Prevalence of Chlamydia trachomatis in the general population in Germany – a triangulation of data from two population-based health surveys and a laboratory sentinel system

Background

Chlamydia trachomatis (chlamydia) is a common, frequently asymptomatic, sexually transmitted infection. It can result in severe sequelae, such as ectopic pregnancy and infertility. In Germany, chlamydia is not notifiable. An opportunistic screening program for women < 25 years was introduced in 2008. The aim of this research was to triangulate different data sources to describe the epidemiological situation of chlamydia in Germany and to investigate whether the current target group of the chlamydia screening program aligns with these findings.

Methods

Urine specimens from participants from population-based health examination surveys of children (2014–17) and adults (2008–11) were tested for chlamydia, using nucleic acid amplification testing. These data were used to generate weighted chlamydia prevalence estimates by age group and sex. Data from a nationwide chlamydia laboratory sentinel system (2014–16) were used to calculate the positive proportion among individuals tested for chlamydia by age, sex and test reason.

Results

Using data from the population-based surveys, we found a chlamydia prevalence estimate of 2.8% (95% confidence interval (CI) 1.0–7.5%) among all 15- to 17-year-old girls and of 9.6% (95% CI 0.0–23) among those reporting to be sexually active. In adult women, we found the highest prevalence among 18- to 24-year-olds (all: 2.3%; 95% CI 1.0–5.3%; sexually active: 3.1%; 95% CI 1.3–7.0%). In adult men, we found the highest prevalence among 25- to 29-year-olds (all: 3.5%; 95% CI 1.6–7.7%; sexually active: 3.3%; 95% CI 1.3–7.8%). Data from the chlamydia laboratory sentinel showed the highest positive proportion among those opportunistically screened in 19-year-old women (6.1%; 95%- CI 5.9–6.4%), among those screened due to pregnancy in 15-year-old girls (10%; 95% CI 8.5–12%), and among those tested due to symptoms or a positive partner in 19-year-old women (10%; 95% CI 9.8–11%) and 19-year-old men (24%; 95% CI 22–26%).

Conclusions

Chlamydia seems to mainly affect adolescents and young adults in Germany, with similar overall prevalence in men and women, but with slightly different age distributions. Women at highest risk of chlamydia are covered by the current screening program but given the on-going discussions in high-income countries on cost-effectiveness and benefit-to-harm ratio of these programs, the program-aim needs reconsideration.

Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection

BACKGROUND

Routine urine culture testing is not recommended for uncomplicated urinary tract infections (UTIs). As a result, the antibiotic resistance patterns or the organisms causing UTIs are not adequately reflected in routine data. We studied the sensitivity of Escherichia coli (E. coli) to trimethoprim (TMP) and to cotrimoxazole (i.e., trimethoprim/sulfamethoxazole, TMP/SMX) in community-acquired UTI and compared the findings with the resistance data of the Antimicrobial Resistance Surveillance System (ARS).

METHODS

General practitioners and internists in private practice prospectively recruited all of their adult patients with symptoms of a urinary tract infection from May 2015 to February 2016. Urine specimens from all patients were tested (including urine culture testing and antibiotic susceptibility) and infections were defined as uncomplicated or complicated UTIs.

RESULTS

1245 participants from 58 medical practices were enrolled in the study. Pathogenic organisms were found in the urine of 877 patients, of whom 74.5% had E. coli infections. Among the E.-coli-positive UTIs, 52.4% were classified as uncomplicated and 47.6% as complicated. The prevalence of E. coli that was resistant to TMP and to TMP/SMX in uncomplicated UTIs was 15.2% and 13.0%, respectively, compared to 25.3% and 24.4%, respectively, from all UTIs in ARS in 2015. Study participants who had previously taken antibiotics had the highest prevalence of E. coli resistance (30.9%), followed by those who had two or more UTIs within the past six months (28.9%).

CONCLUSION

E. coli with resistance to TMP was significantly less prevalent among the study patients with uncomplicated UTIs than in the routine data of the ARS. Accordingly, TMP should still be considered as an option for the treatment of uncomplicated UTIs. TMP/SMX is considered the agent of second choice because of its side effects. Surveillance systems based on routine data do not yield a representative sample for the evaluation of the resistance situation in patients with uncomplicated UTIs.

The Joint Task Group on Clinical Utility of Labelled Antibodies of the Society of Nuclear Medicine Europa (Snme) and the European Nuclear Medicine Society (Enms)

In September 1985 a task group on the clinical utility of labelled antibodies was founded by the Society of Nuclear Medicine - Europe.

This document was elaborated to report the aims and the programs of the group. In September 1986 the European Nuclear Medicine Society decided to partecipate in this initiative and a joint task group was created.

Initial Document

A. The aims ot the Task Group are to monitor, co-ordinate and promote research and clinical application of techniques using radiolabeled antibodies in nuclear medicine. A.1. The Group should develop into a major point of reference, giving scientific and technical support to each member of the Society involved in this field. B. To pursue these purposes it will be necessary to develop the following: B.1. Criteria to evaluate the suitability of antigen-antibody systems for tumour detection and/or therapy. B. 2. Criteria for quality control of radioimmunoreagents. B. 3. Criteria for the prevention of adverse reactions or damage due to the reagent. B. 4. Selection of suitable dosimetric methods for diagnostic or therapeutic applications. B. 5. Elaboration of protocols for clinical experiments, including appropriate techniques to be applied in single cases. B. 6. Organization of cooperative studies. C. The Task Group should promote: C.1. Informal meetings between the members of the Group. C.2. Workshops open to the members of the Society and other researchers. C.3. Publication of reports in appropriate journals.

