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Biomedical subjects

N Elahi

Publications and source records attributed to N Elahi.

17 recordsLinked to original sources
PubMed2002

Diagnosis and management of lost intrauterine contraceptive device.

OBJECTIVE: To study the pattern of referral, method of diagnosis and management of patients admitted with lost Intrauterine Device (IUD). METHODS: A prospective study was conducted about lost intrauterine contraceptive devices and its management, in Gynaecology Department of Nishtar Hospital, Multan. Twenty eight patients with lost IUD were identified out of 7816 gynaecology admissions, during this period. The diagnosis was made on ultrasonography. RESULTS: IUDs were removed after dilatation of cervix and exploration of uterine cavity in 20 patients. Five cases underwent laparotomy, in 2 cases laparoscopic removal was done and in one case IUD was taken out through proctoscope. In most of the cases IUD was inserted by untrained personnel. CONCLUSION: It is recommended that IUDs should be inserted after proper case selection by trained medical professionals.

Adult↗
PubMed2000

Impact of radiotherapy on normal brain tissue: semi-automated quantification of decrease in perfusion.

PURPOSE: We attempted to ascertain the impact of Co-60 conventional external radiotherapy (cRT) on the perfusion of normal brain tissue in relation to the radiation doses delivered to the tumors in patients with primary brain tumors. MATERIALS AND METHODS: After surgery 18 patients (pts) were due to undergo cRT with a total dose of 5400- 6400 cGy. All the patients had a Tc-99m-HMPAO SPECT study prior to cRT (basal), 15th and 30th days of cRT as well as 1 (in 6 pts), 3 (in 9 pts), and 6 (in 3 pts) months after cRT. For quantitative evaluation, the entire set of transverse slices were divided into 4 regions as frontal, parietal, occipital and temporal regions by means of a computer software program. Semi-automated quantification was performed on a total of 1392 regions in 87 studies to determine left to right ratios. An interregional difference of at least 10% was considered abnormal. RESULTS: After elimination of tumor sites, 80 normal brain regions showed decreased perfusion after cRT. The percent decrease in perfusion was (mean 22.5+/-9.9) significantly higher in areas irradiated with doses > 3000 cGy (p < 0.05). CONCLUSION: cRT has adverse effects on the perfusion of normal brain tissue for doses > 500 cGy. Our findings justify treating patients with small and limited lesions with stereotactic radiotherapy in order to minimize the adverse effects of cRT on normal tissues.

Adolescent↗
PubMed1998

Influence of the heterogeneity of P-glycoprotein expression on technetium-99m-MIBI uptake in breast cancer.

UNLABELLED: We prospectively studied a total of 30 patients with breast cancer to evaluate the relationship between the degree of accumulation of 99mTc-sestamibi (MIBI) and the heterogeneity of p-glycoprotein expression in tumor tissues. METHODS: Twenty patients during initial presentation and 10 patients during post-therapy evaluation underwent contemporaneous 99mTc-MIBI imaging and surgery or biopsy. Immunohistochemical studies were performed on multiple nonconsecutive sections of the same tumor using a p-glycoprotein-specific monoclonal antibody, JSB-1. Tumor-to-background (T/B) ratios were correlated with the level and heterogeneity of p-glycoprotein expression determined by immunohistochemical studies. RESULTS: The T/B ratios were lower for those tumors with strong p-glycoprotein expression (Group 1) than those with strong-to-weak expression (Group 2) or those with weak-to-no expression (Group 3) (1.32 +/- 0.19 and 1.85 +/- 0.56 and 2.86 +/- 1.06, respectively). There was statistically significant difference in T/B ratios between all 3 groups (p < 0.005). Although T/B ratios for Group 1 and Group 3 were clearly distinct from one another with no overlapping values, the values for Group 2 overlapped with those of Group 1 and Group 3. When we evaluated the entire patient group with excluding those with strong-to-weak expression, although the p value remained the same (p < 0.001), we obtained a stronger correlation between T/B ratios and p-glycoprotein expression (r = 0.808 versus 0.735). CONCLUSION: Due to the heterogeneous expression of p-glycoprotein, both immunohistochemistry and 99mTc-MIBI scintigraphy may yield confounding results by contrasting with one another if the presence or absence of p-glycoprotein is not extensively explored. Although our data confirmed that 99mTc-MIBI imaging is useful in the determination of the presence of multidrug resistance in patients with breast cancer, the issue of heterogeneous expression of the antigen should be further investigated when unexpected results are obtained.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1997

Dobutamine thallium-201 myocardial SPECT in patients with left bundle branch block and normal coronary arteries.

