Biomedical subjects
I Fogelman
Publications and source records attributed to I Fogelman.
Skeletal uptake of diphosphonate. Method for prediction of post-menopausal osteoporosis.
24-h whole-body retention (WBR) of diphosphonate (a sensitive indicator of skeletal metabolism) was measured in 37 oophorectomised women. 14 women had been prescribed oestrogen supplements and 3 of these had defaulted from therapy. For the study group there was a significant correlation between WBR and both the rate of bone loss as measured by photonabsorptiometry (r = 0.7, p ¿ 0.001) and urinary hydroxyproline (r = 0.53, p < 0.001). The oestrogen-treated group had significantly lower values for WBR and rate of bone loss than the untreated group (p < 0.01, p < 0.01 respectively) indicating suppressed skeletal metabolism. However, the highest values were found in those who had defaulted from oestrogen therapy suggesting a rebound period of accelerated skeletal metabolism and bone loss. There was a significant negative correlation between WBR and oestrogen dosage (r = 0.75, p < 0.02) suggesting that it may be possible to adjust the dosage for optimal skeletal metabolic activity. WBR of diphosphonate provides a simple and sensitive measure of skeletal metabolism which correlates well with conventional measurements of bone loss. WBR may be useful in the screening and identification of women who have increased bone turnover just after the menopause and who may subsequently be at risk of osteoporosis developing.
Skeletal uptake of diphosphonate: a review.
The diphosphonates are currently the skeletal imaging agents of choice and while extremely sensitive for bony abnormality their mechanism of action remains poorly understood. The current concepts in bone uptake mechanisms are reviewed and it is concluded that diphosphonate uptake is most likely related to sites of newly forming bone with diphosphonate adsorbed onto the surface of hydroxyapatite crystals. In situations where there is markedly increased skeletal uptake of tracer, increased vascularity alone cannot account for changes in tracer uptake and changes in skeletal extraction, related to newly forming bone are more important.
A comparison of bone scanning and radiology in the assessment of patients with symptomatic Paget's disease.
Bone scans and X-rays from 23 subjects with symptomatic Paget's disease were evaluated. One-hundred and twenty-seven sites of Pagetoid involvement were found, of which 120 (94.5%) were recognised on the bone scan as compared to 94 (74%) on X-ray. The anatomical distribution and relationship of lesions on scan and X-ray to the patient's symptoms are also discussed. It is concluded that the bone scan is more sensitive than radiology in detecting Paget's disease and only rarely will a lesion that is seen on X-ray not be visualised by scanning.
Lesions in the ribs detected by bone scanning.
Five cases are presented in which lesions in the ribs were first detected on bone scanning. In all cases routine radiology was normal and the bone scans were of value in obtaining either the correct diagnosis or defining the extent of disease.
A comparison of bone scanning and radiology in the evaluation of patients with metabolic bone disease.
Bone scans and radiographs were evaluated in 80 patients with metabolic bone disease (27 with osteoporosis, 14 with primary hyperparathyroidism, 24 with renal osteodystrophy and 15 with osteomalacia). The bone scan did not suggest a metabolic bone disorder in any of 27 patients with histologically proven osteoporosis. In 22 (81%) patients radiographs were reported as showing osteoporosis. In 10 (70%) vertebral fractures were seen on X-ray while these were noted in 11 (41%) patients on the bone scan. Vertebral fractures were usually visualised on the bone scan when these had occurred less than one year previously. In primary hyperparathyroidism the bone scan was suggestive of a metabolic bone disorder in 7 of 14 (50%) patients, while radiographs were reported as showing evidence of hyperparathyroidism in three (21%) cases. The bone scan suggested the presence of a metabolic bone disorder in all 24 patients with renal osteodystrophy and 15 patients with osteomalacia while the correct diagnosis was obtained in 14 (58%) and nine (60%) of these patients on X-ray. It is concluded that the bone scan is the more sensitive investigation in patients with osteomalacia, primary hyperparathyroidism and renal osteodystrophy. For osteoporosis radiology is the investigation of choice but the bone scan may be of value in assessing the duration of vertebral collapse.
A low dose regime of 1 alpha hydroxyvitamin D3 in the management of senile osteoporosis: a pilot study.
A comparison has been made between themetabolic consequences of daily administration for 6 weeks of 1.0 micrograms and 0.5 micrograms 1 alpha hydroxyvitamine D3 (1 alpha(OH)D3) in twenty patients with senile osteoporosis. There was no significant difference in the increase of calcium absorption which occurred in the two treatment groups between the beginning and end of the trial period. Serum and urinary calcium rose significantly in those receiving 1.0 micrograms 1 alpha(OH)D3 but not in the lower dosage group. Serum parathyroid hormone levels were suppressed in the higher dosage group only. There was a significantly greater rise of serum inorganic phosphate, and fall of serum magnesium, on the higher dosage, but no significant change in serum creatinine occurred in either group. It is, therefore, suggested that in long term therapy regimes for osteoporosis incorporating 1 alpha(OH)D3, 0.5 micrograms may be a more suitable daily dose than 1.0 micrograms 1 alpha(OH)D3.
The bone scan in clinical practice.
Radioisotopic bone scanning using technetium-99m labelled phosphate and diphosphonate compounds is a relatively new method of imaging the skeleton which has rapidly assumed major clinical importance. In this review of pathophysiology of bone uptake of radiopharmaceutical, the relative sensitivity of bone scan and radiograph, and the more important uses of bone scanning in clinical practice are described.
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.
Estimation of skeletal involvement in primary hyperparathyroidism. Use of 24-hour whole-body retention of technetium-99m diphosphonate.
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What do we want from a bone-scanning agent?
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[Nuclear medicine technics in the study of bone metabolic diseases].
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Serial scintiscanning in breast cancer: the indications and prognostic value.
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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).
Deafness due to hypervitaminosis D.
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1-Alpha-hydroxy vitamin D3 in primary hyperparathyroidism.
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Autoparathyroidectomy: a case report.
This report describes a patient with primary hyperparathyroidism who became spontaneously normocalcaemic preoperatively. This was due to infarction in a parathyroid adenoma. Plasma parathormone (PTH) levels were monitored pre- and postoperatively.