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Biomedical subjects

M D Gross

Publications and source records attributed to M D Gross.

At least 55 records · Page 3Linked to original sources
PubMed1998

What do patients express as their preferences in advance directives?

BACKGROUND: Since the passage of the Patient Self-Determination Act in 1991, there has been interest in urging patients to execute advance directives (ADs) for medical care. There are not much data, however, as to what the ADs that patients execute actually specify. I have investigated the percentage of inpatients and outpatients who are admitted to a community hospital who have executed ADs, and I have tabulated what preferences are actually expressed in the ADs that are in hospital records. METHODS: A questionnaire is filled out by each patient admitted to this hospital, and their response recorded as to whether they have executed an AD. I have tabulated these responses for inpatients and outpatients for the calendar year 1994. I have also examined the ADs in all available hospital records, and tabulated the wishes expressed in these directives. RESULTS: For inpatient admissions during the calendar year 1994, of 8727 questionnaires completed, 11% of patients indicated that they had executed an AD. For outpatients, the corresponding figures are 22,966 and 15%. A total of 343 hospital records containing ADs were examined. Of these, 15 were nonmedical directives and were excluded. Of the 328 medical ADs, 86 (26%) were living wills, expressing the wish that if the individual had an incurable disease or irreversible injury that he or she not be given any treatment that would only delay death. There were 210 power of attorney for health care forms completed; these were 64% of all the medical ADs. Of these, 7 did not specify any preference that patients wanted their proxy to follow. The remaining 203 forms were divided as follows: 189 individuals requested that they did not want life-sustaining treatment if the burdens of treatment outweighed the expected benefits; 12 wanted their lives to be prolonged unless they were in an irreversible coma; and 2 wanted their lives to be prolonged to the greatest possible extent regardless of the chances for recovery or the cost. There were 32 do not resuscitate forms executed exclusively by residents of nursing homes that specified that they did not want cardiopulmonary resuscitation or artificial feeding. CONCLUSIONS: The overwhelming desire expressed by the patients in the ADs was not to have their lives prolonged if their medical condition were such that treatment would merely delay death. Only a minuscule number of patients, less than 0.7%, wanted everything done to prolong life regardless of the chance for improvement or the cost. Because such a small percentage of patients have ADs, it is recommended that each hospital appoint a committee on ADs to do everything possible to encourage patients to execute an AD. A second mission of this committee would be to do everything possible to encourage physicians to pay close attention to their patients' wishes for medical care at the end of life.

Advance Directives↗
PubMed1998

Diagnosis of spine metastases by FDG imaging using a gamma camera in the coincidence mode.

PURPOSE: To illustrate the detection of metastatic lung cancer using a conventional dual detector gamma camera modified to operate in the coincidence mode to image the static distribution of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG). METHODS: A patient with known lung cancer underwent FDG imaging to evaluate the extent of metastatic disease. Twenty-three-minute emission image acquisition at one bed position using a dual detector coincidence gamma camera was performed to evaluate the entire chest and upper abdomen. RESULTS: In addition to detecting the malignant lung nodule, mediastinal lymph node metastases and a rib metastasis, symptomatic metastases to lower thoracic and upper lumbar vertebral bodies, which were not identified on radiographs, CT, or bone scan, were shown clearly by FDG coincidence gamma camera imaging. CONCLUSION: FDG tumor imaging in the body is feasible using a dual detector gamma camera operating in coincidence mode and may find an important role in a certain subset of FDG tumor imaging.

Aged↗
PubMed1998

Altered radiopharmaceutical distribution in myeloma: bone tracer in the heart and heart tracer in the bone.

Tissue deposits of amyloid may lead to various clinical symptoms and signs, depending on the site of deposition. In addition, a specific subtype of amyloidosis, AL protein type, is associated with multiple myeloma. Two cases representing contrasting examples of altered radiopharmaceutical biodistribution in myeloma and amyloidosis are presented and discussed, with a bone tracer depicting the heart and a heart tracer depicting the bones.

