Effect of chemotherapy on somatostatin receptor detection with octreotide scintigraphy in hormone-refractory prostate cancer patients.

BACKGROUND: Neuroendocrine cells have been found in all stages of prostate cancer. Neuroendocrine differentiation of prostate adenocarcinoma is a possible target for therapeutic strategies, such as administration of GH analogs (e.g., somatostatin), especially in patients with hormone-refractory prostate cancer (HRPC). The presence of receptors for these drugs in tumor cells and tissues is essential and is assessed with 111In-octreotide scintigraphy (Octreoscan). The relationship between these receptors and chemotherapy, the new standard therapy for HRPC, is unknown. PATIENTS AND METHODS: 111In-octreotide scintigraphy was performed on 20 patients affected by HRPC, all with metastatic disease. Chemotherapy with a single agent was also administered to all patients. RESULTS: In 63% of the patients, all metastases were negative to Octreoscan. Several metastases were positive in 37% of patients only, compared to 94% previously described in a chemotherapy-naive population. CONCLUSION: Chemotherapy seemed to reduce the cellular receptors for somatostatin analogs.

Comparative evaluation of SPECT, CT and CW Doppler data in patients with ischemic lesions of the brain.

We report the SPECT, CT and CW Doppler findings in a series of 117 patients with cerebral ischemic lesions and correlate them with the clinical findings. SPECT-PAO proved to be more sensitive in localizing focal lesions than CT, which in 50% of the cases was normal or yielded an image of cerebral atrophy. In the latter cases CW Doppler ultrasound on the supraaortic trunks showed changes, circumscribed or diffuse. On the CW Doppler and SPECT evidence we consider that the CT image of cerebral atrophy may denote an alteration of the cerebral blood flow and metabolism and should be assessed in this light in the diagnosis and prognosis of cerebral ischemic lesions.

Urinary diversion in infants with primary high-grade vesicoureteric reflux, urinary sepsis and renal function impairment.

INTRODUCTION: General consensus on the optimal treatment of septic infants with primary high-grade vesicoureteric reflux (VUR) and renal function impairment has not been reached. Our study aims at evaluating the role of temporary urinary diversion. MATERIALS AND METHODS: Twenty male infants, affected by sepsis and primary high-grade VUR, underwent urinary diversion in 1996-2001 because of estimated risk of renal function deterioration, due to non-compliance with the antibiotic treatment. Plasmatic creatinine clearance, ultrasonography, micturition cystography and scintigraphy were evaluated. RESULTS: Creatinine clearance was abnormal in 13 infants on admission, in 10 after urinary diversion and in 6 after second surgery. Renal damage (focal or diffuse) was evident in 16 patients, without modifications after surgery. No patient developed urinary tract infections (UTI). Vesicostomy was done in 12 cases, ureterostomy in 8. Nephrectomy was performed in 3 cases with poor renal function, and ureteroneocystostomy in 17. CONCLUSIONS: Urinary diversion in septic infants with high-grade VUR can represent an alternative approach to the conservative or surgical treatment in selected patients presenting risk of renal function impairment. This procedure allowed an easy management of UTI without worsening of renal function while waiting for a better anatomical status to perform reconstructive surgery.