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Biomedical subjects

W A Fajman

Publications and source records attributed to W A Fajman.

At least 37 records · Page 2Linked to original sources
PubMed1987

Relation of coronary artery stenosis and pressure gradient to exercise-induced ischemia before and after coronary angioplasty.

The purpose of this investigation was to evaluate the relation of coronary artery stenosis and associated pressure gradient to the magnitude of exercise-induced left ventricular dysfunction in patients with single vessel coronary artery disease. The percent stenosis and minimal cross-sectional area were measured before and after percutaneous transluminal coronary angioplasty and compared with radionuclide measurements of left ventricular function before and after angioplasty in 41 patients with proximal left anterior descending coronary artery lesions, providing 82 points of comparison. The gradient could be measured for 75 comparisons. Forty stenoses less than 50% were associated with a mean left ventricular exercise ejection fraction of 0.66 +/- 0.08 (mean +/- SD), 25 stenoses from 50 to 75% with a mean ejection fraction of 0.59 +/- 0.12 and 17 stenoses greater than 75% with a mean ejection fraction of 0.49 +/- 0.08. Thirty-five stenoses with a gradient less than 20 mm Hg were associated with a mean ejection fraction of 0.65 +/- 0.09, 24 with a gradient from 20 to 50 mm Hg with a mean ejection fraction of 0.58 +/- 0.13 and 16 with a gradient greater than 50 mm Hg with a mean ejection fraction of 0.53 +/- 0.10. These data document a relation between the magnitude of coronary artery stenosis and associated gradient to exercise-induced left ventricular dysfunction in homogeneous patient groups. However, discordance of these variables occurs commonly in individual patients.

Adult↗
PubMed1987

Ectopic parathyroid gland. Localization with thallium-201 SPECT.

Dual isotope Tl-201/Tc-99m subtraction is a useful technique for localization of abnormal parathyroid glands. A case of tomographic localization of nonsubtracted Tl-201 to a mediastinal parathyroid is reported and the possible benefit of this method discussed.

Adenoma↗
PubMed1987

Analysis of homogeneity of alveolitis in pulmonary sarcoidosis by bilateral bronchoalveolar lavage, gallium-67 lung uptake, and chest radiograph.

The use of unilateral lobar bronchoalveolar lavage (BAL) to assess disease activity in pulmonary sarcoidosis assumes that the alveolitis is homogeneous throughout the lung parenchyma. Three studies were used to evaluate this premise in 21 patients with sarcoidosis who had a broad range of abnormalities: bilateral BAL cell counts, quantitated regional gallium-67 lung uptake, and analysis of chest radiographs. Based on results of these studies, we conclude that the alveolitis in sarcoidosis is homogeneous in the majority of patients, although lavage of the lingula may give erroneous results due to the frequently increased proportion of neutrophils. The only moderate level of correlation between the BAL % lymphocytes and gallium-67 lung uptake, even when the same regions of the lung are studied, suggests that these tests may measure different aspects of disease activity.

Adult↗
PubMed1986

Distance-weighted backprojection: a SPECT reconstruction technique.

A method of reconstruction of single-photon emission computed tomographic (SPECT) images--distance-weighted filtered backprojection--is described. The quality of SPECT images using the standard filtered backprojection algorithm for data obtained from 360 degrees acquisitions is limited by the loss of spatial resolution with distance, and the attenuation and scatter inherent in the planar images used for reconstruction. In contrast to the standard techniques in which a reconstructed pixel receives equal contributions from 180 degrees opposed views, distance--weighted filtered backprojection applies a variable weighting factor to the data such that the pixel receives greater weight from the closest planar views. Data derived from hot and cold spot phantoms as well as from various clinical studies show better spatial and contrast resolution with this new technique compared with the conventional 360 degrees algorithm.

Bone and Bones↗
PubMed1986

Comparison of clinical parameters, bronchoalveolar lavage, gallium-67 lung uptake, and serum angiotensin converting enzyme in assessing the activity of sarcoidosis.

