The importance of the renal interstitium for kidney function.
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Biomedical subjects
Publications and source records attributed to B Leisner.
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The case of a 41/2-year-old girl with disseminated neuroblastoma and concomitant osteomyelitis is reported. Neuroblastoma was detected in the vertebral column, the right suprarenal fossa, the left side of cranium and in bone marrow aspirates. Osteomyelitis was present in the left femur and was due to Salmonella tennessee. For the first time in the literature the two lesions were demonstrated by means of simultaneous 131I-MIBG and 99mTc-DPD scintigraphy. The diagnoses were proved by direct histological and microbiological studies.
In a total of 195 children and adolescents of both sex (mean age 12.9, range 5-17 years) with endemic non-toxic goitre the thyroidal iodine concentration (IC) was determined using X-ray fluorescent scanning on admission and during iodine (100 micrograms daily) and L-thyroxine (3 micrograms/kg body weight daily) treatment respectively. Additionally the thyroid volume was measured sonographically in a longitudinal study including 46 patients before and after 4-8 months of iodine supplementation (100 micrograms daily). The IC was 305 +/- 144 micrograms/g. It compared well with that of adult goitre patients (288 +/- 109 micrograms/g) and was significantly inferior to the value of normal controls (389 +/- 170 micrograms/g). Under L-thyroxine therapy the IC further decreased (243 +/- 144 micrograms/g), whereas patients receiving iodide showed an increase of the IC (570 +/- 197 micrograms/g). The mean TSH level fell from 2.3 +/- 0.9 microU/ml to 1.4 +/- 0.6 microU/ml. The average T4/TBG (thyroxine binding globulin) ratio showed a slight increase which, however, was not significant. The mean goitre volume decreased by 40%. It was evidenced that iodide is useful not only in the prophylaxis of non-toxic goitre but also as a more physiologic treatment than thyroid hormones, at least for young subjects with simple diffuse goitres.
In 44 patients with morphea the incidence of internal organ involvement was studied. For the clinical study, only patients with disseminated (22 patients), linear (20 patients), and generalized morphea (2 patients) were considered. Systemic parameters were determined for inflammation and the function of the esophagus, lung, heart and kidneys. In 22 patients, mostly with the linear form of morphea, the muscles were studied by electromyography. In 23 patients the HLA-A, HLA-B, HLA-C and HLA-DR patterns were determined; 27% of the patients showed systemic organ manifestations. Esophagus function was impaired in 10 and lung function in 6 cases; 15 patients showed myositis. The degree of systemic involvement was correlated with the type of morphea and the grade of systemic inflammation. Generalized morphea showed a high rate of organ involvement (2 of 2); in linear morphea organ involvement was reduced to 34% and in the disseminated form, to 14%. There was a significant association of HLA-DR1 and -DR5 with the different types of morphea.
The course of progressive systemic scleroderma was analysed from data collected on 131 patients. Classification was according to the extent of cutaneous involvement, type I (28%): sclerosis as far as the wrist-joint; type II (65%): sclerosis beyond the wrist-joint; type III (7%): sclerosis beginning to affect the trunk. In addition, they were subdivided into those with or without signs of systemic inflammation. The sex ratio was 3.5 females to 1 male. In half of the patients the disease manifested itself between the age of 30 and 50 years, with a clear peak about the 40th year. Serological evidence of inflammatory and immunological phenomena was present in nearly 50%, predominantly in those with type II or III. Oesophageal involvement was present in 84%, of the lung in 56% of all patients. ECG and echocardiographic changes were demonstrated in 34% of patients, while liver, intestines and kidneys were only rarely affected. The degree of organ involvement increased from type I to type III. Signs of systemic inflammation were predominantly associated with a clinically severe course.
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The therapeutic approach in malignant goitre is fairly uniform, apart from use of percutaneous irradiation. The influence of irradiation on survival rate in differentiated carcinomas transgressing organ boundaries was assessed in the evaluation of treatment results in 621 patients (two patient groups: 1960-1980). Early stages of tumour (T0-T1) were seen in only 18% of cases; 24% of all cases had metastases, mainly of the lungs and skeleton. Males died 1.5 times more frequently due to differentiated tumours than did females The 10-year-survival rate was 90% in patients below the age of 50 years in contrast to 60% in older patients. Papillary carcinomas had such a survival rate in 78% and follicular carcinomas in 66%. Stages T0-T2 had a survival of 87% in contrast to 58% in stage T3. Occurrence of distant metastases diminished survival to 48%. 167 patients with irradiation (I) and 73 without (II), but an otherwise equal treatment, with differentiated carcinoma stage T3 could be compared. Group I showed a 5- and 8-year survival of 88% and 75%, group II 68% and 38% (P less than 0.001). Local recurrence was the same in both groups, however metastases occurred more frequently and earlier in group II.
