Search PubMed⌕ Search

Biomedical subjects

M J Gelfand

Publications and source records attributed to M J Gelfand.

At least 55 records · Page 3Linked to original sources
PubMed1992

I-131 MIBG imaging after bone marrow transplantation for neuroblastoma.

Thirty-one children with stage III and IV neuroblastoma were studied with iodine-131 metaiodobenzyl-guanidine (MIBG) scintigraphy, technetium-99m medronate scintigraphy, skeletal plain radiography, and computed tomography (CT) before and after bone marrow transplantation (BMT). Twenty-six pre-BMT and 90 post-BMT studies were reviewed. Fourteen patients were alive without tumor, and one patient died at 4 months while free of tumor. I-131 MIBG scans obtained before and after BMT were negative in eight of the 15 patients. Seven had positive I-131 MIBG scans obtained before BMT that became negative after BMT. Six of 15 patients had small, questionable lesions on CT scans of the chest or abdomen that never increased in size, and the I-131 MIBG scans remained negative. Sixteen children had progressive disease or relapse, including four in whom I-131 MIBG scans showed new abnormalities, four with persistently positive I-131 MIBG scans, and three who had negative I-131 MIBG scans at relapse. Two of the 16 patients initially had small lesions seen on abdominal CT scans that were not seen on I-131 MIBG scans; mass lesions were later seen at CT in these locations. Detectable I-131 MIBG uptake in abdominal and thoracic lesions was related to the diameter of the lesion. Both I-131 MIBG scintigraphy and CT should be used to evaluate patients with neuroblastoma who have undergone BMT.

3-Iodobenzylguanidine↗
PubMed1992

Bone scintigraphy in preschool children with lower extremity pain of unknown origin.

Small children often cannot describe the location of bone pain for parents or physicians. Bone scans were performed in 56 children under five years of age with lower extremity pain and/or gait abnormalities of unknown etiology. Patients with fever, and those known to have infection, child abuse, malignancy, and/or radiographic abnormalities were excluded. Thirty patients had abnormal bone scans. Abnormalities included evidence of hip synovitis (4), femoral head avascularity (2), various proximal femoral abnormalities (3), knee synovitis (3), toddler's fracture (1), various tibial or fibular abnormalities (4), and various abnormalities of the tarsal bones (16). Tarsal bone abnormalities included four with abnormal calcaneal uptake and nine with abnormal uptake in or adjacent to the cuboid bone. Correlative imaging studies were available for 26 sites, and focal bone findings were noted at only five locations. Tarsal bone abnormalities accounted for over half of the scintigraphic abnormalities in these preschool children with gait abnormalities. Abnormal uptake in/or adjacent to the cuboid bone was common and probably represented stress injury.

Bone Diseases↗
PubMed1991

Rib infarcts and acute chest syndrome in sickle cell diseases.

In the absence of evidence for pneumonia or pulmonary embolus, primary pulmonary infarction has been assumed to be the cause of the syndrome of chest pain, fever, and pulmonary infiltrate on chest X-ray that commonly complicates sickle cell anaemia. To find out whether the syndrome might be due to rib infarction, 99mTc-diphosphonate bone scans were done. In the eleven episodes thus investigated (10 patients) the scans showed segmental areas of increased radionuclide uptake in ribs, indicative of bone infarction. A possible sequence of events is that the rib infarcts are primary and cause bone pain, followed by soft tissue reaction, pleuritis, and splinting. The resultant hypoventilation leads to atelectasis and subsequent development of the radiographic changes of the acute chest syndrome. Prevention of hypoventilation and treatment of bone pain are important therapeutic goals.

Acute Disease↗
PubMed1991

Low-grade vesicoureteral reflux. Variability in grade on sequential radiographic and nuclear cystograms.

Paired voiding cystourethrogram (VCU) and nuclear cystogram (NC) studies in 68 children with vesicoureteral reflux (VUR) were analyzed to determine the variability of VUR on sequential studies. Sequential paired examinations included 82 studies where a VCU was followed by a repeat VCU study and 128 studies where a VCU was followed by a NC study. Grade I VUR on the initial VCU was difficult to duplicate on repeat cystography, regardless of the follow-up modality. When the initial VCU showed no VUR, 20% of follow-up studies demonstrated VUR. Follow-up VCU and NC studies showed similar results in detecting increases and decreases in the grade of VUR. Low-grade VUR may be intermittent, and clinical therapeutic decisions should take this variability into account.

