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Biomedical subjects

I Fogelman

Publications and source records attributed to I Fogelman.

At least 271 records · Page 15Linked to original sources
PubMed1982

Diphosphonate bone scanning agents--current concepts.

The bone scan is generally recognized to be an extremely powerful investigational tool in the evaluation of patients with skeletal disease. Currently 99mTc-methylene diphosphonate is the most widely used bone scanning agent, but recently several new diphosphonate compounds have been introduced which appear to have relatively higher skeletal affinity, leading to greater absolute uptake of tracer by bone. While the resulting improved contrast between bone and background soft-tissue may provide more pleasing scan images, it is not clear that increased bone uptake of tracer is equally desirable for identification of disease. Nevertheless, to date, no significant difference in lesion detection has been found in any comparative study of diphosphonate compounds. In this review the clinical studies evaluating diphosphonate bone scanning agents are summarized and the properties required of an ideal bone scanning agent in both benign and malignant disease discussed.

Bone Diseases↗
PubMed1982

Diphosphonates in the evaluation of metabolic bone disease.

The bone scan may be of value in the assessment of patients with metabolic bone disease. However the superiority of the bone scan when compared to radiology in conditions such as renal osteodystrophy, osteomalacia, primary hyperparathyroidism, and osteoporosis requires substantiation with the newer radiopharmaceuticals which have a higher affinity for bone. Two methods of quantitating skeletal uptake of tracer have been assessed to try to remove the subjective aspect of bone scan evaluation. Measurements of bone to soft tissue ratios have proved clinically disappointing, but 24 hour whole body retention of diphosphonate appears to provide a sensitive index of increased bone turnover.

Bone Diseases, Metabolic↗
PubMed1982

Do anticonvulsant drugs commonly induce osteomalacia?

Twenty adult epileptic out-patients who had received anticonvulsant therapy for a mean duration of 15 years were assessed for clinical, biochemical, radioisotopic and bone biopsy evidence of osteomalacia. Occasional biochemical abnormalities were demonstrated but no individual subject was found to have osteomalacia. There is increasing evidence to cast doubt on the existence of a strong relationship between anticonvulsant drugs and osteomalacia. This evidence is reviewed and it is concluded that in the presence of adequate sunlight exposure anticonvulsant therapy alone is most unlikely to lead to osteomalacia in adults.

Adult↗
PubMed1982

Age-related alterations in skeletal metabolism--24-hr whole-body retention of diphosphonate in 250 normal subjects: concise communication.

Twenty-four-hour measurements of whole-body retention (WBR) of Tc-99m diphosphonate (a sensitive measure of skeletal metabolism) have been obtained in 250 healthy volunteer subjects. WBR values were found to fall from the age of 20 yr until 35 yr and then in men to rise linearly thereafter. Women showed a similar pattern initially but there was a marked rise in WBR corresponding to the menopausal years. Our results lend support to the belief that skeletal metabolism increases with age. It is suggested that some imbalance must always exist between resorption and formation in bone, with net loss of bone mineral, and increasing levels of skeletal metabolism will exaggerate this imbalance and accelerate the rate of bone loss.

Adult↗
PubMed1981

Clinical value of adrenal androgen measurement in the diagnosis of delayed puberty.

Serum levels of the adrenal androgens dehydroepiandrosterone (DHA), dehydroepiandrosterone sulphate (DHAS), and androstenedione (A) were measured in 90 males (age range 14 1/2--26 years) presenting with delayed puberty to an adult endocrine clinic over a period of 3 years. The results show that adrenal androgen levels are significantly lower (p less than 0.0005) in subjects with growth-hormone (GH) deficiency than in patients with simple and constitutional delayed puberty and other, less common, conditions. By contrast, subjects with hypogonadotropic hypogonadism had significantly raised values (p less than 0.0005). On initial presentation DHA and DHAS measurements correctly identified all GH-deficient subjects and in addition DHAS measurements identified 89% of subjects with hypogonadotropic hypogonadism. It is suggested that measurement of serum levels of DHA and DHAS may assist greatly in the early diagnosis of conditions causing delayed puberty, and thus may prevent unnecessary delay in treatment.

Adolescent↗
PubMed1981

A critical assessment of bone scan quantitation (bone to soft tissue ratios) in the diagnosis of metabolic bone disease.

