Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs.

This case-control study is based on an investigation of 27 nonsmoking patients with radiologically verified spontaneous pneumothorax (SP) and ten healthy never-smoker control subjects. The posteroanterior and lateral radiographs of patients and control subjects were normal. They were all submitted to the same clinical, laboratory, and radiologic examinations, including computed tomography (CT) of the lungs, with the aim of detecting any parenchymatous lung changes. Emphysema-like changes (ELCs) were detected on CT in 22 (81 percent) of the 27 patients, and if the ELC cases detected during interventional surgery are added, the frequency increases to 24/27 (89 percent). In 20 patients with unilateral SP, at least one ELC was found in 13 of the 20 SP-affected lungs, but only in five of the 20 lungs that were not diagnosed as having SP (p < 0.05). ELCs were found more frequently in the upper than in the lower lung regions (p < 0.05) and more frequently in the radiologically peripheral than in central regions (p < 0.001). No ELC was detected in the control group on CT. No alpha 1-antitrypsin deficiency was found in the 27 nonsmoking patients with radiologically verified SP who had ELCs despite the absence of these known promoters of emphysema.

Provocation of chest pain in patients with coronary insufficiency using the vasodilator adenosine.

Chest pain provoked by intravenous injection of adenosine was compared with natural angina pectoris in five patients with ischaemic heart disease. In seven healthy subjects a possible myocardial site for provocation of the chest pain was evaluated by analysis of time delays from injection to symptoms. The healthy volunteers were given the maximum tolerable dose of adenosine intravenously, together with 99Technetium-diethylentriaminpentaacetate (99Tcm-DTPA). Chest pain started after 4.1 +/- 2.4 s and reached its maximum 8.4 +/- 4.1 s after maximum left ventricular radioactivity. The patients with a history of typical angina pectoris were given similar doses of intravenous adenosine and the provoked chest pain did not differ in quality from the patients' habitual angina pectoris. The patients did not develop electrocardiographic signs suggesting myocardial ischaemia. Heart rate and blood pressure did not indicate increased myocardial work. In conclusion, the results concur with the hypothesis that adenosine elicits angina pectoris by stimulation of intracardiac adenosine receptors.

Regional lung function of non-smokers with healed spontaneous pneumothorax. A physiologic and emission radiologic study.

This study is based on investigations of 11 nonsmokers with healed spontaneous pneumothorax. Physiologic, scintigraphic and radiologic examinations were performed to determine whether they had any impairment of overall or regional lung function. Posteroanterior and lateral chest radiographic examinations revealed no abnormality. Forced expirographic study was normal, but the residual volume was increased. Ventilation was impaired and perfusion decreased in the apical region of the lungs, also the most common location of spontaneous pneumothorax. Findings are consistent with the presence of regional airway obstruction, which may cause, or at least contribute to, development of this condition.

Isotope scanning with Tc99m-MDP of the spine and the costosternal junctions of patients with idiopathic scoliosis.

Bone scanning of the thoracolumbar spine and the anterior thorax was performed in 7 girls with recently diagnosed progressive thoracic idiopathic scoliosis. A reference group consisted of a group of 8 patients submitted to bone scanning for other reasons. In all 7 girls composing the scoliosis group the isotope uptake by the vertex vertebra, the 2 vertebrae above and the 2 below was homogeneous, with no areas of abnormally increased uptake. In 5 of these patients where quantitative studies were performed there was no significant difference in uptake between the vertex and the other 4 vertebrae. Nor did the 2 groups differ significantly as regards the left-right difference in uptake by the costosternal junctions. The results of this investigation confirm the observation in a preliminary study that there was no disturbance of spinal growth during the early stage of development of idiopathic thoracic scoliosis. However, the results do not support a tentative conclusion drawn on the basis of the preliminary study--namely, that the development of spinal deformity in idiopathic scoliosis might be ascribed to asymmetric longitudinal rib growth, reflected in asymmetric isotope uptake by the paired costosternal junctions. It is questionable however, whether scintigraphic scanning can provide an accurate procedure for quantitative measurement of skeletal growth of the ribs, especially in scoliotic patients.

Uteroplacental blood flow in pregnancy hypertension after the administration of a beta-adrenoceptor blocker, pindolol.

