Contribución de las imágenes PET/TC con 18F-FDG en el diagnóstico y manejo de pacientes VIH positivos / Contribution of 18F-FDG PET/CT imaging in the diagnosis and management of HIV-positive patients

Objetivo El virus de la inmunodeficiencia humana (VIH) es un lentevirus, que infecta principalmente ciertas células del sistema inmunitario, por lo que debilita las defensas propias frente a las enfermedades. El objetivo de este estudio fue valorar la significación de la PET/TC con 18F-FDG en la evaluación de pacientes con infección por VIH y determinar la presencia de diferencias cuantitativas de captación de 18F-FDG entre pacientes con infecciones relacionadas con el VIH o neoplasia maligna en pacientes VIH positivos. Métodos Se estudiaron 40 pacientes con infección por VIH mediante PET/TC con 18F-FDG. Se registró el estado inmunitario, el tratamiento antirretroviral y el diagnóstico definitivo de cada paciente. Se describieron todas las lesiones patológicas y áreas relacionadas con la enfermedad, se evaluaron los patrones de captación de 18F-FDG. Se realizó un análisis semicuantitativo de la captación de 18F-FDG mediante el cálculo SUVmax. Resultado Veintiocho pacientes (70%) fueron diagnosticados con infección relacionada con el VIH o neoplasia maligna. La sensibilidad de la PET/TC con 18F-FDG fue del 100% y la especificidad del 92% para las enfermedades concomitantes que requerían tratamiento adicional a la terapia antirretroviral. El SUVmax y el recuento de CD4 no fueron estadísticamente diferentes entre la linfadenopatía reactiva relacionada con el VIH, la neoplasia maligna relacionada con el VIH y las infecciones relacionadas con el VIH. Conclusiones El patrón de distribución de la captación ganglionar/extraganglionar en la PET/TC con 18F-FDG puede facilitar la distinción entre las adenopatías generalizadas relacionadas con el VIH, las infecciones oportunistas relacionadas con el VIH y las neoplasias malignas. En este contexto, se debe realizar el estudio PET/TC con 18F-FDG de forma rutinaria en el manejo de pacientes infectados por el VIH (AU)

Introduction and objectives The human immunodeficiency virus [HIV] is a lentevirus, primarily infects certain cells of the immune system, thereby greatly weakens the body's own defenses against diseases. This study was aimed to explore the value and significance of 18F-FDG PET/CT in the assessment of patients with HIV infection and to examine the presence of quantitative alterations in 18F-FDG uptake among patients with HIV-related infections or malignant diseases in HIV-positive patients. Patients and methods Forty patients with HIV infection were scanned on PET/CT system. The data were registered according to immune status, antiretroviral therapy, and definitive diagnosis. All pathologic lesions and disease related areas were described, 18F-FDG uptake patterns were evaluated. Semiquantitative analysis of 18F-FDG uptake was performed and SUVmax were calculated. Results Twenty-eight patients [70%] were diagnosed with HIV-related infection or malignant diseases. The sensitivity of PET/CT was shown to be 100% and the specificity 92% for concomitant diseases requiring additional treatment to antiretroviral therapy. The SUVmax and CD4 counts were not statistically different between HIV-related reactive lymphadenopathy, HIV-related malignancy, and HIV-related infections. Conclusions The pattern of distribution of nodal/extranodal uptake on 18F-FDG PET/CT may facilitate distinction between HIV-related generalized lymphadenopathies, HIV-related opportunistic infections, and malignancies. In this context, 18F-FDG PET/CT should be preferred for routine use in the management of patients infected with HIV (AU)

¿Es posible la rediferenciación de NET tras la quimioterapia? Captación de imágenes de DOTA-péptidos marcados con 68Ga como cambio de estrategia en el tratamiento terapéutico / Is it possible NET-redifferentiation after chemotherapy? 68Ga DOTA-peptide imaging as a game-changer in therapy management

