published_or_final_version / Community Medicine / Master / Master of Public Health

Purpose: To describe the clinical presentation, ocular complications and clinical implications of acute HZO in HIV positive patients. Method: Prospective descriptive clinical case series of 54 individuals aged 18 – 50 years with confirmed HIV infection and acute presentation of HZO. Results: A female preponderance (1.7:1) and mean age of 36.6 years (range 18 – 49 years) was recorded. The majority of patients were referred from CHC and only 28% of referred patients received appropriate antiviral treatment at the referral site. Mean duration of rash at presentation was 4.7 days (range 1 – 12 days) with 31% of patients presenting within 3 days of rash eruption. Patients attended a mean of 2.7 clinical visits. Equal proportions had known and unknown HIV serostatus at presentation. Mean CD4+ was 276 cells/mm3 (range 44 - 859 cells/mm3). 67% of patients had a CD4+ count < 350 cells/mm3. Periocular discomfort was the most common presenting symptom (70%); decreased VA (2%) was an uncommon presenting symptom. Multidermatomal involvement was uncommon (7%). At presentation normal VA was seen in 69% of patients and 94% had no global visual impairment. Corneal complications (89%) and intraocular inflammation (46%) were the most common ocular complications. Ocular complications at presentation and multiple complications were the rule (70% and 61%). Hutchinson sign was found to be of little clinical value. Visual outcome was fair, 22% of patients having residual visual impairment. Post-herpetic neuralgia was common (74%). Conclusion: HZO is a common HIV marker condition with ocular complications. It may have an application as an indication for the initiation of ARV treatment.

by Patricia Jane Anderson. / "June 1999." / Thesis (Ph.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 300-328). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

目的1)發現與中風相闋的視網膜特徵2) 利用視網膜特徵建立統計模型對老年人中風風險進行分類。 / 方法:配對病例對照研究。病例為中風患者，一部分中風患者來自於糖尿病眼病的篩查項目，另外一部分是腦內科的中風患者。對照是沒有中風的老年人。對照來自糖尿病眼病篩查項目內沒有患中風的患者及在眼科門診沒有中風及特殊眼病的患者。對照與病例在年齡及是否患有糖尿病進行匹配。所有研究對象均來自香港威爾斯親王醫院。我們收集所有研究對象的中風危險因素，包括年齡，性別，吸煙，及是否患有糖尿病，高血壓，缺血性心髒病，心房顫動，高血脂。所有研究對象的彩色視網膜照片都被採集。我們應用軟件“ImageJ"分析並記錄視網膜動靜脈直徑，血管分叉係數，分叉角度，分叉對稱性，視乳頭周長。我們也記錄其他視網膜特徵，如動靜脈壓跡，出血，硬性滲出，動脈阻塞及血管彎曲性。獨立t檢驗用於對連續變量的單因素分析，卡方檢驗用於對分類變量的單因素分析。Logistic 回歸用於建立統計模型對中風風險進行分類。所有統計方法均應用SPSS16.0 軟件。 / 結果:本研究納入122 中風患者及122 例患者做對照。每組分別有81 例糖尿病患者， 41 例非糖尿病患者。視網膜特徵包括動靜脈直徑，血管彎曲度，出血，硬性滲出，動靜脈壓跡在兩組中有顯著性差異。我們建立風險模型對兩組患者進行風險分類。分類準確度最高達的模型裡面包括的因子有：1)中風相關危險因素包括:高血壓，糖尿病，心房顫動2) 視網膜特徵包括:動脈直徑，血管彎曲性，出血，動靜脈壓跡跟靜脈對稱性；3) 視網膜特徵間的交立作用包括:動脈直徑與靜脈對稱性，動脈直徑與出血，靜脈對稱性與血管彎曲度。分類的準確度為80 .4%。只包括視網膜特徵的分類模型的準確度為74.5% 。 / 結論:彩色視網膜照相可成為中風風險的分類工具。與中風相關的視網膜特徵包括血管直徑，血管彎曲度，血管對稱性，出血，動靜脈壓跡。視網膜特徵與中風之間的聯繫存在交互作用。 / Objective: 1) To detect retina characteristics that associated with stroke; 2) To develop a statistics model with variables of retina characteristics for classifying patients with stroke from those without stroke in aged population. / Method: Matched case control study. Patients with stroke from the diabetic retinopathy screening program and stroke patients from Acute Stroke Unit were selected as stroke cases. Controls (patients without history of stroke) with matched diabetes status and age were selected from the diabetic retinopathy screening program and eye outpatient clinics. All subjects in this study were from Prince of Wales Hospital, Hong Kong. Risk factors of stroke from all subjects were collected, including age, gender, diabetes, hypertension, hyperlipidemia, history of ischemic heart disease, atrial fibrillation and smoking. Color retina images of each subject were collected and analyzed. The retina characteristics, including diameters of arterioles and venules, bifurcation coefficients, bifurcation angles, branch symmetry, optic disc perimeter were extracted from the color retina images by software "ImageJ". Other retina characteristics including arteriole-venule nicking, hemorrhages, exudates, arteriole occlusion, and vessel tortuosity were also recorded. Independent t test and Chi-squire test were used to compare the continuous and categorical retina characteristics respectively between patients with stroke and those without stroke. Logistic model combining the risk factors of stroke and retina