ERPF in hyperthyroidism

Ispitan je efektivni bubrežni protok plazme (ERPF) u selekcioniranoj skupini od 35 bolesnica u dobi od 20. do 40 godine, koje su bolovale od Gravesove bolesti. Ispitivanje je vršeno u fazi floridne hipertireoze, te nakon uspostavljanja stabilne eutireoidne faze tijekom medikamentoznog tretmana s karbimazolom (Favistan). ERPF je određivan metodom pojedinačne injekcije 131 J OJH i pojednostavljenim uzimanjem krvnih uzoraka u 20. i 30. minuti od injiciranja za prvu i u 40. minuti za drugu klirens periodu (po Blaufoxu).4 Ispitivanje je vršeno u sjedećem (ortostaza) i ležećem položaju. Srednja vrijednost ERPF-a (x+l SD) u skupini floridnih hipertireoza iznosi 1018,83+223,14 ml u ortostazi, a u ležećem položaju 1059,3+217,5 ml/min\u271,73 m2 Nakon postizanja stabilne eutireoidne faze, ERPF u ortostazi iznosi 753,42 + 135,24 ml/min/l,73 m2 i 795,45 +162,20 mlminTJS m2 u ležećem položaju. Srednja vrijednost kontrolne skupine od 25 ispitanica iznosi 794,53+101,35 ml/min/l,73 m2 u ortostazi i 858,78+155,59 ml/min/l,73 m2 u stanju ležanja. Vrijednosti ERPF-a u floridnih hipertireoza zna­čajno su više u odnosu na stanje stabilne eutireoidne faze kao i na kontrolnu skupinu ispitanica, u ortostazi i pri ležanju. Frekvencija pulsa je značajno viša u floridnih hipertireoza u odnosu na iste bolesnice nakon uspostavljanja stabilne eutireoidne faze i u odnosu na kontrolnu skupinu. Utvrđena je značajna razlika u vrijednosti sistoličkog tlaka u oba položaja tijela, te u vrijednosti dijastoličkog tlaka u ortostazi između floridnih hipertireoza i istih ispitanica nakon postizanja stabilne eutireoidne faze. U promatranoj skupini hipertireoza nije zapažena značajna razlika u vrijednosti dijastoličkog tlaka pri ležanju. Tlak pulsa je osjetno veći u floridnih hipertireoza u usporedbi s istim ispitanicima kada postignu stabilnu eutireoidnu fazu i vrlo je osjetljiv parametar. Potrebno je nastaviti s daljnjim istraživanjima u hiperkinetskoj cirkulaciji hipertireoidizma radi njene osobitosti prema ostalim stanjima hiperkinetske cirkulacije.ERPF was examined in group of 35 selected patients aged 20—40 years with Grave’s disease. The examination was performed in the stage of florid hyperthyroidism, as well as after achieving stable euthyroid phase during the drug treatment with carbimazole (Favistan). ERPF was determined using the single 131 J injection and simplified blood sampling 20 and 30 minutes post injection for the first, and 40 minutes post injection for the second clearance period (according to Blaufox). The mean value of ERPF in the group of patients with florid hyperthyroidism was 1018.35+ 223.14 ml/min/1.73 m2 in orthostasis, and 1059.3+217.5 ml/min/1.73 m2 in the supine position. After achieving stable euthyroid phase the mean value was 753.42+135.24 ml/min/1.73 m2 in orthostasis, and 795.45+162.20 ml/min/1.73 m2 in the supine position. After achieving stable euthyroid phase the mean value was 753.20+135.24 ml/min/1.73 m2 in orthostasis, and 795.45+162.20 ml/min/1.73 m2 in the supine position. The mean value for the control group of 25 female examinees was 794.53 + 101.35 ml/min/1.73 m2 in orthostasis and 858.78+155.59 ml/min/1.73 m2 in the supine position. ERPF values are significantly higher in patients with florid hyperthyroidism in comparison to the stable euthyroid phase, as well as to the control group, in orthostasis and in the supine position. Pulse frequency was significantly higher in the florid hyperthyroidism group in comparison to the same patient after achieving stable euthyroid phase and to the control group. We found a significant difference of the systolic blood pressure in orthostasis between the florid hyperthyroidism group and the same patients after achieving stable euthyroid phase. No significant difference was recorded for the diastolic blood pressure values in the supine position in the examined group of patients with hyperthyroidism. Pulse pressure was significantly higher in the florid hyperthyreoidism group in comparison to the same patients after achieving stable euthyroid phase. We estimate it to be a very sensible parameter. It would be necessary to continue the investigation of hyperkinetic circulation in hyperthyroidism because it has some special features, distinct from other hyperkinetic circulation conditions

