Unusual Breast Metastasis from Atypical Lung Carcinoid on 68Ga-DOTATATE PET/CT.

BACKGROUND: Atypical carcinoid (AC) is one of the rarest lung neuroendocrine tumors (NETs) that rarely metastasize to the breast, and only a few cases have been reported in the literature. Positron emission tomography/computed tomography (PET/CT) with somatostatin analogs (SSAs) labeled with Gallium-68 (68Ga) now represents the gold standard for diagnosis and management of NETs. A case of an unusual metastasis to the breast from an AC detected by 68Ga-DOTATATE PET/CT was reported. CASE PRESENTATION: A 73-year-old woman was presented with a right breast lesion found on mammography screening, which revealed a metastatic neuroendocrine tumor by histopathological analysis with a tru-cut biopsy. Subsequently, 68Ga-DOTATATE PET/CT imaging performed for the initial evaluation showed increased radiotracer uptake in the lesion in the right breast as well as the nodular lesion in the middle lobe of the right lung, which was histologically confirmed to be AC. CONCLUSION: Metastasis of uncommon AC of the lung to the breast is extremely rare. However, it is essential to properly differentiate metastatic tumors from primary disease due to differences in clinical management and prognosis, and 68Ga-DOTATATE PET/CT is a unique diagnostic tool with the advantage of whole-body imaging.

Impact of 68Ga-PSMA PET/CT on Survival and Management in Prostate Cancer.

BACKGROUND: 68Ga-labeled prostate-specific membrane antigen positron emission tomography-computed tomography (68Ga-PSMA PET/CT) has led to altered treatment plans for prostate cancer (PCa) patients. OBJECTIVE: This study aimed to investigate the impact of 68Ga-PSMA PET/CT on overall survival (OS) and management in PCa. METHODS: Consecutive 100 patients who had 68Ga-PSMA PET/CT and conventional imaging (CI) were included in this retrospective study. Disease stages and treatment plans according to both CI and 68Ga-PSMA PET/CT were compared. The effect of 68Ga-PSMA PET/CT on OS was assessed. RESULTS: After 68Ga-PSMA PET/CT, the stage changed in 64 patients (64%). By the reason of 68Ga-PSMA PET/CT findings, treatment plans based on CI were changed in 73 patients (73%). According to the ROC analysis, patients with a PSA value below 8 had higher rates of change in staging (p<0.0001) and treatment (p=0.034). Both a PSA below 8 (OR 8.79 95% CI (2.72-28.43), p<0.001), and having a hormone-sensitive disease at the time of imaging (OR 5.6 95% CI (1.35-23.08), p=0.017) were significant independent factors predicting change in staging with 68Ga-PSMA PET/CT. The results of a phi correlation coefficient analysis showed a significant relationship between therapy and changes in staging (ϕ=0.638, p<0.0001). Two-year OS was statistically different in hormone-sensitive patients with and without treatment change (95% vs 81%, p=0.006). CONCLUSION: 68Ga-PSMA PET/CT has the effect of changing the treatment in 73% of PCa patients. There is a positive correlation between the changes in staging and treatment. Survival of hormone sensitive patients has improved due to treatment changes based on PET/CT findings.

The Sentinel Node and Occult Lesion Localization (SNOLL) Technique Using a Single Radiopharmaceutical in Non-palpable Breast Lesions.