characteristics was established to classify patients with stroke from those without stroke. All data analysis was by SPSS 16.0. / Results: there were 122 stroke cases and 122 controls recruited in this study. There were 41 patients without diabetes and 81 patients with diabetes in each group. Retina characteristics including diameters of arterioles and venules, vessel tortuosity, hemorrhages, exudates, arteriole-venule nicking were significantly different between the two groups. We established risk models to classify patients with stroke from those without stroke. The risk model with highest accuracy of classification included 1) stroke risk factors including hypertension, diabetes and atrial fibrillation; 2) retina characteristics, including arteriole diameters, vessel tortuosity, hemorrhages, arteriolevenule nicking and venule symmetry; 3)interaction between retina characteristics, including arteriole diameters by venule symmetry, arteriole diameters by hemorrhage,and venule symmetry by vessel tortuosity. The accuracy of classification was 80.4%. Using retinal characteristics alone achieved an accuracy of 74.5%. / Conclusion: color retina images are a potential tool for stroke risk stratification. Useful characteristics found in the retinal images included vessel diameters, vessel tortuosity, vessel symmetry, hemorrhage, arteriole-venule nicking. The association between the retinal characteristic and stroke was modified by other retinal characteristics. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Qing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 139-148). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.iii / Acknoledgements --- p.v / Chapter Chapter 1 --- Introduction and review of the Literature --- p.1 / Chapter Section 1: --- Stroke prevention and risk assessment tools --- p.1 / Chapter Section 2: --- Rationale of relationship of vascular circulation between retina and brain --- p.9 / Chapter Section 3: --- Manifestation of hypertensive retinopathy and diabetic retinopathy --- p.12 / Chapter Section 4: --- Retina characteristics related to stroke --- p.15 / Chapter Section 5: --- How to make retina as a tool of risk stratification for stroke --- p.28 / Chapter Section 6: --- Rationale to do study to further explore the useful information in color retina images to make it as tool for stroke risk stratification --- p.31 / Chapter Chapter 2 --- Research hypothesis and general design --- p.33 / Chapter Chapter 3 --- Methods of retia characteristics extraction --- p.34 / Chapter Chapter 4 --- A Study of the Reliability of manual measurement of Retinal characteristics using ImageJ --- p.46 / Chapter Chapter 5 --- A study of comparison of retina characteristics between patients with stroke and patients without stroke --- p.55 / Chapter Section 1: --- Method --- p.56 / Chapter Section 2: --- Result-univariate analysis --- p.62 / Chapter Section 3: --- Results-stratification analysis --- p.68 / Chapter Section 4: --- Result-risk model building for stroke risk stratification --- p.79 / Chapter Chapter 6: --- Discussion --- p.118 / Chapter Chapter 7: --- Limitation of this study --- p.133 / Chapter Chapter 8: --- Future development and application of the study results --- p.134 / Appendix --- p.136 / Reference --- p.139

Patients were selected for the study on the basis of 1: A diagnosis of systemic Lupus Erythematosus according to the 1982 revised American Rheumatology Association criteria47 and 2: An adequate biopsy defined as containing at least six glomeruli. Patients were biopsied at Groote Schuur Hospital during the period 1978 to 1988 and the indications for renal biopsy were clinical based on laboratory results of renal function. Patients were followed between 1 and 120 months with a mean observation period of 34 months. The clinical records were scrutinised and the following pa·rameters were noted at the time of biopsy: age, sex, race, time from diagnosis to biopsy, serum urea, creatinine, creatinine clearence and urinary 24 hour protein. Using the latest serum urea, creatinine, creatinine clearence and / or 24 hour urinary protein where available, outcome was graded as: 1: An improvement in renal function 2: A stable renal function 3: Deterioration in renal function 4: Patient on dialysis 5: Death due to disease.