Comparative analysis of radionuclide and radiographic dacryocystography in the study of obrstructions in lacrimal apparatus drainage

U ovoj studiji analizirana je i vrednovana radionuklidna dakrioscintigraflja (RNDC) u bolesnika s glavnim simptomom pojačanog suzenja, te komparirana s radiološkom dakriocistografijom. Kod 31 ispitanika od 5 - 80 godina (23 muška i 7 ženskih) sa smetnjama u lakrimalnom sustavu učinjena je RNDC i uspoređena s radiografskom dakriocistografijom (XDCG). RNDC je učinjena u sjedećoj poziciji s Tc-99m ukapanim u vidu kapi u oba oka. Snimanje je rađeno svakih 5 minuta do ukupno 25 minuta na gama-kameri širokog vidnog polja s povećanjem 3 puta. XRDC je učinjena pomoću kontrasta nakon sondiranja suznih kanalića. U našoj seriji od 60 RNDC u 30 je nađen normalan nalaz s pojavom aktivnosti u nosu kroz 20 minuta. Opstrukcija kanala je pokazana u 30 suznih uređaja, u 21 bolesnika utvrđena je potpuna blokada drenaže suza, a kod 9 je postojao funkcionalni zastoj drenaže. RNDC i XDCG slagali su se kod 23 (76%) normalna suzna uređaja, a samo u 13 (43%) kod potpune opstrukcije. XDCG ne prepoznaje funkcionalni zastoj drenaže suza, a 4 normalna suzna uređaja proglašena su patološkim. Nasuprot tome, RNDC je prepoznavala opstrukciju bez lažnopozitivnih nalaza. RNDC brzo i sigurno, pod fiziološkim uvjetima, dokazuje suspektnu opstrukciju lakrimalnog drenažnog sustava i upućuje na njegovu lokalizaciju. Također, u stanju je uputiti na postojanje funkcionalne blokade lakrimalnog sustava.Aim: The aim of this study was to evaluate the role of radionuclide dacryocystography (RNDC) in patients with an obstruction in the lacrimal apparatus and to compare it to radiographic dacryocystography. Material and methods: 30 patients (23 women, 7 men, age range 5-80 years) were examined by RNDC and contrast x-ray dacryocystography (XDCG). RNDC was performed with Tc- 99m instilled into each eye in form of drops. Sequential images were obtained every 5 minutes for 25 minutes, using Siemens ZLC large field of view gamma camera, zoom 3, with patients in the sitting position. Results: In the series of 60 dacryoscintigrams, 30 findings were considered normal, with the drainage of the activity medium through the nasolacrimal duct into the nasal cavity occurring within 20 minutes. Lacrimal apparatus obstruction was observed in 30 cases, in 21 of whom a complete block of drainage was established, whereas in 9 cases there was a physiological delay in the drainage. The agreement between RNDC and XDCG findings was found in 23 cases (76%) of normal lacrimal systems, but only in 13 cases (43%) of the total block in drainage. XDCG could not distinguish the physiological delay in drainage so that for 4 lacrimal apparatus without pathological substrate the findings were false positive. On the contrary, RNDC was able to recognize obstruction without false positive findings. Conclusion: RNDC is a fast and safe method, simple to perform, highly physiological, reliable in depicting the site of block in the lacrimal drainage apparatus

