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Vol. 66, No. 1, 1999
Issue release date: January–February 1999
Respiration 1999;66:46–51
(DOI:10.1159/000029336)

Using 99mTc-DTPA Radioaerosol Inhalation Lung Scintigraphies to Detect the Lung Injury Induced by Consuming Sauropus androgynus Vegetable and Comparison with Conventional Pulmonary Function Tests

Kao C.H.a · Ho Y.J.c · Wu C.L.b · ChangLai S.P.d
aDepartment of Nuclear Medicine and bDivision of Chest Medicine, Taichung Veterans General Hospital, cDepartment of Radiology, Jen-Al Hospital, and dDepartment of Nuclear Medicine, Chung-Shan Medical and Dental College Hospital, Taichung, Taiwan
email Corresponding Author

Abstract

Consuming Sauropus androgynus, a Malaysian plant, to reduce body weight began to become fashionable in Taiwan in 1994. According to some reports, people consuming this vegetable developed lung injuries. From July to November 1995, there were 81 nonsmoking women admitted to our hospital. Thirty-six cases had respiratory symptoms/signs and the remaining 45 had no symptoms/signs. We investigated these patients with pulmonary function tests (PFT) and technetium-99m DTPA radioaerosol inhalation lung scintigraphies (DTPA lung scan), a test to evaluate the lung ventilation and alveolar epithelial permeability. Eighteen patients had abnormal results in PFT, including obstructive type (n = 17), restrictive type (n = 5), and both (n = 4). There were 33 patients with abnormalities in DTPA lung scans, including unhomogeneous deposition of DTPA radioaerosols (n = 19), faster clearance of radioaerosols from lung (n = 26), and both (n = 12). Analyzing the results, we found that the patients with respiratory symptoms had a higher incidence of abnormal results of PFT and DTPA lung scans than the patients without respiratory symptoms (p < 0.05). Besides, we found that the DTPA lung scan was more sensitive than chest x-ray and PFT in detecting the lung injuries related to the consumption of S. androgynus (p < 0.05). Consuming S. androgynus can result in symptomatic or asymptomatic lung injuries, manifested as obstructive or restrictive ventilatory impairment, unhomogeneous radioaerosol distribution, and increased alveolar epithelial permeability. In addition, measurement of the 99mTc-DTPA clearance is the most sensitive test to detect the lung injuries caused by consuming S. androgynus.


 goto top of outline Key Words

  • Technetium-99m DTPA
  • Radioaerosol inhalation
  • Scintigraphies, lung
  • Sauropus androgynus vegetable

 goto top of outline Abstract

Consuming Sauropus androgynus, a Malaysian plant, to reduce body weight began to become fashionable in Taiwan in 1994. According to some reports, people consuming this vegetable developed lung injuries. From July to November 1995, there were 81 nonsmoking women admitted to our hospital. Thirty-six cases had respiratory symptoms/signs and the remaining 45 had no symptoms/signs. We investigated these patients with pulmonary function tests (PFT) and technetium-99m DTPA radioaerosol inhalation lung scintigraphies (DTPA lung scan), a test to evaluate the lung ventilation and alveolar epithelial permeability. Eighteen patients had abnormal results in PFT, including obstructive type (n = 17), restrictive type (n = 5), and both (n = 4). There were 33 patients with abnormalities in DTPA lung scans, including unhomogeneous deposition of DTPA radioaerosols (n = 19), faster clearance of radioaerosols from lung (n = 26), and both (n = 12). Analyzing the results, we found that the patients with respiratory symptoms had a higher incidence of abnormal results of PFT and DTPA lung scans than the patients without respiratory symptoms (p < 0.05). Besides, we found that the DTPA lung scan was more sensitive than chest x-ray and PFT in detecting the lung injuries related to the consumption of S. androgynus (p < 0.05). Consuming S. androgynus can result in symptomatic or asymptomatic lung injuries, manifested as obstructive or restrictive ventilatory impairment, unhomogeneous radioaerosol distribution, and increased alveolar epithelial permeability. In addition, measurement of the 99mTc-DTPA clearance is the most sensitive test to detect the lung injuries caused by consuming S. androgynus.


 goto top of outline References
  1. Lin TJ, Lu CC, Chen KW, Deng JF: Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable. J Toxicol Clin Toxicol 1996;34:1–8.