Apolipoprotein E (apoE) is a lipid transport protein which plays a key role in lipid metabolism. In addition to the well known polymorphic coding alleles epsilon2, epsilon3 and epsilon4, APOE promoter single nucleotide polymorphisms (SNPs) have also been reported to modify disease susceptibilities in humans. / In a case-control study involving 710 Chinese type 2 diabetes and 198 non-diabetic subjects, genotyping of three SNPs (-491A/T, -219G/T and +113G/C) within the APOE proximal promoter identified that -491A was associated with increased risk for type 2 diabetes in women (OR=2.44, 95%CI=1.15-5.19, p=0.017). However, the three tested SNPs were not associated with the risk of diabetic nephropathy (DN). Yeast one-hybrid screening of the human brain cDNA library using the polymorphic DNA sequences spanning the APOE promoter -491 site as the 'baits' identified one of the interacting transcription factors being the activating transcription factor 4 (ATF4). Electrophoretic-mobility-shift assay confirmed the physical interaction of the purified recombinant ATF4 protein and APOE promoter -491 A/T spanning region (-521 to -461). The binding of ATF4 to the -491T-containing sequence was stronger than that of the -491A-containing sequence. Chromatin immunoprecipitation (ChIP) assay further confirmed the interaction between ATF4 and APOE promoter -491-spanning region in vivo. The functional significance of APOE -491A/T polymorphism was supported by the dual-luciferase reporter assay showing that -491 A to T single nucleotide substitution significantly decreased the activity of the cloned APOE promoter (-1019 to +407) in human kidney (293), liver (WRL-68) and astrocyte (U-87) cell lines. Further analysis showed that ATF4 over-expression significantly down-regulated the activities of the cloned APOE promoter. The suppression of ATF4 on APOE promoter with -491A allelic form was significantly stronger than that with -491T allelic form in 293 cells (p&lt;0.05). Interestingly, overexpression of recombinant ATF4 stimulated endogenous APOE transcription by about 10% in WRL-68 cells. / In conclusion, APOE promoter -491A/T polymorphism modifies the risk of type 2 diabetes in Hong Kong Chinese women. The -491A/T polymorphism controls APOE promoter activity and is interactive with transcription factor ATF4. / My thesis project aimed at testing two hypotheses: (1) APOE promoter SNPs associate with the risks of type 2 diabetes and diabetic nephropathy, (2) APOE promoter SNPs modify transcriptional control of the gene. / Geng, Hua. / "September 2007." / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4559. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 140-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Leung, Wan Lun Fiona. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 179-204). / Abstracts in English and Chinese. / Abstract --- p.i / 中文摘要 --- p.v / Acknowledgement --- p.viii / List of Abbreviations and Symbols x --- p.vi / List of Tables --- p.xx / List of Figures --- p.xxi / Chapter CHAPTER ONE --- Introduction --- p.1 / Chapter 1.1 --- General Overview --- p.1 / Chapter 1.2 --- Necrotizing Enterocolitis (NEC) --- p.3 / Chapter 1.2.1 --- Epidemiology of NEC --- p.3 / Chapter 1.2.2 --- "Clinical Presentation, Diagnosis and Management of NEC" --- p.5 / Chapter 1.2.3 --- Pathophysiology of NEC --- p.9 / Chapter 1.2.3.1 --- Prematurity --- p.9 / Chapter 1.2.3.2 --- Bacterial Colonization --- p.12 / Chapter 1.2.3.3 --- Enteral Feeding --- p.15 / Chapter 1.2.3.4 --- Hypoxia and Ischemia --- p.16 / Chapter 1.2.3.5 --- Genetic Polymorphism --- p.17 / Chapter 1.2.3.6 --- Inflammatory Mediators --- p.20 / Chapter 1.3 --- Spontaneous Intestinal Perforation (SIP) --- p.24 / Chapter 1.3.1 --- Epidemiology of SIP --- p.24 / Chapter 1.3.2 --- "Clinical Presentation, Diagnosis and Management