Acta medica Austriaca最新文献

Summary: Background: The aim of this retrospective study was to evaluate the accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) images, which were interpreted under daily routine conditions, in patients with Hodgkin's disease (HD) or non-Hodgkin lymphoma (NHL) for restaging after chemotherapy and/or radiotherapy. For this purpose, ¹⁸F-FDG-PET results were compared with morphological imaging methods and the patients’ clinical background.

Methods: 121 PET images of 93 lymphoma patients (44 HD, 49 NHL) were investigated after chemotherapy/radiotherapy. For PET imaging, 160–200 MBq ¹⁸F-FDG was administered intravenously, followed by an infusion of 20 mg Furosemid in 250 mL saline. Whole-body ¹⁸F-FDG-PET images were obtained using a partial-ring PET scanner without attenuation correction. The morphological imaging consisted in computed tomography and ultrasound (CT/US) in all patients, additional MRI in some patients, and iliac crest biopsy in cases of suspicious bone marrow involvement. The standard of reference was composed of biopsy data, clinical status at the time of investigation, and follow-up of at least 12 months. The PET images were evaluated for their sensitivity, specificity and accuracy based on written reports, which were compiled from other imaging data and the clinical history of the patients.

Results: Sensitivity, specificity, and accuracy of ¹⁸F-FDG-PET was 91 %, 81 %, and 85 %; of CT/US, 88 %, 35 %, 56 %, respectively. Major sources of error in ¹⁸F-FDG-PET were due to asymmetric muscular hypermetabolism and inflammatory lesions misinterpreted as persistent viable lymphoma tissue. Furthermore, secondary malignancies other than lymphomas were another reason for misinterpretations of ¹⁸F-FDG-PET studies.

Conclusions: ¹⁸F-FDG-PET showed a comparable sensitivity but a higher specificity and accuracy compared with CT/US. To achieve a high accuracy in ¹⁸F-FDG-PET, the nuclear medicine specialist needs imaging and clinical data as background information, which can only be acquired through close co-operation with the referring clinicians. Pharmacological muscular relaxation in the course of ¹⁸F-FDG-PET imaging may be advisable, as nonspecific muscular hypermetabolism was one of the problems at the image readings and a source of incorrect ¹⁸F-FDG-PET interpretations.

Zusammenfassung: Bei 19 Marathonläufern (2F, 17M) wurde vor und unmittelbar nach dem Lauf die Plasmakonzentration der Parameter Gesamt-CK-Aktivität, CK-MB-Masse, Myoglobin und Troponin I bestimmt. Unter dem Einfluß der Laufbelastung sind bei allen Probanden Gesamt-CK und Myoglobin im Plasma signifikant angestiegen, wobei keine Korrelation mit dem Alter der Läufer und deren Laufzeit feststellbar war. Bei einigen der Läufer ist auch CK-MB auf Werte angestiegen, die sonst für das Bestehen myokardialer Nekrosen sprechen. Es gibt jedoch keinen überzeugenden Hinweis dafür, daß diese Befunde wirklich durch Nekrosen im Myokard verursacht werden. Sie könnten auch Folgen einer zellulären Permeabilitätsstörung durch die Laufbelastung sein, die bei gesunden Läufern durch die Belastung der Muskulatur, etwa so wie das ,,stunning‘‘ des Myokards, lokal auftreten und – so eindrucksvoll die Befunde auch sein mögen – keine gesundheitlich nachteiligen Folgen zeitigen. Ihre Bedeutung für einen Trainingseffekt der Muskulatur erscheint gegenwärtig nicht beurteilbar.

