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Biomedical subjects

D L Citrin

Publications and source records attributed to D L Citrin.

At least 37 records · Page 2Linked to original sources
PubMed1980

A clinical and pathological study of adrenocortical carcinoma: therapeutic implications.

Twenty-one patients with adrenocortical carcinoma (ACC) diagnosed at three hospitals over a ten-year period were reviewed for clinical and pathologic features that might have therapeutic implications. Depending upon the extent of cellular pleomorphism, ACC could be defined as anaplastic or differentiated. Anaplastic ACC occurred more often in male patients, produced more frequent cutaneous metastases (P = 0.01), and was associated with a lack of clinical or laboratory evidence of hormone production (P = 0.01). In contrast, differentiated ACC usually occurred in women and produced clinical or laboratory evidence of hormonal excess. Median survival time of patients with anaplastic ACC was only five months, while median survival time of those with differentiated ACC was 40 months (P = 0.005). Patients with differentiated ACC survived for long periods, even with metastatic disease. Three of 5 such patients had objective responses to o,p'-DDD (Mitotane) therapy. The histopathology of ACC is an important prognostic factor and should be considered in the design of future therapeutic trials.

17-Ketosteroids↗
PubMed1980

Adriamycin enhancement of cyclophosphamide-induced bladder injury.

Hemorrhagic cystitis as a complication of cancer chemotherapy has been most commonly associated with cyclophosphamide. We report on a patient who had received cyclophosphamide for treatment of breast carcinoma and had hemorrhagic cystitis temporally associated with subsequent adriamycin therapy. The development of subclinical bladder injury induced by cyclophosphamide and enhanced by adriamycin similar to their combined toxicities at other sites (skin, esophagus and heart) is postulated.

Breast Neoplasms↗
PubMed1980

Semi-quantitative analysis of the bone scan in acromegaly: correlation with human growth hormone values.

99Tcm-HEDP bone scans were obtained in 20 acromegalic patients. Twelve patients had active disease with elevated basal serum human growth hormone (HGH) levels. Eight patients were in clinical and biochemical remission. The bone scans, assessed independently by three observers, showed features characteristic of metabolic bone disease in patients with active acromegaly. The metabolic index derived from the scan correlated well with serum HGH levels (R = 0.71, p < 0.002). The bone scan may accurately reflect oversecretion of HGH and is of potential value in the assessment of patients with acromegaly.

Acromegaly↗
PubMed1979

Semi-quantitative interpretation of the bone scan in metabolic bone disease: definition and validation of the metabolic index.

Certain easily recognisable features are commonly seen in the bone scans of patients with metabolic bone disorders. Seven such features have been numerically graded by three independent observers in the scans of 100 patients with metabolic bone disease and of 50 control subjects. The total score for each patient is defined as the metabolic index. The mean metabolic index for each group of patients with metabolic bone disease is significantly greater than that for the control group (P less than 0.001).

Bone Diseases↗
PubMed1979

A clinical comparison of Tc-99m HEDP and Tc-99m MDP in the detection of bone metastases: concise communication.

We have compared bone scintigrams made with Tc-99m-tagged HEDP (1-hydroxyethylidene diphosphonate)and MDP (methylene diphosphonate), the former at 4 hr after injection, the latter at both 2 and 4 hr. In 17 patients with skeletal metastases, there was no significant difference in lesion count or scan quality between the 4-hr images. The tumor-to-bone ratio (T/B) was significantly higher with Tc-HEDP (p less than 0.02). Lesion detection rate and T/B ratios were both lower with Tc-MDP at 2 hr when compared with the 4-hr values for both Tc-HEDP (p less than 0.02, p less than 0.005) and Tc-MDP (p less than 0.02, p less than 0.01). The 4-hr Tc-MDP scan was of significantly higher quality than the 2 hr Tc-MDP scan (p less than 0.01). Although Tc-HEDP produces a higher T/B ratio at 4 hr, the present study does not suggest that either agent is superior in clinical practice.

Adult↗
PubMed1978

o,p'-DDD (mitotane) therapy of adrenal cortical carcinoma: observations on drug dosage, toxicity, and steroid replacement.

Four patients with adrenal cortical carcinoma were treated with standard doses of o,p'-DDD. Plasma levels of o,p'-DDD and its metabolites o,p'-DDA and o,p'-DDE were measured. o,p'-DDD was measurable for up to 8 months after stopping therapy, and trace levels of metabolites were detectable at 18 months. Although 2 of 3 patients with measurable disease had objective tumor response and one patient achieved a complete response, severe drug toxicity occurred in all patients and signs of adrenal insufficiency occurred in three. Low dose therapy with o,p'-DDD is suggested, together with full gluco and mineralocorticoid replacement. Measurement of o,p'-DDD and its metabolites in plasma may prove clinically useful in developing effective but less toxic dosage schedules.

