A simple method for the quantification of portosystemic shunting (PSS) in patients with portal hypertension.

Portosystemic shunting (PSS) was evaluated in 32 patients with chronic liver disease by the rectal administration of iodine-123 I-amphetamine (IMP method), a radionuclide which is rapidly absorbed from the sigmoid and extracted by liver and lungs. Simultaneous measurement of pulmonary and hepatic uptake supplies a shunt fraction (SF) as an index of PSS. The IMP method was compared with the ammonia tolerance test (NH3TT), and there proved to be a significant correlation between these two methods (r = 0.75, p < 0.001). Assuming that an increase of > 7 mumol/l in arterial ammonia concentration after NH3TT represents PSS, the IMP method had a sensitivity of 0.93. When fasting (NH3) was > 50 mumol/l, all patients showed pathological PSS with either method, but this was also the case in 50% of patients with normal basal arterial ammonia. There was also a significant correlation between the IMP method and the Child-Pugh classification (r = 0.75, p < 0.001). Endoscopy in 28 patients revealed absence of varices in 11, of whom, however, 7 (64%) had an increased SF and although all 15 patients with ascites had increased SF, this was also the case in 12 of the 17 patients without ascites. In conclusion, PSS evaluation using IMP is a non-invasive, sensitive method without patient discomfort which might be used in the staging and follow-up of chronic liver disease.

Effect of antihypertensive drugs on insulin absorption.

OBJECTIVE: To examine the effects of antihypertensive drugs on the absorption of subcutaneously injected insulin. RESEARCH DESIGN AND METHODS: Eleven healthy volunteers (group 1) were given 1 mg/kg body wt propranolol three times a day during 48 h and a single dose on the morning of investigation. Seven other healthy volunteers (group 2) were given 10 mg nifedipine 30 min before subcutaneous injection of 10 U 125I-labeled soluble insulin. Absorption was measured by counting radioactivity externally. In both groups, control experiments were conducted under the same conditions without administration of propranolol or nifedipine. RESULTS: Propranolol usage was associated with higher mean percentages of remaining activity (P less than 0.05 by analysis of variance [ANOVA]) than in the control experiment. In the nifedipine experiment, mean percentages were significantly lower compared with the control experiment (P less than 0.02 by ANOVA). The mean decline in activity of all 30-min periods was 6.8 +/- 3.5 vs. 3.6 +/- 3.7% for control versus propranolol (group 1) (P less than 0.05) and 6.3 +/- 1.8 vs. 9.6 +/- 3.2% for control versus nifedipine (group 2) (NS). CONCLUSIONS: Antihypertensive drugs can influence insulin absorption. Propranolol (a peripheral vasoconstrictor) decreases insulin absorption, whereas nifedipine (a vasodilatator) increases insulin absorption.

The use of a computer in ventilation-perfusion scintigraphy with Tc-99m macroaggregates and Kr-81m, to obtain a physiological model.

In this article we describe a computer program to demonstrate ventilation-perfusion relationships in the lungs, using 99mTc-MAA and 81mKr, with the patients sitting upright, the normal physiological situation. The ventilation and perfusion scans are performed simultaneously with both gamma camera and computer adjusted for dual isotope mode. Steady state images are acquired in the frontal, dorsal, and left and right posterior oblique positions. Additionally, in the dorsal and frontal projections, a sequence of 12 washout images (5 s) is registered, after closing the Krypton supply. After normalization and further computer processing, the following parameters are calculated in the frontal and dorsal projections, in the whole lung and in four horizontal subregions: washout values, ventilation-perfusion ratios, left to right ratios of ventilation and perfusion, and left to right ratios of the average pixel values for ventilation and perfusion. Results in a group of eight healthy volunteers are described and discussed.

Lung and renal uptake of technetium Tc 99m sulphur colloid related to disseminated intravascular coagulation.

