Clinical value of immunoscintigraphy in the rectal carcinomas: immunoscintigraphy of rectal carcinomas.

BACKGROUND/AIM: The aim of this study was to evaluate the clinical reliability of the immunoscintigraphy with radiolabeled monoclonal antibodies for the detection of metastases and recurrences of rectal carcinomas. METHODOLOGY: A total of 65 patients underwent immunoscintigraphy with radiolabeled monoclonal antibodies. Indication for that examination was suspicious rectal cancer or suspicious rectal cancer recurrence and/or metastases. RESULTS: The method proved to have 92.7% sensitivity, specificity 83.3%, positive predictive value 90.5%, negative predictive value 87.0% and accuracy 89.2%. There was a statistically significant relationship between immunoscintigraphy findings and rectoscopy findings (rs=0.415, p=0.013), as well as significant relationship between immunoscintigraphy findings and US findings (rs=0.332, p=0.001). Tumor marker levels were in positive correlation with findings of immunoscintigraphy (rs=0.845, p=0.001), especially raised CEA level (rs=0.816, p=0.004). Patients with higher CA19-9 level had higher Duke's stage (p=0.025). CONCLUSIONS: We can conclude that immunoscintigraphy can be helpful in the detection of metastases and recurrences of colon carcinomas.

Scintigraphic detection of colon carcinomas with iodinated monoclonal antibodies.

PURPOSE: The aim of this study was to evaluate the clinical reliability of the immunoscintigraphy with iodinated monoclonal antibodies for the detection of metastases and recurrences of colon carcinomas. METHODS: A total of 45 patients with colon carcinoma was investigated with gamma camera, after intravenous application of iodinated monoclonal antibodies. RESULTS: The sensitivity of the method was 90%, specificity 86%, positive predictive value 93%, negative predictive value 80% and accuracy 87%. There was statistically significant relationship between immunoscintigraphic and ultrasonographic (US) findings (p=0.005). Also, there was significant relationship between immunoscintigraphy and Dukes stage (p=0.019). Tumor marker levels were not significantly correlated with immunoscintigraphic findings (p<0.05). Significant difference was noted in patients with positive findings for malignancy on US and immunoscintigraphic findings (p=0.006), i.e. patients with positive findings for malignancy had more frequently immunoscintigraphic findings of malignancy. Correlation with other diagnostic procedures (rectoscopy, colonoscopy, CT) did not show significant correlations. CONCLUSION: We conclude that immunoscintigraphy can be helpful in the detection of metastases and recurrences of colon carcinomas.

Successful outcome after a technically challenging liver transplant during pregnancy.

Little is known about the implications of liver transplantation (OLT) during pregnancy. We report the case of a 26-year-old woman with cryptogenic familial biliary cirrhosis that decompensated rapidly. OLT was performed using the donor iliac vein for a retrogastric portal vein conduit to the superior mesenteric vein and the donor iliac artery for an infrarenal aortic conduit. During the latter anastomosis, a viable fetus was noticed. Both donor and recipient were cytomegalovirus positive. Postoperative ultrasound revealed a 13.5-week-old viable fetus. The patient received tacrolimus, azathioprine, and prednisolone. The pregnancy progressed normally with the vaginal delivery of a healthy male infant after 36 weeks gestation. Nineteen months later, both the mother and child were well. This case demonstrated that even technically difficult OLT during pregnancy can have a successful outcome, raising the question of whether transplant patients of childbearing age should be routinely tested for pregnancy.

Diagnostic value of ocular melanoma immunoscintigraphy.

PURPOSE: To estimate the diagnostic value of ocular immunoscintigraphy (ISG) in the differentiation of melanoma from other ocular tumors or lesions. PATIENTS AND METHODS: ISG was performed in 27 patients. Twenty-four patients were suspected of having ocular melanoma and 3 patients had previous eye enucleation for melanoma and were without recurrent disease. Monoclonal antibody (MoAb) 225.28S was administered intravenously and the patient's head was imaged with gamma camera after 5 minutes and after 5 hours collecting 500.00 counts per image. RESULTS: The diagnosis of malignant melanoma was established by clinical examination in 12 patients (10 of them were subjected to enucleation and histopathological confirmation). ISG was positive in 10 out of 12 patients (sensitivity 83%). Two patients with operated melanoma had negative scintigraphic result. Fifteen patients with non melanoma lesions had negative findings except one patient with haemangioma who had positive ISG. The specificity of ISG was 93%. CONCLUSION: ISG is a sensitive and specific diagnostic method for ocular melanoma. The reliability of the results depends on proper acquisition of data and interpretation of images, including comparison of both eyes and early and late images with contrast enhancement.

A simplified in vitro method of red blood cell labelling with 99Tcm using whole blood.

