Assessment of Midfacial Hypoplasia in Down Syndrome Fetuses - Validity of a Two-Line Approach and Introduction of a Novel Angle (Maxilla-Mandible-Nasion Angle).

PURPOSE: To scrutinize the validity of a novel angle (maxilla-mandible-nasion angle, MMN) as objective proof of midfacial hypoplasia in trisomy 21 fetuses. MATERIALS AND METHODS: Volume data sets of 2(nd) trimester fetuses were reviewed in this retrospective study. After achievement of the correct midsagittal position, the fetal profile line (FP line) and the mandibulo-maxillary line (MML) were applied and the resulting angle was calculated. Additionally, the prefrontal space ratio (PFSR) was assessed. Both measurements were obtained from 401 euploid fetuses and 42 fetuses with trisomy 21. Values for MMN and PFSR<5(th) percentile were considered abnormal. RESULTS: The study included 443 fetuses with a mean gestational age of 21.3 weeks (range: 14.0-26.3). The MMN angle sufficiently identified hypoplasia of the midface in trisomy 21 fetuses (mean: 14.6°; range: 10.1°- 22.0°) compared to controls (mean: 20.5°; range: 17.3°-23.7°; p<0.0001). Concomitantly, the PFSR of Down syndrome fetuses was significantly lower (mean: 0.53; range: 0.21-1.22) than in euploid individuals (1.38; range: 0.54-2.23; p<0.0001). CONCLUSION: Calculation of the novel MMN angle in 2(nd) trimester fetuses reliably allows rapid assessment of craniofacial anatomy in order to rule out the midfacial hypoplasia frequently found in trisomy 21.

[Changes of regional cerebral blood flow in stroke patients assessed by SPECT]. / Zmiany regionalnego przeplywu krwi u chorych z udarem mózgu badane przy pomocy tomografii emisyjnej pojedynczego fotonu.

UNLABELLED: The aim of our work was to evaluate changes in regional cerebral blood flow (rCBF) in patients with TIA and/or completed stroke and localisation of fotopenic foci in basal conditions and, in some cases, after stimulation pharmacological trial with acetazolamide. One hundred and fifty three patients participated in the study--105 with completed stroke and 48 with TIA. Regional CBF (rCBF) was evaluated using a single-headed rotating gamma camera (Diacam, Siemens) with high resolution collimator, after injection of 740 MBq 99mTc-HMPAO (Ceretec, Amersham). Sixteen patients with TIA underwent SPECT at baseline and after injection of acetazolamide (ACZ). Relative regional perfusion was expressed as the ratio of cerebral/cerebellar activity. In the completed stroke population, the perfusion ratios were significantly lower than those of controls and TIA at baseline (p < 0.001) and TIA after ACZ (p < 0.01). CONCLUSIONS: This study shows a significant difference in rCBF in patients with completed stroke and/or TIA and controls. In patients with TIA and rCBF similar to that observed in controls, perfusion deficits may be visible after ACZ injection.

Semiquantitative analysis of SPECT images using 99Tc(m) -HMPAO in the treatment of brain perfusion after the attenuation correction by the Chang method and the application of the Butterworth filter.

The aim of this work was to optimize the parameters for semiquantitative analysis with regard to the average number of counts per pixel in tomographic projections. The analysed studies were divided into three groups, proportionally, to average the counts per pixel. The analysis of results proved the dependence (P<0.05) between the average geometric contrast of images with the maximum counts per pixel higher than 500, reconstructed with the cut-off frequency fc=0.50fn, and the standard image. Also, the same dependence was found between the group with an average of 200 counts per pixel and the standard image at the cut-off frequency fc=0.40fn. The analysis of the attenuation coefficient, c, showed significant differences. The attenuation coefficient c=0.12 cm-1 as accepted for further studies. Optimization of the matrix order of interpolation filter proved increasing of contrast with decreasing size of the matrix. In conclusion, according to the average number of counts per pixel in a projection the parameters of image reconstruction, particularly the cut-off frequency fc of the Butterworth filter, should be changed. Additionally, an attenuation correction with coefficient c=0.12 cm-1 and interpolation with matrix size equal 7x7 should be applied.

