ABSTRACT
The present study evaluated engineered media for plant biofilter optimisation in an unvegetated column experiment to assess the performance of loamy sand, perlite, vermiculite, zeolite and attapulgite media under stormwater conditions enriched with varying nutrients and metals reflecting urban pollutant loads. Sixty columns, 30 unvegetated and 30 Juncus effusus vegetated, were used to test: pollutant removal, infiltration rate, particulate discharge, effluent clarity and plant functional response, over six sampling rounds. All engineered media outperformed conventional loamy sand across criteria, with engineered attapulgite consistently among the best performers. No reportable difference existed in vegetation exposed to different material combinations. For all media, the results show a net removal of NH3-N, PO43--P, Cd, Cu, Pb and Zn and an increase of NO3--N, emphasizing the importance of vegetation in biofilters. Growth media supporting increased rate of infiltration whilst maintaining effective remediation performance offers the potential for reducing the area required by biofilters, currently recommended at 2% of its catchment area, encouraging the use of small-scale green infrastructure in the urban area. Further research is required to assess the carrying capacity of engineered media in laboratory and field settings, particularly during seasonal change, gauging the substrate's potential moisture availability for root uptake.
Subject(s)
Water Purification , Filtration , Metals , Nutrients , PlantsABSTRACT
BACKGROUND: Mechanical ventilation (MV) can result in inflammation and subsequent lung injury. Toll-like receptor (TLR)4 and NF-κB are proposed to play a crucial role in the MV-induced inflammatory response. Resveratrol (RVT) exhibits anti-inflammatory effects in vitro and in vivo supposedly by interfering with TLR4 signaling and NF-κB. In the present study, we investigated the role of RVT in MV-induced inflammation in mice. METHODS: RVT (10 mg/kg, 20 mg/kg and 40 mg/kg) or vehicle was intraperitoneally administered 1 h before start of MV (4 h, tidal volume 8 ml/kg, positive end-expiratory pressure 1,5 cmH2 O and FiO2 0.4). Blood and lungs were harvested for cytokine analysis. DNA binding activity of transcription factor NF-κB was measured in lung homogenates. RESULTS: MV resulted in elevated pulmonary concentrations of IL-1ß, IL-6, keratinocyte-derived chemokine (KC) and NF-κB DNA-binding activity. RVT at 10, 20 and 40 mg/kg reduced NF-κB's DNA-binding activity following MV compared with ventilated controls. However, no differences in cytokine release were found between RVT-treated and control ventilated mice. Similarly, in plasma, MV resulted in elevated concentrations of TNF-α, KC and IL-6, but RVT did not affect cytokine levels. CONCLUSIONS: RVT abrogates the MV-induced increase in pulmonary NF-κB activity but does not attenuate cytokine levels. This implies a less prominent role for NF-κB in MV-induced inflammation than previously assumed.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Cytokines/biosynthesis , NF-kappa B/drug effects , NF-kappa B/metabolism , Respiration, Artificial , Stilbenes/pharmacology , Animals , Cytokines/analysis , DNA/metabolism , Enzyme-Linked Immunosorbent Assay , Heart/drug effects , Heart/physiology , Lung/drug effects , Lung/physiology , Male , Mice , Mice, Inbred C57BL , ResveratrolABSTRACT
BACKGROUND: Mechanical ventilation (MV) induces an inflammatory response in healthy lungs. The resulting pro-inflammatory state is a risk factor for ventilator-induced lung injury and peripheral organ dysfunction. Isoflurane is known to have protective immunological effects on different organ systems. We tested the hypothesis that the MV-induced inflammatory response in healthy lungs is reduced by isoflurane. METHODS: Healthy C57BL6 mice (n=34) were mechanically ventilated (tidal volume, 8 ml/kg; positive end-expiratory pressure, 4 cmH(2)O; and fraction of inspired oxygen, 0.4) for 4 h under general anesthesia using a mix of ketamine, medetomidine and atropine (KMA). Animals were divided into four groups: (1) Unventilated control group; (2) MV group using KMA anesthesia; (3) MV group using KMA with 0.25 MAC isoflurane; (4) MV group using KMA with 0.75 MAC isoflurane. Cytokine levels were measured in lung homogenate and plasma. Leukocytes were counted in lung tissue. RESULTS: Lung homogenates: MV increased pro-inflammatory cytokines. In mice receiving KMA+ isoflurane 0.75 MAC, no significant increase in interleukin (IL)-1beta was found compared with non-ventilated control mice. PLASMA: MV induced a systemic pro-inflammatory response. In mice anesthetized with KMA+ isoflurane (both 0.25 and 0.75 MAC), no significant increase in tumor necrosis factor (TNF)-alpha was found compared with non-ventilated control mice. CONCLUSIONS: The present study is the first to show that isoflurane attenuates the pulmonary IL-1beta and systemic TNF-alpha response following MV in healthy mice.
