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Biomedical subjects

I Fogelman

Publications and source records attributed to I Fogelman.

At least 235 records · Page 13Linked to original sources
PubMed1987

Scintigraphy and treatment of medullary carcinoma of the thyroid with iodine-131 metaiodobenzylguanidine.

We report our experience using [131I]metaiodobenzylguanidine (MIBG) to image nine patients with proven medullary carcinoma of the thyroid (MCT). Positive uptake was seen in four patients, equivocal uptake in one patient, and no uptake in four patients. Data is presented to demonstrate the pharmacokinetics of [131I]MIBG in three of the patients studied. Two patients, with diarrhea and severe pain from known bone metastases and positive uptake on [131I]MIBG diagnostic scanning, subsequently received therapeutic doses of [131I]MIBG, with marked improvement in both pain and diarrhea, but no evidence of significant biochemical response. Iodine-131 MIBG uptake in patients with MCT is variable, and gives a higher false-negative rate than is found when using [131I]MIBG to image other neuroectodermally derived tumors. The therapeutic potential of [131I]MIBG in patients with MCT warrants further evaluation, in view of the symptomatic relief experienced following therapy doses in two patients with extensive disease.

3-Iodobenzylguanidine↗
PubMed1986

Radionuclide measurement of right ventricular function in atrial septal defect, ventricular septal defect and complete transposition of the great arteries.

Right ventricular (RV) function was assessed in 80 patients with congenital heart disease by first-pass and gated equilibrium radionuclide angiography. In 30 patients with a ventricular septal defect (VSD) the mean RV ejection fraction (+/- standard deviation) was 64 +/- 7%. In 30 patients with a secundum atrial septal defect it was 61 +/- 9% and in 20 patients with surgically corrected complete transposition of the great arteries it was 49 +/- 13%. These values are in close agreement with values established with cineangiography for similar groups of patients. The mean ejection fraction in the group with transposition of the great arteries was significantly less than in the group with VSD (p less than 0.001). Phase analysis of the equilibrium studies showed that there was delayed RV contraction in many patients in the absence of conduction abnormalities. This delay was significantly greater in patients with atrial septal defect than in those with VSD (p less than 0.05). There was a strong correlation between size of left-to-right shunt and phase delay in patients with VSD (r = -0.72). Thus, first-pass gated radionuclide angiography provides a valid measurement of RV ejection fraction, and delayed RV contraction on phase analysis may be a sensitive index of early RV dysfunction.

Adolescent↗
PubMed1986

The role of thyroid scanning in hyperthyroidism.

Radionuclide thyroid imaging was performed in 872 consecutive patients with hyperthyroidism. Of these, 84% were found to have diffuse toxic hyperplasia (Graves' disease), while 12% had autonomously functioning nodules (Plummer's disease), 3% had Graves' disease developing in a multinodular gland, and in the remaining 1%, either a clear diagnosis could not be established or the hyperthyroidism was due to thyroiditis or the Jod-Basedow phenomenon. It was found that a thyroid scan seldom provides additional diagnostic information in patients with Graves' disease when a diffuse goitre is present. However, if patients are to be treated with radioiodine (131I), thyroid imaging with tracer quantitation can replace a 24-h 131I uptake measurement, this having the advantages that the patients are required to attend only once, and that the gland size can be measured. In addition, visual confirmation of tracer uptake by the thyroid is obtained and patients with thyroiditis will not receive inappropriate therapy. When single or multiple thyroid nodules are palpated, a thyroid scan is crucial in establishing an accurate diagnosis, as it is not otherwise possible to differentiate between Plummer's disease and Graves' disease developing in a multinodular gland. Indeed, in 20 of our 63 patients (32%) with single autonomously functioning nodules, the initial clinical assessment had been incorrect.

Adenoma↗
PubMed1986

Absorption of oral diphosphonate in normal subjects.