The effect of a beta-adrenoceptor blocker, pindolol, on uteroplacental blood flow was determined in 10 women with pregnancy hypertension using an isotope technique giving a very low radiation dose. 0.5 mCi 113mIn was injected intravenously before and 30 min after 10 mg pindolol was given orally. After the administrations of 113mIn serial scintigrams were recorded for 240 s by a gamma camera on line with a computer, and the placenta was outlined for time-activity analysis of the isotope accumulation curves. From these curves a relative measure of the uteroplacental blood flow could be determined. Pindolol induced a significant fall in mean arterial pressure but there was no reduction of uteroplacental blood flow index.

Labetalol for the treatment of hypertension in pregnancy. Pharmacokinetics and effects on the uteroplacental blood flow.

Plasma levels of labetalol were measured in 7 hypertensive pregnant women who were given 200 mg three times daily orally. The plasma concentrations were usually lower than those reported in the non-pregnant state at a comparative dose. In 5 women the ratio between fetal and maternal plasma labetalol concentrations could be calculated at parturition. The median value of this quotient was about 50%. The effect of labetalol 1 mg/kg body weight intravenously was registered with functional placental scintigraphy. Fifteen women participated. A computer-linked gamma camera above the uterus registered the radioactivity in the placental region after two intravenous bolus injections of 18.5 MBq indium-113m chloride. From the radioactivity uptake curves, uteroplacental blood flow indices could be calculated before and 30 minutes after the labetalol injection. Despite a significant reduction in maternal blood pressure, no change in uteroplacental blood flow index was found. This could indicate that the vascular resistance in the maternal placental circulation was reduced by labetalol.

Quantitative measurements of radioactive isotopes in human nasal secretion.

Four patients receiving an intravenous injection of 99mTc-pertechnetate were investigated concerning transfer of the radioisotope to the nasal secretion. The concentration of isotope in nasal secretion was in all patients found to be approximately 10 times higher than in blood. The results suggest an active transport mechanism in the glandular elements of the nasal mucosa and that they are important as source of nasal secretion during normal conditions.

Functional placental scintigraphy. A methodologic and clinical investigation.

A method to determine the uteroplacental blood flow in the last trimester of pregnancy is presented. After intravenous injection of 37 MBq 113Inm the radiation above the placenta was recorded in 10 s intervals for 240 s by a scintillation camera. The data are presented in a time-activity curve, in which the maximum activity is proportional to the placenta volume, rise time can be defined and the quotient maximum activity/rise time is calculated. This quotient is an index of the uteroplacental blood flow which can be used for comparison of a series of patients.

Uteroplacental blood flow index in intrauterine growth retardation of fetal or maternal origin.

Uteroplacental blood flow index was determined in 30 women with intrauterine growth retardation (IUGR group) and in 26 women without fetal growth retardation (control group) during the last trimester of pregnancy. After 1 mCi (37 MBq) of indium-113m chloride had been injected intravenously the radiation was registered by a computer-linked scintillation camera positioned above the placenta during 10 s-intervals for 240 s. From the isotope accumulation curve a uteroplacental blood flow index could be calculated for each patient. The median blood flow index in the IUGR group was less than half of that in the control group. In the IUGR group the index was as low in the six women who gave birth to infants with congenital malformations as in the other 24 women in whom fetal growth retardation was due to maternal factors.

Acute effect of dihydralazine on uteroplacental blood flow in hypertension during pregnancy.

The uteroplacental blood flow was measured in 12 women with hypertension during pregnancy before and after intravenous injection of dihydralazine. After intravenous administration of 18.5 MBq (0.5 mCi) 113mIn, the gamma radiation emanating from the placenta was recorded with a computer-linked gamma camera during 10-second intervals for 240 s. From time-activity analysis of the isotope curve a uteroplacental blood flow index could be calculated. 30 min after the intravenous injection of dihydralazine, 18.5 MBq 113mIn were again administered, and a second uteroplacental blood flow index was calculated. After dihydralazine administration there was a significant reduction of mean blood pressure (p less than 0.01) and an increase of mean maternal heart rate (p less than 0.01). There was no significant change in uteroplacental blood flow or in uteroplacental vascular resistance.

Uteroplacental blood flow in diabetic pregnancy: measurements with indium 113m and a computer-linked gamma camera.

The uteroplacental blood flow index in the last trimester of pregnancy in 26 women with diabetes mellitus was compared to that in 41 healthy control subjects. After an intravenous injection of 1 mCi of indium 113m, the radiation over the placenta was recorded with a computer-linked gamma camera. From time-activity analysis of the isotope accumulation curve, a uteroplacental blood flow index could be calculated. In the diabetic pregnant women, the maternal-placental blood flow index was reduced 35% to 45% compared to that in healthy women. The blood flow index tended to be further impaired in those diabetic women who had higher blood glucose values.