BACKGROUND: In order to perform a full surgical resection on non-palpable breast lesions, a current method necessitates correct intraoperative localization. Additionally, because it is an important prognostic factor for these patients, the examination of the lymph node status is crucial. OBJECTIVE: The aim of this study was to evaluate the efficiency of the sentinel node and occult lesion localization (SNOLL) technique in localizing nonpalpable breast lesions together with sentinel lymph node (SLN) using a single radiotracer, that is, nanocolloid particles of human serum albumin (NC) labeled with technetium-99m (99mTc). METHODS: 39 patients were included, each having a single non-palpable breast lesion and clinically no evidence of axillary disease. Patients received 99mTc- NC intratumorally on the same day as surgery under the guidance of ultrasound. Planar and single-photon emission computed tomography/computed tomography lymphoscintigraphy were performed to localize the breast lesion and the SLN. The occult breast lesion and SLN were both localized using a hand-held gamma-probe, which was also utilized to determine the optimal access pathway for surgery. In order to ensure a radical treatment in a single surgical session and reduce the amount of normal tissue that would need to be removed, the surgical field was checked with the gamma probe after the specimen was removed to confirm the lack of residual sources of considerable radioactivity. RESULTS: Breast lesions were successfully localized and removed in all patients. Pathological findings revealed breast carcinoma in 11/39 patients (28%) and benign lesions in 28 (72%). Axillary SLNs were detected in 31/39 (79.5%) patients. The metastatic involvement of SLN was only seen in two cases. CONCLUSION: While the identification rate of the SNOLL technique performed with an intratumoral injection of 99mTc-NC as the sole radiotracer in non-palpable breast lesions was great, it was not fully satisfactory in SLNs.

Uptake of 68 Ga-PSMA in Avascular Necrosis of the Femoral Head in a Patient With Prostate Cancer.

ABSTRACT: A 69-year-old man with prostate cancer treated with radical prostatectomy underwent 68 Ga-PSMA PET/CT due to biochemical recurrence. Increased radiotracer uptake in the prostate bed suggestive of local recurrence was detected. The right hip also displayed increased 68 Ga-PSMA activity, which was consistent with the avascular necrosis findings on MRI.

Parathyroid Hormone on Osteoprotegerin Levels in Patients with Primary Hyperparathyroidism.

OBJECTIVE: Osteoprotegerin is a glycoprotein that plays a major role in the regulation of bone turnover. The influence of parathyroid hormone, an important regulator of bone remodeling, on osteoprotegerin production is controversial. The purpose of the study was to assess the influence of parathyroid hormone on the circulating level of osteoprotegerin in patients with primary hyperparathyroidism by comparing it with healthy controls. MATERIALS AND METHODS: Forty-four patients with biochemical verification of primary hyperparathyroidism scheduled for the surgical cure and 38 healthy subjects were included. Blood samples of the study group were taken before surgery. Levels of serum parathyroid hormone, osteoprotegerin, calcium, 25-hydroxyvitamin D [25(OH)D], and alkaline phosphatase were analyzed. Bone mineral density at the L1-L4 vertebrae and femoral neck was calculated by dual-energy X-ray absorptiometry. RESULTS: Osteoprotegerin levels and bone mineral density values were significantly lower in patients than in the healthy subjects (P=.002 and P > .0001, respectively). There was no correlation between osteoprotegerin and parathyroid hormone in the groups. Osteoprotegerin was weakly correlated with bone mineral density in patients. No correlation was noted between osteoprotegerin and bone mineral density in the control group. Furthermore, osteoprotegerin levels were not correlated with calcium, 25(OH)D, and alkaline phosphatase levels in each group. CONCLUSION: The production of osteoprotegerin appears to be inhibited by parathyroid hormone in patients with primary hyperparathyroidism. A weak positive correlation found among osteoprotegerin and bone mineral density recommends that osteoprotegerin may be a molecule that impacts bone metabolism and finally bone mineral density.

Detection of COVID-19 Incidentally in 68Ga-PSMA PET/CT for Restaging of Prostate Cancer.

