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Biomedical subjects

B Shapiro

Publications and source records attributed to B Shapiro.

At least 55 records · Page 3Linked to original sources
PubMed1989

Unusual complications of antithyroid drug therapy: four case reports and review of literature.

Two cases of propylthiouracil-associated acute hepatitis, one case of fatal methimazole-associated hepatocellular necrosis and one case of propylthiouracil-associated lupus-like syndrome are described. The literature related to antithyroid drug side effects and the mechanisms for their occurrence are reviewed and the efficacy and complications of thyroidectomy and radioiodine compared to those of antithyroid drugs. It is concluded that in most circumstances 131I is the therapy of choice for hyperthyroidism.

Adult↗
PubMed1989

Demonstration by iodine-131-hippurate renography of a marked sensitivity of some transplanted kidneys to volume contraction.

Incidental observations made in a canine renal transplant model in which both native and transplanted kidneys were present revealed that abnormal I-131-iodohippurate renograms were derived from some of the transplanted kidneys in the presence of mild dehydration. In these cases, the renogram normalized with fluid administration. In contrast, the renograms derived from the native kidneys were unaffected by the mild dehydration of the animals. These findings demonstrate a greater sensitivity to dehydration of some transplanted kidneys when compared to normal kidneys.

Animals↗
PubMed1989

Management of pheochromocytoma.

The fundamental principles of pheochromocytoma management are reviewed. These are a high index of clinical suspicion; biochemical confirmation of the diagnosis; preoperative localization and pharmacologic treatment with alpha-adrenergic blockers (and occasionally with beta-adrenergic blockers and/or alpha-methylparatyrosine); meticulous anesthesia and intraoperative cardiovascular monitoring; and attention to the surgical principles of wide exposure, careful dissection and complete exploration, early interruption of tumor vasculature, and delivery of the tumor with the capsule intact. For malignant lesions, the roles of pharmacologic management (alpha- and beta-adrenergic blockade, alpha-methylparatyrosine, and drugs for heart failure, diabetes, and pain), teleradiotherapy, radiopharmaceutical treatment with I-131 MIBG and chemotherapy (with cyclophosphamide, vincristine, and dacarbazine) are discussed.

Adrenal Gland Neoplasms↗
PubMed1989

Clinical features, diagnosis, and localization of carcinoid tumors and their management.

In this article, we have focused on the evolving face of neuroendocrine tumors, newer approaches to their diagnosis and localization, the importance of sophisticated immunohistochemistry, tracer scanning, and the role of peptide therapy in the management of the symptom complex as well as the tumor. With recent expansion in our understanding of the pathophysiology of these tumors have come new and innovative approaches to their management. There is, however, much that remains unsolved and that requires diligent research and evaluation if we are ultimately to include neuroendocrine tumors among the curable cancers.

Carcinoid Tumor↗
PubMed1989

Labetalol reduces iodine-131 MIBG uptake by pheochromocytoma and normal tissues.

Iodine-131 metaiodobenzylguanidine [131I]MIBG has proven to be an effective radiopharmaceutical for the scintigraphic localization of pheochromocytomas. Uptake of MIBG is inhibited by blockade of the neuronal uptake pathway for catecholamines ("uptake-1") and by depletion of catecholamine storage vesicle contents, but is not significantly affected by conventional alpha- and beta-adrenoreceptor blocking drugs. Labetalol is an antihypertensive agent with combined alpha- and beta-blocking properties that has been used to manage patients with suspected pheochromocytomas. We report eight patients in whom concurrent or recent therapy with labetalol significantly reduced the uptake of [131I]MIBG into salivary glands, liver, spleen, and general body background. Tumor uptake of MIBG was also reduced in two of the three patients who were proven to have pheochromocytomas. In one case, the effect of labetalol persisted for 36 hr after the drug had been discontinued. The inhibitory effect of labetalol on MIBG uptake in sympathomedullary tissues is likely to be a result of the drug's little-known, additional properties of uptake-1 blockade and depletion of storage vesicle contents, rather than its alpha- or beta-blocking effects. Additionally, labetalol would also appear to hasten clearance of MIBG from other tissues. Labetalol therapy should be discontinued for several days (possibly up to 1 wk) before undertaking [131I]MIBG scintigraphy. A comprehensive list of drugs that should be avoided in patients undergoing MIBG scintigraphy is appended.

