[Single photon emission computed tomography of patients with benign and malignant spinal diseases]. / Die Einzelphotonen-Emissions-Computertomographie (SPECT) bei Patienten mit benignen und malignen Erkrankungen der Wirbelsäule.

SPECT has been used in a comparative study with planar bone scintigraphy in 54 patients. Spatial resolution of the method is sufficient to localise the vertebral bodies, the spinous processes, the intervertebral, costotransverse and costovertebral joints. In all patients it was possible to relate the areas of increased uptake to specific anatomical sites of the spine known to be affected in the different conditions. A detailed localisation is rarely possible using planar scintigraphy alone, due to the complex osseous anatomy of the spine. In some patients lesions could be seen only with SPECT. SPECT is an invaluable supplement to planar scintigraphy of the spine.

Treatment of severe Graves' ophthalmopathy with cyclosporin A.

Ten patients with severe Graves' ophthalmopathy, resistant to other therapeutic regimens were treated with cyclosporin A (CyA) over a period of 6 months. Clinically, 9 patients improved, 2 of them only after addition of corticosteroids. Intra-ocular tension on upward gaze decreased in all of these 9 patients (P less than 0.01). In 6 patients there was a significant decrease in eye muscle thickness under the treatment (P less than 0.05) as determined by computerized tomography. Side effects (e.g., paraesthesia, proteinuria) which were observed under higher doses of CyA, disappeared after lowering the dose. In only one out of 3 patients with hypertension an antihypertensive medication became necessary. CyA appears to be a valuable drug for treatment of severe Graves' ophthalmopathy when previous therapeutic regimens turned out to be unsuccessful.

Brain tumors: detection and typing by use of CPMG sequences and in vivo T2 measurements.

A spin-echo sequence with 24 echoes (Carr-Purcell-Meiboom-Gill sequence) was evaluated to determine the usefulness of magnetic resonance (MR) in detecting and typing brain tumors. The TEs in these examinations were between 28 and 346 msec, and the TR was 860, 1260, or 1660 msec. The results of the MR examination of 32 histopathologically proved tumors are presented. All but one tumor could be detected by MR. Tumors generally were obvious on MR due to the higher contrast enhancement of these lesions, especially with a TE longer than 100 msec. T2 values calculated from an eight-point fit, however, did not allow discrimination of different tumors, nor did they allow differentiation between tumor, inflammatory tissue, and demyelination.

[Skeletal manifestations of generalized mastocytosis in the skeletal scintigram compared with roentgen findings]. / Die ossären Manifestationen bei der generalisierten Mastozytose im Skelettszintigramm im Vergleich zum Röntgenbefund.

Bone scans and skeletal x-rays of eight patients with systemic mastocytosis were reviewed. Mast cell infiltration of bone marrow had been proven histologically in every patient. Bone scan and roentgenographic findings are not specific for the disease and do not correlate well in some patients. A generalized increase of uptake was noted in two patients, a generalized decrease of skeletal activity with poor delineation of bony structures was observed in others. A circumscribed increase of activity was observed in some patients, only one patient had a normal bone scan. Roentgenographic examination revealed diffuse sclerosis of trabecular bone in three patients, osteoporosis with collapse of multiple vertebral bodies in three patients, and no abnormalities in two patients.

[Use of long spin-echo sequences for imaging demyelinating diseases]. / Einsatz von langen Spinechosequenzen zur Darstellung demyelinisierender Erkrankungen.

A multiple spin-echo-sequence has been evaluated in diagnosis of demyelinating diseases. TE in these MR-experiments was between 14 and 336 msec, TR between 860 and 1660 msec. Three groups of patients were examined, and it could be shown that the probability to detect MS-plaques grows with long TE's up to 300 msec. T2-relaxation-time-values range between 126 and 250 msec. Different MS-plaques in the same patient might show different T2-values.

[Sonographic localization of parathyroid adenomas in hyperparathyroidism]. / Sonographische Lokalisation von Nebenschilddrüsen-Adenomen bei Hyperparathyreoidismus.

