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Biomedical subjects

E Buonocore

Publications and source records attributed to E Buonocore.

At least 19 recordsLinked to original sources
PubMed1998

Positron Emission Tomography (PET) with 1-Aminocyclobutane-1-[(11)C]carboxylic Acid (1-[(11)C]-ACBC) for Detecting Recurrent Brain Tumors.

This study was done to determine whether 1-[(11)C]ACBC PET has any advantages over 2-[(18)F]FDG PET, CT, or MRI in detecting recurrent brain tumors, and whether quantitative 1-[(11)C]ACBC PET information improves the accuracy of "visual" image interpretation.Twenty patients with recurrent brain tumor underwent dynamic PET. Images were analyzed by visual interpretation; in addition, standardized uptake values (SUVs) and Patlak values (k(1)*k(3)/k) were evaluated.1-[(11)C]ACBC identified 19/20 recurrent brain tumors, [18F]FDG 13/19, MRI 13/19, and CT 8/16. Based on SUVs, the average tumor-to-contralateral gray matter ratio of 1-[(11)C]ACBC was 5.0 and 0.5 for 2-[(18)F]FDG. Mean Patlak values of 1-[(11)C]ACBC were 0.044 +/- 0.047 for high and 0.034 +/- 0.026 for low grade tumors. However, visual interpretation was effective without quantitative PET data.1-[(11)C]ACBC, accurately detects recurrent tumors for selecting biopsy sites and treatment planning.

Journal Article↗
PubMed1997

Telemedicine for dermatology care in rural patients.

BACKGROUND: Rural patients who develop dermatologic disorders often do not seek specialty care because of multiple logistical and economic factors. OBJECTIVE: To assess the effect of teledermatology consultations on the cost of care for a given episode of illness. METHODS: Telemedicine records were reviewed for 119 visits by 87 patients referred for teledermatology consultation over a 17-month period. RESULTS: Seven patients (8%) required follow-up in the dermatologist office for extended care, while 20 patients (23%) (52 visits) underwent follow-up teledermatology evaluation. The average duration of the dermatologic condition for each patient prior to the telemedical consultation was 17 months. The average of care for the diagnosed dermatologic condition, for all patients during an average period of 8 months prior to teledermatology was $294, compared with $141 for the 6 months after diagnosis by teledermatology. CONCLUSIONS: Telemedicine can be effective for dermatology consultation in new patients referred from rural communities. Our data indicate teledermatology can decrease the cost of care for the diagnosed condition.

Cost-Benefit Analysis↗
PubMed1997

Evaluation of fluorine-18-BPA-fructose for boron neutron capture treatment planning.

UNLABELLED: Boron neutron capture therapy (BNCT) using 4-[10B]boronophenylalanine-fructose (BPA-Fr) is in Phase II clinical trials to validate BNCT as a treatment for glioblastoma multiforme and melanoma. Successful BNCT depends on knowledge of the distribution of boron-containing agents in both tumor and normal tissue as currently determined by chemical confirmation of boron deposition in surgically removed malignant tissue before BNCT. METHODS: We used PET to noninvasively obtain in vivo information on the pharmacokinetics of the 18F-labeled analog of BPA-Fr in two patients with glioblastoma multiforme. Time-activity curves generated from the bolus injection of 18F-BPA-Fr were coinvolved to simulate a continuous infusion used for BNCT therapy. RESULTS: Distribution of 18F-BPA-Fr by PET was found to be consistent with tumor as identified by MR imaging. The 18F-BPA-Fr tumor-to-normal brain uptake ratio was 1.9 in Patient 1 and 3.1 in Patient 2 at 52 min after injection. The 18F-BPA-Fr uptake ratio in glioblastoma paralleled that of nonlabeled BPA-Fr seen in patients as previously determined by boron analysis of human glioblastoma tissue obtained from pre-BNCT surgical biopsy. CONCLUSION: Knowledge of the biodistribution of BPA-Fr enables pre-BNCT calculation of expected tissue dosimetry for a selected dose of BPA-Fr at a specific neutron exposure. Fluorine-18-BPA-Fr PET is capable of providing in vivo BPA-Fr biodistribution data that may prove valuable for patient selection and pre-BNCT treatment planning.

Boron Compounds↗
PubMed1996

Differentiating benign from malignant lung lesions using "quantitative" parameters of FDG PET images.

