Transepidermal water loss, serum IgE and beta-endorphin as important and independent biological markers for development of itch intensity in atopic dermatitis.

BACKGROUND: Although itch is the predominant symptom of atopic dermatitis (AD), it is poorly characterized and subjective. The objective assessment of itch intensity is important for treatment and follow-up in patients with AD. OBJECTIVES: To determine what objective clinical parameter(s) could be used as biomarker(s) for itch intensity in patients with AD. METHODS: This is a retrospective and cross-sectional study. Seventy-five patients, aged 7 months-49 years with equal sex ratio, were enrolled in 2000 according to criteria proposed by Hanifin and Rajka. Thirty-five age- and sex-matched subjects who visited the dermatological clinic but were otherwise healthy served as controls. Subjective itch intensity was divided into four grades of severity. Disease severity was measured by SCORAD index, which also includes itch intensity as part of the measurement. Transepidermal water loss (TEWL) and skin surface pH were measured by noninvasive methods in clinically normal skin on the forearm. Serum beta-endorphin and vasoactive intestinal peptide (VIP) were determined by radioimmunoassay. Ordinal logistic regression was used to assess the trend of the subjective itch intensity and SCORAD index by serum IgE, beta-endorphin, VIP, TEWL and skin pH. RESULTS: There were significant trends for itch intensity with IgE, beta-endorphin and TEWL. After adjustment for sex, age and other variables, the odds ratio (OR) for itch intensity by log IgE, beta-endorphin and TEWL was 2.103 [95% confidence interval (CI) 1.222-3.618], 1.100 (95% CI 1.005-1.203) and 1.081 (95% CI 1.009-1.158), respectively. The OR for disease severity by log IgE, beta-endorphin and TEWL was 2.250 (95% CI 1.149-4.407), 1.156 (95% CI 1.086-1.231) and 1.071 (95% CI 0.971-1.182), respectively. In contrast, there was no association between serum VIP concentration and itch intensity. CONCLUSIONS: Beta-endorphin and IgE are both useful biomarkers for itch and disease severity in patients with AD, while TEWL is a good biomarker for itch intensity. These biomarkers provide a way to assess the itch intensity in patients with AD.

Evaluation of serum CA27.29, CA15-3 and CEA in patients with breast cancer.

The Truquant BR radioimmunoassay (RIA) using monoclonal antibody BR 27.29 to recognize a peptide sequence on the MUC-1 gene product for quantification of the CA 27.29 antigen in serum was used in this report to evaluate in 145 patients with breast cancer and compared the other conventional serum markers such as CA15-3 and CEA. The upper limit of normal (25 u/ml) was determined from CA27.29 values 12.4 +/- 4.1 u/ml (mean +/- 3 S.D.) for 112 female subjects apparently free of disease. The CA15-3 levels above 25 u/ml and CEA levels above 5 ng/ml were considered positive values. Thirty-seven cases of 145 patients studied had elevated CA 27.29 levels (sensitivity: 25.5%), 35 of 145 had positive CA15-3 levels (sensitivity 24.1%) and 27 of 145 patients had positive CEA levels (sensitivity: 18.6%) (p < 0.05). One hundred and ten cases of the breast cancer patients (75.8%) did not have metastatic disease. In this group CA 27.29 sensitivity was 6.4%, while CA15-3 sensitivity was 5.5% and CEA sensitivity was 4.5% (p > 0.05). Mean values were 10.2 +/- 9.2 u/ml for CA 27.29, 14.1 +/- 5.6 u/ml for CA 15-3 and 1.7 +/- 1.5 ng/ml for CEA. Thirty-five patients (24.2%) had metastatic disease. In this group CA 27.29 sensitivity was 85.7%, CA15-3 sensitivity was 82.8% and CEA sensitivity was 62.8% (p < 0.05). Mean values for CA27.29 was 152.6 +/- 131.6 u/ml, CA15-3 was 123.1 +/- 107.6 u/ml and 21.8 +/- 36.9 ng/ml of CEA. With regard to the correlation of three tumor markers with clinical stages, patients had significantly higher levels of CA27.29 than CEA, but they were similar to CA 15-3 in metastatic breast cancer. These results suggest CA27.29 to be more sensitive and specific than CEA, but that it is similar to CA15-3 for metastatic breast cancer detection and monitoring.