Fatty Acid Metabolism in Symptomatic Patients with Mitral Valve Prolapse but without Coronary Artery Disease - Comparison with 201 Tl Myocardial Perfusion Scintigraphy

Using 123l-ω-heptadecanoic acid (HDA) and 201TI, respectively, myocardial fatty acid metabolism and perfusion were studied in 51 symptomatic patients with mitral valve prolapse (MVP) as diagnosed by ventriculography, and no evidence of coronary artery disease. Twelve subjects with normal coronary arteries and normal ventriculogram served as a control group for the evaluation of elimination kinetics of HDA. In the control group, the mean elimination halflife was 26.1 ± 3.6 min, whereas the patients with MVP had a mean value of ± 6.4 min. In patients with MVP, a high incidence concerning abnormalities of accumulation and/or elimination of HDA occurred, namely accumulation defects in 31 % and both prolonged and shortened elimination half-lives in 16% and 29%, respectively. Myocardial perfusion scintigraphy using 201TI showed abnormalities in 76%. Correlations were found between decreased uptake of HDA and prolonged elimination half-life as well as defects by 201TI, presumably due to ischemia based on small-vessel disease or abnormalities of cellular metabolism.

Rezidivrisiko nach thyreostatischer Behandlung immunogener und nicht-immunogener Hyperthyreosen

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogeriic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p <0.001 and 83%, p <0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

Jodmangelstruma mit und ohne funktionelle Autonomie in der euthyreoten Phase: Ein Vergleich

Ziel: Analyse der funktionellen Autonomie in der euthyreoten Phase. Methoden: Es wurden 163 klinisch euthyreote Patienten mit Jodmangelstruma ohne und 179 mit funktioneller Autonomie anhand von Geschlechtsverhältnis, Lebensalter, Beschwerden, Symptomen, sonographischem Befund, qualitativer und quantitativer Szintigraphie ohne und mit Suppression, TRH-Test, Hormonkonzentrationen und Jodausscheidung im Urin verglichen. Ergebnisse: Lebensalter, Beschwerden und Symptome, Schilddrüsenvolumen und Echomuster lieferten keinen ausreichend sicheren Beitrag zur Diagnose. Die quantitative Szintigraphie war dem TRH-Test überlegen. Erhöhte Hormonkonzentrationen ergaben sich bei 15% der Patienten mit funktioneller Autonomie. Als Grenzwert für ein erhöhtes spontanes Hyperthyreoserisiko wurde eine globale thyreoidale 99mTc-Aufnahme unter Suppression von ≥3% ermittelt, die in 20% der Patienten mit funktioneller Autonomie vorlag. Schlußfolgerung: Zur Erkennung und Therapiestrategie einer funktionellen Autonomie in der euthyreoten Phase sind quantitative Szintigraphie unter Suppression sowie TSH- und Hormonbestimmungen unerläßlich.

Assessment of Myocardial Viability in Persistent Defects on Thallium-201 SPECT after Reinjection Using Gradient-Echo MRI

This prospective study assessed myocardial viability in 30 patients with coronary heart disease and persistent defects despite reinjection on TI-201 single-photon computed tomography (SPECT). In each patient, three observers graded TI-201 uptake in 7 left ventricular wall segments. Gradient-echo magnetic resonance imaging in the region of the persistent defect generated 12 to 16 short axis views representing a cardiac cycle. A total of 120 segments were analyzed. Mean end-diastolic wall thickness and systolic wall thickening (± SD) was 11.5 ± 2.7 mm and 5.8 ± 3.9 mm in 48 segments with normal TI-201 uptake, 10.1 ± 3.4 mm and 3.7 ± 3.1 mm in 31 with reversible lesions, 11.3 ± 2.8 mm and 3.3 ± 1.9 mm in 10 with mild persistent defects, 9.2 ± 2.9 mm and 3.2 ±2.2 mm in 15 with moderate persistent defects, 5.8 ± 1.7 mm and 1.3 ± 1.4 mm in 16 with severe persistent defects, respectively. Significant differences in mean end-diastolic wall thickness (p <0.0005) and systolic wall thickening (p <0.005) were found only between segments with severe persistent defects and all other groups, but not among the other groups. On follow-up in 11 patients after revascularization, 6 segments with mild-to-moderate persistent defects showed improvement in mean systolic wall thickening that was not seen in 6 other segments with severe persistent defects. These data indicate that most myocardial segments with mild and moderate persistent TI-201 defects after reinjection still contain viable tissue. Segments with severe persistent defects, however, represent predominantly nonviable myocardium without contractile function.

Radiojodtherapie der funktionellen Autonomie unter Verwendung des funktionellen autonomen Volumens

Zur Bestimmung der effektiven Strahlendosis für die Radiojodbehandlung der funktionellen Autonomie wurde bei 131 Patienten mit unifokaler, multifokaler und disseminierter Autonomie (75 hyperthyreot, 56 euthyreot), die mit einer auf das Schilddrüsengesamtvolumen bezogenen Strahlendosis von 29814-300 Gy behandelt worden waren, retrospektiv das funktionelle autonome Volumen vor und 3-7 Monate nach der Behandlung anhand der globalen thyreoidalen Tc-Aufnahme unter exogener oder endogener Suppression sowie die im autonomen Volumen freigesetzte Strahlendosis berechnet. Eine Strahlendosis von mindestens 350 Gy auf das funktionelle autonome Volumen war notwendig, um einen ausreichenden Therapieeffekt zu erzielen, der nur von der erreichten Strahlendosis im autonomen Volumen abhängig war.

Low Altitude Solar Magnetic Reconnection, Type III Solar Radio Bursts, and X-ray Emissions

Type III solar radio bursts are the Sun's most intense and frequent nonthermal radio emissions. They involve two critical problems in astrophysics, plasma physics, and space physics: how collective processes produce nonthermal radiation and how magnetic reconnection occurs and changes magnetic energy into kinetic energy. Here magnetic reconnection events are identified definitively in Solar Dynamics Observatory UV-EUV data, with strong upward and downward pairs of jets, current sheets, and cusp-like geometries on top of time-varying magnetic loops, and strong outflows along pairs of open magnetic field lines. Type III bursts imaged by the Murchison Widefield Array and detected by the Learmonth radiospectrograph and STEREO B spacecraft are demonstrated to be in very good temporal and spatial coincidence with specific reconnection events and with bursts of X-rays detected by the RHESSI spacecraft. The reconnection sites are low, near heights of 5-10 Mm. These images and event timings provide the long-desired direct evidence that semi-relativistic electrons energized in magnetic reconnection regions produce type III radio bursts. Not all the observed reconnection events produce X-ray events or coronal or interplanetary type III bursts; thus different special conditions exist for electrons leaving reconnection regions to produce observable radio, EUV, UV, and X-ray bursts.

