Cinematic three-dimensional surface display of cardiac blood pool tomography

A method of three-dimensional cinematic display (3D cine) of cardiac blood pool tomography is described. ECG-gated transaxial blood pool imaging was obtained from a set of projection images that were collected from 32 images with 10 ECG-gated images per projection during a 180 degrees arc of a rotating gamma camera. A surface contour of the blood pool was determined by a set of isocount lines (40-55% of the maximum pixel counts) of the transaxial images. 3D cine was made by a depth-shading method, in which brightness of a given point on the contour was set proportional to the distance between the viewing plane and the point and to the incident angle formed by the viewing line and the surface of the point. In 15 patients, 3D cine showed hypokinesia, akinesia, dyskinesia, ventricular aneurysm, and opposite motions of the atria and ventricles. Diagnoses of left ventricular motion by 3D cine agreed well with those by echocardiography and contrast left ventriculography.

[Anesthetic and postoperative management of a patient with Gilbert's syndrome and another with Dubin-Johnson syndrome]

Anesthesia and postoperative management of a patient with Gilbert's syndrome and one with Dubin-Johnson syndrome is reported. The former patient underwent open heart surgery and the latter had a partial resection and reconstruction of the esophagus. The anesthetics used in these two cases were fentanyl and nitrous oxide. The patient with Gilbert's syndrome had remarkable perioperative complications. On the other hand, the patient with Dubin-Johnson syndrome developed conjugated hyperbilirubinemia after the 2nd postoperative day. On the 5th postoperative day, his serum and direct bilirubin levels were elevated to 19.3 mg.dl-1 and 12.8 mg.dl-1, respectively. Therefore, we had to perform daily plasmapheresis on this patient for four days. Thereafter, his serum bilirubin level decreased gradually.

Validation of single-photon emission computed tomography (SPECT) using thallium-201 in patients with lung cancer

To evaluate the primary site, pulmonary hilar, and mediastinal lesions in patients with lung cancer, thallium-201 using single-photon emission computed tomography (SPECT) was used as a tumor agent. The study population consisted of 7 patients (5 men and 2 women), aged 57 to 82 years (mean 68). Tl-201 tomography imaged positive at the primary site in all patients with lung cancer. The images demonstrated the tumor and/or mediastinal lymph nodes that were greater than 2.0cm. In particular, each tomograms facilitated the identification of the Tl-201 increased uptake in proportion to primary site. The short waiting period after injection with Tl-201 clearly offers a major advantage over alternative tumor imaging agents, such as Ga-67 or radiolabeled monoclonal antibodies. Furthermore, Tl-201 SPECT may be useful to detect the tumor and/or mediastinal lymph nodes in patients with lung cancer.

[Clinical evaluation of isosorbide dinitrate (ISDN) spray: a study on the plasma concentrations of ISDN and on its hemodynamic effects using three administration routes]

The effects of ISDN spray has been evaluated using oral, nasal or tracheal routes in patients under enflurane anesthesia. These 30 patients were in ASA I or II physical status without cardiovascular, kidney or liver diseases. Under enflurane anesthesia, hemodynamic parameters (blood pressure and heart rate), blood gas and plasma concentration of ISDN were measured at several points before and after drug administration. The plasma concentration reached a maximum point (C max) 4 min after drug administration in the oral group (O-group) and nasal group (N-group), and the values obtained were 48.4 +/- 5.4 ng.ml-1 and 87.4 +/- 13.8 ng.ml-1 respectively. The C max of the N-group was significantly higher than that of O-group (P less than 0.05). In the O- and N-groups, systolic blood pressure decreased 10% and 17%, after 4 min (P less than 0.05) and recovered 20 after min. Diastolic blood pressure decreased in both groups after 4 min (P less than 0.05). Heart rate significantly increased in the N-group (P less than 0.05), and continued to change up to 60 min after drug administration. In both groups, PaO2/FIO2 decreased 14% and 9% after 10 min (P less than 0.01). In the tracheal group, plasma concentration did not increase and these hemodynamic changes were not observed. These results suggest that nasal route of ISDN spray is the best route of administration.

[Clinical experience with extracorporeal shock wave lithotripsy MFL-5000 for urinary stone]

A Dornier MFL 5000, a new generation extracorporeal shock wave lithotripter, was installed in our hospital and the first Japanese clinical experience has been collected between July and November in 1989. We report our experience with the first 35 patients with 45 stones who were treated in 42 treatments using ESWL. We followed up 3 weeks. No invasive anesthesia was performed except 2 cases of epidural anesthesia. A double J catheter was installed in 2 patients, a ureteral catheter in 4 patients, and PNL was performed in 2 patients before ESWL. We did not use a PNL or a TUL in the postoperative treatment. In the 3 week followed up period, 29 patients (82.9%) were completely free from stone fragments. No serious complications were observed after ESWL. We conclude that the DORNIER MFL 5000 is effective for renal and ureteral stones without serious complications.

