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Biomedical subjects

H Haibach

Publications and source records attributed to H Haibach.

At least 37 records · Page 2Linked to original sources

Prepubertal gynecomastia with lobules and acini: a case report and review of the literature.

The case of an 11-year-old boy with prepubertal gynecomastia is presented. Endocrine workup, including sex steroid and pituitary hormone concentrations, as well as chromosome analysis, was normal. Microscopy of the mastectomy specimen demonstrated, in addition to ductal proliferation and fibrosis, formation of lobules and acini, simulating female breast tissue. The authors report the fourth case with this histologic feature. Review of the literature identified 41 cases of prepubertal gynecomastia; associated or underlying conditions were: adrenal adenoma or carcinoma in nine cases, testicular tumor in two, 11-beta-hydroxylase deficiency in four, familial gynecomastia in two, tuberous sclerosis in two, and, in part overlapping, sexual precocity in four. Gynecomastia usually regressed after tumor removal or cortisol replacement therapy. Histologic examination of breast tissue was performed in 18 cases. Lobule and acinus formation was described in only three.

Breast

Cold pressor thallium-201 myocardial scintigraphy in the diagnosis of coronary artery disease.

Thallium-201 myocardial scintigraphy was performed during cold pressor stimulation in 36 patients aged 36 to 69 years. Thirty-one patients had coronary artery disease and 5 patients did not, as confirmed by coronary cineangiography. Thallium-201 (1.5 to 2 mCi) was injected at 30 seconds of the cold pressor stimulation. The product of systolic pressure X heart rate increased from a baseline of 77.4 +/- 16 (standard deviation [SD]) to 103.6 +/- 17 at 30 seconds of the cold pressor test (p less than 0.0005). Transient perfusion deficits developed in 24 of 31 patients with coronary artery disease (sensitivity 77%), and all 5 patients without coronary artery disease had normal scintigrams. The sensitivity in detecting coronary artery disease was 40% in patients with 1 vessel disease, 91% in patients with 2 vessel disease, and 100% in patients with 3 vessel disease. Exercise electrocardiograms (available in 29 of 36 patients) were positive for ischemia in 18 of 24 patients with coronary artery disease and in 1 of 5 patients without coronary artery disease (sensitivity 75% and specificity less than 80%). Exercise thallium-201 scintigrams, obtained in 16 patients, were positive in 11 patients with coronary artery disease and positive cold pressor thallium-201 scintigrams. Five patients without coronary artery disease and with normal cold pressor thallium-201 scintigrams had normal exercise thallium-201 scintigrams. Coronary cineangiography performed during cold pressor stimulation in 6 patients who had positive cold pressor and exercise thallium-201 scintigrams did not show coronary spasm. Our data indicate that cold pressor thallium-201 scintigraphy offers promise as a noninvasive test in the diagnosis of coronary artery disease and may be used in patients in whom exercise testing is not feasible.

Adult

Rat bladder irrigation with PVP-I2.

Despite technical advances, Foley catheter associated urinary tract infections continue to be the leading cause of nosocomial infections. PVP-I2 has been shown to be nonirritating to abraded tissue and we have shown that dilute solutions are bactericidal for organisms causing Foley catheter associated urinary tract infections. The purpose of this study was to ascertain the toxicity of PVP-I2 on the catheterized rat bladder and to measure the systemic absorption of I2. Bladder catheters were surgically placed into each of 3 groups of rats: group 1, catheters only; group 2, irrigation with PBS q.8h; and group 3, irrigation with a 1:3 dilution of a 10 per cent PVP-1 per cent I2 solution q-8h. One-half of each group was sacrificed at 1 and 2 weeks respectively. Photographs of mounted bladders and histologic sections were then graded by 3 independent observers. Blood for protein bound iodine (PBI), T3 and T4 levels was obtained before the study and at sacrifice. No difference in ulcerations, erythema or inflammation was noted. PBI was higher in group 3 rats at conclusion than group 1 and 2 (6.88 mg./dl. versus 3.42 mg./dl.) (p less than 0.05). There was no difference in T3 or T4 levels. In this study, PVP-I2 was no more toxic to the bladder than catheterization alone or irrigation with PBS.