Adrenal Cortex Neoplasms↗
PubMed1978

The prognostic and therapeutic implications of the positive radionuclide bone scan in clinically early breast cancer.

Seventy-five women with clinical stage I or stage II carcinoma of the breast have had radionuclide bone scans at the time of presentation and at 6-monthly intervals during a mean follow-up period of 39 months. Patients with evidence of metastases on bone scan, either at the time of presentation or during follow-up, had significantly higher mortality and morbidity rates than those with persistently negative scans. Whatever the clinical stage, breast cancer patients with a positive bone scan have a very poor short term prognosis and local therapy to the breast is inadequate. A plan is outlined which incorporates the patient's bone scan status into the decision to introduce endocrine therapy or chemotherapy.

Adult↗
PubMed1978

The use of whole-body retention of Tc-99m diphosphonate in the diagnosis of metabolic bone disease.

The limited role of bone scanning in the diagnosis of metabolic bone disease might be considerably improved by accurate quantification of skeletal uptake of the radiopharmaceutical. Using a standard shadow-shield whole-body monitor, we have measured whole-body retention (WBR) of Tc-99m HEDP up to 24 hr in 11 patients with renal osteodystrophy (mean WBR 88.6% at 24 hr); in ten patients with Paget's disease (mean 56.9%); in seven patients with osteomalacia (mean 40.7%); in five patients with primary hyperparathyroidism (mean 50.7%); in four patients with osteoporosis (mean 21.2%); and in 12 normals (mean 19.2%). The osteoporotic group could not be differentiated from the normal group, but the other groups were significantly different from the normal group at 24 hr (p less than 0.002), and each individual rest for the 24-hr WBR of Tc-99m HEDP in these groups lay outside our normal range. This test may, therefore, provide a sensitive means of detecting conditions with increased bone turnover. We obtained measurements of plasma activity of Tc-99m HEDP in these patients up to 24 hr, and 4-hr bone to soft-tissue ratios from bonescan images, but little additional information resulted.

Adolescent↗
PubMed1977

Problems and limitations of bone scanning with the 99Tcm-phosphates.

99Tcm-phosphate bone scans are being increasingly used in the detection of bony metatases. The sensitivity of the bone scan and the non-specific nature of the isotope image, when compared with radiographs, make it important to be aware of the problems and limitations of the technique. This paper describes and illustrates some of the diagnostic problems encountered by the author over the past 3 years.

Adult↗
PubMed1977

A comparison of the sensitivity and accuracy of the 99TCm-phosphate bone scan and skeletal radiograph in the diagnosis of bone metastases.

The accuracy and sensitivity of the 99Tcm-phosphate bone scan and conventional skeletal radiology have been compared in 372 patients with documented malignant disease and 75 control subjects. Results indicate that the bone scan is a more sensitive method for the detection of skeletal metastases. The incidence of false-positive results with the bone scan is acceptably low. A protocol for the investigation of patients with suspected malignant disease of bone is suggested.

Adolescent↗
PubMed1977

An evaluation of the in vivo properties of 99mTc-HEDP.

The in vitro properties of lyophilized 99mTc stannous diphosphonate bone-scanning agent have been studied with particular reference to those properties which are of relevance to its routine clinical use. The results of quantitative studies in patients with bony tumors indicate that reliable reproducible bone scans will be obtained despite the variations in technetium presentation, labelling and injection procedures which may be anticipated in any department of nuclear medicine.

Bone Neoplasms↗
PubMed1977

Implications of the 99mTc diphosphonate bone scan on treatment of primary breast cancer.

The 99mTc diphosphonate scan is important in the study of primary breast cancer. The short-term prognosis for scan-positive patients is poor. Serial bone scans provide a safe and reliable prognostic index in patients following mastectomy. By correlating the scan with biochemical tumor markers, a matrix of diagnostic tests may be developed that is capable of identifying high-risk patients who may benefit from systemic therapy.

Bone Neoplasms↗
PubMed1976

An assessment of the clinical usefulness of plasma ribonuclease assays.

The usefulness of plasma ribonuclease assays was studied in (i) patients with possible protein deficiency, (ii) patients with myelomatosis, (iii) patients with carcinoma of the breast. In each group, the major factor associated with elevation of plasma ribonuclease was impairment of renal function. The assay was therefore of little value in the assessment of patients with myelomatosis or carcinoma of the breast. However, in the patients with possible protein deficiency and normal renal function, an elevation of plasma ribonuclease is, in general, associated with a decrease in serum albumin, transferrin and cholinesterase. Plasma ribonuclease may therefore be a useful parameter in the assessment of protein nutritional status.

Acute Kidney Injury↗