Biomedical subjects
S Pinsky
Publications and source records attributed to S Pinsky.
Radiation-induced tumors of the head and neck following childhood irradiation. Prospective studies.
Nodules were found in 1108 subjects who received childhood radiation for benign conditions of the cervical area at our institution. This is 37.5% of 2958 subjects, out of a total of 5379, for whom there is follow-up information. Of the 848 subjects who have had thyroidectomies, 297 (35.0%) had thyroid cancer. In addition to thyroid tumors, salivary, neural, and probably parathyroid tumors also occurred as a late consequence of childhood radiation. Prospective studies of the subjects indicate that thyroid nodules are continuing to occur at a constant rate. The measurement of serum thyroglobulin is helpful in identifying individuals for whom the risk of developing a nodule is increased. Follow-up of patients with nonsurgically-treated nodules indicates that some of their nodules are progressive. At the present time there is no indication that radiation-induced cancers behave differently than ones in other settings. However, some of their characteristics, especially their multicentricity and occurrence in younger individuals, indicate that continued follow-up is necessary. On the basis of the data generated by the follow-up program at our institution and programs elsewhere, recommendations for screening, treatment, and follow-up are made. The recommendations stress the importance of estimating risk based on radiation dose, previous tumors, and serum thyroglobulin, in arriving at clinical decisions for these subjects.
Complementary role of chest roentgenogram in interpretation of Tc-99m sulfur colloid liver scan.
Correlation of a chest roentgenogram and a radionuclide scan facilitated the interpretation of a liver scan with a defect in the dome that was due to an extrinsic compression and photon attenuation by a metastatic tumor in the right lung base.
Axillary-femoral shunt visualization. A serendipitous finding during abdominal radionuclide angiograms.
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The effects of inadvertent administration of antineoplastic agents prior to Ga-67 injection: concise communication.
Alteration of the gallium-67 (Ga-67) distribution after administration of chemotherapeutic agents has been demonstrated in experiments on both normal and tumor-bearing animals. We have encountered eight patients who had Ga-67 scintigrams in which the findings were similar to those in the animals experiments: markedly increased uptake in bone, with suppressed uptake in liver, muscle, and tumor. Five of the patients had hematologic neoplasms, and three had solid tumors, and each had received one or more chemotherapeutic agents during the 24 hr preceding Ga-67 administration. In three patients while not on antineoplastic medication subsequent Ga-67 images showed a return to the usual Ga-67 distribution pattern. The altered Ga-67 distribution may result from inhibition of protein synthesis or of a serum-binding agent for Ga-67, or from competitive blockage of specific Ga-67 organ receptors by the antineoplastic agents.
Benefit of fibrin sealing in great vessel surgery.
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Scintigraphic thyroid abnormalities after radiation. A controlled study with 99mTc pertechnetate scanning.
We did 99mTc-pertechnetate thyroid scintigraphy on 99 subjects with no history of therapeutic irradiation to the head or neck. They were compared with 198 irradiated patients selected from a group of over 1700 who were evaluated because of radiation treatment for benign head and neck conditions during childhood. The two groups were similar with respect to age and sex distribution. There were significantly more abnormal scintigrams in the irradiated group (55 of 198 patients versus one of 99 controls). Even after patients and controls with palpable nodules were excluded from the analysis there were still more abnormal scintigrams in the irradiated group (16 of 150 irradiated versus one of 97 control subjects). We conclude that thyroid nodules, including the smaller, nonpalpable nodules discovered by scintigraphy, are related to previous radiation therapy. For persons at substantial risk, such as those who received high-dose treatment (greater than 700 R) during childhood, the data support the use of screening scintigraphy, even with normal findings on palpation.
Sequential scintigraphic staging of small cell carcinoma.
Thirty patients with small cell carcinoma (SCC) of the lung were sequentially staged following a history and physical exam with liver, bran, bone, and gallium-67 citrate scans. Scintigraphic evaluation disclosed 7 of 30 patients (23%) with advanced disease, stage IIIM1. When Gallium-67 scans were used as the sole criteria for staging, they proved to be accurate and identified six of the seven patients with occult metastatic disease. Gallium-67 scans proved to be accurate in detecting thoracic and extrathoracic metastases in the 30 patients with SCC, especially within the liver and lymph node-bearing area. The diagnostic accuracy of gallium-67 fell in regions such as bone or brain. Despite the limitations of gallium-67 scanning, the authors conclude that these scans are useful in staging patients with SCC and should be the initial scans used in staging such patients.
Training social workers for discharge-planning.
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Comparison of radionuclide brain scan and computerized tomography for the detection of intracranial infections.
The findings of radionuclide brain scans are computerized tomography (CT) were compared in 25 consecutive patients with intracranial infectious disease. Seventeen of the 25 patients had diffuse disease and eight had brain abscesses. The radionuclide scans showed abnormalities in 13 of the 17 patients with diffuse inflammatory disease, whereas th CT scans showed abnormalities compatible with inflammatory disease in five. All eight abscesses were demonstrated on the radionuclide scans, whereas the CT scans indicated abnormalities in seven cases. The authors conclude that the radionuclide brain scan is more sensitive than the CT scan for the demonstration of diffuse intracranial infectious disease.