BACKGROUND: A series of pneumonia cases with clinical presentations of viral pneumonia secondary to new coronavirus and subsequent global transmission arose in Wuhan, Hubei, China, in December 2019. Several cases of coronavirus disease 2019 (COVID-19) have been described incidentally in positron emission tomography-computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) as a result of the pandemic. Herein, we describe the findings of a patient with unknown COVID-19 in PET/CT with the other radiopharmaceutical, 68Ga-labeled prostatespecific membrane antigen (68Ga-PSMA). CASE REPORT: A 69-year-old man had previously undergone radical prostatectomy for adenocarcinoma. 68Ga-PSMA PET/CT imaging was performed due to biochemical recurrence. 68Ga-PSMA uptake in the prostate bed suggestive of local recurrence was detected in PET/CT images. Also, bilateral groundglass opacities with slightly increased 68Ga-PSMA uptake were seen in the lungs, suspected of COVID-19. A reverse transcription-polymerase chain reaction test has confirmed the infection. CONCLUSION: Even in asymptomatic patients, nuclear medicine departments must be aware of the possibility of COVID-19, take appropriate post-exposure procedures, and protect employees and other patients.

The Value of 99mTc-MIBI SPECT/CT in the Postoperative Assessment of Patients with Differentiated Thyroid Carcinoma.

BACKGROUND: The therapeutic approaches of differentiated thyroid carcinoma (DTC) are surgery, ablation therapy with the postoperative use of radioiodine-131 (131I), and thyroid-stimulating hormone (TSH) suppression therapy. After the surgical therapy, the patient should be assessed for remnants/metastases. OBJECTIVE: The purpose of this research was to investigate the role of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in the postoperative management of patients with DTC. METHODS: The study comprised 22 DTC patients (13 women, 9 men; mean age 46.55 ± 13.27 y) who underwent a total thyroidectomy previously. All patients were investigated for thyroid remnants/ metastases by99mTc-MIBI SPECT/CT, posttherapy 131I whole-body scan (WBS) and ultrasound (US). Serum TSH, thyroglobulin and anti-Tg antibody levels were measured. Results of imaging modalities and laboratory measurements were compared with each other. RESULTS: 99mTc-MIBI SPECT/CT, 131I WBS and US respectively demonstrated thyroid remnants in 15 (68.18%), 22 (100%) and 14 (63.63%) of all patients and metastatic lymph nodes in 8 (100%), 6 (75%) and 6 (75%) of the 8 patients with lymph node metastases.99mTc-MIBI SPECT/CT also demonstrated lung metastases in 2 patients (9.09% of all patients). The same result was obtained with 131I WBS. CONCLUSION: The findings of this study show that 99mTc-MIBI SPECT/CT can be effective for detecting metastases in patients with DTC who underwent surgery prior to 131I therapy.

Assessment of volumetric parameters derived from 68Ga-PSMA PET/CT in prostate cancer patients with biochemical recurrence: an institutional experience.

OBJECTIVE: The aim of this study was to evaluate the relationship between volumetric parameters calculated using semiautomatic quantification of lesions detected in 68Ga-labeled prostate-specific membrane antigen PET-computed tomography (68Ga-PSMA PET/CT) and clinical characteristics in prostate cancer (PCa) patients with biochemical recurrence. METHODS: A total of 85 consecutive PCa patients with biochemical recurrence who underwent 68Ga-PSMA PET/CT at our institution from January 2019 to March 2020 were retrospectively assessed. 68Ga-PSMA PET/CT-derived volumetric parameters, including whole-body PSMA tumor volume (wbPSMA-TV) and whole-body total lesion PSMA (wbTL-PSMA), as well as the established maximum and mean standardized uptake value (SUVmax and SUVmean), were calculated for each patient. All PET-derived parameters were analyzed for correlation with prostate-specific antigen (PSA) levels and for association with Gleason scores. RESULTS: Eighty-five patients with a mean age of 68.9 ± 7.8 years (range, 47-83 years) and a mean PSA level of 40.9 ± 92.1 ng/ml (range, 0.2-533.2 ng/ml) were analyzed. Volumetric parameters, that is, wbPSMA-TV and wbTL-PSMA, demonstrated a statistically significant correlation with PSA levels (r = 0.403 and r = 0.556, respectively, all at P < 0.001) and only the means of wbTL-PSMA were significantly different between the Gleason score groups (P < 0.05). CONCLUSIONS: The results of our study indicate that 68Ga-PSMA PET/CT might be a valuable tool for the detection and follow-up of recurrence in PCa patients. 68Ga-PSMA PET/CT-derived quantitative volumetric parameters demonstrated a highly significant correlation with changes in PSA levels. Larger prospective studies are needed to help reveal the full potential of parameters such as PSMA-TV and TL-PSMA derived from PET imaging with 68Ga-PSMA.