In addition to a recently published case study, we present another three cases in which we observed both lung and renal uptake of technetium Tc 99m sulphur colloid which was related to a period of disseminated intravascular coagulation. Being familiar with this relationship may influence the diagnosis and course of the illness in certain patients.

Bone scintigraphy in patients with juvenile kyphosis (M. Scheuermann).

A group of 32 patients between 10 and 16 years of age with a positive history and physical examination of juvenile kyphosis were studied. Both radiological and nuclear bone scanning studies of the spinal column were performed. Despite gross radiological abnormalities of the spinal column due to M. Scheuermann the bone scan was always negative. In 2 patients increased radionuclide accumulation was found due to active spondylodiscitis and a healing discitis. Our conclusion is that when a positive bone scan of a patient with M. Scheuermann is found one should consider other causes of involvement of the spinal column than juvenile kyphosis.

Detection of inflammatory bowel disease with 99mTc DTPA.

The possible scintigraphic detection of active inflammation of the bowel was studied after injection of Tc diethylene triamine pentacetic acid (DTPA). The study included 5 cases of proven active colitis ulcerosa or Crohn's disease and 6 volunteers without any gastrointestinal complaints. No significant differences in the images of both groups could be demonstrated. In both groups some accumulation of radioactivity in the intestines was found, but it was impossible to distinguish any anatomical entity. The sensitivity of Tc DTPA scanning seems to be insufficient to differentiate between a reactivation and a chronic inflammatory process.

Radionuclide fetal imaging: radio-activity in the fetal bladder confirmed by ultrasound after maternal hepato-biliary scanning.

Hepato-biliary scanning with 99mTc-P.G. demonstrated in a jaundiced patient at 31 weeks pregnancy the filling of the fetal bladder 6 h after injection. This finding was confirmed by ultrasound. Fetal urinary bladder activity was seen until 33 h after injection. Fetal hepatic radio-activity could not be displayed although the localisation of the fetal liver was marked by ultrasound.

Hepatobiliary scanning with 99mTc-pyridoxylidene glutamate. A retrospective study investigating the criteria for differentiation between intrahepatic and extrahepatic obstruction.

In 70 99mTc-pyridoxylidene glutamate (PG) studies with verified diagnoses, the following scan patterns were found. (1) Normal: within 30 min of PG injection the scan reveals the liver, hepatic ducts, common bile duct, gallbladder and flow to the intestine; after 2 h the liver had a higher concentration of activity than the hepatic ducts or the common bile duct. (2) Complete extrahepatic obstruction: no hepatic excretion to the intestine is observed 18-24 h after PG injection, nor is activity observed in the hepatic ducts, common bile duct and gallbladder. (3) Incomplete extrahepatic obstruction: intestinal activity is observed within 18-24 h of PG injection; after 2 h the concentration of activity in the hepatic ducts or the common bile duct exceeds that in the liver (regardless whether activity is or is not demonstrated in the gallbladder). (4) No extrahepatic obstruction: serum bilirubin normal or increased; intestinal activity is observed within 18-24 h after PG injection, and activity is demonstrable during this period somewhere in the hepatic ducts, the common bile duct or the gallbladder; after 2 h the concentration of biliary activity should not exceed that in the liver. (5) If excretion to the intestine is observed within 18-24 h of PG injection without demonstrable activity in the hepatic ducts, common bile duct or gallbladder, then it is impossible to differentiate between (3) and (4).

Sensitivity of ultrasound in the detection of biliary tract obstruction.

In 28 patient with varying degrees of biliary obstruction, the ultrasonic findings were correlated with the serum bilirubin levels and with the size of the bile ducts as measured by percutaneous transhepatic cholangiography (PTC). With ultrasound, study of the intrahepatic ducts achieved the greatest accuracy (71%); examination of common bile ducts and the gallbladder were found to be less sensitive (54 and 53%). Ultrasound proved to be very accurate in biliary obstruction, when the serum bilirubin was above 4.8 mg/100 ml (80 mumol/1).