Acute effect of an antihypertensive drug, labetalol, on uteroplacental blood flow.

The effect of a new antihypertensive drug, labetalol, on uteroplacental blood flow was determined in eight pre-eclamptic women. After injection of 0.5 mCi of 113mIn the radioactivity in the placenta was recorded by a gamma camera linked to a computer and the placental blood-flow index was calculated from the ratio between the maximum radioactivity of the isotope-accumulation curve and the rise time of the curve. Labetalol, a combined alpha- and beta-adrenoceptor antagonist was given intravenously and after 30 min a second uteroplacental blood-flow index was calculated. There was a significant mean decrease of blood pressure from 147/98 to 128/83 mmHg, but no change in uteroplacental blood-flow index, so that uteroplacental vascular resistance tended to decrease.

Uteroplacental blood flow in pre-eclampsia measurements with indium-113m and a computer-linked gamma camera.

Uteroplacental blood flow was measured with a computer-linked gamma camera after intravenous injection of 1 mCi indium-113m. Results of the measurements from 32 pre-eclamptic pregnancies and 37 normal controls are compared. The uteroplacental blood flow was measured as an index calculated from the rise time and maximum activity of the isotope accumulation curve. The uteroplacental blood flow was reduced with 50% in pre-eclampsia. In severe pre-eclampsia it was more compromised than in mild pre-eclampsia. A diminished uteroplacental blood flow was found in pre-eclampsia even in the absence of intrauterine growth retardation. The maternal placental circulation in the supine position was reduced with one third compared to that in the left lateral recumbent position.

Labetalol, a combined alpha- and beta-blocker, in hypertension of pregnancy.

Labetalol was given to women with hypertension of pregnancy in their last trimester to study its acute effect on circulation and metabolism. Seven women were given 50 mg labetalol i v. There was a significant decrease of blood pressure from a mean of 143/101 +/- 4/2 (SEM) to 127/88 +/- 5/2 mm Hg. Maternal heart rate fell significantly from 77 +/- 5 to 68 +/- 3 beats per min. These changes persisted during a three-hour observation period. The hypotensive response was accompanied by a significant increase in plasma noradrenaline from 1.54 +/- 0.16 to 2.37 +/- 0.41 nmol/l, suggesting sympathetic activation. Plasma cyclic AMP, which is increased by beta 2-adrenoceptor stimulation, was significantly elevated after labetalol. This supports the hypothesis of partial beta-agonist activity of labetalol. Lipid metabolism, as judged from measurements of plasma FFA, glycerol and 3-hydroxybuturic acid, showed little change. The acute effect of labetalol on uteroplacental blood flow was determined in eight women with pregnancy hypertension using a gammacamera on line with a computer. 0.5 mCi indium-113m was given i v before and 30 min after labetalol was administered i v in a dose of 1 mg per kg body weight. After the injections of indium-113m, serial scintigrams were recorded during 10 s periods for 240 s. By computerized summation of the scintigrams, an image was obtained in which the placenta could be outlined for time-activity analysis of the isotope accumulation curve. From this curve a uteroplacental blood flow index could be calculated. Labetalol induced a significant drop of mean arterial blood pressure from 114 +/- mm Hg to 100 +/- 3 mm Hg after 30 min in this group of women. However, the uteroplacental blood flow index did not change. As we have earlier shown with this technique that uteroplacental blood flow can be severely impaired in hypertension of pregnancy, the finding of substained uteroplacental blood flow simultaneously with a decrease in blood pressure should be of clinical importance. Taken together with other studies of clinical effects, these results indicate that labetalol is useful in the treatment of hypertension of pregnancy.

Utero-placental blood flow and the effect of beta 2-adrenoceptor stimulating drugs.

The immediate effect of a beta 2-adrenoceptor stimulating drug, salbutamol, on utero-placental blood flow in the last trimester of pregnancy was evaluated in 16 women without uterine contractions, using a method applying 113-m Indium and a computer-linked gamma camera. Serial scintigrams over the placental site showed a 15 per cent increase in activity during a short salbutamol infusion, denoting an augmented blood pool in the intervillous space. At the end of a 25--30 min salbutamol infusion, a mean prolongation of the rise time of the isotope accumulation curve by 100 per cent could be calculated. A utero-placental blood flow index derived from the ratio of the maximum activity and the rise time of the accumulation curve above the placenta showed a decrease ranging from 18 to 50 per cent. It is conceivable that this initial decrease would disappear during continued infusion, as has been shown to occur in the pregnant sheep model.