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ZusammenfassungSeit 1976 wurden 200 Patienten mit multiplen Skelettmetastasen mit 89Sr- Strontiumchlorid behandelt und die Wirksamkeit dieser Therapie untersucht. Nach einer dreimaligen Applikation von 0 (n = 21), 37 (n = 65), 75 (n = 72), 100 (n = 25) oder 150 (n = 17) MBq 89Sr wurden Schmerzlinderung, skelettszintigraphische Veränderungen, die Überlebensrate und hämatologische Nebenwirkungen beobachtet. Folgende Ergebnisse des Schmerzverhaltens bei Patienten mit und ohne Therapie wurden gefunden: in der Plazebogruppe Verschlimmerung 11%, keine Änderung 55%, Besserung 17% und Schmerzfreiheit 17%; in den Sr-Gruppen (zusammengefaßt) betrugen die entsprechenden Zahlen 3, 38, 26 und 33%! Mit steigender applizierter Aktivitätsmenge wurde die Schmerzlinderung effektiver und Blutbilddepressionen kamen häufiger vor. Gleichzeitig war ein szintigraphisch belegbarer Rückgang der osteoblastischen Aktivität der Metastasen zu beobachten. Die mediane Überlebenszeit wurde durch die 89Sr-Therapie nicht beeinflußt, jedoch sank die Sterblichkeit in den ersten Monaten nach Therapie. Die 89Sr-Therapie reiht sich in ein komplexes interdisziplinäres und langfristig palliatives Therapiekonzept ein.

In a prospective study, an attempt was made to determine the specificity of various imaging methods for defining tumours of the liver rather than their ability to demonstrate them. It was based on 130 patients with histologically confirmed lesions (33 haemangiomas, 17 FNH, 4 hepatocellular adenomas, 28 HCC, 36 adenocarcinoma metastases). The methods were MRT (130 cases), sonography (119), CT (122), dynamic arterial angio-CT (15), 99TC-EHIDA or blood pool scintigraphy (4 FNH, haemangiomas, HCC, 44 cases). MRT showed somewhat better results (accuracy 80%) than CT (73%) and angio-CT (73%) in demonstrating the type of lesion. The results of scintigraphy (53%) and sonography (69%) were rather worse. The range of accuracy for MRT, CT and sonography varied from 94% (haemangiomas with MRT) to 47% (FNH with sonography).

The distribution in rats of 125l-iodolisuride was studied. Three rats each were sacrificed at fixed intervals between 5 min and 24 h p. i., and the radioactivity was measured in isolated organs and parts of the body. The organ distribution and biexponential blood disappearance were similar to values for unlabeled lisuride. The radiation dose was estimated for man assuming a 123l label. The resulting doses were comparable to those from other radiopharmaceuticals in clinical use.

ZusammenfassungBei 14 Patienten mit hepatischer Enzephalopathie wurden SPECT-Unter- suchungen mit 123J-Jomazenil durchgeführt. Der spontane Abfall der Aktivitätskonzentration im Gehirn innerhalb 80 min betrug zwischen 10 und 20%, im Nasenbereich 35%. Nach Injektion von 0,1 bis 0,5 mg Flumazenil wurden innerhalb 20 min bzw. bei Zweitinjektion 29 bis 38% ausgeschwemmt. Eine vergleichbare Ausschwemmung erfolgte in der weißen Substanz und im Nasenbereich. Die Anwendung bekannter Modelle der Rezeptorkinetik war dadurch nicht möglich.

Locoregional chemotherapy has been introduced to reduce the side effects of chemotherapeutic agents by reduction in the load of these agents to the general circulation. A higher yield to the tumor areas is achieved, but the uptake in the cells of the liver parenchyma is high by the first-pass effect, i. e., a high clearance rate of the liver cells. Our study was directed at checking the proper insertion of the implanted catheter, demonstrating the distribution in the liver of material injected through the port system, and estimating the perfusion pattern of parenchym and tumor.