Single-photon Emission CT Combined with Spiral CT for Early Detection and Localization of Bone Metastasis: A Review.

BACKGROUND: Bone metastasis is common in cancer. Evaluating the metastatic status in cancer is of utmost importance in order to provide the best patient's management. DISCUSSION: Bone scintigraphy is widely used for evaluation of bone metastasis. It has high sensitivity with limited specificity. Planar bone scintigraphy has been shown to have increased radiotracer uptake without accurate anatomic localization and characterization. Hybrid Single-Photon Emission Computed Tomography/Computerized Tomography (SPECT/CT) system has been developed by combination of SPECT and CT. Accurate lesion localization and discrimination of equivocal bone lesions is an advantage in this hybrid technique. It improves diagnostic accuracy by differentiation of benign bone lesions from malignant ones due to their morphological changes. So, SPECT/CT improves the specificity of bone scintigraphy leading to better outcomes in diagnosis and treatment outcomes of bone metastatic cancer patients. CONCLUSION: In here, we discussed the prognostic value of bone scintigraphy and SPECT/CT in bone metastasis with our clinical experience and review of the literature.

Comparison between single-photon emission computed tomography/computed tomography and ultrasound in preoperative detection of parathyroid adenoma: retrospective review of an institutional experience.

OBJECTIVE: The aim of this study was to evaluate the accuracy of technetium- 99m-methoxyisobutylisonitrile (Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) and ultrasound in preoperative localization of single parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (pHPT) who would be suitable for minimally invasive parathyroidectomy (MIP). METHODS: A retrospective study of 143 consecutive patients with biochemical evidence of hyperparathyroidism who underwent preoperative localization of parathyroid lesions using Tc-MIBI SPECT/CT and ultrasound, and proceeded to parathyroid surgery at our institution from January 2013 to January 2018. Of these, 125 had single adenomas and are the subject of this study. The sensitivity, positive predictive value (PPV) and accuracy of the two imaging techniques for the accurately identification and lateralization of PTAs were determined using histopathology as the criterion standard. RESULTS: Of 125 PTAs, the correct identification and lateralization were significantly higher by SPECT/CT than ultrasound. SPECT/CT and ultrasound detected lesions with histopathologically proven PTAs in 116 and 95 patients, respectively. The sensitivity, PPV and accuracy were 92.17, 94.64 and 87.60%, respectively, for SPECT/CT and 75.89, 90.43 and 70.25%, respectively, for ultrasound in lateralization analysis. CONCLUSIONS: The results of our study indicate that Tc-MIBI SPECT/CT is more accurate than ultrasound for the preoperative identification of single PTAs in patients with pHPT who are candidates for MIP.

Comparison of glomerular filtration rate measurements with the two-plasma sample technique using Tc-99m DTPA and other methods in donor candidates for renal transplantation.