Cementless Implantation of Zweymueller-Endler Total Endoprostheses of the Hip - Clinical, Radiological and Scintigraphic Follow-Up for 2 Years

Sixty-four patients with cementless Zweymueller-Endler total endoprostheses of the hip underwent follow-up postoperatively for 2 years. In 3 patients loosening or infection occurred. In 61 patients no complications were observed. However, in 74% of these patients increasing activity uptake at the tip of the shaft was found by scintigraphy. This was associated with hypertrophy of the corticalis and/or with a marrow cavity reaction, observed radiologically. The results show that scintigraphic evaluation of cementlessly implanted Zweymueller-Endler endoprostheses of the hip must be interpreted differently compared to isoelastic or to cemented prostheses.

[Aortic thrombosis in a calf]

A two month-old female Simmental calf was presented with sensomotoric dysfunction and recumbency. Neurologic examination revealed dysfunction of the cerebral cortex and paralysis of both hind limbs. Examination of the skeletal system revealed a marked reduction of the skin temperature of both hind limbs and the absence of femoral pulse. Examination of cerebrospinal fluid yielded physiological parameters. The radiographic examination of the vertebral column, hip and femur on both sides revealed no evidence of alteration of the bone structures. Thiamine pyrophosphate test indicated thiamine deficiency. Based on these findings a tentative diagnosis of cerebrocortical necrosis and aortic thrombosis were made and the animal was euthanised. Post mortem examination yielded thrombosis of the abdominal aorta cranial to the branching of the iliac arteries and consecutive necrosis of the skeletal muscle of the hind limbs. Possible causes of pathogenesis are discussed.

Fasciated nerve-muscle explants for in vitro comparison of magnetic and electrical neuromuscular stimulation

Neuromuscular stimulation has become a central technique for research and clinical efforts in rehabilitation, but available devices still do not show the needed performance in strength and selectivity for this approach. However, the knowledge about the exact intramuscular structure formed by the axons, muscle fibers with their different metabolism types and properties as well as the motoric endplates in between is still too rough for purely theoretical optimization. In this text, we present an experimental setup for parametrized studies of the spatial and temporal degrees of freedom (DOF) in electrical as well as magnetic stimulation. For clarification of the physiologic background, nerve-muscle explants are dissected and kept on life support in a nutrient system with glucose and oxygen supply. The setup provides two-channel EMG signals and a dynamic force signal. The design was adapted to meet the conditions for physical compatibility with magnetic stimulation and allows coil position sweeps with four (three translational and one rotational) DOF. The setup provides access to essential boundary conditions and means to simulate lesions as well as the influence of drugs. Besides with the presented setup, comparisons and even combined application of magnetic and electrical stimulation become possible on the level of the neuromuscular system. Finally, this approach shall help to improve rehabilitation by peripheral stimulation after nerve lesions. The focus of this text lies on the setup and the nutrition which will entail particular studies in the sequel.

[Euthyroid goiter with and without functional autonomy in the euthyroid phase: a comparison]

AIM

Analysis of functional autonomy in euthyroid goitre.

METHODS

In an area of moderate iodine deficiency 163 goitrous patients without and 179 with functional autonomy all clinically euthyroid were compared by sex, age, signs and symptoms, sonographic results, qualitative and quantitative scintigraphy without and with suppression, TRH test, hormone concentrations and iodine excretion in the urine.

RESULTS

Age, signs and symptoms, thyroid volume and structure did not contribute sufficiently to diagnosis. To detect functional autonomy quantitative scintigraphy under suppression was superior to the TRH test. Increased hormone concentrations were observed in 15% of patients with functional autonomy. A global 99mTc thyroid uptake of > or = 3% under suppression indicates a higher risk of spontaneous hyperthyroidism. It was present in 20% of patients with functional autonomy.

CONCLUSION

To diagnose and treat adaequately functional autonomy in euthyroid goitre quantitative scintigraphy, determination of TSH and hormone concentrations are inevitable.

Diagnostic value of 123iodine scintigraphy and perchlorate discharge test in the diagnosis of congenital hypothyroidism

AIM

Forty children suffering from congenital primary permanent hypothyroidism were studied to determine the diagnostic impact of 123I scintigraphy in comparison to laboratory findings and ultrasonography.

METHODS

In all patients 123I scintigraphy was performed after intravenous administration of 3.7 MBq 123I. If accumulation of the radiotracer in thyroid tissue occurred a perchlorate discharge test was performed subsequently.

RESULTS

Scintigraphy revealed athyrosis in 7 children. In 11 children a lingual thyroid was observed. Deficiency in iodine organification was diagnosed by a significant discharge of 123I in 15 patients. In four of these children the diagnosis of Pendred's syndrome could be established. Ectopic thyroid tissue could be demonstrated only by scintigraphy where clinical examination and sonography failed in the diagnosis in all cases. Hypoplasia of the thyroid gland as it was diagnosed in 2 cases by ultrasonography appeared to be unlikely because a normal 123I uptake was seen in these patients. In 2 patients with scintigraphic proven athyrosis an orthotopic gland had been considered by ultrasound. In 50% of our patients the final diagnosis could only be established if 123I scintigraphy and perchlorate discharge test were performed.

CONCLUSION

This findings suggest that scintigraphy is indispensible in the correct diagnostic work up of congenital hypothyroidism.