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To study the effect of sclerotherapy of varices on esophageal function, the motility of the tubular esophagus and of the lower esophageal sphincter (LES) were recorded in 19 patients after 7 to 13 sclerotherapy sessions and in 15 healthy volunteers. In addition, esophageal functional scintigraphy (EFS) was performed in the patient group. Compared with the volunteers the patients had lower contraction amplitudes in the distal esophagus (30.5 +/- 17.5 mm Hg versus 43.6 +/- 9.1 mm Hg, p less than 0.01) and a higher percentage of non-propulsive simultaneous contractions (NPC) in the distal (33.4 +/- 23.2% versus 9.0 +/- 8.6%, p less than 0.005) and mid-esophagus (15.0 +/- 8.2% versus 8.3 +/- 8.1%, p less than 0.05). There was a negative correlation between the percentage of NPC in the distal and mid-esophagus and radionuclide transit (rs - 0.53, p less than 0.02). Three of 19 patients had a positive reflux index by EFS. The LES tone was only slightly lower in the patients than in the controls (10.7 +/- 3.2 mm Hg versus 13.4 +/- 3.6 mm Hg, p less than 0.05). Our findings indicate that sclerotherapy of esophageal varices may lead to a reduced peristaltic esophageal motility with an impaired transport function. This could contribute to the development of dysphagia or esophagitis.
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Using ultrasound it is possible to determine the thyroid volume with a maximal error of 12%. The method is based on the electronic planimetry of a sequence of transverse ultrasound scans of the thyroid. Following this, the "slices" are added using a small computer. On 101 patients five commonly used methods of volume determination were compared with this reference technique. The volume estimation by palpation and interpretation of the scintigram as well as the volume calculation from the scintigram area or from an ellipsoid model gave maximal errors between plus or minus 82% and plus or minus 90%. The combination of scintigram area or scintigraphically determined length and width of a single thyroid lobe and the sonographically measured thickness reduced the maximal error to plus or minus 35% and plus or minus 37%. In 10 patients teh reproducibility of the reference technique was excellent and the absolute maximal error was 4.6%, even when the patients were differently positioned.
Twenty children with severe scoliosis underwent spirometry, chest X-ray and 133Xe ventilation studies before surgical correction by the Harrington operation. By means of functional scintigraphy the relative distribution of the functional residual capacity (FRC) and the wash-out curves (3-min-retention without background correction, mean time constant, effectivity index after background correction) were analysed quantitatively. The chest X-ray and the single-breath-phase of the ventilation study remained mostly unchanged, whereas the shifting of the FRC distribution towards the lung of the concave side indicated in all cases a regional ventilation restriction of the convex side. In addition the analysis of the wash-out curves showed a regional impairment of the alveolar ventilation of the convex side which exceeded the shifting of FRC distribution. Even in the cases with normal spirometric values all scintigraphic parameters were slightly pathological, probably due to the decreased lung function caused by the scoliosis. The effectivity index taking into account the respiration frequency, the tidal volume, the FRC and the dead space, was found to be the most accurate and sensitive parameter for the evaluation of regional ventilation impairment.
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In five anesthetized cats the excretion of Tc-99m-DAIDA into the gallbladder and the small bowel and the d.g. reflux were visualized by a gamma camera and analyzed by a digital computer. A d.g. reflux index was calculated following stimulation of the gallbladder by ceruletide and test meals, before and after a Heineke-Mikulicz pyloroplasty. It could be demonstrated that tracing of bile with TC-99m-DAIDA can be used as a noninvasive method for the evaluation of the d.g. reflux. Gastric intubation increases the d.g. reflux rate. Ceruletide is a much more effective choleretic agent than test meals. Despite a wide pyloroplasty neither an augmented d.g. reflux nor gastritis was seen, probably due to the preserved antral innervation.
The validity of various scintigraphic and endocrinological methods was assessed in order to classify confirmed autonomous adenomas (AA) and to differentiate AA from euthyroid and hyperthyroid goitres. Methods used included: Measurement of 131J-uptake 6, 24 and 48 hours after 131J-application, before and after suppression by T3, thyroid scanning, count-rate measurement in the AA and the paranodular tissue, and determination of T4. All patients received 131J-therapy (40,000 rads). In 8 out of 30 scintigraphically compensated autonomous adenomas (CAA) there was no TSH response to TRH. 12 cases showed a subnormal TSH response and 10 patients had a normal TSH response. T4-values were increased in only 2 cases. Out of 73 decompensated autonomous adenomas (DAA), 66 cases (90%) had no TSH response and 7 cases showed only a subnormal response. In 48% of DAA T4-levels turned out to be in the hyperthyroid range. Both, scintigraphic and endocrinological tests were found to agree in most cases of DAA. However, the diagnosis of CAA could only be proved on the basis of a scintigraphically confirmed suppressive effect of T3 on the paranodular tissue. Thus, in the individual case, separation of CAA from DAA turned out to be impossible using the results of TRH-test alone.