Computerized tomography in the diagnosis of cerebral atrophy

Computerized tomograms were studied of 67 adults whose lumbar pneumoencephalograms were normal or showed ventricular dilatation with or without widening of the sulci. The maximum ventricular area, measured from 80 x 80 matrix printouts, correlates well with measures of ventricular size on the pneumoencephalogram. An area of 10 cm2 is suggested as the upper limit of normal. The correlation between measures of sulcal width on computerized tomography and pneumoencephalography is less precise, but normal sulci and gross degrees of cortical atrophy can be identified.     

Single-photon emission-computed tomography in the diagnosis of cerebrovascular diseases

BACKGROUND: SPECT-HM-PAO allows to detect the regional cerebral blood flow and total diminution of the brain perfusion still before morphological substrate evolution in CT scan, without invasive technologies. SEARCH GOAL: The authors have analyzed data obtained by SPECT-99mTc HM-PAO in the group of 46 patients suffering from cerebrovascular disorders and they have compared them with results aimed by CT scans. Both, the SPECT-99mTc HM-PAO and CT scan were performed within 48 hours or later after the onset of the stroke; some of CT scans were repeatedly performed. RESULTS: They discovered 40 positive and 6 negative SPECT-HM-PAO findings, 26 positive and 20 negative CT scans. SPECT investigation more frequently discovers circulatory failures in the clinically altered hemisphere than the CT scan does in a substrate; SPECT discloses hypoperfusion of the clinically unaltered hemisphere if silent hypoperfusion is present. The ipsilateral foci of CT substrates were significantly less frequently observed (p < 0.001) than some ipsilateral regional hypoperfusions. Not only the number, but also size and extent of hypoperfusional foci searched by SPECT are significantly higher and wider than the numbers and dimensions of substrates observed by CT (p < 0.001). CONCLUSION: CT scan diagnostic possibilities are restricted by the time factor (CT examinations performed within 48 hours since the onset of the stroke are significantly less frequently positive than those performed later-p < 0.001). SPECT examination has not such a limiting time factor (p > 0.05). MEANING: Hence SPECT-HM-PAO renders early, long lasting and wide information on the restriction of the overall and regional perfusion, independently of the fact as to whether the reduction of cerebral perfusion is, or is not going to result in ischemic necrosis and/or ischemic sclerosis. SPECT renders correlation of the perfusion disorder earlier, wider in space, and more frequently than the CT scan, and therefore it is a prerequisite to the disclosure of the mentioned silent focal blood flow reductions. (Graph 12, Fig. 3, Ref. 4.)     

Molecular biology in the diagnosis of cardiovascular diseases]

Genes shown to affect risk factors or protective factors with respect to coronary heart disease (CHD) have been identified at the APOB, APOAI, LPA, LDLR, APOE and CETP loci. Rare mutations (e.g., in the LDLR and APOE genes) may have a major effect, whereas genes belonging to normal polymorphism have only a moderate effect. Even genes with only a slight effect can be clinically important in combination with other genes or life-style factors. There is gene to gene interaction between LDLR and APOE genes. Important risk factors determined by genes as well as by environmental factors are homocystein and fibrinogen. In addition to traditional lipid and apoprotein measurements, the levels of Lp(a) lipoprotein, fibrinogen and homocystein should be examined in connection with diagnosing CHD cases. DNA analyses are appropriate when familial hypercholesterolemia is suspected, and it is likely that the importance of mutation analyses will increase significantly in the near future.     

