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Biomedical subjects

E B Silberstein

Publications and source records attributed to E B Silberstein.

At least 19 recordsLinked to original sources

Phosphorus-32 radiopharmaceuticals for the treatment of painful osseous metastases.

Phosphorus-32, employed as the orthophosphate or polyphosphate, can reduce or relieve the pain of osteoblastic metastases without serious hematologic toxicity, especially if used as a single injection. Uptake of this beta-emitter by osteoblastic-reactive bone and possibly by tumor and other cells can lead to pain reduction and often to cell killing. Efficacy has been demonstrated for the treatment of pain in 84% of 322 breast cancer patients and 77% of 444 prostate cancer patients found in a review of the literature. These results match those of the newer radiopharmaceuticals currently under investigation.

Bone Neoplasms

Synthesis and renal excretion of technetium-99m-labeled organic cations.

Organic cations are excreted more efficiently than organic anions in uremia suggesting superiority as renal imaging agents. In this study, three 99mTc-labeled cationic cyclam complexes were synthesized and their renal clearance quantified in rats. The complexes are cleared at a rate of about 2.5-3 times that of inulin and about 60% that of p-amino-hipurate. Inhibition of 99Tc-cyclam excretion by quinine indicates transport by the organic cation process. Comparative in vivo imaging experiments demonstrated that in normal rats 99mTc-cyclam reached peak renal activity 1.8 +/- 0.6 min after injection, a value intermediate between that for [131I]OIH (1.0 +/- 0) and 99mTc-MAG3 (2.8 +/- 0.6). In rats injected with the acute nephrotoxin cisplatin, the times to peak were lengthened with the relative order being 99mTc-cyclam > 99mTc-MAG3 > [131I]OIH. The results demonstrate that cationic complexes may be useful for renal imaging diagnostic applications.

Animals

Cyclic oral phosphate and etidronate increase femoral and lumbar bone mineral density and reduce lumbar spine fracture rate over three years.

We have performed a study of the safety and efficacy of cyclic sequential oral phosphate, diphosphonate and calcium carbonate. Forty-two postmenopausal women with osteoporosis diagnosed by dual-photon absorptiometry were treated with a sequential cyclic regimen of oral phosphate for 3 days, etidronate for 2 wk, and then a calcium salt for 12 wk. This was repeated cyclically for 3 yr. They were rescanned after every two 101-day cycles. A control group of 20 patient receiving only the calcium salt was matched for age, time since menopause, race and sex. The group treated with cyclic phosphate, etidronate, and calcium regimen had 80% fewer fractures than the control group over 3 yr of follow-up. Significant response in halting bone mineral loss and increasing bone mineral density was seen in none of the controls but in 90% of treated patients' lumbar spine and 70%-80% of the three regions of the femoral neck examined.

Bone Density

Radionuclide therapy of hematologic disorders.

32P is effective therapy for polycythemia and primary thrombocytosis. The Polycythemia Vera Study Group is comparing radioactive phosphorus with alkylating agents to determine relative efficacy. Less well investigated is the effectiveness of 32P vs. busulfan in chronic granulocytic leukemia. Endolymphatic administration of radiopharmaceuticals may play a role in the therapy of infradiaphragmatic lymphoma. Among the radionuclides that have at times been used in hematology are 32P, 198Au 24Na, 76As, 89Sr, 52Mb, 54Mn, 91Y, 95Zr, 95Cb, 111Ag, 109Pd, 131I, 185W, and 192Ir. As stated, 32P has proven single most efficacious agent. The hematologic diseases that have been treated include both malignant and benign conditions. Among the malignant conditions are polycythemia vera, agnogenic myeloid metaplasia, thrombocythemia, leukemia, Hodgkin's disease, and multiple myeloma. Hemophilia, and Osler--Weber--Rendu disease are among the benign entities in which the agents have been tried. Polycythemia and thrombocythemia remain those in which the greatest success has been achieved.

Gold Radioisotopes

The relationship of information density to pre-set counts obtained in brain, lung and liver scintigraphy.

The total number of counts required per view for brain and lung scintigraphy to achieve information or count density (CD) of 1 000 counts/cm2 and 2 000 counts/cm2 for liver scans was examined. To achieve these CDs, 600 000 counts per view are required for brain scans. For the lung, 500 000 counts in anterior and posterior views are required; 400 000 counts in the lateral view are sufficient. For 2 000 CD in the liver scan, 600 000 counts should be obtained in the anterior view and 500 000 in the right lateral. This number of counts assures the desired CD in 97% of cases.

