RESUMEN
The present guideline is focused on quality assurance of somatostatin receptor PET/CT (SSTR-PET/CT) in oncology patients. The document has been developed by a multidisciplinary board of specialists providing consensus of definitions, prerequisites, methodology, operating procedures, assessment, and standardized reporting. In particular, imaging procedures for the two most commonly used radioligands of human SSTR, i. e. 68Ga-DOTATOC and 68Ga-DOTATATE are presented. Overall, SSTR-PET/CT requires close interdisciplinary communication and cooperation of referring and executing medical disciplines, taking into account existing guidelines and recommendations of the European and German medical societies, including the European Association of Nuclear Medicine (EANM), German Society for Endocrinology (DGE), German Society for Nuclear Medicine (DGN) and German Society for Radiology (DRG).
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Tomografía Computarizada por Tomografía de Emisión de Positrones , Guías de Práctica Clínica como Asunto , Receptores de Somatostatina/metabolismo , Humanos , Neoplasias/diagnóstico por imagen , Neoplasias/metabolismo , RadiofármacosRESUMEN
This document describes the guideline for peptide receptor radionuclide therapy (PRRT) published by the German Society of Nuclear Medicine (DGN) and accepted by the Association of the Scientific Medical Societies in Germany (AWMF) to be included in the official AWMF Guideline Registry. These recommendations are a prerequisite for the quality management in the treatment of patients with somatostatin receptor expressing tumours using PRRT. They are aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRT and to deliver the treatment in a safe and effective manner. The recommendations are based on an interdisciplinary consensus. The document contains background information and definitions and covers the rationale, indications and contraindications for PRRT. Essential topics are the requirements for institutions performing the therapy, e. g. presence of an expert for medical physics, intense cooperation with all colleagues involved in the treatment of a patient, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how treatment has to be carried out technically. Here, quality control and documentation of labelling are of great importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with the involved medical disciplines. Generally, the decision for PRRT should be undertaken within the framework of a multi-disciplinary tumour board.
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Neoplasias/metabolismo , Neoplasias/radioterapia , Péptidos/farmacocinética , Oncología por Radiación/normas , Radiofármacos/uso terapéutico , Receptores de Somatostatina/metabolismo , Alemania , Humanos , Guías de Práctica Clínica como Asunto , Radiofármacos/farmacocinéticaRESUMEN
BACKGROUND: The histological status of the sentinel lymph node (SLN) is one of the most relevant prognostic factors for the overall survival of patients with cutaneous malignancies, independent of tumour depth of the primary tumour. OBJECTIVES: Our study seeks to evaluate the reliability and medical benefit of SLN excision (SLNE) performed with a portable γ-camera for intraoperative real time imaging of SLN. METHODS: Therefore our study compares the visualization of SLN performed with preoperative lymphoscintigraphy and preoperative SPECT/CT with the intraoperative real time imaging of SLN performed with a new portable γ-camera (Sentinella) in 60 patients who were treated with a SLNE for early stage melanoma (n = 38), high risk cutaneous squamous cell carcinoma (n = 16), Merkel cell carcinoma (n = 4), sebaceous gland carcinoma (n = 1), and sweat glands carcinoma or porocarcinoma (n = 1). RESULTS: Sixty patients were enrolled in this study. The portable γ-camera visualized all 126 preoperatively identified SLN. 23 additional SLN (15.4%) in 15 patients were only identified using the portable γ-camera. Two of these additional SLN showed metastatic involvement. CONCLUSION: The portable γ-camera is an innovative imaging technique, reliable and providing additional information in the detection of SLN. Therefore SLNE with intraoperative γ-camera use is an attractive option to improve the detection of SLN in cutaneous malignancies and could help to reduce false negative SLN results.
