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BACKGROUND: In paralysed limbs quite often edemas are seen, which might pose problems during rehabilitation. The origin of these edemas is not fully understood. METHODS: 48 patients with hemiplegia and edema of the paralysed arm were studied; in 40 patients lymphoscintigraphic studies (static and dynamic lymphography) were performed. RESULTS: In 80% of these cases lymphatic flow in the paralysed arm was increased compared to the healthy arm. If there was marked edema in the paralysed arm, the increase of lymph flow was considerable (p < 0.01). CONCLUSIONS: Edemas in hemiplegic extremities are not due to lymphedema, as in lymphedema the lymph flow usually is very slow. They most likely are caused by disorders of filtration and reabsorption, due to a dysfunction of the autonomic nervous system.

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Delayed gastric emptying is known as an important organic cause for brittle diabetes. We proposed the interval from the start of a meal to the rise in blood glucose, defined as blood glucose latency (T BG) as an index for gastric emptying and a non-invasive test for diabetic gastropathy. In order to validate this test we compared it in 22 type 1 diabetic patients with an established scintigraphic method for the measurement of gastric half-emptying time (T1/2) and found the following correlation: T BG = 4.4 + 0.162 x T1/2; r 0.79, P < 0.001. We therefore suggest measuring the blood glucose latency as a simple non-invasive screening method.

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The effects of 5 and 10 mg bisoprolol once daily for 7 days on exercise ECG, myocardial perfusion and left ventricular function in 25 patients with stable coronary heart disease have been assessed in a double-blind, randomized, parallel group trial design. ST-segment depression during exercise was reduced by 56% by 5 mg bisoprolol and by 64% after 10 mg; the difference between the dose levels was significant. Heart rate, systolic and diastolic blood pressure and the rate-pressure product were reduced to similar extent both at rest and during exercise by both doses. Left ventricular thallium-201 scintigrams indicated a significant reduction in myocardial perfusion defects after 10 mg bisoprolol compared to baseline; however, the difference between the two active treatments was not significant. Left atrial and left ventricular diameters obtained by one-dimensional echocardiography, and the calculated shortening fraction, remained unchanged after bisoprolol, and so gave no evidence of a negative inotropic action. It is concluded that 5 mg bisoprolol was effective in once-a-day treatment of angina pectoris due to coronary heart disease, and a further improvement can be expected on increasing the dose to 10 mg.

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51Cr-EDTA activity was measured in urine and blood of patients receiving non-steroidal anti-inflammatory (NSA) drug treatment and of healthy subjects and other patients (controls), after oral intake of 51Cr-EDTA, for the purpose of deciding whether NSA treatment increases urinary excretion of oral 51Cr-EDTA as an expression of increased intestinal permeability. 51Cr-EDTA activity in urine and blood of patients with rheumatoid arthritis (13) being treated with NSA was significantly higher (similar to results in 13 patients with Crohn's disease) than that of a control group (14) of patients with rheumatoid arthritis without such treatment (9) and patients without rheumatic disease (5). Both in patients with rheumatoid arthritis receiving NSA drugs and patients with Crohn's disease there was a highly significant correlation between urinary and blood activity. There was no effect of NSA drugs on renal function. The results indicate that NSA drugs increase interenterocytic permeability to an extent comparable to permeability abnormalities in Crohn's disease.

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In a retrospective analysis in patients with differentiated thyroid carcinoma, the diagnostic validities of 131I whole-body scans and radioimmunologic determinations of thyroglobulin (hTg) are compared with special regard to late metastases. Metastases were found in 83 out of 311 patients with differentiated thyroid carcinoma. In two thirds of the cases, these were primary metastases while in the remaining third of the cases, metastases developed in later follow-up with a mean time of latency of 3.3 years. While about 70% of the early metastases could bei detected by 131I scintigraphy, this percentage amounted to only 40% in late metastases. With a diagnostic sensitivity of 90%, hTg-RIA was clearly superior in the detection of early as well as of late metastases. hTg was measurable, however, only in iatrogenous hypothyroidism in 4 out of 49 cases. Based on these results and an analysis of the literature, a program for follow-up of differentiated thyroid carcinoma is proposed. The hTg-RIA is thereby used as an alternative to 131I scintigraphy in the late phase of follow-up after complete ablation of any thyroid tissue.

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Part II of the study concerning the clinical applicability of direct and indirect parameters for free thyroxine evaluates the diagnostic accuracy of the FT4-RIAs ImmoPhase, GammaCoat, Liquisol, Amerlex and LisoPhase in relation to FT4 index and T4/TBG ratio. This comparison of methods is done on a thoroughly classified collection (n = 640) of patients with normal and impaired thyroid function including patients with binding protein anomalies (pregnancy, estrogen-medication, phenytoin therapy, renal protein loss). FT4 normal ranges of a given kit harmonize well with data of the manufacturers and of the literature. On the other hand, the normal ranges of the various kits are not comparable. The differentiation of euthyroidism from hyper- or hypothyroidism can be made without problems using any of these methods, with the exception of the FT4-RIA GammaCoat. As expected, patients with euthyroid goiter show, on the average, slightly lower parameters for FT4. In pregnancy all direct and indirect parameters for FT4 have a tendency to lower values after the first trimester. This trend is most distinct for the T4/TBG ratio. A weak negative correlation of FT4 parameters with basal TSH, which does not exceed the upper normal range, however, can be interpreted in the sense of a relative hypothyroxinemia. Under contraceptive estrogen medication FT4 parameters do not fall outside the normal range, with the exception of the FT4-RIA ImmoPhase assay which yields a significantly increased frequency of high FT4 levels. On therapy with phenytoin FT4 values are generally lower than in controls. FT4 parameters in patients with renal protein loss of more than 2 g daily do not behave uniformly. While three of the FT4-RIAs tested (ImmoPhase, GammaCoat, Amerlex) show a tendency to lower values, the results of the remaining FT4 parameters do not differ significantly from the distribution of normals. The study leads to the conclusion that indirect FT4 parameters are still useful in the diagnosis of thyroid function; currently available FT4 radioimmunoassays may yield comparable results. With regard to the varying quality of the various commercial test kits, the choice between FT4-RIAs and indirect FT4 parameters does not depend primarily on clinical but on technical viewpoints.

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