L. Csernay

Effect of decreased local circulation on the absorptive capacity of a small-intestine loop in the dog

SummaryThe effect of local decrease of circulation (produced by arterial clamping) on the absorptive capacity of an isolated small-intestine loop in the dog was examined.In the case of isotonic glucose solution, a certain degree of reduction of blood supply did not result in a proportionate impairment of the absorptive capacity, because of a compensatory increase of the arteriovenous oxygen difference. In the case of glycocoll, the function of the local compensating mechanism observed with glucose could not be found. The absorption of sorbose was not influenced by the change of blood supply; the authors suppose, therefore, that its absorption occurs mostly through passive resorption.

The possible role of F-18 FDG positron emission tomography in the differential diagnosis of focal pancreatic lesions

Purpose To compare the diagnostic values of different methods for the differentiation of malignant from benign pancreatic lesions. Methods In 22 patients with focal pancreatic lesions, the carbohydrate antigen (CA) 19-9 level was measured; abdominal ultrasound (US), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) were performed; and the value of these methods were analyzed for their use in cancer diagnosis. Results Malignant lesions were identified in six patients and verified by surgery or clinical follow-up. The CA 19-9 level was elevated in four of the five patients examined (sensitivity, 80%). In all six cases, US and CT revealed hypoechogenic and hypodense areas (sensitivity, 100%). In one patient, ERCP was unsuccessful but yielded true-positive results in three others (sensitivity, 60%). The sensitivity of FDG PET was 100%. Sixteen focal cases of pancreatic disease proved to be benign. The CA 19-9 level was elevated in four of them (specificity, 73%). Hypoechogenic and hypodense areas were evident on US and CT in eight patients. The specificity of CT was 50% (8 of 16 cases). The specificity of US was 47% (7 of 15 cases). The specificity of successful ERCP was 92%. Fourteen negative FDG-PET results were truly negative. In two patients, however, the PET findings proved to be falsely positive (specificity, 88%). Conclusions FDG-PET is an effective tool to differentiate malignant from benign focal pancreatic lesions. In persons with focal pancreatic hypoechogenic or hypodense lesions detected by CT or US and an elevated CA 19-9 level, FDG PET should be the next step in the diagnostic strategy.

Regional cerebral blood flow single-photon emission tomography with 99mTc-HMPAO and the acetazolamide test in the evaluation of vascular and Alzheimer's dementia

Abstract. The diagnostic potential of technetium-99m hexamethylpropylene amine oxime (HMPAO) following systemic administration of the cerebral vasodilator acetazolamide (acetazolamide test) was evaluated by regional cerebral blood flow (rCBF) single-photon emission tomography (SPET) in patients with Alzheimer’s disease (AD) or vascular dementia (VD). An initial, high-resolution SPET study was performed with 99mTc-HMPAO, and after 2 days the patients were re-evaluated with 99mTc-HMPAO following systemic administration of acetazolamide. Reconstructed SPET slices were evaluated visually and semiquantitatively by a semi-automatic rCBF map method. When 99mTc-HMPAO alone was used, bilateral hypoperfusion was found in the temporal and/or parietal regions in 33% (6/18) of the VD patients and in 70% (23/33) of the AD patients. The corresponding data obtained by quantitative evaluation were 41% (7/17) and 71% (15/21), respectively. The vascular reserve capacity, as determined with the acetazolamide test, was preserved visually in 22% (4/18) and quantitatively in 29% (5/17) of the VD patients, but in 73% (24/33) and 76% (16/21) of the AD patients. The differences in the perfusion patterns between the VD and AD patients were statistically significant (P<0.01, Fischer’s exact test). Of the VD patients with hypoperfusion (bilateral temporal and/or parietal), 4/6 (67%, visual evaluation) and 4/7 (57%, quantitative evaluation) had a decreased vascular reserve capacity as determined with the acetazolamide test. In the AD group of patients the corresponding results were 3/23 (13%) and 4/15 (27%). It is concluded that the acetazolamide test is promising in rCBF SPET to differentiate VD from AD.

