Comparison Between the Maximum Standard Uptake Value and the Ratio of Lymph Node to Primary Tumor Attenuation in Head and Neck Cancers: A Prospective Study.

OBJECTIVE: The study aimed to investigate the relationship between the ratio of lymph node attenuation to primary lesion attenuation on contrast-enhanced CT and the PET/CT standard uptake value (SUVmax) in head and neck squamous cell cancer (HNSCC). METHODS: Volunteers with advanced-stage, histopathologically proven HNSCC, indicated to have radiotherapy/chemoradiotherapy, were evaluated for CT and PET/CT for radiotherapy planning. The attenuation and SUVmax of the primary lesion and the largest, possibly metastatic lymph node, and the round index and volume of the lymph node were calculated. The relationship between lymph node/primary lesion attenuation and SUVmax ratios was investigated. The differences in CT findings between the SUVmax < and ≥3 groups were examined. RESULTS: Thirty-two cases with adequate diagnostic quality were studied. There was a very strong positive correlation between the primary lesion and lymph node attenuation (r=0.817, p<0.001), a strong correlation between the lymph node volume and SUVmax (r=0.681, p<0.001), and a moderate negative correlation between lymph node/primary lesion SUVmax and attenuation (r=-0.503, p=0.004). In patients with ≥3 SUVmax, lymph node volume and lymph node/primary lesion SUVmax were significantly higher, and the attenuation ratio was close to 1 (PPV 94.1, 86.3%, respectively). CONCLUSION: In HNSCC, the lymph node/primary lesion attenuation ratio can be used instead of SUVmax if supported by other conventional CT findings. Metastasis should be considered if lymph node attenuation is similar to primary mass attenuation and excluded if higher. CT attenuation rate can be used as a supportive finding if PET/CT cannot be performed or lymph node SUVmax is close to the acceptable cut-off for metastasis.

Which of the fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography parameters are better associated with prognostic factors in breast cancer?

The aim of the present study is to evaluate the relationship between the immunohistochemical and histopathological prognostic factors and the metabolic fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography (PET/CT) parameters in breast cancer.A total of 94 female patients diagnosed with primary breast cancer (median age: 54.5 years, 94 lesions with size >15 mm) who underwent PET/CT imaging before any treatment were enrolled to this retrospective study. Maximum and average standardized uptake values (SUVmax and SUVavg), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor/liver uptake ratio (TLR) of the primary tumors were calculated and compared between various histopathological and immunohistochemical prognostic factor groups.All metabolic parameters were associated with clinical T stage, metabolic M stage, and nuclear grade. The MTV, TLG, and TLR were significantly higher in patients with suspected lymph node metastasis. There were significant differences according to estrogen receptor and human epidermal growth factor-2 status in the metabolic values other than MTV. In case of progesterone receptor, there were significant differences in the metabolic characteristics except for the MTV and TLG values. The Ki-67 labeling index was moderately correlated with SUVmax, SUVavg, and TLR. All metabolic characteristics except MTV were significantly higher in triple negative breast cancer compared with the other molecular subtypes.The results of the present study suggest that the TLG and TLR values have stronger associations with several prognostic factors in breast cancer (BC) compared with other metabolic parameters.

Prevention of Burn Wound Progression by Mesenchymal Stem Cell Transplantation: Deeper Insights Into Underlying Mechanisms.