UNLABELLED: Fluorine-18 labeled deoxyglucose positron-emission tomography (FDG-PET) applications in oncology include the differential diagnosis of chest masses and single pulmonary nodules. However, FDG is not tumor-specific; rather, it also accumulates in inflammatory processes. This study was performed to identify image parameters that would improve the specificity of PET. METHODS: Twenty-six patients who had benign and malignant lung lesions were examined retrospectively. Positron-emission tomography data were acquired in dynamic scanning mode after intravenous bolus of 250-402 MBq of FDG. Standardized uptake values (SUVs) were calculated and Patlak analyses were performed in selected regions of interest in the PET images. Positron-emission tomography results were related to histological diagnosis (N = 49) or clinical follow-up (N = 3). RESULTS: The specificity and sensitivity of the original PET scan reports, which was based on visual image interpretation and loosely applied SUVs, was 100% and 73%, respectively. Using the SUVs with a cut-off value of 3.8 and Kpat value with a cut-off at 0.025 min-1 improved the specificity to 81% and 85%. CONCLUSION: FDG-PET image interpretation can be facilitated by using SUV information or the accumulation rate of the radiotracer (Patlak). With additional validation, this method could have a significant cost-effective impact on the medical/surgical management of chest masses.

Adult↗
PubMed1996

Using the World-Wide Web to train and certify physicians in the safe use of fluoroscopy.

OBJECTIVE: We sought to create a computer-generated certification examination that concurrently tests and educates fluoroscopy users. MATERIALS AND METHODS: A trial examination was placed on the Internet for area physicians who requested fluoroscopic privileges at our institution. The name and address of each individual who achieves a passing score is automatically sent by e-mail to the examination administrator. RESULTS: Physicians expressed widespread satisfaction with this certification process. The difference in number of attempts and score of the first attempt between groups of radiologists and nonradiologists favored the radiologists (p approximately .03 in both cases) when analyzed using an unpaired t test. CONCLUSION: This examination ensures understanding of the procedural parameters that contribute to skin injury in patients and affords an easy approach to self-education.

Certification↗
PubMed1995

Characterization of chest masses by FDG positron emission tomography.

Radiographic imaging techniques have proved to be of limited value in characterizing chest masses. Likewise, scintigraphic techniques with tumor-seeking single photon emitting agents have shown marginal practical benefit. In contrast, high resolution PET with [F-18]-2-fluoro-2-D-deoxyglucose (FDG) offers a unique opportunity to distinguish benign from malignant processes by determining metabolic characteristics. PET scan results, including graphical analysis of tumor transfer constants (Patlak plot) in 21 patients with primary lung cancer, were compared to clinical outcome (histologic proof or clinical follow-up of longer than 1 year) in 54 patients who had chest masses identified by CT and/or plain film. The patients were categorized into three groups. The first group (N = 23) had primary, unknown, lung masses. Differentiation of benign from malignant tumors by PET had a sensitivity of 100% and a specificity of 67%. The second group (N = 13) had proven lung carcinoma or lymphoma and post-therapy PET scanning for recurrent tumor. In this setting, PET had a sensitivity of 83% and a specificity of 80%. The third group (N = 18) had extrathoracic malignancies and suspected pulmonary metastases. Metastatic lesions were identified with a sensitivity of 87% and specificity of 83%. Glucose uptake by normal tissue is variable and inflammatory/infectious processes can have high FDG uptake and overlap with the glucose uptake of malignant tissue. FDG PET is useful in characterizing chest tumors based on the level of their metabolic activity. Malignant tissue has a high glucose uptake. Elevated FDG uptake by an active inflammatory process may produce overlapping results.(ABSTRACT TRUNCATED AT 250 WORDS)

Deoxyglucose↗
PubMed1995

Assessment of skeletal muscle viability by PET.

UNLABELLED: We investigated the use of [18F]fluoro-2-deoxyglucose (FDG) PET scanning for assessment of skeletal muscle viability in patients with peripheral vascular disease and in patients following free-flap skeletal muscle transfer for closure of open wounds. METHODS: We obtained 32 FDG-PET scans from 30 patients, either at the time of admission for peripheral vascular disease (n = 16) or between 1 and 15 days after surgery for skeletal muscle transfer (n = 16). Ratios between injured and contralateral limb FDG tracer activity uptake were correlated with clinical outcome at 1 mo to 3 yr follow-up. RESULTS: Viable muscle uptake ratios ranged from 0.47 to 7.88 (mean: 2.26 +/- 1.81; n = 26), while nonviable muscle uptake ratios ranged from 0.12 to 0.46 (mean: 0.27 +/- 0.12; n = 6; p < 0.02). After skeletal muscle transfer, two patients with viable tissue, as documented by PET, required amputation due to osteomyelitis, and one patient with peripheral vascular disease who showed viable tissue by PET required amputation 3 mo after the PET scan because of recurrent ulcers. CONCLUSION: FDG-PET scanning can determine skeletal muscle viability in patients with peripheral vascular disease and in patients following free-flap transfer.

