is concluded that lettuce seeds in darkness do not contain the amounts of gibberellin necessary for germination and that under the influence of light these amounts are provided.