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Biomedical subjects

J D Slavin

Publications and source records attributed to J D Slavin.

At least 37 records · Page 2Linked to original sources

Hospital integrated lanes training: brigade-directed implementation of a medical lanes training program during annual training.

The "lanes" concept of training was integrated into a medical site support mission of the 804th Medical Brigade, U.S. Army Reserve, during Annual Training, 1993 at Fort Drum, New York. This training, termed Hospital Integrated Lanes Training (HILT), included STX, FTX, patient play, and full use of Deployable Medical Systems equipment. The medical care of over 33,000 personnel participating in tactical annual training exercises was not interrupted during any concurrent phase of lanes training. Brigade operations planners developed an array of medical exercises that involved both moulaged and paper patient play. These exercises began prior to hospital set-up and continued for 24 hours a day throughout the tactical exercise. Injuries likely to be encountered during combat operations were inserted into the play singly and under a mass-casualty scenario. The standard of care for all injuries was determined with the Army Medical Department Center and School guidance. Prior coordination of brigade medical assets with external air and ground ambulance organizations broadened the scope of the training and facilitated effective use of command and control, communications, and equipment over a wide geographic area. Medical records were collected and evaluated at the conclusion of all exercises. After-action reviews were conducted by all medical units to assist in the planning of future HILT exercises. The HILT concept is a valuable tool for the complex training requirements of field medical units organized under medical Force 2000. The concept of integrated lanes training allows for the development and continuous improvement of individual and sectional skills for medical personnel and should be applied within all echelons of care.

Hospitals, Military↗

Loss of radiogallium from lymphoma after initiation of chemotherapy.

A man with a high-grade lymphoma had radiogallium imaging at 48 hours postinjection, revealing three distinct sites of uptake (neck and thorax). Unknown to the authors, the patient was given cytoxan, vincristine, and prednisone intravenously 27 hours after radiogallium administration. The images at 120 hours showed markedly reduced radiogallium activity at all three sites. Possible reasons for the loss of radiogallium from the tumor sites were presented.

Antineoplastic Combined Chemotherapy Protocols↗

Ventilation-perfusion lung imaging in nitrofurantoin-related pulmonary reaction.

A woman with a history of multiple drug allergies was admitted for cough and dyspnea. She had been taking nitrofurantoin for 10 days, was febrile, and had a rash on the trunk and extremities. A chest radiograph revealed right-sided pleural effusion and basal markings. Because of suspected nitrofurantoin-related pulmonary reaction, the medication was discontinued and the patient was started on an H2-blocker and intravenous corticosteroids. She improved clinically, and within 24 hours a radiograph revealed that her chest had largely cleared. Restricted distribution of radioxenon, seen initially on a ventilation lung scan, also reverted to near normal by the follow-up. The first perfusion lung scan showed multiple but nonspecific changes; this also came back to near normal. The nitrofurantoin-related pulmonary reaction should be considered in patients who present with pulmonary signs/symptoms while on the medication.

Drug Hypersensitivity↗

The "warm" sacroiliac joint. A finding in pelvic abscess.

Two patients with pain referable to the low back and sacroiliac regions had bone scans with similar findings. In each, one sacroiliac joint was "warm" (uptake on that side was slightly greater than that in the contralateral area). Ga-67 imaging also demonstrated increased uptake in the same locale. Subsequent CT scanning revealed pelvic abscesses adjacent to the affected joints. Asymmetric uptake of bone imaging agent may have been related to hyperemia and "heating" of the sacroiliac joint. Rapid defervescence with antibiotics and drainage (and no CT evidence of bone involvement) suggested that osteomyelitis was not involved in these cases.

Abscess↗

Multiple bone metastases in a patient with glioblastoma multiforme.

Extracranial bone metastases from glioblastoma multiforme are rarely reported in the medical literature. The authors describe a case of glioblastoma multiforme with distant osseous metastases that were detected by a Tc-99m MDP image. The metastases were osteolytic and expansile on plain radiographs.

Adult↗

Two false-negative results using morphine sulfate in hepatobiliary imaging.

Morphine sulfate has been used in hepatobiliary imaging to cause contraction of the sphincter of Oddi, thereby increasing pressure in the biliary tree. If the cystic duct is patent, the increased pressure usually causes bile to flow into the cystic duct with filling of the gallbladder. Using this technique, the authors have encountered two false-negative cases. Both patients received 0.04 mg/kg of morphine sulfate intravenously, 40 minutes after the intravenous administration of 5 mCi of technetium 99m-DISIDA. Although both patients filled their gallbladders within 1 hour, they both underwent surgical exploration because of high clinical suspicion of acute cholecystitis. Both were found to have acute cholecystitis.

Biliary Tract↗

Unusual scintigraphic findings in a case of treated monostotic Paget's disease.

A 72-year-old woman with Paget's disease underwent therapy with EHDP for 5 years. A Tc-99m MDP bone scan demonstrated an unusual image in the right femur. The upper one third of the femur was thickened, bowed, and had diffuse and mild uptake. This corresponded to radiographic findings of mixed or chronic Paget's disease. A long area of intense and homogenous uptake was found immediately distal, and with a sharp demarcation. Alterations typical of the lytic phase of Paget's disease were seen on radiographs. The overall lesion in this patient thus demonstrated two distinct patterns, both radiographically and on bone imaging. It is conjectural whether this was related to the chronic use of a diphosphonate in therapy.

Aged↗

Delayed accumulation (flip flop) of Tc-99m DTPA in a leiomyosarcoma.

An 85-year-old woman with leiomyosarcoma occupying the abdominopelvic area had a renal dynamic study with Tc-99m DTPA. The tumor area initially showed almost no content of the radiopharmaceutical. At 24 hours, there was retention of activity in the leiomyosarcoma as compared with surrounding tissues (flip flop). It was noted that, based on literature reports, tumors of mesodermal origin (leiomyoma, spindle cell sarcoma, neurofibroma) may have the ability to concentrate Tc-99m DTPA.

Aged↗