Ultrasound-guided percutaneous ethanol ablation of parathyroid hyperplasia: preliminary experience in patients on chronic dialysis.

OBJECTIVE: We report on a 3-year experience using single-shot, ultrasonography-guided, percutaneous ethanol ablation (PEA) of hyperplastic parathyroid glands in chronic dialysis patients suffering from secondary or tertiary hyperparathyroidism. MATERIALS AND METHODS: Seventeen uraemic patients (mean age 52 +/- 14 years) with hypercalcaemia and elevated serum levels of parathyroid hormone were assessed for ethanol ablation. Ten patients did not fulfil the inclusion criteria and underwent surgical parathyroidectomy. Seven patients were treated using PEA. RESULTS: All patients treated with PEA tolerated the procedure well, and no major complications were observed. Three out of seven patients underwent further ethanol ablation due to recurrent symptomatic hyperparathyroidism. Following the procedures, serum values of total calcium and parathyroid hormone remained within target range with concomitant medical therapy in all patients. CONCLUSION: PEA performed as a single-shot therapy can be used as a minimally invasive and safe supplement to medical therapy in the treatment of secondary or tertiary hyperparathyroidism in selected patients. In case of recurrence, treatment can be repeated without any problems.

Expression of somatostatin receptors in inflammatory lesions and diagnostic value of somatostatin receptor scintigraphy in patients with ANCA-associated small vessel vasculitis.

OBJECTIVE: To assess the usefulness of somatostatin receptor (SSTR) scintigraphy for the evaluation of disease activity in the upper and lower respiratory tract in ANCA-associated vasculitis (AASV). METHODS: Thirty-two consecutive patients with AASV were subjected to SSTR scintigraphy as part of their initial diagnostic evaluation and follow-up. The presence of SSTRs in inflammatory lesions was evaluated with immunohistochemistry in selected cases. RESULTS: In AASV, specificity of SSTR scintigraphy for active vs non-active disease was 96% for pulmonary disease and 100% for ear, nose and throat (ENT) involvement, while sensitivity was 86% and 68%, respectively. Absence of previously present tracer accumulation characterized treatment responders, and treatment resistance was reflected by repeated positive scintigraphy. We could demonstrate the expression of SSTRs in lung and mucosal biopsies obtained from patients with active Wegener's granulomatosis and with microscopic polyangiitis. CONCLUSION: SSTR scintigraphy is useful for the assessment of AASV, indicating disease activity, disease extent and treatment efficacy. SSTRs are expressed in both granulomatous as well as non-granulomatous AASV.

Positive imaging of an inflammatory process at an arteriovenous access site with 111 Indium-labeled platelets.

Complications associated with the vascular access for hemodialysis represent one of the most important causes of morbidity among patients with renal replacement therapy. Early detection of arteriovenous fistula (AVF) dysfunction is of great interest. We present the case of a 70 year old woman who underwent 111In-oxine-labeled-platelet scintigraphy to evaluate thrombogenicity at 3 weeks and 3 months after surgery of a new AVF. In the first post-operative scintigraphy 4 hours after reinjection of autologous 111In-labeled platelets, enhanced focal activity was visible in the AVF projection which could not be detected after 24 hours. Since early platelet accumulation may reflect hyperemia in inflammation, this diagnosis was verified by anti-granulocyte antibody scintigraphy. The platelet scintigraphy performed 3 months later was negative, with persistence of sufficient AVF function. These data show an intense early accumulation of 111In-oxine-labeled-platelets in unspecific inflammation of an AVF.

Imágenes positivas de un proceso inflamatorio en una localización arteriovenosa con plaquetas marcadas con 111indio / Positive imaging of an inflammatory process at an arteriovenous access site with 111Indium-labeled platelets

Las complicaciones asociadas con el acceso vascular para hemodiálisis representan una de las más importantes causas de morbilidad entre los pacientes con terapia de substitución renal. La detección precoz de disfunción de fístulas arteriovenosas (FAV) es de gran interés. Presentamos el caso de una paciente de 70 años de edad que ha sido sometida a una cintigrafía con 111In-oxina-plaquetas para evaluación de trombogenicidad 3 semanas y 3 meses después de cirugía de una nueva FAV. En la primera cintigrafía post-operatoria se ha observado un aumento focal de 111In-plaquetas 4 horas después de la reinyección de plaquetas autólogas en proyección de la FAV, lo que no se observó después de 24 horas. La acumulación precoz de plaquetas puede reflejar hyperemia en inflamación. Este diagnóstico ha sido confirmado por cintigrafía con anticuerpos antigranulocitos. La cintigrafía con plaquetas realizada 3 meses más tarde ha sido negativa, con función FAV persistente suficiente. Estos datos demuestran una acumulación intensa precoz de 111-In-oxinaplaquetas en una inflamación inespecífica de una FAV (AU)

Continuous adaptation of the dialysis prescription maintains adequate Kprt/V in CAPD patients.