Subject(s)
Anesthetics, Inhalation/pharmacology , Interleukin-1beta/metabolism , Isoflurane/pharmacology , Lung/metabolism , Respiration, Artificial , Tumor Necrosis Factor-alpha/metabolism , Animals , Atropine/pharmacology , Blood Pressure/drug effects , Excitatory Amino Acid Antagonists/pharmacology , Hypnotics and Sedatives/pharmacology , Ketamine/pharmacology , Leukocyte Count , Lung/drug effects , Male , Medetomidine/pharmacology , Mice , Mice, Inbred C57BL , Muscarinic Antagonists/pharmacology , Pneumonia/pathologyABSTRACT
We aimed to assess the specificity and sensitivity of (99m)technetium pyrophosphate muscle scintigraphy in the diagnostic workup of patients with suspected myopathy. We reviewed the charts of 166 patients; 52% of the subjects had myalgias, 36% had muscle weakness, 45% had an elevated serum creatine kinase (CK), and 49% had an increased C reactive protein (CRP). Scintigraphy was positive in 34 patients (20%). The test was more sensitive in the presence of muscle weakness, elevated CK, or increased CRP. The presence of myalgias did not influence the odds. Sensitivity was 60% in patients with the final diagnosis of polymyositis, dermatomyositis, or inclusion body myositis, and 70% in noninflammatory myopathies. Eight percent had false positive scintigrams. In individuals with biopsy-proven myopathy (51 subjects), the diagnostic sensitivity was 43%, and its specificity was 60%. Low positive and high negative likelihood ratios (5.0 and 0.65, respectively) document an only limited diagnostic efficiency of (99m)Tc-PYP scintigraphy in the evaluation of inflammatory and noninflammatory myopathies and suggest that the test is not helpful in the routine diagnostic workup of muscle complaints, even after a priori selection of patients for CK plus CRP abnormalities.
Subject(s)
Muscle, Skeletal/pathology , Muscular Diseases/diagnosis , Technetium Tc 99m Pyrophosphate , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/metabolism , C-Reactive Protein/analysis , Creatine Kinase/blood , Female , Humans , Male , Middle Aged , Muscle Weakness/blood , Muscle Weakness/diagnosis , Muscle Weakness/diagnostic imaging , Muscle, Skeletal/diagnostic imaging , Muscular Diseases/blood , Muscular Diseases/diagnostic imaging , Pain/blood , Pain/diagnosis , Pain/diagnostic imaging , Polymyositis/blood , Polymyositis/diagnosis , Polymyositis/diagnostic imaging , Radionuclide Imaging , Sensitivity and SpecificityABSTRACT
Pleuropulmonary blastoma (PPB) is a rare dysembryonic intrathoracic neoplasm in children. It is a malignant tumour originating from the mesenchyme with a poor prognosis. We report on a 3-year-old girl who presented with respiratory symptoms and was diagnosed as having a type III PPB according to histological results attained by open biopsy. Imaging by CT and MRI revealed the exact size of the tumour involving the left lower lobe with displacement of the mediastinum and the diaphragm. Additional FDG-PET was important to evaluate tumour vitality and to decide the time of surgery, which was performed after 12 weeks of chemotherapy with the CWS2002P protocol. After R0 resection without complications and postoperative chemotherapy, the child continues to be in complete remission. This case underlines the importance of radical surgery of the aggressive neoplasm in combination with chemotherapy and the usefulness of multimodal imaging for the optimal planning of local therapy.
Subject(s)
Lung Neoplasms/diagnosis , Pleural Neoplasms/diagnosis , Child, Preschool , Female , Humans , Lung Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Pleural Neoplasms/diagnostic imaging , Positron-Emission Tomography , Tomography, X-Ray ComputedABSTRACT
Von Hippel-Lindau disease is an important hereditary tumor syndrome with a clear option for effective treatment if diagnosed in time. Interdisciplinary cooperation is the key to successful management. Major components of the disease are retinal capillary hemangioblastomas, hemangioblastomas of cerebellum, brain stem and spine, renal clear cell carcinomas, pheochromocytomas, multiple pancreatic cysts and islet cell carcinomas, tumors of the endolymphatic sac of the inner ear, and cystadenomas of the epididymis and broad ligament. A well structured screening program should be performed at yearly intervals.
