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Biomedical subjects

B Shapiro

Publications and source records attributed to B Shapiro.

412 records · Page 23Linked to original sources
PubMedDate not supplied

Locating pheochromocytomas by scintigraphy using 131I-metaiodobenzylguanidine.

Scintigraphy with 131I-MIBG has located most pheochromocytomas. The detected tumors have been intra-adrenal, extra-adrenal, malignant, and familial in type. The method is safe, but requires images taken over three days to attain optimal results. Because of its ability to screen all sites where primary pheochromocytomas may reside, scintigraphy should be employed as the initial procedure in the search for these tumors. It may be the only technique that will locate extra-adrenal pheochromocytomas. The rate of false-negative results is about 10 percent; therefore, other techniques such as computed tomography will be necessary to help find the few elusive pheochromocytomas.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Radioiodine therapy of thyrotoxicosis.

Radioactive iodine treatment of thyrotoxicosis in considered one of, if not the most, successful therapy in Nuclear Medicine. A sixty year experience in virtually hundreds of thousands of patients supports the safety, efficacy and cost effectiveness of radioiodine. However, despite all of the data amassed since its introduction almost all aspects of its use from the indications, selection of patients, goals of therapy and selection of doses in the treatment of hyperthyroidism remain controversial and continue to be a subject of lively debate.

Humans↗
PubMedDate not supplied

Common bile duct obstruction in cystic fibrosis: utility of hepatobiliary scintigraphy.

Abdominal pain occurs commonly in patients with cystic fibrosis, and is the result of a variety of causes, including hepatobiliary disorders. With the increasing duration of survival in these patients, diagnostic investigations for abdominal pain, including hepatobiliary scanning, may be utilized more frequently than in the past. Difficulties in the interpretation of scintigraphic studies may arise because of associated gallbladder anomalies that occur in more than 50% of patients with cystic fibrosis. Hypoplasia of the gallbladder (microgallbladder) occurs commonly. A case is presented in which Tc-99m disofenin hepatobiliary scanning proved diagnostic in a patient with cystic fibrosis and cholelithiasis leading to common bile duct obstruction. The hepatobiliary abnormalities and causes of common bile duct obstruction encountered in cystic fibrosis are reviewed.

Abdominal Pain↗
PubMedDate not supplied

Long-term results of [131I]metaiodobenzylguanidine treatment of refractory advanced neuroblastoma.

Fourteen patients with advanced neuroblastoma, which was unresponsive to or had relapsed despite conventional therapy, were entered into a phase I/II trial of [131I]metaiodobenzylguanidine (131I-MIBG). Doses ranged from 1.85-8.14 GBq each (50-220 mCi), with cumulative doses of 1.85-24.20 GBq (50-654 mCi) in one to three doses. Side effects included mild nausea and vomiting and moderate myelosuppression which occurred in nine patients. Subjective responses occurred in five patients. Four patients had objective responses (one partial, two minor and one mixed). Two of these patients remain alive 80 and 60 months after beginning 131I-MIBG therapy. Comparison of the 131I-MIBG treated patients with 11 carefully matched control patients treated with an advanced current chemotherapy protocol (CCG 8605) was performed by means of Kaplan-Meier life table analysis. The 14% four-year survival with 131I-MIBG compared favorably with the 6% achieved by salvage chemotherapy. We thus believe 131I-MIBG may have a role in the management of neuroblastoma.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Treatment of neuroblastoma with [125I]metaiodobenzylguanidine.

To find a treatment that may be effective against micrometastases of advanced, stage III or IV neuroblastoma, [125I]metaiodobenzylguanidine (125I-MIBG) was used in a phase I toxicity trial. In seven patients, thrombocytopenia was encountered with absorbed whole body doses of 85-135 rad from 125I-MIBG, but the dosimetry was imprecise in predicting bone marrow injury. Three patients survived for over one year, results that may indicate efficacy of 125I-MIBG therapy.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Radiopharmaceutical therapy of malignant pheochromocytoma with [131I]metaiodobenzylguanidine: results from ten years of experience.

Twenty-eight patients with histologically proven metastatic or invasive, unresectable pheochromocytomas, which were shown to concentrate and retain tracer doses of [131I]metaiodobenzylguanidine (131I-MIBG), were treated with therapeutic quantities of this radiopharmaceutical. Between one and six doses ranging from 97 to 301 mCi (cumulative dose 111-916 mCi) were administered. Partial response in tumor size was achieved in 8/28 patients and partial biochemical responses in 12/28 patients. No pharmacological toxicity was observed. Mild radiation sickness (nausea, vomiting, anorexia) occurred in 21/28. Minor degrees of leukopenia and thrombocytopenia were observed in 3/28. There were three cases of hypothyroidism but no significant hepatic, renal, adrenocortical or autonomic nervous dysfunction. We conclude that therapeutic 131I-MIBG can achieve significant therapeutic responses in some cases of malignant pheochromocytoma without pharmacological toxicity and only mild radiotoxicity.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Summary, conclusions, and future directions of [131I]metaiodobenzylguanidine therapy in the treatment of neural crest tumors.