Aged↗
PubMed1998

Oncologic diagnosis with 2-[fluorine-18]fluoro-2-deoxy-D-glucose imaging: dual-head coincidence gamma camera versus positron emission tomographic scanner.

PURPOSE: To compare the performance of a dual-head single photon emission computed tomographic (SPECT) Anger camera operated in coincidence mode with that of a dedicated positron emission tomographic (PET) scanner in the imaging of cancer with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG). MATERIALS AND METHODS: Thirty-one patients with known or suspected malignant neoplasms underwent imaging with both methods, and the images were read blindly. Diagnostic performance on a lesion-by-lesion basis was compared with attenuation-corrected PET as the standard of reference. RESULTS: Of a total of 109 discrete lesions depicted at PET, 60 (relative sensitivity, 55%) were identified on the coincidence-mode images. Of the nodules or masses depicted at PET, 13 (93%) of 14 lung nodules or masses, 20 (65%) of 31 mediastinal lymph nodes, five (71%) of seven lesions in the neck, five (55%) of nine axillary lymph nodes, 11 (50%) of 22 bone metastases, and six (23%) of 26 abdominal tumor deposits were correctly identified on the coincidence gamma camera images. CONCLUSION: These preliminary findings indicate FDG imaging with a modified dual-detector gamma camera operating in coincidence mode can depict many of the lesions depicted with a PET scanner, particularly in the lungs. Sensitivity for lesions detected at dedicated FDG PET was poor in the abdomen and in all locations outside the lungs for tumor deposits generally less than 1.5 cm in short-axis diameter.

Abdomen↗
PubMed1998

Peak bone mass in young healthy men is correlated with the magnitude of endogenous growth hormone secretion.

GH plays a key role during adolescence in longitudinal bone growth and the attainment of peak bone mass. We explored the hypothesis that in early adulthood, bone mineral accretion and/or maintenance in men with normal GH and bone mineral status are related to the magnitude of endogenous GH secretion. Overnight plasma GH concentrations (sampled every 10 min from 2100-0500 h) were measured in 15 healthy, lean, Caucasian men (age, 24+/-1 yr; body mass index, 22.6+/-0.6 kg/m2; mean +/- SE). Total body, femur, and lumbar spine bone mineral mass/density were measured by dual energy x-ray absorptiometry. Total body and femoral bone mineral mass correlated with both total nocturnal GH and maximal GH concentrations even when bone mineral mass was adjusted by height (P = 0.005-0.02; r = 0.58-0.74). Neither spinal nor total body bone mineral density (BMD) correlated with GH. Maximum GH correlated with the BMD of all four femoral sites (P = 0.01-0.04; r = 0.55-0.66), whereas total nocturnal GH correlated with only one (trochanter; P = 0.01; r = 0.64) femoral site. Our data support the hypothesis that GH continues to play a role in the accretion and/or maintenance of bone mass in young men. This relationship is more evident in the bone mineral mass achieved than in the BMD.

Adult↗
PubMed1998

Diagnostic evaluation of the adrenal incidentaloma: decision and cost-effectiveness analyses.

UNLABELLED: The goal of this study was to examine the clinical and economic outcomes of alternative diagnostic strategies for differentiating benign from malignant adrenal masses. METHODS: We used cost-effectiveness assessment derived from decision analysis and the economic perspective of the payer of health care services. One-time evaluation with fine-needle aspiration (FNA) and combinations of chemical-shift MRI, noncontrast CT, 131I-6beta-iodomethylnorcholesterol (NP-59) scintigraphy, with or without FNA, in a hypothetical cohort of 1000 patients with incidentally discovered unilateral, nonhypersecretory adrenal masses. We calculated and compared the diagnostic effectiveness, costs and cost-effectiveness of the alternative strategies based on estimates from published literature and institutional charge data. RESULTS: At an assumed baseline malignancy rate of 0.25, diagnostic utility varied from 0.31 (CT0) to 0.965 (NP-59) and diagnostic accuracy from 0.655 [noncontrast CT using a cut-off attenuation value of > or = 0 (CT0)] to 0.983 (NP-59). The average cost per patient per strategy ranged from $746 (NP-59) to $1745 (MRI +/- FNA). The best and worst potential cost-to-diagnostic utility ratios were 773 (NP-59) and 2839 (CT0) and 759 (NP-59) and 1982 (MRI +/- FNA) for cost and diagnostic accuracy, respectively. The NP-59 strategy was the optimal choice regardless of the expected outcome examined: cost, diagnostic utility, diagnostic accuracy or cost-effectiveness. Varying the prevalence of malignancy did not alter the cost-effectiveness advantage of NP-59 over the other diagnostic modalities. CONCLUSION: Based on available estimates of reimbursement costs and diagnostic test performance and using reasonable clinical assumptions, our results indicate that the NP-59 strategy is the most cost-effective diagnostic tool for evaluating adrenal incidentalomas over a wide range of malignancy rates and that additional clinical studies are warranted to confirm this cost-effectiveness advantage.