of SIP" --- p.26 / Chapter 1.3.3 --- Risk Factors of SIP --- p.28 / Chapter 1.3.3.1 --- Prematurity --- p.29 / Chapter 1.3.3.2 --- Use of Drugs --- p.30 / Chapter 1.4 --- Comparison between NEC and SIP --- p.32 / Chapter 1.5 --- Role of Cytokines in Pathogenesis of NEC and SIP --- p.38 / Chapter 1.6 --- Immunoregulatory Molecules of Interest in This Study --- p.46 / Chapter 1.6.1 --- Angiopoietin-2 (Ang-2) --- p.46 / Chapter 1.6.2 --- v-erb-b2 Erythroblastic Leukemia Viral Oncogene Homolog 2 (avian) (ErbB3) --- p.48 / Chapter 1.6.3 --- Type II Interleukin-1 Receptor (IL-1RII) --- p.52 / Chapter 1.6.4 --- Urokinase Plasminogen Activator Receptor (uPAR) --- p.54 / Chapter CHAPTER TWO --- Objectives --- p.57 / Chapter CHAPTER THREE --- Materials and Methodology --- p.58 / Chapter 3.1 --- Overview of the Experimental Procedures --- p.58 / Chapter 3.1.1 --- Investigation on the Profile of Circulatory Immunoregulatory Proteins in Plasma of NEC and SIP High Risk Neonates --- p.58 / Chapter 3.1.2 --- Investigation on the mRNA Expression Level of Targeted Immunoregulatory Molecules on Resected Intestinal Tissues in NEC and SIP Neonates --- p.58 / Chapter 3.1.3 --- Investigation on the mRNA and Protein Expression Levels of Targeted Immunoregulatory Molecules in Human Intestinal Cell Lines --- p.60 / Chapter 3.2 --- Reagents and Lab-wares with Their Sources --- p.61 / Chapter 3.3 --- Study Population --- p.63 / Chapter 3.4 --- Collection of Neonatal Whole Blood Samples --- p.65 / Chapter 3.5 --- Cytokine Antibody Array Analyses --- p.67 / Chapter 3.6 --- Enzyme-linked Immunosorbant Assays (ELISA) --- p.69 / Chapter 3.6.1 --- Angiopoietin-2 --- p.69 / Chapter 3.6.2 --- sErbB3 --- p.71 / Chapter 3.6.3 --- sIL-lRII --- p.72 / Chapter 3.6.4 --- suPAR --- p.74 / Chapter 3.7 --- Collection of Neonatal Resected Intestinal Tissues --- p.76 / Chapter 3.8 --- Resected Intestinal Tissue RNA Isolation --- p.78 / Chapter 3.9 --- Purity Assessment of the Purified Tissue RNA Samples --- p.80 / Chapter 3.10 --- Integrity Assessment of the Purified Tissue RNA Samples --- p.81 / Chapter 3.11 --- In vitro Stimulation of Human Enterocytes by Lipopolysaccharides (LPS) and/or Platelet Activating Factor (PAF) --- p.84 / Chapter 3.12 --- mRNA Expression Level Assessment of Selected Target Genes in Resected Intestinal Tissues and Human Intestinal Cell Lines --- p.86 / Chapter 3.12.1 --- Synthesis of First Strand cDNA --- p.86 / Chapter 3.12.2 --- Quantitative Polymerase Chain Reaction (qPCR) --- p.87 / Chapter 3.13 --- Statistical Analysis --- p.89 / Chapter CHAPTER FOUR --- Screening of Immunoregulatory Target Protein Molecules in Plasma of NEC and SIP Patients by Cytokine Array Analyses --- p.104 / Chapter 4.1 --- Results --- p.104 / Chapter 4.1.1 --- Screening of Detectable Immunoregulatory Target Molecules --- p.104 / Chapter 4.1.2 --- Selection of Target Molecules Based on the Fold Change in NEC or SIP Compared with Control Samples --- p.105 / Chapter 4.1.2.1 --- Similar Regulation of Target Molecules in Both NEC and SIP patients --- p.105 / Chapter 4.1.2.2 --- Differential regulation of Target Molecules in NEC and SIP Patients --- p.106 / Chapter 4.1.2.3 --- "Relative Normalized Expressions of Selected Circulatory Immunoregulatory Protein Molecules in NEC, SIP and Control Neonates" --- p.108 / Chapter 4.1.2.3.1 --- Anti-inflammation --- p.108 / Chapter 4.1.2.3.2 --- Pro-inflammation --- p.109 / Chapter 4.1.2.3.3 --- Cell Growth --- p.110 / Chapter 4.1.2.3.4 --- Wound Healing --- p.110 / Chapter 4.1.2.3.5 --- Angiogenesis --- p.111 / Chapter 4.1.2.3.6 --- "Anti-apoptosis, Cell Adhesion and Extracellular Matrix Organization" --- p.112 / Chapter 4.1.3 --- Further Selection of Novel Target Molecules Based on Statistical Significance and Fold Change of NEC versus SIP --- p.113 / Chapter 4.2 --- Discussion --- p.115 / Chapter CHAPTER FIVE --- Validation of Target Proteins in Plasma of NEC and SIP Patients by Enzyme-linked Immunosorbant Assay --- p.132 / Chapter 5.1 --- Results --- p.133 / Chapter 5.1.1 --- Demographic Data of the Study Group --- p.133 / Chapter 5.1.2 --- "Comparison of Plasma Levels of Target Proteins between NEC, SIP and Respective Controls" --- p.134 / Chapter 5.1.3 --- Longitudinal Study of the Pre- and Post-operative Target Proteins Levels in Plasma --- p.136 / Chapter 5.2 --- Discussion --- p.138 / Chapter CHAPTER SIX --- Investigation on mRNA Expression Levels of Target Immunoregulatory Protein Molecules in Intestinal Tissue and Intestinal Cell Lines --- p.151 / Chapter 6.1 --- Results --- p.152 / Chapter 6.1.1 --- mRNA Expression Levels of Target Molecules in the Diseased Margin of Resected Intestinal Tissues of NEC and SIP patients --- p.152 / Chapter 6.1.2 --- mRNA Expression Levels of Target Molecules in the Macroscopically Normal and Diseased Margin of Resected Intestinal Tissues of NEC and SIP patients --- p.154 / Chapter 6.1.3 --- mRNA Expression Levels of Target Molecules in Human Intestinal Cell Lines upon LPS and PAF Challenge --- p.156 / Chapter 6.1.3.1 --- FHs-74 Int Cell Line --- p.156 / Chapter 6.1.3.2 --- Caco-2 Cell Line --- p.157 / Chapter 6.2 --- Discussion --- p.158 / Chapter CHAPTER SEVEN --- General Discussion --- p.171 / Chapter 7.1 --- Overall Findings --- p.171 / Chapter 7.2 --- Limitations of Study --- p.174 / Chapter 7.3 --- Future Investigations --- p.177 / References --- p.179

Com o objetivo de se avaliar a importância do \"clearance\" do dietilenotriamino-pentacetato marcado com Tecnécio 99m (DTPA-Tecnécio-99m) em portadores de pneumopatia por amiodarona foram estudados 40 indivíduos, em quatro grupos. Grupo I: 10 voluntários normais, assintomáticos e não fumantes (8 homens e 2 mulheres), com média de idade de 56,80 anos. Grupo II: 10 voluntários normais, assintomáticos e fumantes (6 homens e 4 mulheres ), com média de idade de 27,50 anos. Grupo III: 10 pacientes não fumantes ( 4 homens e 5 mulheres ), com média de idade de 52,90 anos. Todos faziam uso crônico de amiodarona por via oral. Grupo IV: 10 pacientes portadores de pneumopatia por amiodarona, quatro ex-fumantes, dois fumantes e quatro não fumantes ( 8 homens e 2 mulheres) com média de idade de 52,90 anos. Todos faziam uso de amiodarona por via oral e nenhum fumou nas 4 semanas que precederam o estudo. Após espirometria que constou do registro da curva volume-tempo, todos inalaram 4 ml de solução salina contendo 740 MBq de DTPA Tecnécio-99m, durante cinco minutos. Através de uma c~mara de cintilação computadorizada foram obtidas imagens pulmonares, definindo-se 9 áreas de interesse. Para cada região escolhida foi determinada uma curva de \"clearance\" extraindo-se o valor de meia-vida biológica em minu- tos ( T 1/2 ) e a taxa percentual de \" clearance\" alvéolo capilar do radioaerossol por minuto (K%/min). Observamos que, das variáveis espirométricas consideradas, a capacidade vital forçada (CVF) e o volume expiratório forçado no 1 segundo (VEF1) mostraram diferenças significantes entre os grupos I e IV. A contagem total de radioatividade de ambos os pulmões não mostrou relação com a CVF e o VEF1. O \" clearance \" pulmonar do DTPA Tecnécio-99m foi maior nos grupos 11 e IV, porém não permitindo sua diferenciação. Estes resultados permitem concluir: Os pacientes portadores de pneumonite por amiodaro- na apresentam\" clearance \" alvéolo-capilar de DTPA Tecnécio-99m significativamente maior que os indivíduos do grupo de normais não fumantes. Este fato também se verificou em relação aos pacientes em uso crônico de amiodarona mas sem evidências de pneumopatia. Não é possível diferenciar os fumantes dos portadores de pneumonite por amiodarona através da análise da integridade da