3-Iodobenzylguanidine↗
PubMed1989

Alterations of iodine-131 MIBG biodistribution in an anephric patient: comparison to normal and impaired renal function.

Iodine-131 metaiodobenzylguanidine (MIBG) is an effective agent for the scintigraphic portrayal of pheochromocytomas of all types. Iodine-131 MIBG is a relatively stable radiopharmaceutical that is primarily excreted in the urine. Therefore, impaired renal function would be expected to alter [131I]MIBG pharmacokinetics which would thus affect blood levels, as well as scintigraphy. An 18-yr-old anephric male presented with hypertension and suspected pheochromocytoma. We have compared the [131I]MIBG scintigraphy and blood clearance kinetics in this anephric patient, two patients with renal insufficiency and four patients with normal renal function. The degree of renal insufficiency was directly correlated to the CPM/image (an index of whole-body retention) on all 3 days of imaging and the slower clearance of radioactivity from the blood. The relative distribution of radioactivity between the plasma and cell fractions was greatest in the patients with renal insufficiency. We therefore suggest that attention be paid to plasma creatinine levels prior to the administration of [131I] MIBG to permit accurate interpretation of scintigraphy. In addition, the effect of renal insufficiency on radiation dosimetry should be considered. It may thus be prudent to reduce the administered dose of [131I]MIBG given to anephric or renally insufficient patients to decrease radiation dose.

3-Iodobenzylguanidine↗
PubMed1988

Laparoscopic and transvaginal ova recovery: the effect on ova quality.

Transvaginal follicle aspiration guided by transvaginal ultrasound for ova recovery is rapidly gaining popularity in many centers practicing in vitro fertilization and embryo transfer (IVF-ET). Cycle outcome following this new method has not been directly compared to the traditional, laparoscopic recovery technique. To this end, the authors evaluated multiple parameters in 66 laparoscopic (group A), and 44 transvaginal ova recovery procedures (group B) in patients undergoing IVF-ET. No statistically significant differences could be demonstrated between the groups in all but the rate of ova fertilization. The rate of fertilization was higher in the ova recovered by transvaginal follicle aspiration (59.6 versus 69.2%; P less than 0.01). No difference could be demonstrated between the groups in the other parameters examined, which included the number of ova recovered (5.7 +/- 0.4 versus 6.0 +/- 0.7), ova maturity (87 versus 84% intermediate ova), rate of polyspermic fertilization (3.9 versus 5%), rate of cleavage (88 versus 91%), cleavage stage at transfer (3.7 +/- 0.8 versus 3.5 +/- 0.4 cells per embryo), number of embryos transferred per patient (2.7 +/- 0.1 versus 3.3 +/- 0.2), and pregnancy rates. The potential detrimental effects of general anesthesia and CO2 pneumoperitoneum present during laparoscopy but not ultrasound guided recovery on ova quality may underlie the observed difference in fertilization between the groups.

Embryo Transfer↗
PubMed1988

Effects of secretin on the normal and pathological beta-cell.

Secretin is a gastrointestinal hormone that stimulates insulin secretion and enhances the insulin response to glucose. The mechanism by which secretin acts on the beta-cell has not been extensively studied. The plasma insulin responses to secretin (2 U/kg), expressed as the percent increase relative to basal plasma insulin concentrations, were similar in normal (n = 23) and obese subjects with normal glucose tolerance (n = 12), but were decreased in obese subjects with abnormal glucose tolerance (n = 11). The insulin response to secretin was directly proportional to the basal insulin concentration in these three groups. The effects of secretin on beta-cell function was not altered by propranolol (n = 6), atropine (n = 8), or surgical vagotomy (n = 10). Patients with single islet cell tumors secreting insulin (n = 18) had no plasma insulin response to secretin, whereas patients with noninsulin-secreting pancreatic tumors (gastrinomas; n = 6) and patients in whom single insulinomas had been removed (n = 7) responded normally. Two adult patients with multiple B-cell adenomas and hyperplasia (not associated with multiple endocrine neoplasia type I) hyperresponded to secretin, whereas patients with multiple endocrine neoplasia, type I, without hyperinsulinism responded normally. One patient with nesidioblastosis had no response to secretin, indicating that the pathophysiology of this entity is distinct from that of other forms of islet hyperplasia. These data suggest that secretin stimulates beta-cells directly rather than through cholinergic, adrenergic, or vagal peptidergic neural mechanisms. In addition, the ability to respond to secretin appears to be lost in patients with single insulinomas and nesidioblastosis, but not in those with multiple B-cell adenomas and hyperplasia. The lack of a plasma insulin response in patients with single insulinomas and the high normal or exaggerated response in patients with multiple B-cell adenomas and hyperplasia may prove useful in differentiating these entities.