Continuing occurrence of thyroid nodules after head and neck irradiation. Relation to plasma thyroglobulin concentration.
We re-examined 158 subjects from a group of 226 previously normal persons who had received head and neck irradiation, 113 with elevated plasma thyroglobulin levels at their first visit and 113 with normal levels. Twenty-four subjects had thyroid scintigrams that had changed in the follow-up interval of 24 to 60 (mean = 45.3) months. Twelve subjects subsequently had thyroidectomy, and five malignancies were found. In the other 12 the changes tended to be more subtle, but in nine they very likely represented thyroid nodules. We conclude that the prevalence of radiation-induced nodules is not decreasing. More changes (17 of 24) occurred in subjects who initially had elevated plasma thyroglobulin levels (p less than 0.05). However, the difference was not significant when the analysis was limited to the almost certain development of a nodule. Longer follow-up will be needed to ascertain whether a high thyroglobulin level predicts a greater risk of developing thyroid nodules.
Significance of extrathyroidal uptake of Tc-99m and I-123 in the thyroid scan: concise communication.
Areas of extrathyroidal uptake were noted on thyroid scans obtained with Tc-99m and I-123 in five subjects. Four of them had palpable lymph nodes corresponding to the extrathyroidal uptake. All the palpable nodes that showed radionuclide uptake contained metastatic thyroid carcinoma, with predominantly well-differentiated follicular cells. Extrathyroidal areas of uptake on a routine thyroid scan with pertechnetate and/or radioiodine most probably indicate thyroid carcinoma with regional metastases.
Characteristics of 108 thyroid cancers detected by screening in a population with a history of head and neck irradiation.
One hundred and eight cases of thyroid cancer have been discovered as a result of screening 1712 individuals from a well defined population known to be at high risk because of prior head or neck irradiation for benign conditions. Of these 198 cancers, 43 (39.8%) were palpable, 27 (25.0%) were detectable by means of thyroid scintigraphy alone, and 38 (35.2%), referred to as incidental carcinomas, were found when the patients were operated on for lesions which approved to be benign. The most striking feature of these cancers was the high frequency of multicentricity (55%) and bilaterality (36%). This high frequency was found in clinically apparent as well as incidental cancers, and could not be accounted for by the operative pathologic techniques of investigation. Of 42 subjects reevaluated at our institution after a mean time of 38 months, 2 had definite and 2 had probable recurrent or residual thyroid disease. The postoperative thyroglobulin levels in subjects with thyroid cancer were proportional to the amount of thyroid tissue remaining. Follow-up evaluation of the entire group did not disclose any differences in the behavior of these thyroid cancers compared to those not associated with radiation.
Gallium 67 scans in small cell carcinoma.
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Dynamic renal scan in the non-visualizing kidney.
Thirty-one patients with 35 non-visualizing kidneys on excretory urography were studied with 99mtechnetium-diethylenetriaminepentaacetic acid scintiscanning. In 11 cases good renal blood flow and concentration were demonstrated on nucleide scanning. All patients had significant parenchyma and recoverable renal function after appropriate surgical management. In 20 cases there was little or no blood flow on the scan. These patients either had a congenitally absent kidney or severely destroyed parenchyma. The 99mtechnetium-diethylenetriaminepentaacetic acid dynamic renal scan is a sensitive method for predicting renal salvageability of a kidney that fails to visualize on excretory urography.
Lateral-view ventilation images with 133Xe.
For better delineation of regional ventilation abnormalities, a lateral-view imaging has been employed when one or more areas of abnormal retention were visible in posterior views of 133Xe washout images. It is technically simple to obtain lateral views during the 133Xe washout phase. The resulting images were found to be very useful in detecting regions of ventilation-perfusion mismatch and in evaluating regional obstructive lung disease.
Autopsy experience with a radioactive cadaver.
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Plasma thyroglobulin in detecting thyroid carcinoma after childhood head and neck irradiation.
The level of thyroglobulin in plasma was measured in 904 subjects with a history of head and neck irradiation during childhood to evaluate its potential value in screening for and differentiating thyroid neoplasms. Mean plasma thyroglobulin level was significantly elevated in subjects with nodular thyroid disease versus those without evidence of nodules (49.8 versus 27.0 ng/ml). However, the overlap with normal subjects does not allow thyroglobulin assays to serve as the only screening procedure. The mean levels in subjects with benign and malignant thyroid nodules were indistinguishable (48.8 versus 53.9 ng/ml). Thirteen percent of otherwise normal-appearing subjects had elevated values that may represent clinically inapparent thyroid disease. It is concluded that in screening large numbers of persons at risk for thyroid neoplasia, thyroglobulin assays are useful in combination with other modes of evaluation. The assay is without value in distinguishing benign from malignant disease.