Se realizó una PET/TC con 68Ga DOTANOC a un varón de 64 años con tumor neuroendocrino de grado III, para estadificación. La lesión pancreática, múltiples ganglios peripancreáticos y diversas metástasis de gran tamaño en ambos lóbulos hepáticos, se mostraron con captación intensa. Tras 3 ciclos de quimioterapia con cisplatino y etopósido, el tumor primario y las metástasis disminuyeron de tamaño, aunque se reveló una mayor captación en la PET/TC con 68Ga DOTANOC de seguimiento. Otra biopsia hepática reflejó un descenso significativo del índice de proliferación de Ki-67, del 35 al 1%. El paciente recibió 2 ciclos de terapia con radionúclidos de receptores peptídicos con 177Lu DOTANOC

A 64-year-old man with pancreatic grade III neuroendocrine carcinoma underwent 68Ga DOTANOC PET/CT scan for staging. The pancreatic lesion, multiple peripancreatic lymph nodes and multiple gross metastases in both hepatic lobes were revealed with intense uptake. After 3 cycles of chemotherapy containing cisplatin and etoposide the primary and metastatic lesions were decreased in size, however showing higher uptake on follow-up 68Ga DOTANOC PET/CT scan. Another biopsy from liver demonstrated a significant decrease in Ki-67 proliferation index from 35 to 1%. The patient received 2 cycles of peptide receptor-targeted radionuclide therapy with 177Lu DOTANOC

Is it possible NET-redifferentiation after chemotherapy? 68Ga DOTA-peptide imaging as a game-changer in therapy management. / ¿Es posible la rediferenciación de NET tras la quimioterapia? Captación de imágenes de DOTA-péptidos marcados con 68Ga como cambio de estrategia en el tratamiento terapéutico.

A 64-year-old man with pancreatic grade III neuroendocrine carcinoma underwent 68Ga DOTANOC PET/CT scan for staging. The pancreatic lesion, multiple peripancreatic lymph nodes and multiple gross metastases in both hepatic lobes were revealed with intense uptake. After 3 cycles of chemotherapy containing cisplatin and etoposide the primary and metastatic lesions were decreased in size, however showing higher uptake on follow-up 68Ga DOTANOC PET/CT scan. Another biopsy from liver demonstrated a significant decrease in Ki-67 proliferation index from 35 to 1%. The patient received 2 cycles of peptide receptor-targeted radionuclide therapy with 177Lu DOTANOC.

Predicting outgrowth of IgE-mediated cow's milk allergy: Diagnostic tests in children under two years of age

Background: Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow's milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODPfo) with SPT for commercial cow's milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children < 2 years old. Methods: SPTs for CE and FM, tests for sIgEs (cow's milk, casein, alfa-lactoalbumin, Beta-lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis. Results: Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODPfo of 7 mm, 9 mm, and 10.5 kU/L, respectively; these values remained higher with ODPfo of 4 mm, 11 mm, and 10.5 kU/L at the last OFC. Conclusion: Higher initial SPTs for FM and CE and higher initial sIgE levels for cow's milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level < 10.5 kU/L and initial SPT for fresh milk < 9mm are related to the acquisition of tolerance in the follow-up period

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Predicting outgrowth of IgE-mediated cow's milk allergy: Diagnostic tests in children under two years of age.

BACKGROUND: Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow's milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODPfo) with SPT for commercial cow's milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children <2 years old. METHODS: SPTs for CE and FM, tests for sIgEs (cow's milk, casein, α-lactoalbumin, ß-lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis. RESULTS: Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODPfo of 7mm, 9mm, and 10.5kU/L, respectively; these values remained higher with ODPfo of 4mm, 11mm, and 10.5kU/L at the last OFC. CONCLUSION: Higher initial SPTs for FM and CE and higher initial sIgE levels for cow's milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level <10.5kU/L and initial SPT for fresh milk <9mm are related to the acquisition of tolerance in the follow-up period.