Assessment of hypothalamic-pituitary function by hormonal pulsatility, gonadotropin-releasing hormone and thyrotropin-releasing hormone testing in women with euprolactinemic secondary amenorrhea.

To evaluate the integrated hypothalamic-pituitary function of euprolactinemic secondary amenorrhea, blood samples of 23 patients were taken every 15 min for 4 hours in examination of pulsatile LH, FSH, PRL secretions and then 2 hours GnRH, TRH tests were performed. Nine normal cycling women (group I) served as the controls. Thirteen amenorrheic women (group II) revealed responsive bleeding to progestin injection and the other 10 women (group III) were nonresponsive. The LH frequency, amplitude, and LH response to GnRH of groups II and I were comparable, whereas delta PRL after TRH in group II (60.8 +/- 18.9 ng/ml) exhibited a significantly (P < 0.05) exaggerated response, as compared with that of group I (43.6 +/- 11.4 ng/ml). The LH frequency (1.3 +/- 0.4/4h) and amplitude (1.7 +/- 0.4 mIU/mL) of group III were significantly lower (P < 0.01) than those in group I (2.4 +/- 0.5 and 2.5 +/- 0.5, respectively), but their delta LH and delta FSH responses to GnRH showed no differences from those of controls. The frequency, amplitude of PRL and delta PRL response to TRH in group III were no significant difference with those of group I. These results suggest that masked PRL hypersecretion and loss of the regulatory pulsatility of gonadotropin release may be responsible in part for the causes resulting to euprolactinemic secondary amenorrhea. The analysis of these hormonal environments is useful for the understanding of clinical perspectives, pathophysiology and management.

Comparison of cytokeratin fragment 19 (CYFRA 21-1), tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA) as tumour markers in bronchogenic carcinoma.

To elevate the diagnostic value of the serum cytokeratin 19 fragment (CYFRA 21-1) and compare it with carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA) in bronchogenic carcinoma, the sera of 161 patients (58 with benign pulmonary disease and 103 with bronchogenic carcinoma) was investigated using immunoradiometric assay. Sensitivities for CYFRA 21-1, CEA and TPA (using 3.5 ng ml-1, 5.0 ng ml-1, 110 U l-1, respectively, cut-off values corresponding to a 95% specificity for benign pulmonary disease) in bronchogenic carcinoma were 64, 47 and 61%, respectively. Positive CYFRA 21-1 levels were identified in 75% of patients with squamous cell carcinoma (n = 36), in 67% with adenocarcinoma (n = 45), in 17% with large cell carcinoma (n = 6), and in 50% with small cell lung cancer (SCLC) (n = 16). However, CYFRA 21-1 levels were not significantly different between squamous cell carcinoma and the other histological types. The sensitivity of the combined measurement of CYFRA 21-1 with any other tumour marker was significantly higher than that of CYFRA 21-1 measurement alone. Elevated CYFRA 21-1 levels were observed in 44% of Stages I and II (n = 18) and 72% of Stage III and IV (n = 69) patients with non-small cell lung cancer (P < 0.05). A significant inter-marker correlation was observed between CYFRA 21-1 and TPA (n = 103, r = 0.448, P < 0.0001). Twenty-one patients were monitored by CYFRA 21-1, and significantly different changes in progressive patients (P = 0.0058) and regressive patients (P = 0.016) were obtained. These results indicate that CYFRA 21-1 may be not only a sensitive tumour marker in the diagnosis of bronchogenic carcinoma, but also a useful marker for the monitoring of bronchogenic carcinoma.

[The study on the in-vitro stability of Tc(V)-99m dimercaptosuccinic acid].