barreira alvéolo-epitelial com DTPA Tecnécio-99m. Comparativamente, o estudo da integridade alvéolo-epitelial pelo \"clearance\" pulmonar de DTPA Tecnécio-99m é mais sensível que a espirometria na avaliação da pneumonite por amiodarona, permitindo diferenciar estes pacientes dos que fazem uso crônico da droga / In order to evaluate the role of the clearance of 99m Technetium chelated to diethylenetriamine-penta-acetate ( 99mTc-DTPA) in amiodarone induced pulmonary disease, 40 individuaIs were studied in four groups. Group I: 10 normal non smoking volunteers (8 men and 2 women ), whose mean age was 56.80 years. Group lI: 10 normal smoking volunteers ( 6 men and 4 women ), aging 27.50 years in average. Group III: 10 non smoking patients ( 4 men and women ), aging 52.90 years in average, who were chronically taking oral amiodarone. Group IV: 10 patients with amiodarone induced pul- monary disease (8 men and 2 women), four non-smokers, two smokers and four previous smokers. Their mean age was 62.90 years. AIl of them were taking oral amiodarone and none has smoked in the 4 weeks previous to the study. After spirometry, where a volume-time curve was registered, alI individuaIs inhaled 740 MBq of 99mTc-DTPA diluted in 4 ml of saline, for five minutes. Pulmonary images were obtained in a computadorized scintillation camera and 9 regions of interest were selected. A clearance curve of each region was determined, from which the effective half-life in minutes (T 1/2 ) and the alveolar-capilar clearance rate per minute ( k%/min ) of the radiolabeled aerosol were mea- sured. The spirometric analys disclosed a statistically lower value of the forced vital capacity ( FVC ) and forced expiratory volume in the first second ( FEV1 ) in the patients of group IV when compared to group I. The total radioactivity count for both lungs were not influenced by FVC and FEV1. The 99mTc-DTPA clearance rate was higher in groups 11 and IV, but these two groups could not be statistically differentiated. Based on these results it 1s concluded: patients with amiodarone induced pulmonary pneumonitis have higher clearance rates of 99m Tc-DTPA than normal non smoking controls and than patients taking amiodarone but with no lung toxicity. It is not possible to separate patients with amiodarone induced disease from normal smokers by determining 99m Tc-DTPA clearance rates. The determination of the alveolar-epithelial barrier integrity by 99m Tc-DTPA clearance rate is a more sensitive test than spirometry in the evaluation of amiodarone induced pneumonitis making it possible to differentiate these patients from those who take the drug and have no lung toxicity

Com o objetivo de se avaliar a importância do \"clearance\" do dietilenotriamino-pentacetato marcado com Tecnécio 99m (DTPA-Tecnécio-99m) em portadores de pneumopatia por amiodarona foram estudados 40 indivíduos, em quatro grupos. Grupo I: 10 voluntários normais, assintomáticos e não fumantes (8 homens e 2 mulheres), com média de idade de 56,80 anos. Grupo II: 10 voluntários normais, assintomáticos e fumantes (6 homens e 4 mulheres ), com média de idade de 27,50 anos. Grupo III: 10 pacientes não fumantes ( 4 homens e 5 mulheres ), com média de idade de 52,90 anos. Todos faziam uso crônico de amiodarona por via oral. Grupo IV: 10 pacientes portadores de pneumopatia por amiodarona, quatro ex-fumantes, dois fumantes e quatro não fumantes ( 8 homens e 2 mulheres) com média de idade de 52,90 anos. Todos faziam uso de amiodarona por via oral e nenhum fumou nas 4 semanas que precederam o estudo. Após espirometria que constou do registro da curva volume-tempo, todos inalaram 4 ml de solução salina contendo 740 MBq de DTPA Tecnécio-99m, durante cinco minutos. Através de uma c~mara de cintilação computadorizada foram obtidas imagens pulmonares, definindo-se 9 áreas de