INTRODUCTION: Burns are dynamic wounds that may present a progressive expansion of necrosis into the initially viable zone of stasis. Therefore, salvage of this zone is a major subject of focus in burn research. The beneficial effects of mesenchymal stem cells (MSCs) on the survival of the zone of stasis have been previously documented. However, many gaps still exist in our knowledge regarding the underlying protective mechanisms. Hence, this study was designed to evaluate the pathophysiological basis of MSCs in the prevention of burn wound progression. METHODS: Wistar rats received thermal trauma on the back according to the "comb burn" model. Animals were randomly divided into sham, control, and stem cell groups with sacrifice and analysis at 72 hours after the burn. The stasis zones were evaluated using histochemistry, immunohistochemistry, biochemistry, real-time polymerase chain reaction assay, and scintigraphy to evaluate the underlying mechanisms. RESULTS: Gross evaluation of burn wounds revealed that vital tissue percentage of the zone of stasis was significantly higher in the stem cell group. Semiquantitative grading of the histopathologic findings showed that MSCs alleviated burn-induced histomorphological alterations in the zone of stasis. According to CC3a staining and expression analysis of Bax (B-cell leukemia 2-associated X) and Bcl-2 (B-cell leukemia 2) genes, MSCs attenuated increases in apoptosis postburn. In addition, these transplants showed an immunomodulatory effect that involves reduced neutrophilic infiltration, down-regulation of proinflammatory cytokines (tumor necrosis factor α, interleukin 1ß [IL-1ß], and IL-6), and up-regulation of the anti-inflammatory cytokine IL-10 in the zone of stasis. Burn-induced oxidative stress was significantly relieved with MSCs, as shown by increased levels of malondialdehyde, whereas the expression and activity of the antioxidant enzyme superoxide dismutase were increased. Finally, MSC-treated interspaces had enhanced vascular density with higher expression levels for vascular endothelial growth factor A, platelet-derived growth factor, fibroblast growth factor, and transforming growth factor ß. Gamma camera images documented better tissue perfusion in animals treated with MSCs. CONCLUSIONS: The protective effects of MSCs are mediated by the inhibition of apoptosis through immunomodulatory, antioxidative, and angiogenic actions.

Propolis Protects Endotoxin Induced Acute Lung and Liver Inflammation Through Attenuating Inflammatory Responses and Oxidative Stress.

Propolis is a natural bee product, and it has many effects, including antioxidant, anti-inflammatory, antihepatotoxic, and anticancer activity. In this study, we aimed to explore the potential in vivo anti-inflammatory, antioxidant, and antiapoptotic properties of propolis extract on lipopolysaccharide (LPS)-induced inflammation in rats. Forty-two, 3- to 4-month-old male Sprague Dawley rats were used in six groups. LPS (1 mg/kg) was administered intraperitoneally to rats in inflammation, inflammation + propolis30, and inflammation+propolis90 groups. Thirty milligram/kilogram and 90 mg/kg of propolis were given orally 24 h after LPS injection. After the determination of the inflammation in lung and liver tissues by 18F-fluoro-deoxy-d-glucose-positron emission tomography (18FDG-PET), samples were collected. The levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), nitric oxide (NO), and DNA fragmentation were determined. The decrease of MDA levels in inflammation + propolis30 and inflammation + propolis90 groups was determined compared to the inflammation group in lung and liver tissues. The increase of SOD% inhibition in inflammation + propolis90 group was determined in liver, lung, and hemolysate compared to the inflammation group. Increased CAT activities in inflammation + propolis30 and inflammation + propolis90 groups were observed in liver tissue and hemolysate compared to inflammation group. In lung tissue, NO levels were lower in inflammation group compared to the control group, but DNA fragmentation levels were higher. 18F-FDG uptake of tissues in inflammation + propolis30 and inflammation + propolis90 groups was decreased compared to the inflammation group. In conclusion, the data of this study indicate that the propolis application may serve as a potential approach for treating inflammatory diseases through the effect of reducing inflammation and free oxygen radical production.

Posttreatment Effects of Olea Europaea L. Leaf Extract on Carbon Tetrachloride-Induced Liver Injury and Oxidative Stress in Rats.

The aim of this study is to examine the therapeutic effects of Olea europaea L. leaf extract on carbon tetrachloride (CCl4)-induced liver damage in rats. In the experiments, 3- to 4-month-old 28 male Sprague-Dawley rats were divided into four groups: control, O. europaea leaf extract, CCl4, and curative. The CCl4 and curative groups received CCl4 (0.2 mL/kg) intraperitoneally for 10 days to form hepatic injury. O. europaea (80 mg/kg) leaf extract was given orally to the curative group dissolved in distilled water the following 14 days. Hepatic and antioxidant enzyme levels, p53, caspase 3, lipid peroxidation marker malondialdehyde (MDA), and also DNA fragmentation levels were determined to establish oxidative stress in hepatic cell damage and its consequences. After formation of liver damage, oral administration of the O. europaea significantly reduced CCl4-induced elevations of serum alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase levels (P < .001), MDA levels of both blood (P < .001) and liver tissues (P < .001), DNA fragmentation (P < .001), p53 (P < .001), and caspase 3 (P < .001) levels of liver tissues. Also this administration in curative group significantly increased CCl4-induced reductions of superoxide dismutase (SOD) (P < .001) and catalase (CAT) (P < .001) activity of blood samples and decreased SOD (P < .001) and CAT (P < .05) activity observed in liver tissue curative groups compared with CCl4 curative group. In CCl4 group, liver tissue samples exhibited remarkable damage because of CCl4 and reduction of these damages were observed in the curative group. Our results showed that O. europaea leaf extract was effective in reducing hepatic damage caused by CCl4 by reducing lipid peroxidation, regulating antioxidant enzymes, and minimizing DNA damage.