Muscle Cell Proteins are Selectively Released into the Blood Stream by Marathon Running

Summary: In 19 marathon runners of both sexes, plasma concentrations of total creatine kinase (CK) activity, CKMB mass, myoglobin and troponin I were determined before and immediately after the race. Total CK activity and myoglobin increased significantly in all runners and showed neither a correlation with the individual age of the runners nor with the time they needed to reach the goal. In 12 of the runners, CKMB mass increased during the race to a level suggesting myocardial necrosis. However, the runners did not show any detectable deterioration of cardiac function after the race. The appearance of considerable amounts of muscle proteins in plasma precipitated by the muscle strain during the race seems explained by damage of skeletal muscle detected by histological studies. These phenomena may also be a consequence of profoundly disturbed cellular permeability, perhaps due to a kind of local stunning of muscle tissue by prolonged muscular strain.

Zusammenfassung: Ausgehend von der Aktivitätsklassifikation nach Mourits werden die Indikationen zur Entlastungsopera­tion der Augenhöhle dargelegt. Danach werden alle modernen Dekompressionsverfahren erwähnt und deren Vor- und Nachteile beschrieben. Auch auf die transpalpebrale Fettresektion wird eingegangen. Ergebnisse (Exophthalmusabnahme, Komplikationen) werden für die vom Autor durchgeführten koronalen und transkonjunktivalen Zugänge präsentiert und im Vergleich mit anderen Methoden diskutiert.

Decompression for Thyroid Eye Disease: Advantages and Disadvantages of Different Methods

Summary: Based on the disease activity score, current indications for orbital decompression are described. After that, all contemporary decompression techniques are mentioned and their advantages and disadvantages are described. Transpalpebral fat resection is also included. Results (reduction of proptosis, complications) are presented for the coronal and transconjunctival (swinging eyelid and transcaruncular orbitotomy) approach used by the author and discussed in comparison with other methods.

Summary: Obesity is a serious health problem in industrialized countries and is associated with a significant increase in total health care costs. Only few data are available about the costs of drug therapies in patients with an increased body weight treated under clinical routine procedures. Such data could support efforts to intensify obesity prevention and treatment programmes in order to reduce comorbidities and costs.

We have evaluated body mass index (BMI), diagnosis, and medication in 3360 outpatients (2175 women and 1185 men; mean age: 56.7 ± 17.5 years). All patients underwent physical examinations, including BMI determination, and provided a detailed record concerning medication. In 1809 patients, the percentage of body fat content was measured with a bioimpedance method (OMRON BF 302 body fat monitor). Continuous variables were compared using the t-test or Wilcoxon U-test. Frequency distributions were compared using chi-squared tests.

With respect to BMI, most of the patients (n = 1793; 53 %) were overweight or obese, 1349 (40 %) showed a normal BMI and 218 (7 %) a low BMI. The majority of cardiovascular (61 %), rheumatological (61.1 %) and metabolic (60.4 %) medication was administered to overweight and obese patients. Parallel findings could be obtained by analysing the percentage of body fat and the frequency of medication. Overall, 82.5 % of all medication was given to patients with a body fat content >20 %.

Our results support the importance of weight-reduction programmes in order to prevent an overall increase in the costs of medication as a consequence of overweight and obesity.

Summary: Hydatid disease is endemic in several Mediterranean countries, posing an important health problem for these countries. The hydatid cyst is characterized by cystic lesions with clear boundaries, which can be observed in all parts of the body. Approximately 70 % of hydatid cysts are situated in the liver, followed by the lung (25 %). The kidneys, spleen, bile ducts, mesentery, soft tissue and brain are less frequent sites. We investigated patients who were treated for hydatid disease in our departments in the last 5 years with respect to localization of the disease, symptoms, surgical intervention, length of hospitalization, diameters of the cyst, and classification by Gharbi. In this retrospective and descriptive study, 176 patients are evaluated who were treated for hydatid disease between 1995 and 1999 in our departments. Of these patients, 14 were included with localization other than in the liver and lungs. Fourteen of the patients diagnosed with unusually located hydatid disease were men, six were women. Their mean age was 41.6 ± 20.8 years; the length of hospital stay was 7.07 ± 0.4 days. Overall, 28.6 % of patients with unusually located hydatid cyst had recurrent disease.

