Chromosomal instability in multiple endocrine neoplasia type 1. Cytogenetic evaluation with DEB test.

Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant condition with high penetrance and variable expressivity, in which tumors or hyperplasia occur in two or more endocrine organs. Some authors have investigated chromosomal instability in MEN 1 and MEN 2; the results are controversial. Chromosome analyses were performed on lymphocytes from seven patients with MEN 1, four healthy first-degree relatives (three of whom were children), six phenotypically normal volunteers, and three patients with Fanconi's anemia. To evaluate chromosomal instability we analyzed phytohemagglutinin-stimulated lymphocyte cultures with and without diepoxibutane. We observed an increase in the frequency of spontaneous chromosomal alterations in four patients. After the DEB test we found an increase in chromatid breakages, gaps, and exchange figures. These findings support the inclusion of the MEN 1 syndrome among the disorders with "chromosomal instability."

Immunoscintigraphy as an adjunct to diagnostic imaging in septic sacroiliitis. Report of a case.

Septic sacroiliitis in childhood is a relatively rare condition. We describe a case of septic sacroiliitis occurring in an 11-year-old girl in whom the diagnosis was suspected on clinical findings and bone scan. Immunoscintigraphy with 99mTc-labelled antigranulocyte antibodies further supported the hypothesis for a septic origin of the disease. The clinical evolution clinched the diagnosis.

HSP and apoptosis in leukocytes from infected or vaccinated animals by Brucella abortus.

The production of hsp and apoptosis of leukocytes in the peripheral blood of animals naturally infected with Brucella spp or treated with the vaccine Brucella abortus 19 have been investigated in this study. Cytokines able to induce phagocytic activity in macrophages of non treated healthy animals were found in the supernatant of bovine leukocytes cultivated in vitro. A long-lasting antibody response against hsp 60 kDa and 27 kDa, which lasts a long time, is induced in naturally infected animals, while in animals vaccinated with B. abortus 19 we detected an antibody response against hsp 60 and 70 kDa which is much shorter, disappearing in two months. During the early phase of infection, lymphocytes and monocytes of naturally infected animals show a delay of apoptosis in vitro compared to the same cells coming from healthy controls and vaccinated animals.

[New etiopathogenic, clinical and therapeutic findings in multiple endocrine neoplasia type 1]. / Nuove acquisizioni eziopatogenetiche, cliniche e terapeutiche nella neoplasia endocrina multipla di tipo 1.

Multiple Endocrine Neoplasia type 1 (MEN 1) syndrome comprises tumors or hyperplasia of different glands, including parathyroid, pituitary, adrenal cortex and the gastroenteropancreatic system. The vast majority of MEN 1 are found in familial clusters, although a few cases are sporadic. Hypercalcemia and/or nephrocalcinosis are the first and most common clinical manifestation in familial MEN 1 syndrome, followed by islet cell tumors (especially those secreting gastrin or insulin) and pituitary dysfunction due to either functioning or non-functioning microadenomas. Genetic studies indicate that familial MEN 1 syndrome is inherited through a dominant gene with incomplete penetrance and variable expression. The diagnosis of MEN 1 syndrome is mainly based on the careful assessment of the clinical history, symptoms physical evaluation along with the assay of serum electrolytes (i.e., calcium, phosphorus, etc.) and hormonal substances (i.e., gastrin, insulin, pancreatic polypeptide, prolactin, adrenocorticotropic hormone, etc.). In addition, several provocative tests have been used to identify endocrine tumors (particularly those of the gastroenteropancreatic system) and imaging techniques play a crucial role for the diagnostic approach in MEN 1 syndrome. Even though in the long term, the prognosis of MEN 1 syndrome is unfavourable. Recently, however, many therapeutic strategies, including both surgical and pharmacological options, have been developed to reduce the size of the neoplasm and control symptoms associated with hormone oversecretion.

Breast cancer detection with Tc-99m tetrofosmin.

Myocardial SPECT imaging was performed with Tc-99m tetrofosmin. Intense focal uptake at the level of the left breast was observed. At mammography a breast carcinoma was suspected, which was confirmed after surgery. This may be the first report of neoplastic mammary uptake of Tc-99m tetrofosmin.

Kinetics of Tc-99m sestamibi and Tc-99m tetrofosmin in a case of parathyroid adenoma.

The uptake of Tc-99m tetrofosmin (TF) is reported in a case of parathyroid adenoma. A 65-year-old woman was studied on different days with TF, Tc-99m sestamibi (MIBI) and Tl-201 chloride (Tl). TF and MIBI injections were preceded by oral administration of potassium perchlorate. Clear identification of the adenoma was observed in all scans. No further information was obtained using a subtraction technique with Tc-99m pertechnetate. Regarding the thyroid/parathyroid ratio, different kinetics between TF and MIBI appear to be demonstrated. In particular, thyroid washout was observed with MIBI but not with TF.

[Role of magnetic resonance in acute capsular-ligamentous pathology of the knee]. / Ruolo della risonanza magnetica nella patologia capsulo-legamentosa acuta del ginocchio.