BACKGROUND/AIM: Accurate measurement of glomerular filtration rate (GFR) in the evaluation of renal functions in potential kidney donors is associated with important outcomes for both the donor and recipient. We intended to determine the efficacy of various methods while estimating GFR in potential living kidney donors. MATERIALS AND METHODS: Fifty-three potential kidney donors (31 females, 22 males; mean age: 50.1 years) were included in this study. GFR was estimated simultaneously using the following methods: Gates' method, Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) prediction equations, and the two-plasma sample (TPS) technique. Using TPS as the reference method, the estimations of GFR with the other methods were compared with that of TPS. RESULTS: The mean ± SD GFR was 86.43 ± 11.37 mL min-1 1.73 m-2 with TPS. GFR values calculated using Gates' method and MDRD 1, MDRD 2, reexpressed MDRD, and CG prediction equations were 105.25 ± 16.12 mL min-1 1.73 m-2, 114.63 ± 32.51 mL min-1 1.73 m-2, 113.2 ± 35.23 mL min-1 1.73 m-2, 104.23 ± 23.12 mL min-1 1.73 m-2, and 99.35 ± 20.01 mL min-1 1.73 m-2, respectively. While there was a strong statistically significant correlation between the TPS and Gates' methods, moderate correlation was found between TPS and the MDRD 1, MDRD 2, and reexpressed MDRD prediction equations. CONCLUSION: Our results indicated that the performance of Gates' method in total GFR estimation was better than the prediction equations in potential kidney donors.

Evaluation of the effect of isotretinoin on salivary gland function by Tc-99m pertechnetate imaging in acne vulgaris patients.

BACKGROUND/AIM: Isotretinoin is an effective drug utilized in the management of acne vulgaris and is known to cause dry mouth. In this study, we aimed to evaluate this effect of isotretinoin on the salivary gland function in patients with acne vulgaris using technetium-99m (Tc-99m) pertechnetate imaging of the salivary glands. MATERIALS AND METHODS: The study population consisted of 28 patients with acne vulgaris (6 males and 22 females, mean age 20.2 ± 2.3 years), who were treated with isotretinoin for 6 months. We performed radionuclide imaging of the salivary glands pretreatment and at months 3 and 6 of treatment. After 185 MBq (5 mCi) of Tc-99m pertechnetate was intravenously administered, imaging of the salivary glands was performed over a 25-min period. We measured the following glandular function parameters for the parotid and submandibular salivary glands via time-activity curves: uptake ratio, maximum accumulation, and ejection fraction. RESULTS: Statistically significant differences were observed in the values obtained at months 3 and 6 of treatment, compared with the pretreatment values. CONCLUSION: This study demonstrated that radionuclide imaging of the salivary glands can clearly show the glandular functions that are affected by drugs such as isotretinoin.

Tc-99m MDP bone scintigraphy in the evaluation of the joint damage in asymptomatic alpine ski racers.

AIM: To evaluate the role of 99m-technetium methylene diphosphonate (Tc-99m MDP) bone scintigraphy on the detection of joint damage in asymptomatic alpine ski racers. MATERIALS AND METHODS: This study included 20 male asymptomatic alpine ski racers (age range: 18-21 years). None of the skiers had a history of ski crashes. Bone scan findings of the racers were examined with Tc-99m MDP bone scintigraphy during the active racing season and the inactive training season. Planar anterior and posterior images of hip, knee, and ankle joints were obtained 4 h after intravenous injection of 20 mCi Tc-99m MDP. All images were interpreted visually by 2 experienced nuclear medicine physicians. Free regions of interest were drawn on hip, knee, and ankle joints, as well as background regions. Joint-to-background ratios were calculated for each joint, and the uptake ratios of both right and left joints during active ski season were compared to those during the inactive training period. RESULTS: Uptake ratios of the right and left hip, knee, and ankle joints were significantly higher during the active racing period than those calculated during the inactive period (P < 0.005). CONCLUSION: Bone scintigraphy may have an important role in detecting joint injuries of hip, knee, and ankle joints in asymptomatic alpine ski racers and can be used successfully when MRI is unavailable.

The effect of antiallergic treatment with desloratadine-montelukast on salivary glands function in allergic rhinitis.

