Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:3.4.15.1 (ACE)
18,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 62-year-old woman was admitted to our hospital because of tingling numbness in the trunk and upper extremities. She was well until 18 days earlier, when she began to feel tingling numbness on the ulnar side of the left arm. During the next two weeks it spread gradually over the trunk and ulnar side of the bilateral arms. She had also progressive difficulty in taking hold of objects. On neurological examination she was alert and cooperative with normal articulation. The neck was supple. The cranial nerves were intact. Superficial sensation was bilaterally hypesthetic in the distribution from the 7th cervical through 12th thoracic segments. Mild weakness was distally noted in the upper extremities. Deep tendon reflexes were reduced or absent without laterality. Plantar responses were bilaterally flexor. Coordination and gait were normal. Routine laboratory examinations including blood counts, blood chemistries and urinalysis were unremarkable. Serum angiotensin converting enzyme (ACE) was slightly elevated. A lumbar puncture yielded clear, colorless cerebrospinal fluid (CSF) containing 22 white cells/mm3 and protein of 106 mg/dl. Conventional nerve conduction studies were normal. F-wave conduction studies revealed elevated F-ratios for the upper and lower extremities. Studies of short-latency somatosensory evoked potential showed mild prolongation of N13 recorded after stimulation of the right median nerve. An X-ray film of the spine was unremarkable except for mild narrowing of the C5-6 intervertebral disk space. Postcontrast magnetic resonance imaging of the spine with gadolinium-DTPA was unrevealing as well as a precontrast study. A myelogram disclosed enlarged lateral filling defects corresponding to cervical nerve roots from C6 through C8 bilaterally.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of sarcoid polyradiculopathy with nerve roots swelling demonstrated by myelography]. 133 26

Radioisotopic renal scanning after angiotensin converting enzyme inhibition (ACEI) has proven to be an exciting area for research. The biologic activity of markers such as DTPA and hippuran, when combined with the physiological effects of ACEI, may provide noninvasive methods of diagnosing both renal artery stenosis and renovascular hypertension. Recent investigators have demonstrated that the sensitivities and specificities of these tests may vary widely; these differences are probably due to variations in study design, patient population, diagnostic criteria, and outcome measurements. We have reviewed these studies and discuss these possible sources of variation and their impact on the clinical usefulness of these diagnostic tests, especially in relation to the prevalence of disease in the population. Current results suggest that the post-ACEI DTPA scan is relatively accurate in the diagnosis of renal artery stenosis, with sensitivity generally greater than 90% and specificity around 95%. However, the best results in predicting the response to angioplasty or surgery in patients with renal artery stenosis have been with the use of post-ACEI hippuran in combination with furosemide (sensitivity, 96%; specificity, 95%). With confirmation of these findings and continued investigation, it is expected that accurate noninvasive tests will be available for widespread clinical use in the near future.
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PMID:Diagnostic usefulness of renal scanning after angiotensin converting enzyme inhibitors. 188 44

The value of renography before and after angiotensin converting enzyme inhibition with captopril (captopril renography) as a test for renovascular hypertension was studied in fourteen hypertensive patients. The captopril renography was performed with 99mTc-DTPA by means of a gammacamera, allowing determination of single kidney glomerular filtration rate (SKGFR). In all patients determination of renal vein plasma renin concentration and renal angiography were carried out. Eleven patients showed an elevated unilateral renin secretion. All of these had a significant decrease of SKGFR in one or both kidneys after captopril. Three patients without a lateralized renal renin secretion showed no change in SKGFR. In five patients with presumed essential hypertension there was no change in SKGFR during captopril renography. Captopril renography with 99mTc-DTPA gammacamera renography is a promising tool for identification of unilateral increased renin secretion in hypertensive patients suspected of renovascular hypertension.
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PMID:[Captopril renography in the diagnosis of renovascular hypertension]. 205 27

Lung involvement was studied by perfusion scan, ventilation scan, pulmonary clearance rate of 99mTc DTPA and pulmonary function tests in 20 patients with systemic sclerosis (SSc). Decreased plasma angiotensin converting enzyme (ACE) activity and increased levels of von Willebrand Factor Antigen (vWF:Ag) were found in all patients with SSc. The relationship between ACE levels and lung involvement was not statistically significant, however levels of vWF:Ag correlated with parameters of lung vascular alterations. An inverse relationship between the reduced ACE levels and ESR was found. It is likely that ACE levels reflect the inflammatory aspect of the disease. Further studies of ACE synthesis, release and inhibition are needed to determine the mechanism of the observed decreased activity in SSc.
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PMID:Clinical correlations of plasma angiotensin converting enzyme (ACE) activity in systemic sclerosis: a longitudinal study of plasma ACE level, endothelial injury and lung involvement. 217 47

