Ole Munck

Estimation of peripheral arteriosclerotic disease by ankle blood pressure measurements in a population study of 60-year-old men and women.

Abstract The systolic ankle and arm blood pressure has been measured by Doppler ultrasound technique in 666 men and women aged 60 yr. The Doppler method was found suitable for use in a population survey as the cost is low, the measurements are rapid, painless and can be well standardized. The reproducibility was 2.9 mm Hg, measured as the mean standard deviation of 10 measurements in ten persons. Decreased ankle blood pressure was defined as a ratio between the systolic ankle pressure and the arm pressure of less than 90% in at least one of the four leg arteries examined. Decreased ankle pressure in one or more arteries was present in 16% of the men and 13% of the women. The prevalence of intermittent claudication was 5.8% in men and 1.3% in women. Pulselessness in one or two of the arteries of the foot occurred in 11.9% of the men and 8.8% of the women. According to all three criteria 2.3% of the population were abnormal, 3.3% of the men and 1.0% of the women. 82% had no signs of arteriostenosis. The normal individuals had on an average ankle/arm blood pressure indices higher than 100%. The ankle/ arm indices were related to other signs of arteriosclerosis: Angina pectoris, dyspnoea on effort and ECG signs of ischemia. The findings have been used in an evaluation of the risk factors for peripheral arteriosclerosis. The values, at age 50, of blood pressure, serum cholesterol, serum triglyceride, smoking habits, heart rate and male sex were significantly associated with signs of peripheral arteriostenosis and with the ankle/arm index at age 60.

What do early bone scans tell about breast cancer patients

In 1978, 1012 out of a total of 1888 Danish breast cancer patients registered for a nationwide therapeutical trial were bone-scanned to find osseous metastases. A re-reading group (N.R., O.M. and S.P.N.) interpreted 842 of the scans produced in the twelve participating hospitals. Specific criteria were used for grading the scintiscans. Of the 842 scans 682 were performed within 30 days of the operation and were defined as initial. The re-reading group found 50 (7%) of these scans to be equivocal and 46 (7%) to be indicative of bone metastases at the time of operation. The number of X-ray-verified bone metastases was only 5 (0.6%). The frequency of positive bone scans correlated with the age of the patients and tumor size, but not with clinical staging at the time of operation, number of positive axillary lymph nodes or degree of tumor anaplasia. Recurrences and death rates during a 2-yr follow-Up period correlated significantly with initial clinical staging. In the clinical low-risk group a positive initial bone scan worsened the prognosis, but this was not statistically significant for all patients grouped together. Although the prognostic value of the initial bone scan per se is dubious, it serves as a guidance for elective X-ray examination and as a basis for comparing subsequent scans.

The effects of cimetidine on creatinine excretion glomerular filtration rate and tubular function in renal transplant recipients

The renal clearance of endogenous creatinine (CCr), sodium (CNa) and lithium (CLi) was determined before and after a single intravenous bolus of cimetidine in nine renal transplant recipients. The glomerular filtration rate (GFR) was measured with 125I-iothalamate clearance (CTh). The initial CCr of 65 ml/min (median) was reduced to a nadir of 46 ml/min (p less than 0.01) during the first 2 h after infusion of cimetidine. GFR remained unchanged, and thus the fractional clearance of creatinine (CCr/CTh) was reduced from 1.43 (median) to 1.03 (p less than 0.01). CNa and the fractional excretion of sodium decreased throughout the study (p less than 0.05); CLi was unchanged. In conclusion cimetidine, when measured during 1-h clearance periods, interferes with tubular creatinine secretion in the denervated kidney of transplant recipients without affecting the glomerular filtration rate or proximal tubular flow. This suggests that on-going cimetidine treatment must be taken into account when graft function is evaluated by the CCr alone.

Influence of Normal Central Venous Pressure on Onset of Function in Renal Allografts

The central venous pressure was kept above 5 cmH2O during the perioperative and early postoperative period as guidance for fluid replacement in 31 patients receiving a renal graft (group B). In 30 other transplant recipients the central venous pressure was not measured (group A). The two groups were otherwise comparable. Onset of graft function within the first 3 postoperative days was significantly more frequent in group B than in group A (62% vs. 30%), despite absence of difference in the measurable warm and cold ischemic periods. Fluid replacement guided by the central venous pressure thus is concluded to reduce the number of kidneys with delayed function in the immediate postoperative period.

A Comparison of Dipyridamole Thallium 201 Scintigraphy and Clinical Examination in the Determination of Cardiac Risk Before Arterial Reconstruction

Preoperative clinical examination, including a 12-lead resting ECG, and pla nar dipyridamole thallium imaging (DTI) were compared in a prospective study of 65 vascular surgical patients in regard to their value for predicting postopera tive cardiac complications. Fifty-three patients underwent abdominal vascular procedures and 12 were operated on for peripheral artery disease. Thirty-six patients had ischemic heart disease (IHD) and/or abnormal find ings from 12-lead resting ECG. Of these 36 patients, 11 had nonfatal cardiac complications. The remaining 29 patients were free of IHD and had normal results from ECG. No complications occurred among these 29 patients. There was no postoperative death. Thallium imaging results were abnormal in 45 patients, showing either redis tribution and/or scar tissue or low washout. In 18 of these patients major changes with redistribution were present in all projections. Among these patients, 9 had a nonfatal cardiac complication. In the 27 patients with abnormalities in only one or two projections, only 2 had a cardiac event postoperatively. No cardiac complications occurred in patients with normal thallium scintigraphy findings. The patients were operated on irrespective of the results of the scans, and all recovered from any cardiac complications that occurred. In vascular surgical patients with previous IHD and/or abnormal findings from resting ECGs further risk stratification is achieved with DTI.

Peripheral and Renal Venous Plasma Renin Concentration in Hypertensive Patients with Unilateral Renal or Renovascular Disease

Renal venous catheterization was carried out in a consecutive series of 32 hypertensive patients with unilateral renal or renovascular disease. Plasma renin concentration (PRC) was measured in systemic and renal venous blood with a method allowing the expression of results in terms of Goldblatt Units. Blood samples were collected before and after intravenous injection of furosemide (0.33–0.66 mg/kg body weight).Systemic PRC was elevated in ten out of 19 patients with lesions of the main renal artery. Only one out of 11 patients with unilateral parenchymal renal disease had elevated systemic PRC. A unilateral significant veno-arterial renin concentration difference over the affected kidney was found in eight out of 15 patients with renal artery stenosis and in three, out of 11 patients with unilateral parenchymal renal disease. In patients with renal artery stenosis, a close association was found between increased systemic PRC and renal venous PRC-ratios <1.8. Furosemide led to an increased release of reni...

Interobserver variation in the detection of metastases on liver scans

Two specialists in nuclear medicine and two trainees independently read 106 liver scans for abnormalities suggestive of metastases. The four observers made a positive diagnosis with a significantly different frequency. The overall agreement between pairs of observers was 0.83-0.87. After adjusting for the expected chance agreement, kappa-values between 0.66 and 0.74 were obtained. No difference was found in the level of agreement between the two specialists or between the two trainees. After a consensus conference where the observers tried to unify their diagnostic interpretation, another 106 scans were read for abnormalities suggestive of metastases. The conference did not increase the level of agreement. Scintigraphic lesions that especially imply a risk of disagreement are pointed out.

Bone metastases in primary operable breast cancer. The role of serial scintigraphy

In 1978 and 1979, 1060 Danish patients with primary operable breast cancer were bone-scanned for osseous metastases before entering a nationwide therapeutical trial. A re-reading group interpreted the scans produced in 12 participating hospitals. As a consequence standardized guide-lines for interpretation were agreed upon from 1979. The frequency of positive bone scans suggesting bone metastases fell abruptly from 1978 to 1979, as read both locally and by the re-reading group. As measured statistically the difference between the interpretation of the local and the re-reading groups remained unchanged. Of the 1060 patients 760 were followed by repeated pre-scheduled scans 6 and 12 months after surgery until any kind of recurrence was diagnosed. Only 37 of the 760 patients (4.9%) developed bone metastases verified by radiology or autopsy during the first 2 yr after surgery. A single positive scan, especially performed 6 or 12 months after surgery, as well as two or three scans repeatedly staying or becoming positive increase significantly the risk of developing bone metastases within 12 months after the latest scan. In 13 of the 37 patients with otherwise subsequently proven bone metastases the latest scan(s) were negative. It is concluded that a fixed schedule of repeated bone scans in patients with breast cancer is not warranted.

The Transplanted Kidney: Diagnostic and Interventional Radiology

Following kidney allotransplantation a great number of complications threaten the patient and his graft, e.g. acute tubular necrosis, acute and chronic rejection, urologic and vascular complications and complications due to the immunosuppressive treatment. During the last decade a number of technical developments in radionuclide, ultrasonographic and radiographic imaging and intervention has significantly improved the possibility of early recognition and handling of such complications. Knowledge of the capability and limitations of the various techniques is of vital importance for their rational use. The aim of this review article is to give a short description of the various imaging modalities, the rational monitoring of the post-transplant patient, and possible handling of complications by the aid of imaging techniques.

Gastric emptying of liquid before and after gastroplasty for morbid obesity.

Gastric emptying of a liquid meal was investigated with a radionuclide method before and 1 week and 3 and 12 months after gastroplasty operation for morbid obesity. Gastroplasty results in a small proximal pouch with a narrow stoma to the remaining stomach. The total gastric emptying was delayed 3 months after gastroplasty (p less than 0.01). Twelve months after gastroplasty, emptying of the proximal pouch was faster than at 3 months (p less than 0.01). This may indicate dilatation of the stoma between the two gastric pouches during this period. Surprisingly, the total gastric emptying 12 months after gastroplasty was not only faster than at 3 months but also faster than before surgery. The explanation, therefore, cannot only be attributed to a dilated stoma, and hormonal mechanisms may be involved. A lack of correlation between preoperative weight and emptying was observed, but because the material consists of only obese subjects, no conclusion can be drawn about the postulated role of gastric emptying in developing obesity. Emptying of the total stomach and of the proximal pouch failed to correlate with postoperative weight losses. The weight loss after gastroplasty evidently bears little, if any, relation to the postoperative changes in gastric emptying of liquids.