Tc(V)-99m DMS, developed by Yokoyama et al. in 1981, has been recognized to be advantageous for the scintigraphic diagnosis of various malignant tumors and their metastasis, the aim of this study is to assess the in-vitro stability of Tc(V)-99m DMS. Thin-layer chromatography, including paper chromatography and silica gel thin layer chromatography, is performed to determine the change of radiochemical species presented in the reconstituted solution of Tc(V)-99m DMS prepared from the DMS kit (Institute of Nuclear Energy Research, Atomic Energy Council R.O.C.) and the commercial DMSA kit (Nephroscint, IRE CELLTARG Radiopharmaceuticals Japan). The bioscan imaging scanner is used to measure the Rf value and labeling efficiency of radiochemical species on the chromatographic strip. The in-vitro stability of Tc(V)-99m DMS prepared from the DMS kit and the commercial DMSA kit is studied by examining various parameters which include temperature(degree C) and time(hr) after reconstitution. The results show that the in-vitro stability of Tc(V)-99m DMS prepared from the DMS kit is actually better than that from the commercial DMSA kit. The one-step labeling method of DMS kit is much simpler than the two-step labeling method of DMSA kit.

Significance of tumour markers in nasopharyngeal carcinoma.

Ninety-two nasopharyngeal carcinoma (NPC) patients were selected for a study to measure tissue polypeptide antigen (TPA), CA 125, CA 19-9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP). In all, 32 patients with chronic ENT disease and 40 healthy persons were asked to participate as diseased and normal control groups. The results showed (1) TPA was the most effective of all markers; (2) CA 125 was less useful, but had a definite correlation with TPA; (3) CA 19-9, CEA, and AFP were nearly useless; (4) the TPA level increased with advancing tumour, nodal stage, and stage groups; (5) when metastases occurred, the TPA level was extremely high; (6) the TPA level decreased significantly after irradiation at stages II, III, and IV, but increased at stage V; and (7) there was no difference in TPA level between the nonkeratinizing and undifferentiated carcinomas. This study demonstrated that the TPA marker was useful in determining the degree of NPC severity and especially for indicating the presence of metastatic disease.

Cytokeratin fragment 19 (CYFRA 21-1) as a tumor marker in non-small cell lung cancer.

To evaluate the diagnostic value of the serum cytokeratin 19 fragment (CYFRA 21-1) in bronchogenic carcinoma, we investigated the sera of 138 patients (58 with benign pulmonary disease and 80 with non-small cell lung cancer (NSCLC)) using immunoradiometric assay. The mean (SD) value of serum CYFRA 21-1 in NSCLC (13.26 (16.54)) was significantly higher than in benign lung diseases (1.74 (1.55)) (p < 0.0001). Sensitivity for CYFRA 21-1 (using 3.5 ng/ml, a cut-off value corresponding to a 95% specificity for benign pulmonary disease) in NSCL was 62%. Positive CYFRA 21-1 levels were significantly higher in 75% of patients with squamous cell carcinoma (n = 36) than in 53% with other NSCLC (n = 44) (p < 0.05). CYFRA 21-1 levels were significantly different between squamous cell carcinoma (17.28 (19.94)) and the other NSCLC (9.96 (12.44)) (P < 0.05). Elevated CYFRA 21-1 levels in patients with stage III and IV disease (n = 64, 18.19 (26.51)) were significantly higher than in stage I and II (n = 16, 4.41 (5.76)) (p < 0.02). The positive rate of CYFRA 21-1 in tumor stage I and II was only 37%. Our results indicate that CYFRA 21-1 may be a useful tumor marker in NSCLC, especially in squamous cell carcinoma. However, CYFRA 21-1 cannot be used for the diagnosis of early stage disease of NSCLC. CYFRA 21-1 may also contribute to the monitoring of NSCLC.

Comparison of serum CA15-3 and CEA in breast cancer.

The monoclonal antibodies CA15-3 were developed against the two antigens 115D8 of the human milk fat globule membrane and DF3 of breast cancer. CA15-3 was assayed radioimmunologically and CEA was analysed using the enzyme immunoassay. Normal control was achieved in 32 healthy women, the mean values for CA15-3 were 11.5 +/- 3.0 u/ml, range from 7.9 to 16.9 u/ml. We compared serum levels of CA15-3 and CEA in 121 patients with histologically proved breast carcinoma. CA15-3 levels above 25 u/ml and CEA levels above 5 ng/ml were considered positive values. 31 of 121 patients studied had elevated CA15-3 levels (sensitivity: 25.6%) and 21 of 121 patients had positive CEA levels (sensitivity 17.4%). 92 of the breast cancer patients (76%) did not have metastatic disease. In this group CA15-3 sensitivity was 7.6%, while CEA sensitivity was 6.5%. Mean values were 15.1 +/- 6.6 u/ml for CA15-3 and 1.78 +/- 2.47 ng/ml for CEA. 29 patients (24%) had metastatic disease. In this group, CA15-3 sensitivity was 82.8% and CEA sensitivity was 51.7% (P < 0.05). Mean values for CA15-3 were 147.5 +/- 175.9 u/ml and 16.9 +/- 24.0 ng/ml of CEA. With regard to the correlation of two tumor markers with clinical course patients had significantly higher levels of CA15-3 than of CEA in metastatic breast cancer. This result suggests CA15-3 to be the more sensitive and more specific of the two for metastatic breast cancer detection and monitoring.