[Diaphragmatic fatigue under inspiratory resistive load in healthy subjects and the effect of several selections of frequency bands on the H/L (high/low) ratio]

In seven normal adult males the authors studied diaphragmatic fatigue by analysis of the power spectrum of the diaphragmatic electromyogram obtained with an esophageal electrode, and of the change of transdiaphragmatic pressure. Diaphragmatic fatigue was produced by inspiring through a resistive load, and mean value of the index of the tension time of the diaphragm (TTdi) maintained until fatigue was 0.33 +/- 0.09, which has been known to produce fatigue. The mean value of ratios of power at high frequencies to power at low frequencies (H/L) decreased to 61.2 +/- 16.8% of the initial value at just before breaking time. Breaking time was 4.88 +/- 1.37 minutes in average. The selection of low and high band widths for analysis of H/L ratio has differed slightly in the literature, but such differences do not have any substantial influence on the estimation of the changes of H/L ratio.

Sensitivity-enhancing scheme of a polarimetric heterodyne sensor using a birefringent fiber loop

In order to improve the sensitivity of a fiber-optic polarimetric sensor, a new scheme utilizing a birefringent fiber loop with midloop frequency shifters is proposed. In this scheme, heterodyne signals with an integral multiple-phase sensitivity can be obtained in the frequency domain. The validity of the scheme is confirmed experimentally by a bulk-optic configuration. One-order-of-magnitude improvement in sensitivity without changing the dynamic range is expected from the calculation of the signal-to-noise ratio, even in the case of a 40% excess loss in the optical loop.

[Generation of brain scintigram reports with a speech recognition device controlled by a personal computer]

Radiology reporting system using a speech recognition apparatus was applied to generation of reports on brain scintigram and SPECT. The number of words or phrases that were selected for the reporting system by the authors was 259. Rates of correct recognition at the first, second, and third or more utterance of the voices were 91.1, 5.0, and 3.9%, respectively. The recognition rates decreased from 96.6 to 88.0% when the mean lengths of the words or phrases varied from 6.4 to 3.3. Net time for the generation of 8 reports by the system was 21 minutes 26 seconds, while that by the traditional dictation-transcription method was 15 minutes and 53 seconds. This system seems to be useful because of much longer input time expected for an average doctor, who usually is not well trained in using a Japanese-word processor, and convenience for database management offered by the system.

[Intraoperative cardiac output monitoring by the transtracheal Doppler method]

We investigated the cardiac output measured with a transtracheal doppler (TTD) tube in surgical patients and evaluated its usefulness during operations. This tube was located at the point where maximum velocity of blood flow was obtained in the ascending aorta. At this point the cross-sectional area of the ascending aorta was calculated and the cardiac output was obtained by multiplying this area with average blood flow velocity which had been ultrasonically determined. The cardiac output by the TTD method was compared with that of the thermodilution method in 10 patients. The results with both groups showed a direct linear correlation. We obtained the following linear equation: TTD C.O. = 0.61 Thermo C.O. + 1.3 C.O.: cardiac output. The direct correlation coefficient proved to be 0.85 at a risk factor of 0.01. The result suggests that this non-invasive TTD method is easily available and useful in monitoring the intraoperative cardiac output.

[Diuretic effects of aminophylline in patients after cardiac surgery]

Diuretic effects of aminophylline in patients after cardiac surgery were studied by using the local renal thermodilution catheter (Goodman Co. Ltd.). The subjects were 11 patients who underwent cardiac surgery in our hospital. All patients had shown almost normal renal and endocrine function. On the day of operation, we indwelld renal thermodilution catheter into the left renal vein under fluoroscopy. After operation, when the urinary volume decreased below 1 ml.kg-1.hr-1, we administered aminophylline at a rate of 2 ml.kg-1.hr-1. We measured HR, BP, CO, PAP, CVP, renal blood flow, urinary volume, urinary electrolytes, plasma renin activity, angiotensin II, aldosteron, ADH and alpha hANP just before and after infusion of aminophylline. The urine volume, renal blood flow and renal blood flow distribution rate showed significant increases of about 70%, 40% and 35% respectively. But hemodynamic parameters including HR, mean BP and CO increased for 5%, 10% and 8% respectively after administration of aminophylline. In the endocrine system, only angiotensin II increased significantly but aminophylline did not cause any change in endocrine system. The results suggest that diuretic effect of aminophylline is mainly achieved by increasing renal blood flow.

