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Biomedical subjects

B Lentle

Publications and source records attributed to B Lentle.

At least 19 recordsLinked to original sources
PubMed1997

Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis.

BACKGROUND AND METHODS: Osteoporosis is a recognized complication of corticosteroid therapy. Whether it can be prevented is not known. We conducted a 12-month, randomized, placebo-controlled study of intermittent etidronate (400 mg per day for 14 days) followed by calcium (500 mg per day for 76 days), given for four cycles, in 141 men and women (age, 19 to 87 years) who had recently begun high-dose corticosteroid therapy. The primary outcome measure was the difference in the change in the bone density of the lumbar spine between the groups from base line to week 52. Secondary measures included changes in the bone density of the femoral neck, trochanter, and radius and the rate of new vertebral fractures. RESULTS: The mean (+/-SE) bone density of the lumbar spine and trochanter in the etidronate group increased 0.61 +/- 0.54 and 1.46 +/- 0.67 percent, respectively, as compared with decreases of 3.23 +/- 0.60 and 2.74 +/- 0.66 percent, respectively, in the placebo group. The mean differences between the groups after one year were 3.72 +/- 0.88 percentage points for the lumbar spine (P = 0.02) and 4.14 +/- 0.94 percentage points for the trochanter (P = 0.02). The changes in the femoral neck and the radius were not significantly different between the groups. There was an 85 percent reduction in the proportion of postmenopausal woman with new vertebral fractures in the etidronate group as compared with the placebo group (1 of 31 patients vs. 7 of 32 patients, P = 0.05), and the etidronate-treated postmenopausal women also had significantly fewer vertebral fractures per patient (P = 0.04). CONCLUSIONS: Intermittent etidronate therapy prevents the loss of vertebral and trochanteric bone in corticosteroid-treated patients.

Adult↗
PubMed1997

Radiological sciences, past and present.

Few observations can have been as rapidly and widely disseminated in medicine as the diagnostic X-ray (radiograph). The first few decades after Röntgen's discovery saw technical developments that made radiography more practical, quicker, safer for both imager and patient, and able to achieve greater contrast. This article reviews the history of imaging but it also looks to the future and begins to open up some of the issues that radiology faces in the 21st century--issues that the next six articles in this Lancet series will enlarge upon. The conventional radiograph remains the most common medical image but a host of new techniques have come along. Are they research tools, clinical methods, or both--and how, in an age of sensitivity about the costs of health care, do they stand up?

History, 19th Century↗
PubMed1996

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 2. The use of bone density measurement in the diagnosis and management of osteoporosis.

OBJECTIVE: To determine the best method of diagnosing osteoporosis and determining fracture risk and to promote standards in the use of bone densitometry and the reporting of results. OPTIONS: Methods of bone mineral density measurement: dual-energy x-ray absorptiometry (DXA), radiographic absorptiometry, single-photon absorptiometry, dual-photon absorptiometry, quantitative computed tomography, quantitative ultrasound, neutron activation analysis. The options of using bone densitometry in individual patient management and as a mass screening tool are also considered. OUTCOMES: Appropriate use of densitometry to promote accurate diagnosis and assessment of fracture risk and timely, appropriate treatment. EVIDENCE: Relevant clinical studies and reports were examined. Clinical practice in Canada was also considered. VALUES: Accurate assessment of osteoporotic fracture risk and diagnosis of osteoporosis and assuring low exposure to medical radiation were given a high value. BENEFITS, HARMS AND COSTS: Early diagnosis through bone density measurement allows proper management of osteoporosis to minimize injury and disability, improve quality of life and reduce the personal and social costs associated with the condition. Potential harms include radiation exposure and cost. The harms and costs of appropriate use of DXA are minimal compared with the harms and costs associated with osteoporosis. RECOMMENDATIONS: Bone mineral density should be measured only to assist in making a clinical management choice. DXA is the best method of measuring bone density and, thus, the best available indicator of osteoporotic fracture risk. Plain radiographs may supplement DXA if there is a specific reason for their use. Measurement of the lumbar spine and femoral neck is standard, but a different site or a single measurement is recommended in specific cases. Unless accelerated bone loss is suspected, DXA should be repeated every 2 to 4 years for patients receiving ovarian hormone therapy and 1 to 2 years for patients undergoing bisphosphonate therapy. Measurements and reporting of results must be standardized. Reports should refer to the World Health Organization's recommended definitions of osteopenia and osteoporosis and provide actual measurement and its relation to peak bone mass.

Aged↗
PubMed1994

Imaging after arthroplasty.

Arthroplasty is now an important and frequently performed orthopedic procedure. This article focuses on the imaging of abnormalities frequently encountered in patients who have undergone arthroplasty. The emphasis is on plain film analysis, although arthrography, computed tomography and nuclear medicine are also discussed. Among the problems illustrated are loosening of the prosthesis, component fatigue or failure, and infection. The authors recommend techniques to optimize imaging. Although most of the entities illustrated involve hip arthroplasty, the principles are valid for arthroplasty at other sites.

Arthrography↗
PubMed1991

Malrotation simulating gallbladder perforation on Tc-99M IDA scintigraphy. Pitfall to avoid.