Beta-2 microglobulinemia - glomerular filtration rate

U skupini od 94 ispitanika Ispitali smo korelaciju serumskog beta-2 mikroglobulina i serumskog kreatinina sa glomerularnom filtracijom (GF) procijenjenom klirensom 51Cr-EDTA. Odnos nivoa beta-2 mikroglobulina, a i kreatinina, u serumu s klirensom 51Cr-EDTA najbolje je opisan inverznom potencijalnom funkcijom. Koeficijent korelacije za beta-2-mikroglobulin iznosi —0,9427, a za kreatinin 0,9114. Razlika između dobivenih koeficijenata korelacije je statistički značajna na razini značajnosti od 1 % (t=2,68). Od veće praktične važnosti je značajna razlika utvrđenih koeficijenata regresije. U logaritamskoj skali koeficijent regresije za pravac koji opisuje odnos nivoa serumskog beta-2-mikroglobulina i GF iznosi —0,95122, a za odnos kreatinina i GF iznosi —0,79796. To potvrđuje da je beta-2 mikroglobulin po svojim karakteristikama bli­ži idealnoj endogenoj supstanci za procjenu GF i pokazuje bolju osjetljivost za detekciju umjereno reducirane GF.The correlation of serum beta-2-microglobulin was examined and serum creatinine with glomerular filtration rate (GF). GF was evaluated by clearence Cr5, -EDTA. The best description of correlation between serum beta-2-microglobulin (also and serum creatinin) and GF was by inversely potential function. The coefficient of correlation for the beta-2-microglobulin was —0.9427 and for the creatinin test —0.9114. The difference between obtained coefficients of correlations was statistically significant (p = 0.001 t = 2.68). More important is the significant difference between the obtained coefficients of regression. In the logaritmic scale the coefficient of regression of the straight line which described the relation of serum level of beta-2-microglobulin and GF was —0.9512 and —0.7979 for the relation of the serum level of creatinine and GF. It indicates that beta-2-microglobulin is more similar to the ideal endogenic substance for evaluation of GF and shows better sensitivity for the detection of moderately reduced GF

Evaluation of the diagnostic value of static brain scintigraphy in the detection of brain tumors

U radu se daje usporedna nuklearno-neurološka, neuroradiološka i oftalmološka studija 55 bolesnika s tumorima mozga, čija je dijagnoza patohistološki potvrđena. Procijenjena je dijagnostička vrijednost statičke scintigrafije mozga i njezina podudarnost s nalazima fundusa, elektroencefalografije, cerebralne angiografije i kompjutorizirane tomografije u otkrivanju moždanih tumora i njihovih recidiva. Preoperativna dijagnostička senzitivnost statičke scintigrafije mozga iznosi 92%, a nešto je niža za otkrivanje recidiva nakon učinjene kirurške ekstirpacije tumora (85%). Postoperativna je specifičnost pretrage za recidiv manja od njezine osjetljivosti (66%). Međutim, zahvaljujući različitom vezivanju radiofarmaka u moždanim lezijama, istaknuto je da statička scintigrafija mozga, osim natomskopatoloških, može dati i patofiziološke diferencijalnodijagnostičke podatke o svojstvima tumorskog tkiva, značajne za planiranje kirurškog zahvata. Ova metoda, zbog svoje neinvazivnosti, mogućnosti ambulantnog izvođenja i malog radijacijskog opterećenja bolesnika, ostaje vrlo dobra screening metoda u otkrivanju moždanih tumora.In this study, nucleo-neurologic, neuro-radiologic and opthalmologic findings of 55 patients with pathohistologically verified diagnosis were analyzed. The diagnostic value of brain scinthigraphy and its complementarity with the findings of fundus examination, electroencephalography, cerebral angiography and computerized tomography in the detection of brain tumors and their postoperative recurrence were estimated. Preoperative diagnostic sensitivity of static brain scintigraphy was 92%, but it was somewhat lower in the detection of recurrence after surgical tumor removal (85%). The postoperative specificity of this procedure was lower than its sensitivity (66%). Yet, due to different binding of radiopharmacenticals within brain lesions, static brain scintigraphy could apart from anatomicopathologic data, provide important pathophysiologic differential diagnostic data on the tumor tissue, essential for determination of the surgical procedure. This method remains a very good brain screening technique, due to its non-invasiveness, possibility of ambulatory procedure and low patient iradiation