The aim of this study was to evaluate the possible favorable effect of desloratadine-montelukast combination on salivary glands (SG) function in patients with allergic rhinitis (AR) using SG scintigraphy. The study population consisted of 64 patients with AR and 28 healthy controls: 14 males and 14 females, with mean age 32.3±8.6 years. The patients were divided into two groups: the untreated patients group of 32 patients, 16 males and 16 females, mean age 28.5±5.4 years and the treated group, who received the standard clinically recommended oral dose of montelukast 10mg/d and desloratadine 5mg/d for 6 weeks. This group consisted of 32 patients, 16 males and 16 females, mean age 38.3±8.4 years. All patients and healthy controls underwent SG scintigraphy. After the intravenous injection of technetium-99m pertechnetate, ((99m)Tc-P), dynamic SG scintigraphy was performed for 25min. Using the time-activity curves, the following glandular function parameters were calculated for the parotid and the submandibular SG: uptake ratio, maximum accumulation and ejection fraction. Results showed SG hypofunction. All functional parameters obtained for the untreated patients and for the desloratadine-montelukast treated patients were significantly lower than those in healthy controls (P<0.05). There was no statistically significant difference between treated and untreated patients (P>0.05). In conclusion, our study showed that hypofunction of SG was present in all patients with AR. This hypofunction, as tested by semi-quantitative SG scintigraphy, and also the quality of life did not improve after treatment with montelukast and desloratadine.

The Importance of FDG-PET/CT in Cogan's Syndrome.

The present study gives a detailed report of a patient with atypical Cogan's syndrome with uveitis and sensorineural hearing loss. Cogan's syndrome is characterized by nonsyphilitic interstitial keratitis and audiovestibular dysfunction. This syndrome can be divided into two groups, typical and atypical, based on the presence of interstitial keratitis. It may sometimes be associated with systemic vasculitis. Fluoro-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) scanning was used to investigate the presence of vasculitis. With FDG-PET/CT scanning, there is no pathological involvement in the walls of the arteries; thus the patient is protected from aggressive and long term immunosuppressive treatment's side effects. Hence, we can conclude that FDG-PET/CT may play an important role in excluding the presence of vasculitis.

Vesicoureteral reflux in a nonfunctioning kidney detected by 99mTc-DTPA study.

Vesicoureteral reflux (VUR) is a well-recognized condition in the pediatric population, but is less well described in the adult population, and its prevalence decreases with increasing age. We describe the case of a 53-year-old male with nonfunctional kidney in which accumulation of radioactivity was observed in the ureter and renal pelvis owing to VUR, which was detected by technetium-99m diethylenetriamine pentaacetic acid dynamic renal scintigraphy.

Evaluation of bone metastasis as the first presentation of hepatocellular carcinoma using 18-fluorodeoxyglucose positron emission tomography-computed tomography.

We report a case of a patient with hepatocellular carcinoma (HCC) who presented with back pain related to bone metastasis. HCC metastasizes by hematogenous and lymphatic routes commonly to the lungs, regional lymph nodes, kidney, bone marrow and adrenals. In this extremely rare case, the patient had no known liver disease, but presented with liver lesions and multiple bone lesions involving vertebrae, ribs, pelvic bones and left femur with associated expansile soft-tissue components. These bone lesions were first detected from a positron emission tomography scan. Pathological examination of biopsy material taken from the left eighth rib confirmed metastatic HCC. In conclusion, if a patient has expansile osteolytic bone lesions, bone metastasis from HCC should be included in the differential diagnosis.

The role of carnitine on ovariectomy and inflammation-induced osteoporosis in rats.

