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Biomedical subjects

A J Hilson

Publications and source records attributed to A J Hilson.

87 records · Page 5Linked to original sources
PubMed1984

Selective effect of low protein diets in chronic renal diseases.

It has recently been established that the rate of progression of chronic renal failure in man can be slowed by restricting dietary protein. Consequently, the short term and long term effects of a low protein diet on the course of different chronic nephropathies were studied in an attempt to delineate the factors that determine the response to such a diet. When a low protein diet was given for six months renal function improved significantly in nine patients with chronic tubulointerstitial nephritis (p less than 0.025); the diet had a marginally beneficial effect in 12 patients with chronic glomerulonephritis (p less than 0.05) and no effect in nine with hypertensive nephrosclerosis. The heterogeneous functional response in the patients with chronic glomerulonephritis correlated closely with the effect of the diet on these patients' proteinuria (r = 0.76, p less than 0.01). In a short term study (four weeks) of 12 patients with chronic renal failure changes in renal plasma flow were proportional to dietary protein intake. Renal vascular resistance fell during a high protein diet and increased when dietary protein was restricted. The changes in renal plasma flow during the low protein diet correlated well with the patients' long term functional response to the diet (r = 0.76, p less than 0.01). It is concluded that the response to a low protein diet in chronic renal failure is determined, firstly, by the nature of the underlying nephropathy, with maximal benefit being observed in non-glomerular disorders; secondly, by the effect of the diet on the proteinuria in chronic glomerulonephritis; and, thirdly, by the haemodynamic response to the diet, with patients with a reactive renal vascular bed improving with a low protein diet.

Adolescent↗
PubMed1981

An improved method for sacro-iliac joint imaging: a study of normal subjects, patients with sacro-iliitis and patients with low back pain.

A new method is described for quantitative measurement of the uptake of 99mTc--methylene diphosphonate (MDP) by the sacro-iliac joints. The method uses 'regions of interest' providing advantages over the previously described 'slice' method; the two methods are compared in normal subjects, patients with known sacro-iliitis and patients with low back pain. Sacro-iliac activity, as calculated by the sacro-iliac index (SII) in normal patients, was shown to decrease with age in females but not in males. The SII was compared with radiographs of the sacro-iliac joints in the patients with known sacro-iliac joint disease and in those with low back pain. The method is useful for the exclusion of sacro-iliitis as a specific cause of back pain.

Adolescent↗
PubMed1980

Complications of renal transplantation: appearances using Tc-99m-DTPA.

Dynamic renal imaging has now become an essential part of the management of patients with renal transplants. In this study of over 2900 renal transplant scans, the authors have produced a compendium of the abnormal appearances that they have encountered. Apart from the most commonly seen complications, those of acute tubular necrosis and rejection, we now recognize many different complications. These can be classified as urinary (e.g., leaks and obstruction), vascular (e.g., hematomas and infarcts), or a miscellaneous group that includes lymphoceles. Many of these may cause problems in scan interpretation by masquerading as episodes of rejection. Recognition of these patterns can prevent patients from receiving unnecessary antirejection therapy and also enable the physician to ask for the correct investigation in reaching an accurate diagnosis.

Graft Rejection↗
PubMed1979

Cold pressor test in detection of coronary heart-disease and cardiomyopathy using technetium-99m gated blood-pool imaging.

50 normotensive subjects (22 controls with no cardiac disease, 24 patients with coronary heart-disease, and 4 with early cardiomyopathy) were investigated with gated cardiac blood-pool scintigraphy before and during cold pressor stimulation. The controls had no change or a significant rise (p less than 0.005) in left ventricular ejection fraction and preserved normal myocardial-wall motion, whereas patients with coronary-artery disease or cardiomyopathy had a significant fall (p less than 0.001) in left ventricular ejection fraction and many developed abnormal regional wall motion despite the absence of angina pectoris. Cold pressor gated cardiac blood-pool studies were more sensitive than single-lead exercise electrocardiography (p = 0.03) in the detection of patients with severe coronary-artery disease without previous myocardial infarction.

Adolescent↗
PubMed1979

Stress lesions of the lower leg and foot.

Technetium 99 methylene diphosphonate scans were performed on 32 patients with suspected stress fractures. Twenty-six patients had abnormal scans, 13 had abnormal X-rays and on these only nine had either fresh periosteal new bone and/or a fracture line. A logical approach of the use of X-ray and radionuclide techniques in patient management is suggested.

Adolescent↗
PubMed1979

Serial quantitative imaging with 99Tcm-DTPA in pediatric renal transplantation.

Three hundred and fifty-eight renal imaging studies with quantitation of renal perfusion were performed following injection of 99Tcm-DTPA in 22 children aged 6--15 years with renal transplants. In 58 of 62 scans performed at the onset of a rejection episode, renal perfusion was decreased. This was the only feature of rejection in 6 episodes, in 5 of which the patient was oliguric due to post-operative acute tubular necrosis. In 4 episodes perfusion fell, but antirejection treatment was not given as a repeat scan was normal. On 18 occasions the plasma creatinine concentration (Pc) rose, but the scan was unchanged; no treatment was given and repeat Pc was normal. Three patients had a ureteric obstruction and 2 patients a lymphocoele detected from the images. There was no morbidity. Sequential renal scintigraphy was valuable in the early diagnosis of rejection and in the avoidance of unnecessary therapy.

