The medical records of 90 patients with acromegaly were reviewed. Arthralgias were noted in 76% of the patients with 17% having the onset of joint pain concomitant with the clinical onset of acromegaly. Of 47 patients followed prospectively for 5 or more years after pituitary irradiation, six (12.8%) were unaffected by arthralgias. A statistically higher mean baseline growth hormone level was found for the 19 (40.4%) radiotherapy patients who had severe and disabling arthropathy. Mean intervals between clinical onset of acromegaly and the development of arthropathic symptoms were shorter (4.1 years) for patients over 40 years of age and longer (9.7 years) for those under 31 years of age. Severely affected patients tended to have increased joint spaces in both weight-bearing and non-weight-bearing joints followed by a progressive decrease in joint spaces. Arthropathy is a common complication of acromegaly and may progress independently of a fall in growth hormone, induced by any form of treatment, once significant cartilage overgrowth develops. Cartilage overgrowth is a predisposing factor in the development of an arthropathy associated with the wide range of growth hormone levels characteristic of acromegaly.
Sclerosteosis or Van Buchem's disease is a rare genetic craniotubular hyperostosis that becomes evident in early childhood and is associated with progressive involvement of the skull. The pathologic changes in the cranium noted on CT are described in three cases. Although the disease is incurable, CT is useful to display the morbid anatomy of the cranium before palliative surgery.
Ethiodized Oil Emulsion 13 (EOE-13) is an intravenous liver-spleen specific CT contrast agent. We infused EOE-13 directly into the hepatic arteries of five rhesus monkeys. Normal saline was administered in the same fashion in two control animals. Serial laboratory studies showed no major toxicity over a seven-day period. Intra-arterial EOE-13 has potential usefulness in the evaluation of hepatic artery infusion chemotherapy.
Perfusion of absolute ethyl alcohol into the middle cerebral artery of six rhesus monkeys was performed using the Pevsner miniballoon catheter system. The animals were sacrificed by thoracotomy and intracardiac perfusion of a mixed aldehyde solution for fixation. Preliminary angiography and electron microscopy suggest absolute ethyl alcohol is a good neurovascular occlusive agent, and a possible replacement for isobutyl 2-cyanoacrylate in the treatment of angiomas and tumors.
Summar y : Positron emission tomography (PE T) was em ployed to examine time-dependent changes in blood brain barrier (BBB) permeability to [68Ga]ethylenedi aminetetraacetate (EDTA) in the rhesus monkey, fol lowing reversible barrier opening by intracarotid infusion of a hypertonic mannitol solution. The PET technique, when combined with measurements of plasma radioac tivity, provided a quantitative measure of the cerebro vascular permeability-area product (PA) at different times The blood-brain barrier (BBB) at the cerebral vasculature is due to a continuous layer of endo thelial cells connected by tight junctions (Reese and Karnovsky, 1967; Rapoport, 1976). When the BBB integrity is disturbed in a number of pathological conditions, including intracerebral tumors, trauma, vasculitis, stroke, and hypertensive encephalop athy, brain metabolism and function are altered, and cerebral edema results (Rapoport, 1976; Pappius et aI. , 1979; Rapoport et aI. , 1980a). In addition, a method exists for opening the BBB reversibly in animals and humans. This disturbs cerebral metab olism and function only transiently (Rapoport et aI. The method involves the intraca rotid infusion of a hypertonic solution of a water soluble agent such as mannitol or arabinose, and results in transient modification of the tight junc-323 following mannitol infusion. Hypertonic mannitol treat ment reversibly increased PA to [68Ga]EDTA more than lO-fold; much of the barrier effect was over by 10 min after mannitol treatment. The results show that PET can be used to measure transient changes in BBB integrity in specific brain regions, under in vivo, noninvasive condi tions. Ke y Words: Blood-brain barrier-[68Ga] Ethylenediaminetetraacetate-Permeability-Positron emission tomography. Several techniques have been employed to ex amine BBB integrity in humans. These include "1-scintigraphic brain scanning, positron emission to mography (PET), and computerized transmission axial tomography (CT), all of which employ intra vascular water-soluble molecules, which normally have a low permeability at the BBB, to detect brain because of the absence of an ad equate model to evaluate the BBB integrity quan titatively, these techniques provide only semiquan titative data. We thought it of interest, therefore, to develop a quantitative method to measure BBB integrity in humans, so as to localize BBB dysfunction in re lation to pathological changes within the brain. We decided to employ the reversible osmotic procedure to open the BBB in rhesus monkeys, as the param eters of this procedure and its effects have been reported fully in terminal experiments with rats and monkeys (Rapoport and Thompson, 1973; Ohno …
