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Biomedical subjects

I Zanzi

Publications and source records attributed to I Zanzi.

At least 37 records · Page 2Linked to original sources

Effect of PEEP on regional ventilation and perfusion in the mechanically ventilated preterm lamb.

Improvement of gas exchange through closer matching of regional ventilation (V) and lung perfusion (Q) with the application of positive end-expiratory pressure (PEEP) was evaluated in vivo in six mechanically ventilated preterm lambs (107-126 days/145 days gestation). Changes in V and Q were determined from in vivo scintigraphic measurements in four lung regions with inhaled radioactive 81mKr, and infused 81mKr/dextrose and/or [99mTc]MAA as PEEP was applied at 2, 4, and 6 cm H2O in each animal. Dynamic compliance varied between 0.02 and 0.40 ml/cm H2O, which was consistent with surfactant deficiency. As PEEP was increased, the regional distribution of Q shifted from the rostral to the caudal lung regions (p less than 0.02 to less than 0.05), while that of V remained unchanged. Regional V/Q matching improved together with a trend towards improvement of arterial blood gases as PEEP was increased from 2 to 4 cm H2O. Pulmonary scintigraphy offers a noninvasive methodology for the quantitative assessment of regional V and Q matching in preterm lambs and may be clinically applicable to ventilated neonates.

Animals↗

Scintigraphic and magnetic resonance studies in a patient with Gaucher's disease.

In-111 chloride imaging was used in the evaluation of a patient with Type I Gaucher's disease before splenectomy for pancytopenia. This case is the first report of its use in this clinical setting. The image demonstrated the presence of adequate marrow reserve, thereby suggesting that the pancytopenia was due to hypersplenism rather than marrow replacement. Normalization of blood counts after splenectomy confirmed this interpretation. Eight months later, the patient had acute pain in the left knee. Bone imaging suggested a left lateral tibial plateau fracture that was not seen on plain radiographs or magnetic resonance imaging, but was confirmed by x-ray tomography. The significance and implications of these findings are discussed.

Bone and Bones↗

Splenic hypofunction in the nephrotic syndrome of childhood.

The reticuloendothelial system, including the spleen, subserves important immunologic functions. Loss of splenic function results in an increased incidence of severe bacterial infections and is accompanied by thrombocytosis. Several nephrotic children were noted to have remarkably high platelet counts and predisposition to bacterial infection with encapsulated organisms. We, therefore, investigated the splenic function of nine children with primary nephrotic syndrome and measured the phagocytic function of the spleen by sequestration of Technetium-99-labelled heat-treated autologous RBC, administered intravenously. Four children had decreased splenic function. Repeat studies performed in two of these children after remission of the nephrotic syndrome gave normal results. There were six episodes of bacterial infection (3 peritonitis, 1 septic arthritis, 1 cellulitis, and 1 Escherichia coli urinary tract infection) among the four patients with decreased splenic function. There were no episodes of bacterial infection among the five nephrotic children with normal splenic function. Nephrotic patients with decreased splenic function had significantly increased platelet counts (921,000 +/- 196,000; mean +/- SEM) compared to those with normal function (435,000 +/- 46,000; P less than 0.001). Our findings suggest the possibility that some nephrotic children may have decreased splenic function in association with increased susceptibility to bacterial infections.

Adolescent↗

Cholescintigraphic abnormality in a case of Kawasaki syndrome.

A 26-month-old girl with Kawasaki syndrome (mucocutaneous lymph node syndrome) is presented. Liver function studies were abnormal and sonographic examination revealed hydrops of the gallbladder. The Tc-99m DISIDA cholescintigraphy demonstrated both early and delayed nonvisualization of the gallbladder. A photopenic area was noted in and below the gallbladder fossa and there was medial and upward displacement of the common bile duct. It appears that Kawasaki syndrome may result in nonvisualization of the gallbladder by cholescintigraphy. Accordingly, this diagnosis should be added to the list of conditions associated with nonvisualization of the gallbladder by biliary scintigraphy.

Child, Preschool↗

Combination therapy for osteoporosis with estrogen, fluoride, and calcium.

Nine women with postmenopausal spinal osteoporosis were treated with combination therapy consisting of estrogen, fluoride, and calcium. Their data were compared with those of a control group treated with fluoride, and calcium without estrogen. Bone mass was measured about every six months by photon absorptiometry (bone mineral content/bone width (BMC/BW)] and total-body neutron activation analysis [total-body calcium (TB Ca)]. Time-trend analysis revealed positive slopes for TB Ca (P = 0.002) and BMC/BW (P = N.S.) for the combination therapy group. The change in BMC/BW in the combination therapy group was significantly different from the response in the fluoride - calcium group. These data suggest that combination therapy may be successful in increasing bone mass in postmenopausal osteoporosis. A clinical trial to establish efficacy and examine risk/benefit ratios should be performed.

Adult↗

Rate of bone loss in postmenopausal and osteoporotic women.