Subject(s)
Hemangioblastoma/therapy , Hemangioma/therapy , Ophthalmology/history , Pathology/history , Patient Care Team , Retinal Neoplasms/therapy , von Hippel-Lindau Disease/history , von Hippel-Lindau Disease/therapy , Adenocarcinoma, Clear Cell/therapy , Adrenal Gland Neoplasms/therapy , Adult , Diagnosis, Differential , Female , Germany , Hemangioblastoma/diagnosis , Hemangioma/diagnosis , History, 19th Century , History, 20th Century , Humans , Interprofessional Relations , Kidney Neoplasms/therapy , Magnetic Resonance Imaging , Male , Pheochromocytoma/therapy , Positron-Emission Tomography , Referral and Consultation , Retinal Neoplasms/diagnosis , Sweden , von Hippel-Lindau Disease/classification , von Hippel-Lindau Disease/diagnosis , von Hippel-Lindau Disease/diagnostic imaging , von Hippel-Lindau Disease/geneticsABSTRACT
UNLABELLED: Preoperative localization of parathyroid adenomas (PA) can shorten operation time and improve curative rate; it becomes especially important in minimally invasive surgical techniques. AIM of this study was to investigate whether positron emission tomography (PET) with 3-,4-dihydroxy-6- (18) F-fluorophenylalanine ( (18) F-DOPA), which showed very promising results in other neuroendocrine tumours, also helps to localize PA. PATIENTS, METHODS: Eight patients with proven primary hyperparathyroidism were studied preoperatively with PET. Seven also underwent scintigraphy with (99m) Tc-MIBI and ultrasonography of the neck. All patients were operated and the histological finding was used as a gold standard. RESULTS: All eight patients had a histologically proven PA. None of the PA showed any detectable uptake of (18) F-DOPA. However, ultrasonography detected 5/7 PA, scintigraphy detected 3/7 PA. CONCLUSION: These results suggest that PET with (18) F-DOPA is not useful in the detection of PA in patients with primary hyperparathyroidism.
Subject(s)
Adenoma/diagnostic imaging , Dihydroxyphenylalanine/analogs & derivatives , Hyperparathyroidism/diagnostic imaging , Parathyroid Neoplasms/diagnostic imaging , Positron-Emission Tomography , Adenoma/pathology , Aged , Fluorine Radioisotopes , Humans , Hyperparathyroidism/pathology , Middle Aged , Parathyroid Neoplasms/pathology , Positron-Emission Tomography/methods , Reproducibility of Results , UltrasonographyABSTRACT
This review article highlights several diagnostic imaging modalities in giant cell arteritis. Color-coded Duplex sonography is a relatively cost-efficient but strongly observer-dependent imaging modality. It may be difficult to distinguish inflammatory from atherosclerotic mural changes. Positron emission tomography with (18)F-fluoro-2-deoxy-D-glucose is very sensitive in detecting extracranial involvement of large vessel vasculitis. However, it provides no information on inflammatory changes of the superficial cranial arteries. High-resolution MRI is a new observer-independent method that allows visualizing and assessing the superficial cranial arteries in high detail. Extracranial large artery involvement can be evaluated during the same investigation. At present, only single-center experiences with this promising but rather complex procedure exist. A comparative multicenter trial is about to be initiated.