Child↗
PubMed1991

Gastric emptying in infants and children: limited utility of 1-hour measurement.

Gastric emptying measurements were performed in infants and children at 1 and 2 hours after a liquid feeding. The 1-hour measurements were predictive of only 58% of the variability in the 2-hour measurements, indicating that the 1-hour measurement was not a good predictor of the 2-hour measurement. Gastric emptying measurements in children should be continued until 2 hours after feeding unless rapid emptying is observed during the 1st hour of the study.

Child, Preschool↗
PubMed1990

Neonatal jaundice: clinical and ultrasonographic findings.

We reviewed the laboratory parameters, clinical information including presence or absence of stool pigmentation, and ultrasonographic findings in 67 patients with neonatal conjugated hyperbilirubinemia and liver biopsies. Hepatobiliary nuclear scintigraphy was done in 14 of the patients. Final diagnoses included extrahepatic biliary atresia, neonatal hepatitis, cystic fibrosis, metabolic liver disease, alpha 1-antitrypsin deficiency, bile duct stenosis, Alagille syndrome (arteriohepatic dysplasia), choledochal cyst, panhypopituitarism, and miscellaneous causes of intrahepatic cholestasis. A single diagnostic criterion is insufficient to distinguish the various causes of neonatal jaundice. Clinical laboratory values varied widely among patients with medical and surgical causes of jaundice. Absence of stool pigmentation was not specific for biliary atresia and was found in patients with medical causes of jaundice. Conversely, two patients with biliary atresia had pigmented stools at presentation. Ultrasonography was diagnostic only for choledochal cyst and bile duct stenosis. Nonvisualization of the gallbladder by either ultrasonography or nuclear hepatobiliary scintigraphy was nonspecific in the discrimination of medical from surgical causes of jaundice. A multidisciplinary approach to the evaluation of neonatal jaundice is necessary, since no single test or imaging modality can reliably define the cause in all cases.

Bile Duct Diseases↗
PubMed1989

Advances in nuclear imaging.

Emission computed tomography such as positron emission tomography and single-photon emission computed tomography may have use in the diagnosis of acute cerebral and myocardial lesions. The technology, as well as its possible applications, is discussed.

Brain Diseases↗
PubMed1989

I-123 iofetamine single photon emission tomography in school-age children with difficult-to-control seizures.

Interictal I-123 iofetamine (IMP) single photon emission tomography (SPECT) was performed in 15 children with difficult-to-control partial or generalized seizures. SPECT studies were compared with magnetic resonance imaging and CT in seven patients, with magnetic resonance imaging only in five, and with CT only in three. Electroencephalography was performed on all subjects, including invasive studies in nine. SPECT was abnormal in six patients. Magnetic resonance and/or CT studies were abnormal in two of the six patients. The other four patients with abnormal SPECT imaging studies had four magnetic resonance and two CT studies that were normal. The SPECT abnormality corresponded to EEG localization in each of the six cases. Lesions localized on SPECT were in or near the temporal lobes. Five other patients with normal SPECT had well-localized abnormalities on EEG. Four magnetic resonance and five CT studies were also negative in these five cases. Four patients whose EEGs did not show adequate lateralization had four normal SPECT, two normal CT, and three normal magnetic resonance studies. In children as in adults, IMP SPECT imaging shows promise in the localization of seizure foci in or near the temporal lobes.

Adolescent↗
PubMed1989

Iofetamine hydrochloride I 123: a new radiopharmaceutical for cerebral perfusion imaging.

Iofetamine hydrochloride I 123 permits cerebral blood perfusion imaging with single photon emission computed tomography (SPECT). SPECT is more widely available than positron emission tomography, and complements anatomic visualization with X-ray computed tomography (CT) or magnetic resonance imaging. Iofetamine is an amphetamine analog that is rapidly taken up by the lungs, then redistributed principally to the liver and brain. The precise mechanism of localization has not been determined, but is believed to result from nonspecific receptor binding. Brain uptake peaks at 30 minutes postinjection and remains relatively constant through 60 minutes. The drug is metabolized and excreted in the urine, with negligible activity remaining at 48 hours. When compared with CT in stroke patients, visualization may be performed sooner after symptom onset and a larger zone of involvement may be evident with iofetamine. Localization of seizure foci and diagnosis of Alzheimer's disease may also be possible. As CT has revolutionized noninvasive imaging of brain anatomy, SPECT with iofetamine permits routine cerebral blood flow imaging.

