Pulmonary embolism--diagnosis by lung perfusion scintigraphy or digital subtraction angiography?
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Acute Disease↗
Biomedical subjects
S Lindberg
Publications and source records attributed to S Lindberg.
Effects of neurokinin A and calcitonin gene-related peptide on mucociliary activity in rabbit maxillary sinus.
Substance P (SP) released from sensory C-fibers in the airways increases the mucociliary (m.c.) activity in the rabbit maxillary sinus. The purpose of the present study was to investigate the m.c. effects of two other neuropeptides, coexisting with SP in sensory neurones, neurokinin A (NKA) and calcitonin gene-related peptide (CGRP). NKA increased the m.c. activity dose-dependently (dose range 0.1-10.0 micrograms/kg, 88 pmol to 8.8 nmol/kg), the maximum increase being 41.9 +/- 2.6%. The effect was inhibited by pretreatment with the tachykinin antagonist (D-Pro2,D-Trp7,9)SP, but not with atropine or hexamethonium. Thus NKA released from sensory C-fibers may contribute to the non-cholinergic increase of m.c. activity observed after C-fiber stimulation. In contrast CGRP did not influence the m.c. activity. Neither did it influence the responses to NKA or SP. It is concluded that CGRP is unlikely to be involved in the control of m.c. function.
Animals↗
Influence of substance P on ciliary beat frequency in airway isolated preparations.
The neuropeptide substance P (SP), which is released from sensory C-fibres after stimulation by chemical irritants. accelerates mucociliary activity in rabbit maxillary sinus in vivo. In order to investigate the mechanism behind this finding, we recorded ciliary beat frequency (CBF) in vitro from various respiratory explants by a photoelectric technique. It was noticed that ciliated cells from the maxillary sinus displayed a higher beating frequency than cells from the trachea and the bronchus, in that order. SP 10(-10)-10(-4) M did not influence the CBF in explants from rabbit maxillary sinus, rabbit trachea and main bronchi, guinea-pig trachea and human adenoids. Neurokinin A (NKA) 10(-6)-10(-5) M, which is also thought to be released from sensory C-fibres, did not influence the CBF in guinea-pig trachea. Neither did the C-fibre stimulant capsaicin 10(-8)-10(-4) M increase CBF in explants from human adenoids. The present findings indicate that the mucociliary effect of SP in vivo is not mediated by an effect on the cilia themselves.
Animals↗
Post-operative thromboembolism in neurosurgery. A study on the prophylactic effect of calf muscle stimulation plus dextran compared to low-dose heparin.
This study compares the safety and effectiveness of two methods for the prophylaxis of post-operative thromboembolism in neurosurgical patients: A: low-dose heparin (5,000 IU X 2 s.c.) started preoperatively and continued daily for one week post-operatively, and B: per-operative electrical calf muscle stimulation with groups of impulses plus post-operative dextran infusions every other day for one week. Neurosurgical patients aged 40 years or more with normal laboratory coagulation values and operated under general anaesthesia were included. The 125:I-fibrinogen uptake test (FUT) was used for screening and phlebography for verification of deep venous thrombosis (DVT). 122 patients entered the study and 104 completed the prophylactic protocol, 58 in group A and 46 in group B. The two groups were comparable according to pre-operative data and distribution of diagnoses. 89 patients completed screening for post-operative DVT. We found an overall incidence of 5/49 (10 percent) DVT in group A and 5/40 (13 percent) in group B, compared to a frequency of 32-50 percent for controls without prophylaxis reported in the literature, In spite of prophylaxis our patients with intracranial neoplasms and intracranial vascular disease showed a relatively higher incidence of DVT, 4/23 (17 percent) and 4/14 (29 percent) respectively, compared to patients with spinal diagnoses 2/25 (8 percent). In combination with cranial diagnoses paretic lower limbs meant an apparent risk factor, 4/7 (57 percent). However, paretic limbs appearing in cases with spinal disorders did not predetermine an unsuccessful prophylaxis, 2/14 (14 percent). Blood loss, transfusion requirements and post-operative complications did not differ significantly between the two prophylactic groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Central Nervous System Diseases↗
Capsaicin stimulates mucociliary activity by releasing substance P and acetylcholine.