Subject(s)
Diagnostic Imaging , Giant Cell Arteritis/diagnosis , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Positron-Emission Tomography , Sensitivity and Specificity , Temporal Arteries/pathology , Ultrasonography, Doppler, ColorABSTRACT
Paragangliomas are tumours that arise within the sympathetic nervous system originating from the neural crest. These tumours can be found anywhere from the neck to the pelvis in locations of sympathetic ganglions. Although in the majority of paragangliomas the diagnosis is based on measuring catecholamines and metabolites in plasma or urine, imaging plays an important preoperative role. Today, there are several morphological and radionuclide imaging methods available that predict tumour localisation and tumour extent and give anatomic information to the surgeon. MRI is the morphological imaging modality of choice in localising pheochromocytomas and extra-adrenal paragangliomas. It provides excellent anatomic detail and has the advantage of lacking ionising radiation. The overall accuracy of computed tomography (CT) in detecting primary adrenal pheochromocytomas is very high, but CT lacks in specificity as difficulties may occur in distinguishing between paragangliomas and other tumour entities. The major advantages of radionuclide imaging are very high specificity and routinely performed whole-body scanning. Furthermore, metabolic imaging is not influenced by artifacts like scar tissue or metallic clips in post-surgical follow-up. Currently, a reported specificity of 99% and a cumulative sensitivity of about 90% in paragangliomas make (123)I-MIBG the most important nuclear imaging method. However, (18)F-DOPA-PET seems to be a very promising procedure which offers higher accuracy. The higher spatial resolution of PET-scanners enables the detection of small lesions not visualised with (123)I-MIBG. Both use of radiolabelled somatostatin analogue like (111)In-pentetreotide and (18)F-FDG is limited due to low specificity of the tracers and should be restricted to MIBG- and F-DOPA-negative cases.
Subject(s)
Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/pathology , Paraganglioma/diagnostic imaging , Paraganglioma/pathology , Pheochromocytoma/diagnostic imaging , Pheochromocytoma/pathology , 3-Iodobenzylguanidine , Dihydroxyphenylalanine/analogs & derivatives , Fluorodeoxyglucose F18 , Humans , Magnetic Resonance Imaging , Positron-Emission Tomography , Radiopharmaceuticals , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
The initial localization of metastases in the bone in patients with solid tumors has a relatively good prognosis in comparison with visceral metastasization. The early detection of bone marrow metastases allows for a rapid initiation of therapy and a subsequent reduction in the morbidity rate. Modern MRI is superior to the 30-year-old skeletal scintigraphy and bone marrow scintigraphy with respect to sensitivity, specificity, as well as the extent of osteal metastasis. MRI provides substantial, therapy-relevant additional information. MSCT plays an important role in the management of cancer patients in clinical routine and gives an excellent survey of the axial skeleton by demonstrating osteolytic and osteoblastic metastases. Extensive comparative studies of MRI with 18F-FDG-PET and 18F-fluoride-PET have not yet been carried out. Whole body MRI is a very promising new staging method for the oncological diagnosis of solid tumors and the detection of osteal metastases. The adoption of 18F-FDG-PET and 18F-fluoride-PET FDG as well as the side by side PET-CT image fusion and the two in one PET/CT examinations appears to be slightly less sensitive to whole body MRI in the detection of osteal metastases. Larger, prospective multicenter studies are necessary to establish these as new, promising methods for the detection of osteal metastases.
Subject(s)
Bone Neoplasms/diagnosis , Bone Neoplasms/secondary , Magnetic Resonance Imaging/methods , Contrast Media , Fluorodeoxyglucose F18 , Humans , Neoplasm Metastasis/diagnosis , Neoplasm Staging , Radiopharmaceuticals , Sensitivity and Specificity , Tomography, Emission-Computed , Tomography, X-Ray ComputedABSTRACT
Primary cardiac lymphoma (PCL) is a rare disorder with a poor prognosis and response monitoring is often difficult. Delay in the diagnosis and infiltration of cardiac structures contribute to the unfavorable prognosis. We report on a 76-year-old woman who was diagnosed as having an immunoblastic B-cell PCL according to a histology attained by catheter-guided biopsy. Systemic chemotherapy with six cycles of CHOP (Cyclophosphamide, Doxorubicine, Vincristine = Oncovine, Prednisone), combined with the monoclonal anti-CD20 antibody Rituximab induced only a partial remission, based solely on monitoring of tumor size. However, cardiac gadolinium-enhanced magnetic resonance imaging (CMR) disclosed a reduced lymphoma perfusion and, therefore, indicated decreased tumor vitality. Nine months after the final treatment, the cardiac tumor further decreased to 10% of the initial size, and the patient is in sustained remission as monitored by CMR and validated by florine-18 fluorodeoxyglucose positron emission tomography (PET). Determination of PCL perfusion was, in our case, beneficial for clinical decision making on additional therapy.
