Lege Artis Medicinae

[Dipyridamole-thallium scintigraphy]

KÉKES Ede

MARCH 31, 1992

Lege Artis Medicinae - 1992;2(03)

[Thallium 201 myocardial scintigraphy; Dipyridamole-thallium scintigraphy; Test schedule; Expected results; Side effects; Advantages and disadvantages of D-TI201; Method modifications; Adenosine-thallium scintigraphy]

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Lege Artis Medicinae

[A newly discovered vasoconstrictor peptide: endothelin]

SÜTŐ Tamás, DEVECSERI Zsuzsanna, ROSIVALL László

[The discovery of endothelium-derived relaxing (prostacyclin, EDRF) and contracting factors (EDCF) in the last decade opened up new vistas in investigating the regulation of the cardiovascular system. In this review, recent results of the research of a 21 amino acid residue EDCF, called Endothelin, including its discovery, isolation, biosynthesis, tissue specific expression, receptors and the characteristics of the Endothelin converting enzyme are summarized. Based on present knowledge of the wide variety of biological actions of Endothelins, we present their possible autocrine, paracrine and humoral actions, and their significance in the physiological regulation of the cardiovascular system as well as in pathological conditions. Despite the abundance of information however, the actual role of Endothelins in the short- and long-term modulation of the tissue function still remains to be determined.]

Lege Artis Medicinae

[ATP-sensitive potassium channels, and their modulators]

FINTA P. Ervin, PETER Illes

[Recently great interest has been concentrated on potassium channels inhibited by intracellular adenosine triphosphate (ATP-sensitive potassium channels), which connect the metabolic state of cells with their electrical activity. Channel closure initiates the secretion of insulin from pancreatic ß-cells; a number of hormones altering the level of blood-sugar act via these channels. The channels are present in neurones; they regulate both in the cell bodies and the nerve terminals (e. g. peripheral nerves) the excitability. The reby, in the central nervous system, they influence the neuronal activity both in the satiety center and some catecholaminergic brain nuclei. These channels mediate the effects of endogenous vasodilators in vascular smooth muscle. They have a pathophysiological role in protecting neurones and muscle cells from hypoxic damage. The ATP-sensitive potassium channels are targets of the sulphonylurea antidiabetic agents and of a new class of drugs, the potassium channel agonists. The latter compounds are investigated or used for the treatment of hypertension, angina pectoris, cardiac insufficiency, bronchial asthma, irritable bladder syndrome, chronic occlusive arterial disease and even in impotence. They are relatively well-tolerated drugs. Their adverse effects are related to their basic vasodilator profile and most commonly include headache, dizziness, palpitation or oedema. ]

Lege Artis Medicinae

[Native CT examination of the intraarticular ligaments of the knee joint]

ESZTERGÁLYOS János

[The high incidence of intra-articular ligament injuries of the knee justifies a more frequent use of noninvasive diagnostic procedures such as the native CT scan. In positive cases, a correct preoperative diagnosis may be produced; a negative result is especially important, since diagnostic arthroscopy may be avoided. Due to the anatomic arrangement of the knee joint ligaments and theis density, which differentiates them from adjacent structures, an accurate, reliable, and reproducible image can be obtained with the native CT scan. With the high resolution charactaristic of the native CT scan, the ligaments of Humphry and Wrisberg can be visualized, and the two bundles of the anterior cruciate ligament can be distinguished from one another. Exact localization of intra-articular ligament rupture is essential in the planning of an optimal treatment schedule. According to the literature and the authors experience, the native CT scan is equivalent to the MRI as a diagnostic procedure in knee intra-articular ligament lesions. It has the advantage of being far less expensive and it is presently available in Hungary. ]

Lege Artis Medicinae

[Dipyridamole test: comparative evaluation of simultaneous 2D echocardiography and 201TL scintigraphy in ischaemic heart disease]

GRUBER Noémi, FORSTER Tamás, VARGA Albert, ÉDES István, CSANÁDY Miklós, MESTER János, CERNAY László

[Simultaneous 2D echocardiography and 2017 scintigraphy were performed during dipyridamole testing (DT) in 57 patients with suspected IHD. The dipyridamole dose was 0.56 mg/kg/bm in 4 minutes. If no effect was observed, the test was continued from the eighth minute with a dose of 0.28 mg/kg/bm in 2 minutes. 2D echomonitoring of the left ventricular motion using apical views was initiated at the beginning of DT and continued for 7 or 13 minutes in case of the longer test. After 6.5 or 12.5 minutes, 74 MBq 201TI was injected intravenously. Standard planar scintigraphy was performed in 3 views starting within 15 minutes. On the basis of the clinical results, 25 patients were subsequently referred for coronary angiography. The sensitivity, specificity and positive and negative predictive values of 2D echocardiography were 79%,55%,69% and 67%, respectively. The corresponding values for 201TIscintigraphy were 93%, 27%, 62%, and 75%. Where the results of both methods were positive, the combined sensitivity and specificity values were 71% and 73%. The results indicate the suitability of both methods for detecting IHD. Furthermore, they suggest a higher specificity, but lower sensitivity of 2D echocardiogaphy as compared to 201TI scintigraphy. Our observations demonstrate that the com binaton of these 2 techniques is very useful in clinical practice for the evaluation of IHD.]

Lege Artis Medicinae

[Multiple Risk Factor Intervention Trial]

[The aim of the study: to investigate whether a multi-risk factor programme can reduce coronary heart disease mortality.]