123I-Szintigraphie und Perchlorat-Depletionstest bei der Diagnostik der kongenitalen Hypothyreose

Ziel: Die vorliegende retrospektive Studie an 38 Kindern soll Aufschluß über den aktuellen Stellenwert der 123I-Szintigraphie im Vergleich mit der Sonographie und laborchemischen Methoden bei der Diagnostik der kongenitalen primären Hypothyreose geben.

Methoden: Alle Patienten erhielten 3,7 MBq 123I intravenös zur Lokali-sationsdiagnostik der Schilddrüse. Ließ sich 123I speicherndes Schilddrüsengewebe nachweisen, wurde ein Depletionstest nach oraler Gabe von 300 mg Perchlorat (Irenat®) durchgeführt.

Ergebnisse: Bei 7 Kindern lag szintigraphisch eine Athyreose und bei 9 Kindern eine Zungengrundschilddrüse vor. Bei 15 Patienten mit ortho-top gelegener Schilddrüse wurde aufgrund einer signifikanten Depletion nach Perchlorat eine lodinationsstörung diagnostiziert. Vier von diesen Kindern hatten ein Pendred-Syndrom. Der Nachweis einer Zungengrundschilddrüse gelang klinisch oder sonographisch in keinem einzigen Fall. Bei zwei Patienten mit einem Enzymdefekt wurde sonographisch fälschlicherweise von einer Hypoplasie ausgegangen. Bei zwei athyreo-ten Kindern war aufgrund der Sonographie orthotop gelegenes funktionsfähiges Schilddrüsengewebe vermutet worden. Insgesamt konnte bei 44% der Kinder die endgültige Diagnose erst durch die 123I-Szintigraphie und den Perchlorat-Depletionstest gestellt werden.

Schlußfolgerung: Die Ergebnisse belegen, daß szintigraphische Methoden bei der Diagnostik kongenitaler Hypothyreosen unverändert ihren Stellenwert besitzen und durch die Sonographie oder laborchemische Verfahren z. Z. nicht ersetzbar sind.

[123I-scintigraphy and perchlorate depletion test in the diagnosis of congenital hypothyroidism]

AIM

Thirty eight children suffering from congenital primary permanent hypothyroidism were studied to determine the diagnostic impact of 123I scintigraphy in comparison to laboratory findings and ultrasonography.

METHODS

In all patients 123I scintigraphy was performed after intravenous administration of 3.7 MBq 123I. If accumulation of the radiotracer in thyroid tissue occurred a perchlorate discharge test was performed subsequently.

RESULTS

Scintigraphy revealed athyrosis in 7 children. In 9 children a lingual thyroid was observed. Deficiency in iodine organification was diagnosed by a significant discharge of 123I in 15 patients. In four of these children the diagnosis of Pendred's syndrome could be established. Ectopic thyroid tissue could be demonstrated only by scintigraphy where clinical examination and sonography failed in the diagnosis in all cases. Hypoplasia of the thyroid gland as it was diagnosed in 2 cases by ultrasonography appeared to be unlikely because a normal 123I uptake was seen in these patients. In 2 patients with scintigraphic proven athyrosis an orthotopic gland had been falsely considered by ultrasound. In 44% of our patients the final diagnosis could only be established if 123I scintigraphy and perchlorate discharge test were performed.

CONCLUSION

This findings suggest that scintigraphy is indispensible in the correct diagnostic work up of congenital hypothyroidism.

Somatostatin receptor scintigraphy in the staging of lymphomas

In this prospective study we evaluated the somatostatin receptor scintigraphy in the initial staging of 19 patients suffering from Hodgkin's (HD) and non-Hodgkin's lymphomas (NHL) and in the restaging of 16 patients. Scintigraphy was compared to the results of the methods applied for adequate staging of lymphoma patients in the large multicentre trials. Planar imaging and SPECT was performed after intravenous injection of 110 or 220 MBq of 111In-pentetreotide. The patient-based analysis yielded an overall sensitivity of 88%, contrasting lesion-based sensitivities of 57%, 35%, and 43% in HD, low-grade NHL and high-grade NHL, respectively. The best results were obtained in the head-and-neck region and the worst in the abdomen (sensitivities of 61% and 24%, respectively). Bone marrow infiltration was visible in 1/12 cases only. There was no significant difference between the outcomes of patients in the initial staging and restaging and no influence of the amount of injected radiopharmaceutical on the results. In terms of the Ann-Arbor classification, 10/35 patients were concordant whereas 22 were understaged and 3 overstaged scintigraphically. In conclusion, somatostatin receptor scintigraphy is not useful in the initial staging or restaging of malignant lymphomas, especially NHL, due to low lesion detection rates most probably because of low receptor densities. In addition, intraindividual heterogeneity of somatostatin receptor expression has to be considered.

Assessment of myocardial viability in persistent defects on thallium-201 SPECT after reinjection using gradient-echo MRI

This prospective study assessed myocardial viability in 30 patients with coronary heart disease and persistent defects despite reinjection on TI-201 single-photon computed tomography (SPECT). In each patient, three observers graded TI-201 uptake in 7 left ventricular wall segments. Gradient-echo magnetic resonance imaging in the region of the persistent defect generated 12 to 16 short axis views representing a cardiac cycle. A total of 120 segments were analyzed. Mean end-diastolic wall thickness and systolic wall thickening (+/-SD) was 11.5 +/- 2.7 mm and 5.8 +/- 3.9 mm in 48 segments with normal TI-201 uptake, 10.1 +/- 3.4 mm and 3.7 +/- 3.1 mm in 31 with reversible lesions, 11.3 +/- 2.8 mm and 3.3 +/- 1.9 mm in 10 with mild persistent defects, 9.2 +/- 2.9 mm and 3.2 +/- 2.2 mm in 15 with moderate persistent defects, 5.8 +/- 1.7 mm and 1.3 +/- 1.4 mm in 16 with severe persistent defects, respectively. Significant differences in mean end-diastolic wall thickness (p < 0.0005) and systolic wall thickening (p < 0.005) were found only between segments with severe persistent defects and all other groups, but not among the other groups. On follow-up in 11 patients after revascularization, 6 segments with mild-to-moderate persistent defects showed improvement in mean systolic wall thickening that was not seen in 6 other segments with severe persistent defects. These data indicate that most myocardial segments with mild and moderate persistent TI-201 defects after reinjection still contain viable tissue. Segments with severe persistent defects, however, represent predominantly nonviable myocardium without contractile function.