    External Resources

  2. Pulmonary Utilities Operator’s Manual. Yorba Linda, SensorMedics, 1988.
  3. American Thoracic Society: Lung function testing: Selection of reference values and interpretative strategies. Am Rev Respir Dis 1991;144:1202–1218.
  4. Kao CH, Huang CK, Tsai SC, Wang SJ, Chen GH: Evaluation of lung ventilation and alveolar permeability. J Nucl Med 1996;37:437–441.
  5. ChangLai SP, Kao CH, Wang SJ, Lin WY, Lan JL: The change in the distribution of Tc-99m human serum albumin radioaerosol in asthma after one week-long course of corticosteroid inhalation treatment. Clin Nucl Med 1995;20:626–629.
  6. Taplin GV, Tashkin DP, Chopra SK, et al: Early detection of chronic obstructive pulmonary disease using radionuclide lung-imaging procedures. Chest 1977;71:567–575.
  7. Pulera N, Santolicandro A, Bernard P, Solfanelli S, Giuntini C: Monodisperse labeled aerosol to visualize airflow redistribution in the lung after a mucokinetic drug. J Nucl Med Allied Sci 1989;33:258–263.

    External Resources

  8. Padmavathi P, Rao MP: Nutritive value of Sauropus androgynus leaves. Plant Foods Hum Nutr 1990;40:107–113.
  9. Bender AE, Ismail KS: Nutritive value and toxicity of Sauropus androgynus. Proc Nutr Soc 1973;32:79A–80A.

    External Resources

  10. Sewester CS, Dombeck CE, Olin BR, Kastrup EK, Hebel SK: Drug Facts and Comparisons. St. Louis, Facts and Comparisons, 1994, pp 735–737.
  11. Epler GR: Disease of the Bronchioles. New York, Raven Press, 1994, pp 107–108.
  12. Ezri T, Kunichezky S, Eliraz A, Soroker D, Halperin D, Schattner A: Bronchiolitis obliterns – Current concepts. Q J Med 1994;87:1–10.

    External Resources

  13. Satub NC, Hyde RW, Crandall E: NHLB Workshop Summary – Workshop on techniques to evaluate lung alveolar microvascular injury. Am Rev Respir Dis 1990;141:1071–1077.
  14. Susskind H: Technetium-99m-DTPA aerosol to measure alveolar-capillary membrane permeability. J Nucl Med 1994;5:207–209.
  15. Kao CH, Hsu YH, Wang SJ: Evaluation of alveolar permaebility and lung ventilation in patients with chronic renal failure using Tc-99m DTPA radioaerosol inhalation lung scintigraphy. Lung 1996;174:153–158.
  16. Sweatman MC, Pantin CF, Lawrence R, Turner-Warwick M: Lung permeability in adult obliterative bronchiolitis. Respir Med 1989;83:323–327.

 goto top of outline Author Contacts

Chia-Hung Kao, MD
Department of Nuclear Medicine, Taichung Veterans General Hospital
160 Taichung Harbor Road, Section 3
Taichung 40705, Taiwan (Republic of China)
Tel. +886 43741349, Fax +886 43741348, E-Mail kao@vghtc.vghtc.gov.tw


 goto top of outline Article Information

Received: Received: June 23, 1997
Accepted after revision: April 20, 1998
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 3, Number of References : 16


 goto top of outline Publication Details

Respiration (International Review of Thoracic Diseases)
Founded 1944 as ‘Schweizerische Zeitschrift für Tuberkulose und Pneumonologie’ by E. Bachmann, M. Gilbert, F. Häberlin, W. Löffler, P. Steiner and E. Uehlinger, continued 1962–1967 as ‘Medicina Thoracalis’

Vol. 66, No. 1, Year 1999 (Cover Date: January-February 1999)

Journal Editor: C.T. Bolliger, Basel; H. Zerzog, Basel
ISSN: 0025–7931 (print), 1423–0356 (Online)

For additional information: http://www.karger.com/journals/res


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Consuming Sauropus androgynus, a Malaysian plant, to reduce body weight began to become fashionable in Taiwan in 1994. According to some reports, people consuming this vegetable developed lung injuries. From July to November 1995, there were 81 nonsmoking women admitted to our hospital. Thirty-six cases had respiratory symptoms/signs and the remaining 45 had no symptoms/signs. We investigated these patients with pulmonary function tests (PFT) and technetium-99m DTPA radioaerosol inhalation lung scintigraphies (DTPA lung scan), a test to evaluate the lung ventilation and alveolar epithelial permeability. Eighteen patients had abnormal results in PFT, including obstructive type (n = 17), restrictive type (n = 5), and both (n = 4). There were 33 patients with abnormalities in DTPA lung scans, including unhomogeneous deposition of DTPA radioaerosols (n = 19), faster clearance of radioaerosols from lung (n = 26), and both (n = 12). Analyzing the results, we found that the patients with respiratory symptoms had a higher incidence of abnormal results of PFT and DTPA lung scans than the patients without respiratory symptoms (p < 0.05). Besides, we found that the DTPA lung scan was more sensitive than chest x-ray and PFT in detecting the lung injuries related to the consumption of S. androgynus (p < 0.05). Consuming S. androgynus can result in symptomatic or asymptomatic lung injuries, manifested as obstructive or restrictive ventilatory impairment, unhomogeneous radioaerosol distribution, and increased alveolar epithelial permeability. In addition, measurement of the 99mTc-DTPA clearance is the most sensitive test to detect the lung injuries caused by consuming S. androgynus.