Magnetic Resonance (MR) imaging was employed to evaluate musculoskeletal pathoanatomy, and proved to be extremely useful in characterizing knee pathology. Between October 1986 and November 1987, 24 patients with suspected traumatic ligament injuries were examined with high resolution MR imaging in the RMRC diagnostic center, Naples, with a 0.5 T superconducting magnet (5000 Magniscan CGR) using a surface coil and a 500/28 (repetition time: TR: ms/echo time: TE-ms), 1200-1600/35-105 spin-echo pulse sequence. Nineteen patients with positive MR imaging exams underwent diagnostic and/or therapeutic arthroscopy. Arthroscopy confirmed MR diagnosis in the whole of cases. In 6 patients with negative MR findings no arthroscopy followed and the patients' successful outcome confirmed the accuracy of MR negative predictive value. Such results prove MR imaging to have a high diagnostic accuracy in the evaluation of acute joint injuries of the knee. Moreover, MR imaging--an uninvasive screening technique--appears to have high potentials for the evaluation of those cases where diagnostic arthroscopy is not required.

111In-octreotide in the evaluation of autoimmune thyroid diseases.

Aim of our study was to evaluate the uptake of Indium-111 Octreotide (OCT) at the level of thyroid and orbits in autoimmune thyroid diseases. Nine patients with Graves' disease (GD) who were also affected with thyroid associated ophthalmopathy (TAO) and four patients with Hashimoto's thyroiditis (HT) were evaluated. A patient with lung cancer, presenting ophthalmopathy did not related to autoimmune dysthyroidism, was also studied. All patients with ophthalmopathy were evaluated by a Clinical Activity Score and an A-scan standardized echography. Multiple planar images were acquired over a 24-hour period after i.v. injection of 111 MBq of 111In-OCT. A SPECT study was also obtained in 7 patients five hours after the injection. A qualitative analysis was performed. Semiquantitative ratios comparing the counts on the thyroid with respect to background (T/BK) and on the orbits and brain with respect to the blood-pool were also obtained. Thyroid uptake of OCT was higher in GD with respect to HT, and was not related to the functional state of the gland. The highest T/BK ratio was observed at the 24 hour control. Intense orbital uptake was observed only in case where a clinically active ophthalmopathy was present.

Immediate and late effects of ventricular shunting in infantile hydrocephalus.

This paper analyzes our findings in a series of 1900 CT examinations carried out on 950 children after ventricular drainage. Blood in the ventricles is a relatively frequent findings in the immediate postoperative course, and gliotic or poroencephalic phenomena are often found in the late course. Persistence of ventricular dilatation and periventricular lucency has been observed several times. Extracerebral collections and septic complications are not rare findings, but trapped fourth ventricle and choroidal-ependymal reactions are only rarely observed.

High resolution CT spinal scanning with Acta 0200 FS.

The diagnostic features of CT images of the spine are constantly influenced by some limitations of the method because of the peculiar configuration of the human spine. Recent generations of CT scanners greatly improve the results but with the second generation (Acta 0200 FS Pfizer Scanner) we have been able to develop a modified scan reconstruction method to maintain the quality of our spinal images, thanks to the very flexible software of our CT scanner.

Indium-111 octreotide in Graves' disease and in the evaluation of active exophthalmos.

Thyroid Associated Ophthalmopathy (TAO) is an autoimmune disorder generally associated with Graves' disease (GD). The aim of our study was to evaluate the uptake of indium-111 Octreotide (111In-OCT), a somatostatin (SS) analogue able to bind specific SS receptors, at the level of the thyroid and orbits in patients with TAO. Seven patients with exophthalmos were investigated: six had GD while one was affected with a non small cell lung cancer (NSCLC). One patient with GD had undergone total thyroidectomy (TT) for a thyroid cancer. At the time of the study two patients were hyperthyroid, four were euthyroid and one was hypothyroid. 111 MBq of 111In-OCT were i.v. injected and two 30-minute scans were performed at 4 and 24 hours; 5 minute planar images were also obtained at 25, 60 and 120 minutes. A 180 degrees SPECT was carried out 5 hours after the injection in one patient. A qualitative analysis was performed, comparing these images with those obtained in 7 control patients without thyroid illness or exophthalmos. Moreover, in the TAO patients thyroid, orbit and brain counts were evaluated in comparison with background (BK) and blood activity (BA), measured at the level of the venous longitudinal sinus. In GD intense thyroid uptake was demonstrated independently of the functional state, with highest ratio compared to BK seen at 24 hours. Low uptake in the patient with NSCLC, no activity in the patient with GD that underwent TT, and slight or absent thyroid uptake in the controls were observed. Intense uptake was seen in the orbits of the patient who clinically had the most severe ophthalmopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic and prognostic role of 99mTc-Tetrofosmin in breast cancer.

99mTc-Tetrofosmin (TF) is a lipophilic diphosphine compound routinely used for myocardial scintigraphy. Extracardiac utilization has occurred in evaluation of patients with malignant neoplasms and in parathyroid adenomas. Although its uptake mechanisms are not completely understood, they appear similar to those of 99mTc Setamibi (MIBI). The importance of flow and the metabolic status of cells with an intracellular uptake depending on mitochondria and the Na+/K+ pump have been hypothesized. It has also been demonstrated that Tetrofosmin shares with MIBI the property of being a substrate for P-glycoprotein (P-gp), a multidrug resistance transporter. In this review the possible clinical role in breast cancer is analysed. First experiences suggest that scintimammography with TF is useful in patients with indeterminate Mammography and to obtain complementary data to avoid surgery and/or biopsy. TF is a reliable tracer for diagnosis of primary cancer, of local recurrence of axillary lymph node metastases. Preliminary data stimulate a possible role in functional imaging of chemoresistance and in differential diagnosis of distant metastases with main reference to the evaluation of single hot lesions at bone scan.