sodium-pertechnetate-tc-99m and Cystic-Fibrosis

A study was designed to evaluate the reproducibility of right and left ventricular ejection fraction measurements (RVEF, LVEF) by equilibrium radionuclide angiography in cystic fibrosis (CF) and to determine the effect of the acute administration of aminophylline on RVEF and LVEF in this disease. Both RVEF and LVEF were measured at rest and during incremental supine bicycle exercise by equilibrium radionuclide angiography in 18 patients with CF. In 9 of these patients, radionuclide studies were repeated after an infusion of aminophylline (9 mg/kg), whereas the remaining patients had radionuclide studies repeated after a placebo infusion. No significant increase in mean RVEF or LVEF values either at rest or at peak exercise was seen after aminophylline infusion. In the patients who underwent sequential radionuclide studies without intervening active drug intervention, the mean (+/- standard deviation) variability in RVEF and LVEF measurements between the 2 studies was 2.6 +/- 2% and 3.6 +/- 2.9%, respectively. We conclude that (1) equilibrium radionuclide angiography is a reasonably reproducible technique for serial assessment of biventricular function at rest and during exercise in CF, and that (2) the acute administration of aminophylline does not augment cardiac function either at rest or during exercise in this disease.

Topics: Adolescent; Adult; Aminophylline; Cardiac Output; Cystic Fibrosis; Erythrocytes; Female; Heart; Humans; Male; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Theophylline

The neutrophil elastase inhibitor, secretory leucocyte protease inhibitor (SLPI), is a potential therapeutic tool in inflammatory lung diseases such as cystic fibrosis and pulmonary emphysema. The distribution and disappearance in the lung of aerosolised recombinant SLPI (rSLPI) was investigated in healthy humans and in patients with cystic fibrosis or alpha 1-antitrypsin-associated emphysema.. To distinguish aerosolised rSLPI from endogenous SLPI the recombinant inhibitor was radiolabelled with 99m-technetium (99mTc) pertechnetate. Distribution and disappearance of aerosolised 99mTc-rSLPI in the lungs were studied by gamma radiation imaging.. The deposition of 99mTc-rSLPI in normal volunteers was homogeneous in all lung lobes, while in patients with cystic fibrosis or emphysema only well ventilated areas showed deposition of the aerosol. The disappearance rate of 99mTc-rSLPI was biexponential. The half life of the rapid phase was 0.2-2.8 hours, while that of the slow phase was more than 24 hours.. Future aerosol therapy with rSLPI will be most beneficial for well ventilated lung tissue that needs protection against neutrophil derived elastase. It may be more difficult to neutralise the burden of elastase in poorly ventilated, highly inflamed areas as are seen in cystic fibrosis.

Topics: Adult; Aerosols; alpha 1-Antitrypsin Deficiency; Animals; Cricetinae; Cystic Fibrosis; Half-Life; Humans; Lung; Male; Mesocricetus; Phenotype; Proteinase Inhibitory Proteins, Secretory; Proteins; Pulmonary Emphysema; Radionuclide Imaging; Recombinant Proteins; Secretory Leukocyte Peptidase Inhibitor; Serine Proteinase Inhibitors; Sodium Pertechnetate Tc 99m

The objective of this study was to assess the performance of a new pneumatic nebuliser NL9 Atomisor. The performance was assessed in terms of particle distribution, fraction nebulised, fraction inhaled and percentage of particles of a diameter of between 1 and 4 microns for the nebulisation of physiological serum, colistin, tobramycin and amiloride. The solutions were nebulised in the approved formula for their reconstitution as used in the clinic after the addition of sodium pertechnetate. The validity of this indirect isotopic method has been shown before. The nebuliser was coupled, during the nebulisation, to a pump respirator with six settings. The fraction nebulised was defined as the percentage of the volume of the solution which had left the aerosol generator at the end of the nebulisation. The fraction inhaled was defined as a percentage of the volume of the solution which was gathered at the end of the nebulisation on a filter placed in the inspiratory circuit of the aerosol generator. The study of the distribution of aerosol particle sizes was carried out using a cascade impactor at ten stages. Each of these parameters was determined in triplicate for the four solutions studied. The nebulised fraction consisted of between 33.5 and 58.6% (mean 49.7 +/- 8.1%). The inhaled fraction consisted of between 14 and 30.4% (mean 24.5 +/- 5.5) and the duration of nebulisation was between 10 and 20 minutes. The MMAD was between 1.6 microns with tobramycin 3.5 microns with physiological serum.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aerosols; Amiloride; Colistin; Cystic Fibrosis; Evaluation Studies as Topic; Humans; Nebulizers and Vaporizers; Particle Size; Sodium Pertechnetate Tc 99m; Surface Tension; Tobramycin

While gravity-assisted positions (postural drainage) and the forced expiratory technique are known to promote sputum clearance, the additional value of percussion, vibratory-shaking and breathing exercises individually in chest physiotherapy is uncertain. These modalities have been evaluated in 8 patients with copious sputum production (mean: 44 g/day), using an inhaled radioaerosol technique. Tracheobronchial clearance was unaffected by the addition of either vibratory-shaking or percussion with and without breathing exercises to postural drainage. There was however a significant (p less than 0.01) increase in the dry weight of sputum produced during each of these treatments. The combination of postural drainage used in conjunction with the forced expiration technique is responsible for the majority of mucus mobilisation and should form the basis of routine chest physiotherapy programmes; the other modes appear to be of lesser value.

Topics: Breathing Exercises; Bronchial Diseases; Bronchiectasis; Bronchitis; Cystic Fibrosis; Drainage; Forced Expiratory Volume; Humans; Microspheres; Percussion; Posture; Sodium Pertechnetate Tc 99m; Sputum; Vibration; Vital Capacity

Right and left ventricular performance during exercise was evaluated in 31 patients with cystic fibrosis using equilibrium radionuclide cineangiography. There were 21 males and 10 females (mean age 17, range 10.4 to 34.9 yr) with a wide range of clinical involvement. Thirteen patients had arterial desaturation at rest and an additional 4 became desaturated with exercise. Nine patients (29%) were unable to increase their right ventricular ejection fraction more than 5% during exercise. Left ventricular ejection fraction at rest was normal (greater than 55%) in all but 2, and with exercise, performance was impaired in 9 (29%). No relationship was found between resting or exercise radionuclide ejection fraction, M-mode echocardiography or pulmonary function studies. This study suggests that both right and left ventricular dysfunction may occur during stress in patients with cystic fibrosis without other conventional clinical signs or symptoms. Radionuclide cardiac angiography appears to be a safe method of assessing cardiac response to exercise in patients with chronic lung disease, and may be useful in evaluating therapeutic interventions.

Topics: Adolescent; Adult; Angiography; Bicycling; Blood Volume; Child; Cystic Fibrosis; Echocardiography; Electrocardiography; Female; Heart Function Tests; Heart Rate; Heart Ventricles; Humans; Male; Physical Exertion; Respiratory Function Tests; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume