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Biomedical subjects

D Emrich

Publications and source records attributed to D Emrich.

At least 19 recordsLinked to original sources
PubMed1992

Myocardial distribution of indium-111-antimyosin Fab and technetium-99m-sestamibi in experimental nontransmural infarction.

Early revascularization in acute myocardial infarction results in normal, necrotic and partially damaged and partially salvaged ("intermediate") myocardium. By combining a perfusion tracer and a marker for myocardial injury, we attempted to differentiate between these three types of cardiac tissue. The LAD was occluded in nine pigs for 45 min and then reperfused. After 48 and 72 hr, 74 MBq 111In-antimyosin Fab and 740 MBq 99mTc-sestamibi, respectively, were injected intravenously. Normally perfused myocardium was labeled with fluorescein and the heart excised. Three to four slices were cut from the apex. Tetrazolium staining revealed the zone of necrosis. Tracer distribution on double-nuclide scintigrams of the slices also reflected the three different myocardial zones. Guided by fluorescence and macrohistochemistry, tissue samples were excised from each zone. In relation to normal myocardium, mean activity in the intermediate zone was 0.82 +/- 0.20 for 99mTc-sestamibi and 2.84 +/- 1.31 for 111In-antimyosin Fab. Activity in necrotic myocardium was 0.30 +/- 0.19 and 3.95 +/- 2.47, respectively. These results show that 111In-antimyosin Fab fragments not only accumulate in necrotic but also in intermediate myocardium. Therefore, an overestimation of infarct size may occur if 111In-antimyosin Fab fragments are used alone without a perfusion tracer.

Animals↗
PubMed1991

[201Thallium reinjection after exertion-redistribution myocardial scintigraphy. A new method for distinguishing between scars and vital myocardium].

In a prospective study 38 patients (35 men, 3 women; median age 56 [37-71] years) with known coronary heart disease in whom conventional thallium-201 exercise-redistribution myocardial scintigraphy (ERMS) had demonstrated segments with diminished activity, thallium-201 was again injected ("reinjection scintigraphy"). Its purpose was to test whether in myocardial segments with persisting diminished radioactivity improved activity after reinjection provided evidence for still viable myocardium. Seven myocardial segments were evaluated in each patient, i.e. a total of 266 segments. Activity in the conventional ERMS was diminished in 94 of the 166 abnormal segments, but improved on reinjection in 21 of the 94 segments (22.3%). Nine of the 38 patients (23.7%) benefitted from the reinjection: only scar tissue without any viable myocardium would have been diagnosed by conventional ERMS in four patients, while extent and spread of ischaemic myocardium was better visualized in five.

Adult↗
PubMed1991

Radioimmunoimaging of subacute infective endocarditis using a technetium-99m monoclonal granulocyte-specific antibody.

Immunoscintigraphy with a technetium-99m murine monoclonal IgG1 antibody directed against non-specific cross-reacting antigen (NCA-95) and carcinoembryonic antigen was performed with 20 patients with suspected subacute infective endocarditis (SIE) and 6 controls with suspected inflammatory/infectious disease elsewhere in the body. Immunoscintigraphy and echocardiography localised SIE in 11 of 15 patients in whom the disease could be confirmed. In 4 patients with validated SIE, the immunoscan was abnormal, and the echocardiogram was normal. In another 4 patients, the result was exactly the opposite. These findings suggest that the combination of immunoscintigraphy and echocardiography improves diagnostic efficacy in patients with suspected SIE.

Adolescent↗
PubMed1991

[Criminal law and forensic medicine in the 16th century].