Quantification of the negative feedback mechanism between pituitary and thyroid in subjects with normal thyroid function

Using sufficiently sensitive and precise assays, we systematically investigated the correlation between thyrotropin, thyroglobulin, index of free thyroxine and index of free triiodothyronine after different doses of thyroxine (25, 50, 100, 150 micrograms), which were administered daily for 10 days to individuals with normal thyroid function and in a control group. Analysis of the data using relative median values expressing changes to basal values before administration of thyroxine yielded the following results: (i) thyrotropin and thyroglobulin decreased monoexponentially, depending on the doses of thyroxine administered; (ii) the extent of their decrease showed a linear correlation with the dose of thyroxine administered and was greater for thyrotropin than for thyroglobulin; (iii) the relative velocity of their decrease increased monoexponentially with the dose of thyroxine and did not differ between thyrotropin and thyroglobulin. These results provide strong evidence for a clear quantitative reaction of the feedback mechanism and confirm that the secretion of thyroglobulin is a physiological process dependent on thyrotropin. The high intra-individual variations obtained for thyrotropin were probably due to its pulsatile secretion.

[Simultaneous double nucleotide scintigraphy with indium 111 antimyosin Fab and technetium sestamibi for evaluation of myocardial viability after experimental and clinical infarct]

This study combined In-111 antimyosin Fab (AM) with Tc-99m sestamibi (MIBI) to assess myocardial viability in the subacute stage of infarction. In 9 pigs, the LAD was occluded for 45 min. Seventy-four MBq of AM were injected after 48 h of reperfusion and 740 MBq of MIBI 24 h later. In myocardial specimens, activity relative to normal myocardium (n = 35) in the region of necrosis (n = 35) was found to be 3.96 +/- 2.48 for AM and 0.30 +/- 0.20 for MIBI, in the intermediate zone of macrohistochemically reversibly damaged myocardium (n = 35) 2.79 +/- 1.29 and 0.83 +/- 0.28, respectively. Discriminant analysis classified all 105 specimens with a sensitivity of 83% and specificity of 96%. On the scans, the intermediate zone presented as overlap between both tracers. Twelve patients aged 40 to 76 years with invasively documented acute myocardial infarction (4 x anterior, 8 x inferior) were injected also with 74 MBq of AM 27 to 110 h after the onset of chest pain and with 740 MBq of MIBI 21 to 26 h later. In 8 patients, the infarct vessel was open not later than 5 h after the onset of chest pain. MIBI markedly supported reconstruction of the sections and localization of the lesions with AM on simultaneous double-nuclide single-photon emission computed tomography (SPECT). In 7 patients both tracers overlapped. Four patients showed only faint AM uptake. This demonstrates that in experimental infarction AM overestimates the region of necrosis while the combination with MIBI allows the delineation towards the intermediate zone and normal myocardium. In patients, SPECT shows similar patterns of tracer distribution. MIBI facilitates AM SPECT.

Leakage measurement during selective limb perfusion using a gamma probe

The objective of this study was to establish a probe system for intraoperative quantitative leakage measurement during selective limb perfusion for adjuvant high-dose chemotherapy in patients with malignant melanomas. We used a portable gamma probe with digital display and investigated the physical properties in a phantom study simulating blood pool activity at different angles of the probe to the surface and different distances. In 20 patients the limb circulation was surgically separated from the systemic blood circulation, and the limb was then selectively perfused (cytostatics added) for 60 min. Initially, 15 MBq technetium-99m labelled autologous red blood cells was injected into the limb circulation, and an equal amount was kept as a standard. Every 10 min, blood samples were drawn from the body circulation and count rates were simultaneously measured by the probe system at the lower end of the sternal body. At the end of perfusion, the circulation of the limb was reconnected, the standard injected into the systemic circulation, and a blood sample drawn after 10 min. All blood samples were counted for calculation of leakage in terms of percent of the injected dose, and the results compared with the intraoperative count rates of the probe system. In the range of leakage observed in this study (0%-86%), the count rate of the probe system (corrected for blood volume, i.e. for body surface) correlated with the results of conventional measurement (r=0.92) according to the equation: %leakage=counts per sx[1.2xbody surface (m2)-1.19]. In conclusion, the use of the described probe system is a feasible approach for leakage quantification which continuously yields data during selective limb perfusion.

Immunoscintigraphy for the detection of brain abscesses

The aim of this prospective study was to assess the diagnostic usefulness of a 99Tcm-anti-granulocyte antibody in the early differentiation of the aetiology of a ring-enhancing structure on computed tomography (CT) scans following neurosurgical intervention. In 26 patients (15 males, 11 females) aged 20-82 years with suspected intracranial infection, 29 SPET scans of the head were obtained 4-6 h following the intravenous injection of 555 MBq 99Tcm-anti-granulocyte antibody. The patients had antibiotic, antimycotic or corticosteroid therapy. The diagnosis was confirmed by surgery (19 cases) or subsequent CT/MRI (magnetic resonance imaging) scans and clinical follow-up (10 cases). The immunoscan was true-positive (abscess) in 6 (sensitivity = 100%), true-negative in 19 and false-positive in 4 (specificity 83%) cases. There was no obvious detrimental effect on the results due to the antibiotic, antimycotic or corticosteroid therapy. In conclusion, despite false-positive results, the 99Tcm-anti-granulocyte antibody is a useful tool in the early detection and exclusion of intracranial abscess after neurosurgical interventions.