Accurate quantitation from the bone scan image of skeletal uptake of radiopharmaceutical would be of value in the assessment of patients with metabolic bone disease. Repeat measurements of bone to soft tissue (B/ST) ratios on the one set of images were made for 103 subjects, a) by the same observer using lumbar vertebra 2 for the area of bone; b) by the same observer using lumbar vertebra 2 then lumbar vertebra 4; c) by two observers both using lumbar vertebra 2. The median difference between repeat measurements by the same observer was well under 1% but the 5-95 percentile range was -13 to +14%. Between the two observers there was a median difference of 10.6% with a 5-95 percentile range of -11 to +44%. We also measured B/ST ratios in 150 control subjects and 139 patients with various metabolic bone disorders. While statistically significant differences for B/ST ratios were found between the osteomalacia, renal osteodystrophy, Paget's groups, and the control population (P less than 0.001 in all cases), there was appreciable overlap between individual patient results and the control range. It is concluded, therefore, that measurement of B/ST ratios for the individual is of limited value in clinical practice.

Adult↗
PubMed1981

The role of bone scanning in Paget's disease.

In Paget's disease, the bone scan allows visualisation of the whole skeleton, permitting accurate assessment of disease extent. The scan appearances are usually characteristic, and as uptake of tracer depends upon skeletal metabolic activity, this study reflects the severity of Paget's disease, in addition to providing early appreciation of alterations in disease activity. While correlation of x-rays and bone scans in Paget's disease have shown that neither method alone detects all lesions, it is clear that the bone scan is the more sensitive technique. In addition, those sites that are occasionally missed by bone scan are metabolically inactive. The bone scan is the investigation of choice in Paget's disease, and radiology should be used to provide supplementary information, as and when required.

Bone and Bones↗
PubMed1981

Assessment of synthetic steroid (Org OD 14): effect on skeletal metabolism by 24-h whole-body retention of diphosphonate.

Using a 24-h whole-body retention (WBR) of Tc99m hydroxyethylidene diphosphonate (HEDP), a sensitive measure of skeletal metabolism, 24 women receiving the synthetic steroid hormone Org OD 14 were studied. OD 14 was found to have a powerful suppressive effect on skeletal metabolism in both oophorectomized and non-oophorectomized women when compared with control subjects (P less than 0.001 and P less than 0.01, respectively). The degree of suppression was similar to that found with oestrogen therapy. While it has previously been shown that OD 14 prevents bone mineral loss (as measured by photon-absorptiometry), the present study provides further evidence as to the efficacy of this compound in suppressing skeletal metabolism.

Alkaline Phosphatase↗
PubMed1981

Pseudohypoparathyroidism presenting as severe Parkinsonism.

A case of pseudohypoparathyroidism in a middle-aged female presenting with severe Parkinsonism is reported. Correction of serum calcium led to marked clinical improvement suggesting that symptoms and signs were exacerbated by hypocalcaemia and tetanic spasm. Calcification of the basal ganglia was not detected on skull X-ray but was revealed by computerized axial tomography.

Brain Diseases↗
PubMed1981

Tampon-associated toxic shock syndrome--a case report.

We report a case of tampon-associated toxic shock syndrome occurring in a 16-year-old girl. While this condition has been reported almost exclusively from the USA it is likely that TSS will be recognised elsewhere with increasing frequency as physicians become more aware of its existence. We consider that TSS must be considered in any hypotensive female in the reproductive age group with diarrhoeal illness.

Adolescent↗
PubMed1981

A comparison of skeletal uptakes of three diphosphonates by whole-body retention: concise communication.

Twenty normal volunteers had measurements of 24-hr whole-body retention (WBR) of three structurally related Tc-99m-labeled phosphonate skeletal imaging agents: (1-hydroxyethylidene) diphosphonate (HEDP), methylene diphosphonate (MDP), and hydroxymethylene diphosphonate (HMDP). The average WBR values, reflecting skeletal uptake, were 18.4, 30.3, and 36.6%, respectively. These results clearly illustrate that slight alterations in diphosphonate molecular structure have a significant effect upon specificity for osseous tissue, and thus may affect skeletal image quality and the usefulness of the WBR technique in diagnosing metabolic bone disease.

Adult↗
PubMed1981

Measurement of 24-hour whole-body retention of Tc-99m HEDP by a gamma camera.

Measurement of 24-hr whole-body retention of Tc-99m HEDP, using a shadow-shield, whole-body monitor, has been shown to be a sensitive measure of skeletal metabolism and of value in the diagnosis of metabolic bone disease. A new method of measuring the retention using a gamma camera, with a scanning (fishtail) collimator and patient placed at 2.,3 m distance, has been evaluated in 18 patients undergoing routine bone scans. The patients also had whole-body monitor (WBM), and the two methods correlated well, yielding a regression line GC% = -0.82 + 0.98 WBM%, r = 0.975, p less than 0.001. The limitations to, and repeatability of, the gamma-camera measurements are discussed. This work shows that measurements of whole-body retention can be obtained in any nuclear medicine department possessing a gamma camera with a suitable collimator.

Body Burden↗