At the Reichstag of Regensburg the Constitutio Criminalis Carolina was declared empire law in 1532. This was the most important impulse for the development of the legal medicine in Germany as the courts now found themselves constrained to hear physicians, barber surgeons or midwives in cases of abortion, infanticidal, poisoning, murder or manslaughter. Article 147 was chiefly significant because it fixed that in killing crimes the cause of death had to be ascertained by versed medical persons. The consequences for the opinions of the medical experts in the 16th century were examined by evaluating court records from the municipal archives of Frankfurt am Main. It was found out that the medico-legal investigations in cases of killing crimes always were carried out by committees consisting of several barber surgeons. In difficult cases a physician, an academic educated medical person, joined the committee. In the trial the physicians and barber surgeons as experts were interrogated as witnesses and they based on examinations of the victim's lifetime, on autopsies and partial autopsies.

Criminal Law↗
PubMed1990

Intravenous streptokinase in acute myocardial infarction (I.S.A.M.): assessment of left ventricular function 1 and 7 months after infarction by radionuclide ventriculography.

I.S.A.M. was a prospective, placebo-controlled, double-blind multicentre trial of high-dose short-term intravenous streptokinase in acute myocardial infarction (AMI) within 6 h of the onset of symptoms. Determination of left ventricular ejection fraction (LVEF) by radionuclide ventriculography was performed 1 and 7 months after AMI in a subset of 192 patients at rest and, in 140 of them, also during exercise. Regional myocardial function was analysed in all 145 patients with neither a history of a previous myocardial infarction nor revascularization procedures or reinfarction within the 7-month follow-up period. One month after AMI, mean LVEF was higher in the streptokinase group in patients with anterior AMI (50 +/- 15% vs 42 +/- 16%, P = 0.013). This difference was more marked in the subgroup treated within 3 h (53 +/- 14% vs 42 +/- 15%, P = 0.004), whereas patients treated 3-6 h after the onset of symptoms did not differ from respective controls (41 +/- 16% vs 41 +/- 18%). In patients with inferior AMI, the difference in mean LVEF was small (57 +/- 11% vs 55 +/- 12%, P = 0.47). After anterior AMI benefit due to streptokinase therapy was preserved up to 7 months (52 +/- 14% vs 44 +/- 17%, P = 0.013). During exercise, the increase of mean LVEF was greater in the streptokinase group at both dates, especially 7 months after AMI (4.1 +/- 6.1% vs 1.2 +/- 6.3%, P = 0.015). In streptokinase-treated patients with anterior AMI, regional LVEF at rest was higher at both dates compared with controls, within the infarct zone as well as in remote myocardium. No treatment-control differences were demonstrable in patients with inferior AMI. During exercise, regional contractile reserve was better in the streptokinase group within the infarct zone as well as in remote myocardium, irrespective of the site of infarction. Thus, intravenous streptokinase within 3 h after the onset of AMI preserves global left ventricular function in anterior AMI over a period of at least 7 months. Intravenous streptokinase improves regional myocardial function within the infarct zone as well as in remote areas. In inferior AMI investigation solely at rest may underestimate the benefit of streptokinase therapy.

Aged↗
PubMed1990

Immunoscintigraphy with 111In antimyosin Fab.

Monoclonal 111In antimyosin Fab is a marker for myocytes which have lost their membrane integrity. Because of the slow blood pool clearance of the radiopharmaceutical, imaging is usually started 24-48 h after intravenous injection of 74 MBq of the tracer. This long postinjection interval restricts its utilization in the primary diagnosis of acute myocardial infarction. However, antimyosin may help to differentiate between necrotic and viable myocardium in the subacute stage of incomplete myocardial infarction. Serial endomyocardial biopsy for early detection of transplant rejection after heart transplantation may be partially replaced or supplemented by antimyosin scintigraphy. The compound may facilitate the diagnosis of myocarditis. Other potential indications may be prognostic assessment of dilated cardiomyopathy, monitoring cardiotoxic side-effects of chemotherapeutics, recognition of cardiac contusion as well as diagnosis of rhabdo- and leiomyosarcoma. In specific clinical situations 111In antimyosin Fab immunoscintigraphy may provide valuable diagnostic information.