Adenoma↗
PubMed1988

Sarcoidosis of the thyroid presenting as a painful nodule.

A patient, known to have sarcoidosis, developed a painful, enlarging right thyroid mass. Thyroid lobectomy was performed revealing sarcoidosis involving the thyroid. A review of the literature shows sporadic reports of involvement of the thyroid with sarcoidosis. There were no previous reports of this entity presenting as painful thyroid enlargement. Thyroid lobectomy was curative.

Adult↗
PubMed1987

Exercise-induced hyperphagia in the hamster is associated with elevated plasma somatostatin-like immunoreactivity.

Syrian golden hamsters when allowed free access to food and an exercise wheel will run long distances and develop hyperphagia and accelerated linear body growth with high circulating levels of growth hormone and insulin. Somatostatin, a widely distributed brain-gut neurohormonal peptide, modulates nutrient absorption and may regulate food intake. To examine the role of circulating plasma somatostatin-like immunoreactivity (SRIF-LI; pg/ml) in exercise induced hyperphagia 4 groups of animals were studied; an unrestricted exercise group (279.0 +/- 107.7, n = 10); a sedentary group (121.1 +/- 40.8, n = 8); a restricted exercise group (107.7 +/- 12.4, n = 6); and a restricted no exercise group (115.5 +/- 45.9, n = 9). Thus, the unrestricted exercise group has a significantly elevated SRIF-LI concentration (P less than 0.01) while there was no difference between the other 3 groups. The elevation of plasma SRIF-LI in the unrestricted exercise group may represent a response to modulate increased nutrient entry in this group or may represent an incompletely effective satiety signal.

Animals↗
PubMed1987

Clonidine-induced suppression of plasma catecholamines in states of adrenal medulla hyperfunction.

To assess adrenal medulla activity in states of hyperfunction, a single 0.3 mg oral dose of clonidine hydrochloride (Catapres) was given to twelve patients with varying evidence of familial adrenal medullary hyperplasia and pheochromocytomas from kindreds with Multiple Endocrine Neoplasia type 2 syndrome (MEN-2), seven patients with sporadic pheochromocytomas and six normal subjects. Mean arterial blood pressure and plasma norepinephrine (NE) levels were lower than baseline values 2 h after clonidine in the normal subjects. Plasma epinephrine (E) rose in one normal but fell in the remainder after clonidine administration. In sporadic pheochromocytoma patients, E fell slightly in 4 and NE fell in 3 while mean arterial blood pressure was not significantly lower than baseline values in 7 patients 2 h after clonidine. In MEN-2, mean arterial blood pressure fell and there was a variable response of plasma E and NE to clonidine, which appears to be related to the presence of detectable anatomic (CT scan) and functional (131I-mlBG scintigraphy) abnormalities of the adrenal medulla. These findings are thus compatible with the spectrum of adrenal medulla dysfunction and the presumed development of pheochromocytoma in this syndrome.

Adolescent↗
PubMed1987

A new device to facilitate intrauterine instillation of dextran 70 for hysteroscopy.

Dextran 70, a commonly used distension medium for diagnostic and operative hysteroscopy, is difficult to handle because of its high viscosity, which makes manual instillation cumbersome. We have developed an electric pump that facilitates the instillation of this distension medium at hysteroscopy. This new device is safe and easy to use, and improves the view of the uterine cavity during the procedure. Our initial experience using this pump in 43 hysteroscopic procedures is encouraging.

