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Biomedical subjects

B Shapiro

Publications and source records attributed to B Shapiro.

At least 217 records · Page 12Linked to original sources
PubMed1986

The scintigraphic localization of mineralocorticoid-producing adrenocortical carcinoma.

I-131-6 beta-iodomethylnorcholesterol (NP-59) was used to localize mineralocorticoid-secreting adrenocortical carcinomas in two patients and functioning metastases in a third patient studied after the removal of the primary tumor. The presence of sufficient NP-59 activity within these lesions for discernable imaging is unusual and would not have been expected based on previous experience with other functioning and nonfunctioning carcinomas of the adrenal cortex. These cases serve to illustrate the variable spectrum of iodocholesterol uptake into adrenocortical malignancies and suggest that scintigraphic studies, preoperatively for localization and postoperatively to confirm the presence of recurrence or metastases, might be useful to identify and characterize these rare neoplasms.

19-Iodocholesterol↗
PubMed1986

Primary extra-adrenal pheochromocytoma: positive I-123 MIBG imaging with negative I-131 MIBG imaging.

I-131 metaiodobenzylguanidine (I-131 MIBG) is a well established imaging agent that reliably detects pheochromocytoma. In some patients, however, I-131 MIBG may fail to localize pheochromocytoma. I-123 MIBG has several potential advantages over I-131 MIBG, and these advantages may enable locating pheochromocytomas which have eluded other techniques, including I-131 MIBG imaging. A patient with primary extra-adrenal pheochromocytoma is described who illustrates the superiority of I-123 MIBG for the imaging of pheochromocytoma.

3-Iodobenzylguanidine↗
PubMed1986

Enterohepatic circulation and distribution of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59).

The enterohepatic circulation and distribution of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) was assessed in a rabbit model to examine the relative distribution of NP-59 and its metabolites. Adrenal, bile and serum samples were obtained from seven rabbits at 48 h following NP-59 administration (240 to 570 microCi) and the distribution of 131I radioactivity examined using thin layer chromatography. In serum 71% of the radioactivity circulated as NP-59 and 20% as NP-59 esters. In contrast greater than 90% of the adrenal radioactivity was in the form of NP-59 esters while in bile 70% of the activity was NP-59 with the remainder in the form of bile acids. In another group of animals, adrenal activity was observed 5 days after intragastric administration of NP-59. Thus, we have demonstrated a significant enterohepatic circulation of NP-59 that may have the potential to influence the distribution of and resultant adrenal imaging with NP-59.

19-Iodocholesterol↗
PubMed1986

The influence of hypercholesterolaemia on the adrenal uptake and metabolic handling of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59).

The biodistribution of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) was assessed in hypercholesterolaemic patients and in a rabbit model of HC to examine the alterations in the relative distribution of NP-59 and its metabolites and to explain the changes in the patterns of adrenal cortical imaging in patients with expanded cholesterol pools. Rabbits were rendered hypercholesterolaemic with a diet supplemented with 2% cholesterol for 2 weeks prior to the intravenous administration of 240 to 570 microCi of NP-59. Adrenal, bile and serum samples were obtained from four hypercholesterolaemic rabbits at 48 h following NP-59 administration, and the distribution of 131I radioactivity was compared to that of seven rabbits maintained on a standard laboratory diet. Serum cholesterol levels were 1940 +/- 248 mg dl-1 in the hypercholesterolaemic rabbits as compared to 268 +/- 62 mg dl-1 in the controls. Adrenal cortical uptake of NP-59 was decreased in HC rabbits but no significant differences were observed in the relative proportions of NP-59 or its metabolites in the bile and adrenal tissues of hypercholesterolaemic versus control animals. Hypercholesterolaemic animals did exhibit an increase in NP-59 esters in serum as compared to controls. In three of five patients with hypercholesterolaemia, adrenal uptake of NP-59 was enhanced after successful lowering of serum cholesterol levels, while the remaining two patients who responded inadequately to cholesterol-lowering therapy showed a slight drop in NP-59 uptake.

19-Iodocholesterol↗
PubMed1986

Bone metastases in pheochromocytoma: comparative studies of efficacy of imaging.

Bone is the most common site of metastasis from pheochromocytoma. Now that the effects of hypercatecholaminemia can be adequately controlled with adrenergic blockade, pathologic fractures are becoming an increasingly significant cause of morbidity in patients with metastatic pheochromocytoma. Bone metastases from pheochromocytoma have not been extensively reevaluated since the advent of computed tomography (CT), high-resolution bone scintigraphy, and iodine 131 MIBG scintigraphy. Plain radiographs, CT scans, bone scans, and I-131 MIBG scans of 38 patients with pheochromocytoma bone metastasis were reviewed. The axial skeleton was the most common site of metastasis. Metastases typically appeared expansile and mixed lytic-sclerotic on radiographs. Bone scintigraphy was the most sensitive modality for detecting bone metastasis, with 74% of all alleged lesions being identified. In screening for bone metastasis from pheochromocytoma, bone scanning in conjunction with I-131 MIBG scanning is recommended, followed by scan- and symptom-directed radiography and - where a question still exists - CT.

3-Iodobenzylguanidine↗
PubMed1986

Hallucinations: theoretical and clinical overview.

The authors review the literature on hallucinations; provide theoretical background on these phenomena from physiological, biochemical, and psychological points of view; and discuss the presentations of hallucinations in different diagnostic categories. The longstanding notion that hallucinations are to be equated with schizophrenia, they conclude, is clearly unfounded, and hallucinations are never pathognomonic of any given disorder but can be relatively specific for some conditions. Current knowledge and methods of research have produced no single mechanism to account for the etiology or pathogenesis of hallucinations. The authors present an integrated approach toward viewing the etiology and clinical presentation of hallucinations that involves concepts of biological vulnerability and psychological influences.