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Carcinoma de Células de Merkel/patología , Carcinoma de Células de Merkel/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Cámaras gamma , Linfocintigrafia/métodos , Melanoma/patología , Melanoma/cirugía , Neoplasias de las Glándulas Sebáceas/patología , Neoplasias de las Glándulas Sebáceas/cirugía , Biopsia del Ganglio Linfático Centinela/métodos , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Neoplasias de las Glándulas Sudoríparas/patología , Neoplasias de las Glándulas Sudoríparas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Periodo Intraoperatorio , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Imagen Multimodal , Tomografía de Emisión de Positrones , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: There is some controversy around the value of sentinel lymph node excision (SLNE). Especially SLNE of cutaneous head and neck malignancies has been debated intensively, in part because of the complexity of the lymphatic drainage in this region associated with potential high morbidity. In order to improve preoperative three-dimensional mapping of sentinel lymph nodes (SLN), in the head and neck region, by means of hybrid single photon emission computed tomography/computed tomography (SPECT/CT) is gaining significance. Our study seeks to identify the potential medical and economic advantages of preoperative SPECT/CT in direct comparison to standard SLNE without SPECT/CT in patients with cutaneous head and neck malignancies. METHODS: We retrospectively analysed the data of 48 clinically lymph node-negative patients with early stage melanoma, high risk cutaneous squamous cell carcinoma and porocarcinoma, who underwent SLNE with or without preoperative SPECT/CT within 4 years. RESULTS: The SLNE in the head and neck region with SPECT/CT-technique demonstrated better postoperative aesthetic results had lower morbidity and significantly reduced operating time. Moreover, SLNE with SPECT/CT-technique in the head and neck region was feasible using local anaesthesia (LA) and significantly reduced resulting costs (32.65/SLNE with LA vs. 334.57/SLNE with general anaesthesia, P < 0.0001). CONCLUSION: SPECT/CT is an innovative imaging technique, reliably and readily providing additional anatomical/functional information to detect and to excise SLN in the head and neck region. Therefore, SLNE with SPECT/CT-technique is an attractive option to improve the detection of SLN in cutaneous head and neck malignancies.
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Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Melanoma/diagnóstico por imagen , Imagen Multimodal , Tomografía de Emisión de Positrones , Periodo Preoperatorio , Neoplasias Cutáneas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenocarcinoma Sebáceo/diagnóstico por imagen , Adenocarcinoma Sebáceo/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestesia/economía , Carcinoma de Células Escamosas/cirugía , Niño , Análisis Costo-Beneficio , Porocarcinoma Ecrino/diagnóstico por imagen , Porocarcinoma Ecrino/cirugía , Estética , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Ganglios Linfáticos/cirugía , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas/cirugía , Factores de Tiempo , Adulto JovenRESUMEN
Positron emission tomography (PET) and computed tomography (CT) complement each other's strengths in integrated PET/CT. PET is a highly sensitive modality to depict the whole-body distribution of positron-emitting biomarkers indicating tumour metabolic activity. However, conventional PET imaging is lacking detailed anatomical information to precisely localise pathologic findings. CT imaging can readily provide the required morphological data. Thus, integrated PET/CT represents an efficient tool for whole-body staging and functional assessment within one examination. Due to developments in system technology PET/CT devices are continually gaining spatial resolution and imaging speed. Whole-body imaging from the head to the upper thighs is accomplished in less than 20 min. Spatial resolution approaches 2-4mm. Most PET/CT studies in oncology are performed with (18)F-labelled fluoro-deoxy-D-glucose (FDG). FDG is a glucose analogue that is taken up and trapped within viable cells. An increased glycolytic activity is a characteristic in many types of cancers resulting in avid accumulation of FDG. These tumours excel as "hot spots" in FDG-PET/CT imaging. FDG-PET/CT proved to be of high diagnostic value in staging and restaging of different malignant diseases, such as colorectal cancer, lung cancer, breast cancer, head and neck cancer, malignant lymphomas, and many more. The standard whole-body coverage simplifies staging and speeds up decision processes to determine appropriate therapeutic strategies. Further development and implementation of new PET-tracers in clinical routine will continually increase the number of PET/CT indications. This promotes PET/CT as the imaging modality of choice for working-up of the most common tumour entities as well as some of the rare malignancies.
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Fluorodesoxiglucosa F18 , Neoplasias/diagnóstico , Tomografía de Emisión de Positrones/métodos , Técnica de Sustracción , Tomografía Computarizada por Rayos X/métodos , Imagen de Cuerpo Entero/métodos , Estudios de Seguimiento , Humanos , Estadificación de Neoplasias , RadiofármacosRESUMEN
The energy density (ED) of nine species of sub-Antarctic fishes was estimated by calorimetry. The fish, seven notothenioids, one atherinopsid and one galaxiid, represents some of the more abundant species in the ichthyofauna of the Beagle Channel. Principal-components analysis (PCA) of the ED of the different organs/tissues indicated that PC(1) and PC(2) accounted for 87% of the variability. Separation along PC(1) corresponded to differences in muscle and liver energy densities whereas separation along PC(2) corresponded to differences in the ED of the gonads. Differences between species were significant except for P. sima. Inclusion of the gonadosomatic index (GSI) as an explanatory variable enabled us to establish the existence of energy transfer from muscle and liver to the gonads in ripe P. tessellata females. Total ED values varied between 4.21 and 6.26 kJ g(-1), the pelagic Odontesthes sp. being the species with the highest ED. A significant relationship between ED and muscle dry weight (DW(M)) was found for all the species except P. tessellata. These data are the first direct estimates of ED of fishes from the Beagle Channel.