 goto top of outline Author Contacts

Chia-Hung Kao, MD
Department of Nuclear Medicine, Taichung Veterans General Hospital
160 Taichung Harbor Road, Section 3
Taichung 40705, Taiwan (Republic of China)
Tel. +886 43741349, Fax +886 43741348, E-Mail kao@vghtc.vghtc.gov.tw


 goto top of outline Article Information

Received: Received: June 23, 1997
Accepted after revision: April 20, 1998
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 3, Number of References : 16


 goto top of outline Publication Details

Respiration (International Review of Thoracic Diseases)
Founded 1944 as ‘Schweizerische Zeitschrift für Tuberkulose und Pneumonologie’ by E. Bachmann, M. Gilbert, F. Häberlin, W. Löffler, P. Steiner and E. Uehlinger, continued 1962–1967 as ‘Medicina Thoracalis’

Vol. 66, No. 1, Year 1999 (Cover Date: January-February 1999)

Journal Editor: C.T. Bolliger, Basel; H. Zerzog, Basel
ISSN: 0025–7931 (print), 1423–0356 (Online)

For additional information: http://www.karger.com/journals/res


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Lin TJ, Lu CC, Chen KW, Deng JF: Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable. J Toxicol Clin Toxicol 1996;34:1–8.

    External Resources

  2. Pulmonary Utilities Operator’s Manual. Yorba Linda, SensorMedics, 1988.
  3. American Thoracic Society: Lung function testing: Selection of reference values and interpretative strategies. Am Rev Respir Dis 1991;144:1202–1218.
  4. Kao CH, Huang CK, Tsai SC, Wang SJ, Chen GH: Evaluation of lung ventilation and alveolar permeability. J Nucl Med 1996;37:437–441.
  5. ChangLai SP, Kao CH, Wang SJ, Lin WY, Lan JL: The change in the distribution of Tc-99m human serum albumin radioaerosol in asthma after one week-long course of corticosteroid inhalation treatment. Clin Nucl Med 1995;20:626–629.
  6. Taplin GV, Tashkin DP, Chopra SK, et al: Early detection of chronic obstructive pulmonary disease using radionuclide lung-imaging procedures. Chest 1977;71:567–575.
  7. Pulera N, Santolicandro A, Bernard P, Solfanelli S, Giuntini C: Monodisperse labeled aerosol to visualize airflow redistribution in the lung after a mucokinetic drug. J Nucl Med Allied Sci 1989;33:258–263.

    External Resources

  8. Padmavathi P, Rao MP: Nutritive value of Sauropus androgynus leaves. Plant Foods Hum Nutr 1990;40:107–113.
  9. Bender AE, Ismail KS: Nutritive value and toxicity of Sauropus androgynus. Proc Nutr Soc 1973;32:79A–80A.

    External Resources

  10. Sewester CS, Dombeck CE, Olin BR, Kastrup EK, Hebel SK: Drug Facts and Comparisons. St. Louis, Facts and Comparisons, 1994, pp 735–737.
  11. Epler GR: Disease of the Bronchioles. New York, Raven Press, 1994, pp 107–108.
  12. Ezri T, Kunichezky S, Eliraz A, Soroker D, Halperin D, Schattner A: Bronchiolitis obliterns – Current concepts. Q J Med 1994;87:1–10.

    External Resources

  13. Satub NC, Hyde RW, Crandall E: NHLB Workshop Summary – Workshop on techniques to evaluate lung alveolar microvascular injury. Am Rev Respir Dis 1990;141:1071–1077.
  14. Susskind H: Technetium-99m-DTPA aerosol to measure alveolar-capillary membrane permeability. J Nucl Med 1994;5:207–209.
  15. Kao CH, Hsu YH, Wang SJ: Evaluation of alveolar permaebility and lung ventilation in patients with chronic renal failure using Tc-99m DTPA radioaerosol inhalation lung scintigraphy. Lung 1996;174:153–158.
  16. Sweatman MC, Pantin CF, Lawrence R, Turner-Warwick M: Lung permeability in adult obliterative bronchiolitis. Respir Med 1989;83:323–327.