This study was carried out to assess the protective bone-sparing effect of carnitine with anti-inflammatory properties on chronic inflammation-induced bone loss in ovariectomised (OVX) rats. A total of 64 rats were divided into eight groups. Sixteen rats were sham-operated (SH) while the others were ovariectomised (OVX). (1) SH, (2) sham + inflammation (SHinf), (3) OVX, (4) ovariectomy + inflammation (OVXinf), (5) OVX + CAR1, (6) OVX + CAR2, (7) OVXinf + CAR1, (8) OVXinf + CAR2. After the ovariectomy surgery, all the groups (3, 4, 5, 6, 7, and 8) were allowed to recover for two months. Sixty days after the OVX, inflammation was induced by subcutaneous injections of talc in groups 2, 4, 7, and 8. Group 5 and 7 were given 50 mg/kg CAR; Group 6 and 8 were given 100 mg/kg CAR from the 60th to the 80th day. Serum levels of TNF-α, IL-1, IL-6, OP, and OC were assessed to determine inflammation and to evaluate osteoblastic activity. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry in femur bones of rats. Carnitine administration was able to restore BMD up to values measured in both the OVX and the SH animals. The serum levels of TNF-α, IL-1ß, and IL-6 were increased significantly in the OVXinf rats compared with the SH group. In OVX rats, inflammation which is evaluated by serum cytokine levels exacerbated this bone loss, as supported by values of BMD of the total femur. The two different doses of carnitine reduced bone loss and improved inflammatory biomarkers.

Effect of methylprednisolone on bone mineral density in rats with ovariectomy-induced bone loss and suppressed endogenous adrenaline levels by metyrosine.

OBJECTIVES: In this study, effect of methylprednisolone on bone mineral density (BMD) was investigated in rats with overiectomy induced bone lose and suppressed endogenous adrenalin levels, and compared to alendronate. MATERIALS AND METHODS: Severity of bone loss in the examined material (femur bones) was evaluated by BMD measurement. RESULTS: The group with the highest BMD value was metyrosinemetyrosine + methylprednisolone combination (0.151 g/cm(2)), while that with the lowest BMD was methylprednisolone (0.123 g/cm(2)). Alendronate was effective only when used alone in ovariectomized rats (0.144 g/cm(2)), but not when used in combination with methylprednisolone (0.124 g/cm(2)). In the ovariectomized rat group which received only metyrosine, BMD value was statistically indifferent from ovariectomized control group. CONCLUSIONS: Methylprednisolone protected bone loss in rats with suppressed adrenaline levels because of metyrosinemetyrosine.

Effects of tirofiban maintenance duration on myocardial perfusion defect severity in anterior myocardial infarction.

INTRODUCTION: Percutaneous coronary intervention (PCI) does not often produce optimal results, despite restoration of coronary blood flow at myocardial recovery, because of impaired microvascular perfusion. This study aimed to investigate and evaluate with (99m)Tc-sestamibi scan whether the results of PCI can be changed by maintenance infusion of tirofiban for 24 or 48 h in patients presenting with anterior ST-elevation myocardial infarction (STEMI). METHODS: The study included 84 patients with anterior STEMI who were candidates for primary PCI and whose occlusion was in the proximal or mid-left anterior descending artery. Patients were given 25 µg/kg/3 min tirofiban and randomized to receive maintenance infusion at 0.15 µg/kg/min for 24 or 48 h. A resting (99m)Tc sestamibi scan was performed on the 5th day post-procedure before discharge. The primary efficacy endpoint was a patient's score on a 5-point scoring system for perfusion defect severity. Major adverse cardiac events (MACE) were defined as death from any cause, re-infarction, and clinically driven target-vessel revascularization within the first 6 months. RESULTS: Baseline characteristics of the patients were similar in the two infusion groups (n = 42 per group). There was no significant difference in the symptom onset-to-presentation time or door-to-balloon time between the two groups. With the exception of basal anteroseptal and basal anterior segments, significant reductions were obtained on the 5-point scoring system for perfusion defect severity in segments and in the summed rest scores. No significant differences were observed between the two groups in the incidence of MACE at 6 months. The safety profile did not differ between 24 and 48 h infusions of tirofiban. CONCLUSION: The use of tirofiban, when administered at a high bolus dose and maintained for 48 h, was safe and significantly reduced perfusion defect severity in patients with anterior STEMI presenting early after symptom onset and undergoing primary PCI.