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Metabolismo Energético , Peces/metabolismo , Animales , Regiones Antárticas , Calorimetría/veterinaria , Femenino , Gónadas/química , Hígado/química , Masculino , Músculos/química , Océanos y Mares , Análisis de Componente Principal , Agua/análisisRESUMEN
PURPOSE: Intravenous contrast materials (CM) are of benefit in PET/CT imaging. However, CM may influence tracer quantification and may cause artifacts when using the CT data for PET attenuation correction. The aim of the study was to assess the feasibility of applying a highly concentrated CM (HCCM, 400 mg iodine/ml) in PET/CT in comparison to a lower concentrated CM (LCCM, 300 mg iodine/ml). MATERIALS AND METHODS: In 60 whole-body FDG PET/CT scans (30 scans each with HCCM and LCCM), tracer uptake (maximal standardized uptake value - SUVmax) and CT attenuation (Hounsfield Units) were quantified at 16 positions in different vessels and parenchyma. The number of potential PET artifacts was documented. The Mann-Whitney-Wilcoxon Test was performed for statistical assessment (p < 0.05). RESULTS: HCCM did not cause a significant increase in the SUVmax (p > 0.05) or the number of PET artifacts (p = 0.69) while simultaneously significantly increasing CT attenuation (p = 0.002) as compared to LCCM in 11 / 16 positions. CONCLUSION: The application of HCCM seems feasible in PET/CT and should be considered in future protocols.
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Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Yopamidol/análogos & derivados , Neoplasias/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Imagen de Cuerpo Entero/métodos , Adolescente , Adulto , Anciano , Artefactos , Relación Dosis-Respuesta a Droga , Estudios de Factibilidad , Femenino , Humanos , Yopamidol/administración & dosificación , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/diagnóstico por imagen , Neoplasias/cirugía , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
AIM: The standardized uptake value (SUV) of 18FDG-PET is an important parameter for therapy monitoring and prognosis of malignant lesions. SUV determination requires delineating the respective volume of interest against surrounding tissue. The present study proposes an automatic image segmentation algorithm for lesion volume and FDG uptake quantitation. METHODS: A region growing-based algorithm was developed, which goes through the following steps: 1. Definition of a starting point by the user. 2. Automatic determination of maximum uptake within the lesion. 3. Calculating a threshold value as percentage of maximum. 4. Automatic 3D lesion segmentation. 5. Quantitation of lesion volume and SUV. The procedure was developed using CTI CAPP and ECAT 7.2 software. Validation was done by phatom studies (Jaszczak phantom, various "lesion" sizes and contrasts) and on studies of NSCLC patients, who underwent clinical CT and FDG-PET scanning. RESULTS: Phantom studies demonstrated a mean error of 3.5% for volume quantification using a threshold of 41% for contrast ratios >or=5 : 1 and sphere volumes >5 ml. Comparison between CT- and PET-based volumetry showed a high correlation of both methods (r = 0.98) for lesions with homogeneous FDG uptake. Radioactivity concentrations were underestimated by on average -41%. Employing an empirical threshold of 50% for SUV determination, the underestimation decreased to on average -34%. CONCLUSIONS: The algorithm facilitates an easy and reproducible SUV quantification and volume assessment of PET lesions in clinical practice. It was validated using NSCLC patient data and should also be applicable to other tumour entities.