A modified method of in vitro labelling of red blood cells with 99Tcm using whole blood is presented. Blood samples from patients with normal blood counts were used. First, the blood sample was exposed to a low concentration of stannous ions (0.02-0.4 micrograms/2 ml blood), citrate phosphate glucose solution was then added followed by 99Tcm pertechnetate. A high labelling yield of greater than 90% was achieved in a maximum of 30 min.

Epidural analgesia and liver resection: postoperative coagulation disorders and epidural catheter removal.

BACKGROUND: The aim of this study was to quantify the duration and severity of postoperative coagulopathy in order to establish the optimal time for epidural catheter removal. METHODS: In a 2-year retrospective study, 140 consecutive patients underwent major liver resection. RESULTS: Epidural catheters were present in 123 patients (87.9%). Resections were: 33 (26.8%) right hepatectomy (with or without left metastasectomy), 9 (7.3%) left hemihepatectomy (with or without right metastasectomy), 37 (30.1%) trisectionectomy (extended hemihepatectomy) and 44 (35.8%) non-anatomical metastasectomy. Surgery was quantified by segments resected (4 [range: 1-7]). Vascular inflow occlusion was used in 65.6%. Ischaemic time was 26.5 min (range: 0-104 min). Platelet count fell postoperatively and was lowest on day 2 (205±72 10(9) L(-1)). There was a significant increase in prothrombin time, activated partial thromboplastin time and International Normalised Ratio (INR) postoperatively, peaking on day 2 (21.5±5.6 s, 37.9±5.8 s and 1.9±0.5, respectively). Changes persisted beyond day 6. Epidural catheters were removed on day 5 (1-11), with a protocol criterion of INR <1.2. Actual INR on day 5 was 1.49±0.36. CONCLUSION: Despite this, no epidural or spinal haematoma was recorded.

Determination of culprit lesion in patients undergoing elective percutaneous coronary intervention by myocardial perfusion imaging.

UNLABELLED: The aim of this study was to determine and localize culprit lesion by myocardial perfusion imaging (MPI) in cases of angiographically detected coronary narrowing >or= 75% of at least one coronary artery. MATERIAL AND METHODS: One hundred and thirty-two (132) patients with angiographically detected significant coronary narrowing (>or= 75% luminal stenosis of at least one major coronary artery) were studied. All the patients submitted MPI (99m)Tc-MIBI, with pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DipyEX). We measured relative uptake (99m)Tc-MIBI for each myocardial segment using short-axis myocardial tomogram study. A 5-point scoring system was used to assess the difference between uptake degree in stress and rest studies for the same segments, and we created two indices: Sum reversibility score (SRS), Index of sum reversibility score (ISRS). RESULTS: A total of 396 vascular territories (2244 segments) were analyzed before elective percutaneous coronary intervention (ePCI). Overall sensitivity, specificity and accuracy using SRS were 90.2%, 87.5%, and 89.4%, with a positive predictive value of 94.1%. Overall sensitivity, specificity, and accuracy using ISRS were 94.4%, 90.6%, 93.2% and the positive predictive value was 95.7%. CONCLUSION: DipyEX MPI with the two indices created, SRS and ISRS, significantly improves sensitivity, specificity and accuracy in the determination and localization of culprit lesions in patients undergoing elective PCI.

Fatal haemothorax following large-bore percutaneous cannulation before liver transplantation.

Percutaneous bypass catheters are routinely used for veno-venous bypass (VVBP) during orthotopic liver transplantation (OLT). The recognized risks include bleeding, injury of vascular and nerve structures and lymphatic leakage. We describe a case where there were difficulties during catheterization and the patient suffered a cardiac arrest on commencing VVBP. Post-mortem examination revealed the bypass catheter tip in the pleural space and a large right haemothorax. Possible mechanisms of vascular perforation and preventative measures are discussed.

[Combined spinal-epidural anaesthesia for urgent Hartmann's procedure].

A 46- year old patient without previous history of general anaesthesia was admitted for urgent Hartman's procedure. The suspected tumor of sigmoid colon caused the obstructive ileus with extreme abdominal distension and threatened colon perforation. After induction of anaesthesia and adequate muscle relaxation it appeared that endotrh ileus because of possible regurgitation and aspiration.

[Enteral nutrition and surgical patient]. / Enteralna ishrana i hirurski bolesnik.

Enteral nutrition can be applicated alone or in combination with parenteral nutrition. Enteral feeding should be applicated as early as possible in preoperative preparation or in postoperative period in respect of contraindications and everyday evaluation of patients. Immunomodulatory substances like arginine, 3-omega-fat acids, ribonucleic acid and glutamine are incorporated in "ready to use" solution for enteral feeding. Enteral feedings oral or via tubes are safe if some precautions are taken: like sitting position and control of feeding tubes position. Use of jejunostomy and promotility agents improved enteral feeding after major abdominal surgery and acute pancreatitis. Enteral feeding and immunonutrition improved postoperative course in reduction of hospital stay, incidence of postoperative complications especially infections. The aim of this review article is to validate pro and con for enteral nutrition in preoperative and postoperative course.