Intraarterial injection of the neuropeptide substance P (SP) accelerates mucociliary (MC) activity. The physiological significance of this finding was investigated using capsaicin, which is known to release SP from unmyelinated C-fibers in sensory nerves. Capsaicin (3.0-150.0 micrograms/kg) stimulated MC activity in the rabbit maxillary sinus in vivo, recorded with a photoelectric technique. This effect was resistant to pretreatment with the adrenergic blocker guanethidine, and to a combination of propranolol and phentolamine. Pretreatment with an SP antagonist (D-Pro2, D-Trp7,9)SP totally inhibited the effect of capsaicin. The muscarinic antagonist atropine suppressed the initial phase of the response to capsaicin, whereas the response was uniformly suppressed by the ganglionic blocker hexamethonium. These results suggest that capsaicin activates a reflex, via afferent C-fibers containing SP and efferent parasympathetic cholinergic neurons. The final response of the MC system reflects the local release of both SP and acetylcholine.
Acetylcholine↗
Hyperparathyroidism subsequent to neck irradiation. Risk factors.
A follow-up examination of 444 persons treated with x-rays for tuberculous cervical adenitis was performed to determine if the risk for hyperparathyroidism (HPT) following radiation exposure can be related to the age at treatment, the dose of x-rays, or the sex of the patient. The overall incidence of HPT was 14%. There was no definite age-dependent difference in susceptibility to the induction of HPT. The doses of radiation among the 63 subjects who developed HPT ranged from 0.6 to 45.7 Gy (60-4570 rad). There was a statistically significant positive correlation between the dose of radiation and the probability of developing HPT. After doses of 14 Gy (1400 rad) or more 29% of the subjects had developed HPT. After neck irradiation women had twice the relative risk of men of developing HPT. This sex ratio was lower than in the series of nonirradiated HPT patients treated at the same institution during the time of the follow-up study.
Adolescent↗
An assessment of the risk of developing hyperparathyroidism and thyroid disorders subsequent to neck irradiation in middle-aged women.
We investigated the occurrence of thyroid and parathyroid disorders in 100 women (age 66-70 years) irradiated for cervical spondylosis on average 25 years previously and in 100 control women of similar age. Hyperparathyroidism (HPT), proven by operation, was diagnosed in one patient of each group, and three additional cases were diagnosed biochemically among irradiated women. The difference in incidence is not significant. Nor was there any significant difference in incidence of thyroid disorders. No thyroid carcinoma was found in either group. Even if there is a moderate increase of HPT after neck irradiation in middle-aged women the risk is not so great as to warrant organised follow-up.
Aged↗
Substance P antagonists and mucociliary activity in rabbit.
Substance P (SP) is known to accelerate mucociliary (m.c.) activity in the rabbit maxillary sinus in vivo. The physiological significance of this finding was investigated by testing three putative SP antagonists. [Arg5, D-Trp7,9, Nle11]SP5-11 could not be used as an antagonist because it stimulated m.c. activity. [D-Arg1, D-Trp7,9, Leu11]SP had no effect on the m.c. activity changes induced by SP. [D-Pro2, D-Trp7,9]SP was found to be an effective antagonist, 1 mg/kg of this drug reversibly inhibiting both the effects of 0.1 micrograms/kg SP and the stimulating effect of 1.0 micrograms/kg bradykinin and 30.0 micrograms/kg capsaicin; the stimulating effect of 0.5 micrograms/kg methacholine was not inhibited. It is suggested that bradykinin and capsaicin stimulate m.c. activity at least partly by releasing SP. The results of this investigation also support the view that the accelerating effect of SP on m.c. activity reflects physiological SP-mediated protective mechanisms in the airways. It is concluded that [D-Pro2,D-Trp7,9]SP is a useful pharmacological tool for studying the role of SP in the control of m.c. activity in rabbits.
Animals↗
Adrenal scintigraphy in Cushing's syndrome caused by bilateral hyperplasia, adenoma or carcinoma.
The results of scintigraphy in 29 patients with Cushing's syndrome were evaluated. It was possible to separate bilateral hyperplasia from unilateral abnormality. In cases of unilateral abnormality correct localization of the tumour was accomplished and it was possible to visualize adrenocortical carcinoma. The many advantages of adrenal scintigraphy are listed and it is concluded that adrenal scintigraphy is the best means of investigation to differentiate between ACTH-dependent and ACTH-independent Cushing's syndrome.
19-Iodocholesterol↗
Severity of alcohol problems at follow-up--an outcome measure.