Prophylactic application of thyrostatic drugs during excessive iodine exposure in euthyroid patients with thyroid autonomy: a randomized study

In a prospective, randomized study we examined the influence of prophylactic short-term thyrostatic therapy on thyroid iodine metabolism in patients with euthyroid autonomy undergoing elective coronary angiography. From a total of 1177 patients, 51 fulfilled the criteria of euthyroid autonomy before coronary angiography (negative thyrotropin-releasing hormone test, 10-min uptake of at least 1.2%, 99mTc and no elevation of free thyroxine and free triiodothyronine indices) and were randomized into three groups: group 1 (N = 17) received 20mg/day of thiamazole and group 2 (N = 17) received 900 mg/day of sodium perchlorate; thyrostatic therapy was begun on the day before angiography and continued for 14 days; group 3 (N = 17) served as controls without treatment. Parameters of thyroid function-free thyroxine (FT4) index and free triiodothyronine (FT3) index, thyrotropin (TSH) and delta-TSH urine iodine excretion and 99mTc uptake were determined before and 30 days after coronary angiography. At the end of the study the mean FT4 index and FT3 index were elevated significantly in the control group compared with baseline values, but were still within the normal range. In contrast, the mean FT4 index and FT3 index remained unchanged in the treated groups. Four mild cases of hyperthyroidism were observed at the end of the study: two cases in the control group and one case in each of the treated groups. Thyrotropin suppression, urine iodine excretion and 99mTc uptake differed significantly between the treated groups and the control group. In the treated groups TSH suppression, urine iodine excretion and 99mTC uptake remained unchanged 30 days after coronary angiography compared with baseline values. In the control group the degree of TSH suppression and the level of urine iodine excretion increased (about twofold) significantly after coronary angiography, whereas 99mTc uptake decreased significantly (ca. 50%). In conclusion, short-term prophylactic thyrostatic therapy seems to have a protective effect against iodine excess in patients with euthyroid autonomy. However, mild hyperthyroidism could not be prevented in some cases. Probably a combination therapy of thiamazole and perchlorate would be more effective.

[123I]IBZM SPET analysis of dopamine D2 receptor occupancy in narcoleptic patients in the course of treatment

Elevated levels of central D2 dopamine receptors were found on postmortem examination in cases of human narcolepsy. In vivo investigations using positron emission tomography (PET) and single photon emission tomography (SPET) found no changes of D2 binding in the striatal structures. To investigate whether the elevated D2 receptors in postmortem investigations are due to long-term treatment effects, we applied 123I-labeled (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl) benzamide (IBZM) ([123I]IBZM, a highly selective CNS D2 dopamine receptor ligand) and SPET in narcoleptic patients in the course of treatment with stimulants and/or antidepressants. Before treatment we found no changes in D2 binding in 10 patients (in comparison to 10 normal controls). After treatment (performed in five patients for 3 months) we found changes in D2 binding in four of them, indicating that the results of the postmortem studies could have been influenced by long-term medications. Human narcolepsy seems not to be related to a striatal D2 dopaminergic disturbance.

Falsely negative 99mTc-antigranulocyte immunoscintigraphy and positive 99mTc-HMPAO-labelled leukocyte scan in active Crohn's disease. Possible effects of immunosuppressive therapy?

A 19-year-old woman with active Crohn's disease under immunosuppressive therapy underwent scintigraphy with 99mTc-anti-NCA-95 antigranulocyte antibodies in order to determine the extent of inflammation. It turned out to be falsely negative whereas a 99mTc-HMPAO-labelled leukocyte scan revealed a marked terminal ileitis and pancolitis. It is assumed that immunosuppressive therapy was the main reason for the falsely negative antibody scan, possibly affecting the red bone marrow where most of the antibodies bind to granulocytes. Peripheral leukocytes labelled in vitro do not seem to be subject to these hypothetical effects on red bone marrow.

[Radioiodine therapy of funcitonal autonomy using the functional autonomous volume]

In order to determine the effective radiation dose to be delivered by 131I in functional autonomy we have used the functional autonomous volume calculated from the global 99mTc thyroid uptake under exogenous or endogenous suppression before and 3 to 7 months after treatment. The radiation dose to the autonomous volume was calculated retrospectively in 131 patients with unifocal, multifocal and disseminated autonomy (75 hyperthyroid, 56 euthyroid) who received 131I treatment of 200-300 Gy to the total volume of the gland. It could be shown that at least 350 Gy to the autonomous volume are required to reach the desired effect of treatment which was dependent only on the radiation dose delivered to the functional autonomous volume.

Improved dose concept for radioiodine therapy of multifocal and disseminated functional thyroid autonomy

The present study analyzes the improvement of the outcome of radioidine therapy in non-immunogenic hyperthyroidism by adapting the target dose to the 99mTc-pertechnetate thyroid uptake under suppression (TcTUs) prior to radioiodine therapy. The TcTUs is a substitute for the non-suppressible iodine turnover. The 89 patients presented with a basal thyrotropin level of < 0.1 mU/l, normal values for free triiodothyronine and thyroxine and with multifocal or disseminated thyroid autonomy. These terms describe the scintigraphic distribution pattern of autonomous iodine turnover. Thirty-two patients had a TcTUs between 1.6 and 3.2% (group A) and 57 had a TcTUs > 3.2% (group B). Fifty-five patients (three of group A and 52 of group B) were treated previously for overt hyperthyroidism with antithyroid drugs. Target doses of 150 and 200 Gy were used in both groups and 300 Gy in group B only. Six months after radioiodine therapy, a basal TSH level of > or = 0.5 mU/l as criterion of therapy success was observed in 94% of group A and in 54% of group B. Further differentiation of group B shows an increasing success rate with the target dose used: 45% after 150 Gy, 50% after 200 Gy and 90% after 300 Gy. In patients with a basal TSH level of < 0.5 mU/l after radioiodine therapy, the TcTUs was evaluated again.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrovascular reactivity to acetazolamide in (senile) dementia of Alzheimer's type: relationship to disease severity

Neuropathological reports about denervation and amyloid angiopathy in dementia of Alzheimer's type (DAT) as well as signs of selective incomplete white matter infarctions point to a vascular involvement within the degenerative process. In order to investigate potential alterations of cerebrovascular function we performed cerebral blood flow measurements before and after intravenous injection of 1 g acetazolamide using technetium-99m hexamethylpropyleneamine oxime and single photon emission tomography in 12 patients (6 female, 6 male; mean age 70.8 +/- 9.6 years) with probable (senile) dementia of Alzheimer's type (SDAT) and 9 controls (7 female, 2 male; mean age 71.2 +/- 8.6 years). SDAT patients revealed significantly reduced cerebrovascular reactivity with lower values with increasing cognitive impairment. We discuss possible underlying mechanisms.