Absorption

Left ventricular function in patients with mitral valve prolapse. A radionuclide evaluation.

Thirty patients with cineangiographically confirmed mitral valve prolapse (MVP) were studied by radionuclide angiography at rest and during exercise. Twelve patients had isolated MVP and 18 patients had associated coronary artery disease. All patients had normal resting left ventricular ejection fraction and wall motion. Of 18 patients with MVP and coronary artery disease, the left ventricular ejection fraction remained unchanged during exercise in 15 patients, decreased in two patients, and increased in one patient. Of 12 patients with MVP without associated coronary artery disease, ejection fraction increased during exercise in 6 patients, remained unchanged in 4 patients, and decreased in 2 patients. We conclude that an abnormal left ventricular function response during exercise does not always indicate the presence of coronary artery disease and may occur in patients with isolated MVP. Furthermore,the left ventricular dysfunction of patients with isolated MVP may be obvious only during exercise.

Adult

Evidence of impaired myocardial perfusion and abnormal left ventricular function during exercise in patients with isolated systolic narrowing of the left anterior descending coronary artery.

Seven men ranging in age from 35 to 63 years with a chest pain syndrome and cineangiographically documented systolic narrowing of the left anterior descending coronary artery underwent thallium-201 myocardial scintigraphy and gated cardiac blood pool imaging. Grade II (50 to 75 percent) systolic coronary arterial constriction was present in three patients and grade III constriction (greater than 75 percent) in four. Three of the four patients with grade III constriction had an exercise-induced perfusion abnormality in the thallium-201 scintigram and impaired left ventricular ejection fraction response during exercise. (In two patients the left ventricular ejection fraction did not change and in one patient it decreased.) Each of the three patients with grade II constriction had normal thallium-201 perfusion and a normal increase in ejection fraction during exercise. These data provide evidence of abnormal myocardial perfusion and impaired left ventricular function during exercise in patients with high grade systolic coronary arterial narrowing.

Adult

Comparative evaluation of renal transplant rejection with radioiodinated fibrinogen 99mTc-sulfur collid, and 67Ga-citrate.

The diagnostic accuracy, ease, and technical feasibility of imaging with 131I-or 125 I-fibrinogen, 99mTc-sulfur colloid, and 67 Ga-citrate in renal transplant rejection are compared. Radiofibrinogen data resulted from literature review, radiocolloid data from 125 studies in 52 transplant patients, and gallium citrate data from 24 examinations in seven renal transplant patients performed simultaneously with the radiocolloid studied. Specificity of graft labeling during rejection appears to be similar with radiofibrinogen, 99mTc-sulfur colloid, and 67Ga-citrate. For routine clinical use 99mTc-sulfur colloid surpasses radiofibrinogen and radiogallium because of its better imaging qualities with a permissible radiation dose, leading to better separation of positive and negative results. The 99mTc-sulfur colloid accumulates in areas of intravascular fibrin thrombosis in acute and chronic rejecting renal transplants. Hence, the mechanisms for accumulation of 99mTc-sulfur colloid and labeled fibrinogen in rejecting transplants would seem to be similar. Such physiologic properties as rapid blood clearance and such physical properties as short physical half-life combine to produce reliable graft visualization with adequate definition, thus favoring 99mTc-sulfur colloid as the single agent of choice for clinical evaluation of renal transplant rejection at this time.

Animals

Hyperthyroidism in Graves disease. Current trends in management and diagnosis.

The radioimmunoassay for T3 is now widely available and is a useful diagnostic tool for hyperthyroidism, especially in T3-thyrotoxicosis. It is an essential tool in the management of hyperthyroidism that persists after treatment with normal T4 serum levels or, in euthyroid cases, with low T4 serum levels. In these conditions, it reflects the metabolic state more accurately than serum levels of T4. A promising new test is the response of radioimmunoassayable TSH to protirelin (TRH) administration. An absent response indicates pituitary suppression and thyroid autonomy as seen in frank hyperthyroidism or euthyroid Graves disease, treated or untreated. It is safer and quicker than the conventional T3 suppression test of thyroid radioactive iodine uptake and may replace it at least partly in the future.

Adult