interesse. Para cada região escolhida foi determinada uma curva de \"clearance\" extraindo-se o valor de meia-vida biológica em minu- tos ( T 1/2 ) e a taxa percentual de \" clearance\" alvéolo capilar do radioaerossol por minuto (K%/min). Observamos que, das variáveis espirométricas consideradas, a capacidade vital forçada (CVF) e o volume expiratório forçado no 1 segundo (VEF1) mostraram diferenças significantes entre os grupos I e IV. A contagem total de radioatividade de ambos os pulmões não mostrou relação com a CVF e o VEF1. O \" clearance \" pulmonar do DTPA Tecnécio-99m foi maior nos grupos 11 e IV, porém não permitindo sua diferenciação. Estes resultados permitem concluir: Os pacientes portadores de pneumonite por amiodaro- na apresentam\" clearance \" alvéolo-capilar de DTPA Tecnécio-99m significativamente maior que os indivíduos do grupo de normais não fumantes. Este fato também se verificou em relação aos pacientes em uso crônico de amiodarona mas sem evidências de pneumopatia. Não é possível diferenciar os fumantes dos portadores de pneumonite por amiodarona através da análise da integridade da barreira alvéolo-epitelial com DTPA Tecnécio-99m. Comparativamente, o estudo da integridade alvéolo-epitelial pelo \"clearance\" pulmonar de DTPA Tecnécio-99m é mais sensível que a espirometria na avaliação da pneumonite por amiodarona, permitindo diferenciar estes pacientes dos que fazem uso crônico da droga / In order to evaluate the role of the clearance of 99m Technetium chelated to diethylenetriamine-penta-acetate ( 99mTc-DTPA) in amiodarone induced pulmonary disease, 40 individuaIs were studied in four groups. Group I: 10 normal non smoking volunteers (8 men and 2 women ), whose mean age was 56.80 years. Group lI: 10 normal smoking volunteers ( 6 men and 4 women ), aging 27.50 years in average. Group III: 10 non smoking patients ( 4 men and women ), aging 52.90 years in average, who were chronically taking oral amiodarone. Group IV: 10 patients with amiodarone induced pul- monary disease (8 men and 2 women), four non-smokers, two smokers and four previous smokers. Their mean age was 62.90 years. AIl of them were taking oral amiodarone and none has smoked in the 4 weeks previous to the study. After spirometry, where a volume-time curve was registered, alI individuaIs inhaled 740 MBq of 99mTc-DTPA diluted in 4 ml of saline, for five minutes. Pulmonary images were obtained in a computadorized scintillation camera and 9 regions of interest were selected. A clearance curve of each region was determined, from which the effective half-life in minutes (T 1/2 ) and the alveolar-capilar clearance rate per minute ( k%/min ) of the radiolabeled aerosol were mea- sured. The spirometric analys disclosed a statistically lower value of the forced vital capacity ( FVC ) and forced expiratory volume in the first second ( FEV1 ) in the patients of group IV when compared to group I. The total radioactivity count for both lungs were not influenced by FVC and FEV1. The 99mTc-DTPA clearance rate was higher in groups 11 and IV, but these two groups could not be statistically differentiated. Based on these results it 1s concluded: patients with amiodarone induced pulmonary pneumonitis have higher clearance rates of 99m Tc-DTPA than normal non smoking controls and than patients taking amiodarone but with no lung toxicity. It is not possible to separate patients with amiodarone induced disease from normal smokers by determining 99m Tc-DTPA clearance rates. The determination of the alveolar-epithelial barrier integrity by 99m Tc-DTPA clearance rate is a more sensitive test than spirometry in the evaluation of amiodarone induced pneumonitis making it possible to differentiate these patients from those who take the drug and have no lung toxicity

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