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Biomedical subjects

G Coates

Publications and source records attributed to G Coates.

At least 109 records · Page 6Linked to original sources
PubMed1983

Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan.

Inherent contradictions in current diagnostic recommendations for pulmonary embolism have created considerable confusion and controversy. To resolve these contradictions, we did a prospective study of ventilation-perfusion scanning, pulmonary angiography, and venography in consecutive patients with clinically suspected pulmonary embolism and abnormal perfusion scans. Ventilation scanning increased the probability of pulmonary embolism in patients with large perfusion defects and ventilation mismatch, but a ventilation-perfusion match was not helpful in ruling out pulmonary embolism. Small perfusion defects with mismatch had neither sufficiently high nor low probability to be of diagnostic value. The observed frequency of proximal vein thrombosis (19% to 51%) and its association with the range of ventilation-perfusion defects have important implications for management of pulmonary embolism. Pulmonary angiography is required in combination with venography in most patients with perfusion abnormalities because the probability of pulmonary embolism is neither sufficiently high nor low to confirm or exclude pulmonary embolism.

Adolescent↗
PubMed1983

[Ventilation scintigraphy of the lung with 99mTc-DTPA or with 99mTc-sulfur colloid?].

Ventilation scintigraphy of the lung, obtained with sufficiently small 99mTc-labelled aerosol particles, provides an image of ventilation distribution that is acceptable in clinical routine. Whether 99mTc-DTPA or 99mTc-sulfur colloid is more suitable as a carrier was studied in 6 smokers and 8 non-smokers with chronic obstructive pulmonary disease. 99mTc-sulfur colloid was not absorbed by the bronchial mucosa and therefore appears to be an almost ideal agent. In contrast, 99mTc-DTPA was absorbed by the bronchial mucosa in all smoking patients more rapidly and inhomogenously than in non-smokers. The quantitative and qualitative comparison of the two dorsal ventilation scans taken both immediately after inhalation and 20 min later, showed in all 6 smoking patients after 20 min significant differences which influenced the diagnosis result. 99mTC-DTPA is therefore not recommended for use in ventilation lung scintigraphy, especially in smoking patients.

Adolescent↗
PubMed1981

The low specificity of postoperative perfusion lung scan defects.

Ventilation and perfusion lung scans were performed preoperatively and postoperatively in 169 patients and classified blindly according to preset criteria. Perfusion lung scan abnormalities were present in 25 (15%) of the preoperative scans and 42 (25%) of the postoperative scans; 16 (38%) of the 42 abnormal postoperative scans were identical to the preoperative scans. Perfusion defects indicating a "high probability" of pulmonary embolism (lobar or segmental defects) were present in 5 preoperative scans and 10 postoperative scans; the 10 postoperative scans were classified as showing "definite" (5), "possible" (1) or "no" (4) pulmonary embolism on the basis of the preoperative scan and the ventilation scan; none of the 10 patients had clinical evidence of pulmonary embolism. Venous thrombosis was present in 12 patients, including 4 of the patients whose lung scans showed definite pulmonary embolism. Thus, postoperative perfusion lung scan defects are potentially misleading even when large.

Adult↗
PubMed1980

The use of radioactive isotopes for analysis of cutaneous allergic responses.

Local exudation at the sites of allergic and histamine-induced cutaneous reactions, was measured with an in vivo double-labelling procedure, based upon local serial simultaneous measurements of indium-113 m (113mIn) labelled transferrin and technitium-99m labeled red blood cells (99mTc RBC). Analyses depended upon the reaction index i.e. comparison of the ratio of 113mIn/99mTc counts at the reaction site with the ratio of 113mIn/99mTc at the corresponding unreacted site in the skin of the opposite arm. Reaction indices were initially significantly elevated at the sites of histamine and allergic reactions. After the first hour, there was a progressive reduction at histamine sites indicating a tapering of the local accumulation of indium-labelled transferrin. By contrast allergic reaction sites showed a continuing increase in the reaction index after one hour. During the first hour the curves were comparable, but they diverge and were significantly different after one hour (0.05 greater than P greater than 0.02). This is consistent with the known occurrence of late cutaneous reponses at the site of allergic but not histamine reactions.

Dermatitis, Contact↗
PubMed1980

Retinal studies at 446 torr in a hypobaric chamber.

This study was designed to see if retinal haemorrhage occurred after 24 h of decompression to a pressure of 446 torr. Four subjects were studied after 24 h of decompression and had retinal photography and fluorescein angiography performed at rest and following maximum exercise. No haemorrhages or fluorescein leakage was noted, even though the subjects experienced typical symptoms of acute mountain sickness and showed an increase in lung density-consistent with subclinical pulmonary edema. We conclude that 24 h exposure to 446 torr with a period of maximal exercise is an inadequate stress, either in time and/or degree, of hypoxia to produce retinal haemorrhage or leakage, as measured by flourescein.

Adult↗
PubMed1978

Xenon-127.

