The Comparison of Low and High-Dose Scintigraphy Findings in Patients with Primary Parathyroid Lesions in which Intraoperative Gamma-Probe was Applied.

OBJECTIVE: We aimed to evaluate the effectiveness of high-dose and low-dose use of radioactive material in intraoperative gamma probe application methods in patients diagnosed with primary hyperparathyroidism and planned for surgery. METHODS: 47 patients with primary hyperparathyroidism underwent minimally-invasive parathyroid surgery (MIS) after preoperative imaging studies consisting of ultrasonography (USG) and sestamibi parathyroid scintigraphy (SPS) showed a possible primary parathyroid lesion (PPL). All patients received Tc-99 sestamibi on day-of-surgery imaging (DOSI) to help with the localization of a primary parathyroid lesion (PPL) via both DOSI and intraoperative gamma probe (IGP). Patients in Group I were administered 20-25 mCi Tc-99m sestamibi (methoxy isobutyl isonitrile) and images were obtained at the 20th and 120th minutes. Patients in Group II were administered 8-10 mCi doses and images were obtained at the 20th and 40th minutes. Two nuclear medicine specialists independently evaluated the images. Lesions in the localizations determined by DOSI and IGP were compared with the histopathological results of these lesions. RESULTS: 47 patients, 35 females, and 12 males were included in the study. The mean age of 28 patients in the first group given the high dose was 54 (41-60), and the mean age was 48 (42-57) in the second group given the low dose (p=0.011). In the group given low-dose radioactive material during intraoperative gamma probe application, the observer's sensitivity, specificity, positive, and negative predictive values for finding pathology were 61.1, 100, 100, and 12.5, respectively. In the group given high-dose radioactive material, the same values were 90.9, 33.3, 50, and 83.3, respectively. While the success of MIS increases with the use of DOSI and IGP in large lesions, the success decreases with the prolongation of the accumulation time of the given dose. CONCLUSIONS: In the intraoperative gamma probe technique used in primary hyperparathyroidism patients, the method used with low-dose radioactive material has lower sensitivity but higher specificity in estimating the post-operative pathology compared to the high-dose technique.

Evaluation of Interstitium by Lymphatic Uptake Method in Chronic Bilateral Lower Extremity Edema.

OBJECTIVE: Symmetrical bilateral lower extremity edema (BLEE) needs to be treated effectively. Finding the cause of this condition increases the success of treatment. Fluid increase in the interstitial space (FIIS) is always present as a cause or a result. Subcutaneously administered nanocolloid is transported by uptake by lymphatic pre-collectors, and this uptake takes place in the interstitium. We aimed to evaluate the interstitium with labeled nanocolloid and contribute to the differential diagnosis in cases with BLEE. METHODS: Our retrospective study included 74 female patients who underwent lymphoscintigraphy for bilateral lower extremity edema. Technetium 99m (Tc-99m) albumin colloid (nanocolloid), a marked colloidal suspension, was applied subcutaneously to two different areas on the dorsum of both feet with a 26 gauge needle The dose volume administered intradermally is approximately 0.2-0.3 ml, and each injector has 22-25MBq of activity. Siemens E-Cam dual-headed SPECT gamma camera was used for imaging. Dynamic and scanning images were taken with a high-resolution parallel hole collimator. Ankle images were re-evaluated by two nuclear medicine specialists, independent of physical examination and scintigraphy findings. RESULTS: 74 female patients with bilateral lower extremity edema were divided into two groups based on physical examination and lymphoscintigraphy findings. There were 40 and 34 patients in Groups I and II, respectively. In the physical examination, patients in Group I were evaluated as lymphedema, and patients in Group II were evaluated as lipedema. The main lymphatic channel (MLC) was not observed in any of the patients in Group I in the early images, and the MLC was observed at a low level in the late imaging in 12 patients. The sensitivity of the presence of distal collateral flows (DCF) in the presence of significant MLC in early imaging in demonstrating increased fluid in the interstitial space (FIIS) was calculated as 80%, specificity as 80%, PPV 80%, and NPV 84%. CONCLUSIONS: While MLC is present in early images, concomitant DCF occurs in cases of lipoedema. The transport of increased lymph fluid production in this group of patients can be covered by the existing MLC. Although MLC is evident, the presence of significant DCF supports the presence of lipedema. It can be used as an important parameter in the diagnosis in early cases where physical examination findings are not evident.