Use of 99Tcm-MIBI scintigraphy in the evaluation of perfusion improvement after myocardial revascularization with the use of the left internal thoracic artery.

In spite of successful revascularization, in a significant group of patients myocardial ischaemia is present after surgery. The final effect of surgery depends on preoperative left ventricular function, initial coronary artery status, completeness of revascularization, the use of arterial or venous grafts, and many other factors. The aim of our 99Tcm-MIBI scintigraphy study was to examine the improvement of perfusion in the left anterior descending artery (LAD) vascular territory after revascularization with the use of the left internal thoracic artery (LITA), with respect to the LAD diameter and use of additional venous graft to diagonal artery. The study group consisted of 45 subjects (42 male, three female) aged 34-68 years (mean age 50.9+/-8.3 years) recruited from patients in whom LITA was grafted into LAD. The operation and postoperative period was uneventful in all patients. Two weeks before, and 3-4 months after surgery, dipyridamole-rest sestamibi SPECT were performed. The revascularization significantly improved both stress (deltaPI = 0.77+/-0.66; P < 0.001) and rest (deltaPI = 0.32+/-0.60; P < 0.001) perfusion of the LAD territory. The improvement was slightly better in patients who received two grafts (deltaPI = 1.42+/-0.91) for the LAD territory in comparison to the group revascularized only with LITA (deltaPI = 0.80+/-0.69; P = patients who received an arterial bypass to the LAD artery the perfusion was abnormal in all eight patients after anterior myocardial infarction and in 39% of patients without a history of infarction. The perfusion improvement was the best when the diameter of LAD was > or = 1.5 mm (deltaPI = 0.88+/-0.95). The independent predictors of perfusion improvement were the number of segments with reversible perfusion defect within the revascularized area (beta = 0.84, P < 0.001), the diameter of revascularized artery (beta = 0.17, P = 0.03) and the presence of pathological Q wave at preoperative ECG (beta = -0.20, P = 0.02). We conclude that the degree of perfusion improvement in the LAD territory after revascularization with the use of LITA depends on the diameter of bypassed coronary artery, completeness of revascularization and the reversibility of preoperative perfusion defect.

[Incidence of thyroid cancer in children and adolescents in Bialorus after the Chernobyl catastrophe in 1986]. / Wystepowanie raków tarczycy u dzieci i mlodziezy na Bialorusi po katastrofie czarnobylskiej w 1986 roku.

Fifteen years after Chernobyl nuclear plant catastrophe thyroid cancer was diagnosed in 882 persons among the group of 2,618,482 persons aged 6-18 years. The radioactive contamination, mainly with isotopes of radioactive iodine, seems to be a major cause of such a high incidence of thyroid cancer in children and adolescents. However, it is necessary to consider other factors which also might influence the process of transformation of the thyroid cells to the thyroid cancer. The iodine deficiency in environment was recognized as an important factor. Therefore, the countrywide programme of the investigations of iodine deficiency and goiter prevalence was established in the Republic of Belarus with the assistance of WHO Office for Europe. Within this program the examination of 11,562 children and adolescents aged 6-18 years from 30 schools in urban and rural areas was performed. The results obtained are typical for significant iodine deficiency and moderate goiter endemy. The analysis of these two factors and their influence on the incidence and distribution of thyroid cancer in different regions of Belarus is a subject of this paper. It is worth adding that 15 years after the catastrophe a visible rise in the number of thyroid cancers is noted in the group of adolescents and adults.

[The evaluation of goiter frequency and iodine prophylaxis efficiency in children population in Wielkopolska area from 1992 to 1998]. / Ocena czestosci wystepowania wola i skutecznosci profilaktyki jodowej u dzieci na terenie Wielkopolski w latach 1992-1998.