Subject(s)
Contrast Media , Drug Monitoring/methods , Gadolinium , Heart Neoplasms/diagnosis , Lymphoma, B-Cell/diagnosis , Magnetic Resonance Imaging/methods , Aged , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Female , Heart Neoplasms/drug therapy , Humans , Lymphoma, B-Cell/drug therapy , Positron-Emission Tomography , Prednisone/administration & dosage , Remission Induction , Rituximab , Vincristine/administration & dosageABSTRACT
Following 30 min of forebrain ischaemia in the rat, delayed neuronal death occurs in the CA1 sector of the hippocampus within two to three days, whereas neurons in other selectively vulnerable regions, such as the dorsolateral striatum, die within 6-12 h. In this study, we investigated cyclin D1 expression, which codes for a regulatory protein in cell cycle regulation, but it is also induced in sympathetic neurons undergoing programmed cell death. Cyclin D1 messenger RNA could not be detected by in situ hybridization techniques in brains of control rats, but was found at one and two days after ischaemia in regions of the dorsolateral striatum with neuronal degeneration. DNA fragmentation in this region, identified by the terminal transferase biotinylated-UTP nick end labelling (TUNEL) procedure, was observed from 6 h after ischaemia onward. In the hippocampus, increased levels of cyclin D1 messenger RNA were found at two and three days after ischaemia in the striatum pyramidale of the CA1 sector. This expression was associated with the occurrence of neuronal damage and TUNEL-stained neurons. By seven days cyclin D1 messenger RNA was found in hardly any brain structure. There was no temporospatial overlap of cyclin D1 expression with the expression of the immediate-early genes c-fos, c-jun, and mkp-1, a result which is clearly distinct from findings in sympathetic ganglion neurons undergoing programmed cell death. These results do not suggest a role for cyclin D1 in neuronal cell death following transient forebrain ischaemia. The similarity of the cyclin D1 expression profile with that of the microglia-specific CR3 complement receptor beta-subunit messenger RNA, and the results of combined in situ hybridization and microglia-specific immunohistochemistry suggest that microglia are the source of cyclin D1 messenger RNA in the postischaemic brain. Since cyclin D1 codes for a critical regulatory protein for progression of the G0 to G1 phase in the cell cycle and we did not observe prominent occurrence of DNA fragmentation in microglial cells in the hippocampus at time points when cyclin D1 messenger RNA was found, we suggest that cyclin D1 induction is involved in the onset of microglial cell proliferation.
Subject(s)
Cyclins/genetics , Ischemic Attack, Transient/genetics , Ischemic Attack, Transient/physiopathology , Microglia/physiology , Neurons/physiology , Oncogene Proteins/genetics , Prosencephalon/cytology , Animals , Antibody Specificity , Arterial Occlusive Diseases/physiopathology , Astrocytes/physiology , Base Sequence , Biotin , Cell Death/physiology , Cyclin D1 , DNA Damage , Deoxyuracil Nucleotides , Gene Expression Regulation/physiology , Genes, Immediate-Early/physiology , HSP70 Heat-Shock Proteins/genetics , In Situ Hybridization , Male , Microglia/immunology , Prosencephalon/blood supply , RNA, Messenger/metabolism , Rats , Rats, Wistar , Receptors, Complement/genetics , Staining and LabelingABSTRACT
UNLABELLED: This study was designed to evaluate the age dependency of 18F-FDG uptake in the thymus and the frequency of PET confirmation of thymus hyperplasia after chemotherapy in cancer patients. METHODS: Whole-body FDG PET recordings of 168 patients were retrospectively examined for a retrosternal lesion in the anterior mediastinum that was attributable to the thymus. The patients were assigned to the following four groups: children with malignant lesions before the first therapy (group Ia; n = 15; mean age +/- SD, 11.9 +/- 3.7 y), children with malignant disease after chemotherapy (group Ib; n = 12; mean age, 10.3 +/- 5.0 y), adults with histologically confirmed malignant lymphoma before the first therapy (group IIa; n = 37; mean age, 43.9 +/- 16.7 y), and adult lymphoma patients 3 wk to 4 mo after chemotherapy (group IIb; n = 104; mean age, 40.9 +/- 14.6 y). RESULTS: Increased FDG accumulation in the thymus was seen in 11 patients (73%) of group Ia and 9 patients (75%) of group Ib. Thymus hyperplasia was found in 5 patients (5%) of group IIb. The eldest of these 5 patients was 25 y old. No increased FDG accumulation in the thymus was observed in any of the group IIa patients. In cases of visible FDG uptake in the thymus, standardized uptake values did not exceed 4. CONCLUSION: FDG accumulation in the thymus is a common finding in children and can occasionally be observed in young adults after chemotherapy. Knowledge of the characteristics of a typical retrosternal lesion in conjunction with the clinical history allows avoidance of diagnostic uncertainty and unnecessary procedures.
