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Biomedical subjects

A F Jacobson

Publications and source records attributed to A F Jacobson.

At least 73 records · Page 4Linked to original sources
PubMed1990

Persistent chest pain following oral dipyridamole for thallium 201 myocardial imaging.

A patient was admitted to the hospital with acute chest pain. After acute myocardial infarction was ruled out, he underwent a stress thallium 201 scintigraphy using oral dipyridamole and developed persistent angina with ST-segment elevation. This complication has not been reported previously. It is recommended that appropriate intervention be available if severe ischemia develops following administration of dipyridamole for diagnostic imaging.

Angina Pectoris↗
PubMed1990

Coumadin-induced gastrointestinal hemorrhage associated with an ileal duplication.

A 31-year-old man had recurrent gastrointestinal hemorrhage after aortic valve replacement and initiation of anticoagulation therapy with coumadin. Radionuclide bleeding scan and subsequent contrast angiogram demonstrated a site of hemorrhage in the distal ileum, and at surgery a 1.8-cm spherical duplication was found. On histologic examination, the duplication was lined with normal ileal mucosa, and near the mouth of the duplication an inflammatory ulceration proved to be the site of hemorrhage. In a young patient with anticoagulation-associated gastrointestinal hemorrhage, alimentary tract duplication should be considered.

Adult↗
PubMed1990

Bone scans with one or two new abnormalities in cancer patients with no known metastases: reliability of interpretation of initial correlative radiographs.

To determine the reliability of radiographs obtained for correlation with bone scans showing one or two new abnormalities in cancer patients without known metastases, a retrospective study of 306 scans showing such lesions was performed. Overall, 14% of the lesions proved to be malignant. The initial radiographic interpretation was normal for 43% of the new bone scan lesions; 17% of these lesions were metastases. A benign process was identified on radiographs for 38% of the abnormalities; only one (1%) was a metastasis. Twelve percent of new bone scan lesions correlated with radiographic abnormalities considered either suggestive of or consistent with metastasis, of which 24% and 71%, respectively, proved to be metastases. In cancer patients with one or two new bone scan abnormalities, correlative radiographs showing a benign abnormality are reliable. However, if the radiographs are either normal or show findings considered suggestive of or consistent with metastasis, further evaluation or follow-up is warranted.

Bone Diseases↗
PubMed1990

Bone scans with one or two new abnormalities in cancer patients with no known metastases: frequency and serial scintigraphic behavior of benign and malignant lesions.

Scintigraphic, radiologic, and clinical follow-up findings were reviewed in cases in which bone scans (n = 301) showed one or two new abnormalities in patients with malignancy but no known metastases. Metastatic disease was confirmed for 25 of 231 scans (11%) with one new abnormality and for 17 of 70 scans (24%) with two new abnormalities. The prevalence of metastases was 0.06 to 0.13 for lesions in all regions of the skeleton, except the sternum (three of six) and the pelvis (10 of 32). On follow-up scans, in the absence of an interval change in therapy, 19 of 21 metastases became more intense, whereas most benign abnormalities either remained unchanged (47%) or resolved (41%). Benign lesions in the ribs, extremities, and pelvis generally resolved within 12-24 months, while most benign skull and spine abnormalities were still apparent after 35-58 months of follow-up.

Bone Neoplasms↗
PubMed1990

Increased lung uptake on technetium-99m-sulfur colloid liver-spleen scans in patients with hepatic venoocclusive disease following bone marrow transplantation.

Three patients who developed signs and symptoms of liver dysfunction following autologous bone marrow transplantation showed varying degrees of increased lung uptake on technetium-99m-sulfur colloid (99mTc-SC) liver-spleen-scans and were subsequently demonstrated to have hepatic venoocclusive disease (VOD) at autopsy. Although increased lung uptake of labeled colloid has been noted in solid organ and bone marrow transplant patients, an association between this phenomenon and VOD has not been previously reported.

Adult↗
PubMed1990

Association between number and sites of new bone scan abnormalities and presence of skeletal metastases in patients with breast cancer.

Review of 1,441 bone scans performed on 242 breast cancer patients without known skeletal metastases identified 239 scans with new abnormalities. Findings on 54 of these 239 scans (23%) represented bone metastases. The proportion of scans reflecting metastases, grouped by the number of new abnormalities, was: (1) 20/182 (11%); (2) 9/26 (35%); (3) 4/9 (45%); (4) 1/2 (50%); greater than or equal to 5-20/20 (100%). When metastatic disease presented as a bone scan with 1-4 new abnormalities, the spine was the most common site of involvement (18 of 34 (53%)), followed by the skull (5/34; 15%), extremities and sternum (each 4/34; 12%). Rib lesions were the most common new findings on scans with less than 5 new abnormalities (seen on 76 of 219 scans (35%)) but only infrequently represented metastases (n = 2). Considering as indicative of malignancy only, those bone scans which demonstrated either (a) greater than or equal to 5 new abnormalities, (b) initial radiographic correlation suggestive of metastases, or (c) thoracic spine lesions with normal correlative radiographs, the presence of skeletal metastatic disease could be predicted with a sensitivity of 0.80 and a specificity of 0.94.

Bone Neoplasms↗
PubMed1990

Pleuroperitoneal communication associated with malignant ascites. A potential cause for new pleural effusion suggestive of pulmonary embolism.