Regional and total bone mass were determined in three groups of women by photon absorptiometry of the distal radius [bone mineral content BMC)] and total body neutron activation analysis [total body calcium (TBCa)], respectively. There were three groups of patients: group A, osteoporotic women treated with a variety of pharmacologic agents; group B, osteoporotic women (controls) taking only calcium supplements; and group C, normal postmenopausal women. The mean TBCa and BMC were considerably higher in the postmenopausal women than in the osteoporotic women. The rate of change of bone mass in group C was -0.45%/yr and -0.9%/yr for the total skeleton and radius, respectively. Group B had no significant rate of loss, whereas group A demonstrated a significant increase in TBCa of 0.75%/yr with no change in the BMC of the radius. There were no significant between-subject correlations for the slopes (rates of change) of the two bone mineral measurements.

Bone Resorption↗

Total body bone mineral and lean body mass by dual-photon absorptiometry. II. Comparison with total body calcium by neutron activation analysis.

Total body bone mineral (TBBM) was measured in vivo using dual-photon absorptiometry (DPA) in 10 subjects. The total body calcium (TBCa) was measured in the same subjects using neutron activation analysis. The correlation between the two methods was very high (r greater than 0.99) and the standard error of estimate was low. The TBCa relative to TBBM was about 39%. The two noninvasive methods provided nearly identical indications of skeletal mass, but the radiation exposure with DPA was 500 to 5000 times smaller (0.6 mrem vs 300 to 3000 mrem). The radius shaft bone mineral content was highly correlated with the TBBM (0.97) and the TBCa (0.98) and could be used to estimate the latter variables with errors (1 SEE) of 9% and 6%, respectively.

Body Composition↗

Compartmental body composition of cancer patients by measurement of total body nitrogen, potassium, and water.

Quantitative measurement was made of body composition in patients with several forms of neoplastic disease. Total body nitrogen was determined by means of the prompt gamma neutron activation technique; total body potassium was measured with the use of a whole body counter. The mass and protein content of the muscle compartment and nonmuscle lean tissue were estimated by application of the technique of compartmental analysis. Total body water, determined simultaneously with the use of tritium label, provided a measure of lean body mass. From these data, the body fat can be inferred. The prompt gamma neutron activation and whole body counting techniques represent a considerable advance over the balance and radioisotope techniques used in earlier studies. The new techniques make possible sequential studies over prolonged periods of time with a considerable degree of accuracy. The loss of body weight by patients with solid tumors consisted primarily of the loss of muscle mass and body fat. Even in severe wasting, the patients appear to retain significant amounts of body fat. It is the skeletal muscle which is predominantly lost; the visceral life-supporting system is, to a considerable extent, spared. The nonmuscle tissue including the visceral fraction did not change in this study, and actually appeared to increase in size when comparison was made with the normal contrast population. The loss of total body water was slight in the cancer patients studied.

Adipose Tissue↗

Critical concentrations of cadmium in human renal cortex: dose-effect studies in cadmium smelter workers.

Cadmium was measured in vivo in the left kidney and liver of 82 industrially exposed workers and 10 control subjects. The range of Cd values for the industrial group was 0.9-57 mg for the whole kidney and 0.8-120 ppm for the liver, compared to 0.4-11.8 mg and 0.6-7.9 ppm for the control group. Below 40 ppm in the liver, the kidney Cd burden tended to increase with increasing liver concentration. Above 40 ppm, the kidney Cd content decreased as the liver concentration increased. This biphasic relation between Cd in the kidney and the liver for all subjects showed a critical level of approximately 31 mg Cd in the kidney. Estimates of the critical level by beta 2-microglobulin and urinary protein measurements yielded critical values of 31-42 mg Cd for the whole kidney (300-400 microgram/g for the renal cortex).

Cadmium↗

In vivo measurement of critical level of kidney cadmium: dose effect studies in cadmium smelter workers.

In vivo measurements of kidney and liver cadmium burdens were obtained in 82 industrially exposed workers and ten control subjects. Kidney cadmium levels ranged from 0.9 mg to 57 mg, and liver concentrations ranged from 0.8 ppm to 120 ppm for the industrial group. Comparison values for the control group were 0.4 mg to 11.8 mg for the kidney and 0.6 ppm to 7.9 ppm for the liver. A biphasic relationship between kidney Cd levels and liver Cd levels was observed. The kidney and liver Cd levels showed an increase until approximately a 40 ppm concentration was reached in the liver. Thereafter, the kidney levels decreased as the liver concentration continued to increase. The kidney cadmium level at which this change occurred was approximately 31 mg for the total kidney. Further estimates of the critical level, based on years of exposure and renal dysfunction (beta 2-microglobulin, proteinuria), yielded estimates of 31 mg to 42 mg cadmium (300-400 micrograms/gm for the renal cortex).

Cadmium↗

Compartmental body composition based on total-body nitrogen, potassium, and calcium.

