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Biomedical subjects

S Heyman

Publications and source records attributed to S Heyman.

At least 73 records · Page 4Linked to original sources

The extraction factor: an estimate of single kidney function in children during routine radionuclide renography with 99mtechnetium diethylenetriaminepentaacetic acid.

An estimate of absolute renal function in children is described using the initial extraction of 99mtechnetium diethylenetriaminepentaacetic acid. The extraction factor correlates well with the glomerular filtration rate as determined by the clearance from the blood of 99mtechnetium diethylenetriaminepentaacetic acid with a correlation coefficient of 0.92. The normal mean extraction factor in the newborn is 1.5 per cent by each kidney, which increases to 2.5 per cent in the first year of life. The method is simple to perform and it is reproducible provided care is taken. We recommend that this procedure be included as part of the routine renal scan in children.

Antineoplastic Agents↗

The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients.

Single photon emission computed tomography (SPECT) is a method of scintigraphy that provides sectional and multi-planar imaging that should improve the sensitivity for diagnosis in remote areas of the spine. To test this hypothesis, the authors reviewed 15 patients with low-back pain and compared the results of the radiographs, planar bone scans (PBS), and SPECT. Four of 15 had normal examinations with all three methods of imaging. The rest had a positive test in at least one of the three methods. Single photon emission computed tomography was positive in eleven, PBS in six, and the radiograph in three of the 11 patients. It appears that the SPECT was the most sensitive method of imaging and greatly enhanced our diagnostic acumen for stress fractures or stress reactions of the spine.

Adolescent↗

Association of congenital megacalycosis and ipsilateral segmental megaureter.

Four cases of congenital megacalycosis associated with ipsilateral segmental megaureter in children are presented. This association has not been emphasized, although review of the English and French literature revealed eight such cases. In all cases, the concurrent entities are unilateral, with a left-sided predominance and a male prevalence. The diagnosis of megacalycosis is presumed in four of the cases by normal function and prompt emptying of the calyceal systems on diuretic renography and/or urography. The presence of normal caliber renal pelvis interposed between the dilated collecting system and the distal dilated ureter without evidence of vesicoureteral reflux implies the coexistence of ipsilateral idiopathic megaureter. The patients usually present because of urinary tract infection and/or calculus formation, but respond well to conservative therapy.

Adolescent↗

Slow versus rapid closed-chest cardiac compression during cardiopulmonary resuscitation in puppies.

The recommended rates for closed-chest cardiac compressions during CPR are based on physiologic variations with increasing age rather than experimental data. Using puppies, we compared mean arterial pressure, cardiac index (CI), and cerebral blood flow (CBF) at a slow (40/min, group 1) and a rapid (120/min, group 2) rate. CBF was measured in all experiments by N2O uptake before and during CPR from cardiac arrest induced with KCl. Both CI and CBF were measured in half of the subjects with radiolabeled microspheres. Groups 1 and 2 were similar in terms of baseline mean weight, mean arterial pressure, CI, CBF, and arterial and venous blood gases. During resuscitation for group 1, the mean CI was 221 ml/min . m2, and the mean CBF was 4 ml/100 g . min determined by N2O uptake (2 ml/100 g.min by microspheres); in group 2, the respective means were 248 ml/min . m2 and 4 ml/100 g . min with both techniques. The values for mean CI and CBF (N2O or microspheres) did not differ significantly at either rate of compression. The N2O uptake and microsphere techniques for measuring CBF correlated closely during spontaneous cardiac contractions and mechanical chest compressions. We conclude that a) closed-chest cardiac compressions at either rate studied provided inadequate CBF, and b) the N2O uptake and microsphere techniques give similar measures of CBF under conditions of normal and low flow.

Animals↗

Extraosseous uptake of technetium-99m MDP in secondary deposits of neuroblastoma.

Extraosseous uptake of radiophosphate compounds i well recognized in primary neural crest tumors. In a review of 32 cases of neuroblastoma presenting over a three-year period at Children's Hospital of Philadelphia, nine patients were noted to have secondary lesions in eleven different sites accumulating radiotracer. The extraosseous uptake in metastases included: ascites, liver, lung, anterior mediastinum, and posterior mediastinum. These cases are reported to emphasize the ability of bone imaging to detect the presence of extraosseous soft tissue metastases and primary lesions.

Bone Neoplasms↗

Scintigraphic findings in infantile hemangioendothelioma.

The scintigraphic findings on sulfur colloid liver-spleen imaging, Tc-99m labeled RBC blood pool imaging, and Tc-99m MDP bone imaging in four patients with infantile hemangioendothelioma are described. Thirteen radionuclide studies were performed, with serial sulfur colloid images obtained in three patients, allowing interval assessment of liver size and tumor involvement. Findings of Tc-99m MDP uptake in the livers of two patients with hemangioendothelioma and diffuse increase in hepatic RBC labeled blood pool activity in one patient also are reported.

Child, Preschool↗

Diphosphonate intestinal activity seen on two bone images in neuroblastoma.