Adosterol↗
PubMed1997

Predictors of red cell folate level in women attempting pregnancy.

OBJECTIVE: To identify predictors of red cell folate level in women attempting to become pregnant. DESIGN: Cohort study. SETTING: A health maintenance organization serving the Minneapolis-St Paul, Minn, area. PARTICIPANTS: A total of 189 healthy, primarily white women aged 22 to 35 years enrolled in the Diana Project, a population-based prospective study of preconceptional and prenatal risks to reproductive outcomes. The sample represents 189 of 219 enrolled women who were sequentially selected from the total Diana Project sample to receive additional laboratory analyses. MAIN OUTCOME MEASURE: Red cell folate level. RESULTS: Folic acid supplements, folic acid intake from fortified cereals, vitamin C supplements, and serum zinc level (inverse) were found to predict red cell folate levels. Previous research has shown that red cell folate levels higher than 906 nmol/L (400 ng/mL) may be optimal for the prevention of folate-responsive neural tube defects. For folic acid supplement users, folate intakes of 450 microg per day and higher corresponded to these protective levels of red cell folate. In nonusers of supplements, intakes of more than 500 microg of folate per day from foods and folic acid-fortified cereals may be needed to attain red cell folate levels higher than 906 nmol/L (400 ng/mL). Red cell folate levels higher than 906 nmol/L (400 ng/mL) were primarily found in women who took folic acid supplements. Only 1 in 4 women had red cell folate levels higher than 906 nmol/L (400 ng/mL), while 1 in 8 had red cell folate levels indicative of a negative folate balance. Addition of a daily, 400-microg folic acid supplement to the usual diet would result in red cell folate levels over 906 nmol/L (400 ng/mL) in a majority of women in this study. CONCLUSIONS: Supplementation of diets of women of childbearing potential with 400 microg of folic acid per day would effectively raise red cell folate to levels associated with a low risk of folate-responsive neural tube defects. Protective levels of red cell folate may also be obtained by ample consumption of vegetables, fruits, and folic acid-fortified breakfast cereals. Efforts to increase folic acid supplement use and folate consumption among women of childbearing potential must go beyond fortification of refined cereal and grain products and reach women within all educational and income groups.

Adult↗
PubMed1997

Diagnostic dilemma of small incidentally discovered adrenal masses: role for 131I-6beta-iodomethyl-norcholesterol scintigraphy.

