Biomedical subjects
Publications and source records attributed to P Braunstein.
A retrospective study of efficacy of radioisotopic renal scan intravenous urogram in 10 infants with various urologic diseases showed the scan to be more rapid and accurate in depicting the lesions. Since the radioisotopic renal scan requires less irradiation than the intravenous pyelogram, it should be used first as a screening test in infants suspected of having urologic problems.
Forty-seven patients with a final diagnosis of brain metastases were studied with both computed tomography (CT) and radionuclide (RN) scanning. Fifty-three percent of these patients also underwent contrast enhanced CT. Radionuclide scanning detected 94% of the cases, while CT without contrast enhancement was positive in 89%. The addition of contrast material to the CT examination increased the total sensitivity of CT to 94% and permitted the detection of two cases that were falsely negative on RN scanning and CT without contrast. With both techniques, lesions in the cerebral hemispheres were detected more readily than infratentorial lesions. Radionuclide scanning was less sensitive than CT without contrast in the detection of multiple metastases. Contrast enhanced CT should be used in all cases of suspected cerebral metastases unless contraindicated.
Three groups of 24 C57BL/6J black mice were studied. One group was implanted with B16 malignant melanoma, another was implanted with mammary adenocarcinoma, and the third was not given tumor implants. After 14 to 17 days, the mice were given injections i.v. of technetium-99m sulfur colloid and killed 30 min later. Organs were weighed, and radioactivity was counted. The ratios of specific radioactivities of the spleens to those of the liver were higher only in the group of mice bearing malignant melanomas. This finding suggests that the "hot spleen" phenomenon observed in humans with malignant melanomas may be due to increased specific activity rather than increased splenic volume.
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Total cerebral angiography has been performed on five patients who were demonstrated to have a cerebral circulatory deficit by the bedside isotope flow determination. In all five instances cerebral angiography confirmed the results of the isotope examination.
Advances in the physical and biological sciences have in recent years led to a rapidly increasing use of radioactive agents in clinical medicine. The distinctive properties of these agents have made them invaluable for a large variety of unique in vivo and in vitro diagnostic tests. In order to help the clinician employ such tests productively and realistically, we have attempted to review the present status of radiosotopes with regard to gastrointestinal diseases. Emphasis has been placed not only on their value but also on their limitations; the degree of safety for in vivo application has also been briefly considered.
Echoencephalography and radionuclide brain imaging are used to aid in the diagnosis of a variety of intracranial abnormalities. Because of technical considerations, A-mode rather than B-mode echography must, under most circumstances, be employed for examination of the head. There are technical limitations to echoencephalography, and it tends to be relatively subjective and dependent on the skill of the sonographer. These factors have, to some extent, been responsible for the more limited application of ultrasound to neurologic diagnosis, as compared to the application of radionuclides. The most common use of echoencephalography is in the detection of midline shifts associated with various sequelae of head trauma. Ultrasound has also been used to detect space-occupying lesions, either directly or more usually by determing associated midline displacements. The characterization and follow-up of known lesions with ultrasound has also been described. In the above instances its usefulness is usually as a noninvasive technique complementary to nuclear medicine studies, which under most circumstances are more effective than ultrasound. The evaluation of ventricular enlargement, which is not usually possible per se with radionuclides, is possible with ultrasound. Computerized transverse tomography (CTT) can be applied more efficiently in a routine way in many of the above circumstances, including evaluation of ventricular size. The combination of CTT and nuclear medicine procedures in the brain area is so effective and comprehensive that where these are both available the demand for ultrasound will probably decrease but will not be eliminated.
In order to evaluate and quantitate the therapeutic efficacy of disodium etridonate (EHDP) in the treatment of Paget's disease, a prospective double-blind study was instituted. Subjects received either placebo, low-dose EHDP, or high-dose EHDP and were evaluated prior to therapy and 6 months later. Bone scans were performed with 99mTc or 18F and radioisotopic uptake studies were conducted. The results were correlated with clinical improvement, biochemical parameters, and radiographic skeletal surveys, and indicate that the radioisotopic uptake studies are both a sensitive and reproducible means of evaluating the degree of response to EHDP.
A portable radioisotopic technique was developed to demonstrate cerebral circulatory deficit, as part of a collaborative study to define and diagnose cerebral death simply and rapidly, in comatose, apneic patients with electrocerebral silence. The method involves an intravenous injection of 2mCi of 99mTcO4, and recording time/activity curves over the cranial cavity and a femoral artery simultaneously, using twin probe radioisotope detector equipment. Eight comatose, apneic patients had 142 studies in conjunction with clinical electroencephalographic and other laboratory evaluations. The results indicate that the absence of a bolus tracing from the head, as contrasted to the usual bolus seen is indicative of significant circulatory deficit to the cerebrum. This test may be used as an adjunct in confirming the diagnosis of cerebral death. A normal bolus tracing should be simultaneously observed over a femoral artery and this is used as a control. The method is safe and simple and offers significant information about the irreversibility of cerebral blood flow. Although further studies are indicated, the method appears to be most promising as a fundamental bedside laboratory test in the diagnosis of cerebral death in conjunction with other clinical and laboratory criteria.
Thirteen patients with biopsy-proven osteosarcomas were studied with 99mTc-labeled bone-scanning agents. In addition to the dense areas of abnormal uptake corresponding to the tumors, ten patients exhibited a relative increase of radioactivity at the ends of the long bones of the affected extremities. Several of these areas were included in the surgical specimens but no tumor cells were found.
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