The Anti-Inflammatory and Antioxidant Effects of Salvia officinalis on Lipopolysaccharide-Induced Inflammation in Rats.

Salvia officinalis, which has a high phenolic acid and flavonoid content, is a powerful antioxidant and anti-inflammatory herb. Inflammation plays an important role in the pathophysiology of many diseases and could cause damage by means of oxidative stress. The aim of this study was to investigate the anti-inflammatory and antioxidant activity of S. officinalis formed lipopolysaccharide (LPS)-induced experimental inflammation model. Four- to five-month-old 42 female Wistar albino rats were divided into six groups. Three groups were administered intraperitoneally 1 mg/kg LPS. Twenty-four hours after injection of LPS, 10 and 30 mg/kg S. officinalis extract were given orally to treatment groups. Pulmonary and hepatic 18F-fluoro-deoxy-D-glucose (18F-FDG) uptake was calculated to determine the status of inflammation by 18F-fluoro-deoxy-D-glucose-positron emission tomography (18FDG-PET) scan. Antioxidant enzyme activities and nitric oxide (NO) and malondialdehyde (MDA) levels were determined. Nuclear factor-kappa B (NF-κB) and tumor necrosis factor-alpha (TNF-α) levels were also detected in serum. As a result, lung and liver 18F-FDG uptake was found to be higher in the inflammation group than control group. MDA levels in erythrocyte and all tissue samples (liver, lung, and kidney) were found to be significantly higher compared to treatment groups. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase activities of the inflammation group in the liver, lung, kidney tissues, and erythrocyte SOD and CAT activities were determined to significantly lower than groups treated with S. officinalis. Increased NO, NF-κB, and TNF-α levels were found in the inflammation group. S. officinalis has been observed to have useful effects on LPS-induced inflammation and oxidative stress in rats.

Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?

OBJECTIVE: To investigate the effect of fusion on short segment including fractured level (SSIFL) and long segment (LS) transpedicular fixation after acute thoracolumbar junction burst fractures. The 2-year clinical and radiologic follow-up results of the 2 groups also were compared. METHODS: Seventy-four patients were randomized into one of 2 groups: SSIFL (n = 39) or LS (n = 35). The SSIFL group included one level above and one level below, including the fracture level, whereas the LS group included 2 levels above and 2 levels below, excluding the fracture level, for the transpedicular fixation. Fusion was assessed by technetium 99m-methylendiphosphonate, bone scintigraphy, and single-photon emission computed tomography. The 2-year follow-up results were compared clinically (Oswestry Disability Index and visual analog scale) and radiologically (kyphosis angle, sagittal index, anterior vertebral body height loss) at regular intervals. The clinical scores and radiologic parameters of patients with and without fusion also were compared. RESULTS: The number of patients with fusion was significantly greater in the SSIFL group compared with the LS group. There was a significant reduction of the clinical scores of patients who had fusion compared with the fusion-free group; however, there was no radiologically significant difference. Furthermore, there was no significant difference between the SSIFL and LS groups in terms of the 2-year radiologic and clinical follow-up results. CONCLUSIONS: Fusion occurred sooner and patients experienced earlier clinical recovery in the SSIFL group compared with the LS group.

What approach should we take for the incidental finding of increased 18F-FDG uptake foci in the colon on PET/CT?