Subject(s)
Antineoplastic Agents/therapeutic use , Fluorodeoxyglucose F18 , Radiopharmaceuticals , Thymus Gland/diagnostic imaging , Thymus Hyperplasia/chemically induced , Tomography, Emission-Computed , Adolescent , Adult , Age Factors , Antineoplastic Agents/pharmacology , Child , Diagnosis, Differential , Humans , Lymphoma/diagnostic imaging , Lymphoma/drug therapy , Middle Aged , Neoplasms/drug therapy , Retrospective Studies , Thymus Gland/drug effects , Thymus Hyperplasia/diagnostic imaging , Thymus Neoplasms/diagnostic imaging , Thymus Neoplasms/secondaryABSTRACT
AIM: To investigate whether results of [F-18]-fluorodeoxy-d-glucose (FDG) positron emission tomography (PET) of esophageal cancer (EC) before and after neoadjuvant radio-chemotherapy correlate with histopathology after esophageal resection. METHODS: Twenty consecutive patients with EC without distant metastases were examined twice with 18F-FDG-PET during primary staging and after neoadjuvant radio-chemotherapy. FDG standardised uptake values (SUV) were correlated with the histopathological findings (percentage of viable tumour cells, tumour regression grade 1-5). RESULTS: Regression analysis revealed a slight (not significant) positive correlation between SUV(pre) (R=0.41, p=0.08) and SUV(post) (R=0.37, p=0.11) and the percentage of viable tumour cells in the resectate. Although all patients showed a significant decrease in SUV after radio-chemotherapy (p < 0.01) the percentual decrease of the SUV after therapy (DeltaSUV%) did not significantly differ between the TRG-groups. In 12 of 20 patients (60%), therapy-induced esophagitis was detected in post-therapeutic PET images. CONCLUSION: In EC, a higher pre-therapeutic SUV might be correlated with a higher fraction of vital tumour cells remaining after radio-chemotherapy. Applying the neoadjuvant therapy protocol and the study design used in this examination, there is no correlation between decrease in SUV and histopathology.
Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/therapy , Fluorodeoxyglucose F18/therapeutic use , Neoadjuvant Therapy , Radiopharmaceuticals/therapeutic use , Tomography, Emission-Computed , Adenocarcinoma/classification , Adult , Aged , Chemotherapy, Adjuvant/adverse effects , Esophageal Neoplasms/classification , Esophagitis/chemically induced , Esophagitis/radiotherapy , Esophagus/diagnostic imaging , Esophagus/pathology , Female , Germany , Humans , Male , Middle Aged , Neoplasm Staging , Radiotherapy, Adjuvant/adverse effects , Statistics as Topic , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The effect of hypericum extract LI 160 on the stimulated cytokine expression was investigated in vitro in a whole blood culture system. Blood samples were taken from five healthy volunteers and four depressive patients. The release of interleukin-6 (IL-6), interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) was measured quantitatively after an incubation time of 24 hours on microtiter plates. A massive suppression of the interleukin-6 release was found for PHA-stimulated hypericum extract. Possible relations to the antidepressive effects of hypericum extract are discussed.