Adolescent↗
PubMed1978

Dynamic renal transplant imaging with Tc-99m DTPA (Sn) supplemented by a transplant perfusion index in the management of renal transplants.

We have performed 955 studies on 152 patients with 167 renal transplants. Images were recorded following bolus injection of 12-15 mCi Tc-99m DTPA (Sn). The data were stored on a computer and analyzed by generation of region-of-interest curves from (a) the iliac artery distal to the transplant, (b) the kidney, and (c) a background area. A perfusion index was adopted: formula see text. In 276 studies the patient clearly had acute tubular necrosis (ATN), rejection, or a normal kidney on retrospective analysis. The normal perfusion index has a value below 150, and it increases with falling perfusion, such as is seen in rejection and in renal-artery stenosis. The use of this index in addition to sequential images and changes in the region-of-interest curves usually allows separation of rejection from ATN and, particularly, rejection from normals. When serial studies are performed, the separation of rejecting from nonrejecting transplants is excellent, although renal-artery stenosis may cause similar changes in perfusion.

Acute Kidney Injury↗
PubMed1976

99Tcm-DTPA for the measurement of glomerular filtration rate.

Comparison of the blood clearances of 51Cr-EDTA and 99Tcm-Sn-DTPA, in a series of 45 patients with a wide range of glomerular filtration rates, showed that there was a good correlation between the estimates of G.F.R. obtained using the two chelates simultaneously. The single-injection, single-exponential method of G.F.R. estimation was used, with a correction factor of 0.964 for 99Tcm-DTPA, which gave a relationship of G.F.R.Cr = 2.3+G.F.R.Tcml/min with a correlation coefficient of 0.99. 99Tcm-DTPA is a suitable agent for the estimation of glomerular filtration rate.

Chromium Radioisotopes↗
PubMedDate not supplied

Correlation between uptake of Tc-99m sestaMIBI and prognostic factors of breast cancer.

UNLABELLED: The purpose of this retrospective study was assessment of correlation between Tc-99m sestaMIBI uptake and some prognostic factors of breast cancer. The following prognostic factors have been included in this study: size of the tumour, age of the patients, axilla node involvement, oestrogen and progesterone receptor (ER, PR) status, grading system of Bloom-Richardson and Ki-67 antigen expression. METHODS: 79 patients were enrolled in this study, with 85 lesions confirmed as primary breast cancers. Mean age of patients was 53 years. Scintimammography (SMM) was performed after intravenous injection of 740MBq. At 5-10 min after injection standard planar images were obtained in prone lateral and anterior supine views. Assessment of correlation between known prognostic factors of breast cancer and uptake of MIBI (evaluated as a tumour to background ratio-TBR) was performed used non-parametric (Kendall-tau correlation) statistical analysis. RESULTS: There were 85 breast cancers (73 invasive ductal carcinomas, 11 DCIS (ductal carcinoma in situ) and 1 lobular carcinoma. There was positive correlation between TBR Tc-99m MIBI uptake and size of the tumour (t = 0.19, p = 0.01), presence of axilla node involvement (t = 0.2, p = 0.006) and also grade of the IDC tumours evaluated using Bloom-Richardson's criteria (t = 0.18, 0.03). There were negative correlation between TBR and presence of PR (t = -0.16, p = 0.02) and borderline negative correlation between TBR and age of patients (t = -0.137, p = 0.06) and also TBR and ER status (t = -0.135, p = 0.065). Patients who are younger and/or have PR or ER negative cancers have higher Tc-99m MIBI uptake. Patients who presented with high grade of malignancy (B-R) also have higher uptake of radiotracer. Also those with higher uptake of radiotracer often had axillary node involvement. This would suggest that more aggressive tumours have higher uptake of Tc-99m MIBI. Finally this study suggest correlation between in vivo uptake of MIBI and some of the known prognostic factors of breast cancer.

Breast Neoplasms↗
PubMedDate not supplied

Uptake of Tc-99m MIBI related to tumour size and type.

The accuracy of Tc-99m MIBI scintimammography depends on the uptake in cancer cells being greater than surrounding normal tissue. The aim of this study was to determine which were the dominant factors affecting uptake of Tc-99m MIBI in breast cancer cells in vivo. The tumour to background ratio (TBR) was measured in 74 focal breast lumps occurring in 70 women, of whom 53 had breast cancer. In patients with breast cancer the TBR was compared in those under and over 45, those with tumours over and under 20 mm, those who had auxiliary disease, the histological type of the tumour and whether ductal on the Bloom Richardson scale. The only factor which appeared to have an influence on uptake of Tc-99m MIBI was the histological type of the tumour. Ductal carcinomas had a mean TBR of 2.07, significantly greater than either other types of breast cancer (TBR = 1.31) and benign tumours (TBR = 1.46). The histological type of tumour appears to be the dominant factor affecting uptake of Tc99m MIBI in vivo.

Adult↗