The ventilation perfusion study is of proven value in the diagnosis of patients with lung disease. The technique would be even more useful if the ventilation study could be performed after the perfusion lung scan. Then only those patients with a perfusion defect would require a ventilation study and the study could be performed in the position which best demonstrates the lesion. This cannot be done satisfactorily with 133Xe. Because of its physical properties, 127Xe is the isotope of choice for ventilation studies. With this gas, the ventilation study can be performed after the perfusion lung scan with no interference from the 99mTc. The resolution of lesions within the lung is better with 127Xe than with 133Xe. Finally, the reduced tissue absorption and high photon yield permit the use of small amounts of 127Xe and therefore reduced cost and a smaller radiation dose to the patient.

Diagnosis, Differential↗
PubMed1977

Lung density: clinical method for quantitation of pulmonary congestion and edema.

The density of a defined volume of the human lung can be measured in vivo by a new noninvasive technique. A beam of gamma-rays is directed at the lung and, by measuring the scattered gamma-rays, lung density is calculated. The density in the lower lobe of the right lung in normal man during quiet breathing in the sitting position ranged from 0.25 to 0.37 g.cm-3. Subnormal values were found in patients with emphsema. In patients with pulmonary congestion and edema, lung density values ranged from 0.33 to 0.93 g.cm-3. The lung density measurement correlated well with the findings in chest radiographs but the lung density values were more sensitive indices. This was particularly evident in serial observations of individual patients.

Absorptiometry, Photon↗
PubMed1977

Xenon-127, a comparison with xenon-133 for ventilation studies.

In 133Xe ventilation studies the 81-keV gamma photon emitted is a major disadvantage for imaging. Using a lung model with the same attenuation coefficient as inflated lung, we compared 133Xe with 127Xe to determine the smallest "lesion" that could be imaged at different places within the lung. With the "lung lesion" directly against the collimator, the lesion had to be 10 ml in volume in order to be seen with 127Xe, but with 133Xe "lesion" had to be 30 ml. Xenon-127 gave better resolution, no matter where the lesion was placed within the lung. Xenon-127 was not better than 133Xe in resolving a lead bar phantom. When 133Xe was used with 99mTc in a model of pulmonary embolism, a "ventilation defect" was apparent even though the distribution of xenon was even throughout the model. This artifact was not seen when the 127Xe model was imaged.

Lung Diseases↗
PubMed1975

Detection of acute myocardial infarction by technetium-99m polyphosphate.

Experimental work has shown that technetium-99m (99mTc) pyrophosphate accumulates in recently infarcted myocardium and can be detected by external imaging techniques. Twenty-two 99mTc polyphosphate myocardial studies were performed in 17 patients (in 3 after cardiac surgery) 3 to 20 days after myocardial infarction. Seventeen myocardial studies were performed in 17 control patients (in 6 after cardiac surgery). Twenty millicuries of 99mTc polyphosphate was injected intravenously 60 to 120 minutes prior to gamma camera imaging in several views. Myocardial images were processed by the Gamma-11 computer system using standardized background subtraction and contrast enhancement. Results of 16 myocardial studies performed 4 to 20 days after transmural myocardial infarction in 12 patients were positive in 13 instances and questionable in 1. The location of the myocardial infarction by imaging corresponded to location by standard electrocardiograhic criteria in 8 of the 10 patients with positive findings. In five patients with nontransmural myocardial infarction, results of myocardial imaging were positive in two, questionable in one and normal in one. In one patient with questionable findings results were normal when imaging was repeated 16 days after nontransmural myocardial infarction. Results of 17 control myocardial imaging studies were normal in 16 and questionable in 1. Therefore, 99mTc polyphosphate myocardial imaging appears promising in the detection and location of transmural myocardial infarction. Its accuracy in detecting nontransmural myocardial infarction may be increased with greater experience and development of sophisticated digital analysis techniques. The method may prove useful in clinical situations such as cardiac surgery in which standard diagnostic aids are difficult to interpret.

Acute Disease↗
PubMed1975

Pharmacokinetics of radioiodinated streptokinase.

The pharmacokinetics of radioiodinated streptokinase have been investigated in mice and dogs in order to explore further its potential usefulness as a radiopharmaceutical to detect thrombi and neoplasms. The purified streptokinase used in these studies showed no alteration in its physical or enzymatic properties following radioiodination. In the mouse, radioiodinated streptokinase accumulated rapidly in the liver and at 4 hr, large amounts of free iodine were detected in the plasma. The plasma clearance curve in dogs was biexponential showing that 70% of the protein-bound radioactivity was cleared with a half-life of 1525 min while the remaining 30% was cleared with a half-life of 6080 min. Seventy percent of the plasma radioactivity appeared as free iodine after 4 hr. No change in clearance was obtained by preloading animals with unlabeled streptokinase. Based primarily on the rapid plasma clearance, deiodination, and possible limitations of effectiveness of preloading with unlabeled streptokinase, the results of these studies are in accord with the conclusion that radioiodinated streptokinase may have restricted usefulness as a radiopharmaceutical for detecting thrombi and neoplasms. The full extent of its potential usefulness, however, awaits the provision of further in vivo and in vitro studies directed at testing a covalently modified enzyme that retains streptokinase activity but whose immunologic properties have been altered so that the enzyme is not as rapidly cleared from the plasma.

Animals↗