Subject(s)
Antidepressive Agents/pharmacology , Cytokines/drug effects , Perylene/analogs & derivatives , Plant Extracts/pharmacology , Quercetin/analogs & derivatives , Xanthenes/pharmacology , Cytokines/metabolism , Depression/immunology , Humans , Hypericum , In Vitro Techniques , Interleukin-1/metabolism , Interleukin-6/metabolism , Perylene/pharmacology , Pilot Projects , Plants, Medicinal , Quercetin/pharmacology , Tumor Necrosis Factor-alpha/drug effects , Tumor Necrosis Factor-alpha/metabolismABSTRACT
OBJECTIVE: The impact of the (2-(fluorine-18)-fluoro-2-2deoxy-D-glucose)-positron emission tomography ((18)F-FDG-PET) for discrimination of pulmonary lesions was evaluated in a single centre prospective study. METHODS: In the study, 109 patients with pulmonary lesions of unknown origin verified by computed tomography were enrolled consecutively (April 1999--May 2000). They were subject to (18)F-FDG-PET diagnostics. (18)F-FDG-PET images were interpreted by two independent nuclear medicine physicians who were blinded to the results of other imaging procedures. In 87 patients, surgery was applied followed by histological investigation, which served as the gold standard. In 22 other patients, extensive tumour load or assumed benign dignity of the lesions prevented surgery. RESULTS: Overall sensitivity of (18)F-FDG-PET in 87 resected patients was 0.86. Differentiation in malignant (n = 69) and benign lesions (n = 18) revealed sensitivities of 0.9 and 0.72, respectively. Sensitivity of (18)F-FDG-PET in inflammatory lesions was markedly lower (0.43) than in benign tumours (0.91). Standard uptake values were significantly increased in malignant tumours compared with benign lesions (9.9 and 1.6, respectively; P = 0.035). There was a clear correlation of sensitivity with tumour size with a failure rate of 27% in lesions < or = 1cm (n = 15), 10% (n = 20) in lesions between 1 and 2 cm and 12% (n = 45) above 2 cm. In primary bronchial carcinoma, a clear correlation of sensitivity was observed with regard to tumour grading (G1, three out of five; G2, 24 out of 27; G3, 26 out of 26; and G4, one out of one). Lymph node involvement was correctly suggested in 10 out of 19 (52.6%) patients. However, false positive lymph node enhancement was indicated in one out of 18 (5.5%) operated patients with benign lesions and eight out of 39 (20.5%) with bronchial carcinoma. CONCLUSION: (18)F-FDG-PET at present does not serve as the gold standard for early detection of small and well-differentiated tumours. However, it contributes efficiently to the detection of malignancy in tumours >1cm, which are moderately or poorly differentiated. Positive lymph node imaging must not preclude surgery but requires histological proof. Discrimination of benign and malignant pulmonary tumours by (18)F-FDG-PET appears to be hampered in inflammatory lesions.
Subject(s)
Lung Diseases/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Tomography, Emission-Computed , Adenocarcinoma/diagnostic imaging , Adult , Aged , Aged, 80 and over , Carcinoma, Large Cell/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Female , Fluorodeoxyglucose F18 , Humans , Male , Middle Aged , Prospective Studies , Radiopharmaceuticals , Sensitivity and SpecificityABSTRACT
We describe the case of a 42-year old female patient with a carcinoma of the adrenal cortex. The primary tumor was resected without residual tumor tissue; only two weeks later there was a new large tumor formation in the adrenal gland's bed. PET-investigation showed the large local recurrency, multiple lung-, and liver-metastasis, so that no further operative therapy was performed. FDG-PET seems to be suitable for diagnosis and staging of adrenal cortex carcinoma in one single examination.
Subject(s)
Adrenal Cortex Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Liver Neoplasms/secondary , Lung Neoplasms/secondary , Radiopharmaceuticals , Tomography, Emission-Computed , Adrenal Cortex Neoplasms/pathology , Adrenal Cortex Neoplasms/surgery , Adult , Female , Fluorodeoxyglucose F18/pharmacokinetics , Humans , Liver Neoplasms/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Neoplasm Recurrence, Local , Radiopharmaceuticals/pharmacokinetics , Time FactorsABSTRACT
AIM: Identification of a rationale for the appropriate uptake period for static clinical extracranial head and neck PET imaging and evaluation of the diagnostic accuracy of such an optimized FDG PET approach for lymph node staging in the head and neck region. METHODS: In a subset of 5 patients, kinetic tumour studies were performed in order to identify the cellular activity plateau phase of FDG accumulation for head and neck cancer. Seventy-eight consecutive patients (11 women, 67 men; mean age +/- SD: 55 +/- 11 years; range, 36-78 years), presenting with histologically proven squamous cell carcinoma and sonographically detected lymph nodes in 86 neck sides, underwent clinically indicated FDG PET imaging. PET results were compared to those derived from histological examinations and follow-up imaging results after 6 months in order to calculate sensitivity and specificity for lymph node staging. RESULTS: FDG kinetics in head and neck cancer indicate that the cellular activity plateau of FDG accumulation is reached after an uptake period of 90 min. Using this protocol metastatic involvement of neck sides with lymph nodes less than 1 cm in diameter was correctly identified with a sensitivity of 71.4% and a specificity of 92.3%. Sensitivity increased with the lymph node diameter (1.1-1.5 cm 83.3%, 1.6-2.0 cm 100%, > 2 cm 88.9%). CONCLUSION: The appropriate uptake period for static clinical extracranial head and neck PET imaging that allows measurements in the activity plateau phase is about 90 min. FDG PET may add some significant information regarding metastatic spread into regional lymph nodes.