99mTc-HMPAO-SPECT in the diagnosis of senile dementia of Alzheimer's type--a study under clinical routine conditions

This study was designed to evaluate, whether investigations of cerebral blood flow can be a helpful diagnostic tool in the differential diagnosis between (senile) dementia of Alzheimer's type [(S)DAT] and geriatric depression with cognitive impairment. Under clinical routine conditions we performed Single Photon Emission Computed Tomography (SPECT) using 99mTc-Hexamethylpropyleneamine Oxime (HMPAO) in 23 patients with (S)DAT (14f, 9m; mean age 68.9 y), 17 patients with geriatric depression (9 f, 8 m; mean age 66.4 y) and 12 age-matched controls (9 f, 3 m; mean age 69.2 y). Semiquantitative analysis (corticocerebellar ratios) of eight different regions of interest (ROI) revealed a significantly (p < 0.05) reduced perfusion in the (S)DAT patients compared to the control group. The depression group exhibited perfusion values between the (S)DAT and control group. The difference between the depression and (S)DAT group was most prominent in the left parieto-occipital ROI (p = 0.008). We discuss the data with extensive regard to the literature and conclude that 99mTc-HMPAO SPECT is a valuable additional tool in the differential diagnosis of depression and dementia in the elderly.

Single photon emission tomography (SPET) imaging of dopamine D2 receptors in the course of dopamine replacement therapy in patients with nocturnal myoclonus syndrome (NMS)

Single photon emission tomography (SPET) permits the in vivo measurements of regional cerebral radioactivity in the human brain following the administration of compounds labeled with photon-emitting isotopes. According to our SPET findings of a reduced binding of [123I]labeled (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl) benzamide (IBZM) (a highly selective CNS D2 dopamine receptor ligand) to D2 dopamine receptors in striatal structures in untreated patients with nocturnal myoclonus syndrome (NMS) it seemed to be of interest to investigate whether there are changes in D2 receptor binding under dopamine replacement therapy or not. We studied the uptake and distribution of [123I]IBZM before and in the course of dopamine replacement therapy in four patients with severe insomnia caused by a nocturnal myoclonus syndrome (NMS). We found an increase of the IBZM binding to D2 receptors in the course of treatment, which was associated with an improvement of sleep quality. Reasons for this are discussed. The [123I]IBZM SPET technique in conclusion offers an intersting tool for in vivo investigations of functional changes in the dopaminergic neurotransmitter system in longitudinal studies.

Falsely Negative 99mTc-Antigranulocyte Immunoscintigraphy and Positive 99mTc-HMPAO-La be I led Leukocyte Scan in Active Crohn’s Disease

A 19-year-old woman with active Crohn’s disease under immunosuppressive therapy underwent scintigraphy with 99mTc-anti-NCA-95 antigranulocyte antibodies in order to determine the extent of inflammation. It turned out to be falsely negative whereas a 99mTc-HMPAO-labelled leukocyte scan revealed a marked terminal ileitis and pancolitis. It is assumed that immunosuppressive therapy was the main reason for the falsely negative antibody scan, possibly affecting the red bone marrow where most of the antibodies bind to granulocytes. Peripheral leukocytes labelled in vitro do not seem to be subject to these hypothetical effects on red bone marrow.

Nocturnal myoclonus syndrome (periodic movements in sleep) related to central dopamine D2-receptor alteration

The nocturnal myoclonus syndrome (NMS) consists of stereotyped, repetitive jerks of the lower limbs that occur during sleep or wakefulness. NMS is often related with restless-legs syndrome (RLS) and can cause severe sleep disturbances and daytime sleepiness. The efficacy of dopamine agonists in the treatment points to a dopaminergic dysfunction in NMS. We investigated the central dopamine D2-receptor occupancy with [123I] labeled (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl) benzamide (IBZM) (a highly selective CNS D2 dopamine receptor ligand) ([123I]IBZM) and single photon emission tomography (SPET) in 20 patients with NMS and in 10 healthy controls. In most of the patients with NMS there was a lower [123I]IBZM binding in the striatal structures compared to controls. The results indicate that NMS is related to a decrease of central D2-receptor occupancy.

[Functional autonomy of goiter]

The article summarizes the status of knowledge on functional autonomy of the thyroid gland from the standpoint of definition, pathogenesis, pathophysiology, epidemiology, diagnostics and treatment.

Scintigraphic detection of inflammatory heart disease

Inflammatory diseases of the heart encompass myocarditis, endocarditis and pericarditis. This paper discusses the diagnostic potential of scintigraphy in these entities. In myocarditis, indium-111 antimyosin Fab imaging can visualize active myocyte damage and thus contribute substantially to the diagnosis. Antimyosin uptake is also seen in a large subset of patients with dilated cardiomyopathy, indicating ongoing myocyte injury in these cases. In endocarditis, immunoscintigraphy using monoclonal technetium-99m-labelled antigranulocyte antibodies provides useful diagnostic information in patients with equivocal echocardiographic findings. Immunoscintigraphy seems to indicate the floridity of the inflammatory process in endocarditis and may be used to monitor antibiotic therapy. In pericarditis, the clinical value of scintigraphy has not been convincingly demonstrated.