The diagnostic efficacy of sonography for localisation of adenomas of the parathyroid glands in the neck region was investigated in 13 patients with hypercalcaemia and increased serum parathormone levels. Solitary parathyroid adenoma was demonstrated in all patients. The diagnosis was confirmed by surgery in 12 patients. In one patient, adenoma of the parathyroid can be assumed due to sonographically demonstrated increase in size and increase of serum parathormone. Adenomas of the parathyroid are characterised sonographically by typical dorsal position at the posterior surface of the thyroid, by echo-paucity and echo-density of the "capsular structure" around the adenomas. Sonography is suitable as screening method in hypercalcaemia and in increased parathormone serum levels for preoperative localisation of parathyroid adenomas.

Conversion of monomeric human growth hormone and big growth hormone into different molecular weight forms in vitro and after injection into humans.

Monomeric human growth hormore (hGH) and big hGH obtained by a new purification procedure from human pituitary glands were examined for a possible conversion into different molecular weight forms under in vitro and in vivo conditions. Sephadex G-150 gel filtration was used for separation. Big or monomeric hGH was incubated in hormone-free serum or injected into normal individuals in order to induce a peak of immunoreactive hGH. Specimens from early and late stages of the surge were subjected to gel filtration. It could be shown that not only the big hGH is converted to the smaller form but that monomeric hGH is also recovered in two higher molecular weight regions by gel filtration in vitro and in vivo experiments. A significantly higher conversion of monomeric to big hGH was found in vitro. This suggests an inhibition of big hGH formation from monomeric hGH in normal individuals. There was no apparent time relation of big hGH formation from monomeric hGH in vivo. Regarding the conversion of big hGH, more of this material remained in its original form in vitro. The immunoreactivity recovered in the region of the very large form was found to be higher in vivo. The formation of the monomer from big hGH was similar under in vitro and in vivo conditions.

Persisting cyclic ovarian activity in cervical cancer after surgical transposition of the ovaries and pelvic irradiation.

The effect of surgical transposition of the ovaries on gonadal function was investigated in ten young women with carcinoma of the uterine cervix, stages I and II. Gonadotrophin-, oestradiol- and progesterone-levels were determined before and during pelvic irradiation. A control group consisted of seven patients with cervical cancer who did not undergo ovaria transposition. In the control group gonadotrophins began to rise after radiation doses of 560-2400 rad (FSH) and 1130-2600 rad (LH) respectively. The excessive secretion was not seen in patients who had ovarian lifting. Ovulatory cycles occurred during or after pelvic irradiation in seven women of the study group, either spontaneously or induced by clomiphene treatment. This indicates that transposition preceding radiotherapy is an effective means of preserving ovarian secretion in young women in whom malignancies of the pelvic region demand irradiation.

Pituitary and ovarian function in women with vesicovaginal fistuale after obstructed and prolonged labour.

This study concerns 11 patients with menstrual disorders dating back to an obstructed and prolonged labour, and 5 women with similar histories but without menstrual disorders. All patients were able to secrete gonadotrophins. According to the gonadotrophin pattern, the patients could be divided into three groups: in the amenorrhoeic and in 2 normally menstruating women various degrees of suppression of basal and peak levels of luteinising hormone (LH) could be observed; patients with infrequent menstrual periods showed temporarily arrested secretion of gonadotrophins and ovarian steroids; and in polymerrhoea a non-cyclic but high secretion was seen. The gonadotrophin response to oestrogen levels was temporarily or permanently disordered in all but 3 patients in this series, whereas an ovarian refractoriness to gonadotrophins was only infrequently observed. There were 2 cases of 'ovulatory amenorrhoea' as judged by the normal profiles of ovarian steroids. Biopsies indicated inadequate endometrial transformation in many cases of amenorrhoea. Abnormal responses to the stimulatory tests of pituitary secretion of human growth hormone (HGH) and/or LH were seen in 6 patients. The study suggests that menstrual disorders after obstructed labour are associated with derangement of different hypophyseotrophic areas of the hypothalamus.

Comparative determination of total serum thyroxine. Radio-immunoassay and protein-binding assay.

The precision, accuracy, sensitivity and clinical results of a radio-immunological method for the determination of total serum thyroxine are compared with similar criteria of a competitive protein-binding assay. Application of both methods in the assay of thyroxine in 150 serum samples gave good agreement between the two techniques. The radio-immunoassay offers certain methodological advantages and is considerably less costly than thyroxine determinations in which commercially available kits are used.