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Imagenología Tridimensional/métodos , Neoplasias/diagnóstico por imagen , Tomografía de Emisión de Positrones , Algoritmos , Simulación por Computador , Fluorodesoxiglucosa F18 , Humanos , Procesamiento de Imagen Asistido por Computador , Fantasmas de Imagen , RadiofármacosRESUMEN
The density of transmitter receptors varies between different locations in the human cerebral cortex. We hypothesized that this variation may reflect the cyto- and myeloarchitectonical as well as the functional organisation of the cortex. We compared data from different imaging modalities (postmortem studies: cyto- and myeloarchitecture, quantitative in vitro receptor autoradiography; in vivo studies: PET receptor neuroimaging) in order to test our hypothesis. The regional and laminar distribution of the densities of numerous receptor types representing all classical transmitter systems as well as the adenosine system are visualized and measured in different cortical areas. The receptor distribution patterns segregate motor, primary sensory, unimodal sensory, multimodal association and other functionally identified cortical areas from each other. Areas of similar function show similar receptor fingerprints and differ from those with other properties. Thus, receptor distribution patterns reflect an organisational structure strictly correlated with the architectonics and functions of the human cerebral cortex.
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Corteza Cerebral/metabolismo , Receptores de Neurotransmisores/metabolismo , Anciano , Autorradiografía , Corteza Cerebral/anatomía & histología , Corteza Cerebral/diagnóstico por imagen , Femenino , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana Edad , Ensayo de Unión Radioligante , Receptores Adrenérgicos/metabolismo , Receptores Colinérgicos/metabolismo , Receptores Dopaminérgicos/metabolismo , Receptores de GABA/metabolismo , Receptores de Glutamato/metabolismo , Receptores Purinérgicos P1/metabolismo , Receptores de Serotonina/metabolismo , Tomografía Computarizada de EmisiónRESUMEN
The dopamine D4 receptor has lately attracted interest since it has been hypothesized to be involved in the pathogenesis and pharmacotherapy of neuropsychiatric diseases. The present study provides first in vivo evidence of dopamine D4 receptors in primate brain using a [11C]benzo[g]quinoline, the novel radioligand [11C]SDZ GLC 756 ([11C]GLC: in vitro dissociation constants at human receptor clones [nM]: 1.10 at D1; 0.40 at D2; 25 at D3; 0.18 at D4.2; 6.03 at D5). Dynamic positron emission tomography scans were performed on healthy baboons (Papio hamadryas, n = 3). Specific receptor binding (SB) was calculated for striatum and neocortex (frontal, temporal, parietal, and occipital) based on the differences between the regional and the cerebellar concentration of [11C]. Blockade of D1 and D5 receptors by SCH23390 (1.7 pmol/kg) diminished SB in the striatum by 55 +/- 4% (mean +/- standard deviation, P < 0.05) and in the frontal cortex by 13 +/- 8% (P < 0.05) when compared to SB in the unblocked state (SB(D1-D5)). In the presence of the dopamine antagonists SCH23390 (1.7 micromol/kg) and raclopride (5.7 pmol/kg)--which mask the D1, D2, D3, and D5 subtypes--SB of [11C]GLC to D4 receptors (SB(D4)) was demonstrated in the striatum and all cortical regions of interest. In the striatum, the ratio of SB(D4)/SB(D1-D5) was 0.13 +/- 0.07. In the neocortex, SB(D4)/SB(D1-D5) was notably higher (0.77 +/- 0.29; mean of all cortical regions of interest). The widespread distribution of dopamine D4 receptors suggests a basic functional role of this receptor subtype in the modulation of cortical and subcortical neuronal activity.
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Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Papio/metabolismo , Receptores de Dopamina D2/metabolismo , Tomografía Computarizada de Emisión , Animales , Benzazepinas/farmacología , Encéfalo/efectos de los fármacos , Antagonistas de Dopamina/farmacología , Femenino , Masculino , Quinolinas/farmacología , Racloprida , Receptores de Dopamina D2/efectos de los fármacos , Receptores de Dopamina D4 , Salicilamidas/farmacología , Distribución Tisular/efectos de los fármacosRESUMEN
Diabetic cardiovascular autonomic neuropathy (CAN) has been directly characterized by reduced or absent myocardial [123I]metaiodobenzylguanidine (MIBG) uptake, but there is no information available on the relationship between the myocardial adrenergic innervation defects and long-term glycaemic control. In a prospective study over a mean of 4 years we examined myocardial sympathetic innervation in 12 Type 1 (insulin-dependent) diabetic patients using MIBG scintigraphy (absolute and relative global MIBG uptake at 2 h p.i.) in conjunction with cardiovascular autonomic function tests, QTc interval, and QT dispersion. Six healthy non-diabetic subjects served as controls for the MIBG scintigraphy at baseline. HbA1c was measured twice a year. One patient, in whom MIBG accumulation was reduced maximally, died during follow up. Among the remaining patients 5 had good or borderline glycaemic control (mean HbA1c < 7.6%; Group 1), whereas 6 patients were poorly controlled (mean HbA1c > or = 7.6%; Group 2). Absolute global MIBG uptake increased from baseline to follow-up by 260 (-190-540) [median (range)] cpm/g in Group 1 and decreased by -150 (-450-224) cpm/g in Group 2 (p < 0.05 vs Group 1). Relative global MIBG uptake decreased by -1.7 (-3.4-9.4) % in Group 1 and by -4.7 (-17.4-1.3) % in Group 2 (p < 0.05 vs Group 1). No differences between the groups were noted for the changes in the automatic function tests, QTc interval, and QT dispersion. In conclusion, long-term poor glycaemic control constitutes an essential determinant in the progression of left ventricular adrenergic dysinnervation which may be prevented by near-normoglycaemia. Evaluation of susceptibility to metabolic intervention may be superior when CAN is characterized directly by MIBG scintigraphy rather than by indirect autonomic function testing.