Subject(s)
Fluorodeoxyglucose F18 , Head and Neck Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Neoplasm Metastasis/diagnostic imaging , Radiopharmaceuticals , Adult , Aged , Biological Transport , False Negative Reactions , False Positive Reactions , Female , Fluorodeoxyglucose F18/administration & dosage , Fluorodeoxyglucose F18/pharmacokinetics , Head and Neck Neoplasms/pathology , Humans , Injections, Intravenous , Male , Middle Aged , Neoplasm Staging , Observer Variation , Radiopharmaceuticals/administration & dosage , Radiopharmaceuticals/pharmacokinetics , Reproducibility of Results , Tomography, Emission-Computed , UltrasonographyABSTRACT
AIM: Left ventricular volume and function can be computed from gated SPECT myocardial perfusion imaging using Emory Cardiac Toolbox (ECT) or Gated SPECT Quantification (GS-Quant). The aim of this study was to compare both programs with respect to their practical application, stability and precision on heart-models as well as in clinical use. METHODS: The volumes of five cardiac models were calculated by ECT and GS-Quant. 48 patients (13 female, 35 male) underwent a one day stress-rest protocol and gated SPECT. From these 96 gated SPECT images, left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were estimated by ECT and GS-Quant. For 42 patients LVEF was also determined by echocardiography. RESULTS: For the cardiac models the computed volumes showed high correlation with the model-volumes as well as high correlation between ECT and GS-Quant (r > or = 0.99). Both programs underestimated the volume by approximately 20-30% independent of the ventricle-size. Calculating LVEF, EDV and ESV, GS-Quant and ECT correlated well to each other and to the LVEF estimated by echocardiography (r > or = 0.86). LVEF values determined with ECT were about 10% higher than values determined with GS-Quant or echocardiography. The incorrect surfaces calculated by the automatic algorithm of GS-Quant for three examinations could not be corrected manually. 34 of the ECT studies were optimized by the operator. CONCLUSION: GS-Quant and ECT are two reliable programs in estimating LVEF. Both seem to underestimate the cardiac volume. In practical application GS-Quant was faster and easier to use. ECT allows the user to define the contour of the ventricle and thus is less susceptible to artifacts.
Subject(s)
Gated Blood-Pool Imaging , Heart/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Ventricular Function, Left , Algorithms , Humans , Image Processing, Computer-Assisted , Reproducibility of Results , SystoleABSTRACT
AIM: Identification of a rationale for the appropriate uptake period for myocardial (18)F-FDG-PET imaging of patients with and without diabetes mellitus. METHODS: In a subset of 27 patients, static 2D-PET examination was performed of patients with chronic coronary artery disease and known myocardial infarction. The patients fasted (at least 4 h) before examination. (18)F-FDG (330 +/- 20 MBq) was injected intravenously. The image quality was semiquantitativly determined by ROI-analysis and the myocardium-to-blood pool activity ratio (M/B) was calculated. I.) Scans 30, 60, and 90 min p. i. of 10 non-diabetic patients (60 g oral glucose loading one hour before FDG-injection, low-dose intravenous insulin bolus if necessary). II.) Scans 30, 60, and 90 min p. i. of 10 patients with known non-insulin dependent diabetes (20 g glucose, insulin bolus). III.) Scans 90 min p. i. of 7 patients with known non-insulin dependent diabetes and elevated fasting serum glucose level (140-200 mg/dl; insulin bolus, no glucose). RESULTS: I.) The M/B ratio significantly increases in nondiabetic patients with the uptake time (30 min 1.95 +/- 0.20; 60 min 2.96 +/- 0.36; 90 min 3.78 +/- 0.43). II.) In patients with non-insulin dependent diabetes the M/B ratio also significantly increases with uptake time. Compared to non-diabetic patients group II reached smaller M/B values (30 min 1.56 +/- 0.10; 60 min 2.15 +/- 0.14; 90 min 2.71 +/- 0.19). III.) In the group of patients with elevated fasting serum glucose level (who only got insulin but no glucose loading) the M/B activity ratio 90 min p. i. was clearly inferior compared with diabetic patients after oral glucose loading and insulin administration (M/B 2.71 +/- 0.19 versus 2.16 +/- 0.07). CONCLUSIONS: In static myocardial viability PET studies with (18)F-FDG an uptake time of 90 min yields image quality superior to that obtained after shorter uptake time.