Evaluation of Dyspepsia with Optimal and Suboptimal Gastric Emptying Tests in Patients with Euthyroid Goiter.

OBJECTIVE: The presence of gastroparesis in patients with dyspepsia can be evaluated by gastric emptying scintigraphy. We aimed to evaluate gastroparesis with optimal solid gastric emptying scintigraphy and suboptimal liquid gastric emptying scintigraphy in euthyroid goiter patients with dyspepsia. METHODS: We included 67 patients diagnosed with euthyroid goiter with dyspepsia complaints. The patients did not use any medication and did not have any other chronic diseases. Solid and liquid gastric emptying scintigraphy was performed on all patients. In our retrospective study; the images were reevaluated. The region of interest was plotted on the area compatible with the stomach and timeactivity curves were obtained. The correlation of solid and liquid gastric emptying test results was evaluated. RESULTS: Twelve (18%) of the patients were male and the mean age of the patients was 64 (49-75). There is a correlation between solid and liquid gastric emptying scintigraphy (p< 0.0005, r: 0.0880). Solid gastric emptying time was prolonged in 27 patients (40%). Liquid gastric emptying was prolonged in 23 patients (34%). Solid gastric emptying was also prolonged in all patients with prolonged liquid gastric emptying. CONCLUSION: According to the results of the optimal gastric emptying test performed with radio-labeled solid food. The rate of gastroparesis was low in our patient group with dyspepsia complaints. However, there is a correlation between the optimal test and suboptimal gastric emptying test results in our patient group. Liquid gastric emptying scintigraphy may be preferred in specific patient groups in case of suspected gastroparesis because of its easy application and short duration.

Antibacterial and antioxidant activities of traditional medicinal plants from the Erzurum region of Turkey.

BACKGROUND: In this study, 13 different extracts were investigated which are grown in the region of Erzurum. OBJECTIVE: The aim of this study was to screen various plant extracts that are known and used for medicinal purposes such as Ferula communis L., Rumex patientia L., Gundelia tournefortii L., Rheum ribes L., Asphodeline taurica, Polygonum arenastrum, Allium schoenoprasum L., and Ferula orientalis L. MATERIALS AND METHODS: Medicinal parts of plants such as leaves, flowers, and stems were investigated by 2,2-diphenyl-1-picrylhydrazyl, ferric reducing antioxidant power, and cupric reducing antioxidant capacity assays: Centaury and Blackthorn. Total phenolic content, total flavonoid content, and antimicrobial properties were also determined. Antibacterial and antifungal activities were investigated by the microdilution method and the agar diffusion method respectively. RESULTS: Accordingly, the results of the Rheum ribes L. plant have the highest antioxidant activity among all analyses made. But in almost all antioxidant analysis methods, the lowest antioxidant activity was found in Ferula orientalis L. According to the antibacterial analysis applied, it was found that the plant extracts were generally more effective on yeast strains than the test bacteria used; that is, most of the plants have antifungal effect. CONCLUSIONS: Due to their antimicrobial, antifungal, and antioxidant properties, the extracts of these plants might be used as natural sources in the pharmaceutical and cosmetic industries.

Synthesis of somenew hybride molecules containing several azole moieties and investigation of their biological activities.

1,2,4-Triazole-3-one prepared from tryptamine was converted to the corresponding carbotioamides by several steps. Their treatment with ethyl bromoacetate or 4-chlorophenacyl bromide produced the corresponding 5-oxo-1,3-thiazolidine or 3-(4-chlorophenyl)-1,3-thiazole derivatives. Acetohydrazide derivative that was obtained starting from tryptamine, was converted to the corresponding Schiff basis and sulfonamide by the treatment with suitable aldehydes and benzensulphonyl chloride, respectively. 2-[(4-Amino-5-thioxo-4,5-dihydro-1H-1,2,4-triazole-3-yl)methyl]-4-[2-(1H-indole-3-yl)ethyl]-5-methyl-2,4-dihydro-3H-1,2,4-triazole-3-one was synthesized starting from hydrazide via the formation of the corresponding 1,3,4-oxadiazole compound, while the other bitriazole compounds were obtained by intramolecular cyclisation of carbothioamides in basic media. The treatment of 1,2,4-triazole or 1,3,4-oxadiazole compound with several amines generated the corresponding Mannich bases. Ethyl (2-amino-1,3-thiazole-4-yl)acetate was converted to the corresponding 1,3,4-oxadiazole derivative, arylidenehydrazides, 1,2,4-triazole-3-one and 5-oxo-1,3-oxazolidine derivatives by several steps. The structural assignments of new compounds were based on their elemental analysis and spectral (FT IR, 1H NMR, 13C NMR and LC-MS) data. The antimicrobial, antilipase and antiurease activity studies revealed that some of the synthesized compounds showed antimicrobial, antilipase and/or antiurease activity.