Comparison of myocardial ischaemia in post-infarction patients with and without angina: assessment by dipyridamole 201T1 imaging.

Ninety patients with old myocardial infarction were studied to evaluate the efficacy of intravenous dipyridamole 201Tl imaging for the detection of myocardial ischaemia in post-infarction patients, and to compare the prevalence of ischaemia in 63 patients with post-infarction angina (group I) and 27 patients without angina (group II). Thirty-four of the patients in group I and 15 of the patients in group II received coronary arteriography (CAG) for comparison; these were labelled groups IA and IIA, respectively. On 201Tl imaging, the incidence of scar with ischaemia in the infarct zone and scar with ischaemia at a distance were 72% and 42% in all patients, 89% and 52% in group I vs 33% and 19% in group II (P < 0.001 and P < 0.01, respectively). On CAG testing, the rates of infarct-related recanalization vessel and multi-vessel disease were 76% and 68% in group IA vs 40% and 40% in group IIA (P < 0.05 and P > 0.05, respectively). Thus, dipyridamole 201Tl imaging is a useful modality and post-infarction angina a proper indicator in the detection of myocardial ischaemia in post-infarction patients

Technetium-99m albumin scintigraphy in the diagnosis of protein-losing enteropathy: a case report.

A 34-year-old female presenting with bilateral lower leg edema and distended abdomen was admitted to our hospital. The serum albumin was 1.42g/dl. Renal function and hepatic function were normal. Urinalysis did not show proteinuria. Tc-99m albumin scintigraphy was arranged for this patient to rule out protein-losing enteropathy. The results demonstrated loss of albumin into the intestines. We conclude that Tc-99m albumin scintigraphy of the abdomen is a valuable adjunct in the diagnosis of protein-losing enteropathy.

Does Helicobacter pylori infection play a role in the pathogenesis of non-ulcer dyspepsia--a study of gastric emptying time.

UNLABELLED: To investigate the relationship between gastric motility and Helicobacter pylori infection in patients with non-ulcer dyspepsia, 28 patients and 10 asymptomatic healthy persons underwent gastroduodenal endoscope examinations and scintigraphic test of solid phase gastric emptying time using Chinese fried rice as a test meal. Clinical symptoms were also recorded using questionnaires for scoring. Half emptying times for ingested food (t1/2) between H. pylori infected (190.86 +/- 112.53 minutes) and uninfected patients (227.69 +/- 179.29 minutes) were not different statistically. Seven of the 15 patients with H. pylori infection (46.6%) had delayed gastric emptying time (t1/2 > 197.7 minutes), compared to 4 out of 13 without infection (30.07%) (p > 0.05). There was also no association between the status of H. pylori infection and severity of clinical symptoms (total symptoms scores: H. pylori positive: 10.07 +/- 3.84; H. pylori negative: 7.62 +/- 2.25) (p > 0.05). Seven patients from whom H. pylori was found to have been eradicated using triple therapy (colloid bismuth subcitrate 120 mg q i d, tetracycline 500 mg q i d and metronidazole 250 mg q i d for 14 days) did not show significant changes in gastric emptying time (before: 171.14 +/- 128.13; after: 158.57 +/- 182.49 minutes) but showed improvement in total symptoms scores (before: 9.28 +/- 3.85; after: 3.85 +/- 4.22) (p = 0.0277). CONCLUSIONS: infection by H. pylori in patients with non-ulcer dyspepsia did not influence solid phase of gastric emptying time and was not associated with clinical symptoms. Eradication of H. pylori infection relieved the clinical symptoms of the patients with non-ulcer dyspepsia.(ABSTRACT TRUNCATED AT 250 WORDS)

Subcutaneous radionuclide venography. An effective method for diagnosis of deep venous thrombosis.