Amphetamines↗
PubMed1989

Nuclear cystography and renal sonography: findings in girls with urinary tract infection.

This retrospective study documents the findings on nuclear cystography and renal sonography of 455 girls who had urologic imaging for a proved urinary tract infection (UTI). Nuclear cystograms were normal in 313 (69%) of 455 patients. Vesicoureteral reflux was seen in 142 patients (31%): six with grade I, 90 with grade II, 43 with grade III, and three with grade IV. Twelve percent of patients with vesicoureteral reflux had renal parenchymal scars. Increasing grades of reflux were associated with an increase in the severity and number of parenchymal scars. Normal renal sonograms were seen in 83% of patients. Abnormalities noted on sonograms included parenchymal scarring in 31 (7%) of the 455 patients, anomalies in 19 patients (4%), mild to moderate dilatation of the renal pelvis and or ureters in 45 patients (10%), and bladder wall thickening in 45 patients (10%).

Adolescent↗
PubMed1988

Congenital nephrotic syndrome. Gallium-67 imaging.

Congenital nephrotic syndrome is a rare disorder. Heavy proteinuria, hypoalbuminemia, and edema occur during the first 3 months of life. Initial cases were reported from Finland and sporadic cases have occurred elsewhere. Finnish cases demonstrated an autosomal recessive inheritance pattern; currently, Finnish and non-Finnish types are recognized. The clinical course consists of failure to thrive, frequent infections, declining renal function, and early death by age 4 years from sepsis or uremia. Recently renal transplantation has improved the prognosis of patients with this disease. An abnormal Ga-67 scan in a case of congenital nephrotic syndrome is presented.

Gallium Radioisotopes↗
PubMed1987

Predictors of postoperative ventricular dysfunction in infants who have undergone primary repair of a ventricular septal defect.

By means of postoperative radionuclide angiography we identified a subset of infants undergoing primary repair of their ventricular septal defects (VSD) who had postoperative morbidity and ventricular dysfunction. Twenty-three consecutive infants undergoing repair of an uncomplicated VSD were studied. Radionuclide-determined postoperative ventricular dysfunction (VD), as defined by a left ventricular ejection fraction less than 0.30 2 to 4 hours after surgery, was correlated with clinical signs of postoperative morbidity. Six patients developed postoperative VD. Clinical correlates of VD included the use of postoperative inotropic support, increased number of postoperative intensive care days, and a low growth rate 3 months postoperatively. Potential predictors of VD were evaluated. A preoperative pulmonary-to-systemic blood flow ratio (Qp/Qs) greater than 3.0 and a pulmonary-to-systemic vascular resistance ratio (Rp/Rs) less than 0.20, taken in combination, gave a positive predictive value for VD of 100%. It is concluded that the preoperative Qp/Qs and Rp/Rs can be used to predict those infants at risk for postoperative morbidity following repair of their VSD.

Cardiac Catheterization↗
PubMed1986

Pinhole radionuclide ventriculography in small infants.

Radionuclide equilibrium gated ventriculograms were performed in 23 infants before and after surgery for congenital heart disease using standard parallel hole general purpose collimation followed by a pinhole collimation technique to magnify images and improve spatial resolution. A second group of nine infants had pinhole collimated gated ventriculography during cardiac catheterization for comparison with cineangiographic ejection fraction. In group I, pinhole collimation gave improved ventricular and atrial separation over general purpose parallel collimation for determination of left ventricular ejection fraction (42 of 42 studies calculable vs 37 of 42) and for right ventricular ejection fraction (36 of 37 studies calculable vs 20 of 37). In patients with transposition, pinhole technique allowed right ventricular ejection determination in nine of nine studies but in only one of nine was right ventricular ejection fraction possible by standard parallel collimation. In group II, the correlation between left ventricular ejection fraction by cineangiography and pinhole radionuclide ventriculography was excellent (r = 0.95). The correlation for right ventricular ejection fraction between cineangiography and pinhole radionuclide ventriculography was 0.82. Pinhole radionuclide ventriculography is a useful, practical clinical tool that can be used to assess ventricular function in small infants in an intensive care or outpatient setting.