Syntheses and biological activities of new hybrid molecules containing different heterocyclic moieties.

4-Aryl-5-(pyridin-3-yl)-4H-1,2,4-triazole-3-(thi)oles 5-7, obtained starting from nicotinic acid hydrazide were converted to the corresponding Mannich bases 12-24 by the reaction with several heterocyclic amines in the presence of formaldehyde. The synthesis of S-alkylated compounds 8-11 was performed from the reaction of the corresponding triazol-5-thioles with various alkyl halides. The condensation of carbo(thio)amides 2-4 with 4-chlorophenacyl bromide afforded the corresponding 1,3-thia(oxa)zol-2(3H)-ylidene]pyridine-3-carbohydrazides 25-27. 1,3-Thia(oxa)zolidine derivatives 28-30 were obtained from the cyclization reaction between compounds 2-4 and ethyl bromoacetate. All newly synthesized compounds were screened for their antimicrobial, antiurease, and antilipase activities. The biological activity studies revealed that all the compounds screened showed good or moderate antimicrobial, antiurease, and/or antilipase activity.

Antimicrobial and antiurease activities of newly synthesized morpholine derivatives containing an azole nucleus.

2-[6-(Morpholin-4-yl)pyridin-3-ylamino]acetohydrazide (4) was obtained starting from 6-morpholin-4-ylpyridin-3-amine (2) via the formation of ester (3) and then converted to the corresponding Schiff bases (5, 6) with the reaction with aromatic aldehydes. The carbothioamide (9), obtained from the reaction of hydrazide with phenylisothiocyanate, was converted to the corresponding 1,2,4-triazole (11) and 1,3,4-thiadiazole (12) derivatives by the treatment with NaOH or H2SO4, respectively. The cyclocondenzation of 9 with 4-chlorophenacyl bromide or ethyl bromoacetate produced the corresponding 1,3-thiazole (10) or 1,3-thiazolidine derivatives (13), respectively. Antimicrobial and antiurease activities of newly synthesized compounds were investigated. Some of them were found to be active on M. smegmatis, and they displayed activity toward C. albicans and S. cerevisiae in high concentration. Compound 10 proved to be the most potent showing an enzyme inhibition activity with an IC50 = 2.37 ± 0.19 µM.

Predicting malignant potential of gastrointestinal stromal tumors: Role of p16 and E2F1 expression.

Altered expression of cell cycle regulatory proteins in GISTs (gastrointestinal stromal tumors) may be the mechanism for their diversity in clinical behavior. The use of these tumorigenetic and cell proliferative proteins may provide an alternative route for follow-up and treatment. The aim of this study was to determine the prognostic relevance of the E2F1 and p16 expression in GISTs. Tissues from 21 cases with GIST were collected retrospectively. Tumor grade was designated according to the consensus system. Immunohistochemistry was done with antibodies against Ki-67, p16, E2F1. For statistical analysis, Ki-67 proliferation index was evaluated in 2 categories: < or =10% and >10%, whereas p16 expression was scored as negative or positive. E2F1 expression cutoff values were tested for risk group variables as >5% and >10%. Correlation between the presence of necrosis, Ki-67 proliferation index, p16, E2F1 expression and the risk grade was determined by Spearman correlation test. Sensitivity and specificity were determined by Fisher exact test with P < or =0.05 considered as significant. High E2F1 expression (over 10%) and high Ki-67 proliferation index (over 10%) correlated significantly with increasing risk grade. There was also a significant correlation between the presence of necrosis and high-risk grade. No correlation was found between the risk grade and p16 expression. Our results suggest that in addition to high Ki-67 proliferation index, high E2F1 expression may also be a useful predictive marker for malignant potential of GISTs.