Traditional acupuncture points K-3 are physiologically tender points located halfway between the Achilles tendon and the medial malleolus. Recently, the authors developed a new method of radionuclide venography of the lower limbs, namely subcutaneous radionuclide venography (SC-RNV), by subcutaneous injection of Tc-99m pertechnetate at these points. The authors applied this method in a patient with suspected deep vein thrombosis of both lower limbs. For comparison, ascending radionuclide venography by intravenous injection (IV-RNV) of Tc-99m MAA and color Doppler ultrasound were also done. The SC-RNV showed partial obstruction of right popliteal vein and complete obstruction of the left popliteal vein with prominent collateral flows. These results were compatible with the findings of color Doppler ultrasound. However, the IV-RNV showed small narrowing with patency of the left popliteal vein, and normal flow on the right. This suggests that the results of SC-RNV may be different from that of IV-RNV. The benefits of SC-RNV in the detection of deep vein thrombosis are described.

Comparison of intravenous dipyridamole and adenosine Tc-99m MIBI myocardial imaging for detection of coronary artery disease.

A total of 44 patients referred for Tc-99m MIBI myocardial imaging for detection of coronary artery disease (CAD) were studied to compare the differences in heart beat, blood pressure, electrocardiographic changes and side effects during intravenous infusion of dipyridamole (ID) and adenosine (IA) and also to determine the degree of concordance between ID and IA Tc-99m MIBI imaging. These patients were divided into two groups: 20 suspected CAD patients constituted group I and 24 proven CAD patients formed group II. All patients received ID 0.56 mg/kg for 4 min and within about 10 days IA 0.14 microgram/kg/min for 6 min with Tc-99m MIBI imaging. The results revealed that maximal heart beat increased and maximal systolic blood pressure decreased in both IA and ID patients with no statistically significant differences. Transient second-degree AV block occurred with IA in 3 patients. Side effects, such as, chest pain, headache, dizziness and shortness of breath occurred more often and were in general more intense in IA patients, but they were typically mild and resolved spontaneously within 1 or 2 min of discontinuation of IA. Both IA and ID Tc-99m MIBI imaging were normal in 18 of 20 group I patients and were concordant for the presence of perfusion defects in the other 2 patients. Of 24 group II patients, all had myocardial perfusion defects on both tests and were concordant for the severity of the perfusion abnormalities. However, in other 2 patients. Of 24 group II patients, all had myocardial perfusion defects on both tests and were concordant for the severity of the perfusion abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Radionuclide venography by subcutaneous injection of Tc-99m pertechnetate at acupuncture point K-3: a case report.

Recently, we developed a new method of radionuclide venography of lower limbs, namely SC-RNV, by subcutaneous injection of Tc-99m pertechnetate at acupuncture points K-3. In this study, we applied this method to evaluate the venous drainage of lower limbs in a patient with severe varicose veins and edematous swelling of the left lower extremity. For comparison, an ascending radionuclide venography by intravenous injection of Tc-99m MAA (IV-RNV) was also done. The SC-RNV showed normal venous drainage of the right side but complete obstruction of the left popliteal vein with a prominent collateral flow, compatible to the findings of IV-RNV. The findings in this case again demonstrated that SC-RNV may be useful as an alternative method of venography as previously suggested.

Radionuclide venography of lower limbs by subcutaneous injection: a clinical evaluation.

SC-RNV, radionuclide venography by subcutaneous injection of Tc-99m pertechnetate at acupuncture points K-3, a new alternative of lower limb venography, was recently developed in our clinical laboratory. In some of the previous studies, we have proved its superiority to radionuclide venography by intravenous injection. The current investigation was conducted to understand the reliability of SC-RNV in the diagnosis of deep vein thrombosis (DVT). Fifty-seven cases with lower leg edema, from Nov., 1989 through Oct., 1990, received both SC-RNV and duplex US for causative evaluation. As a result of duplex US, 26 were considered normal (non-DVT), 19 were classified as unilateral DVT, and 12 as bilateral DVT. In nineteen cases (61%, 19/31) with DVT also a XCT and/or a CV (contrast venography) was taken, that showed compatible results. All of the non-DVT had a normal pattern of SC-RNV, all of the unilateral DVT had unilateral impairment of deep vein drainage in SC-RNV, and all of the bilateral DVT had impaired deep venous drainage bilaterally in SC-RNV. It is therefore concluded that SC-RNV is one of the best choices among available non-invasive lower-limb venographic methods.