[Effects of knowledge and behaviour of pre-school children of oral health]. / Efekti stecenog znanja i ponasanja prema oralnom zdravlju dece predskolskog uzrasta.

The preventive potential of each sector of the society must be engaged in premotion of dental health. The article deals with the effect of dental health education and caries prevention in children's gardens after a certain period of time, The work was carried out by dentists, nursery-staff and parents. The correlation between dental health education and behaviour of children to healthy teeth is one of the most important and statistically significant factors. The investigation concerned the two different children's gardens ("Ciciban" = 41 children and "Cika Andra" = 62 children), 5-7 years old and their parents. The obtained results revealed a certain correlation between dental health education and prevention on one side, and dental health of pre-school children, on the other side. That was evident in DMF of primary dentition and in the number or intact first permanent molars.

[Epidural analgesia in total gastrectomy--combination of bupivacaine with ketamine or fentanyl]. / Epiduralna analgezija za totalnu gastrektomiju--kombinacija bupivakaina sa ketaminom ili fentanilom.

The effects of intraoperative epidural administration of ketamine added to bupivacaine were compared with fentanyl added to bupivacaine in patients undergoing total gastrectomy. Prospective, randomized, double blind study was designed to compare: group F: 20 patients (pts) receiving 20 ml of 0.125% bupivacaine and 50 ug of fentanyl and group K: 20 pts in whom 20 ml of 0.125% bupivacaine was combined with 50 mg of ketamine. Pts received an epidural injection through peridural catheter introduced through either T7-8 or T8-9 interspinous space. Non invasive arterial blood pressure, heart rate and ECG were recorded every 5 mins. We measured supplementary fentanyl requirement, ephedrine consumption, first postoperative complain on pain, tracheal extubation time. The groups were comparable with regard to patients characteristics, operation and anaesthesia related factors. There were no difference between groups in mean intraoperative fentanyl requirements (F vs. K = 118.5 (122.5) ug vs. 122.5(122.5)ug) (p n > 0.05), in the duration of epidural pain relief (F vs. K = 393.72 (98.75)min vs.403.63 (111.41)min, in the tracheal extubation time (F vs.K = 52.31 (50.4) vs.46.75 (48.35) min), postoperative sedation score (F vs.K = 1.26 (0.73) vs.1.11 (0.32)) (p > 0.05). Significantly higher systolic blood pressure was measured in group K comparing with group F in 20, 75, 105, 120, 150 min (p > 0.05). Statistically significant more ephedrine was applied in F group (F vs.K = 0.88(1.76)ml vs.0.05(0.23)ml) (p > 0.05). There were no statistically significant differences between groups in heart rate during the operation. None of the pts complained of bad dreams or awakeness during operation. Both fentanyl and ketamine added to bupivacaine and given as a bolus provided good intraoperative analgesia in combination with general anaesthesia, minimal sensorimotor disturbance and early tracheal extubation. In our study fentanyl added to bupivacaine caused higher incidence of hypotension than ketamine added to bupivacaine.

[Use of taurolin in the prevention of septic complications in emergency abdominal surgery]. / Primena taurolina u prevenciji septickih komplikacija u urgentnoj hirurgiji abdomena.

The purpose of the study was to evaluate effectiveness of local application of Taurolin in prevention of septic complications after abdominal emergency surgery. Group A included 30 patients in whom intraoperative peritoneal lavage was performed with 0.5% solution of taurolin. In the first 12 postoperative hours peritoneal lavage was repeated through the drain. Group B included 30 patients in whom intraoperative lavage was performed with either physiologic saline or Povidon solution. All patients had suppurative peritonitis provoked by perforation of some of the abdominal organs. Intraoperatively samples of abdominal pus were taken for bacteriological analysis, while postoperatively samples were taken from drains placed abdominally and subcutaneously. Twelve hours after the surgery therapy was conducted according to the operative findings, postoperative course, x-ray and laboratory findings and results of sensitivity testing. Analysis of the results revealed significant differences in postoperative morbidity and mortality between the two groups. No fatal outcomes were recorded in the immediate postoperative course in group A where only one case of recurrent intraperitoneal infection occurred and three cases of wound infection. In group B, however, three patients died in the immediate postoperative course, recurrent intraperitoneal infection developed in four cases and wound infection in 12. Intraoperative and early postoperative local application of Taurolin in addition to appropriate surgical treatment and postoperative care has an important role in prevention of postoperative septic complications and decrease of postoperative mortality.