An ordinal scale to measure severity of alcohol problems in a follow-up study was constructed. The measure refers to the preceding 6 months and is based on reports of amount of alcohol consumed, drinking pattern, signs of alcohol dependence and time sober. The measure was tested on 300 patients reinvestigated about 2 1/2 years after discharge for inpatient treatment for alcoholism. Thirteen percent of the patients had no alcohol problems and 22% had severe alcohol problems. Rather more than one quarter of the group (27%) were classified as positive intermediates and 38% as negative intermediates. These results were compared with other data and information obtained from official records. It was concluded that the measure had satisfactory validity.
Adult↗
Effects of nicotine bitartrate on mucociliary activity.
The in vivo effect of nicotine bitartrate on mucociliary (mc) activity in the rabbit maxillary sinus was investigated. An animal model was used, which permitted administration of drugs directly into the artery feeding the sinus and simultaneous recording of changes in the mc activity. When nicotine was given ia (0.5-10.0 micrograms/kg) it resulted in a brief (1 min at most) acceleration of the mc wave frequency. The response was dose-dependent and a maximum increase of 34.9% was recorded at a dose of 10.0 micrograms/kg. The response was inhibited by a preceding injection of the ganglionic blocker hexamethonium (0.2 mg/kg) or the cholinergic antagonist atropine (0.2 mg/kg). The alpha and beta-adrenoceptor antagonists phentolamine (0.2 mg/kg) and propranolol (0.2 mg/kg) did not influence the response to nicotine injection. It is concluded that the acceleration of mc wave frequency after nicotine administration is probably mediated via stimulation of nicotinic receptors on postganglionic parasympathetic nerve cells.
Adrenergic Agonists↗
Serum triiodothyronine and hyperthyroidism in a population sample of women.
The serum T3 assay has been regarded as the most sensitive single test for hyperthyroidism although impaired conversion of T4 to T3 in non-thyroidal illness (NTI) might decrease its diagnostic sensitivity. The present report gives experience from the T3 assay in middle-aged females under conditions similar to those in a general health survey. The assays were performed during two periods with an interval of six years. In 1974-75 we studied a representative sample (n = 1283) of women of ages 44, 52, 56, 60 and 66 years in Göteborg, Sweden. Individuals with serum T3 concentration greater than mean + 2.5 SD were selected for a follow-up study (n = 21). Of 16 individuals with no previous thyroid disease and no present treatment with thyroid hormones or oestrogens, 14 were subjected to a TRH-stimulation test giving a normal TSH response in 10 cases having T3 concentrations up to mean + 3.5 SD. Four women with serum T3 concentration greater than or equal to mean + 3.5 SD had previously unrecognized autonomous function thyroid function, of whom two developed hyperthyroidism after two years. The original population sample was reinvestigated after six years in 1980-81 (n = 1138) together with an additional sample of women giving a total sample of 1422 women of ages 26, 38, 50, 58, 62, 66 and 72 years. Of the females studied in 1974-75 eight had developed hyperthyroidism between the two studies; three of these had raised serum T3 at the investigation in 1974-75. No case of hyperthyroidism had been missed by the T3 assay in the 1974-75 study. Of individuals with serum T3 greater than or equal to mean + 2.5 SD selected for a follow-up (n = 29) at least five were found to have previously unrecognized thyroid autonomy. We found a raised serum T3 to be associated with hyperthyroid (n = 2) and euthyroid Graves' disease, autonomously functioning thyroid adenoma(s), possible painless subacute thyroiditis, possible thyrotoxicosis factitia, diminished thyroid reserve and thyroid substitution therapy.
Adult↗
Hemodynamic findings before and after resection of abdominal aortic aneurysm.
A preoperative and postoperative hemodynamic study was performed in 20 consecutive patients undergoing elective resection of abdominal aortic aneurysm. Screening for venous thrombosis and pulmonary embolism with 125I uptake test, measurements of maximal venous emptying and pulmonary perfusion scintigraphy were also done before and after the operation. Only five patients complained of intermittent claudication preoperatively, but the laboratory investigations revealed signs of peripheral arterial insufficiency in 15 cases. Maximal venous emptying from the legs was markedly decreased on the first postoperative day and remained significantly below normal on the sixth day. Signs of postoperative thromboembolism appeared in eight patients. These patients did not differ from the others in regard to the pattern of maximal venous emptying. In the three-year follow-up period, the calf blood flow and the ratio of systolic toe pressure to systemic systolic blood pressure were further decreased, despite significant rise in systemic blood pressure.
Aged↗
Prediction and prophylaxis of postoperative thromboembolism--a comparison between peroperative calf muscle stimulation with groups of impulses and dextran 40.