99mTc-DTPA clearance was studied in ten healthy non smokers, five asymptomatic smokers and nine non smoking patients with sarcoidosis in the supine position with a dual head gamma camera allowing simultaneous information of regional clearance rates in frontal and dorsal projections. In the patients with sarcoidosis, a bronchoalveolar lavage was performed prior to the clearance study. DTPA clearance rate was measured during 60-90 min and data were corrected for recirculating radioactivity. The coefficients of variation for measurements on 2 consecutive days in the 10 healthy non smokers were 9%-11% for the right and left lung, anterior and posterior projections. The T1/2 calculated from total lung projections were 90-92 min for the anterior view and 84-85 min for the posterior view. Regional measurements did not add further information. No apico-basal difference was found but there was a significant fronto-dorsal gradient in 99mTc-DTPA clearance in the supine position. Smokers had significantly (P less than 0.01) faster clearance rates (T1/2 28 +/- 10 min) than healthy controls. In the sarcoidosis group clearance rates were increased in four patients and no relationships were found between DTPA clearance rates and inflammatory markers (lymphocytes, albumin, ACE) in the bronchoalveolar lavage fluid.
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PMID:99mTc-DTPA clearance measured by a dual head gamma camera in healthy subjects and patients with sarcoidosis. Studies of reproducibility and relation to bronchoalveolar lavage findings. 264 22

Identification of patients with renovascular hypertension (RVH) among the larger group of patients with essential hypertension has been aided by a wide variety of in vitro and in vivo nuclear medicine procedures. The most valuable in vitro procedure remains the radioimmunoassay (RIA) for renin activity obtained from individual renal vein catheterization studies. Lateralizing renin activity provides valuable prognostic information about the likelihood for surgical cure of RVH. Older in vivo procedures for the diagnosis of RVH included rectilinear scanning and probe renography, which suffered from poor resolution and specificity, respectively. These tests have been replaced by computer-interfaced gamma camera scintirenography using 131I- or 123I-labeled orthoiodohippurate (OIH), or scintiangiography using 99mTc-DTPA. False-positive (FP) results for RVH persist due to a wide variety of relatively common conditions that can cause asymmetric renal size and function, including outflow obstruction and parenchymal renal disease. Newer approaches promise to improve the specificity of nuclear medicine procedures for identification of RVH. In particular, the number of FP exams appears to improve when scintirenography is performed before and after the administration of oral angiotensin converting enzyme (ACE) inhibitors, using either 99mTc-DTPA or OIH. The incentive for improved diagnostic testing has increased with the availability of percutaneous transluminal angioplasty (PCTA) for treatment of renal artery stenosis (RAS). Follow up of PCTA with scintirenography is of great value in assessing its effect on renal function and in evaluating the subsequent clinical course of the patient.
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PMID:Differential diagnosis and management of renovascular hypertension through nuclear medicine techniques. 265 10

Renal DTPA studies were analysed to produce numerical data of renal function (blood flow, glomerular filtration, and excretion), and this was used as an adjunct to the routine imaging information in a study of renal artery stenosis (RAS). The results show an overall accuracy of 81%, with a sensitivity of 96% and a specificity of 61%. In patients with RAS, beta-blocking drugs reduced the difference between the two kidneys. ACE-inhibiting drugs appeared to preserve renal blood flow but also to cause a deterioration in the glomerular filtration rate of kidneys with RAS. An explanation is proposed, in which renal capillary pressure is more important for function than is renal blood flow.
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PMID:A comprehensive analysis of renal DTPA studies. III. Renal artery stenosis. 288 22

