Biomedical subjects

Jonathan G Goldin

Publications and source records attributed to Jonathan G Goldin.

25 records · Page 2Linked to original sources

PubMed2003

Lung micronodules: automated method for detection at thin-section CT--initial experience.

An automated system was developed for detecting lung micronodules on thin-section computed tomographic images and was applied to data from 15 subjects with 77 lung nodules. The automated system, without user interaction, achieved a sensitivity of 100% for nodules (>3 mm in diameter) and 70% for micronodules (<or=3 mm). With the same images, a radiologist detected nodules and micronodules with sensitivities of 91% and 51%, respectively, without system input. With assistance from the automated system, these sensitivities increased to 95% and 74%, respectively. Preliminary results indicate that the automated system considerably improved the radiologist's performance in micronodule detection.

Aged↗

PubMed2003

Unresectable pulmonary malignancies: CT-guided percutaneous radiofrequency ablation--preliminary results.

PURPOSE: To assess whether percutaneous radiofrequency (RF) ablation of unresectable pulmonary malignancies is safe and technically feasible and to evaluate the usefulness of computed tomographic (CT) nodule densitometry as a tool for following up tumors after ablation. MATERIALS AND METHODS: Twelve patients (seven men and five women; mean age, 60.6 years) with unresectable disease (because of poor lung reserve or multifocality) underwent nodule CT densitometry and CT-guided percutaneous RF ablation of 19 lung tumors (six [32%] tumors were adenocarcinoma, one (5%) was large cell carcinoma, two (10%) were bronchoalveolar carcinoma, four (21%) were colorectal carcinoma, and six (32%) were sarcoma less than 50 cm2 in area (range, 0.25-35.00 cm2). No patients had symptoms of their disease before RF ablation. Follow-up CT densitometry was scheduled for 1, 3, 6, and 12 months after RF ablation. Lesions were evaluated for change in area and contrast enhancement at follow-up CT. RESULTS: RF ablation was well tolerated by all patients. Intraprocedural complications included 12 cases of pneumothoraces (two patients required chest tube placement, while 10 were asymptomatic and required no further treatment), two cases of pleural effusion, and two cases of moderate pain (one case during and one case both during and after the procedure). Mean follow-up was 4(1/2) months (range, 1-12 months). In the eight patients with 3-month follow-up, lesion size increased in two and remained stable in six. Mean contrast enhancement, however, decreased from 46.8 HU (range, 19-107 HU) at baseline to 9.6 HU (range, 0-32 HU) at 1-2-month follow-up. In the one patient with 12-month CT densitometry follow-up, lesion enhancement was less than 50% of that at baseline, and lesion diameter remained stable. CONCLUSION: These preliminary results show that percutaneous RF ablation is a safe and technically feasible management option for unresectable pulmonary malignancies. CT densitometry may have potential for future use as a noninvasive method of following up tumors after RF ablation.

Adenocarcinoma↗

PubMed2002

A pilot study of all-trans-retinoic acid for the treatment of human emphysema.

Emphysema results from progressive destruction of alveolar septae and was considered irreversible until all-trans-retinoic acid (ATRA) was shown to reverse anatomic and physiologic signs of emphysema in a rat model. To evaluate the feasibility of ATRA as a clinical therapy, 20 patients with severe emphysema were enrolled into a randomized, double-blind, placebo-controlled pilot study. Participants included 16 male and 4 female former smokers, two with alpha(1)-antitrypsin deficiency. Patients were treated with either 3 mo of ATRA (50 mg/m(2)/d) or 3 mo of placebo, followed by a 3-mo crossover phase. Plasma drug levels were followed and outcome measures included serial pulmonary function tests, blood gases, lung compliance, computed tomography (CT) imaging, and quality of life questionnaires. In general, treatment was well tolerated and associated with only mild side effects including skin changes, transient headache, hyperlipidemia, transaminites, and musculoskeletal pains. Plasma drug levels varied considerably between subjects and decreased significantly over time in 35% of the participants. Physiologic and CT measurements did not change appreciably in response to therapy. We conclude that ATRA is well tolerated in patients with emphysema, and trials evaluating higher doses, longer treatment, or different dosing schedules are feasible.

Aged↗

PubMed2002

Quantitative CT of the lung.

