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C M Kirsch

Publications and source records attributed to C M Kirsch.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Diagnostic value of somatostatin receptor scintigraphy with indium-111 pentetreotide in small-cell bronchial carcinoma].

Small-cell lung cancer (SCLC) cells may express somatostatin receptors [14]. Receptor-positive tissue can be visualised in vivo by scintigraphy with radiolabelled somatostatin analogues. In a prospective study we examined 18 patients with histologically proven SCLC for the diagnostic value of somatostatin receptor scintigraphy using indium-111 pentetreotide. Planar whole body scanning was performed 4 and 24 hours after administration. Additional SPECT imaging of the thorax and the abdomen was done at 24 hours. The results were compared with conventional staging procedures: ultrasound, x-ray, computed tomography and bone scintigraphy. In all 18 patients the primary tumour was correctly identified. Out of 13 patients with mediastinal lymphoma formation 10 patients showed positive SRS. In 2 more patients SRS showed mediastinal uptake while CT scanning was negative. The detection of distant metastases in patients with extensive disease was true positive in 8 cases (OSS, HEP, BRA), false negative in 4 cases (PLE, ADR, HEP), corresponding to a sensitivity of 67%. In 2 patients cerebral metastases were no longer detectable by SRS after previous local irradiation. Even though the method is limited in respect of revealing distant metastases in the upper abdominal area due to physiological uptake in liver, spleen and kidneys, differentiation between limited disease (LD) and extensive disease (ED) was possible in all cases. We conclude that [111In]pentetreotide scintigraphy is a suitable method for the detection of SCLC primary tumours and a substantial tool for differentiation between LD and ED if combined with ultrasonography of the upper abdomen.

Adult↗
PubMed1998

[Comparison of 51Cr-EDTA with 99m-Tc-DTPA slope clearance for estimation of glomerular filtration rate using the one compartment model].

AIM: Of this study is to determine the relationship between 51Cr-EDTA and 99mTc-DTPA slope clearance applying the "one-compartment model". METHODS: The "one-compartment model" was chosen to calculate and to compare the glomerular filtration rates of 25 patients with normal and pathological creatinin values after injection of 51Cr-EDTA and 99mTc-DTPA simultaneously. RESULTS: The two clearance values correlated well (r = 0.996), and the 99mTc-DTPA clearance was systematically higher (28%). The 99mTc-DTPA was calculated and compared after taking three plasma samples. Taking two samples, only minor differences were seen and the correlation was high (r = 0.992). CONCLUSION: The results of this study encouraged us to adopt the use of 99mTc-DTPA instead of 51Cr-EDTA in determining the glomerular filtration applying the "one-compartment model" in slope with two plasma samples.

Chromium Radioisotopes↗
PubMed1998

Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma.

UNLABELLED: The present investigation is an evaluation of intermediate and long-term side effects in patients after high-dose radioiodine treatment due to differentiated thyroid carcinoma. METHODS: A total of 203 patients were interviewed using a standardized questionnaire. RESULTS: After radioiodine treatment, 76.8% of the patients reported intermediate (from discharge up to 3 mo) or long-term (more than 3 mo after treatment) complaints, and 61.1% reported long-term side effects. Nonstochastic side effects included sialoadenitis, which occurred in 33.0% of cases, and 27.1% of patients suffered from a transient loss of taste or smell. More than 1 yr after the last radioiodine application, 42.9% of patients suffered from reduced salivary gland function. Complete xerostomia occurred in 4.4% of patients. Hematological abnormalities were found in 9 patients. In 28.1% of patients a transient episode of alopecia was reported. In 22.7% of patients chronic or recurrent conjunctivitis was reported, and 4 patients underwent dacryocystorhinostomy; 13.8% of patients suffered from an increased frequency of influenza, but 3.4% reported a reduced occurrence of such infections. For sialoadenitis, the loss of taste/smell and dry mouth, the dependence on accumulated activity was significant. CONCLUSION: Severe long-term side effects are rare after high-dose radioiodine treatment. Moderate side effects are common. The side effects are commonly the result of radiation damage to the salivary glands. The frequency of such complaints advocates regular protection of the salivary glands.

Alopecia↗
PubMed1997

[Palliative treatment for pain in osseous metastasized prostatic carcinoma with osteotropic rhenium-186 hydroxyethylidene diphosphonate (HEDP)].

Systemic administration of strontium-89 is an important option for pain relief in advanced prostate carcinoma with multiple osseous metastases. Recently, rhenium-186-HEDP was introduced as a new substance which has important advantages (shorter physical half-life, scintigraphic imaging, dose distribution). The myelosuppressive effect can be estimated more accurately in advance, so that adverse effects can be reduced and the treatment can be repeated after a shorter period of time and more often. Our study comprises 15 treatments with rhenium-186-HEDP in advanced prostate cancer patients using the 1.4- to 2-fold standard dose. The response rate, estimated as reduction in pain and increase in patient mobility, was 87% with no major myelosuppressive effects. The mean duration of pain relief was 4-6 weeks. All four patients with repeated therapy were also responding to the second treatment. Radionuclide therapy for painful osseous metastases with rhenium-186-HEDP appears to be an effective and, even at higher doses, safe procedure.