[Radiation therapy for human renal cell carcinoma transplantable to the nude mice]

Efficacy of radiation therapy was studied using human renal cell carcinoma strain (AM-RC-3) implantable in nude mice. Cobalt 60 gamma-ray was used dosage of 5 Gy, 10 Gy, 15 Gy and 20 Gy in single, localized exposures of subcutaneously implanted tumors of the lower right femoral region. Therapeutic efficacy was determined using the Battelle Columbus Standard and evaluation of histological changes based on National Cancer Research Institute (Shimosato's classifications). Conclusion based on the obtained data are as follows: I) The T RW/C RW ratio on the tumor growth curve was 42% or less for all dosage groups except the 5 Gy group; dosages other than 5 Gy are believed effective. The 15 and 20 Gy dosage were particularly effective and the respective groups had RW of 0.96 and 0.95. II) Although Grade IIa and IIb changes were observed in the 15 and 20 Gy dosage groups, respectively, two weeks after irradiation, four weeks after irradiation all groups exhibited microscopic tissue formations that could be considered regrowth of tumor cells. Determination of histopathological effectiveness two weeks after irradiation is thought most suitable. III) Radiation therapy is appropriate as an adjuvant treatment in cases of renal cell carcinoma and should be used in combination with other therapies.

[Combination chemotherapy of human renal cell carcinoma in athymic nude mice with human lymphoblastoid interferon (HLBI) and UFT, 5-Fu]

The effectiveness of interferon alpha (HLBI) for nude mouse transplantable human renal cell carcinoma 72nd general meeting, in combination with UFT and 5-Fu, was examined using, 1 x 10(7) IU/kg, 2 x 10(7) IU/kg HLBI; 25 mg/kg 5-Fu; and 10 mg/kg, 20 mg/kg UFT, administered for 10 consecutive days. The ratio of relative mean tumor weight of treated group to control group was under 42% for the combination of 25 mg/kg (I.P.) 5-Fu, 20 mg/kg UFT, and HLBI and the effect was particularly clear for the combination with 2 x 10(7) IU/kg which indicated a grade IIA histologic classification. In comparison with the control groups only UFT (20 mg/kg) and HLBI (2 x 10(7) IU/kg) showed significant inhibition when administered alone. Although none of the drugs had an inhibitory effect when administered alone, in combined use they showed a strong antitumor effect which was more than synergistic. Orally administered 5-Fu showed a statistically significant difference only in the combination with 2 x 10(7) IU/kg HLBI. Furthermore, the concentration of 5-Fu in the tumor tissue was not affected by the route of administration or drug combination, whereas that in the serum was below the limit of detection in the intraperitoneally administered cases, 0.0096 +/- 0.0079 microgram/ml, lower than the value for orally administered cases. The 5-Fu concentration was 0.026 +/- 0.012 microgram/ml for orally administered UFT which was significantly higher than the value obtained for orally administered 5-Fu. Thus, combination therapy of HLBI and UFT for renal cell carcinoma is expected to be clinically useful.

Recurrence of anti-glomerular basement membrane antibody glomerulonephritis

Recurrence of anti-glomerular membrane antibody glomerulonephritis seems to be an unusual clinical phenomenon. We report a 57-year-old man with recurrence of anti-glomerular basement membrane antibody glomerulonephritis. He developed a rapidly progressive glomerulonephritis with anti-glomerular basement membrane antibody (anti-GBM Ab), and recovered with a combined treatment of prednisolone, anticoagulant and antiplatelet agents. After a 2-year remission, hematuria and proteinuria followed by renal functional deterioration occurred without any obvious cause. The second renal biopsy revealed cellular crescents with linear IgG deposition along GBM, a finding similar to the first one. The aforementioned combined treatment resulted in a gradual recovery from proteinuria and renal functional derangement.