111In-pentetreotide (somatostatin analogue) scintigraphy as an imaging procedure for endocrine gastro-entero-pancreatic tumors

It was the aim of the present study to examine whether 111In-pentetreotide, a somatostatin analogue with predominantly renal excretion, is a suitable receptor agonist for scintigraphic imaging of endocrine gastro-entero-pancreatic (GEP) tumors, and to evaluate the contribution of the usual imaging times 4 and 24 h p.i. In 36 patients, planar scintigrams obtained 4 h, and 24 h after i.v. injection of 111 or 222 MBq 111In-pentetreotide were compared to the results of other imaging procedures and of surgery. Single photon emission computed tomography (SPECT) was also performed 24 h p.i. Positive scintigraphies were obtained in 32 out of 36 patients (18/19 patients with carcinoid syndrome, 8/9 with non hormone-producing endocrine GEP tumors, 2/4 with gastrinomas, 1/1 with glucagonoma, 1/1 with a VIPoma, 2/2 with paragangliomas). In 9 patients tumor manifestations previously not detected by conventional imaging procedures were disclosed by 111In-pentetreotide scintigraphy. 24-h images yielded significantly more true positive findings than 4-h images. In 4 patients liver metastases missed on planar scans were detected by SPECT. A discrepancy between patient-based and organ-based analysis of the results was encountered thus indicating a possible intraindividual heterogeneity in somatostatin receptor expression. In conclusion, 111In-pentetreotide is a suitable somatostatin analogue for scintigraphic in vivo demonstration of somatostatin receptors and for imaging of most tumor manifestations in patients with endocrine GEP tumors. Further studies will have to evaluate whether or not a positive receptor scintigraphy predicts response to treatment with long-acting somatostatin analogues.

Funktionelle Autonomie der Schilddrüse

In einer Übersicht werden die bisherigen Befunde und Kenntnisse über die funktionelle Autonomie der Schilddrüse unter den Gesichtspunkten Definition, Pathogenese und Pathophysiologie, Epidemiologie, Diagnostik und Therapie zusammengefaßt.

[Immunogenic and non-immunogenic hyperthyroidism--a comparison]

In a retrospective study 161 hyperthyroid patients without treatment were divided into 74 with immunogenic hyperthyroidism (IMH) and 87 with non-immunogenic hyperthyroidism (NIMH). The frequency of complaints and the mean hormone concentrations were significantly higher in IMH and the median thyroid volume was significantly smaller. Diffusely reduced sonographic echoes were observed in only 50% of patients with IMH compared to 5% of those with NIMH. Homogeneous distribution of 99mTc in the thyroid was observed scintigraphically in 95% of patients with IMH and in only 3% of those with NIMH. Although the median of global thyroid uptake of 99mTc was significantly higher in IMH there was a broad overlap between the two groups. The mean hormone production is higher in IMH than in NIMH. In order to separate IMH and NIMH, several criteria have to be employed which differ concerning their diagnostic significance.

Determination of the autonomously functioning volume of the thyroid

The aim of this work was to determine the autonomously functioning volume in euthyroid and hyperthyroid goitres for prognostic and therapeutic purposes. To this end, various groups of patients were selected: individuals without evidence of thyroid disease, euthyroid patients with diffuse goitre of normal structure and function, euthyroid patients with evidence of autonomy and patients with hyperthyroidism due to autonomy. In all of them the thyroid uptake of technetium-99m was determined under exogenous suppression (TcUs) in the euthyroid state and under endogenous suppression (TcU) in the hyperthyroid state. It was demonstrated that: 1. In patients with unifocal autonomy the TcUs and TcU correlated linearly with the autonomous volume delineated and measured by sonography. 2. A nearly identical result was obtained if the mean autonomous volume in individuals without thyroid disease of 2.2 +/- 1.1 ml calculated by TcUs/TcU x total thyroid volume was used as a basis. 3. The critical autonomous volume, i.e. the volume at which hyperthyroidism will occur, was found to be 16 ml at a cumulated sensitivity and specificity of > 0.9. The method can be used to select patients for definitive treatment before hyperthyroidism occurs and to measure the autonomously functioning volume independent of its distribution within the thyroid for treatment with radioiodine. The method is easy to perform and is also an example of how a relative parameter of a function can be converted into an absolute parameter of a functioning volume.

Inverse correlation between disappearance of intrathecally injected 111In-DTPA from CSF with CSF protein content and CSF-to-serum albumin ratio

By means of cerebrospinal fluid (CSF) scintigraphy with 111In-DTPA injected following lumbar puncture in 18 patients after meningitis (12), with traumatic head injury (4), cholesteatoma (1) or a communicating hydrocephalus (1) the hypothesis of whether slow movement of CSF may contribute to the elevation of CSF protein and albumin content in neurological diseases other than spinal block was tested. The ratios of the count rates over the head (geometric mean of anterior and posterior view) at 23-25 h to 4-6 h after 111In-DTPA application (C24 h/C5 h) and the ratio 47-49 h to 23-25 h after injection (C48 h/24 h) were taken as measures of the velocity of 111In-DTPA disappearance from CSF. Both the CSF protein content and the CSF-to-serum albumin ratio correlated with C24 h/C5 h and C48 h/C24 h. Assuming log-linear elimination between 24 and 48 h the elimination half-life of 111In-DTPA was estimated to be 12.4-131.1 h (median = 31.7 h). It was concluded that slow CSF kinetics probably are involved in the elevation of CSF protein content in several neurological diseases.

Dopamine D2 receptor alteration in patients with periodic movements in sleep (nocturnal myoclonus)

Periodic movements in sleep (PMS) can cause severe sleep disturbances. We investigated the central dopamine D2 receptor density in patients with PMS with 123I-IBZM and single photon emission tomography (SPET). In PMS there was a lower 123I-IBZM binding in the basal ganglia compared to the control group. The results indicate a loss of central D2 receptors in PMS.