Adolescent↗
PubMed1993

Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-[18F]deoxyglucose (2-[18F]FDG).

The potential of positron emission tomography (PET) to distinguish benign from malignant ovarian tissue was evaluated by comparing the results of F-18 fluoro-2-D-deoxyglucose (F-18-FDG) PET scans with computed tomography and surgical findings. If sufficiently sensitive, this method might play a role in localizing metabolically active tumor sites for diagnosis, staging, and follow-up of ovarian cancer. Fifty-one patients had imaging studies prior to laparotomy for suspected ovarian cancer. PET scans were done with an ECAT 931-08-12 or ECAT EXACT (Model 921, Siemens/CTI, Knoxville, TN) after iv injection of 185-370 MBq of F-18-FDG. (ECAT is a trade name for "emission computerized axial tomograph.") Data were acquired in dynamic scanning mode and time activity curves (TACs) were evaluated in multiple regions of interest identified by visual interpretation of the PET scans. Scan interpretation, standardized uptake values, and TAC profiles were related to surgical and histological findings. The results of this pilot study show good correlation between PET and histological findings. The positive predictive value of PET for ovarian cancer was 86% and, perhaps more important, the negative predictive value was 76%. This early work indicates that PET may be useful in the management of patients with ovarian neoplasms by identifying occult foci of metabolically active tumor that do not appear on morphological studies.

Adolescent↗
PubMed1991

Gadolinium-labeled liposomes containing various amphiphilic Gd-DTPA derivatives: targeted MRI contrast enhancement agents for the liver.

Unique paramagnetic liposomal contrast agents were synthesized and utilized for selective augmentation of T1 MR imaging of the livers of normal Balb/c mice. A series of amphipathic gadolinium complexes, which mimic phospholipids, was incorporated into the lamella of small unilamellar liposomes such that they become an integral part of its surface. The amphipathic complexing agents consisted of DTPA reagents in which two stearyl chains are attached via amide, ester, and thioester linkages. The in vitro stability and the in vivo lifetimes of the new amphipathic agents were dependent on the method used to attach the long-chain alkyl groups.

Animals↗
PubMed1990

Pulmonary embolism. How V/Q scanning helps in diagnosis.

Ventilation-perfusion (V/Q) scanning is a useful predictor of pulmonary embolism. However, chest films and arterial blood gas studies are essential for proper interpretation of V/Q studies. The combination of clear, rapid reporting and good clinical judgment leads to improved management of patients in whom pulmonary embolism is suspected and avoids severe, life-threatening consequences.

Adult↗
PubMed1989

Blood flow in the carotid arteries: quantification by using phase-sensitive MR imaging.

The feasibility of MR phase-sensitive imaging for the quantification of blood flow in the carotid arteries was studied in two normal volunteers and six patients with carotid artery and/or cerebrovascular disease. The technique consists of sensitizing the phase of the MR signal to blood flow velocity gated to different times in the cardiac cycle. Flow velocities and volumes were measured by using transverse planes in the common, internal, and external carotid arteries, and flow curves were generated. Measurements made by using flow phantoms correlated well with calculated results. The MR measurements yielded values between 250 and 580 ml/min for the total flow through each of the common carotid arteries in the two normal volunteers. Markedly reduced flow (about 50% below normal) was detected in a patient whose arteriogram showed severe occlusion of the internal carotid artery. In a second patient, who had a large frontal intracranial arteriovenous malformation noted by arteriography, the MR-quantified flow was abnormally high (about 1 liter/min). In the remaining four patients, the findings on phase-sensitive quantification were consistent with those expected from clinical and other laboratory studies (including arteriography and sonography). These preliminary findings suggest that MR phase mapping may be a feasible tool for the noninvasive quantification of carotid blood flow.

Adult↗
PubMed1988

Gadolinium-labeled liposomes containing paramagnetic amphipathic agents: targeted MRI contrast agents for the liver.

