ZusammenfassungBei insgesamt 35 Probanden und Patienten (je 12 gesunde Nichtraucher und symptomlose Raucher und 11 Patienten mit Bronchitis) wurde die Wertigkeit der Inhalationsszintigraphie mit 99mTc-markiertem Humanalbumin zur Früherkennung von morphologisch-funktionellen Veränderungen der Atemwege untersucht. Das Depositionsmuster unmittelbar nach Inhalation (Primärdeposition = PD) wurde quantitativ mit einer ROI-Technik und qualitativ (visuelle Bewertung der zentralen Deposition, der Homogenität und der Lungenkontur) bewertet. Zusätzlich wurde die Abnahme der intrapulmonal deponierten Aktivität über 60 min registriert (Selbstreinigung der Lungen in erster Linie durch die mukoziliäre Clearance = MC). Anhand der PD konnte zwischen Patienten mit Bronchitis und lungengesunden Probanden unterschieden werden. Eine Diskriminierung zwischen Nichtrauchern und Rauchern war anhand der PD alleine nicht möglich. Dagegen unterschied sich das Probandenkollektiv der Raucher von den symptomlosen Rauchern durch eine bessere MC. Raucher und Patienten mit Bronchitis wiesen keinen Unterschied bei der MC auf.

MRI and scintigraphy were compared in 73 patients with 104 vertebral fractures aged between three days and 64 months. MRI was performed at 0.5 Tesla and 1.5 Tesla using T1- and T2-weighted spin-echo sequences. Isotope uptake was divided into four grades (normal, mild, moderate and marked increase). 92% of cases aged 0-6 months showed increased signal intensity on T2 sequences. This finding reflects edema in the bone. All these cases showed moderate or markedly increased uptake in 86%. The increased signal intensity in T2 spin-echo images provides a criterion for differentiating new from old fractures. The identification of normal fatty marrow in 91% of fractured vertebrae provides an important means for distinguishing traumatic from neoplastic fractures. One can also demonstrate bleeding, fatty change and sclerotic bone. MRI is less sensitive than scintigraphy, but more specific in following the posttraumatic healing process.

The effect of low-molecular weight (LMW) heparin fragment (one injection of 1500 aPTT [activated partial thromboplastin time]-U/24 h)--group 1--was compared with unfractionated (UF) heparin (3 x 5000 IU/24 h)--group 2--in a randomized prospective double-blind trial of 404 patients (202 patients in each group), aged 50 years or older, undergoing abdominal surgery. The two groups were well matched for thromboembolic risk factors. The first subcutaneous injection was made two hours preoperatively; postoperative injections continued for at least seven days. The radiofibrinogen test served as the test criterion. If positive, phlebography and lung sequence scanning were performed. On complete prophylaxis the thrombosis rate was nearly identical in the two groups--10.8% vs 11.4%. No pulmonary emboli were detected in either group if correctly treated. There was no significant difference between the two groups with respect to peroperative blood loss, re-operation rate and wound haematoma rate. But there was a significantly higher number of injection haematomas in group 2. These results suggest that a single daily injection of 1500 aPTT-U LMW heparin provides effective prophylaxis against postoperative venous thromboembolism.

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