Differences in acupuncture point SP-10 and non-acupuncture point following subcutaneous injection of Tc-99m pertechnetate.

A new method of radionuclide venography, namely SC-RNV, by subcutaneous injection of Tc-99m pertechnetate at acupuncture points was recently developed in our laboratory. The time-activity curve of SC-RNV can be divided into 3 phases as: the phase of diffusion of radioisotopes through the subcutaneous space, the phase of entrance of radioisotopes into intravascular space to reach a peak concentration and the phase of equilibrium state of radioisotopes in the intravascular space. In this study, we used the 3 phases of SC-RNV to evaluate the absorption of Tc-99m pertechnetate injected subcutaneously in the acupuncture point SP-10 (Xuehai) and in a non-acupuncture point near SP-10. The results revealed that the absorption of Tc-99m pertechnetate via SP-10 was significantly greater than that of non-acupuncture point, evidenced by shorter phase 1, higher peak activity and greater accelerating rate of phase 2. This suggests that the absorption of radioisotopes from acupuncture point is faster and greater than that of non-acupuncture point.

[Dipyridamole Tc-99m MIBI myocardial perfusion scintigraphy in patients with post-infarction chest pain symptom].

To evaluate the efficacy of stress Tc-99m MIBI myocardial perfusion imaging using intravenous dipyridamole in detecting coronary artery disease (CAD) and to determine if chest pain symptom is a proper index for detection of myocardial ischemia in post-infarction patients, we observed 73 cases (65 men, 8 women, 38-79 years old) between Sept. 1990 and May 1992. All patients were suffered from old myocardial infarction (MI) evidenced by history and ECG and were divided into two groups: group I involving 41 patients with post-infarction chest pain symptom and group II including 32 patients without post-infarction chest pain symptom. Among them, 19 (group IA) of group I and 11 (group IIA) of group II received coronary arteriography (CAG) for comparison. Of the 41 group I post-infarction chest pain patients, 17 suffered from old anterior or antero-septal wall (AW) MI, 21 from old inferior wall (IW) MI, 1 from old lateral wall (LW) MI and 2 from combined old AW and IW (AIW) MI by ECG. All 17 patients with AWMI suffered from AW perfusion defect (7 were MI, 10 were MI with ischemia) but 7 of them from multivessel disease (MVD) by Tc-99m MIBI. All 21 patients with IWMI suffered from IW perfusion defect (9 were MI, 12 were MI with ischemia) but 13 of them from MVD by Tc-99m MIBI. Of the patient with LWMI and 2 patients with AIWMI suffered from MVD by Tc-99m MIBI. Of the 32 group II post-infarction patients without chest pain symptom, 12 suffered from old AWMI, 14 from old IWMI, 2 from old LWMI, 3 from AIWMI and 1 from ALWMI by ECG. Of the 12 patients with AWMI, 11 suffered from AW perfusion defect (6 were MI, 5 were MI with ischemia) but 1 of them from MVD by TC-99m MIBI. All 14 patients with IWMI suffered from IW perfusion defect (12 were MI, 2 were MI with ischemia) but 4 of them from MVD by Tc-99m MIBI. Of the 2 patients with LWMI suffered from LW infarction by Tc-99m MIBI. Of the 3 patients with AIWMI and 1 with ALWMI suffered from MVD by Tc-99m MIBI. Of the 11 patients in group IA and 5 patients in group IIA with AWMI, CAG revealed the incidence of infarct-related recanalization of LAD was 9/11(82%) and 4/5(80%) respectively and the respective incidence of MVD was 6/11(55%) and 0/5(0%).(ABSTRACT TRUNCATED AT 400 WORDS)

Intravenous dipyridamole technetium-99m MMI myocardial perfusion scintigraphy for detection of coronary artery disease.

To evaluate the efficacy of stress technetium-99m MMI (N-2-methoxy-2-methyl propyl isonitrile) myocardial perfusion scintigraphy (Tc-99m MMI) using intravenous dipyridamole for detection of coronary artery disease (CAD), we collected 66 cases (53 men, 13 women, aged 40-79 years old) between Sept. 1990 and Oct. 1991. The cases were divided into two groups: group I involving 44 patients received coronary arteriography (CAG) examination without previous percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG); group II embracing 22 patients received no CAG examination but all were suffering from old myocardial infarction (MI) evidenced by history and electrocardiography (ECG). All cases underwent Tc-99m MMI planar and single photon emission computed tomography (SPECT) both on intravenous dipyridamole stress and separate day rest tests. Of the 44 group I patients receiving both Tc-99m MMI and CAG, 35 (79.5%) were positive and 7 (16%) were negative by both tests and another 2 (4.5%) were positive by CAG only. Of those positive by both tests, 21 (60%) suffered from identical coronary arterial involvement, including 13 one-vessel disease, 5 double-vessel disease and 3 triple-vessel disease. Of group II patients, 14 suffered from old inferior wall (IW) MI, 6 from old anterior or anteroseptal wall (AW) MI, 1 from old lateral wall (LW) MI and another 1 from combined old anterior and lateral wall (ALW) MI by ECG. Of the 14 patients with IWMI by ECG, all suffered from right coronary artery (RCA) disease but 7 (50%) of them from multivessel disease (MVD) by Tc-99m MMI. 5 of the 6 patients with AWMI by ECG suffered from left anterior descending coronary artery (LAD) disease, but 3 of them from MVD by Tc-99m MMI. Both patients with LWMI and ALWMI by ECG suffered from triple-vessel disease by Tc-99m MMI. The sensitivity of Tc-99m MMI in detecting CAD in group I was 95%, the specificity was 100%. The sensitivity for detection of individual coronary artery disease in LAD, left circumflex coronary artery (LCX) and RCA was 96%, 45% and 89% in this order and the respective specificity was 94%, 100% and 88%. In group II the sensitivity was 95%. The overall sensitivity of intravenous dipyridamole Tc-99m MMI for detection of CAD in groups I and II was 95%; specificity was 100% and accuracy was 95%. In conclusion, stress Tc-99m MMI using intravenous dipyridamole is a valuable method for evaluation and detection of CAD.

[Radionuclide study of acupuncture points].

During recent years, upon investigation of the meridian which is an important part of the traditional concept in Chinese medicine, we have obtained several significant findings using radionuclide: 1. By subcutaneous injection (SC) of Tc-99m pertechnetate at acupuncture points K-3 and B-60, it was found that certain acupuncture points may be closely related to the venous drainage. 2. A new technique of radionuclide venography, namely SC-RNV of the lower limbs, was established through the above study. The SC-RNV subsequently proved to be clinically available in diagnosis of DVT and calf varicose veins. By SC injection of Tc-99m pertechnetate at various acupuncture points (APP) and nonacupuncture points (non-APP) it seemed that not every APP is closely related to venous drainage, and so is not the non-APP. As for the mechanism of SC-RNV, through SC injection of T1-201 chloride and Ga-67 citrate at K-3 respectively, it was found that the Na-K pumping system may play a major role in the drainage of soft tissue fluid from the APP into th venous flow. We now continue to investigate the meridian with radionuclide and hope to understand more clearly the physiological function of the APP, especially its relationship with the veins.

Subcutaneous injection of 99mTc pertechnetate at acupuncture points K-3 and B-60.

The acupuncture points are known to be morphologically related to the nerves and vessels. Yet the physiological role of blood vessels in the formation of acupuncture points remains unknown. With subcutaneous injection of 99mTc pertechnetate at the acupuncture points K-3 and B-60 and with intra-acupuncture point injection of 99mTc pertechnetate at K-3 and B-60, a lower-limb venography like what was obtained by intravenous injection of 99mTc macroaggregated albumin was demonstrated in the present study. It seems that some acupuncture points do play a role in drainage of tissue fluid from soft tissue into the veins.