[Evaluation of image quality and lesion detectability on I-123 IMP brain SPECT]

Influence of image quality on lesion detectability in I-123 IMP brain SPECT was discussed in forty-two cases with various cerebrovascular disorders. Fifty nine lesions, which were considered to show decreased uptake of I-123 IMP, were analyzed in this study. In all cases, SPECT examinations were started within 30 minutes after intravenous administration of 3 mCi of I-123 IMP. To determine the lesion detectability, fourteen radiologists from nine hospitals were gathered and film reading was carried out. To classify the image quality into valuable or not, findings of five points on SPECT image were visually evaluated; 1) uniformity of cortex accumulation, 2) separation of bilateral visual cortices, 3) density of white matter, 4) separation between basal ganglion and thalamus, 5) density of basal ganglion and thalamus. Mean lesion detections were 10.3/14 for the lesions of cerebral cortex, 9 for cerebellum, 3.58 for white matter and 3.22 for basal ganglion and thalamus, respectively. The detectability was certainly influenced by the image quality in the lesion of basal ganglion and thalamus, white matter and single lobe of cerebral cortex. We concluded that detection of small lesions and deep lesions with I-123 IMP SPECT was dependent on the image quality and the proposed classification of I-123 IMP SPECT image was useful for evaluating image quality from the points of view of the lesion detectability.

[Clinical significance of I-123 IMP brain SPECT in children with brain diseases]

Single photon emission computed tomography (SPECT) of the brain using N-isopropyl p-I-123-iodoamphetamine (I-123 IMP) was performed in 43 children with suspected brain diseases. Forty-three children (25 males and 18 females), with an age range of 24 days-15 years (mean: 6.6 years), were included in the study. Six patients were subsequently diagnosed as normal. Early SPECT of the brain was performed 30 minutes after intravenous administration of 74-111 MBq (2-3 mCi) I-123 IMP using a rotating gamma camera equipped with a 30-degree slant hole and medium energy collimator. Transverse images were reconstructed by Shepp-Logan filtered back projection method with attenuation correction after spatial filtering using an 8th order Butterworth-Wiener filter. Findings of I-123 IMP SPECT were compared with those of X-ray computed tomography (CT) and electroencephalography (EEG). The results showed that 1) In I-123 IMP SPECT, abnormality was found in 30 out of 37 children with brain diseases. The incidence of abnormal findings in the 37 patients was 81% in I-123 IMP SPECT, 61% in X-ray CT, and 78% in EEG., 2) In both cryptogenic and secondary epilepsy, the incidence of abnormality was higher in I-123 IMP SPECT than in X-ray CT. (70% and 94% vs 50% and 81% respectively). Epileptic foci detected by EEG did not correspond with defects found using I-123 IMP SPECT in 27% of the patients., 3) In asphyxiated infants, a high incidence of abnormality was observed on both I-123 IMP SPECT (86%) and X-ray CT (86%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraarterial urokinase infusion therapy for arterial occlusive disease of the pelvis and extremities with special reference to short-term high dose infusion]

Thirty-five complete arterial occlusions of pelvis and extremity in 29 patients were treated with intraarterial urokinase infusion therapy. In 28 limbs, the occlusions were due to arteriosclerotic change and in 7 lesions, the occlusions were due to Burger's disease. The patients with arteriosclerotic change ranged in age from 52 to 84 years with a mean age of 68 years, and the patients with Burger's disease ranged in age from 35 to 47 years with a mean age of 43 years. There were 24 men and 5 women. The estimated duration of the occlusion was from 5 days to 5 years with a mean duration of 11 months. The length of the occluded segments ranged from 1 to 45 cm with a mean length of 13.9 cm. The occlusion was located in the iliac artery in 13 patients, the femoral artery in 11 patients, both the iliac and the femoral artery in 2 patients, the popliteal artery in 5 patients, the femoro-popliteal artery in 1 patient, the brachial artery in 2 patients and the radial artery in 1 patient. The infusion catheter was gently advanced into the proximal portion of the clot over a flexible guide wire, and urokinase was infused at a rate of 5000-10000 IU/min, as a short term high dose infusion (SHI), until antegrade blood flow was reestablished. The catheter was then withdrawn to a point proximal to all of the remaining clot, and the infusion rate was reduced to 10000-20000 IU/h as a continuous low dose infusion (CLI). After thrombolytic recanalization, a percutaneous transluminal angioplasty (PTA) was performed in those cases which demonstrated a residual narrowing of the lumen. The initial success rate was 86%. Reocclusions were observed in 5 lesions (17%) and a second recanalization was successful in 2 of 3 patients. The 1-year cumulative patency rate following recanalization was 88.4% and the 2-year patency rate was 78.6%. No significant complications directly related to the procedure were observed. SHI combined with CLI and PTA appears to be an effective and safe therapy for chronic long segmental arterial occlusion.