Our experience in the long-term follow-up and treatment of a family with MEN 2A (2) syndrome

U 15-godišnjoj studiji članova jedne porodice s MEN 2A (2) sindromom ispitivali smo učinke ranog liječenja bolesti. U tom razdoblju praćeno je 20 članova porodice, u 9 članova je učinjena totalna tireoidektomija, u jednog obostrana adrenalektomija zbog feokromocitoma. Prosječna dob operiranih je 25,1 god. (16 -41 god.) . U 6 bolesnika dokazan je medularni karcinom štitnjače, u 3 bolesnika C-stanična hiperplazija. Samo u jedne bolesnice perzistira viša razina kalcitonina bez dokaza metastaza. Kalcitonin je mjeren nakon stimulacije pentagastrinom i alkoholom (votka) . Smatramo da je stimulacija kalcitonina alkoholom još uvijek praktična i zadovoljavajuća metoda. Niti u jedno god 20 s rodnika nije dokazana paratireoidna bolest.The effects of early treatment of the disease were studied in a 15-year study of the members of a family with MEN 2A syndrome. Twenty members of the family were followed-up during that period. Total thyreidectomy was performed in nine members and bilateral adrenalectomy due to pheochromocytoma in one. The mean age of operated persons was 25.1 years (16-41 year). Medullary thyroid was established in six patients and C-cell hyperplasia in three patients. A higher calcitonine level, without any evidence of metastases, has persisted in one female patient only. Calcitonine levels were measured after stimulation with pentagastrine and alcohol (vodka). It is our opinion that calcitonine stimulation with alcohol is still an appropriate and satisfying method. Any parathyroid disease has been established in none of twenty relatives

Tc-99m-MDP scintimammography in the diagnostics of primary breast cancer

Cilj ove studije je istražiti međusobni odnos scintimamografije s Tc-99m-MDP prije kirurškog zahvata i histopatoloških nalaza nakon kirurškog zahvata u 32 žene sa suspektnim promjenama u dojkama. Rađena je anteriorna i dvije lateralne projekcije dojki 10 minuta nakon intravenozne aplikacije 740 MBq Tc-99m-MDP. Scintimamogrami su ocijenjeni kao patološki ukoliko je nađena povećana akumulacija aktivnosti. U 10 ispitanica nalaz scintimamografije je uredan, a patološki nalaz je nađen u 22 ispitanice. Histopatološki nalazi ukazuju na benignu leziju u 7 ispitanica, a u 25 je pronađen karcinom dojke. U 4 ispitanice povećana akumulacija Tc-99m-MDP je nađena u benignim lezijama. Jasno-pozitivan nalaz nađen je u 18, jasno-negativan u 4, lažno-pozitivan u 3, a lažno-negativan u 7 ispitanica. Ukupna senzitivnost iznosila je 85%, specifičnost 64%, pozitivna prediktivna vrijednsot 82%, a negativna prediktivna vrijednost 70%. Zaključno, na izvjestan način, naši rezultati su razočaravajući i smatramo da scintimamografija ne može sa sigurnošću razlikovati suspektne promjene u dojkama.The aim of the present study was to investigate the interrelationship of presurgical Tc-99m-MDP scintimammography and post-surgical histopathological findings in 32 women with suspicious breast lesions. Anterior and lateral views of the breasts were acquired 10 min after i.v. injection of 740 MBq of Tc-99m-MDP. Scintimammograms were judged pathological if any increased accumulation of activity was found. Scintimammogrphy was normal in 10 patients and pathological in 22 patients. Histopathological findings revealed benign lesions in 7 patients and breast carcinoma in 25 patients. In 4 patients the uptake of Tc-99m-MDP was found in benign lesions. In total, there were 18 true positive findings, 4 true negative, 3 false positive and 7 false negative ones. Overall sensitivity of the scintimammography was 85%, specificity was 64%, positive predictive value was 82% and negative predictive value was 70%. In conclusion, our results are somewhat disappointing; scintimammography alone does not discriminate breast lesions accurately