The effects of peroperative electrical calf muscle stimulation with groups of impulses giving a short lasting tetanus of the calf muscles on postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) were compared with that of dextran 40 given per and postoperatively. The incidence of DVT and PE during the first 4-6 postoperative days was recorded. The diagnosis of DVT was based on the 125I-fibrinogen uptake test and phlebography and of PE on pre- and postoperative perfusion pulmonary scintigram and chest X-ray examination. Both methods reduced the incidence of PE. Calf muscle stimulation reduced the DVT incidence in patients with malignant disease while the reduction in DVT incidence for the whole group only was significant in the stimulation as well as the dextran 40 group. Mean values for preoperatively determined levels of antithrombin III, beta-thromboglobulin, fibrinopeptide A, plasminogen and ability to release fibrinolytic activity during venous stasis did not differ between those patients who developed or those who did not develop postoperative DVT or PE. However, antithrombin III levels below 80 per cent appeared to predispose to postoperative thromboembolism. The two prophylactic methods have similar effects on the incidence of postoperative thromboembolism. The stimulation method has certain advantages due to its safety and simplicity.
Adult↗
Parasympathetic and sympathetic influences on mucociliary activity in vivo.
An in vivo test model has been developed to measure the influence of pharmacological substances on mucociliary activity in the rabbit maxillary sinus. Test solutions are administered via the feeding vessel to the investigated mucous membrane. The model permits administration of test substances and simultaneous recording of the obtained effects under conditions that closely mimic the normal situation. The parasympathomimetic agonist methacholine accelerates the mucociliary wave frequency dose-dependently. Atropine has no influence on the resting mucociliary activity but reduces or abolishes the effect of methacholine. The sympathomimetic beta 2-adrenoceptor agonist salbutamol accelerates the mucociliary activity dose-dependently whereas beta 1-adrenoceptor stimulation with prenalterol is without effect. Agonists acting on alpha 1- and alpha 2-adrenoceptors, phenylephrine and oxymetazoline, retard the mucociliary activity dose-dependently. beta- and alpha-adrenoceptor antagonists (propranolol and phentolamine, respectively) have no influence on the resting mucociliary activity but reduce the effect of beta- and alpha-adrenoceptor agonists, respectively. It is concluded that the resting mucociliary activity during anesthesia functions independently of parasympathetic and sympathetic nervous activity, and that the role of the parasympathetic and sympathetic innervation is to increase the mucociliary activity.
Animals↗
Chronic sclerosing osteomyelitis of the mandible. Scintigraphic and radiographic findings.
Fourteen patients with chronic sclerosing osteomyelitis of the mandible were investigated with 99mTc-labeled bone-seeking agents. Scintigraphic findings were compared with radiographic features. High uptake of diphosphonate and polyphosphate was demonstrated in diseased areas. Good agreement was found between radiography and scintigraphy concerning the extent and activity of each process. The use of bone-seeking radiopharmaceuticals in other types of skeletal lesions and differential diagnostic aspects are discussed.
Adolescent↗
Occurrence of previous neck radiotherapy among patients with associated non-medullary thyroid carcinoma and parathyroid adenoma or hyperplasia.
Sixteen consecutive patients with co-existent non-medullary thyroid carcinoma and parathyroid adenoma or hyperplasia are reported. Ten of these patients had earlier been treated with external radiation in the neck region. The estimated absorbed dose varied between 5 and 23 gray. The diagnosis of thyroid carcinoma and hyperparathyroidism (HPT) was established 36 years (average) after exposure to radiation. The findings are in accordance with the hypothesis that radiation can serve as an etiological factor in the development of associated thyroid carcinoma and HPT.
Adenocarcinoma↗
Hyperparathyroidism in persons treated with X-rays for tuberculous cervical adenitis.
Follow-up examinations of one hundred persons treated with x-rays for tuberculous adenitis between 1930 and 1946 have been carried out to determine if there is an increased incidence of hyperparathyroidism (HPT) after radiation exposure. Neck explorations were done in patients with hypercalcemia and signs and symptoms compatible with HPT. Individuals with thyroid masses were also operated upon when examination of fine needle specimens gave suspicions of malignancy. Eleven subjects were found to have developed parathyroid adenoma or hyperplasia. Four other individuals have hypercalcaemia but are asymptomatic. The mean absorbed dose in the parthyroid glands varied between 75 and 2,200 rads. Six individuals received more than 1,200 rads; four of them later developed HPT, while no HPT occurred below a dose of 300 rads. The high incidence of HPT among patients who had been heavily exposed to radiation suggests a cause and effect relationship between radiation treatment and development of HPT.
Adenoma↗