Antibodies, Monoclonal↗
PubMed1990

[The risk of recurrence following the thyrostatic treatment of immunogenic and nonimmunogenic hyperthyroidism].

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-immunogenic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p less than 0.001 and 83%, p less than 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.

Adolescent↗
PubMed1989

TSH binding-inhibiting antibodies in hyperthyroidism: relationship to clinical signs and hormone levels.

TSH binding-inhibiting antibody (TBIAb) activity was measured in 809 European patients with different forms of hyperthyroidism. Distribution of these TBIAb was skewed, with a peak in the range of normal controls, and an ill defined, not clearly separated peak at higher levels of TSH displacement. There was no unequivocal separation of two possible subgroups of hyperthyroidism (immunogenic and non-immunogenic). TBIAb distributions of patients with and without endocrine ophthalmopathy (EO) overlapped considerably. Although patients with Graves' disease, arbitrarily defined by the presence of endocrine ophthalmopathy or diffuse nuclide uptake by thyroid scanning, had mostly elevated TBIAb activity, 24.3% had values within the range of normal controls (mean + 2SD). Patients with diffuse thyroid uptake had significantly higher TBIAb levels than patients with nodular scan findings. In Graves' disease, TBIAb activity was positively correlated with the severity of endocrine ophthalmopathy, the size of the thyroid, and the serum levels of total and free triiodothyronine. There was no influence of age, sex, pretreatment, or regional iodine supply. These results suggest (1) that the clinical manifestations of Graves' disease are statistically related to TBIAb activity and (2) that separation of immunogenic and non-immunogenic forms of hyperthyroidism by means of TBIAb determination is unsatisfactory. The almost continuous distribution of TBIAb points to insufficient sensitivity of the present technique and raises doubts as to whether TBIAb values can be reliably classified as 'positive' or 'negative'.

Age Factors↗
PubMed1989

Treatment of endemic goitre due to iodine deficiency with iodine, levothyroxine or both: results of a multicentre trial.

Preliminary clinical studies and recent in vitro investigations suggest that iodine administration may be an effective alternative in the treatment of the diffuse euthyroid goitre of iodine deficiency. Therefore a 12-month multicentre study was initiated in which 166 patients were randomly assigned to take either 150 micrograms levothyroxine day-1 (group A, n = 61), 400 micrograms iodine day-1 (group B, n = 50), or a combination of 75 micrograms levothyroxine and 200 micrograms iodine day-1 (group C, n = 55) for 8 months with follow-up examinations at 4 and 8 months as well as 4 months after cessation of treatment. Initially, thyroid volume, as determined by ultrasound, was not significantly different in the three groups. In all three groups, during treatment a significant and comparable mean decrease in goitre size was documented (-32.1% in group A, -37.3% in group B, -38.7% in group C). After cessation of treatment in group A mean thyroid volume again increased to near the baseline value (-12.0% compared to the initial investigation), while the therapeutic effect was sustained in group B (-32.5%). In group C, only a slight rebound effect was observed (-26.3% vs baseline volume). Total thyroxine (T4) increased sharply and significantly in group A from 7.8 +/- 1.9 to 10.9 +/- 2.8 micrograms dl-1 after 8 months (P less than 0.001), but only slightly, although significantly in group B (from 7.8 +/- 1.5 micrograms dl-1 to 8.9 +/- 1.6 micrograms dl-1; P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

[Changes in thyroid function after application of iodinated contrast media to normal subjects (author's transl)].

In 39 patients without thyroid disorder the influence of radiographic contrast media (Conray 60, Biligram) on the thyroid function was studied. 6 weeks after the application of the iodine compounds a significant increase of T3 in blood serum could be established being accompanied by decreased TSH level and reduced response of TSH rpoduction to TRH injection. These findings showed to be even more marked 6 months later. It is assumed that the observed hormonal changes may possibly be due to a persistent Wolff-Chaikoff block induced by diffusion of free iodide and subsequent shifting of the intrathyroidal MIT/DIT ratio, which is finally followed by an increase of T3-levels in serum.