INTRODUCTION: F-Fluorodeoxyglucose (F-FDG) PET/CT represents an imaging modality that is gaining increasingly more prominence in screening, staging, and therapeutic monitoring of malignant diseases. An incidental focus of uptake in different regions of the body is not an uncommon finding during PET/CT imaging. Patients with incidental gastrointestinal tract findings comprise ∼3% of the overall patient group. The aim of the current study was to provide contributory information in relation to the answer on the most appropriate approach in cases with incidental colonic F-FDG uptake. PATIENTS AND METHODS: A retrospective examination was performed on PET/CT results of 5258 patients. Of these, 152 were recommended to undergo colonoscopy because of the presence of suspicious foci and 31 underwent colonoscopy within 60 days with biopsy from all visible lesions. These dates were also examined. RESULTS: Of the 24 patients undergoing colonoscopy with a suspicion of malignancy, five (20.83%) had no pathological findings. Of the 19 (79.17%) cases with a pathological finding in endoscopy, histopathology showed a benign lesion in five (20.83%), premalignant lesion in seven (29.17%), and a malignant lesion in seven (29.17%). Among seven patients undergoing colonoscopy because of a suspicion of inflammatory bowel disease, five were free of pathological signs and two patients with pathological endoscopy findings had nonspecific inflammation as documented by histopathological examination. CONCLUSION: Colonoscopic and histopathological examination of the increased foci of colonic F-FDG uptake incidentally detected at PET/CT seems to be a plausible approach.

Anti-inflammatuar and anti-oxidative effects of Nigella sativa L.: 18FDG-PET imaging of inflammation.

Inflammation has an important role in many diseases such as cystic fibrosis, allergies and cancer. The free radicals produced during inflammation, can induce gene mutations and posttranslational modifications of cancer related proteins. Nigella sativa L. (N. sativa) is herbaceous plant and commonly used as a natural food. It has many pharmacological effects including antibacterial, antifungal, antitumor, analgesic, antipyretic activity. The aim of this study was to investigate the anti-inflammatuar and anti-oxidant activity of N. sativa in acute inflammation. Thus we used the experimental lipopolysaccharides (LPS)-induced model. Intraperitoneal LPS 1 mg/kg was administered to groups. N. sativa (500 mg/kg) and essential oil (5 ml/kg) were given orally to treatment groups, after 24-h of intraperitoneal LPS-injection. To determine the lung inflammation, 18F-fluoro-deoxy-D-glucose (0.8 ml/kg) was administrated under the anesthesia before the 1 h of PET-scanning. After the FDG-PET, samples were collected. Lung and liver 18F-FDG-uptake was calculated. Serum AST, ALT, LDH and hcCRP levels were determined and liver, lung and erythrocyte SOD, MDA and CAT levels were measured. Liver and lung NO and DNA fragmentation levels were determined. MDA levels were decreased in treated inflammation groups whereas increased in untreated inflammation group. SOD and CAT activities in untreated inflammation group were significantly lower. According to the control group, increased AST and ALT levels were found in untreated inflammation group. 18F-FDG uptake of inflammation groups were increased when compare the control group. We found increased 18F-FDG uptake, DNA fragmentation and NO levels in LPS-induced inflammation groups. We conclude that, in LPS-induced inflammation, N. sativa have therapeutic and anti-oxidant effects.

Discordant findings in patients with non-small-cell lung cancer: absolutely normal bone scans versus disseminated bone metastases on positron-emission tomography/computed tomography.

OBJECTIVE: At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. The objective of our study was to compare the sensibility of the 2-deoxy-2-[18F] fluoro-d-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for the detection of bone metastasis in patients with non-small-cell lung cancer (NSCLC) whose technetium 99m methylenediphosphonate (Tc-99m MDP) bone scans were absolutely normal. MATERIAL AND METHODS: This study based on the retrospective analysis of 95 consecutive patients with histologically proven NSCLC who underwent F-18 FDG PET/CT and Tc-99m MDP bone scan at the Eskisehir Osmangazi University School of Medicine, Department of Nuclear Medicine between November 2006 and October 2008. Nineteen patients (19 of 95, 20%) with absolutely normal Tc-99m bone scan versus multiple high-grade F-18 FDG avid bony metastases on F-18 FDG PET/CT were selected for the review. Their ages ranged from 46 to 73 years (15 males and four females; mean: 57.2 years). RESULTS: Nine patients had squamous cell carcinoma, six had adenocarcinoma, three had large cell carcinoma and one had adenosquamous cell carcinoma. Tc-99m MDP bone scan that did not reveal bony abnormalities or radiotracer uptake was characteristic of benign disease (defined as absolutely normal) in these patients. Whereas, F-18 FDG PET/CT not only showed extremely disseminated heterogeneous nest-like high-grade FDG avid metastatic foci within the marrow cavity of the upper and lower thoracic spine, lumbar spine, pelvis, rib cages and bilateral proximal long bones, but also showed disseminated osteolytic bony metastases in these areas. CONCLUSION: Discordant findings of skeletal metastasis between Tc-99m MDP bone scans and F-18 FDG PET/CT imaging may be seen in 20% of the patients with NSCLC. F-18 FDG PET/CT could detect metastatic bone involvement more accurately than bone scintigraphy. Bone scans are insensitive to early bone marrow neoplastic infiltration. Assessment of glucose metabolism with FDG PET/CT can represent a more powerful tool to detect early bone metastases in lung cancer than with traditional bone scans.

Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study.

BACKGROUND: Several studies have already addressed the potential role of an increased fluorine 18 fluorodeoxyglucose (18F FDG) uptake in identification of pleural malignancy. In this pilot study, we investigate the role of 18F-FDG positron emission tomography/computed tomography (PET/CT) for differentiating asbestos-related benign pleural disease from malignant mesothelioma. MATERIALS AND METHODS: The study population comprised 31 consecutive patients (17 malignant mesotheliomas, nine benign asbestos pleurisies, and five diffuse pleural fibrosis) with a mean age of 61 years between January 2006 and December 2008. Thoracoscopy or image-guided pleural needle biopsy were systematically performed to reveal pathologic diagnosis and/or clinical follow-up for at least 3 years for presence or absence of malignant pleural effusion. ROCs analyses for standardized uptake value (SUV) adjusted to body weight were calculated between benign and malignant pleural diseases. RESULTS: 18F-FDG PET/CT imaging correctly detected the presence of malignancies in 15 of 17 patients with malignant mesothelioma for sensitivity, specificity, and overall accuracy of 88.2%, 92.9%, and 90.3%, respectively. 18F-FDG PET/CT imaging correctly identified 13 of 14 cases of benign pleural disease. The mean SUV values were 6.5 +/- 3.4 for malignant mesothelioma cases and 0.8 +/- 0.6 for benign pleural diseases (p < 0.001). When we compared the two groups of pleural disease, a cut-off value of 2.2 for SUV gave the best accuracy with 94.1%, 100%, 100%, and 93.3% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. CONCLUSION: Preliminary results of this trial provide evidence that 18F-FDG PET/CT imaging is a highly accurate and reliable noninvasive test to decide for further investigation of differentiating malignant mesothelioma from benign pleural disease.

Bladder dysfunction in type 2 diabetic patients.

AIMS: To reevaluate urodynamic findings of bladder dysfunction (BD) in type 2 diabetic patients with patient characteristics and concommittant chronic complications. METHODS: Patients (M/F:27/27) with lower urinary tract symptoms (LUTS) underwent a detailed urodynamic investigation. Urodynamic findings were classified as diabetic cystopathy [DC, characterized by impaired bladder sensation, increased post-void residual urine (PVR) and increased bladder capacity and decreased bladder contractility], detrusor overactivity, bladder outlet obstruction (BOO), urge and stress urinary incontinence or BD in which one of the alterations was included. Glycated hemoglobin (HbA1C), diabetic retinopathy, nephropathy, sensorimotor, and autonomic neuropathies were evaluated. RESULTS: BD was present in 74.07% of men (DC, 50%; BOO, 25%; detrusor overactivity, 25%) and in 59.26% of diabetic women (DC, 43.75%; detrusor overactivity, 31%; urge incontinence, 12.5%; stress urinary incontinence 12.5%). In men, age, duration of diabetes and HbA1C threshold values predicting BD were >64 years, >9 year, >7.9%, while in women, they were >56 years, >8 years, >7%, respectively. Prolongation of QTc, abnormal esophageal transit and gastric emptying times, diabetic retinopathy, and microalbuminuria were associated with an increased risk of PVR >or= 100 ml. CONCLUSIONS: DC was the most frequent finding in patients. Ageing, duration of diabetes, worse metabolic control, PVR 100 ml, cardiac, esophageal and gastric parasympathetic autonomic neuropathies, retinopathy, and microalbuminuria provided a means to predict BD in patients in order to investigate by urodynamics. The establishment of DC in at least 8-9 years after the diagnosis of type 2 DM was an important parameter to inform our diabetic patients.

Factor V Leiden mutation and deep venous thrombosis in a patient with hypereosinophilic syndrome.