The role of diagnostic [131I/123I]metaiodobenzylguanidine (*I-MIBG) scintigraphy in the management of pheochromocytoma and neuroblastoma is established, but for other neural crest tumors is less defined. Radiopharmaceutical therapy of all these tumors with large activities of suitably radiolabeled MIBG is a compelling concept. In the five years since the first workshop on 131I-MIBG therapy held in Rome, the initial therapeutic promise appears to have been maintained for neuroblastoma and pheochromocytoma. A significant fraction of patients enter partial remission but complete remission is rare and relapse frequent. To date, experience with other neuroendocrine tumors and the use of 125I in place of 131I remains limited. Many promising areas remain incompletely explored. These include development of appropriate in vitro cultures and animal models, basic pharmacological mechanisms, drug interactions, macro- and microdosimetry and human clinical trials. The latter includes determining dose-limiting toxicity of 131I- and 125I-MIBG, treatment of patients at earlier times or stages of disease, optimal integration with other therapy including granulocyte-stimulating factor and marrow transplant rescue from otherwise limiting myelotoxicity. Progress to date has been slow and painstaking, but nevertheless significant, while the future holds both challenges and promise.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Evaluation of sodium etidronate in the treatment of Paget's disease of bone. Osteitis deformans.

Thirteen cases of advanced Paget's Disease of bone were treated with Sodium Etidronate (EHDP) at 20 mg/kg/day for 6 months and followed at 2 to 3-month intervals for 20 months with serum alkaline phosphatase, 24-hour urinary hydroxyproline, radiographic skeletal survey, whole-body scanning with Tc-99m-Sn-EHDP and F-18, external body counting with the same radiopharmaceuticals over preselected areas, skin temperature, densitometry of normal phalanges and bone biopsies. Sodium etidronate had a marked effect on Pagetoid bone in all cases with reduction of bone turnover demonstrated by the chemistries, scanning, external counting, skin temperature and X-ray diffraction studies of the bone biopsies. Normal bone did not appear to be materially affected by the drug. Complications drug dose-related included new pain in 6 cases, two fractures in Pagetoid areas and one case of severe demineralization. There was one case of spinal cord compression unlikely to be drug related. All complications cleared or were successfully treated by the end of the study. Some patients continued to show reduction in bone turnover to the end of the study, as long as 14 months after stopping EHDP. Long-term follow-up is needed for final evaluation of the efficacy of the drug. Sodium etidronate shows promise as an agent in the treatment of Paget's Disease. Smaller doses or shorter courses of therapy or combination of EHDP and calcitonin may be just as efficacious and may avoid complications.

Aged↗
PubMedDate not supplied

Improving intramuscular pH needle electrode stability.

An improved design for an intramuscular pH needle electrode, which slows the rate of accumulation of protein deposits and increases the stability of the needle electrodes, has been developed. To further stabilize the electrode, a counter EMF pulsing technique was also developed. As presently fabricated and used, needle electrodes remain stable for months in nonprotein solutions and for about 53 hours in albumin solutions.

Acid-Base Equilibrium↗
PubMedDate not supplied

The family experience of cancer pain management in children.

This study describes the family perspective of cancer pain management in pediatric patients. Family caregiver knowledge and attitudes regarding pain, caregiver burden associated with pain, and caregiver moods were identified. This study was conducted in a children's hospital (n = 31) and a community hospice (n = 8) with family caregivers of pediatric cancer patients as the participants. Pain intensity was rated by children and family caregivers using pain assessment scales applicable to children with cancer. Differences in pain ratings were reported. The Family Pain Questionnaire was used to identify parents' knowledge and attitudes about pain and its management. Areas for family teaching were identified with the questionnaire. Understanding the pain experience from the perspective of family caregivers and their role in pain management can assist healthcare providers in relieving pain in children with cancer.

Adolescent↗
PubMedDate not supplied

Changes in bone density with lactation.

OBJECTIVE: To test the a priori hypotheses that significant bone loss occurs in lactation of greater than 5 months' duration and that bone mass returns to baseline levels when breast-feeding ceases. DESIGN: Prospective cohort study design of 12 months' duration. SETTING: General community setting with recruitment occurring at birthing education classes. PARTICIPANTS: Volunteer sample of 98 healthy women of white (n = 95) and Asian (n = 3) origin, aged 20 to 40 years, and 0 to 1 parity prior to parturition, grouped according to lactation duration: 0 through 1, 2 through 5, and 6 or more months. MAIN OUTCOME MEASURES: Bone mineral density (BMD) of the proximal femur was measured by dual-energy x-ray densitometry at 2 weeks (baseline), 2 months, 4 months, 6 months, and 12 months following parturition, and BMD of the lumbar spine was measured at baseline, 6 months, and 12 months after parturition. RESULTS: Women with lactation duration of 6 months or longer had mean BMD losses of 5.1% and 4.8% at the lumbar spine and femoral neck, respectively, comparing baseline values with those at 6 months post partum. Women who breast-fed 0 through 1 month lost no BMD at either bone site. Bone loss in women who breast-fed 6 months or longer was not explained by differences in age, diet, body size, or physical activity. Among women who breast-fed 6 months or longer, there was evidence of return to baseline levels of the lumbar spine at 12 months after parturition. The BMD of the lumbar spine of those women who continued to breast-feed more than 9 months had increased but was still significantly lower than baseline. CONCLUSION: Extended lactation (> or = 70% of energy intake is provided for > or = 6 months) is associated with bone loss; however, there is evidence of return to baseline BMD measurement at 12 months after parturition.

Absorptiometry, Photon↗