Incidentally discovered adrenal masses are detected in 0.35% to 5. 00% of patients imaged with computed tomography (CT) for reasons other than suspected adrenal pathology. Most small adrenal masses are benign, although malignant tumors </= 3 cm in diameter are well described. In the setting of normal adrenal hormonal secretion, the preferential accumulation of 131I-6beta-iodomethyl-norcholesterol (NP59) by adrenocortical tissues allows the distinction of adenomas from other space-occupying or destructive lesions, with diagnostic images being obtained in 100% of lesions > 2 cm. Although some lesions </= 2 cm have yielded nondiagnostic images, the frequency of this phenomenon and thus the utility of NP59 scintigraphy for the evaluation of small adrenal lesions has remained incompletely characterized. Between January 1976 and December 1994 a total of 166 patients with nonhypersecretory unilateral adrenal masses </= 3 cm in maximal diameter, discovered incidentally during CT examinations of the abdomen or chest for reasons other than clinically suspected adrenal disease, were studied with NP59 scintigraphy. Nonhypersecretory masses </= 1 cm, > 1 to </= 2 cm, and > 2 to </= 3 cm yielded diagnostic images in 52%, 89%, and 100% of patients, respectively. Lesions other than adenomas, including malignancies, > 1 to </= 2 cm and > 2 to </= 3 cm were present in 9% and 10% of patients, respectively. These findings emphasize the need to determine the nature of small incidentally discovered adrenal masses whose management may alter patient care and confirm the utility of NP59 scintigraphy to evaluate nonhypersecretory adrenal masses regardless of size.

19-Iodocholesterol↗
PubMed1997

Induction of HL-60 cell differentiation by carotenoids.

Recent observations indicated that carotenoids affected the proliferation and differentiation of certain cell lines. In the current experiments, beta-carotene and lutein were tested for the induction of differentiation with HL-60 cells, a bipotent promyelocytic leukemia cell line. Cultures were incubated with lutein (0.0-10.0 mumol/l), beta-carotene (0.0-10.0 mumol/l), and retinoic acid (0.0-1.0 mumol/l); retinoic acid incubations were positive controls for the differentiation of HL-60 cells into granulocytes. The carotenoid-incubated cultures developed significantly more (p < or = 0.05) differentiated cells than control cultures (vehicle alone). Morphology of the carotenoid-incubated cells indicated differentiation along the granulocytic pathway. The percentage of differentiated cells increased significantly throughout a seven-day incubation period to 25% (lutein), 35% (beta-carotene), and 75% (retinoic acid). A dose response was found for lutein (0.0-10.0 mumol/l), but not for beta-carotene. Throughout the incubation period, the percentage of differentiated cells in negative control cultures did not change, remaining at the initial background level (approximately 5%). These results provide evidence for carotenoid-induced differentiation of cells. Induction of cell differentiation by a carotenoid without (lutein) and with (beta-carotene) vitamin A activity suggested a vitamin A-independent mode of action for carotenoids in cell differentiation.

Carotenoids↗
PubMed1997

Solubilization of beta-carotene in culture media.

Several methods were evaluated for the solubilization of supraphysiological concentrations of beta-carotene in culture media. The addition of beta-carotene in ethanol as 0.1% (vol/vol) of culture medium that contained 10% fetal bovine serum and incubation at 37 degrees C for 30 minutes solubilized approximately 50% of the added carotenoid. Solubilized beta-carotene concentrations from 3.06 to 36.4 mumol/l were obtained by this method. Ultracentrifugation studies localized the solubilized beta-carotene to low-density lipoproteins (67.0%) and high-density lipoproteins (24.9%). Other methods utilizing various amounts of fetal bovine serum, ethanol, and hexane as solvents did not significantly improve the solubilization of beta-carotene compared with the use of ethanol as 0.1% (vol/vol) of culture medium that contained 10% fetal bovine serum. Nonetheless, solubilization of supraphysiological concentrations of beta-carotene indicated the feasibility of preparing culture media containing physiological concentrations (approximately 0.5 mumol/l) of beta-carotene.

Animals↗
PubMed1997

Serum total cholesterol and risk of hospitalization, and death from respiratory disease.