Dextrans↗
PubMed1987

Iodine-131 MIBG scintigraphy of neuroendocrine tumors other than pheochromocytoma and neuroblastoma.

Metaiodobenzylguanidine (MIBG) locates most pheochromocytomas and neuroblastomas. The tracer is concentrated in intracellular storage vesicles by an active process. Many other neuroendocrine tumors of the amine precursor uptake and decarboxylation (APUD) series have hormonal storage vesicles and, thus, the potential to take up [131I]MIBG. A variety of neuroendocrine tumors in 57 patients were studied 1, 2, and 3 days after 0.5 mCi [131I]MIBG. Views from skull to pelvis were obtained. Results of MIBG scans were compared with all available imaging modalities (including plain radiography, liver scan, ultrasound, computed tomography, and angiography) and surgical exploration. The neuroendocrine nature of the tumor was determined by histology, immunohistochemistry, electron microscopy, and the assay of appropriate biogenic amines and peptide hormones. Results were (positive/total cases): carcinoids (four of ten), nonsecreting paragangliomas (three of three), sporadic medullary carcinomas of the thyroid (MCT) (one of five), familial MCT (one of 26), chemodectomas (two of five), oat cell carcinomas (zero of four), choriocarcinoma (one of one), atypical schwannoma (with storage granules) (one of one), Merkel cell skin cancer (one of one), islet cell carcinoma (zero of one). We conclude that a wide range of neuroendocrine tumors show [131I]MIBG uptake; tumors other than pheochromocytomas and neuroblastomas are less often seen scintigraphically, but in certain cases (e.g., carcinoid and nonsecreting paragangliomas) scintigraphy may be useful in depicting the extent and location of disease and may indicate therapeutic potential. Iodine-131 MIBG shows promise in the diagnosis and staging of tumors of varied types.

3-Iodobenzylguanidine↗
PubMed1987

Iodine-131 MIBG scintigraphy of the extremities in metastatic pheochromocytoma and neuroblastoma.

Iodine-131 MIBG scintigraphy may be used to determine the presence or absence of metastases to the appendicular skeleton in malignant pheochromocytoma and neuroblastoma. Normal bones show no uptake of [131I]MIBG and the joints are seen as photon-deficient areas surrounded by background muscle activity. Discrete concentrations of radioactivity in bone are often seen in patients with malignant pheochromocytoma and neuroblastoma. Bone marrow involvement in neuroblastoma may be indicated by diffuse uptake of [131I]MIBG or focal accumulation at the metaphyses. Uncommonly, bone involvement may not be displayed by the [131I]MIBG images. Since conventional bone scanning agents may also fail to detect these tumors, skeletal scintigraphy with both [131I]MIBG and [99mTc]MDP is necessary to reliably stage malignant pheochromocytoma and neuroblastoma.

3-Iodobenzylguanidine↗
PubMed1986

Hallucinations: theoretical and clinical overview.

The authors review the literature on hallucinations; provide theoretical background on these phenomena from physiological, biochemical, and psychological points of view; and discuss the presentations of hallucinations in different diagnostic categories. The longstanding notion that hallucinations are to be equated with schizophrenia, they conclude, is clearly unfounded, and hallucinations are never pathognomonic of any given disorder but can be relatively specific for some conditions. Current knowledge and methods of research have produced no single mechanism to account for the etiology or pathogenesis of hallucinations. The authors present an integrated approach toward viewing the etiology and clinical presentation of hallucinations that involves concepts of biological vulnerability and psychological influences.

Alcoholism↗
PubMed1986

Acquired epileptic aphasia. Diagnostic aspects of progressive language loss in preschool children.

A case of acquired epileptic aphasia presenting as language delay and hyperactivity is presented and clinical aspects reviewed. Acquired epileptic aphasia is a diffuse neurologic process of unknown etiology that presents in preschool children. Although progressive language loss and seizures are the major manifestations, deficits in attention and socialization may be noted. The electroencephalogram is usually diagnostic. While almost all (80%) children develop seizures, approximately half present as language delay without seizures. Recognition of the progressive and global nature of the language dysfunction may permit earlier diagnosis and intervention.

Aphasia↗