OBJECTIVE: To analyze the effect of individual adaptation of the dialysis prescription in continuous ambulatory peritoneal dialysis (CAPD), as compensation for the decline of residual renal function (RRF), on peritoneal (Kpt/V) and total (Kprt/V) urea clearance as well as on peritoneal (Kpcr) and total weekly creatinine clearances (CCr). DESIGN: Retrospective analysis of a 2-year period. PATIENTS: We analyzed 18 patients [15 male, 3 female; mean age 58.2 (24 - 80) years]. MAIN OUTCOME MEASURES: Correlations between increased dialysis prescription and Kpt/V, Kprt/V, and Kpcr. Kprt/V and CCr measurements were based on a 24-hour dialysate and urine collection. Measurements were performed over a time period of 3 to 6 months. RESULTS: The results show a linear correlation between Kpt/V and Kpcr and the prescribed volume by kilogram body weight. Kprt/V was increased slightly by increasing the dialysis prescription. Dialysate-to-plasma (D/P) ratios of urea and creatinine remained unchanged. The mean prescribed dialysate volume increased from 7.4+/-1.1 L to 10.6+/-2.5 L. Mean Kprt/V could be maintained on a stable level for a 36-month period. CONCLUSION: By adapting the dialysis prescription on an individual basis to the continuous decline of RRF, and taking the patient's body weight into account in the prescription decision, the increases in Kpt/V offset the decline in RRF. We recommend early individualization of prescription for patients on CAPD.

111In-labelled platelets for assessment of thrombogenicity of new haemodialysis vascular access.

Using platelet scintigraphy to evaluate early thrombogenicity, we examined 39 new vascular accesses 4 weeks and 3 months after surgery. We found a significant association between platelet deposition and Doppler flow (P < 0.01) and blood pressure (P < 0.01). Compared with arteriovenous fistulae, prosthetic grafts showed significantly higher platelet uptake (after 4 h: 2.4 +/- 1.1 vs 1.2 +/- 1.1 eU, P < 0.05; after 24 h: 2.1 +/- 1.0 vs 0.6 +/- 0.8 eU, P < 0.01) and a higher Doppler flow (1184 +/- 202 vs 609 +/- 342 ml.min-1, P < 0.001). In 8 of 39 accesses, a thrombosis occurred. Accumulation of activity was not related to shunt thrombosis (specificity 61%, sensitivity 71%). We conclude that 111In-platelet scintigraphy is not suitable for the early detection of shunt thrombosis or for identifying patients at risk.

[Plasma membrane separation. A therapeutic possibility in thyrotoxic crisis]. / Die Plasmamembranseparation. Eine Therapiemöglichkeit der thyreotoxischen Krise.

A case of thyroid storm is presented, successfully treated with a combination of antithyroidal drugs and plasma exchange. A 280% separation removed 447 micrograms T4 and 12 micrograms T3. During separation, the elevated T4 and T3 values returned to normal. Basic concepts of plasma membrane separation investigated by plasma and whole body counting after administration of 131I-T4, as well as radioimmunoassay measurement of thyroid hormones in plasma and separate are discussed.

[Angina pectoris anamnesis in patients with their first myocardial infarct]. / Angina-pectoris-Anamnese bei Patienten mit erstem Myokardinfarkt.

In 650 consecutive patients with first acute myocardial infarction the time interval between the first anginal attack and the acute infarction as well as the time interval between onset of symptoms suggestive for acute myocardial infarction and hospitalization were evaluated. Our results demonstrate that in 25% of patients the history of angina was less than 24 hours, in 50% of all patients less than three days; furthermore, the time interval from onset of symptoms of acute myocardial infarction to hospitalization correlated with the history of angina; the depression of left ventricular function after myocardial infarction was independent of a previous history of angina; in patients with a very short history of angina there was a significantly higher incidence of single vessel disease. Thus, prevention of acute myocardial infarction would have been possible only in about half of the patients with impending myocardial infarction due to the short duration of preceding angina.

[Early carcinoma of the stomach. Observations of the course over 23 months. A case report]. / Frühkarzinom des Magens. Verlaufsbeobachtungen über 23 Monate. Ein Fallbericht.

A case of an early cancer of the stomach is reported, in which the development of the lesion could be followed by repeated biopsies. Because of a high cardial risk of the patient, the tumor was resected as late as 23 months after the first diagnosis. During this time the lesion changed from a borderline lesion into an early cancer with penetration into the submucosa.