Unique paramagnetic liposomal contrast agents were synthesized and utilized for selective augmentation of T1 MR imaging of the livers of normal Balb/c mice. Amphipathic gadolinium complexes, which mimic phospholipids, were incorporated into the lamella of small unilamellar liposomes (SUV) such that they became an integral part of its surface. T1 signal enhancement of normal liver approached 150% after iv administration of the paramagnetic liposomes, determined by experiments performed on a 1.9-T, experimental whole-body MRI unit. Tracer studies utilizing gadolinium-153-tagged SUV revealed that the agents exhibited excellent in vivo stability, compared to liposomal preparations in which paramagnetic agents are simply entrapped in the aqueous core of the liposome vesicle.

Animals↗
PubMed1987

Gadolinium-labeled liposomes: targeted MR contrast agents for the liver and spleen.

A contrast agent for use in magnetic resonance (MR) imaging of the liver and spleen has been designed in which gadolinium-DTPA is chemically incorporated into the lamellar phase of liposome particles. This agent has excellent in vivo stability and is taken up by liver and spleen of normal mice after intravenous administration. The T1 increased by 110% in liver and 66% in spleen at 4 degrees C. At 37 degrees, the relaxation rate in the liver increased by 180%. This method is an attractive concept for the development of various organ-specific liposomal contrast agents that may be used for either MR imaging or nuclear medicine.

Animals↗
PubMed1987

The role of suggestion in asthma. II. Effects of a bronchoconstrictor drug on bronchial reactivity under bronchoconstrictor or bronchodilator suggestion.

Previous studies have shown that suggestion may modify bronchial reactivity to both inactive diluents and pharmacologically bronchoconstrictor or dilator substances. In our study, 14 patients were subjected to two methacholine challenge tests presented, respectively, as a bronchoconstrictor or as a bronchodilator drug. Forced expiratory volumes in one second were recorded and a PD20 was determined. No significant differences were reported in PD20 values of each patient after the two kinds of suggestion.

Adolescent↗
PubMed1986

Beneficial use of an evocative test in chronic relapsing pancreatitis in children.

The true incidence and cause of chronic recurrent pancreatitis in children remains enigmatic because little is known about its early natural history, it is considered only infrequently, and diagnosis is difficult. Chronic recurrent abdominal pain in children continues to be common. To help evaluate the possibility that such pain is related to chronic recurrent pancreatitis, this study used the morphine-prostigmine pancreatic evocative test with the recent addition of concomitant pancreatic ultrasonography to evaluate ductal activity. Fourteen of 67 children studied had positive results and 13 underwent operation, which included 2 partial pancreatectomies and 12 sphincteroplasties in 12 patients. At last follow-up seven were asymptomatic, five were significantly improved, and one who had pancreatography only continued to have pain. The remaining patient, who has not yet operated on, continues to have pain. This series supports the use of the morphine-prostigmine test to determine which patients have abdominal pain that is potentially related to pancreatitis and which patients would benefit from operation.

Abdomen↗
PubMed1984

Intravenous digital subtraction angiography in the assessment of patients with left to right shunts before and after surgical correction.

Pre- and postoperative structural changes and pulmonary to systemic flow (QP/QS) ratios were assessed using digital angiography in 34 patients documented to have a left to right shunt at cardiac catheterization. There were 16 men and 18 women whose ages ranged from 4 months to 60 years. The radiographic single mask mode was used for all digital subtraction angiographic studies with a typical radiographic sequence being 80 to 100 kV, 5 to 10 mA/frame at six frames/s for 15 seconds. Renografin-76 was used as a bolus injection at 0.5 to 1.0 ml/kg via an arm vein in most patients. The level of the left to right shunt and any associated anomalies were noted and compared with results from cardiac catheterization. Digital subtraction angiographic flow curves were generated from the pulmonary arteries, and QP/QS ratios were calculated pre- and postoperatively using the gamma variate fit method and compared with the QP/QS ratio from first pass radionuclide studies. A strong correlation between preoperative digital subtraction angiographically derived QP/QS ratio and radionuclide-derived QP/QS ratio was found, with an r value equal to 0.89, p less than 0.0001. Postoperatively, all patients had a QP/QS ratio less than 1.2:1.0 for both digital subtraction angiography and radionuclide studies. The level of left to right shunt was accurately assessed in all patients, and its absence observed postoperatively. Associated anomalies, such as a persistent left superior vena cava, coarctation of the aorta and partial anomalous venous return, were identified in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