Idiopathic hypereosinophilic syndrome is a rare condition characterized by extremely high peripheral blood eosinophil counts. Patients with idiopathic hypereosinophilic syndrome are at increased risk for thrombosis. The coexistence of idiopathic hypereosinophilic syndrome with other thrombotic disease is rare. We present an additional case of idiopathic hypereosinophilic syndrome and factor V Leiden mutation, which lead to deep vein thrombosis.

Detection of hibernate myocardium by 99mTc sestamibi gated SPECT during low-dose dobutamine infusion plus nitrate in patients with first acute myocardial infarction.

AIM: To investigate the role of Tc-MIBI gated SPECT imaging following the administration of low-dose dobutamine plus nitrate (LDD+nitrate) in the assessment of left ventricular function and the perfusion of hibernate myocardial tissue. METHODS: The study group comprised 29 patients diagnosed as having acute myocardial infarction. In the first month post-infarction, Tc-MIBI gated SPECT imaging was performed in all patients at rest-dobutamine stress and LDD+nitrate. Ejection fraction, end diastolic volume (EDV), end systolic volume (ESV), stroke volume, volume, extent score, and reversibility score values were calculated. RESULTS: The findings of Tc-MIBI gated SPECT imaging following the administration of LDD+nitrate and the rest Tc-MIBI gated SPECT findings revealed that while the levels of ejection fraction (P=0.004) and reversibility score (P=0.000) increased significantly, there was a significant decrease in EDV (P=0.001), ESV (P=0.001), volume (P=0.017), stroke volume (P=0.257) and extent score (P=0.039) values. CONCLUSION: The use of Tc-MIBI gated SPECT concomitantly with the administration of LDD+nitrate is useful in the determination of myocardial hibernation in patients with left ventricular failure following acute myocardial infarction.

Long-term effects of antilipidaemic therapy on left ventricular function in patients with dyslipidaemia: multigated radionuclide ventriculography study.

AIM: It has been reported that dyslipidaemia impairs left ventricular systolic (LVs) and diastolic (LVd) functions, irrespective of atherogenic effects, in the setting of coronary artery disease. The aim of the present study was to evaluate the effects of anti-lipidaemic therapy on LVs and LVd functions by means of multigated radionuclide ventriculography (RNV) in subjects with signs of dyslipidaemia and with preserved left ventricular function. METHODS: Eighteen patients with dyslipidaemia (eight men, 10 women, mean age 50+/-10 years) were included in the study. While the clinical examination and treadmill exercise test results were normal in all patients, low-density lipoprotein levels exceeded 160 mg . dl. Patients with medical conditions including coronary artery disease, hypertension, diabetes, cardiomyopathy and valvular heart disease which would influence left ventricular function were excluded from the study. RNV was performed in all subjects, taking into account the best septal position to differentiate the left ventricle from the right ventricle. The following parameters were calculated: ejection fraction, peak ejection rate (PER), time to peak ejection (TPER), a ejection rate (aER), a ejection fraction (aEF), Peak filling rate (PFR), time to peak filling rate (TPFR), a filling rate (aFR), a filling fraction (aFF). RESULTS: The low-density lipoprotein value decreased and the high-density lipoprotein value increased after statin therapy (P<0.001 and P<0.003, respectively). PER, aER and aFF significantly increased and TPER decreased as a consequence of statin therapy (respectively, P<0.05, P<0.05, P<0.05 P<0.05). CONCLUSION: Anti-lipidaemic therapy is effective in dyslipidaemic patients. RNV is a useful and non-invasive method for monitoring changes in ventricular function following anti-lipidaemic treatment strategies.

Regional distribution and extent of perfusion abnormalities, and the lung to heart uptake ratios during exercise thallium-201 SPECT imaging in patients with cardiac syndrome X.