Absorption of the diphosphonate etidronate (HEDP) was measured in 20 volunteer subjects at two centres (Glasgow and Madison) using a new method based on simultaneous administration of HEDP and intravenous 99mTc-HEDP (Osteoscan). The mean absorption of HEDP in fasting subjects in Glasgow was 3.5% (range 1-8.9%) and in Madison 1.5% (0.7-2.8%) (P less than 0.035). In four subjects studies were repeated with good agreement between results (mean 3.9 cf. 3.5%). Six subjects had studies repeated when drug was ingested with food and in all cases absorption was effectively reduced to zero. We conclude that absorption of HEDP is significantly higher in normal subjects in Glasgow than in Madison. This may be of importance with regard to the finding of histological osteomalacia and fracture associated with HEDP use in Glasgow.

Administration, Oral↗
PubMed1986

A single plasma sample method to assess disease activity in patients with bone metastases from carcinoma of the prostate.

A single blood sample method was used to measure total skeletal activity during routine radionuclide bone scans in 114 patients with known carcinoma of the prostate. The method is based on the measurement of radioactivity in plasma after administration of 99mTc MDP and 51Cr EDTA, providing an assessment of total skeletal activity independent of renal function. The results showed a significant elevation of skeletal activity in patients with untreated bone metastases when compared with patients with no metastatic spread. Significant elevation with increasing extent of metastases was also shown, the highest activity being in patients with diffuse metastatic spread (superscan). Patients with treated metastatic disease showed significantly lower skeletal activity than patients with untreated bone metastases. The method requires the use of two radiopharmaceuticals injected as a mixture and potential errors may arise from pharmaceutical instability. In addition, elevation of total skeletal activity may be caused by coexistent metabolic bone disease. The results suggest that the measure may provide quantitative information in the assessment of the activity of bone metastases from prostatic carcinoma.

Bone Neoplasms↗
PubMed1986

Radioiodine treatment of solitary functioning thyroid nodules.

Forty-eight patients with hyperthyroidism due to a single toxic nodule have been treated with radioiodine (131I). The mean follow-up period is 37 months. All patients were rendered euthyroid and no cases of hyperthyroidism have been observed. Forty patients required only one dose of 131I to render them euthyroid, six patients required more than one dose and two patients initially rendered euthyroid relapsed during follow-up and required further 131I treatment. It is concluded that a single fixed dose of 131I is a simple, effective treatment for a solitary toxic thyroid nodule and does not cause hypothyroidism.

Adult↗
PubMed1986

The evaluation of radioiodine therapy for thyroid patients using a fixed-dose regime.

Ninety-six patients with toxic diffuse goitre (Grave's disease) in whom rapid control of disease was necessary were treated with an "ablative" dose of 550 MBq of radioiodine (131I) with the intention of inducing hypothyroidism. Outcome was established in 93 cases (mean follow-up 37 months), 45 patients (48%) becoming hypothyroid, 30 (32%) remaining euthyroid and 18 (19%) with persistent thyrotoxicosis requiring further 131I therapy. It is thus apparent that a fixed dose of 550 MBq 131I cannot be considered ablative, with less than 50% of patients developing hypothyroidism.

Adult↗
PubMed1986

Osteopaenia of the lumbar spine and femoral neck in anorexia nervosa.

The bone density in the spine, femoral neck and radius in 31 outpatients with anorexia nervosa (AN) was measured by photon absorptiometry and compared with 31 age matched controls. In all bone sites measured the patients with anorexia nervosa had reduced bone mineral density (spine- control 0.91 + .10 gHA/cm2, AN 0.75 + .09 gHA/cm2; femur- control 0.87 + .09 gHA/cm2, AN 0.67 + .07 gHA/cm2; radius-control 0.41 + .04 gHA/cm2, AN 0.38 + 0.9 gHA/cm2). The mean difference between the groups was greatest in the femoral neck at 0.21 gHA/cm2 (95% CI 0.18-.024 p less than 0.001) and least at the radius 0.04 gHA/cm2 (95% CI 0.02-0.06, p less than 0.05), the lumbar spine was intermediate with a mean difference of 0.16 gHA/cm2 (95% CI 0.12-0.2 p less than 0.001). Femoral and spinal bone mineral density was positively correlated with body mass and negatively correlated with duration of amenorrhoea. Three of these patients had vertebral crush fractures which suggests that this diminution in bone density is of clinical significance.

Adolescent↗
PubMed1985

Pregnancy in a woman with premature ovarian failure.