A patient with upper abdominal discomfort had Tc-99m IDA scintigraphy performed for suspected gallbladder disease. In addition to filling of the bile ducts and the gallbladder, tracer collected in the right side of the abdomen and was thought at first to be the right paracolic gutter, indicating a gallbladder rupture. Discussion with the surgeon and radiographic correlation indicated that the patient did not have gallbladder perforation but, rather, a malrotation of the bowel. This diagnosis became clear on delayed images.

Adult↗
PubMed1991

Bilateral subdural hematomas diagnosed with technetium-99m-HMPAO brain SPECT.

An elderly patient with a complex history of organic dementia but a normal neurologic examination had a 99mTc-hexamethylpropylene-amine-oxime (HMPAO) brain scan for a suspected cerebrovascular accident or space-occupying lesion. The study showed no perfusion abnormality in the brain parenchyma, but bilateral flattening and inversion of the normal hemispheric convexities, with separation from the skull was identified. Bilateral subdural hematomas (SDH) were suspected and the patient had a computed tomographic scan that confirmed the diagnosis.

Aged↗
PubMed1983

Gastrin, gastric emptying, and gastroesophageal reflux after ranitidine.

In a double-blind study comparing ranitidine to placebo in the treatment of symptomatic gastroesophageal reflux disease (GERD), we assessed gastric emptying time, gastroesophageal reflux, and gastrin response to food. Mean half-time for gastric emptying, measured using 99mTc-sulfur colloid, was 109 minutes in GERD and 102 minutes in nine healthy asymptomatic controls. This difference was not significant, but one-third of GERD had emptying times of 2 S.D.s beyond the mean for the normal controls. The patients with GERD refluxed an average of 2.3% (0.1-10%) of the isotope in 120 minutes compared with only 0.2% (0.0-0.5%) in control subjects. Reflux scans and gastric emptying times did not change with healing of esophagitis or with symptomatic improvement from ranitidine and antacids. There was no relationship between the percentage of the test dose refluxed into the esophagus and the rate of gastric emptying. The mean fasting gastrin concentration in GERD, 133 +/- 12 pg/ml, was higher than in healthy controls, 93 +/- 10 pg/ml (p less than 0.01). After stimulation with a standard meal, the integrated gastrin response (IGR) was similar in controls and GERD patients, but IGR was significantly higher after 6 weeks therapy with ranitidine. These results suggest that: 1) gastric emptying time may be prolonged in some patients with GERD, 2) basal but not food-stimulated gastrin concentrations may be abnormal in GERD, 3) reflux scans have limited use in the investigation of GERD, and 4) ranitidine therapy is associated with an increase in food-stimulated gastrin concentrations.

Adult↗
PubMed1982

Pathophysiologic and ultrastructural basis for intestinal symptoms in Fabry's disease.

Fabry's disease is a rare, sex-linked disorder of glycolipid metabolism. We describe a patient with watery diarrhea, early satiety, and asymptomatic cholelithiasis. The jejunal aspirate demonstrated bacterial overgrowth; sigmoidoscopy showed rectal angiokeratoma corpora diffusum. The gastric emptying rate measured with 99mTc-sulfur colloid was markedly prolonged and the fasting gastrin was elevated at 276 pg/ml. The (14C)glycocholate breath test demonstrated a markedly elevated peak at 4 h, associated with an increased fecal bile acid loss of 0.82 g/day. Oral cholecystogram showed a solitary radiolucent stone in a functioning gallbladder. The bile acid pool size and lithogenic index were normal. Light microscopy of small bowel and rectal biopsy specimens revealed normal surface epithelium, but enlarged and vacuolated ganglion cells in Meissner's plexus. Electron microscopy showed laminated and amorphous osmiophilic deposits within ganglion cells of the submucosal plexus, within smooth muscle cells of the muscularis mucosae, and within endothelial cells lining arterioles, venules, and capillaries, but not in autonomic nerve fibers or enterocytes. The diarrhea and early satiety responded promptly to metoclopramide and to tetracycline. The early satiety was likely on the basis of delayed gastric emptying due to deposition of sphingolipid within ganglion cells of the autonomic nervous system; the diarrhea was likely on the basis of intestinal stasis with bacterial overgrowth and bile salt wastage.

Adult↗
PubMed1979

Pulmonary manifestations in patients with malignant melanoma during BCG immunotherapy. A preliminary report.

Ten patients with malignant melanoma who were treated with bacillus Calmette-Guérin (BCG) were studied with chest roentgenograms, scintiscans with radioactive 67gallium citrate, and the single-breath diffusing capacity of carbon monoxide (Dsb). Three patients (stage 1B) with normal findings had no evidence of progression of disease. Seven patients had abnormal findings on at least one test. Two patients (stage 3B and stage 4B) with focal uptake in the lungs on the scintiscan had metastatic melanoma. Three patients (stage 3B) with diffuse uptake on the scintiscan and a reduced Dsb had no evidence of progression of disease. One patient (stage 1B) with an abnormal chest roentgenogram had a benign pleural effusion, and one patient (stage 4B) with a reduced Dsb was free of melanoma. A diffuse increase in the uptake of radioactive 67gallium in the lungs and a low Dsb may not indicate progression of melanoma. On the other hand, a focal uptake of 67gallium in the lungs is highly suggestive of metastatic disease.

Administration, Oral↗