An unknown pregnancy at term detected by a FDG-PET/CT study in a patient with Hodgkin's lymphoma: A case report / Embarazo a término desconocido descubierto por un FDG-PET/TAC en una paciente con linfoma de Hodgkin: presentación de un caso

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Role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in diagnosis and management of pancreatic cancer; comparison with Multidetector Row Computed Tomography, Magnetic Resonance Imaging and Endoscopic Ultrasonography / Papel de 18F-Fluorodeoxiglucosa por emisión de positrones/tomografía computarizada en el diagnóstico y tratamiento de cáncer de páncreas; una comparación con la tomografía computarizada multidetector, la resonancia magnética y la ecografía endoscópica

Objectives: We aimed to analyze the contribution of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging to the diagnosis and management of pancreatic cancer compared with multidetector row computed tomography (MDCT), magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS). Material and methods: We retrospectively scanned the data of 52 patients who were referred for FDG PET/CT imaging for evaluation of pancreatic lesions greater than 10 mm. The diagnostic performances of 4 imaging methods and the impact of PET/CT on the management of pancreatic cancer were defined. Results: Pancreatic adenocarcinoma was diagnosed in 33 of 52 patients (63%), 15 patients had benign diseases of pancreas (29%), and 4 patients were normal (8%). Sensitivity and NPV of EUS and PET/CT were equal (100%) and higher than MDCT and MRI. Specificity, PPV and NPV of PET/CT were significantly higher than MDCT. However, sensitivities of two imaging methods were not significantly different. There was no significant difference between PET/CT and MRI and EUS for these values. When the cut-off value of SUVmax was 3.2, the most effective sensitivity and specificity values were obtained. PET/CT contributed to the management of pancreatic cancer in 30% of patients. Conclusion: FDG PET/CT is a valuable imaging method for the diagnosis and management of pancreatic cancer, especially when applied along with EUS as first line diagnostic tools (AU)

Objetivo: El objetivo fue analizar la contribución de la PET/TC con 18F-FDG (FDG PET/TC) en el diagnóstico y tratamiento del cáncer de páncreas en comparación con la tomografía computarizada multidetector (TCMD), la resonancia magnética (RM) y la ecografía endoscópica (EUS). Material y métodos: Se revisaron retrospectivamente 52 pacientes que fueron remitidos para la evaluación de lesiones pancreáticas mayores de 10 mm mediante FDG PET/TC. Se definieron los hallazgos diagnósticos de los 4 métodos de imagen y el impacto de la FDG PET/TC en el tratamiento del cáncer de páncreas. Resultados: En 33 de los 52 pacientes (63%) se diagnosticó un adenocarcinoma pancreático; 15 pacientes tenían enfermedades benignas del páncreas (29%) y 4 pacientes no mostraron enfermedad pancreática (8%). La sensibilidad y el valor predictivo negativo (VPN) del EUS y la FDG PET/TC fueron iguales (100%) y superior a la TCMD y a la RM. La especificidad, el valor predictivo positivo y el VPN de la FDG PET/TC fueron significativamente mayores que la TCMD; sin embargo, la sensibilidad de 2 métodos de imagen no fue significativamente diferente. No hubo diferencias significativas entre la FDG PET/TC, RM y EUS. Con un punto de corte de SUVmax igual a 3,2 se obtuvieron los valores más efectivos de sensibilidad y de especificidad. La FDG PET/TC contribuyó al manejo clínico del cáncer de páncreas en 30% de los pacientes. Conclusión: La FDG PET/TC es un método de imagen valioso para el diagnóstico y tratamiento del cáncer de páncreas, especialmente cuando se aplica junto con la EUS como primera línea de herramientas de diagnóstico (AU)

Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener's granulomatosis / Captación intensa de FDG en una PET/TC del tracto respiratorio superior e inferior indicativa de granulomatosis de Wegener

Wegener's granulomatosis (WG) is an uncommon systemic vasculitis, which involves the upper and lower respiratory tracts and the kidneys. Because the patients generally present with clinical manifestations that are similar to common diseases, WG may be initially misdiagnosed as infection or malignancy. We report the case of a 55-year-old male presenting with weight loss, cough, hemoptysis, low-grade fever, and pulmonary nodules detected on the thoracic CT scan. Malignancy was initially suspected, so a PET/CT was performed. It demonstrated intense FDG uptake in the upper and lower respiratory system. The diagnosis of WG was based on PET findings, elevated serum levels of inflammatory markers, and the presence of c-ANCA. We consider that the knowledge of FDG-PET/CT findings may help to make an easier and earlier diagnosis of WG (AU)