BACKGROUND: In earlier studies, serum total cholesterol was inversely associated with death due to respiratory diseases. METHODS: Relationships of cholesterol with risk of respiratory diseases were examined between 1978 and 1993 in a health maintenance organization in Northern California (48,188 men, 55,276 women, about 60% white, age range 25-89). Incident and fatal endpoints were ascertained using hospital discharge diagnostic codes and underlying cause of death, respectively. RESULTS: An inverse association of cholesterol level with pneumonia/influenza hospitalization was found among men and women except that, contrary to hypothesis, a positive association was seen in women under 55 years of age. Inconsistent inverse associations were found in men, but not women, between cholesterol level and hospitalization for chronic obstructive pulmonary disease (COPD). Hospitalization for asthma was unrelated to cholesterol level. An inverse association existed between cholesterol level and hospitalization for miscellaneous respiratory diseases among men, but not women. Exclusion of early hospitalizations tended to attenuate risk for cholesterol level below 4.14 mmol/l, but not the risk gradient across higher cholesterol levels. For deaths, cholesterol level was statistically significantly inversely associated only with COPD. CONCLUSIONS: Cholesterol had graded inverse associations with some respiratory diseases, but not others, tending to be stronger in men than in women, and in older than in younger participants. Associations varied for hospitalizations compared to deaths. More epidemiological and basic research is needed to elucidate the potential mechanisms underlying the observed associations.

Adult↗
PubMed1997

Scintigraphy of acute inflammatory lesions in rats with radiolabelled recombinant human interleukin-8.

We compared 125I-labelled recombinant human interleukin-8 (125I-IL-8) with 111In-labelled human leukocytes (111In-WBC) and 67Ga-citrate for scintigraphic depiction of acute sterile inflammatory lesions in rats. Radioiodination of IL-8 was catalysed by chloramine-T, and human leukocytes were radiolabelled with 111In-oxine. Inflammatory lesions were induced in male rats by subcutaneous injection of 2% carrageenan suspension into their left hindlimbs. Twenty-four hours later, each rat received 1.8-3.7 MBq (50-100 microCi) of a single agent by intravenous injection. Sequential whole-body scintigrams were obtained between 0 and 96 h post-injection. Activities in the lesion-bearing and control hindlimbs were expressed as regional percent injected activity corrected for physical decay (%IA) by reference to concurrently imaged standards, and for 125I-IL-8 by direct tissue counting at necropsy as well. 125I-IL-8 displayed appropriate electrophoretic mobility, retained chemotactic and high-affinity receptor-binding activity in vitro, and exhibited exponentially decreasing activity in most tissues beginning shortly after intravenous injection. Scintigrams showed asymmetrically increased activity in the lesion-bearing hindlimb for all three agents. By scintigraphy, 125I-IL-8 activity in the lesion-bearing hindlimb reached a zenith 1-3 h post-injection at 4.8 +/- 0.5 %IA and decreased exponentially thereafter, with little change in lesioned-to-control limb ratios (mean L/C = 3.0 +/- 0.7) over the imaging period. By direct tissue counting, abscess-associated mean IL-8 activity per gram of tissue increased to four times that of adjacent muscle and nearly seven times that of contralateral muscle by 24 h post-injection. Lesion-bearing hindlimb 111In-WBC activity also rose rapidly, reaching 4.2 +/- 0.6 %IA by scintigraphy at 3 h and an eventual plateau (maximum of 4.5 +/- 0.4 %IA) by 24 h. 67Ga scintigraphic activity in the lesion-bearing hindlimb peaked briefly at 3-6 h post-injection (9.2 +/- 0.5 %IA) and subsequently declined to a constant level of about 7.5 %IA. However, L/C for 111In-WBC and for 67Ga-citrate each averaged only 1.5 +/- 0.3 over the imaging period, compared with a mean L/C of 1.2 +/- 0.2 for a blood pool radiotracer. We conclude that 125I-IL-8 is rapidly and selectively concentrated in regions of acute inflammation, presumably by high-affinity binding to IL-8 receptors on neutrophils within the inflammatory focus. Radioiodinated IL-8 offers an attractive alternative to 67Ga-citrate and 111In-WBC for early imaging of acute inflammatory lesions, and demonstrates significantly higher target-to-nontarget activity ratios in this model. The potential usefulness of radiolabelled IL-8 for clinical scintigraphy should be evaluated.

Animals↗
PubMed1997

Association of serum vitamin levels, LDL susceptibility to oxidation, and autoantibodies against MDA-LDL with carotid atherosclerosis. A case-control study. The ARIC Study Investigators. Atherosclerosis Risk in Communities.