UNLABELLED: Dobutamine is a positive inotropic and chronotropic agent and is being widely used as a pharmacologic stress agent in patients unable to achieve maximal dynamic exercise test. The purpose of the current study was to document the dobutamine induced false-positive septal defect in terms of its frequency and extent on 201Tl myocardial SPECT in patient with left bundle branch block (LBBB). METHODS: Twenty-five symptomatic patients with LBBB underwent dobutamine and redistribution 201Tl myocardial SPECT studies. Coronary angiographies were also performed. Only those patients with normal coronaries (n = 19) were included in the study. For each study, tomograms were divided into 19 segments, and each segment was analyzed qualitatively as to presence and type of perfusion defect (reversible or fixed). In addition, septal perfusion was scored in each patient (1 = markedly, 2 = moderately reduced, 3 = normal uptake). RESULTS: Sixteen of 19 patients (84.21%) had false-positive septal reversible perfusion defect, and the remaining 3 had normal images. Perfusion defects were confined to only the septum in 5 of 16 patients (31.25%), whereas a greater proportion of patients had septal defect extending to the contiguous myocardial areas, mainly to the anterior wall. Five of 16 patients with false-positive defects had a septal perfusion score of 1, while the remaining 11 had a score of 2. CONCLUSION: Dobutamine myocardial scintigraphy in patients with LBBB was misleading for the diagnosis of coronary artery disease, since up to 84.21% of patients had false-positive septal perfusion defects.

Adult↗
PubMed1997

Clinical validation of the influence of P-glycoprotein on technetium-99m-sestamibi uptake in malignant tumors.

UNLABELLED: We prospectively studied 48 patients with either breast cancer (30 patients) or lung cancer (18 patients) to ascertain the relationship between the degree of accumulation of 99mTc-sestamibi and the expression of p-glycoprotein in tumor tissues. METHODS: During initial presentation (37 patients) or post-therapy evaluation (11 patients), the patients underwent contemporaneous 99mTc-sestamibi imaging and biopsy (30 patients) or surgery (18 patients). The interval between surgery/biopsy and imaging varied between 3 and 15 days. All patients had radiologically detectable tumors. Immunohistochemical studies were performed on paraffin sections using a monoclonal antibody, JSB-1, developed against the internal epitope of p-glycoprotein. Tumor-to-background ratios were correlated with the level of p-glycoprotein expression determined by immunohistochemical studies. RESULTS: Our results showed an inverse correlation between the tumor-to-background ratios of 99mTc-sestamibi and the density of p-glycoprotein expression in tumor tissues. The values for the tumor-to-background ratios were significantly lower for those tumors expressing p-glycoprotein at high levels than those with scattered and no expression (p < 0.01 and p < 0.001, respectively). CONCLUSION: Although our results warrant further studies at the molecular level using PCR techniques after the extraction of mRNA, our data strongly suggest that 99mTc-sestamibi imaging is useful to noninvasively determine the presence of multidrug resistance in patients with malignant tumors.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1996

Comparison of 99mTc(V)-DMSA, 201Tl and 99mTc-MIBI imaging in the follow-up of patients with medullary carcinoma of the thyroid.

Radionuclide scanning with tumour-seeking agents such as pentavalent technetium-99m dimercaptosuccinic acid [99mTc(V)-DMSA], thallium-201 and technetium-99m sestamibi (MIBI) has been reported to be useful in the detection of medullary thyroid carcinoma (MTC). We undertook a study in 14 MTC patients to determine the comparative imaging potential of 201Tl, MIBI and 99mTc(V)-DMSA in the detection of recurrent or metastatic MTC. All patients underwent total thyroidectomy and had persistently elevated serum calcitonin levels after the surgery. Scintigraphic studies were carried out 20 min after the injection of 111 MBq of 201Tl or 555 MBq of MIBI and 2 h following the injection of 370 MBq of 99mTc(V)-DMSA. All scintigraphic findings were correlated with contemporaneous CT or MRI studies. CT, MRI and bone scans showed 42 (26 bone, 16 soft tissue) metastatic sites in 11 of the 14 patients. In the remaining three patients no lesions were detected during diagnostic evaluation. 99mTc(V)-DMSA showed all of the soft tissue metastases but could not show two bone lesions. On the other hand, MIBI imaging was false-negative in 22 (52%) sites and 201Tl was false-negative in 34 (80%) sites. Overall, lesion detection sensitivities for 99mTc(V)-DMSA, MIBI and 201Tl were 95%, 47% and 19% respectively. We conclude that 99mTc(V)-DMSA is clearly superior to MIBI and 201Tl in the follow-up of MTC patients.