La granulomatosis de Wegener (GW) es una vasculitis sistémica poco común que afecta principalmente a las vías respiratorias superiores e inferiores y a los riñones. Debido a que los pacientes generalmente se presentan con manifestaciones clínicas similares a las enfermedades comunes, la GW puede ser confundida inicialmente como una infección o una neoplasia. Se presenta un varón de 55 años de edad con pérdida de peso, tos, hemoptisis, febrícula y nódulos pulmonares detectados en una TC torácica. Inicialmente, se sospechó un proceso maligno, por lo que se realizó una PET/TC que identificó una intensa captación de FDG en las vías respiratorias superiores e inferiores. El diagnóstico de GW se basó en los hallazgos de la PET/TC, los niveles séricos elevados de marcadores inflamatorios y la presencia de c-ANCA. Pensamos que el conocimiento de los hallazgos FDG-PET/TC ayuda a realizar un diagnóstico fácil y precoz de la GW (AU)

Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener's granulomatosis.

Wegener's granulomatosis (WG) is an uncommon systemic vasculitis, which involves the upper and lower respiratory tracts and the kidneys. Because the patients generally present with clinical manifestations that are similar to common diseases, WG may be initially misdiagnosed as infection or malignancy. We report the case of a 55-year-old male presenting with weight loss, cough, hemoptysis, low-grade fever, and pulmonary nodules detected on the thoracic CT scan. Malignancy was initially suspected, so a PET/CT was performed. It demonstrated intense FDG uptake in the upper and lower respiratory system. The diagnosis of WG was based on PET findings, elevated serum levels of inflammatory markers, and the presence of c-ANCA. We consider that the knowledge of FDG-PET/CT findings may help to make an easier and earlier diagnosis of WG.

Role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis and management of pancreatic cancer; comparison with multidetector row computed tomography, magnetic resonance imaging and endoscopic ultrasonography.

OBJECTIVES: We aimed to analyze the contribution of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging to the diagnosis and management of pancreatic cancer compared with multidetector row computed tomography (MDCT), magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS). MATERIAL AND METHODS: We retrospectively scanned the data of 52 patients who were referred for FDG PET/CT imaging for evaluation of pancreatic lesions greater than 10mm. The diagnostic performances of 4 imaging methods and the impact of PET/CT on the management of pancreatic cancer were defined. RESULTS: Pancreatic adenocarcinoma was diagnosed in 33 of 52 patients (63%), 15 patients had benign diseases of pancreas (29%), and 4 patients were normal (8%). Sensitivity and NPV of EUS and PET/CT were equal (100%) and higher than MDCT and MRI. Specificity, PPV and NPV of PET/CT were significantly higher than MDCT. However, sensitivities of two imaging methods were not significantly different. There was no significant difference between PET/CT and MRI and EUS for these values. When the cut-off value of SUVmax was 3.2, the most effective sensitivity and specificity values were obtained. PET/CT contributed to the management of pancreatic cancer in 30% of patients. CONCLUSION: FDG PET/CT is a valuable imaging method for the diagnosis and management of pancreatic cancer, especially when applied along with EUS as first line diagnostic tools.

FDG PET/CT findings in rare sarcomas / Hallazgos de FDG PET/CT en sarcomas raros

Hasta la fecha se ha descrito en muchos estudios el papel de la FDG PET/TAC en el manejo de los sarcomas de tejido blando y hueso. Sin embargo, la contribución de la PET/TAC al diagnóstico y al tratamiento de muchos tipos de sarcomas con baja incidencia no ha sido identificada aún. El sarcoma de células claras, el sarcoma sinovial en tórax y el liposarcoma mixoide constituyen tipos raros de sarcomas. Tratamos de describir las pautas de captación de la FDG en estos tumores raros y de averiguar el papel de la FDG PET/TAC en el manejo de la enfermedad(AU)

The role of FDG PET/CT in management of soft tissue and bone sarcomas has been described in many studies up-to-date. However, contribution of PET/CT to diagnosis and treatment in some types of sarcomas that are seen with low incidence has not been identified properly yet. Clear cell sarcoma, synovial sarcoma of chest and myxoid lyposarcoma are rare types of sarcomas. We aimed to describe the FDG uptake patterns of these rare tumors and find out the role of FDG PET/CT in management of disease(AU)

FDG PET/CT findings in rare sarcomas.