Oxidative modification of LDL is believed to be a crucial step in atherosclerosis. Thus, antioxidant vitamins may have a role in the prevention of coronary disease. We examined the cross-sectional association of serum vitamin levels, the susceptibility of LDL to hemin-induced oxidation (lag phase to conjugated diene formation), and the malondialdehyde-LDL (MDA-LDL) to native LDL radioactivity binding ratio with carotid intima-media thickness (IMT), a measure of asymptomatic early atherosclerosis. The participants in this observational study were 231 asymptomatic age-, sex-, race-, and field center-matched case-control pairs selected from the Atherosclerosis Risk in Communities (ARIC) study cohort on the basis of B-mode carotid artery ultrasonograms obtained from 1986 through 1989. Cases exceeded the 90th percentile of IMT, and control subjects were below the 75th percentile of IMT for all arterial segments. Biochemical analyses were performed on fasting frozen (-70 degrees C) serum specimens collected from 1990 through 1992. In conditional logistic regression adjusting for age, blood storage time, total cholesterol, and log-triglyceride concentrations, serum beta-cryptoxanthin and lutein plus zeaxanthin levels were inversely related to the extent of atherosclerosis (odds ratio [OR] per 1-SD increase: 0.75, 95% confidence interval [CI]: 0.59-0.94; and OR per 1-SD increase: 0.76, 95% CI: 0.59-0.95, respectively). Increases in alpha-carotene and lycopene were associated with nonsignificantly lower odds of being a case, whereas beta-carotene, retinol, and alpha-tocopherol were unrelated to IMT. Although not reaching statistical significance, the lag phase and autoantibodies against MDA-LDL were positively associated with asymptomatic atherosclerosis. After adjustment for potential confounders, only the inverse association of lutein plus zeaxanthin with asymptomatic atherosclerosis was maintained. This study supports a modest inverse association between circulating levels of some carotenoids, particularly lutein plus zeaxanthin, and carotid IMT. These findings suggest that these carotenoid compounds (regarded as biomarkers of fruit and vegetable intake) may be important in early stages of atherosclerosis.

Antioxidants↗
PubMed1997

Frequency and severity of asymptomatic coronary disease in patients with different causes of stroke.

BACKGROUND AND PURPOSE: We sought (1) to compare the frequency and severity of asymptomatic coronary artery disease (CAD) in patients with different causes of brain ischemia and (2) to determine profiles of patients with brain ischemia who are at highest risk of asymptomatic CAD. METHODS: Sixty-nine patients with transient ischemic attack or stroke and without overt CAD underwent a cardiac stress test and a diagnostic evaluation to determine the cause of brain ischemia. The frequency of abnormal cardiac stress tests was compared in patients with large-artery cerebrovascular disease versus other causes of brain ischemia (90% of whom had penetrating artery disease or cryptogenic stroke). Additionally, the frequencies of vascular risk factors, resting electrocardiographic abnormalities, and cause of stroke (large-artery disease versus other causes) were compared in patients with abnormal stress tests versus patients with normal stress tests. RESULTS: The frequency of abnormal stress tests was 50% (15 of 30) in patients with large-artery cerebrovascular disease versus 23% (9 of 39) in patients with other causes of brain ischemia (P = .04). Moreover, 60% of abnormal stress tests (9 of 15) in patients with large-artery cerebrovascular disease suggested severe underlying CAD that was confirmed in 7 of 7 patients who underwent coronary angiography. On the other hand, less than 25% of abnormal stress tests (2 of 9) in patients with other causes of brain ischemia suggested severe underlying CAD. Features that were more common in patients with abnormal stress tests were smoking (P = .006), large-artery cerebrovascular disease (P = .02), veteran status (P = .02), and left ventricular hypertrophy (P = .07). CONCLUSIONS: Patients with penetrating artery disease or cryptogenic stroke have a significantly lower frequency of asymptomatic CAD than patients with large-artery cerebrovascular disease. Large-artery cerebrovascular disease, smoking, veteran status, and possibly left ventricular hypertrophy may be useful features for identifying patients with transient ischemic attack or stroke who are at highest risk of harboring asymptomatic CAD.