Lung disease is a leading cause of morbidity and mortality. HRCT, currently the best test to assess lung involvement in emphysema and interstitial lung disease, relies on abnormalities being detected when there is sufficient morphologic distortion to result in visually identified changes that, for the most part, correlate poorly with conventional lung function tests and outcome. QIA offers a technique to assess both structure and function on a regional and global basis. With the advent of user-friendly software packages, this approach is finding application in clinical practice and in clinical studies of new treatment alternatives for diffuse lung disease

Asthma↗

PubMed2002

Progression of coronary artery calcification in patients taking alendronate for osteoporosis.

RATIONALE AND OBJECTIVES: As with their actions on bone, bisphosphonates may play a role in coronary artery calcification (CAC) by inhibiting calcium resorption from plaque. The objective of this study was to determine whether the osteoporosis treatment agent alendronate accelerates the rate of CAC. MATERIALS AND METHODS: The study was a pilot comparative analysis of 56 alendronate-treated patients with osteoporosis compared with 56 control subjects matched for age, sex, risk factors, and CAC scores and with a reference cohort that included 213 control subjects. Patients received alendronate sodium (10 mg daily) for a mean of 24 months and underwent annual assessment of CAC with electron-beam computed tomography and bone mineral density with dual x-ray absorptiometry. The principal outcome measure was the rate of change in CAC score in patients and control populations. RESULTS: There was significant progression of CAC in both alendronate-treated and matched-control groups (paired t test, P = .004 and .006, respectively) but no difference in the rates of CAC progression between the alendronate-treated patients and either the matched or reference control cohort. CONCLUSIONS: This small pilot study indicates that oral alendronate administration does not accelerate the rate of CAC, but a larger cohort should be studied to confirm these findings.

Absorptiometry, Photon↗

PubMed2002

Calcium begets calcium: progression of coronary artery calcification in asymptomatic subjects.

PURPOSE: To test the hypothesis that the rate of coronary artery calcium progression is sex specific, namely, that it is greater in men than in women, and that it is age related, particularly in women. MATERIALS AND METHODS: This was a retrospective study of the progression of coronary artery calcium in 217 consecutive asymptomatic subjects who underwent at least two electron-beam computed tomographic studies of the heart. Calcium in the distribution of the epicardial arteries was quantified by using both the conventional coronary artery calcium score (CCS) and the calcium volume score (CVS). Linear regression models were used to judge the joint influence of various risk factors, including sex and age, on rates of coronary artery calcium progression. RESULTS: This study included 103 women and 114 men. The mean interval between the subjects' first and last studies was 25 months +/- 11 (SD). Regression analyses clearly demonstrated that the amount of coronary artery calcium present at the initial study was the most important determinant of calcium progression. This was true when coronary artery calcium was quantified by using the conventional CCS (P <.001) or CVS (P <.001). Neither sex nor age was a significant predictor of coronary artery calcium progression. Among traditional risk factors, only hypertension (P =.02) and diabetes (P =.01) were significant independent factors for calcium progression. CONCLUSION: In asymptomatic subjects, the initial CCS and CVS were the most important factors that affected rate of coronary artery calcium progression. Neither age nor sex was as important as these factors in determination of coronary artery calcium progression.

Adult↗

PubMedDate not supplied

Determinants of plaque instability in atherosclerotic vascular disease.

BACKGROUND: Despite numerous advances in the understanding of the pathogenesis of atherosclerosis, the factors that determine atheromatous plaque instability remain unclear. The prediction of the vulnerability of a plaque to rupture and subsequent thrombosis would be useful in guiding development of diagnostic and therapeutic approaches. METHODS: Aortas with areas of gross atherosclerosis were obtained from seven autopsy cases. These were then serially sectioned at 3-mm intervals, analyzed histologically, and scored as to plaque size, calcification, lipid content, intraplaque hemorrhage, inflammation, plaque disruption, and plaque thrombosis. Bivariate correlations and binary multivariate regression analyses were performed using SPSS software. RESULTS: Plaque instability was highly correlated with intraplaque hemorrhage, lipid content, and plaque size. Weaker but statistically significant correlations were found with inflammation and calcification. However, in multivariate regression analyses, only plaque size, intraplaque hemorrhage, and lipid content, independent predictors of plaque instability, were significant. CONCLUSIONS: Atheromatous plaques may be rendered unstable by increases in size, increased intra- and extracellular lipid accumulation, and intraplaque hemorrhage. Based on these results, diagnostic modalities that detect plaque size, plaque hemorrhage, and/or lipid content are most likely to be useful in predicting unstable plaques.

Aorta↗