The techniques of prompt gamma neutron-activation analysis for the measurement of total-body nitrogen and whole-body counting for the measurement of total-body potassium were used to determine the mass of muscle and nonmuscle lean tissue and their protein content in 135 normal male and female subjects, 20-80 yr of age. Age-related changes in the size of the muscle and nonmuscle compartments and their protein content provide basic data for the investigation of protein metabolism in aging subjects and in individuals with various metabolic disorders, particularly wasting diseases such as cancer. Significant age-related changes in the size of various body compartments were noted. The loss of muscle mass and its protein content contrasts with the relative constancy of the nonmuscle lean tissue and suggests that skeletal muscle is particularly vulnerable to the aging process.

Adult↗

Total-body sodium and sodium excess.

Total-body levels of sodium (TBNa), chlorine (TBCl), calcium (TBCa), and potassium (TBK) were measured by neutron activation and analysis of results by whole body counting in 66 postmenopausal women. The relationship between TBNa, and TBCl, TBK, and TBCa on the one hand, and height and weight on the other, were found to compare with those previously reported. The hypothesis that TBNa and TBCl are distributed normally could not be rejected. The sodium excess (Naes) is defined as the sodium that is present in excess of that associated with the extracellular fluid (chlorine) space; the Naes approximates nonexchangeable bone sodium. In these 66 postmenopausal women, and in patients with different endocrinopathies previously described, the values of Naes did not differ from the normal values except in the thyrotoxicosis patients, where they were decreased. A close relationship between Naes and TBCa was maintained in the endocrinopathies studied. This relationship was found in conditions accompanied by either an increment or a loss of skeletal mass. It appear

Body Composition↗

Cadmium: in vivo measurement in smokers and nonsmokers.

Absolute amounts of cadmium (in milligrams) in the left kidney and concentrations of cadmium (micrograms per gram) in the liver were measured in vivo in 20 healthy adult male volunteers. Organ cadmium levels of smokers were significantly elevated above those of nonsmokers. No relationship was evident between body stores of cadmium (liver and kidney) and cadmium or beta 2-microglobulin in urine or blood. The average total body burden of cadmium in man at age 50 is estimated to be 19.3 milligrams for nonsmokers and 35.5 milligrams for smokers (38.7 pack-year smoking history). Biological half-time for the whole body was, on average, 15.7 years (10- to 33-year range). Dietary absorption was 2.7 micrograms per day. Cigarette smoking resulted in the absorption of 1.9 micrograms per pack.

Adult↗

Skeletal mass in postmenopausal women.

The techniques of photon absorptiometry of the radius and total body neutron activation analysis were used for the determination of bone mineral content and total body calcium, respectively. The subjects consisted of 71 normal women who were 1-5 yr postmenopausal and 44 osteoporotic women who had crush fractures of the dorsal spine. Both bone mineral content and total body calcium were corrected for age and body size by using the ratio of observed values to those predicted from previously derived equations. Discrimant analysis involving both osteoporotic and normal postmenopausal women resulted in the successful assignment of 81% of the 115 subjects to their correct group. Statistical analyses of the distribution of the bone mass of the postmenopausal women yielded no evidence to support the hypothesis that a subgroup exists with bone mass levels markedly different from the remainder of the women.

Aged↗

Hydroxyproline peptides and bone mass in postmenopausal and osteoporotic women.

Total and nondialyzable hydroxyproline excretion was measured in 59 postmenopausal women and 68 women with spinal osteoporosis. Hydroxyproline excretion was similar in both groups of women and the hypothesis that hydroxyproline excretion is normally distributed could not be rejected for either group. No relationship was found between hydroxyproline excretion (total and percentage of nondialyzable) and body weight, height, body surface area, or total body calcium or bone mineral content of the radius, or these latter values normalized for age, sex, and body size. There was no difference in hydroxyproline excretion in osteoporotic women who took supplemental calcium as compared to those that did not. These data fail to provide any evidence that bone turnover in osteoporotic women differs from that in younger postmenopausal women, or that osteoporosis arises from a subpopulation of women with rapid bone loss.

Body Height↗

Comparative skeletal mass and radial bone mineral content in black and white women.

The age-related changes in both skeletal mass and muscle mass were directly measured in normal black women ages 30-80 yr. The levels of total-body calcium (TBCa) were determined with the use of in vivo neutron activation. The muscle mass was measured by wholebody counting of 40K. In the same population, the bone mineral content of the radius was measured using a photon absorptiometric technique. Although there was no significant difference in stature, black women had a greater skeletal mass and bone mineral content of the radius than age-matched white female subjects. When the TBCa values were normalized for body size (i.e., corrected for height and lean body mass), the TBCa was still higher for the black women but not as high as the absolute TBCa values. Clearly, it is the larger muscle mass (as reflected by the 40K measure) in relation to weight and height that accounts for this difference. The lower prevalence of fracture and osteoporosis observed in black women relative to white women is due in part to this greater quantity of skeleton. American black women with a higher bone density (i.e., skeletal mass) maintain mechanical integrity of the skeleton longer than individuals with a lower bone density. It is suggested that the larger muscle mass in black women is, in part, a determinant of their increased skeletal mass and is partly responsible for their apparent resistance to osteoporosis and fracture of the skeleton.

Adult↗