The aim of the study was to compare the current state and efficiency of iodine prophylaxis during the last six years. The study included 800 children from the rural and urban area (462 children in 1992 and 338 children in 1998) with the proportional sex and age (8-13 years) distribution, 24.936 newborns (9875 in 1992/1993 and 15.061 - mostly in the early part of 1998). The thyroid size (by USG), serum thyroglobulin (TG) concentration, urinary iodine (UI) concentration, %age of neonatal-TSH above 5 micro U/ml were evaluated using current ICCIDD and WHO criteria. The prevalence of goiter detected in children population in 1992 was 26% (recount by current criteria), in the early part of 1998 it was reduced to 21%. Parallelly, mean urinary iodine concentration increased from 49 micro g/l to 79 micro g/l. The reduction of goiter prevalence was associated with the reduction of mean serum thyroglobulin concentration from 26 ng/ml to 18 ng/ml. In the group of newborns the %age of TSH results above 5 micro U/ml decreased from 6 to 2.6%. Generally, the study proved significant increase of iodine prophylaxis efficiency in Wielkopolska Region in the period of the last six years, but it is still the area with mild iodine deficiency, which suggests the necessity of using other forms of iodine prophylaxis except for salt iodization. The obtained results suggest the necessity to extend the study on the role of other goitrogenic factors, which are probably present in the whole Wielkopolska Region.

99Tcm-sestamibi tomoscintigraphy at rest and after nitrate administration in predicting wall motion recovery after revascularization.

To evaluate whether nitroglycerin administered before the injection of sestamibi improves the detection of viable but hypoperfused myocardium, 41 post-infarction patients with left ventricular dysfunction underwent echocardiography and SPET at rest and after nitrate administration. In 25 revascularized patients, perfusion at rest and contractility were assessed 3-4 months after coronary artery bypass grafting. Perfusion (PI) and wall motion indices (WMI) were calculated for each revascularized area. There was a strong correlation between contractility and perfusion defect (r = 0.58, P < 0.0001). Nitrates significantly reduced the number of perfusion defects in hypokinetic (delta PI = 0.25 +/- 0.66) and akinetic (delta PI = 0.32 +/- 0.62), but not in dyskinetic (delta PI = 0.08 +/- 0.62), segments. Twenty-five revascularized patients had 110 asynergic segments and 136 segments with a resting perfusion defect. Function improved in 42% and perfusion in 64% of segments after surgery. Viable segments had a lower PI at rest (2.78 +/- 1.38 vs 3.86 +/- 1.29, P < 0.001) and a lower WMI (2.46 +/- 0.50 vs 2.79 +/- 0.59, P = 0.002). Nitrates reduced the number of perfusion defects slightly more in viable than non-viable segments (delta PI = 0.58 +/- 0.89 vs 0.30 +/- 0.46, P = 0.06). Contractility and perfusion at rest were the most important predictors of functional recovery. The sensitivity and specificity in predicting contractile improvement were 74% and 64% for resting SPET respectively, and 80% and 50% for nitrate SPET respectively. Nitrate administration significantly reduces perfusion defects in asynergic regions; however, its usefulness in predicting contractile recovery may be limited owing to its low specificity. Contractility and sestamibi uptake at rest were the strongest predictors of post-operative wall motion improvement.

[Diagnostic value of regional cerebral blood flow in SPECT pattern in Alzheimer's disease]. / Wartosc diagnostyczna badania regionalnego przeplywu krwi w mózgu metoda tomografii emisyjnej w chorobie Alzheimera.

Regional cerebral blood flow in SPECT pattern was estimated in 20 cases of Alzheimer disease. In all patients diffuse hypoperfusion was found evidencing a great diagnostic value of SPECT. A special significance has the study of regional cerebral blood flow in the differential diagnosis of Alzheimer disease, frontal lobe dementia and pseudodementia in major depression.

[The efficiency of goiter prevention due to iodine deficiency in pregnant women]. / Skutecznosc profilaktyki wola z niedoboru jodu u kobiet ciezarnych.

The iodine is indispensable element for life that is also fundamental substract for thyroid hormone synthesis which make very important influence on protein's lipid's, carbohydrate's and highly caloric substances metabolism and are a requisite of proper man development. The pregnant women are one of population group which is the most sensitive on iodine's deficiency. The results of researches indicate on insufficient iodine intake in pregnant women diet, whose take food even according to diet's recommendation given by physician. The wide iodine's prophylaxis which was provided as yet is insufficient in case of pregnant and nursing women. It is confirmed the necessity of additional iodine supplementation. A set of control tests should be done in requires cases that inform physician about changes in function and size of thyroid gland and make possible the individualization of treatment. The supplementation doses of iodine about 150 micrograms are safe and there was not observed any side effects during their taking.