Since 1976 200 patients with multiple skeletal metastases from prostatic cancer were treated with 89Sr. In the present study the results were evaluated in order to confirm the efficacy of this therapy. Following the application of 3 injections each of 0 (n = 21), 37 (n = 65), 75 (n = 72), 100 (n = 25) or 150 (n = 17) MBq 89Sr subjective pain relief, scintigraphic follow-up observations, survival times and haematological complications were recorded. In comparison to the results of placebo administration the effects of 89Sr on pain were: in the placebo group deterioration 11%, no change 55%, improvement 17% and full pain relief 17% whereas in the Sr groups combined the corresponding figures were 3, 38, 26 and 33%. Pain relief correlated with the activity administered. A dose relationship to scintigraphic regression is probable, the latter correlating with pain relief. Due to a decrease of early deaths the survival rate increased during the first months after start of treatment but later on returned to the level observed in untreated patients. Pain relief and regressive scintigraphic findings were combined with increased marrow involvement which, however, did not by itself influence survival rates. 89Sr therapy is an effective additional treatment of patients with multiple skeletal metastases from prostatic cancer.

SPECT studies with 123I-iomazenil were performed in 14 patients with hepatic encephalopathy. The activity concentration in the brain decreases spontaneously by 10 to 20% within 80 min, in the nasal tissue by 35%. After an i.v. injection of 0.1 to 0.5 mg flumazenil a decrease of 29 to 38% is observed within 20 min, with a comparable decrease in white matter and nasal tissue. The application of well-known models of receptor kinetics is therefore impossible.

The aim of the study was to determine the pulmonary 67-gallium uptake, bronchoalveolar lavage (BAL) cell differentiation and the activity of BAL cells, measured as release of superoxide anion (O2-), and to investigate the results whether there are relations. In 11 nonsmoking systemic scleroderma (SS) patients and 11 systemic lupus erythematosus (SLE) patients with lung involvement double-sided BAL were performed, mainly in regions with increased 67-gallium uptake. Release of O2- was measured by INT-assey. BAL cell differentiation was in SS and SLE pathological in 68.2% without side-difference. In contrast to SS, O2(-)-release in SLE depends on BAL cell differentiation and is most increased in normal BAL cell differentiation. There is no correlation between 67-gallium uptake and both BAL cell differentiation and O2(-)-release. The results suggest, that in contrast to SS, BAL cells in SLE with pathological differentiation are less activated than BAL cells with normal differentiation probable due to autoimmunological factors. Pulmonary 67-gallium scan and BAL seem to be independent from each other.

The distribution in rats of 125I-iodo-lisuride was studied. Three rats each were sacrificed at fixed intervals between 5 min and 24 h p.i., and the radioactivity was measured in isolated organs and parts of the body. The organ distribution and biexponential blood disappearance were similar to values for unlabeled lisuride. The radiation dose was estimated for man assuming a 123I label. The resulting doses were comparable to those from other radiopharmaceuticals in clinical use.

In a prospective study, an attempt was made to determine the specificity of various imaging methods for defining tumours of the liver rather than their ability to demonstrate them. It was based on 130 patients with histologically confirmed lesions (33 haemangiomas, 17 FNH, 4 hepatocellular adenomas, 28 HCC, 36 adenocarcinoma metastases). The methods were MRT (130 cases), sonography (119), CT (122), dynamic arterial angio-CT (15), 99TC-EHIDA or blood pool scintigraphy (4 FNH, haemangiomas, HCC, 44 cases). MRT showed somewhat better results (accuracy 80%) than CT (73%) and angio-CT (73%) in demonstrating the type of lesion. The results of scintigraphy (53%) and sonography (69%) were rather worse. The range of accuracy for MRT, CT and sonography varied from 94% (haemangiomas with MRT) to 47% (FNH with sonography).

It is reported about 6 patients suffering from sarcoidosis with splenomegaly. In these cases indication for splenectomy was given by symptoms of hypersplenism, abdominal pain and ineffective cortisone therapy. In general after operation activity of sarcoidosis is unchanged. Different markers of activity were used after a time interval of 2-11 years. In one case it has to be discussed an overwhelming postsplenectomy infection (OPSI).

