Regional V/Q changes in asthmatics after histamine inhalation.

The immediate changes in regional ventilation and pulmonary blood flow were studied in seventeen adults with perennial asthma and in two control persons, who were challenged by histamine inhalation (histamine induced asthma (HIA)). The studies were based on gammacamera images of 81mKr and of 99mTc labelled particles in the lungs and the results were compared with simultaneous changes in peak expiratory flow (PEF). No changes were observed in normal persons. After histamine inhalation the ventilation pattern became patchy, but no changes were seen in the blood flow distribution. PEF was markedly reduced. On repeated challenges ventilatory changes after HIA did not result in stereotypic images. HIA-defects were dissimilar to exercise- and antigen-induced defects when studied in the same patient(s) and were different, too, from the result in the same patients during a spontaneous asthmatic attack. The therapeutic and prophylactic effects of terbutaline were demonstrated in patients exposed to a histamine challenge.

Regional V/Q changes in asthmatics after antigen inhalation.

The immediate changes in regional ventilation and pulmonary blood flow were studied in five adults with perennial asthma, who were challenged with an allergen inhalation (pollen or moulds). The studies were based on gammacamera images of 81 mKr and of 99mTC labelled particles in the lungs and the results were compared with simultaneous changes in peak expiratory flow. Moderate to profound changes were observed after antigen-induced asthma (AIA), and ventilation and perfusion defects were matched in most regions. Peak expiratory flow was reduced in most of the cases after AIA.

Regional V/Q changes in asthmatics after exercise.

The immediate changes in regional ventilation and pulmonary blood flow were studied in fifteen adults with perennial asthma and in two control persons, who were challenged by moderate exercise on a treadmill or bicycle ergometer. Ventilation was studied before and immediately after the exercise, and again about five min after stopping the provocation. Peak expiratory flow was checked at regular intervals. Five min after cessation of the exercise ventilation had become patchy and irregular, but the pulmonary blood flow distribution remained "normal", i.e. as seen in the resting state. The ventilatory defects could be prevented by pretreatment with terbutaline or eliminated by terbutaline treatment after development of signs and symptoms. From repeat studies it can be concluded that the development of regional ventilatory defects after EIA do not follow a stereotypic course nor are defects similar to those provoked by histamine or allergens.

131I-meta-iodobenzylguanidine scintigraphy of neuroblastomas.

Sixteen neuroblastoma patients have been studied by 131I-meta-iodobenzylguanidine (MIBG) scintigraphy. Three patients were possibly cured, and their scintigraphy results were normal. Thirteen patients had tumors and metastases demonstrated by 131I-MIBG, two of these patients had a normal vanillylmandelic acid (VMA) excretion level. One patient has been treated by 131I-MIBG, but died. 131I-MIBG was concentrated in other cells too, eg, in erythrocytes and platelets.

Nation-wide TSH-screening with low recall rate. Laboratory results of a two-year study.

The laboratory results from the Danish neonatal TSH screening programme for congenital hypothyroidism are reported for a period of 2 years. The screening was based on a single determination of TSH in blood samples taken on the fifth day of life (PKU-filterpaper). The TSH assay (double antibody radioimmunoassay) has a sensitivity of 10 mU TSH/1 blood and a precision of 20-30%. 127,111 samples have been tested. In 3% TSH was greater than 10mU/1 and in 0.64% greater than 25 mU/1. The cut-off point was fixed at 25 mU TSH/1. Values above this level were corroborated by a T-4 radioimmunoassay on the original blood specimen. TSH greater than 25 mU/1 together with T-4 less than 45 nmol/1 blood was found in 37 samples. In 18 samples with TSH greater than 25 mU/1 there was no material left for the T-4 determination. These 55 samples (37 + 18) resulted in a request for a venous sample (recall rate 0.043%). An elevated TSH was verified in 32 of the 55 samples. The repeat samples were collected on average on the 25th day after birth. Three of the 32 babies were clinically diagnosed before the screening result was available.

Thyroxine-binding globulin deficiency in early childhood. Postnatal changes in serum concentrations of thyroid hormones and thyroid hormone-binding proteins.

Serial determinations of serum thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), thyroid hormone-binding globulin (TBG), prealbumin (TBPA) and albumin were performed in a euthyroid girl with TBG deficiency and in her mother for a period of 22 months after delivery. At 8 days old the child had a serum TBG concentration around 50% of normal level which remained essentially unchanged during infancy. Total serum T4 and T3 concentrations were low, the free serum T4, free serum T3 and serum TSH concentrations were normal. The mother had received thyroid hormone from the age of 15 years. Her serum TBG level at 6 weeks post partum was similar to that of non-pregnant adults but decreased to about 50% of normal level, indicating a TBG deficiency. She remained euthyroid after withdrawal of T4 therapy. Serum TBPA and albumin concentration were normal in mother and child. An X-linked inheritance of the TBG deficiency was suggested from a study of the family.

131I-19-iodocholesterol scintigraphy of the adrenal cortex.

131-I-19-iodocholesterol scintigraphy of the adrenal cortex has been carried out in 26 patients. In 4 patients with normal adrenocortical function the tracer was equally accumulated on the two sides. In 7 patients with untreated Cushing's syndrome, bilateral uptake was found in 4 patients with bilateral hyperplasia whereas unilateral visualization was obtained in three cases of cortisol producing adenomas. The side localization was confirmed at operation. Eight patients had been operated for Cushings syndrome prior to the scintigraphy. Remnant adrenocortical tissue with negligible or subnormal function (4 patients) could not be visualized. Normo- or hyperfunctioning remnant tissue was visualized in 3 patients. One patient had recurrent hypercorticism due to metastases from a previously removed adrenocortical carcinoma; a single pelvic accumulation was seen, whereas several metastases in the abdomen and thorax were not visualized. Four patients with aldosteronism were investigated. Three had primary aldosteronism due to an adrenocortical adenoma. In two of these, the site of the adrenal lesion was localized pre-operatively. In the third patient, equal bilateral accumulation of iodocholesterol was seen even after suppression with dexamethasone. At operation a small tumour was found. In 1 patient with indeterminate aldosteronism both glands were visualized and at a second examination the uptake was equally suppressed by dexamethasone.