The role of FDG PET/CT in management of soft tissue and bone sarcomas has been described in many studies up-to-date. However, contribution of PET/CT to diagnosis and treatment in some types of sarcomas that are seen with low incidence has not been identified properly yet. Clear cell sarcoma, synovial sarcoma of chest and myxoid lyposarcoma are rare types of sarcomas. We aimed to describe the FDG uptake patterns of these rare tumors and find out the role of FDG PET/CT in management of disease.

The human Lgl polarity gene, Hugl-2, induces MET and suppresses Snail tumorigenesis.

Lethal giant larvae proteins have key roles in regulating polarity in a variety of cell types and function as tumour suppressors. A transcriptional programme initiated by aberrant Snail expression transforms epithelial cells to potentially aggressive cancer cells. Although progress in defining the molecular determinants of this programme has been made, we have little knowledge as to how the Snail-induced phenotype can be suppressed. In our studies we identified the human lethal giant larvae homologue 2, Hugl-2, (Llgl2/Lgl2) polarity gene as downregulated by Snail. Snail binds E-boxes in the Hugl-2 promoter and represses Hugl-2 expression, whereas removal of the E-boxes releases Hugl-2 from Snail repression. We demonstrate that inducing Hugl-2 in cells with constitutive Snail expression reverses the phenotype including changes in morphology, motility, tumour growth and dissemination in vivo, and expression of epithelial markers. Hugl-2 expression reduced the nuclear localization of Snail and thus binding of Snail to its target promoters. Our results placing Hugl-2 within the Snail network as well as its ability to suppress Snail carcinogenesis identifies Hugl-2 as a target molecule driving cascades, which may have preventative and therapeutic promise to minimize cancer progression.

Grievances in cases using antibiotics due to orodental problems and assessment of the need for antibiotics.

OBJECTIVE: To assess the complaints of patients who were prescribed antibiotics following orodental problems and the need for antibiotics prescribed for this purpose. SETTING: Examinations were carried out in the Department of Oral Diagnosis and Radiology, Ege University, Turkey. PARTICIPANTS: A total of 203 patients (129 females and 74 males) between 8-70 years of age (mean age 37.7 +/- 13.9). INTERVENTION: Examination and report. MAIN OUTCOME MEASURES: Frequency of unnecessary antibiotic use. RESULTS: Antibiotic therapy was not necessary for 151 (74.4 per cent) cases. Antibiotics were unnecessarily prescribed in 45 cases of acute irreversible pulpitis, 10 chronic apical abscess, 6 acute apical paradontitis, 7 gingivitis, 10 periodontitis, 4 epulis, 2 TMJ (temporomandibular junction) dysfunction, 2 sharp ridge of alveolar bone, 1 burning mouth syndrome and 1 recurrent aphthous stomatitis. In 108 (53.2 per cent) of the cases, the prescribed antibiotics were found to be penicillins, 102 of which were broad-spectrum. It was also determined that only 6 (7.7 per cent) of the 78 cases diagnosed as acute apical abscess were given drainage as local therapy. CONCLUSIONS: Principles for treating dental infections suggest that an antibiotic should only be used to supplement and not substitute for conventional surgical methods. Therefore, in cases with acute apical abscess, mechanical treatment (drainage) should be the first step. Inappropriate antibiotic use is quite widespread in dentistry. Dentists should avoid inappropriate use of antibiotics. To prevent inappropriate administration, necessary precautions need to be taken against dispensing antibiotics without prescription.

Bruxism in Rett syndrome: a case report.

Rett syndrome is a unique and puzzling disorder noted in females and is possibly caused by fundamental failures in critical brain connectivity during early infancy. The most frequent habits in Rett syndrome are hand sucking or biting, bruxism and mouth breathing. Children with musculoskeletal disorders and children who suffer from mental retardation commonly grind their teeth. A five year old female case with Rett syndrome is presented with significant bruxism in this article.