In nuclear medicine new trends in the diagnosis of renal function are based on the introduction of new radiopharmaceuticals, improvements in the methodological part of the procedure and precise pharmacological intervention in response to given indications. Tc99m mercaptoacetyltriglycine (Tc99m MAG3) was tested as replacement for I123 orthoiodohippuric acid (I123 oIH) both in the form of a HPLC purified substance and as an impure kit preparation. HPLC purified Tc99m MAG3 clearance determinations in anuric patients showed a low extrarenal excretion amounting to only about 5% of the total clearance in normal patients. Kit preparations yielded about 90% of the labelled product; impurities were pertechnetate, reduced hydrolyzed Tc99m and chemically unidentified labelled products which showed a significantly lower renal, but increased hepatobiliary excretion in comparison with Tc99m MAG3. The renal clearance with kit preparations of Tc99m MAG3 was 55% of the clearance with oIH at a comparable urinary excretion. Significantly higher protein binding and therefore, a decrease in the distribution volume of Tc99m was found in comparison with I123 oIH. No difference was recorded between the two substances with respect to the renogram curves in normal subjects, apart from a modest delay in the elimination of Tc99m MAG3. For clinical purposes kit preparations of Tc99m MAG3 proved equal to I123 oIH. The influence of angiotensin converting enzyme (ACE) inhibitors (captopril) leads to characteristic changes in the renograms of patients with Goldblatt hypertension. Quantitative criteria for the evidence of haemodynamically significant renal artery stenosis were derived from investigations without and with captopril (25 mg) (I123 oIH and Tc99m DTPA) in 21 patients with essential hypertension. The criteria were defined as follows: a delay in peak activity (Tmax) in the I123 oIH captopril renogram exceeding 2 minutes as compared with the baseline value and/or a lower uptake of Tc99m DTPA in comparison with the uptake of I123 oIH (uptake quotient I123 oIH/Tc99m DTPA greater than 1.2). The diagnostic and prognostic potential of the captopril renogram was compared with that of the captopril test by investigating 34 patients with renal artery stenosis (23 uni-, 11 bilateral) (atherosclerosis: 23, fibromuscular hyperplasia: 11). The captopril renogram was positive more often (n = 12) than the captopril test (n = 4) in patients without renal functional impairment of the stenosed kidney. Similar results were obtained with both methods in patients with atrophic kidneys: captopril renography was positive in all cases with a positive captopril test.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[New aspects of nuclear medicine diagnosis of kidney function: improved potential by pharmacologic intervention and quantitative analytic procedures]. 297 26

In order to improve on the technique of noninvasive detection of renal artery stenosis, we studied the effects of angiotensin converting enzyme inhibition with captopril on individual kidney hemodynamics and function as assessed by technetium-99m diethylenetriaminepentaacetic acid [( 99mTc]DTPA) renal flow studies and iodine-131 orthoiodohippurate [( 131I]hippuran) renography in experimental Goldblatt's hypertension. In two-kidney, one-clip (renin-dependent) hypertension, captopril (1.5 mg/kg bolus with 1.5 mg/min infusion) reduced mean arterial pressure (MAP) and ipsilateral glomerular filtration rate (GFR) without changes in the contralateral kidney. Captopril infusion resulted in alterations in both the [99mTc]DTPA and [131I]hippuran studies, which were most evident in the 15-min [99mTc]DTPA renal flow studies. In one-kidney, one-clip (volume-dependent) hypertension, captopril reduced MAP but did not alter GFR, renal plasma flow, or the radionuclide studies. These studies suggest that the [99mTc]DTPA renal flow study coupled with captopril challenge may unmask intrarenal angiotensin II-dependent functional and hemodynamic changes of the stenotic kidney, and offers promise in the detection of renin-dependent hypertension.
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PMID:Captopril renography in two kidney and one kidney Goldblatt hypertension in dogs. 329 73

Suppression of the renin-angiotensin system (RAS) by angiotensin converting enzyme (ACE) inhibition may induce renal failure in patients with bilateral renal artery stenosis. Recent scintigraphic studies with the glomerular tracer technetium-99m-diethylenetriaminepenta-acetate (99m-Tc DTPA) indicate that in patients with unilateral renal artery stenosis, glomerular filtration rate (GFR) may be markedly reduced in the affected kidney after inhibition of ACE. This finding reflects the important role of the RAS in maintaining GFR (by increasing postglomerular resistance) in states of low renal perfusion pressure. Preliminary observations suggest that this scintigraphic test might be useful in the detection of renovascular hypertension.
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PMID:Kidney scintigraphy after ACE inhibition in the diagnosis of renovascular hypertension. 391 23


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