Carbachol-induced potentiation and inhibition of acid secretion by guinea pig gastric gland

The effects of muscarinic ligands on acid secretion were examined by estimating the accumulation of [14C]aminopyrine in gastric glands isolated from guinea pigs. The accumulation of [14C]aminopyrine in the presence of 0.1 mM histamine was potentiated by 1 microM carbachol but suppressed by 1 mM. These two effects of carbachol were abolished by atropine, pirenzepine and AF-DX 116. Assuming that the binding of carbachol to one site (Site 1) increases [14C]aminopyrine accumulation but its binding to the other site (Site 2) reduces [14C]aminopyrine accumulation, we analysed the dose-response curves for the carbachol effects in the absence and presence of different concentrations of atropine, pirenzepine and AF-DX 116. The dissociation constants determined for these ligands at Sites 1 and 2 were as follows: carbachol, 0.28 and 7.1 microM; atropine, 0.28 and 0.54 nM; pirenzepine, 45 and 560 nM; and AF-DX 116, 380 and 4400 nM, respectively. The binding of [3H]N-methylscopolamine to the gastric glands indicated the presence of two populations of binding sites with different affinities for the above ligands, other than atropine. The apparent dissociation constants, which were estimated by analysing the displacement curves for [3H]N-methylscopolamine binding, were as follows: carbachol, 0.18 microM (10%) and 31 microM (90%); atropine, 1.24 nM; pirenzepine, 15 nM (16%) and 220 nM (84%); and AF-DX 116, 370 nM (10%) and 2970 nM (90%). These results suggest that there are two kinds of muscarinic acetylcholine receptors in the guinea pig gastric gland, one potentiating and the other inhibiting the acid secretion induced by histamine.

Role of hormonal factors in plasma K alterations in acute respiratory and metabolic alkalosis in dogs

Studies were performed on previously nephrectomized dogs to examine roles of hormonal factors in plasma potassium alterations in acute alkalosis. Respiratory and metabolic alkalosis were induced by hyperventilation and intravenous NaHCO3 or tris(hydroxymethyl)aminomethane (Tris) infusion, respectively. Respiratory and NaHCO3-induced alkalosis provoked decreases in plasma potassium from the control value of 5.12 +/- 0.68 (SE) to 4.21 +/- 0.55 meq/l (P less than 0.01) and from 4.65 +/- 0.26 to 3.91 +/- 0.16 meq/l (P less than 0.01) within 180 min, respectively. In contrast, Tris-induced alkalosis elicited an increase in plasma potassium from the control value of 4.56 +/- 0.30 to 5.31 +/- 0.30 meq/l (P less than 0.01). Hypokalemia in respiratory alkalosis was associated with a decrease in the plasma norepinephrine concentration from the control level of 377 +/- 104 to 155 +/- 41 pg/ml (P less than 0.05) but not with changes in plasma levels of epinephrine, insulin, glucagon, cortisol, and aldosterone. However, this hypokalemia was not affected by phentolamine. Also, somatostatin did not modify the hypokalemic response. NaHCO3-induced hypokalemia was associated with a decline in the plasma aldosterone and norepinephrine concentrations. The decline in plasma norepinephrine in NaHCO3-induced alkalosis followed the decrease in plasma potassium. In Tris-induced alkalosis, plasma insulin increased but norepinephrine decreased. The findings do not suggest fundamental roles of the hormonal factors in the plasma potassium alterations in bilaterally nephrectomized dogs with acute alkalosis.

[The experience of a new double-catheter introducer for simultaneous bilateral internal iliac angiography]

We developed a new 8F catheter-introducer system designed for simultaneous insertion of two catheters into each internal iliac artery via a single puncture. This introducer has a common distal limb and a pair of proximal limbs connected in a Y-shaped fashion. Each of the proximal limbs has its own check valve and flushing side arm, through which one can pass two catheters separately. We succeeded in placing each of two catheters at desired sites in three cases of pelvic angiography. This system will be of great help in pelvic angiography and infusion-chemotherapy when bilateral catheterization is required.

Carnitine deficiency following massive intestinal resection: a morphological and biochemical study

A 65-year-old man with progressive muscle weakness and liver dysfunction following massive small bowel resection showed myriad lipid-filled vacuoles in type I muscle fibers. Carnitine was significantly decreased in muscle, serum and urine. Carnitine supplementation was followed by clinical improvement and decreased lipid droplets in biopsied muscle. He had been receiving carnitine-deficient total parenteral nutrition. This form of carnitine deficiency may be due to a defect in carnitine biosynthesis, as well as dietary carnitine deficiency.