The time period since last cyst operation was 5.25 ± 3.5 years. The mean cyst diameter was 96.5 ± 54.5 mm. According to Gharbi's classification, three cases (21.4 %) of the unusually located hydatid cysts were type I, two (14.3 %) type II, and eight (57.1 %) type III. There was only one case of type IV and no cases of type V. Spleen and kidneys are the organs where hydatid disease is most frequently observed after the liver and lung. It can be observed in all parts of the body including the brain, peritoneum, mesenterium, choledochus, pancreas, bone and muscles. The type of treatment is determined by the localization and type of hydatid disease. Surgical treatment for splenic hydatid cysts is splenectomy. The functional kidney should be saved in non-communicable hydatid disease. Total excision is almost never possible; endocystectomy and drainage procedure should be preferred for hydatid disease of the brain, pancreas and choledochus. Chemotherapy is usually given because of the risk of recurrence; this medical treatment consists in albendazole and mebendazole administration for 3–6 months in the postoperative period.

Summary: Trends in primary health care consumption were monitored in the elderly (60 or more years of age). Respondents (5162) were picked by random mechanical selection. They were monitored for a complex of characteristics composed of frequency of visits to a GP office, frequency of procedures performed at the GP office, drug prescriptions, frequency (and type) of procedures performed at specialists’ offices, and hospitalization. The study was conducted in 1982, 1992, 1993 and 1996. Results were statistically analysed. There was a statistically significant increase in the consumption of primary health care by the elderly: GP office visits rose from 80 % to 98.8 %, and there was a quantitative change in procedure types. There was also a marked increase in drug prescription: from 77 % receiving prescriptions in 1982 to 97 % in 1996. The highest consumption was of cardiotonics, analgesics and antipyretics, which corresponds to an increasing prevalence of chronic diseases and multimorbidity. The results of our studies underline the important role of primary care physicians in the care of the elderly, who represent 80 % of the clientele of their offices in our country.

Zusammenfassung: Wir untersuchten und behandelten insgesamt 25 Patienten mit endokriner Orbitopathie: 21 Frauen im Alter zwischen 19 und 74 Jahren (mittleres Alter 50,8 Jahre) und 4 Männer im Alter zwischen 38 und 56 Jahren (mittleres Alter 47,5 Jahre). Unter den weiblichen Patienten fanden sich zwei mit euthyreoter endokriner Orbitopathie und eine Patientin mit einer Immunthyreoiditis Hashimoto, unter den männlichen Patienten ist einer an einer euthyreoten EO erkrankt. Die Behandlung wurde je nach Augenbefund für alle Arten der Orbitopathie ident durchgeführt. Drei und sechs Monate nach Therapie­ende wurde eine augenärztliche Untersuchung durchgeführt, zu diesem Zeitpunkt waren alle Patienten euthyreot. Bei insgesamt fünf Patienten (2 Männer und 3 Frauen) musste nur eine Sicca-Therapie durchgeführt werden, da sich die endokrine Orbitopathie im Zuge der Therapie der Schilddrüsenerkrankung zurückgebildet hat. Bei drei Frauen, die über drei Monate nur mit Cortison peroral behandelt wurden, kam es zu einer Vollremission. Neun Frauen wurden wegen Progredienz einer Kortison- und Bestrahlungsbehandlung unterzogen, wobei es bei sechs von neun Patientinnen (66 %) zu einer signifikanten Besserung kam. In einem Fall musste wegen unbeherrschbarer Progredienz eine akute Dekompressionsoperation durchgeführt werden. Bei sechs Frauen führten wir wegen Nichtansprechen auf Kortison- und Bestrahlungsbehandlung eine Behandlung mit Somatostatin über insgesamt sechs Monate durch, die in fünf von sechs Fällen eine signifikante Besserung des Krankheitsbildes bewirkte. In einem Fall musste ein chirurgischer Eingriff an der Orbita vorgenommen werden. Zwei Männer erhielten eine Kortison- und Strahlenbehandlung, die keine deutliche Besserung brachte. Eine Somatostatintherapie wurde bei negativem Octreoscan nicht durchgeführt. Mit Ausnahme einer Nichtraucherin, die trotz intensiver konservativer Therapie operiert werden musste, zeigten sich bei Rauchern schlechtere Behandlungsergebnisse.