In the present 2.1 T15N NMR study two different kinds of experiments are presented. In one we show that metabolic reactions of 15N-labelled glycine can be followed in the isolated rat liver. In the second we demonstrate that [15N]glycine can be detected using NMR in vivo. For quantification and identification of glycine and metabolites 15N-isotope analysis (emission spectrometry technique) was used. To our knowledge, this is the first demonstration of 15N NMR for study of the metabolism of 15N-labelled compounds in vivo.

Folgende Untersuchungen an Rattenorganen waren durch 15N-NMR-Messungen moglich: – Verteilung von in vivo applizierten 15N-markierten Verbindungen auf verschiedene Organe in Abhangigkeit von der Einwirkungszeit; – Ermittlung der Biotransformationskinetik von [15N]Glycin als Maβ fur die fortdauernde metabolische Aktivitat der entnommenen Leber; – Nachweis intermediar auftretender Metabolite des Glycins. Es wurden [15N2]Harnstoff und [15N]Glycin injiziert. Aus den Ergebnissen folgt, daβ die 15N-NMR-Spektroskopie in Verbindung mit der traditionellen 15N-Analyse eine neue Moglichkeit zur Verfolgung des Stickstoffstoffwechscls von Pflanze, Tier und Mensch am intakten Organismus eroffnet. Using 15N NMR measurements functional studies in rat organs were possible and could be demonstrated with the following examples: – 15N distributions to various rat organs depending on the effective time of the injected compounds; – measurement of biotransformation kinetics of [15NJglycine showing the continued metabolic activit...

In 14 patients with chronic renal failure and without obvious signs of congestive heart failure, cardiac function was analyzed immediately before and after hemodialysis through radiocardiography, phon

In 20 patients a method for left-to-right shunt calculation based on precordial radiocardiographic curves after in- dicator (RISH) injection into the antecubital vein was compared with arterial dye (U

Experiences in the blood-flow measurement (133Xe washing out method) and function test (131J-bromsulphthalein, 99mTc-IDA) were reported after auxiliary liver transplantation in miniature swine. Normal values for the global blood-flow [70 (35-144) ml/100 g . min] and the bromsulphthalein half-time (6,5 +/- 2,4 min) were defined pre-operatively. Selective blood-flow measurements were carried out after transplantation invasively. Only insufficient experiences could be received about the liver-cholescintigraphy in consequence of graft insufficiency.

Kinetics of propranolol after oral administration were investigated in 9 children aged 5--11 years with intact liver function who had undergone porto-systemic anastomosis surgery for pylethrombosis and in a 16-year-old boy with a Warren shunt. Bioavailability of the drug had increased by twice the values measured in physiologic liver blood flow; elimination half-life had doubled. These alterations must be taken into consideration in medication, e.g. extreme care must be exercised in the oral administration of "first pass" drugs in porto-systemic shunt patients and it is recommended that the initial dose should be at the level of intravenous administration. The reduced rate of elimination should be taken into account in the case of drugs whose elimination depends on liver blood flow.

A programme for the investigation of the behaviour of bioactive and bioinactive implant materials by the osseous bed was enlarged by the scanning. This one allows a follow-up of bone processes in vivo. The implants were inserted into the patellar surface of the right and left femur of rabbits. The bone regeneration after defect formation without implant serves as standard of comparison. The scintigrams were taked down with 99m-Tc-EHDP. The bone scanning provides differentiate statements about the temporal process incorporation. Its non-specificity allows no separation between the behaviour of bioactive and bioinactive materials in biologic surroundings. The scintigraphic findings can be interpreted below employment of the results of the other tests and previously known material qualities.

It is sought for alternative methods for the endogenous creatinine clearance as parameters for the GFR. For this purpose served investigations with Tc-99m-Sn-DTPA. It was found a good reproducibility for the slope clearance with 3 blood takings between 60 and 120 minutes. When combined with the camera function scintigraphy a side-separated quantitative statement of the clearance equivalent is possible. The inulin clearance serves as reference method. The investigations at the gamma-camera with Tc-99m-Sn-DTPA also allow the determination of the perfusion which is particularly of interest in patients with hypertension. According to the comparison at the gamma camera a diagnostic schema is recommended.

