Biomedical subjects
Publications and source records attributed to M Koenigsberg.
The frequency of sister chromatid exchanges increased in freshly isolated human lymphocytes as well as in a continuously growing lymphoblast line by exposure to diagnostic levels of ultrasound for 30 minutes. The results confirm previous findings indicating that ultrasound of diagnostic intensities can affect the DNA of animal cells.
This report summarized our experience with a consecutive series of 800 women referred for midtrimester amniocentesis for prenatal diagnosis of a fetal genetic abnormality. The results are compared before and after introduction of sonography immediately prior to the tap as a routine adjunct of the procedure. Following use of sonography there was a statistically significant reduction in the frequency of bloody taps, and an increase in the proportion of successful and informative initial taps. Moreover, in many instances sonography provided information useful for identification of fetal abnormalities or for management of pregnancy. These findings support the recommendation that examination by sonography should be utilized routinely as an adjunct to amniocentesis, despite the uncertainities relating to possible long-term adverse effects of intrauterine exposure to ultrasound.
In two patients infective endocarditis developed as the primary manifestation of idiopathic hypertrophic subaortic stenosis. Infected vegetations were present on the mitral and aortic valves. In addition, bacterial vegetations were observed on the septal endocardium at the site of contact between the mitral valve leaflet and the hypertrophic septum. Thus, chronic endocardial trauma, a common finding in idiopathic hypertrophic subaortic stenosis, may provide a fertile nidus for the development of bacterial vegetation.
The effects of diagnostic levels of ultrasound on DNA of HeLa cells included: increased immunoreactivity to antinucleoside antibodies in G1 cells, strongly suggestive of unwinding of the helix or single-strand break induction, and low levels of non-semiconservative synthesis in logarithmically growing cells treated with hydroxyurea, indicating repair synthesis. In the C3H mouse cell line 10T-1/2, Cl 8, loss of contact inhibition with a criss-crossed growth pattern was seen. In one experiment, tumors developed in syngeneic mice at the site of injection of ultrasonically treated cells. Ultrasound in the diagnostic range appears to cause detectable effects on DNA and growth patterns of animal cells.
The value of sonography in determining the site and nature of biliary obstruction with surgical jaundice is described in 32 patients. All diagnoses were subsequently established by surgery and pathology. The site of obstruction was delineated in 94%, while the nature of the lesion was established in 81%. In comparison, contrast cholangiography correctly delineated the site in 96%, but helped determine the etiology in only 82%. Sonography is sufficient to adequately evaluate patients prior to surgery, while percutaneous transhepatic cholangiography should probably be used only when satisfactory ultrasound examinations cannot be obtained.
Technetium-99m HIDA cholescintigraphy and ultrasonography are noninvasive, safe, simple procedures that can document the presence, location, and extent of a bile leak. Early detection of posttraumatic or postoperative biliary tract disruption can significantly reduce morbidity and mortality. The possibility of biliary tract disruption should be considered in any patient who has had blunt or penetrating abdominal trauma. In two cases reported, the new hepatobiliary radiotracer 99mTc dimethyliminodiacetic acid (HIDA) was quite useful in detecting such leaks. Sonography was particularly useful in detecting small intra- or perihepatic bile collections which no longer communicate with the biliary tree. An active bile leak at a surgical anastomosis may also be documented by 99mTc-HIDA cholescintigraphy and can yield information of potential prognostic importance. Serial cholescintigraphy is also useful in evaluating the response to medical or surgical treatment.
A case of gallbladder empyema is presented, which opacified initially on excretory urography and then on nephrotomography, mimicking a renal mass. Correct diagnosis was accomplished by angiography and ultrasound examination. With normal renal function gallbladder visualization on urography is indicative of a gallbladder abnormality.
A canine model has been devised using electromagnetic flowmeter probes to study the sensitivity of radiopertechnetate renal angiography. Highly significant correlations were obtained when the measured flow rates were compared with normalized values of the peak activity and uptake slopes for each kidney. Analysis of the data suggests the unilateral renal disease associated with less then 20% difference in flow between the kidneys may not be diagnosed reliably from the pertechnetate perfusion test.
Symptoms and signs of interstitial pregnancy cannot be differentiated from symptoms and signs of other ectopic pregnancies. Unruptured interstitial gestations are usually diagnosed incidental to the work-up of a suspected ectopic gestation. Unlike some teaching, a characteristic pelvic mass was palpable in 3 of 4 cases. Incomplete induced abortion helped in diagnosing 2 cases. Ultrasound and laparoscopy will aid in establishing the correct diagnosis.
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Scintiphotographic demonstration of a pulmonary arteriovenous malformation in an 8-year-old child is presented. Using a data processor, the transit of radiopertechnetate through the lesion as well as various portions of the lung is shown. The "steal" of blood flow from the left lobe is documented.
Radionuclide imaging with labeled colloids is widely used to evaluate and localize primary and metastatic tumors of the liver. The method is fairly sensitive, but the nonspecificity of focal defects remains a significant limitation. Lesions such as cysts and abscesses appear as space occupying areas that are indistinguishable from neoplastic masses. Utilizing a variety of radiopharmaceuticals, one may obtain additional information concerning such lesions. Hepatic blood flow scintiphotography is performed with the Anger camera following the intravenous injection of a high activity, small volume bolus of 99m-Tc pertechnetate. Vascular lesions such as hepatomas or hemangiomas will show increased activity in the lesion which should easily differentiate them from avascular processes such as abscesses, cirrhotic pseudomasses and most metastatic lesions, all of which remain "cold" on these flow studies. If one does not posses a camera, useful blood pool rectilinear scans of these lesions may be obtained with 131-I or 99m-Tc human serum albumin or ionic 113m-In. Additional information concerning the metabolic activity of focal defects on the colloid study is obtained using 75-Se-selenomethionine or 67-Ga. The former is an indicator of active protein metabolism while the latter attaches to lysozymes of metabolically active cells. With either agent, hepatomas show avid uptake, metastatic lesions show variable uptake, and cysts or chronic pseudotumors of cirrhosis show poor uptake. The two agents differ in abscess detection where 75-Se-selenomethionine uptake is poor while 67-Ga concentration generally is intense. 131-I-Rose Bengal occasionally may prove useful in demonstrating impression by an atypically positioned gallbladder or focal dilatation of the biliary tract as a cause of a defect on the colloid scan. Ultrasound examination may complement the radionuclide studies. It is useful for corroborating the presence of lesions and for evaluating their consistency (cystic vs. solid). The information obtained from this multinuclide approach has made scintigraphy examination of the livermore specific. After the completion of this non-invasive series of studies, one generally may venture an intelligent opinion concerning the etiology of the space occupying disease.
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