Adult↗
PubMed1996

Comparison of 201Tl, 99Tcm-MIBI and 131I imaging in the follow-up of patients with well-differentiated thyroid carcinoma.

Problems stemming from the withdrawal of TSH suppressing doses of T4 or T3 and false-negative studies associated with 131I scintigraphy have justified the search for other radionuclides in the follow-up of patients with well-differentiated thyroid carcinoma. Although 201Tl and 99Tcm-MIBI (MIBI) have been suggested as alternatives, their role in the detection of residual and recurrent disease has yet to be established. We therefore studied 36 patients who had undergone total or near total thyroidectomy for well-differentiated thyroid carcinoma to determine the imaging potential of 201Tl, MIBI and 131I in the detection of residual or recurrent disease. Eighteen of the 36 patients had undergone 131I ablation. Imaging was performed 20 min following the intravenous injection of 111 MBq 201Tl or 555 MBq MIBI, or 48 h after the oral ingestion of 185 MBq 131I. The overall concordance between the 201Tl, MIBI and 131I scans was 70%. The concordance between thyroglobulin (TG) levels and the 131I scans was 78%; that between the 201Tl and MIBI scans and TG levels was 83%. Among the group of pre-ablative patients, there were six false-negative results with 201Tl and three false-negative results with MIBI. Among the post-ablation group, the 201Tl and MIBI scans were falsely negative in five patients. The 131I scans revealed all known residual or recurrent diseases. In conclusion, 201Tl, MIBI or TG levels should not be used in the place of 131I for the detection of residual or recurrent thyroid cancer. However, in patients who have not had their TSH suppressing doses of T4 or T3 withdrawn, the role of 201Tl and MIBI is debatable.

Adenocarcinoma, Follicular↗
PubMed1996

Pre- and post-therapy thallium-201 and technetium-99m-sestamibi SPECT in nasopharyngeal carcinoma.

UNLABELLED: We prospectively studied the diagnostic potential of 201Tl and 99mTc-sestamibi (MIBI) SPECT for evaluating the extent of primary disease and differentiating residual/recurrent disease from post-therapy changes in patients with nasopharyngeal carcinoma (NPC). METHODS: Fifty patients (20 initial presentation, 30 post-therapy evaluation) underwent 201Tl and MIBI imaging. The findings were correlated with CT/MRI results. Tumor-to-background ratios were obtained. Biopsy confirmation (14 patients) and/or 6-12 mo clinical follow-up data (16 patients) were available in the post-therapy group. RESULTS: All primary disease sites were accurately detected by both imaging studies in the pretherapy group. However, MIBI-SPECT was superior to 201Tl SPECT (p = 0.0057) in detecting regional metastases (sensitivities of 95% versus 68%). In the post-therapy group, MIBI and 201Tl imaging were true-positive in 14 of 16 patients with proven residual/recurrent. In 17 patients who had no evidence of residual/recurrent tumor. CT/MRI was false-positive in 13 when MIBI and 201Tl imaging were true-negative in 10 and false positive in 3. MIBI, 201Tl and CT/MRI had sensitivities of 87.5%, 87.5%, 100%, specificities of 82.4%, 76.5%, 23.5% and accuracies of 85%, 82%, 61%, respectively. Tumor-to-background ratios were < or = 1.5 in all false-positive cases except one. CONCLUSION: MIBI-SPECT proves more accurate than 201Tl SPECT in detecting regional metastases at initial presentation. MIBI and 201Tl imaging have higher specificity and accuracy than CT/MRI and MIBI-SPECT is slightly more specific than 201Tl SPECT in differentiating residual/ recurrent disease from post-therapy changes in patients with NPC.

Adolescent↗
PubMed1982

Magnetically propelled, encapsulated XAD-2 and microphase extraction technique for a rapid quantitation of basic drugs in serum by GC.