Thyroid volume and function in patients with acromegaly living in iodine deficient areas.

The aim of our study was to evaluate the size and function of the thyroid in patients with acromegaly. In 39 patients concentrations of HGH, PRL, TSH, T3 and T4 were measured and the thyroid volume was calculated with the using of ultrasound examination. The control group comprised 5 patients with acromegaly in a stage of remission and 98 controls. We concluded that the size of the goiter in patients with acromegaly depends on serum concentration of HGH, but it does not depend on the concentration of TSH, T3, T4 and PRL. Goiter is present in 87% of patients with acromegaly, 46% of them are nodular goiters. The thyroid function in acromegaly is normal.

Iodine deficiency in Belarusian children as a possible factor stimulating the irradiation of the thyroid gland during the Chernobyl catastrophe.

Ten years after the Chernobyl nuclear plant catastrophe more than 500 children in Belarus are suffering from thyroid cancer. The major cause of the high incidence of thyroid cancer in children under 15 years of age appears to be contamination resulting from that catastrophe, mainly with isotopes of radioactive iodine. Another important factor may be iodine deficiency in the environment. A countrywide program for investigation of goiter prevalence and iodine deficiency has been established in the Republic of Belarus with the assistance of the European World Health Organization office. The program will oversee the examination of 11,000 children and adolescents 6 to 18 years of age from 30 schools in urban and rural areas. The results obtained in a group of 824 children and adolescents (the pilot phase) are typical for significant iodine deficiency and moderate goiter endemism. It is clear that the present situation does not completely reflect the situation that existed at the time of the Chernobyl catastrophe. However, data from epidemiologic studies conducted many years before the accident showed high goiter prevalence in the contaminated areas, indicating that the prevalence of iodine deficiency at the time of the catastrophe was similar to the present one or even greater. Such an assumption could lead to a better understanding of the thyroid pathologies that have been observed.

[The assessment of regional cerebral blood flow using HMPAO-SPECT during depressive episode and in remission]. / Ocena przeplywu mózgowego krwi za pomoca HMPAO-SPECT u chorych w czasie fazy depresyjnej oraz po jej ustapieniu.

Twenty patients who met the DSM-IV criteria for major depressive disorder were investigated at rest using Single Photon Emission Computed Tomography (SPECT). Participation in the study required a minimum score of 18 points on the 17-item Hamilton Rating Scale. All patients were drug free for at least one week before the SPECT scan. Assessments were made twice during depression and after recovery. Regional tracer uptake was measured by a semiquantitative method. The reference region was delineated on the cerebellum. In remission a significant increase of 99m Tc-uptake in almost all regions of interest was observed what may point on the improvement of regional blood flow after recovery from depression. For most regions except right frontal and left parietooccipital there were no significant differences of tracer uptake between patients with bipolar and unipolar depression. The negative correlation between regional cerebral blood flow and Hamilton score was found in temporal areas and left temporo-parietal region. We did not find the influence of age on regional cerebral blood flow. In conclusion, during depression global reduction of brain metabolism was observed, which may point on the role of subcortical nuclei with diffuse cortical projection in pathogenesis of depression.

[The Landau-Kleffner syndrome. SPECT and EEG investigations]. / Zespól Landaua i Kleffnera. badania SPECT i EEG.

Four children (three boys and one girl) with acquired epileptic aphasia (the Landau-Kleffner syndrome) have been observed in the Department of Developmental Neurology University of Medical Sciences in Poznan. We present the dynamic of clinical symptoms and fluctuations in EEG studies. The changes in the brain in single photon emission computed tomography (SPECT) during remission of clinical symptoms are discussed.

[Primary hyperparathyroidism--diagnostic problems]. / Pierwotna nadczynnosc przytarczyc--problemy diagnostyczne.