Brain Ischemia↗
PubMed1997

Imaging of the pancreas and related diseases with PET carbon-11-acetate.

UNLABELLED: The purpose of this study was to evaluate [1-11C]-acetate as a tracer for functional imaging of the pancreas and related diseases using position emission tomography (PET). METHODS: Thirty-three patients underwent 30 min of dynamic attenuation-corrected PET after intravenous administration of 740 MBq (20 mCi) of [1-11C]-acetate. RESULTS: The normal pancreas demonstrates prompt uptake of [1-11C]-acetate and is visualized as early as 2 min post-injection, with maximal activity achieved by 5 min. Subsequent clearance of tracer from the pancreas is slow relative to adjacent organs and background, such that by 10 min post-injection the pancreas is the most prominent organ in the imaging field of view. Pancreatic uptake of [1-11C]-acetate was unaffected by pancreatic endocrine insufficiency, but is absent in chronic pancreatitis complicated by exocrine insufficiency. Moderately reduced [1-11C]-acetate uptake was observed in acute uncomplicated pencreatitis. The level of tracer accumulation was substantially reduced in phlegmatous masses complicating pancreatitis and in chronic mass forming pancreatitis. Adenocarcinoma of the pancreas likewise demonstrated no significant uptake of [1-11C]-acetate. CONCLUSIONS: Accumulation of [1-11C]-acetate by the pancreas allows rapid metabolic imaging using PET, and may be a useful metabolic probe for the study of pancreatic physiology and disease.

Acetates↗
PubMed1996

131-I treatment of micronodular pulmonary metastases from papillary thyroid carcinoma.

BACKGROUND: Pulmonary metastases from papillary thyroid carcinoma shorten the survival of the hosts. Treatments with 131-I have been reported to induce disappearance of these tumors in a large proportion of afflicted patients. In this study, consecutive patients with diffuse micronodular lung metastases from papillary thyroid carcinoma were examined to determine if disappearance of tumor occurred, and how much disappeared, after substantial amounts of 131-I were administered. METHODS: Of 232 patients treated with 131-I for thyroid carcinoma between 1985 and 1994, 12 patients between the ages of 5 and 45 years exhibited evidence of micronodular metastases to the lungs that concentrated 131-I. Each patient had undergone total or nearly total thyroidectomy and cervical lymph node dissection. All neoplasms were well differentiated papillary carcinoma, but one also had focal, poorly differentiated insular components. Follicle formation by tumors varied from less than 10% to 100% of the histologic sections. Effects of treatment were measured by three indices: chest X-ray and/or CT images, scintigraphic images, and serum thyroglobulin levels. Individual activities of 131-I ranged from 2.2 gigabequerel (GBq) (initial activity in the 5-year-old patient) to 13 GBq, and were greater than 7.4 GBq in 6 patients. Only one treatment was given to three patients, two were given to seven, and more than two were given to two. The duration of follow-up was at least one year. RESULTS: In two patients, the only evidence of lung metastases was on scintigraphic images made a few days after treatment. Another patient had a normal X-ray but showed diffuse uptake of 131-I in the lungs on a diagnostic scintiscan. Of the nine patients with abnormal X-ray and CT images, seven showed improvement, but tumors disappeared in only two. In the ten patients with abnormalities on the diagnostic scintiscans, five eventually manifested no abnormality. At the outset, thyroglobulin levels exceeded 10 ng/mL in each patient; 3 individuals exhibited a decline in level by 25% or more, and a value of less than 6 ng/mL, uncomplicated by thyroglobulin antibodies, was seen in two patients. Only two patients attained normality in all three indices. Hematologic toxicity was modest and reversible. CONCLUSIONS: Despite a number of previous reports that pulmonary metastases from thyroid carcinoma disappear in approximately half of patients treated with 131-I, evidence of tumor reduction was found in most, but a complete remission occurred in only 2 of 12 patients. Nevertheless, 131-I therapy may be useful to decrease the tumor burden in many such patients.

Adolescent↗