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7. Clinical Intervention for Quality Improvement of Gastric-Emptying Studies.

Author

Bonta, Dacian V., Brandon, David C., Hernandez, Jeranfel, Patel, Minesh, Grant, Sandra, and Alazraki, Naomi

Abstract

Prompted by clinical concerns for false-negative tests, we implemented a clinical intervention consisting of a training session and an image-based verification procedure to document homogeneous radioactivity distribution in the radiolabeled meal (egg substitute per the guideline). Methods: A technologist training session emphasized the importance of thorough mixing of 99mTc-sulfur colloid in the egg meal. For 6 mo after training, an image of the prepared mixed egg was acquired before patient ingestion. Consecutive gastric-emptying studies performed 6 mo before and after training were reviewed by 2 experienced physicians. Results: There were 7 abnormal and 44 normal studies before and 15 abnormal and 29 normal studies after training (P < 0.05). Subjective evaluations of images for meal-mixing quality by 2 readers correlated with each other and with an objective measure of expected gastric-emptying physiology (correlation coefficients, 0.54 and 0.38, respectively). Conclusion: The described clinical intervention improved the accuracy of our gastric-emptying studies by decreasing false-negative studies. [ABSTRACT FROM AUTHOR]

Published
2014
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30. Multiorgan scans for staging lung cancer

Author

Ramsdell, Joe W., Peters, Richard M., Taylor, Andrew T., Alazraki, Naomi P., and Tisi, Gennaro M.

Abstract

One hundred consecutive patients with findings suggestive of resectable bronchogenic carcinoma were studied prospectively to determine if routine liver, brain, and bone scans (multiorgan scans) detected metastases which were not suggested by a history, physical examination, and serum chemistries. Multiorgan scans were compared with clinical evaluations in 52 patients found to have operable bronchogenic carcinoma. There was a discordance between scans and clinical evaluations in 25/153 scans (16 per cent). Two of the 22 negative scans in patients with abnormal clinical findings were false negative. Sixteen of the 17 positive scans in patients with normal clinical findings were false positive. One of the 131 scans done in patients with no evidence of metastases on clinical evaluation was true positive. These data indicate that the routine use of multiorgan scans in the initial staging of potentially resectable bronchogenic carcinoma is not justified.

Published
1977
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31. Evidence for a midgastric transverse band in humans

Author

Moore, John G., Dubois, Andre, Christian, Paul E., Elgin, Drew, and Alazraki, Naomi

Abstract

When the solid fraction of a standardized meal is labeled with technetium 99m-sulfur colloid-labeled chicken liver and fed to human subjects, linear regions of decreased radioactivity that have the appearance of a band are identified on the scintillation camera images of the stomach. The band is not a peristaltic contraction because it persists in individual subjects after 4 h of imaging. The band has also been identified in the dog, pig, and monkey. It is transverse and midgastric in location. William Beaumont noted a similar band in his observations on Alexis St. Martin in 1833, and a transverse band was noted in autopsy specimens of food-filled human stomachs in 1919. However, the finding has been ignored in current gastrointestinal or radiologic textbooks because the band cannot be identified with conventional barium sulfate meals. The anatomic basis for the band and its role in regulating gastric emptying remain unclear.

Published
1986
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39. Coccidioidal Meningitis—Intrathecal Treatment with Hyperbaric Amphotericin B

Author

Glynn, Kevin P., Alazraki, Naomi P., and Waltz, Thomas A.

Subjects
Male, Coccidioidomycosis, Amphotericin B, Methods, Humans, Meningitis, Articles, Injections, Spinal, Aged
Abstract

The localization of coccidioidal meningitis in the basilar regions, with resultant hydrocephalus and uniformly fatal outcome, has necessitated intrathecal injection of amphotericin B via cisternal puncture or subcutaneous ventricular reservoir for successful therapy. A simpler form of treatment is described here, whereby amphotericin B diluted in 10 percent glucose solution is injected via lumbar puncture, and delivered to the base of the skull by tilting the patient to a head-down position. A simultaneously performed hyperbaric cisternogram with (131)I-serum albumin has demonstrated satisfactory migration of the injected bolus to the occiput. This method of administration resulted in successful suppressive treatment of one patient, including two years of follow-up without serious sequelae or relapse.

Published
1973

50. The utilization of Gleason grade as the primary criterion for ordering nuclear bone scan in newly diagnosed prostate cancer patients.

Author

Ritenour CW, Abbott JT, Goodman M, Alazraki N, Marshall FF, and Issa MM

Subjects
Aged, Algorithms, Biomarkers, Tumor, Bone Neoplasms diagnosis, Bone Neoplasms secondary, Bone and Bones diagnostic imaging, Decision Making, Humans, Male, Middle Aged, Radionuclide Imaging, Retrospective Studies, Neoplasm Staging methods, Prostate-Specific Antigen analysis, Prostatic Neoplasms diagnostic imaging
Abstract

Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased dramatically due to PSA-driven stage migration. The current criteria for performing bone scans are based on limited historical data. This study evaluates serum PSA and Gleason grade in predicting positive scans in a contemporary large series of newly diagnosed prostate cancer patients. Eight hundred consecutive cases of newly diagnosed prostate cancer over a 64-month period underwent a staging nuclear scan. All subjects had histologically confirmed cancer. The relationship between PSA, Gleason grade, and bone scan was examined by calculating series of crude, stratified, and adjusted odds ratios with corresponding 95% confidence intervals. Four percent (32/800) of all bone scans were positive. This proportion was significantly lower in patients with Gleason score or=8 (18.8%, p < 0.001). Among patients with Gleason score 30 ng/ml compared to or=8, the rate was significantly higher (27.9 vs. 0%) when PSA was >10 ng/ml compared to 30 ng/ml. However, for patients with a high Gleason score (8-10), we recommend a bone scan if the PSA is >10 ng/ml.

Published
2009
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