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3-Yodobencilguanidina , Glucemia/metabolismo , Diabetes Mellitus Tipo 1/fisiopatología , Hemoglobina Glucada/análisis , Corazón/inervación , Radiofármacos , 3-Yodobencilguanidina/farmacocinética , Adulto , Anciano , Biomarcadores/sangre , Presión Sanguínea , Diabetes Mellitus Tipo 1/diagnóstico por imagen , Diabetes Mellitus Tipo 1/metabolismo , Neuropatías Diabéticas/fisiopatología , Retinopatía Diabética/fisiopatología , Electrocardiografía , Femenino , Corazón/diagnóstico por imagen , Frecuencia Cardíaca , Humanos , Síndrome de QT Prolongado , Masculino , Persona de Mediana Edad , Nervios Periféricos/fisiopatología , Cintigrafía , Radiofármacos/farmacocinética , Valores de Referencia , Sistema Nervioso Simpático , Función Ventricular IzquierdaRESUMEN
1. An association has been reported between QT interval abnormalities and cardiovascular autonomic neuropathy in diabetic patients. The QT interval abnormalities reflect local inhomogeneities of ventricular recovery time and may be related to an imbalance in cardiac sympathetic innervation. Sympathetic innervation of the heart can be visualized and quantified by single-photon emission-computed tomography with m-[123I]iodobenzylguanidine. In this study we evaluated cardiac sympathetic integrity by m-[123I]iodobenzylguanidine imaging and the relationship between both QT interval prolongation and QT dispersion from standard 12-lead ECG variables and m-[123I]iodobenzylguanidine uptake in insulin-dependent diabetic patients. 2. Three patient groups were studied, comprising six healthy control subjects, nine diabetic patients without cardiovascular autonomic neuropathy (CAN-) and 12 diabetic patients with cardiovascular neuropathy (CAN+). Resting 12-lead ECG was recorded for measurement of maximal QT interval and QT dispersion. The QT interval was heart rate corrected using Bazett's formula (QTc) and the Karjalainen approach (QTk). Quantitative measurement (in counts/min per g) and visual defect pattern of m-[123I]iodobenzylguanidine uptake were performed using m-[123I]iodobenzylguanidine single-photo emission-computed tomography. 3. Global myocardial m-[123I]iodobenzylguanidine uptake was significantly reduced in both diabetic patient groups compared with control subjects. The visual defect score of m-[123I]iodobenzylguanidine uptake was significantly higher in CAN+ diabetic patients than in control subjects and in CAN- patients. This score was not significantly different between control subjects and CAN- patients. QTc interval and QT dispersion were significantly increased in CAN+ diabetic patients as compared with control subjects (QTc: 432 +/- 15 ms versus 404 +/- 19 ms, P < 0.05; QT dispersion: 42 +/- 10 versus 28 +/- 8 ms, P < 0.05). QT dispersion was also significantly longer in CAN- diabetic patients than in control subjects (41 +/- 9 ms versus 28 +/- 8 ms, P < 0.05). QTc interval was significantly related to global myocardial m-[123I]iodobenzylguanidine uptake and defect score in diabetic patients (r = -0.648, P < 0.01, and r = 0.527, P < 0.05, respectively). There was no correlation between QT dispersion and both m-[123I]iodobenzylguanidine uptake measures. 4. In conclusion, these findings suggest that m-[123I]iodobenzylguanidine imaging is a valuable tool for the detection of early alterations in myocardial sympathetic innervation in long-term diabetic patients without cardiovascular autonomic neuropathy. Insulin-dependent diabetic patients with cardiovascular autonomic neuropathy have a delayed cardiac repolarization and increased variability of ventricular refractoriness. The cardiac sympathetic nervous system seems to be one of the determinants of QT interval lengthening, but does not appear to be involved in dispersion of ventricular recovery time. It is assumed that QT dispersion is based on more complex electrophysiological mechanisms which remain to be elucidated.