A major problem in pulmonary sarcoidosis is the assessment of disease activity. We established a clinical score system composed of degree of dyspnea, chest radiographic stage, forced vital capacity, and clinical assessment of disease activity (normal = 0, maximum = 16). We evaluated this score in 50 patients with sarcoidosis along with other proposed measures of disease activity: bronchoalveolar lavage percent lymphocytes (% lymphs), Gallium-67 lung uptake measured as total lung to background ratio (TL/B ratio), and serum angiotensin converting enzyme (SACE) levels. The patients we studied had an average clinical score of 5.6 +/- 2.7 (+/- SD). Though bronchoalveolar lavage % lymphs (32 +/- 20%), TL/B ratio (192 +/- 73), and SACE (137 +/- 66) were all significantly elevated in these patients, Gallium-67 uptake was most frequently abnormal (80% of patients). However, the TL/B ratio was higher in smokers (231 +/- 91) than nonsmokers (178 +/- 64, p less than 0.05). There was no correlation between our clinical score, or any part of the clinical score, and other laboratory measures of alveolitis. Bronchoalveolar lavage % lymphs and TL/B ratio correlated weakly (n = 50, r = 0.36, p less than 0.02), while % lymphs and SACE correlated less well (n = 29, r = 0.36, p = 0.051). There was no correlation between TB/L ratio and SACE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Prediction of therapeutic response in steroid-treated pulmonary sarcoidosis. Evaluation of clinical parameters, bronchoalveolar lavage, gallium-67 lung scanning, and serum angiotensin-converting enzyme levels.

To find a pretreatment predictor of steroid responsiveness in pulmonary sarcoidosis we studied 21 patients before and after steroid treatment by clinical evaluation, pulmonary function tests, bronchoalveolar lavage (BAL), gallium-67 lung scan, and serum angiotensin-converting enzyme (SACE) level. Although clinical score, forced vital capacity (FVC), BAL percent lymphocytes (% lymphs), quantitated gallium-67 lung uptake, and SACE levels all improved with therapy, only the pretreatment BAL % lymphs correlated with the improvement in FVC (r = 0.47, p less than 0.05). Pretreatment BAL % lymphs of greater than or equal to 35% predicted improvement in FVC of 10/11 patients, whereas among 10 patients with BAL % lymphs less than 35%, 5 patients improved and 5 deteriorated. Clinical score, pulmonary function parameters, quantitated gallium-67 lung uptake, and SACE level used alone, in combination with BAL % lymphs or in combination with each other, did not improve this predictive value. We conclude that steroid therapy improves a number of clinical and laboratory parameters in sarcoidosis, but only the pretreatment BAL % lymphs are useful in predicting therapeutic responsiveness.

Adult↗
PubMed1984

Varicoceles: a coaxial coil occlusion system.

A modified transfemoral technique for testicular venography and occlusion of the testicular vein (TV) was used to treat 30 patients with a total of 43 varicoceles (17 left-sided and 13 bilateral). Occlusion was satisfactory in all left varicoceles and 90% of right varicoceles. This coaxial technique facilitates subselective catheterization of the TV and its collaterals and enables coils to be placed deep within these vessels, either alone or in combination with detachable balloons.

Catheterization↗
PubMed1984

Assessing the activity of sarcoidosis: quantitative 67Ga-citrate imaging.

Three different methods of quantitating 67Ga-citrate lung images--a visual index, a computer-assisted index, and the total-lung-to-background ratio--were compared in 71 studies of patients with biopsy-proven sarcoidosis. Fifty consecutive cases were analyzed independently by two different observers using all three methods. In 45 patients, both gallium lung scans and bronchoalveolar lavage were performed within 2 weeks. In these studies, each index was correlated with the cell differential in the bronchoalveolar lavage fluid. The total-lung-to-background ratio proved to be the simplest to perform; correlated best with the original visual index (r = 0.81, p less than 0.00001) and the percentage of lymphocytes obtained in bronchoalveolar lavage fluid (r = 0.39, p less than 0.004); and showed the lowest interobserver variation. Sensitivity for detecting active disease was 84% compared with 64% and 58% for the visual and computer-assisted indices, respectively, with no sacrifice in specificity.

Cell Count↗
PubMed1984

Noninvasive determination of exercise cardiac function following Fontan operation.

The purpose of this investigation was to define mechanisms which increase cardiac output during exercise in patients without a functioning right ventricle. Radionuclide studies were performed at rest and during upright bicycle exercise on 16 patients following Fontan procedures and compared to studies in 10 normal children. The mean cardiac index of patients following Fontan procedures was 5.2 +/- 2.0 L/min/m2 (standard deviation) at rest and increased to 9.4 +/- 3.5 L/min/m2 during exercise (p less than 0.0001). Exercise values were similar to those observed in normal children. The mechanisms utilized to achieve high cardiac output following Fontan procedures included an increase in heart rate. Mean systemic ventricular ejection fractions were significantly less than in normal children. The resting ventricular end-diastolic volume and stroke volume indices were above normal and remained constant during exercise to high heart rates. These data clearly document that a large exercise cardiac output can be achieved by patients without a functioning right ventricle.

Adolescent↗
PubMed1982

Clinical experience with the radioisotope varicocele scan as a screening method for the detection of subclinical varicoceles.