Age Factors↗
PubMed1986

The effects of rate and route of nutrient intake on protein metabolism.

Isotopic measurements of protein kinetics are useful for the investigation of metabolic protein disorders during surgical illness. The effects of rate and route (oral vs parenteral) of nutritional substrate intake have not been well defined. Fischer 344 rats were infused with a total parenteral nutrition (TPN) solution at either 25, 100, or 175% of their normal substrate intake or were fed an oral diet ad libitum. After 4 days, [15N]glycine was infused at 0.138 mg 15N/hr for 24 hr. Whole-body protein turnover (WPT), synthesis, and catabolism were determined by 15N urea enrichment. Fractional synthesis rates (FSR) of liver and muscle protein were calculated by analyzing 15N tissue enrichment. WPT (r = 0.93, P less than 0.001) and liver FSR (r = 0.57, P less than 0.01) increased linearly with TPN infusion rates. All rats had protein synthesis rates greater than catabolism rates except for the rats infused with 25% TPN. Although caloric intake was the same in rats fed orally and those infused with 100% TPN, the orally fed rats had faster WPT (P less than 0.001), synthesis (P less than 0.05), catabolism (P less than 0.001), and liver FSR (P less than 0.05) than the TPN rats. Muscle FSR was not significantly affected by either the route of feeding or the TPN infusion rate. In this study, rate and route of substrate intake affected protein kinetics in the whole animal and liver, but not in muscle. Rate and route of nutrient intake need to be carefully specified and controlled during isotopic studies of protein kinetics.

Animal Nutritional Physiological Phenomena↗
PubMed1986

Low grade pelviureteric junction obstruction with normal diuretic renography.

We report five patients with normal diuretic renograms who underwent Whitaker pressure perfusion testing. They were found to have normal pressure at low flow rates (2-4 ml/min) and an abnormally elevated pressure at high flow rates (8-10 ml/min). Because of persistent symptoms, two patients underwent surgery, while the other three have been followed up. Our findings indicate that a negative diuretic renogram in a well hydrated patient with good renal function may not rule out low grade obstruction. Renal pelvic perfusion at low flow rates as well as high flow rates is recommended to determine better the function of the pelviureteric junction.

Adolescent↗
PubMed1986

Frequency and patterns of abnormality detected by iodine-123 amine emission CT after cerebral infarction.

Single photon emission computed tomography (SPECT) was performed in 31 patients with cerebral infarction and 13 who had had transient ischemic attacks, using iodine-123-labeled N,N,N'-trimethyl-N'-(2-hydroxyl-3-methyl-5-iodobenzyl)-1,3-propanediamin e (I-123-HIPDM) as the radiopharmaceutical. SPECT scans were compared with computed tomographic (CT) scans. SPECT was as sensitive as CT in detecting cerebral infarction (94% vs. 84%). The abnormalities were larger on the SPECT scans than on the CT scans in 19 cases, equal in seven, and smaller in five (SPECT abnormalities greater than or equal to CT abnormalities in 86% of cases). Fifteen of 30 patients with hemispheric infarction had decreased perfusion (decreased uptake of I-123-HIPDM) to the cerebellar hemisphere contralateral to the cerebral hemisphere involved by the infarction (crossed cerebellar diaschisis). Nine of these 15 patients had major motor deficits, while only one of the 15 without crossed cerebellar diaschisis had a major motor deficit.

Cerebral Infarction↗
PubMed1984

Chenodeoxycholic acid pool size determination from children using isotope dilution mass spectrometry.

An isotope dilution mass spectrometry method is described for determining chenodeoxycholic acid pool size in children. The stable isotopically labeled tracer, (11,12-2H2) chenodeoxycholic acid, was administered orally to children, and the enrichment of bile was measured by selected ion monitoring gas chromatography mass spectrometry. The level of (11,12-2H2)chenodeoxycholic acid enrichment found in the patient samples was in the range of 0.5 to 5%. Data are presented illustrating the duplication of this method in two independent laboratories using standard quadrupole mass spectrometers. This procedure provides the clinician with a non-radioactive method for determining chenodeoxycholic acid pool size which is especially beneficial in studies involving children and pregnant women.

Chenodeoxycholic Acid↗