A novel, simple, and highly economical technique is described for a rapid gas chromatographic screening and quantitation of basic drugs in serum. The drugs are adsorbed directly form 1 ml of serum onto 400 mg of XAD-2 resin, encapsulated within a rigid, porous, spherical polypropylene capsule, 2 cm in diameter. The capsule also contains a ferromagnetic bar that provides controlled agitation of contents under the influence of a rotating magnet. Resolution and quantitation of samples spiked with 18 basic drugs are provided by a nitrogen detector. The yields are quantitatively linear in both sub-therapeutic and toxic ranges for most drugs; the extracts exhibit minimal background in the range of sensitivities indicated; total extraction time is 20 min.

Autoanalysis↗
PubMedDate not supplied

Encapsulated XAD-2 extraction technique for a rapid screening of drugs of abuse in urine.

This paper describes a novel technique for the rapid screening of drugs of abuse in urine involving extraction with encapsulated Amberlite XAD-2 resin followed by gas chromatographic analysis. Each capsule is fabricated as a rigid, porous, polypropylene sphere, 2 cm in diameter, and contains 300 mg of the XAD-2 resin. Two mL of urine is shaken with one capsule under slight positive pressure for eight minutes. A sequential extraction is employed to obtain separate elution of the acidic-neutral and basic drugs. Identification is by dual column gas chromatography. The results, as given for spiked urine samples containing 16 commonly encountered drugs, were found to be linear and reproducible over both the therapeutic and toxic ranges. Extraction efficiencies using the encapsulated XAD-2 technique are comparable to those reported in literature for XAD-2 column chromatography. The purity of the extracts, as seen from the gas chromatographic analysis, is demonstrably better than that seen with the conventional procedures. There was minimal interference from polymer bleed. The total volume of solvents used in the sequential scheme is 5 mL. Total extraction time to achieve dried residues is 15 minutes.

Capsules↗
PubMedDate not supplied

Analysis of the dynamics of Pneumocystis carinii in vitro.

Three culture systems employing mammalian lung cell monolayers were evaluated in terms of their ability to support the replication of primary isolates of rat-derived Pneumocystis carinii. For each system, analysis of variance was used to identify changes in the numbers of P. carinii over time. Significant replication was consistently demonstrated over lung fibroblasts (MRC-5), however, increases perceived in the culture supernatant were clearly influenced by the density of the underlying monolayer.

Animals↗
PubMedDate not supplied

Influence of immediate post-therapy bone scintigraphy in the assessment of response to therapy in a case of nasopharyngeal carcinoma.

A patient with undifferentiated stage IV (T3N3M0) nasopharyngeal carcinoma (WHO type III) underwent pre- and one-month post-therapy bone scintigraphy as part of an ongoing trial combining scintigraphic and radiographic modalities. The patient had advanced disease in the nasopharynx and bulky cervical lymph nodes at presentation. Initial bone scintigraphy performed 10 days prior to therapy was negative for bone metastases. Immediately after concomitant chemoradiotherapy, bone scintigraphy revealed distant metastases, whereas clinical assessment of disease disclosed complete response to therapy in the nasopharynx and cervical lymph nodes. The scintigraphic findings were also confirmed by a subsequent MRI scan of the corresponding regions.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Can bone scintigraphy detect additional metastatic sites unrevealed by CT in patients with recurrent ovarian carcinoma?

A patient who presented with recurrent ovarian carcinoma with elevated levels of CA 125 was evaluated for skeletal metastases by routine whole body bone scintigraphy. Although no bone metastasis was visualized, there was intense accumulation of tracer in the soft tissues corresponding to the liver, pelvis, and intestinal/peritoneal surface, suggestive of metastatic disease. Although liver and pelvic soft tissue metastases were confirmed by CT and USG, intestinal/peritoneal metastases could not be disclosed by either modality.

Abdominal Neoplasms↗
PubMedDate not supplied

Double-phase Tc-99m-SestaMIBI SPECT imaging in a case of glomus jugulare tumor.

We performed a double-phase Tc-99m-SestaMIBI SPECT study on a patient who presented with a mass located at the skull base. The results were compared with double-phase T1-201 SPECT study. Early phase (30 min) SPECT images of both radiopharmaceuticals demonstrated increased radiotracer uptake in the region of the tumor. However, late images (180 min) revealed rapid wash-out of Tc-99m-SestaMIBI from the tumor, suggestive of a benign vascular tumor, while T1-201 images showed slower wash-out. Tc-99m-SestaMIBI SPECT findings were also confirmed by carotid angiography and biopsy, while a contemporaneous MRI scan was inconclusive in differentiating benign from malignant tumor. Initial and one-year follow-up whole body CT scans were negative for any metastatic sites, supporting the diagnosis of benign glomus jugulare tumor.

Angiography↗