Adolescent↗
PubMed1979

[Cytological diagnosis of thyroiditis (author's transl)].

In 2347 patients fine needle aspiration of the thyroid gland was performed. In 49 cases (2.1%), a final diagnosis of thyroiditis was established. Non-specific granulomatous thyroiditis occurred most frequently (n = 24), followed by lymphocytic hypertrophic thyroiditis Hashimoto (n = 18), focal lymphocytic (n = 5), atrophic lymphocytic (n = 1) and chronic fibrosing thyroiditis (n = 1). Fine needle aspiration biopsy is most suited to diagnose granulomatous thyroiditis. In Hashimoto's thyroiditis cytological investigations are superior to estimation of thyroglobulin antibodies. The cytological method is of little value for the diagnosis of atrophic lymphocytic and chronic fibrosing thyroiditis.

Biopsy, Needle↗
PubMed1979

[Non bacterial thyreoiditis, diagnosis and differential diagnosis (author's transl)].

Retrospective analysis of signs, symptoms, and laboratory data (BSR, thyroid scan, thyroxine, triiodothyronine, TRH-test and antibodies against thyroglobulin) was performed on 68 individuals. Diagnosis of subacute and of chronic thyreoiditis was proven in 26 patients and 21 patients respectively by cytological examination. It was excluded by the same procedure in 21 patients, in whom there were some indications of these two kinds of thyroiditis. The following mosaic of clinical and laboratory parameters showed a sensitivity of 0.73 at specificity of 0.95 for diagnosis and exclusion of the two diseases: spontaneous pain, pain by palpation, fever, elevated BSR, thyroid scan, free thyroxine index, and TRH-test.

Adolescent↗
PubMed1979

[Typical presentation of sequential scintigraphy images in the diagnosis of cyanotic heart disease in the newborn, using a computer-assisted imaging technique (author's transl)].

The technique of sequential scintigraphy in investigating newborn infants in order to exclude or detect cyanotic congenital heart disease has been improved. The primary scintigraphic data are recorded digitally (list mode, 1 ms, 128 by 128 pixels) and evaluated automatically as a sequence of 1/2 s frames in 1/8 s increments. A 35 mm film is exposed to a scanning pulsed light spot on a CRT-screen with quantitative correspondence between local count density and the local number of light pulses. A series of highly resolved images of the rapidly changing scintigraphic pattern is achieved in 30 min. The results of 3 investigations are discussed. They prove the importance of adequate spatial resolution and definition in time in nuclear angiocardiography in infancy. Three case results are discussed in detail. In one case cardiac catheterisation and angiocardiography had been omitted, since the radioisotopic findings excluded cyanotic congenital heart disease. Two further investigations are discussed with reference to the findings at cardiac catheterisation.

Angiocardiography↗
PubMed1979

[The determination of the left ventrical volume curve without background correction and its validation by direct intercomparison with the ejection fractions as determined by biplane laevocardiography (author's transl)].

Background corrections applied on the left ventricular volume curve determined by the "gated blood pool"--method are based on an estimated rather than on a directly measured background. This imposes an uncertainty on the values determined from the volume curve, especially on the ejection fraction. A method which does not require background correction may be applied if all available measurement and evaluation facilities are utilized fully. High temporal and spatial resolution is of fundamental importance, permitting the exact determination of the time-dependent scintigraphic contour variations of the left ventricle during the mechanical action of the heart. A good criterion of the validity of the volume curves with respect to interfering background radiation is the ejection fraction calculated from these curves. The direct intercomparison of 10 ejection fractions obtained by an expanded "gated blood pool"-method, employing cardiac catheterization, immediately before a biplane laevocardiography demonstrated very good agreement. A small systematic underestimation of the ejection fraction by the nuclear method was observed. This understimulation shows that the influence of the true background is small if other interfering count rate contributions or methodical uncertainties are excluded systematically.

Angiography↗