A patient with metastatic gastric carcinoma and malignant ascites developed sudden-onset dyspnea secondary to a new large left pleural effusion. A radionuclide lung scan performed for suspected pulmonary embolism was indeterminate. Scintigraphy performed following intraperitoneal administration of Tc-99m sulfur colloid subsequently demonstrated rapid accumulation of activity in the left pleural space, indicating the presence of a pleuroperitoneal communication. In a patient with known or suspected ascites, a new pleural effusion, and an indeterminate lung scan, peritoneal scintigraphy may identify the origin of the effusion and obviate the need for further invasive evaluation for possible pulmonary embolism.

Aged↗
PubMed1989

Assessment of myocardial viability with SPECT and PET imaging.

The use of thrombolytic therapy for the treatment of acute myocardial infarction has increased the number of patients presenting for assessment of myocardial viability. Stress SPECT 201Tl perfusion imaging performed in the conventional manner with delayed imaging at 4 hr can identify a large percentage of patients with ischemic but viable areas of myocardium. In some patients, delayed imaging up to as long as 24-48 hr after exercise may be required to show 201Tl redistribution indicative of viability. Thus, in most patients, stress 201Tl scintigraphy will correctly identify the presence of viable myocardium. PET imaging, with its ability to assess blood flow and metabolism separately, offers the ability to identify myocardial areas with diminished blood flow but preserved metabolism. Areas with such a blood flow-metabolism mismatch may benefit from revascularization, even in the absence of 201Tl redistribution. The exact role PET will play in the initial evaluation of patients presenting for assessment of myocardial viability remains to be established as more clinical data are accumulated.

Heart↗
PubMed1989

Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis.

Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using 111In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities.

Abscess↗
PubMed1987

Supine versus upright anterior images: comparison in T1-201 myocardial scintigraphy.

In patients undergoing exercise thallium-201 myocardial scintigraphy, activity in the inferior wall on anterior images may appear diminished when the standard supine view is used, but normal when the view is acquired with the patient upright. To determine the clinical significance of this observation, the distribution of thallium-201 activity was semiquantitatively assessed in supine and upright anterior images obtained immediately after exercise in 93 patients (65 men, 28 women). The presence of inferior wall and coronary artery disease was established with coronary angiography or from documentation of previous myocardial infarction. Supine and upright images were compared with use of receiver operating characteristic curves. In male patients diagnostic accuracy for identification of both inferior wall and coronary artery disease was improved through the use of the upright anterior image. In women, there was no significant difference in reader performance with upright and supine images. Upright anterior images should be routinely obtained in men in order to reduce the frequency of false-positive identification of inferior wall defects.

Adult↗
PubMed1987

Sequential hepatobiliary scintigraphy demonstrating apparent transient biliary obstruction.

A case of acute acalculous cholecystitis in which sequential hepatobiliary scintigraphy demonstrated apparent transient biliary obstruction is presented. An initial technetium-99m diisopropyliminodiacetic acid ([99mTc]DISIDA) study in a patient suspected of acute cholecystitis showed persistent hepatic activity, nonvisualization of the gallbladder, and minimal intestinal activity seen only at 24 hr. Following a second injection of [99mTc]DISIDA administered shortly after the 24-hr image from the first study, the gallbladder and bowel were both visualized within 75 min. At subsequent surgery, acute and chronic cholecystitis were present without evidence of choledocholithiasis or other source of obstruction. Intrahepatic cholestasis following clearance of biliary obstruction may result in late bowel visualization on delayed cholescintigraphic images similar to that seen in partial obstruction. Accurate reflection of the state of hepatobiliary function may require reinjection with [99mTc]DISIDA.

Acute Disease↗
PubMed1986

Comparative efficacy of estazolam, flurazepam, and placebo in outpatients with insomnia.

The efficacy and safety of estazolam, an investigational triazolobenzodiazepine, and flurazepam were compared in 65 insomniac outpatients. Patients completed sleep questionnaires each morning. Global evaluations demonstrated that both treatments were significantly superior to placebo. However, estazolam was preferred over flurazepam in a global rating that reflected how well rested and refreshed the subjects felt on arising. Improvement in complaints of difficulty in going to sleep showed only a trend toward significance favoring estazolam and flurazepam over placebo. Residual daytime drowsiness and fatigue accounted for approximately 70% of all side effects with both active treatments. Significantly more side effects occurred with flurazepam than with estazolam. Flurazepam-treated patients had a significantly more severe rating of adverse reactions than did placebo-treated patients.

Adult↗
PubMed1985

Hypnotic efficacy of a modified triazolodiazepine, brotizolam.

Fifty-nine outpatients with insomnia were treated in a 3-week study to assess the safety and efficacy of a new triazolothienodiazepine with a short t1/2, brotizolam. Therapy was initiated with 0.25 mg at night, but by the end of the study all subjects who were receiving brotizolam were taking 0.50 mg. Results indicate brotizolam efficacy as measured by daily subject and weekly physician questionnaires in essentially all sleep parameters, including global subject and physician evaluation of treatment efficacy, sleep latency and sleep maintenance, and quality of sleep. Tolerance to the hypnotic action of brotizolam was not observed after 21 days of daily dosing.

Azepines↗