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[Comparison of the extended-release dipyridamole-ASA combination with clopidogrel in patients with strokes]

SZAPÁRY László

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[Treatment of ureter stenosis of the transplanted kidney using invasive radiological methods]

DOROS Attila, WESZELITS Viola, PUHL Mária, RUSZ András, JANSEN Judit

[INTRODUCTION - Stenosis, occlusion and necrosis of the ureter after kidney transplantation occur in 2-13%. The therapeutic choices are surgery or minimally invasive endourological and percutaneous procedures. We analysed our therapeutic plan and results using percutaneous dilatation and stenting. PATIENTS AND METHODS - The patients after kidney transplantation are regularly examined by ultrasound. In cases of suspected obstruction we perform scintigraphy and CT-urography, and if indicated, we place percutaneous nephrostomy. Between July of 2000 and September of 2002, 15 stenosis in 14 patients were dilated and stented percutaneously. RESULTS - We found one restenosis after 6 months due to compression. This patient underwent surgery, but after the operation another stenosis has developed. We treated it percutaneously. One nephrectomy had to be performed due to serious infection. In one patient stent migration occured and surgical intervention was performed. 12 patients have free urine passage and good kidney function as a result of percutaneous therapy. CONCLUSION - We have good results with percutaneous ureter dilatation and stenting, but our follow-up time (31 months) must be longer for the evaluation of long-term results. The percutaneous treatment can partly replace endourological and surgical methods or can be combined with each other.]

Hungarian Immunology

[Hand perfusion scintigraphy in primary and secondary Raynaud's syndrome]

GARAI Ildikó, GALUSKA László, VARGA József, SZŰCS Gabriella, CSIKI Zoltán

[INTRODUCTION - The aim of the study was to investigate the circulatory characteristics of primary and secondary Raynaud’s syndrome patients using the hand perfusion scintigraphic method developed by the Nuclear Medicine Department of the DUMHC. PATIENTS AND METHODS - The authors examined 84 patients presenting classical symptoms of the disease: episodic ischemia with three-phase color change of the fingers. After visual evaluation theyanalyzed the obtained images quantitatively, using of the finger/palm ratio. Statistical analysis comparisons were made between the clinically separated primary and the secondary Raynaud's group. RESULTS - With the visual evaluation regional perfusion disturbances were frequently found in the secondary group - 37 from 51 patients - while only 2 from 33 patients in the primery group; the difference was statistically significant (p<0,001). The results of the quantitative analysis showed that the finger/palm ratio (FPR) values were significantly lower (p<0.05) in primary Raynaud’s group. In the FPR values there were not any differences between genders or the fingers of the right and left hands. CONCLUSIONS - The hand perfusion scintigraphy applying Tc-99m-DTPA is a noninvasive, cost effective diagnostic tool, which reflects objectively the global and regional microcirculatory abnormalities of the hands, and offers quantitative data for the follow-up.]

Hungarian Radiology

[Comparison of the results of lung helical CT and lung scintigraphy in pulmonary embolism]

WENINGER Csaba, BODROGI Gabriella, BOROS Szilvia, SCHMIDT Erzsébet, UDVAROS Eszter, ZÁMBÓ Katalin

[INTRODUCTION - The frequency of the pulmonary embolism is high and the underdiagnosis or delayed recognition of the disease occurs. Recently the helical CT is used to detect pulmonary embolism. The authors compare the results of single-slice spiral thoracic CT and lung scan. PATIENTS AND METHODS - During one year period chest CT examination was performed in 49 patients due to the suspicion of pulmonary embolism, in 30 of them lung scan was also performed. RESULTS - The results of the two diagnostic methods were the same in 21 cases out 30 (in 13/21 cases both methods demonstrated embolism and 8/21 cases the findings were normal). In the remaining nine cases the findings were different. CONCLUSIONS - The lung CT examination is a rapid, non-invasive method to depict the central pulmonary embolism and small infarcts in non fresh cases. The negative result of perfusion lung scan can exclude the pulmonary embolism. If the lung scan demonstrates perfusion defect(s), it is necessary to perform another diagnostic tests (e.g. chest X-ray, ventillation scan). While the lung scan is a cheap, simple method with low radiation dose, it can play important role in the screening.]

Lege Artis Medicinae

[Examination of the efficacy of clopidogrel-hydrogen-sulphate in patients with cerebrovascular disease]

SZAPÁRY László, FEHÉR Gergely

[INTRODUCTION - On the basis of current guidelines, acetylsalicylic acid plus dipyridamole or clopidogrel monotherapy should be used for the long-term treatment of patients with cerebrovascular disease, whereas acetylsalicylic acid monotherapy is not recommended. The efficiency of recently introduced generic clopidogrels has not been assessed in patients with a history of acute stroke. PATIENTS AND METHODS - 100 patients with a history of acute stroke or transient ischaemic attack were involved in our study. The patients received acetylsalicylic acid monotherapy in the first 48 hours, followed by clopidogrel-hydrogen sulphate (Egitromb®) monotherapy. The efficiency of the therapy was assessed on day 7 and 28 of medical therapy. RESULTS - At the first measurement (day 7) after clopidrogel-hydrogen sulphate treatment, the therapy seemed to be inefficient in 11 patients (11%). A strong, clinically significant correlation was found between blood pressure values, blood glucose and lipid parameters, hsCRP levels and platelet aggregation values. At the second measurement (day 28), an aggressive secondary preventive threapy resulted in the normalisation of the above mentioned parameters, and the efficiency of platelet aggregation inhibtion therapy was also improed, whereas no patients proved to be resistant. No unwanted events or haemorrhagic complications were registered. CONCLUSIONS - On the basis of the result of our study, treatment with clopidogrel- hydrogen sulphate is safe and efficient both clinically and on the basis of optical aggregometry. The significance of an aggressive secondary preventive therapy should be considered as a factor that might influence the efficiency of thrombocyte aggregation inhibitory therapy.]