Polyuria and polydipsia in the diagnosis of endocrine diseases

Elevated plasma von Willebrand factor (vWf) levels are found in diabetes and other vasculopathies, and predict cardiovascular mortality. vWf is stored and released from endothelial cell secretory granules, along with equimolar amounts of its propeptide (vWf:AgII). In the present study, we examined plasma propeptide levels as a marker of endothelial secretion in vivo, using an ELISA based on monoclonal antibodies. vWf but not propeptide levels are influenced by blood groups, explaining in part the smaller variation in plasma propeptide levels among normal individuals. In both controls and insulin-dependent diabetic patients, we found a close correlation between propeptide and immunoreactive vWf levels (r2=0.54, p <0.0001). vWf and propeptide were elevated in patient subgroups with microalbuminuria or overt diabetic nephropathy, whereas only the propeptide was significantly elevated in the normoalbuminuric subgroup. This observation suggests that in conjunction with vWf, propeptide measurements may improve the identification of endothelial activation, which occurs frequently even without increased urinary albumin excretion. In 12 NIDDM patients, a 3-week diet enriched in monounsaturated fat (MUFA) resulted in parallel decreases in vWf (-22%, p <0.05) and propeptide (-17%, p <0.05) levels, indicating that the experimental diet affected endothelial secretion rather than vWf catabolism. A carbohydrate-enriched control diet did not significantly influence either marker. Our results suggest that concomitant determinations of plasma vWf and propeptide are useful tools to assess endothelial activation in vivo, and reinforce our previous conclusion that a diet rich in MUFA can improve endothelial function in NIDDM.     

Radioisotope diagnosis in lung diseases]

Following immunization against sheep erythrozytes, it is possible to induce a double-peaked antibody response curve in the serum of experimental animals (rats) by using vincristine sulfate (Vi). Immunosuppression is enhanced in thymectomised and sensitised animals during rechallenge following Vi/Cy, as compared to animals treated with cyclophosphamide (Cy) alone, and an attentuated anamnestic reaction is subsequently observed. Survival time of allogeneic skin grafts in colony bred and inbred rat strains could not be prolonged by using Vi/Cy, as compared to animals treated with Cy alone.     

Cathepsin D in diagnosis of neoplastic diseases

The paper presents a review of results concerning the aspartic proteinase cathepsin D and its role in tumor invasion and metastasis. Special attention was paid to the clinical prognostic value of cathepsin D determination in the breast cancer cytosol.     

Progress in imaging diagnosis of circulatory diseases

Five patients with femoral nonunion and a broken interlocking nail were treated with the augmentative plating procedure. This group included two male and three female patients whose average age was 25 years (range, 21-35 years). All of the injuries resulted from traffic accidents and were closed fractures. Four of the injuries were initially managed with a Grosse-Kempf interlocking nailing system, and one case was managed with an AO interlocking nailing system. The broken interlocking nail was left in place in situ, and an augmentative plate fixation was applied to the fracture site to provide a rigid fixation. Simultaneous bone grafting was performed in three of the patients to repair the bony defect. All of these patients walked bearing full weight on the extremity without aching at the fracture site within 3 months, and all of these five fractures obtained a bony union within an average of 5.4 months after this treatment. From our experience, we have found this method to be a useful treatment for the nonunion of femoral shaft fracture with a broken interlocking nail.     

Peroral pancreatoscopy for the diagnosis of pancreatic diseases

PURPOSE: The purpose of our study was to evaluate the relevance of MR mammography in the diagnosis of early and late tumor recurrence after breast-conserving therapy. METHOD: Sixty-seven patients receiving breast-conserving therapy underwent 84 MR mammographies in a period between 1 month and 14 years after end of therapy. Dynamic measurements were made following application of contrast agent. The course of signal intensity changes was evaluated in focal lesions and irradiated and contralateral glandular tissue. RESULTS: All 10 malignant lesions (7 local recurrences, 1 chest wall recurrence, 2 contralateral carcinomas) showed a > 75% increase in signal intensity within th first minute after contrast agent application. In all patients examined during the first year after end of therapy (n = 29), increased enhancement in irradiated parenchyma was observed compared with the contralateral breast, but only in two patients the increase was > 75% within the first minute. CONCLUSION: Already in the first year after end of therapy, MRI can improve diagnostic accuracy in the assessment of breast cancer recurrence. More than 12 months following end of therapy, MR mammography can demonstrate tumor recurrence with a sensitivity of nearly 100% and a specificity rising to > 90% in differentiating tumor from therapy-induced changes.