We report the case of a 32 year old woman with premature ovarian failure associated with ovarian autoantibodies, autoimmune Addison's disease and primary hypothyroidism who became pregnant following the treatment of her thyroid and adrenal deficiencies.

Addison Disease↗
PubMed1985

Hormone binding globulins and anticonvulsant therapy.

Serum sex hormone binding globulin, thyroxine binding globulin, cortisol binding globulin and vitamin D binding globulin, together with total levels of the appropriate bound hormones, were determined in 21 epileptic subjects who had been stabilised by long-term anticonvulsant therapy. Serum sex hormone binding globulin capacity was higher in these patients than in appropriate control groups (men p less than 0.05; women p less than 0.01), and values correlated with serum phenytoin levels in the female subjects (p less than 0.01). Thyroxine binding globulin levels were unaffected by anticonvulsants, but significant reductions in serum thyroxine (men p less than 0.05; women p less than 0.001) and triiodothyronine (men p less than 0.05; women p less than 0.01) were observed. Cortisol binding globulin capacity was appreciably elevated in patients of either sex (p less than 0.001), and in the women this was accompanied by a reduction in serum cortisol (p less than 0.001) and a significant correlation with the serum phenytoin concentration (p less than 0.01). Neither vitamin D binding globulin capacity nor serum 25-hydroxycholecalciferol levels were influenced by anticonvulsants in this study. It is concluded that anticonvulsant drug therapy causes widespread alterations in the normal homeostasis between hormones and their serum binding globulins. Such alterations may well have clinical significance.

Adult↗
PubMed1985

Nuclear medicine: a clinical service.

While nuclear medicine is essentially an imaging specialty, it often provides functional information which may not be obtained in any other way. This review considers how best such information can be presented and how physicians can become more familiar with nuclear medicine techniques.

Bone and Bones↗
PubMed1984

Relative contribution of humoral and metastatic factors to the pathogenesis of hypercalcaemia in malignancy.

Some relations between metastatic bone disease and calcium homoeostasis were determined in a consecutive series of 81 patients with solid malignant tumours attending for radionuclide bone scans. Biochemical evaluation showed that bone resorption from metastatic disease was generally not enough to account for hypercalcaemia. While skeletal metastases were present in about half of the patients who developed hypercalcaemia, biochemical indices of bone resorption in these subjects were greatly increased and disproportionate to the extent of metastatic disease detected by the bone scans. Furthermore, a reduced renal phosphate threshold and increased tubular calcium reabsorption were generally observed in hypercalcaemic patients when compared with their normocalcaemic counterparts. These findings suggest that in most cases malignancy associated hypercalcaemia may be caused by the release of a humoral factor by tumour tissue which exhibits "parathyroid-hormone-like" activity with regard to bone resorption, renal phosphate threshold, and renal calcium handling. It may be postulated that this putative humoral mediator predisposes to hypercalcaemia both by stimulating generalised osteolysis and in most cases also by impairing the renal excretion of the resultant increase in filtered calcium load. While hypercalcaemia may arise as a result of metastatic bone disease alone, these data indicate that this may be the exception rather than the rule. Hence the term "metastatic hypercalcaemia" should probably be reserved for patients with extensive skeletal tumour disease in whom biochemical evaluation fails to yield evidence of an underlying humorally mediated cause.

Bone Neoplasms↗
PubMed1984

Focal osteomalacia due to low-dose diphosphonate therapy in Paget's disease.

Transiliac bone biopsies carried out on 13 patients with Paget's disease to evaluate the effects of low-dose diphosphonate (disodium etidronate) therapy showed focal osteomalacia in the 9 patients in whom post-therapy specimens were taken through pagetic bone. Active bone resorption persisted in 5 of these. A mineralisation defect not amounting to osteomalacia--ie, osteoid of increased thickness but of normal extent--was present in the 4 specimens taken through non-pagetic bone. Although 9 patients experienced symptomatic improvement, 2 suffered fissure fractures in affected lower limbs. In Paget's disease, the combination of osteomalacia and continuing active resorption within a lytic lesion may increase the risk of fracture in a weight-bearing bone. It is suggested that although disodium etidronate often provides effective pain relief it should be administered with caution until the optimum dose and duration of therapy are further evaluated.

Aged↗