The association of varicoceles and subfertility has been well documented. Although varicoceles remain the most common surgically correctable cause of male infertility the diagnosis of small varicoceles remains a challenge. We evaluated 40 men with an isotope blood pooling scan. Seven volunteers served as either positive or negative controls. Complete correlation between physical findings and the isotope scan was found. The 6 patients with obvious clinical varicoceles and a stress pattern on semen analysis all had positive scans. The 18 patients with a stress pattern and who were clinically suspected of having a varicocele all had positive scans. Of 9 patients evaluated for infertility with a stress pattern but no clinical evidence of varicocele 6 had positive scans. We believe that the isotope scan will prove to be a useful procedure in the detection of nonpalpable varicoceles in selected subfertile men.

Adult↗
PubMed1982

An unusual cause of an isolated, focal splenic defect demonstrated by liver-spleen scintigraphy.

Metastatic involvement of the spleen is uncommon. Lymphoma is the most common cause of primary and secondary malignant lesions of the spleen, whereas splenic metastases from carcinoma are rare and usually occur in a setting of concomitant carcinomatosis with melanoma, breast, ovary and lung accounting for the principal primary tumors. We report a case of an isolated, focal splenic defect demonstrated by Tc-99m-sulfur colloid scintigraphy which was the only visual evidence of metastatic adenocarcinoma of the colon. To our knowledge this unusual cause of a focal splenic defect on liver-spleen scintigraphy has not been previously described.

Adenocarcinoma↗
PubMed1982

Multiimage formatting: effect on scintillation image quality.

Multiimage formatters designed for use with scintillation cameras allow convenient presentation of as many as 90 images on a single film. Three different multiimagers (Searle Microdot 3132, Toshiba Gamma Imager GMI-04A, and Matrix Multi-imager 4) were evaluated with phantoms. Image quality was not equivalent in all positions on the resultant film, and was unacceptable in some cases. Individual laboratories should be aware of the potential loss of diagnostic information when using multiimage formatters and should evaluate their devices for this potential problem.

Image Enhancement↗
PubMed1981

Comparison of the barium test meal and the gamma camera scanning technic in measuring gastric emptying.

In 21 patients with nonresected stomachs and symptoms of delayed gastric emptying, obstruction was excluded by upper gastrointestinal series and upper endoscopy; all had abnormal results of barium test meal (BTM) study. Each had repeat BTM after the administration of 10 mg of metoclopramide. Each patient also had two gamma camera studies after a technetium Tc 99m sulfur colloid labeled meal; normal saline or metoclopramide was administered before each test in a blinded and random manner. Half-time (T1/2) and percentage of isotope remaining at six hours (GC6) were recorded. Ten asymptomatic controls had a gamma camera scanning study, and seven of these had a BTM. Nine of 19 patients had a T1/2 in the normal range, and in 12 of 19 patients the GC6 was in the normal range. The magnitude of retention of barium at six hours on the BTM did not correlate with the T1/2 (r = 0.076) or the GC6 (r= 0.296). Thus, these tests were not comparable in this study. By regression analysis, a significant reduction was shown in the amount of retained food and barium (P less than .01), the T1/2 (P less than .01), and the GC6 (P less than .01) after intramuscular administration of metoclopramide, indicating that both tests were able to evaluate the effects of this drug.

Adult↗
PubMed1981

A noninvasive method for measuring portal venous/total hepatic blood flow by hepatosplenic radionuclide angiography.

Radionuclide angiography was used to generate first-pass radioactivity vs. time curves for the left heart, right hepatic lobe, right lung, spleen, and both kidneys following rapid intravenous injection of 20 mCi (740 MBq) of 99mTc-pertechnetate. Seven normal subjects were examined as well as 57 cirrhotic patients, who also underwent angiographic grading of portal venous perfusion. For analysis, two time points were identified: (a) t0, when 99mTc first entered the liver (the initial rise of either curve); and (b)tc, when 99mTc was maximal in abdominal organs (the renal peak). Analysis was based on the slopes of the two phases of the hepatic curves t0 + 7 seconds and Tc + 7 seconds; this time selection permitted analysis of all curves. The hepatic perfusion index (HPI) = slope (tc + 7 secs)/slope (t0 + 7 secs) + slope (tc + 7 secs). The mean HPI for the normal subjects was 66% +/- 7; for the cirrhotic patients with angiographic Grades I, II, III, and IV, the HPI was 52% +/- 9, 37% +/- 6, 15% +/- 7, and 3% +/- 4, respectively. Correlation between HPI and angiography was significant (p less than 0.001). This method offers a readily available, rapid, relatively inexpensive, and quantitative method of grading the ratio of portal venous to total hepatic blood flow.

Adult↗