Neuroblastoma is well recognized as a cause of soft tissue uptake of Tc-99m MDP. Two cases of neuroblastoma arising in the midline from the celiac axis are reported. Bone imaging performed on two separate days showed not only typical soft tissue uptake, but also the appearance of the radiopharmaceutical in the bowel. At surgery, a midline upper abdominal neuroblastoma was found in both patients without evidence of involvement of the liver, kidneys, bowel, gallbladder or mesentery. It became apparent with delayed images in the second patient that this activity was in the bowel and moving around the abdomen in a typical large bowel pattern. Bowel activity was not seen in other patients having bone scans at this time. Follow-up bone imaging on the first patient after resection of the tumor did not demonstrate diphosphonate activity in the bowel. These authors have never seen or read of this finding previously in this condition, and report it in these two patients.

Abdominal Neoplasms↗

Biliary scintigraphy in children with sickle cell anemia and acute abdominal pain.

The patterns of radionuclide hepatobiliary scans in nine children with sickle cell disease and acute right upper quadrant abdominal pain were reviewed. The most common pattern observed was delayed gall bladder visualization, consistent with chronic cholecystitis. The value of hepatobiliary imaging in distinguishing acute cholecystitis from crisis is presented.

Abdomen↗

Thyroidal uptake of iodine-123 in children using a gamma camera and computer.

The measurement of thyroidal uptake of radioiodine using a gamma camera and computer is described. In 12 children there was good agreement with simultaneous measurements using a probe, while in a further 14 patients the uptake values were consistent with the clinical diagnosis. The technique should be especially useful for infants and small children.

Adolescent↗

Liver-spleen scintigraphy in glycogen storage disease (glycogenoses).

Some forms of glycogen storage disease (GSD) primarily affect the liver, including types I, III, IV, VI, IX and 0. Scanning with Tc-99m sulfur colloid, while not being specific, does reveal some characteristic features. Most experience is with scanning in type I disease, though there are few reports in the literature. Six patients with type I, type III, type IV, and probably type VI disease are presented in this report. GSD should be considered in infants and young children presenting with hepatomegaly and abnormal liver-spleen scans. Sequential imaging is useful in following these patients. When focal defects are present, long term follow-up is indicated to detect hepatocellular adenocarcinoma.

Adenocarcinoma↗

Ultrasound evaluation of neck masses in children.

Neck masses in children are a frequent occurrence and in some instances create a diagnostic dilemma for the clinician. The authors' two-year experience using ultrasonography in the evaluation of 34 children with neck masses is reviewed. Twenty-two patients had lesions arising outside the thyroid gland; 12 lesions arose from the thyroid gland. Ultrasonography proved to be an accurate imaging modality for localizing the mass and demonstrating its relationship to the thyroid gland, trachea, and major neck vessels. The borders and extent of the lesions were well outlined, as well as their internal consistency. Based on this review, the authors recommend that ultrasonography be the first screening procedure in pediatric patients who present with perplexing neck masses.

Adenoma↗

Cardiac involvement in cystic fibrosis: early noninvasive detection and vasodilator therapy.

Cardiac involvement in cystic fibrosis (CF) occurs commonly but may remain undetected by usual evaluation in its early stages when right ventricular dysfunction (RVD) may be treatable. To assess the role of vasodilator therapy for early RVD in CF, we performed a prospective study in 23 ambulatory CF patients with mild CF (clinical score m = 79 +/- 8, range 61 to 90). Echocardiography (echo) and radionuclide angiography (RA) were performed at rest and with exercise stress testing (EST) in all 23 to select patients with early RVD. Thirteen of twenty-three had RVD on echo or RA evidenced by increased RV dimensions (P less than 0.001) on echo and decreased RV ejection fraction (EF) on RA (P less than 0.01) but 30% of these patients were abnormal only with EST. All 13 with RVD underwent inpatient double-blinded randomization to receive placebo or hydralazine orally without changing other standard therapy. Nine of thirteen received hydralazine (2 mg/kg/day) for 3 days. With hydralazine no change from placebo was seen on any echo or RA measurement at rest or with EST other than left ventricular STI which fell (P less than 0.05). These data indicate: 1) EST with echo and RA detects RVD in CF earlier than resting studies, 2) patients with mild CF (clinical score less than 85) frequently have RVD on EST, and 3) hydralazine does not improve RVD in CF even very early in its development.

Adolescent↗

Dacryoscintigraphy in children.

Dacryoscintigraphy was performed in 34 pediatric patients aged between 13 months and 20 years. Twenty-six were 12 years of age or younger. The study is easy to perform and provides useful information regarding the function of the nasolacrimal system. The radiation dose to the lens of the eye, estimated to be 4-14m rads/100 uCi of technetium pertechnetate, is considerably less than that of a skull x-ray or dacryocystography. Of the 74 nasolacrimal systems studied, the findings were in agreement with the clinical observations and other methods of testing in 63. In nine instances, the findings altered the clinical management while the results were inconclusive or misleading in the remaining two. Dacryoscintigraphy was found to be a useful physiological test in the evaluation of children with epiphora.

Adolescent↗