Aged↗
PubMed1997

Detection of hepatocellular carcinoma with a new alpha-fetoprotein antibody imaging kit.

PURPOSE: The aim of this phase II study was to assess the clinical utility and safety of AFP-Scan (Immunomedics, Inc, Morris Plains, NJ), a technetium-99m (99mTc)-labeled anti-alpha-fetoprotein (AFP) Fab' imaging kit, in the evaluation of hepatocellular carcinoma (HCC), in comparison to computed tomography (CT). PATIENTS AND METHODS: Twenty-five consecutive patients with a history of HCC were examined by planar and single-photon emission computed tomography (SPECT) imaging at 6 and 24 hours after intravenous (I.V.) injection of 1 mg AFP-Scan labeled with 925 MBq 99mTc. RESULTS: In 20 patients, there was a specific binding of the Fab' antibody to the tumor, whereas in four patients who presented with elevated serum AFP levels, no specific targeting was found and no malignant lesions were evident by CT or biopsy. One patient was diagnosed as false-negative by AFP-Scan. In five of six patients with normal serum AFP levels, focal uptake was demonstrated. In one case, metastatic disease in the lower abdomen was found. In all patients, diagnostically relevant information was provided by the 24-hour antibody images, especially with SPECT. Comparing AFP-Scan versus CT, the former showed a higher sensitivity (95% v 63%) and specificity (67% v 17%), with an overall accuracy of 88% versus 52% for AFP-Scan versus CT, even in patients with normal serum AFP titers. No adverse reactions or human antimouse antibody (HAMA) elevations were found in any of the patients. CONCLUSIONS: AFP-Scan appears to be a promising new antibody imaging kit for the disclosure of sites of HCC and should aid in the management of these patients by revealing primary, recurrent, and metastatic disease with a single imaging modality.

Adult↗
PubMed1997

The optimal number of pleural biopsy specimens for a diagnosis of tuberculous pleurisy.

STUDY OBJECTIVES: To determine the optimal number of pleural biopsy (PLBX) specimens for a diagnosis of tuberculous pleurisy. DESIGN: Retrospective review. SETTING: County hospital. METHODS: We reviewed all percutaneous needle biopsy specimens of the parietal pleura in 30 patients who had tuberculous pleurisy. Data are reported as mean+/-SEM and statistical comparisons are done with the Mann-Whitney test. We accepted p<0.05 as statistically significant. RESULTS: The number of biopsy specimens obtained from each patient ranged from 4 to 10 with 1 sample submitted for mycobacterial culture and the rest submitted for histologic study. Sixty percent of patients had pleural cultures positive for Mycobacterium tuberculosis and 80% had diagnostic histology. Overall pleural biopsy sensitivity (histology and culture) for tuberculous pleurisy was 87%. On average, 40.4%+/-4.7% of all PLBX specimens contained pleura. Diagnostic PLBX procedures compared to false-negative procedures produced more tissue specimens (7.1+/-0.3 vs 4.8+/-0.5, p=0.005) containing more pleural specimens (2.4+/-0.2 vs 0.8+/-0.5, p=0.01). If only PLBX procedures yielding more than six tissue specimens (n=18) or more than two pleural specimens (n=12) were analyzed, then the diagnostic sensitivity of PLBX for pleural tuberculosis was 100%. There seemed to be a direct relationship between the sensitivity of PLBX and the number of specimens submitted. CONCLUSIONS: The sensitivity of percutaneous needle biopsy for diagnosis of tuberculous pleurisy is highest when more than six specimens are obtained which, on average, contain more than two specimens of parietal pleura. There are no conclusive data indicating how many tissue specimens to submit for mycobacterial culture, but one specimen seems sufficient.

Adult↗
PubMed1997

Diagnostic strategies for Pneumocystis carinii pneumonia.

Pneumocystis carinii is an opportunistic organism that is a common cause of pneumonia in immunocompromised patients. Its life cycle begins when cysts rupture and release sporozoites, which mature into trophozoites that eventually form cysts. The diagnostic methods for P. carinii pneumonia (PCP) have progressed from open lung biopsy to bronchoalveolar lavage (BAL) and induced sputum analysis (ISA). Detection of P. carinii organisms is done with various stains that highlight sporozoites, trophozoites, or the cyst wall. Noninvasive, cost-effective methods to aid in the diagnosis of PCP have been proposed and include chest radiograph analysis, gallium scintigraphy, serum lactate dehydrogenase levels, CD4 lymphocyte counts, pulmonary function tests, arterial blood gas analysis, and exercise hemoglobin oxygen saturation measurements. Some investigators propose empiric treatment of PCP to reduce the number of bronchoscopies performed. Most physicians prefer to make a definitive diagnosis of PCP to ensure appropriate therapy.