Correlations between clinical symptoms, working memory functions and structural brain abnormalities in men with schizophrenia.

Thirteen male patients with schizophrenia and thirteen male normal control subjects were compared by magnetic resonance imaging (MRI) on volumes of the straight gyrus (SG), anterior cingulate gyrus, middle frontal gyrus, hippocampus, third ventricle, cavum septi pellucidi, total brain volume and intracranial volume. In addition, neuropsychological tasks were used to measure working memory and executive functions. Healthy volunteers and schizophrenic patients showed no significant differences in mean values for volumes of regions of interests. In the case of the SG, we found a significant difference in laterality: the tendency toward left dominance in healthy volunteers changed to significant right dominance in patients. The schizophrenic patients showed lower performance in working memory tasks, and strongly significant group differences were observed in measures of neurological signs assessed by the Neurological Evaluation Scale (NES). Negative symptoms correlated with the level of spatial working memory and executive functions. Negative symptoms also correlated with the volume of the right hippocampus, while the rate of anhedonia negatively correlated with the relative volume of the left SG.

HM-PAO-labeled leukocyte scintigraphy in pediatric patients with inflammatory bowel disease

Leukocyte scintigraphy (LS) was performed in 20 pediatric patients with inflammatory bowel disease (IBD: 10 with ulcerative colitis, 2 with indeterminate colitis, and 8 with Crohn disease) in different stages of clinical activity. Leukocytes were separated from 15 to 60 ml venous blood and were labeled in vitro with [99mTc]HM-PAO. The segmental extent (small intestine; ascending, transverse, and descending colon; and recto-sigmoideum) of the process was determined by LS. The uptake of each bowel segment was scored in relation to the bone marrow uptake. The scintigraphic activity, calculated by summing the segment scores, was compared with laboratory parameters. The mean labeling efficacy was 76% (60-86%). The segmental extent of the process determined by LS was compared with the results of barium enema or colonoscopy with regard to 32 bowel segments. The sensitivity, specificity, and accuracy of LS were 93, 88, and 91%, respectively. Two extraintestinal manifestations (abdominal abscess and joint involvement) were also detected by LS. These lesions were verified by computed tomography (CT) (abscess) and on the basis of the clinical outcome (arthritis). The scintigraphic activity correlated with the C-reactive protein (CRP) level (r = 0.82, p < 0.001), the alpha 2-globulin level (r = 0.63, p < 0.02), the sedimentation rate (r = 0.51, p < 0.05), and the fS iron level (r = -0.66, p < 0.005). LS is applicable in pediatric patients. The method is an excellent technique for assessment of the extent of IBD in children. Extraintestinal manifestations of IBD can also be investigated by LS. The scintigraphic activity is a useful parameter for determination of the activity of IBD in children.

Anti-granulocyte immunoscintigraphy and [99mTc]hexamethylpropyleneamine-oxime-labeled leukocyte scintigraphy in inflammatory bowel disease

A prospective study was carried out on 13 patients with ulcerative colitis and 11 with Crohns disease to compare the value of radioimmunoscintigraphy involving99mTc-labeled antigranulocyte monoclonal antibody (BW 250/183) with that of hexamethylpropyleneamine-oxime-labeled leukocyte scintigraphy. The extent of the process (various segments of the small bowel; ascending, transverse, and descending colon; and rectosigmoideum) was determined in 115 segments by means of radioimmunoscintigraphy and leukocyte scintigraphy and compared with the results of enteroclysis and colonoscopy in 64 segments. The scintigraphic activity, calculated by summing the segment scores, was compared with clinical and laboratory parameters. During radioimmunoscintigraphy, the 24-hr fecal excretion of the antibody was measured. The two methods revealed a different extent of the process (P<0.01). The segmental sensitivity and specificity were 63% and 96% in radioimmunoscintigraphy, and 87% and 94% in leukocyte scintigraphy. Leukocyte scintigraphy proved to be superior in cases with small intestine involvement, but the methods are of similar value in cases with large bowel involvement. The scintigraphic activity determined by radioimmunoscintigraphy and the fecal excretion of monoclonal antibody correlated with seven parameters, while that determined by leukocyte scintigraphy did so with 12 variables. Both methods are of similar value for the detection of large bowel involvement, but leukocyte scintigraphy was the better method for determination of the involved segments in the small intestine. The scintigraphic activity proved a useful parameter, correlating well with the clinical and laboratory variables.