Brain

An evaluation of undergraduate family care programs.

Evaluation of the many new family care programs (FCP), and others of similar intent, however defined, is as essential as determining the value of any other curriculum change. Replies to a questionnaire from 101 U.S. and 15 Canadian medical schools indicated that 80% of the former and 93% of the latter had FCPs; 35% and 29%, respectively, were not evaluating their program by any method. No single evaluative technique was used by more than 42% of the American medical schools. A review of the literature on FCPs frequently indicated that the conclusions that could be drawn about the programs were ambiguous. Students in the University of Cincinnati Medical Center FCPs elected family practice or pediatric internships significantly more often than did the FCP nonparticipants, but they indicated that the program had little effect on this choice, despite almost uniformly favorable testimonials. We discuss the possibility that FCPs may be educating the wrong students, that FCPs, if not reinforced in other clinical areas, may have few lasting effects on student attitudes or career choice, and that we may be asking the wrong questions, and with inadequate methods.

Adult

Radionuclide imaging of Meckel's diverticulum in children.

Fifty-eight children were studied for the presence of Meckel's diverticulum by scintigraphy with 99mTc-pertechnetate. Meckel's diverticulum was found at surgery in 6 of 6 patients with positive radionuclide studies and in 2 of 48 patients with negative studies. Four studies could not be interpreted because of widespread intestinal activity. Using the criteria described in this paper, false-positive readings did not occur.

Adolescent

Clinical comparison of technetium-99m diphosphonate and pyrophosphate in bone scintigraphy: concise communication.

Thirty patients had bone scintigraphy with both Tc-99m pyrophosphate (Tc-PPi) and Tc-99m diphosphonate (Tc-HEDP). The images were given a composite rating for quality and the basis of three sets of criteria, and were also compared for the number of lesions detected by each agent. The two agents provided no difference in scan quality. Nevertheless, in ten of the 30 patients, at least two of the three readers detected with Tc-HEDP lesions that were not seen with Tc-PPi, and in two such cases all three readers considered the Tc-PPi scan normal. In another of these ten, two of three readers felt the Tc-PPi image was norm, whereas all three detected the lesion with Tc-HEDP. The reverse never occurred (P less than 0.01).

Bone Neoplasms

Radionuclide imaging. Use in diagnosis of osteomyelitis in children.

Forty-four children were studied for the presence of osteomyelitis by scintigraphy using Tc 99m etidronate tin complex. Evidence of osteomyelitis on radionuclide images was found in 16 of 19 patients considered to have osteomyelitis by their attending physicians. Bone scintigraphic changes were noted prior to or in the absence of roentgenographic abnormalities in 10 of 19 patients. Cases of acute hematogenous osteomyelitis, chronic osteomyelitis, and osteomyelitis caused by penetrating trauma and contiguous infection were identified. Three bone infarctions were correctly diagnosed.

Bone Diseases

Physiologic and biologic behavior of autologous canine 131L-fibrinogen labeled by a chloramine-T method.

Autologous canine 131I-fibrinogen labeled by a chloramine-T method was examined to determine whether the fibrinogen had been altered by the iodination procedure as suggested by other investigators. Before and after radioiodination, clottability of the fibrinogen was always equal to or greater than 89 percent. Gel chromatography studies revealed that labeled fibrinogen behaved as unlabeled fibrinogen and no high molecular weight material was found. Gamma camera scintigraphy reflected the chromatography results, as iodinated material did not appear in the liver or spleen until 48 to 72 hours. The slow-moving component of the whole blood clearance curves, respresenting undenatured fibrinogen, had a mean half-life of 61.4 +/- 5.1 hours (+/- S.E.M.) and comprised 51.5 +/- 7.5 percent of the initial activity. Similarly, a mean falf-life of 53.4 +/- 2.0 hours and 59.6 +/- 7.7 percent initial activity wwere attributed to fibrinogen according to the plasma clearance curves as determined by trichloracetic acid precipitation. The results clearly demonstrated that chloramine-T iodination of fibrinogen can yield an excellent product, biologically and chemically, which is free from macroaggregates.

Animals