Reference is made to the significance of hypercalciuria in the aetiology of calcium oxalate lithiasis. Differentiation between the various forms of hypercalciuria allows the therapy to be suited to the respective causes. In order to measure intestinal calcium absorption the authors examined serum samples from 22 patients after oral administration of Ca47; in 13 cases absorptive calciuria was diagnosed.

At the problem of the auxiliary liver transplantation has been worked for about 30 years. Extensive series of tests with animals with a novel transplantation model justify these promises well of a successful clinical use. Laboratory chemical, histologic, angiographic and nuclearmedical examinations prove the fitness of this method. Basic supposition for a success is the preservation of physiological conditions at the donor liver with sufficient perfusion of the recipient liver.

An injection of 99mTc-labelled antimony sulphide colloid was used to show the lymphatic pathways in patients with malignant melanoma of the trunk skin. Using a gamma camera, optimal visualisation was obtained 15-30 min postinjection. Surprising deviations of the lymphatic pathways were found; therefore, this method makes it possible to plan continuity dissection appropriate to individual cases. Two examples are presented.

6 patients with therapy resistant ascites underwent implantation of a Le-Veen shunt. The risk of infection in this procedure is low, the surgical technique can easily be handled. In all 6 patients a significant reduction of the ascites could be demonstrated. Postoperatively, a right ventricular insufficiency could be observed in every case and, in addition, there were imbalances of the water and electrolyte metabolism Disseminated intravascular coagulation could not be traced.

BAL was performed in different courses of sarcoidosis in order to evaluate the importance of this examination. We found a higher degree of lymphocytosis in Löfgren's syndrome and in relapses than in the others. Probably there is a direct connection between high intensity alveolitis and reduction of diffusing capacity. There could not be found any correlation to other markers of activity (lung function, SACE, 67-Gallium-Scan).

On 23 investigations in dogs the 133xenon eluation method was compared with the bloody measurement of the renal blood supply. The most favourable correlation presents the measurement of the initial decrease of the curves with r = 0.827 and y = 0.889x + 53.3, besides the modified hight-surface-method. Possibilities of error exist especially by the recirculation of xenon and the influence on the blood supply by the xenon-injection.

Calcium metabolism was studied in the serum of 10 patients before and during haemodialysis with the help of 47-Ca. The patients were in a stabilized condition within a chronic dialysis programme. The measured metabolic rate fell from 0.395 h-1 to 0.208 h-1 during dialysis. This corresponds to a reduction of metabolism by 0.43 mmol L-1 h-1. It is to be assumed that this alteration corresponds to the calcium inflow rate through the dialyser.

Durch Weiterentwicklung der lymphoszintigraphischen Untersuchungstechnik ist es uns 1984 erstmals gelungen, den detaillierten Verlauf der sehr variablen ableitenden Lymphbahnen des Tumorgebietes zu erkennen und mit Farbstofflosung auf der Haut zu markieren.

Gallium-67 scan has an increased importance in the examination of activity in sarcoidosis. Compared with other markers of activity only gallium-67 can give an information about the localization of active granulomas in the body. It is profitable to distinguish between the accumulation of 67-gallium in the region of hilus and of lung parenchyma. SACE and gallium-67 scan complement each other. There is a good correlation between SACE and gallium-67 score, especially if there is an involvement of lung parenchyma.

For characterising the elimination and metabolisation performance of the liver in chronic renal insufficiency the galactose load test was carried out. 9 children with healthy liver and kidneys, 35 children with chronic renal insufficiency (15 were conservatively treated = group 1, 20 were in the chronic haemodialysis programme = group 2) as well as 5 children after kidney transplantation were examined. In group 1 a normal blood galactose concentration was present. Patients of the 2nd group showed increased concentrations of galactose in the blood which might refer to a decreased redox potential in the liver caused by the uraemic intoxication. In the group of patients who underwent a kidney transplantation in the patients with azathioprine therapy a disturbed use of galactose was present. Children with cyclosporin-A had a normal galactose concentration.