Effect of glucose and glycine solution on the circulation of the isolated jejunal loop in the dog

SummaryIsotonic glucose and glycine solution put into the isolated jejunal loop of the dog increased local blood flow and oxygen consumption. Similar but smaller increases were obtained with physiologic saline solution. An intraluminal pressure increase brought about by administering similar quantities of air caused no increase.It is suggested that the observed changes in circulation are the consequence of an autoregulatory mechanism of the small intestine.

Technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy in ulcerative colitis and Crohn's disease

Technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy (LS) was performed on 45 occasions in 30 patients with ulcerative colitis and on 53 occasions in 34 patients with Crohns disease. Serial images were taken following re-injection of the labelled leucocytes. The segmental extent of the inflammation and the grade of the leucocyte uptake were calculated, and compared with the laboratory results and colonoscopy findings. The sensitivity and specificity of LS proved higher in ulcerative colitis (87% and 93%) than in Crohns disease (53% and 89% in cases with large intestine involvement, and 82% and 100% in cases with small intestine involvement). The activity of the process determined by LS correlates with the α2 globulin level (r=0.47), fibrinogen level (r=0.50), fS iron level (r=−0.57), sedimentation (r=0.44), leucocyte count (r=0.38), platelet count (r=0.34) and Best index (r=0.31) in ulcerative colitis, but not in Crohns disease.

The effect of vasoactive substances on the circulation and glucose absorption of an isolated jejunal loop in the dog

SummaryThe effects of vasoactive substances—histamine, epinephrine, and acetylcholine—on the circulation and glucose absorptive capacity of an in-vivo isolated jejunal loop were examined by functional and morphologic methods. These investigations furnish data for the existence of functioning arteriovenous connections in the small intestine of the dog.

Gastroesophageal reflux disease: work-related disease?

Background: An occupation-related susceptibility of professional singers to experience gastroesophageal reflux has been suggested. Aims: To investigate the prevalence of gastroesophageal reflux symptoms in a series of professional opera choristers, wind players, glassblowers and water polo players in comparison with a sample of general population. Subjects and Methods: A total of 202 professional opera choristers from well-known choirs in different Hungarian regions, 71 professional wind players, 43 glassblowers, 54 water polo players were identified and 115 control subjects were compared prospectively. Reflux symptoms together with selected individual characteristics and lifestyle habits were investigated in study groups through a reflux questionnaire. Results:Professional opera choristers reported a statistically significantly higher prevalence of heartburn, regurgitation and hoarseness than control subjects (p < 0.001). Among professional wind players, heartburn and regurgitation were significantly more frequent compared with controls (p < 0.05 and p < 0.01, respectively). Glassblowers reported a significantly higher prevalence of acid regurgitation in comparison with controls (p < 0.01). The prevalence of reflux symptoms in water polo players was similar to that of controls. In opera choristers, wind players and glassblowers, reflux symptoms appeared to be significantly correlated with the cumulative lifetime duration of professional singing, playing and working activity, respectively (p < 0.05). Conclusions: Our results demonstrate that professional opera choristers, professional wind players and glassblowers have a higher prevalence of reflux symptoms compared with control subjects. Gastroesophageal reflux in these professions should be considered as a work-related disorder that may have an impact on quality of life and may negatively interfere with professional performance.