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Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Enfermedades Cardiovasculares/fisiopatología , Diabetes Mellitus Tipo 1/fisiopatología , Neuropatías Diabéticas/fisiopatología , Frecuencia Cardíaca/fisiología , Corazón/fisiopatología , 3-Yodobencilguanidina , Adulto , Enfermedades del Sistema Nervioso Autónomo/diagnóstico por imagen , Enfermedades Cardiovasculares/diagnóstico por imagen , Diabetes Mellitus Tipo 1/diagnóstico por imagen , Neuropatías Diabéticas/diagnóstico por imagen , Electrocardiografía , Femenino , Corazón/diagnóstico por imagen , Pruebas de Función Cardíaca , Humanos , Radioisótopos de Yodo , Masculino , Persona de Mediana Edad , Procesamiento de Señales Asistido por Computador , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
There is evidence that autonomic nerves are disturbed in spontaneous diabetic BB rats indicating a peripheral diabetic autonomic neuropathy. For histofluorescent visualization of catecholamine containing nerve fibres in myocardium the method of De La Torre was applied. For electron microscopy, tissue specimens of ventricular and atrial myocardium were prepared. In myocardium of BB rats diabetic for 28 weeks morphometric quantification of catecholamine histofluorescence revealed a loss of fluorescent nerve fibres and varicosities of 57% from 1.18 +/- 0.17 to 0.51 +/- 0.18 per cent of the total field area (p < 0.009). Ultrastructurally, morphometric quantification of the density of axon profiles containing synaptic vesicles in transverse sectioned atrial myocardium showed a decrease of 42% (p < 0.021) in the diabetic group. In the diabetic nerves, axoplasmic lysis and a reduction in the Schwann cell envelope were prominent. Morphologic changes of nerves in ventricles were comparable to the findings in atrial tissue. It is concluded that a diabetic autonomic neuropathy of intramural sympathetic nervous tissue occurs in myocardium of spontaneous diabetic BB rats despite insulin substitution.
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Sistema Nervioso Autónomo/patología , Diabetes Mellitus Tipo 1/patología , Neuropatías Diabéticas/patología , Corazón/inervación , Sistema Nervioso Simpático/patología , Animales , Sistema Nervioso Autónomo/ultraestructura , Axones/ultraestructura , Catecolaminas/análisis , Microscopía Electrónica , Miocardio/patología , Miocardio/ultraestructura , Fibras Nerviosas/ultraestructura , Ratas , Ratas Endogámicas BB , Sistema Nervioso Simpático/ultraestructura , Vesículas Sinápticas/ultraestructuraRESUMEN
Fifty three patients with Pectus excavatum, 12.5 years of age on average, were studied. They frequently had respiratory history (in 36% of cases): asthma, repetitive bronchites or rhinopharyngites, and associated squeletal deformities (17%) : kyphoscoliosis, lordo-kyphosis and scoliosis. As far as ventilation is concerned, the restrictive syndrome was found in 49% of cases, severely in 23% (20% decrease in C. V.) An obstructive syndrome was found only in cases of associated asthma. Bodypletysmography done parallely in 5 cases puts in evidence or increases the ventilatory abnormalities. In the cardio-vascular check up, the chest X ray, E.C.G., the pulmonary scintigraphy or straight microcatheterization, usually reveal some abnormality (15% of cases). The synthesis of results points out two facts : 1) when the heart is in its position and the cardiomediastinal shadow enlarges, the E.C.G. abnormalities are unimportant; when the heart is displaced towards the left, the electrical disorders are bigger ; 2) microcatheterization done on 22 subjects revealed a gradient of systolic pressure, right ventricle-pulmonary artery, definite or severe in 4 cases, lesser in 9. Surgery rarely improves the spirometry and E.C.G. abnormalities, but does seem to cure the hemodynamic disorders.