BACKGROUND: Cardiac syndrome X is defined as angina-like chest pain with transient ischemic ST-segment changes during exercise and angiographically normal epicardial coronary arteries. Studies with myocardial perfusion imaging in this syndrome have indicated that some patients, but not all, have an abnormality on perfusion scan. However, the impact of these perfusion abnormalities on pulmonary thallium uptake is not clear in this group of patients. OBJECTIVE: To evaluate the regional distribution and extent of perfusion abnormalities, and the lung to heart (L:H) uptake ratios using exercise thallium-201 single-photon emission computed tomography (TI-201 SPECT) in patients with cardiac syndrome X. METHODS: The study group consisted of 31 selected cardiac syndrome X patients with regional perfusion abnormalities during exercise TI-201 SPECT imaging. A control group included 26 healthy subjects with normal coronary angiograms, exercise testing and exercise TI-201 SPECT imaging. Exercise TI-201 SPECT results were analyzed with further estimation of the L:H ratios, number and localization of regional perfusion defects, and their mean extent scores expressed in pixels and in per cent of the left ventricular wall. Twenty-two patients with known coronary artery disease were also included in the analysis of the L:H ratios. RESULTS: Multiple perfusion defects were detected in 13 (42%) patients and perfusion defects of single localization were detected 18 (58%) patients. All patients had reversible perfusion abnormalities: 21 (67.7%) had anterior, 14 (45.2%) had inferior and 12 (38.7%) had lateral localization of perfusion defects. The analysis of the extent of the perfusion defects revealed that the mean scores of the extent of the single regional defects were 38.61+/-43.8 pixels and those of multiregional defects were 106.1+/-55.2 pixels, which corresponded to 6.05+/-1.8% and 16.6+/-5.4% of the left ventricular wall defects, respectively. Patients with cardiac syndrome X had a significantly higher L:H ratio during exercise than the healthy subjects (0.46+/-0.02 versus 0.34+/-0.03, P<0.01). In addition, L:H ratios were found to be higher in patients with multiple perfusion defects (0.50+/-0.02) than in patients who had only anterior (0.45+/-0.08) or inferior (0.43+/-0.02) perfusion defects (P<0.05 for both). There were no statistically significant differences in the rest L:H ratios between the study and control groups. Also, no significant differences were observed in exercise L:H ratios between the cardiac syndrome X patients and the patients with coronary artery disease (0.46+/-0.02 versus 0.49+/-0.03, P>0.05). CONCLUSIONS: The results suggest that multiple perfusion defects in multiple vascular regions are relatively common in cardiac syndrome X patients, with the majority of these patients having at least one abnormal perfusion bed. Patients with this syndrome who have perfusion abnormalities also had significantly higher L:H ratios during exercise than did the control patients. Increased exercise L:H ratios were more prominent in patients with multiple perfusion defects.

Quantitative three-phase bone scintigraphy in the evaluation of intravenous regional blockade treatment in patients with stage-I reflex sympathetic dystrophy of upper extremity.

OBJECTIVE: To investigate the role of quantitative three phase bone scintigraphy (QTPBS) in the evaluation of efficacy of intravenous regional blockade treatment in patients having reflex sympathetic dystrophy (RSD) of the upper extremity. MATERIAL AND METHODS: Twenty-six patients with stage-I RSD were focused on in this study. Patients were treated with physical therapy and intravenous (I.V.) regional blockade therapy consisting of dexamethasone and lidocaine. All patients were clinically evaluated before and 1 month after the completion of the therapy protocol. QTPBS was applied to patients before therapy and 1 month after the therapy. As a control group, 11 healthy subjects also underwent QTPBS. Perfusion, hyperemic and fixation indices were calculated from three-phase bone scintigraphy. RESULTS: All patients showed statistically significant clinical improvement after the therapy (p < 0.01). Pre-treatment, perfusion (1.67 +/- 0.63), hyperemic (1.44 +/- 0.48) and fixation (1.69 +/- 0.48) indices of patients were higher than those of healthy subjects (PI: 0.95 +/- 0.05, HI: 0.94 +/- 0.06, FI: 1.01 +/- 0.2) (p < 0.01) and all indices significantly decreased after the treatment (PI: 1.33 +/- 0.46, HI: 1.18 +/- 0.23, FI: 1.42 +/- 0.26) (p < 0.01). CONCLUSION: I.V. regional blockade therapy combined with corticosteroids is a simple, safe and effective method for the treatment of patients with stage-I RSD in the upper extremity. QTPBS is a valuable and objective method to evaluate the response to therapy and may be useful for staging of patients and predicting the response to therapy.

Reversible myoglobinuric renal failure following rhabdomyolysis as a rare complication of cardioversion.

Reversible myoglobinuric renal failure following rhabdomyolysis that was related to repeated countershocks delivered for the treatment of refractory recurrent VT and VF attacks during acute myocardial infarction is presented in this case report, in which scan with technetium-99m pyrophosphate has been used for in the diagnosis of extensive skeletal muscle damage.