Treatment Results in 25 Patients with Graves' Ophthalmopathy during 1998 and 2001

Summary: In our outpatient clinic 25 patients with Graves' ophthalmopathy were treated, 21 women, mean age 58.8 years (range 19 – 74 years) and 4 men, mean age 47.5 years (range 38 – 56 years). In the female group two showed euthyroid Graves' ophthalmopathy and one Hashimoto's disease; in the male group one showed euthyroid ophthalmopathy. Treatment was done depending on the findings of the ­NOSPECS-classification in identical way for each group. Final results were obtained three and six months after therapy, at that time all patients were euthyroid. In five patients (two men and three women) sicca-treatment was sufficient because the ophthalmopathy improved by therapy of the thyroid disease only. Three women were treated by oral steroids over three months and had a complete remission. Nine women were treated by oral steroids and external radiation, six of them showed major improve

Summary: Advice against smoking is one of the means frequently used in the management of patients with Graves’ ophthalmopathy (GO). The objective of this study was to prospectively evaluate the efficacy of such advice. The study was performed at a referral centre. Eighty-five smokers out of 102 consecutive patients with GO, who were examined during a 1-year period, were included in the study. Severity of the disease, smoking history, and the results from a patients’ self-assessment questionnaire were recorded.

The behavioural intervention consisted in a standardized 2-min message from the attending ophthalmologist strongly advising each patient to quit. The main outcome measure was smoking cessation during the 1-year follow-up period. None of the 85 smokers reported smoking cessation either during the follow-up visits or at the end point of the study.

The results of our study show that advice against smoking is not effective among patients with GO. Specifically designed intervention programmes may be necessary and should be evaluated in a controlled trial.

Summary: Background: The purpose of this study was to assess the potential of fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (¹⁸F-FDG-PET) for monitoring the efficacy of iodine-131 metaiodobenzylguanidine (¹³¹I-MIBG) therapy in neuroendocrine tumours.

Methods: A total of seven ¹³¹I-MIBG therapies with 3.7 to 10.2 GBq were carried out in three patients suffering respectively from a phaeochromocytoma, a paraganglioma and a metastatic neuroendocrine tumour of an unknown primary. The post-therapeutic whole-body scintigrams were compared with the results of six ¹⁸F-FDG-PET studies performed at the time of the therapies. One patient received three PET scans prior to each one of the MIBG therapies, and one patient was studied twice.

Results: ¹⁸F-FDG uptake in tumour sites seemed to correlate well with tumour differentiation, showing no uptake in one patient with a highly differentiated neuroendocrine tumour, and moderate-to-intense uptake in the two other patients with metastatic disease. Those tumour sites that had a simultaneous positive uptake in both the MIBG scintigram and the PET scan showed response to therapy as a continuous reduction in MIBG uptake over time. They also showed a qualitative decrease in FDG accumulation during the follow-up. This was associated with a decrease in the mean and maximum standard uptake values of more than 50 % in some metastases, while the X-ray computed tomography showed no decrease in tumour volume. Two patients revealed additional metastases that were unknown on the basis of prior diagnostic or therapeutic PET scans and radiological follow-up.

Conclusions: It may be concluded from these cases that ¹⁸F-FDG-PET is a valuable tool for an initial metabolic staging of neuroendocrine tumours prior to ¹³¹I-MIBG therapy, as it can reveal tumour sites beyond the reach of radioisotope therapy. It may also be of importance in assessing therapeutic potential in those tumour sites that do show positive MIBG uptake.