AIDS-Related Opportunistic Infections↗
PubMed1997

Pulmonary manifestations of strongyloidiasis.

Strongyloides stercoralis (SS) is endemic in tropical and subtropical areas worldwide and in the southeastern United States. The lifecycle of SS is both unique and complex. Human infection begins with the penetration of skin by filariform larvae that migrate hematogenously to the lungs. Larvae then ascend the airway, are swallowed, and mature in the gut. Unlike other nematodes, SS can autoinfect the same host and persist for decades. Categorization of infection includes acute, chronic-uncomplicated, and disseminated forms. Clinical manifestations depend on the particular organs involved. Fifteen to thirty percent of chronically infected people may be asymptomatic. On the other hand, SS may cause the adult respiratory distress syndrome, septic shock, and death. The diagnosis of SS infection is suspected in patients from endemic areas who have blood eosinophilia, and gastrointestinal or pulmonary symptoms. A definitive diagnosis is established by demonstration of SS larvae in stool, body fluids, or tissues. A presumptive diagnosis of SS infection can be achieved by serology. Thiabendazole is the mainstay of treatment, but repeat doses may be necessary if the parasite is not initially eradicated. The low incidence of disseminated SS in areas endemic for both SS and AIDS is surprising and unexplained.

AIDS-Related Opportunistic Infections↗
PubMed1997

[18Fluoro-FDG SPECT for the demonstration of hibernating myocardium: an interim account].

AIM: The present investigation demonstrates an intraindividual comparison of FDG-PET and FDG-SPECT. MATERIAL AND METHODS: Thirty patients with CHD and planed revascularisation underwent both modalities. Myocardial perfusion was evaluated by 99mTc-MIBI SPECT. The myocardium was divided into 25 segments and the results were compared by two experienced observers. RESULTS: Segmental concordance of FDG-PET and -SPECT was 94.1%. PET indicated a higher percentage of hibernating myocardium (8.9% vs. 5.7%) and a lower rate of matched defects (11.5% vs. 16.0%). In 22 cases the need for revascularisation was assessed identically. In the remaining 8 patients FDG-PET and FDG-SPECT required an intervention in 6 and 2 cases, respectively. CONCLUSION: The results of FDG-PET and FDG-SPECT showed a high segmental concordance, but the individual assessment of hibernation worthwhile for revascularisation demonstrated important differences in patient management.

Aged↗
PubMed1996

Endovascular stenting of an aortopulmonary fistula presenting with hemoptysis. A case report.

We present a 45 year old man with massive hemoptysis due to an aortopulmonary fistula. Our patient had a history of a previous patent ductus arteriosus repair which was complicated by a previous aortopulmonary fistula. Computed tomography of the chest and aortography made the diagnosis of a recurrent aortopulmonary fistula. Because of the history of previous surgical aortic procedures, repair of the fistula was completed through a retroperitoneal aortotomy with intravascular insertion of an expandable stainless steel stent covered by a polyester graft. The patient has had no hemoptysis or computed tomographic evidence of fistula recurrence thirty eight months after the procedure.

Aneurysm, False↗
PubMed1995

Scintigraphic evidence for cardiac sympathetic dysinnervation in long-term IDDM patients with and without ECG-based autonomic neuropathy.

To analyse the presence and extent of global and regional distributions of cardiac sympathetic dysinnervation in long-term insulin-dependent diabetes mellitus (IDDM) without myocardial perfusion abnormalities (99mTc-methoxy isobutyl isonitrile study), 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy was performed in two clinically-comparable groups (20 diabetic patients with and 22 diabetic patients without ECG-based cardiac autonomic neuropathy). For comparison nine control subjects without heart disease were investigated. Only six diabetic patients (27%) without and one diabetic patient (5%) with ECG-based autonomic neuropathy were found to have a uniform homogeneous uptake of 123I-MIBG, in contrast to a uniform homogeneous uptake in all control subjects. The uptake of 123I-MIBG in the posterior myocardium of diabetic patients was smaller than in the anterior, lateral and septal myocardium (p < 0.001, p < 0.001, p = 0.001). In addition, diabetic patients with cardiac autonomic neuropathy (> or = two of five age-related cardiac reflex tests abnormal) demonstrated a more reduced uptake in the global, lateral and posterior myocardium than diabetic patients without (p < 0.01, p < 0.01, p < 0.001). A correlation between global or regional myocardial 123I-MIBG uptake, however, and duration of diabetes, HbA1c, body mass index or QT interval length was not observed. Our study demonstrates that cardiac sympathetic dysinnervation is common in long-term IDDM even in patients without ECG-based cardiac autonomic neuropathy and that the posterior myocardium is predominantly affected. We conclude that 123I-MIBG scintigraphy is a promising approach to further elucidate the pattern and natural history of myocardial dysinnervation in IDDM.

3-Iodobenzylguanidine↗