Alcoholism↗
PubMed1986

Acquired epileptic aphasia. Diagnostic aspects of progressive language loss in preschool children.

A case of acquired epileptic aphasia presenting as language delay and hyperactivity is presented and clinical aspects reviewed. Acquired epileptic aphasia is a diffuse neurologic process of unknown etiology that presents in preschool children. Although progressive language loss and seizures are the major manifestations, deficits in attention and socialization may be noted. The electroencephalogram is usually diagnostic. While almost all (80%) children develop seizures, approximately half present as language delay without seizures. Recognition of the progressive and global nature of the language dysfunction may permit earlier diagnosis and intervention.

Aphasia↗
PubMed1986

Scintigraphic evidence of adrenal cortical dysfunction in the polycystic ovary syndrome.

The polycystic ovary syndrome (PCO) is frequently associated with elevated plasma levels of adrenal androgens and/or abnormal adrenal androgen responses to hormonal stimulation and suppression. Because of the overlap in the output of hormones between the adrenal glands and the ovaries, we measured adrenal iodocholesterol accumulation as an index of adrenocortical function in 11 women with PCO confirmed by laparoscopy or culdoscopy. All patients had normal dexamethasone suppression of plasma cortisol or urinary 17-hydroxycorticosteroid excretion. 6 beta-[131I]Iodomethylnorcholesterol (NP-59) adrenal scintiscans showed bilateral and excessive adrenal cortical uptake in PCO patients [0.46 +/- 0.08% (+/- SE) of the administered dose compared to 0.21 +/- 0.01% in a group of normal women; P less than 0.05]. The elevation of adrenal cortical NP-59 uptake in PCO was quantitatively similar to that in women with ACTH-dependent Cushing's syndrome (0.64 +/- 0.11%; P greater than 0.1). These data support the presence of abnormal adrenal cortical function in patients with PCO. The adrenal dysfunction of PCO most likely represents abnormal control of adrenal androgen production/secretion.

17-Hydroxycorticosteroids↗
PubMed1986

Familial partial peripheral and pituitary resistance to thyroid hormone: a frequently missed diagnosis?

The diagnosis of partial peripheral and pituitary resistance to thyroid hormone was ultimately made in two boys, 7 and 9 years of age, and a 10-year-old girl who had goiters and hyperthyroxinemia. The boys were treated with propythiouracil and/or thyroidectomy or iodine 131 for suspected thyrotoxicosis but had poorly suppressible serum thyroid-stimulating hormone (TSH) post treatment in spite of the usual L-thyroxine replacement. The girl had increasing goiter size while receiving propylthiouracil, 100 mg every eight hours. These findings led to reevaluation of thyroid hormone dynamics in these children and their families. Twelve additional family members, 3 to 38 years of age, compatible with an autosomal dominant inheritance, were also found to have peripheral and pituitary resistance to thyroid hormone. All affected individuals had elevated serum thyroxine and triiodothyronine levels, normal to slightly elevated triiodothyronine resin uptakes, and a nonsuppressed serum TSH. The five individuals who were given thyrotropin-releasing hormone showed exaggerated TSH responses, which normalized on L-thyroxine therapy. Misdiagnosis in six of 15 family members led to significant morbidity (hypothyroidism, delayed growth, and therapy risk). A nonsuppressed serum TSH in a patient with suspected thyrotoxicosis should lead to suspicion of this disorder. Appropriate management for this condition includes L-thyroxine therapy to decrease goiter size and normalize TSH responses to thyrotropin-releasing hormone.

Child↗
PubMed1986

Diabetic oesophagoparesis: assessment by solid phase radionuclide scintigraphy.

Oesophageal function was assessed by solid phase radionuclide scintigraphy in 13 normal volunteers and 23 patients with diabetes mellitus. The diabetics had significantly delayed oesophageal emptying times 23 min versus 7.6 min in normals (p less than 0.02). In addition, the diabetics had significantly more oesophageal activity at 5 and 10 min than normals (p less than 0.03). These differences were unrelated to the age of the patients. Despite these population differences, no clear relationship was seen within the diabetic population between oesophageal emptying time and duration of disease, insulin dose, or presence of neuropathy. Oesophageal emptying time was only weakly correlated with gastric emptying times (r = 0.37, p less than 0.03). These data indicate that by using sensitive radionuclide techniques, abnormalities of oesophageal emptying are common in diabetics, even in those without evidence of other end-organ complications of diabetes.

Adult↗
PubMed1986

Iodine-123-4-amino-3-iodobenzylguanidine, a new sympathoadrenal imaging agent: comparison with iodine-123 metaiodobenzylguanidine.

Iodine-123-4-amino-3-iodobenzylguanidine ([123I]AIBG), an analog of 123I metaiodobenzylguanidine ([123I]MIBG), has an advantage in having a more rapid and simple synthesis. This, combined with animal data that suggested a greater affinity of the new radiopharmaceutical for the autonomic innervation of the myocardium led us to study the biodistribution of [123I]AIBG in three men with metastatic pheochromocytoma. In all instances, [123I]AIBG revealed the same metastatic deposits shown by [123I]MIBG. Iodine-123 AIBG uptake, however, was greater than [123I]MIBG in lung, gut, and spleen. These higher backgrounds may pose diagnostic problems in some cases.

3-Iodobenzylguanidine↗