Parathyroid imaging with 99m Tc-MIBI, introduced at the beginning of the 90's seems to be a promising method for parathyroid adenomas localization. The aim of the study was to assess the efficacy of parathyroid imaging with 99m Tc-MIBI for preoperative localization of parathyroid adenomas and to compare that method with the high-resolution ultrasonography. Thirteen patients with primary hyperparathyroidism of duration from 2 to 25 years were included in the study. The presence of parathyroid adenomas was confirmed by histopathology in all patients. The sensitivity for scintigraphy and ultrasonography was 92.8% and 78.5%, the number of false positive results was 0 and 2 and false negative-0 and 1, respectively. Parathyroid imaging with 99m Tc-MIBI is a useful method for parathyroid adenomas localization, and in contrast to ultrasonography its sensitivity does not decrease if a parathyroid adenoma is located ectopically. Nevertheless, because of the greater accessibility, lower costs and its simplicity ultrasonography should be used as a screening modality for parathyroid adenoma localization.

A comparison of bone scans in uremic patients treated with intermittent peritoneal dialysis or hemodialysis.

The aim of the study was a comparative analysis of bone scans in uremic patients treated with intermittent peritoneal dialysis (IPD) or hemodialysis (HD). Bone scintigraphy was performed using technetium Tc 99m etidronate (EHDP) in 28 uremics (age 46.0 +/- 13.5 years, x +/- SD) on IPD for 3.1 +/- 3.0 months and 28 uremics (age 43.5 +/- 11.6 years) on HD for 47.3 +/- 33.9 months. Serum c terminal parathormone (cPTH) exceeded 5.3 +/- 3.3 and 6.8 +/- 3.5 times the upper normal limit of 1.4 ng/mL in IPD and HD patients, respectively. Despite significant differences in dialysis treatment duration in IPD and HD patients, an increased Tc 99m EHDP uptake in bones was shown with similar frequency, when all the groups were compared. However, in the group of patients with serum cPTH exceeding four times the upper normal limit (n = 30) or in the age group less than 45 years old (n = 26), a greater marker uptake was observed in HD patients. Significant differences (p < 0.05) were shown in the cranial vault: 33% of HD patients (n = 18) with higher cPTH and 47% of those less than 45 years old (n = 15) revealed an increased marker uptake, whereas it was not observed in any IPD patient. When scans of HD patients dialyzed less than (n = 11) and more than (n = 17) 30 months were compared, a significantly higher appearance of increased marker uptake was shown in cranial vault (41% vs 0%, p < 0.02) and in sacral bone (82% vs 36%, p < 0.02) in patients with longer dialysis. The latter group of HD patients also showed an increased marker uptake in cranial vault compared to the entire group of PD patients (41% vs 7%, p < 0.01). Our studies suggest that bone scan changes, indicating secondary hyperparathyroidism, progress significantly with prolongation of dialysis treatment, especially in patients with higher cPTH levels of younger age.

Principles, main goals and methods of the nationwide program: "investigations on iodine deficiency and model of iodine prophylaxis in Poland".

The main reasons to start investigations on IDD in Poland as a nationwide project of the Ministry of Health and Welfare sponsored by the State Committee For Scientific Research and Foundation for Polish Science were: cessation of iodizing of kitchen salt in Poland in 1980, increase of the incidence of goitre in the population and hyperthyrotropinemia in newborns, results of the survey undertaken after Chernobyl disaster indicating an increase of goiter incidence (Nauman et al.) and results of the pilot study (Gutekunst, Gembicki, Kinalska and Rybakowa) indicating an increase of thyroid volume and diminishing of iodine excretion in urine of children in Kraków, Bialystok ad Poznan regions. Therefore the main goals of the project were as follows: to evaluate IDD in Poland on the population basis, to map goiter incidence and iodine deficiency in geographic areas, to evaluate a voluntary model of iodine prophylaxis in Poland (20 mg of KI/kg of salt). The investigations were carried out in 19330 children (48.7% of boys and 51.3% for girls) in age group 6-13 years, attending 111 coeducational randomly selected schools from all the country. This number represents 0.35% of children subpopulation in the above age-groups. For practical purposes local coordinating centers at the relevant Departments of Endocrinology and Board of Coordinators were set up. The programme of survey included: filling the questionnaire by children's parents, thyroid palpation and classification according to WHO and ICCIDD criteria, thyroid volume determination by means of ultrasonograph Kontron Sigma 1 L with linear transducer 7.5 MHz, determination of iodine in casual morning urine sample using Sandell and Kalthoff method. Determination of iodine concentration in urine was performed in each case of goiter and in the same number of children without goiter. The results were segregated according to coordinating centers and according to 6 geographical areas of the country. The results were calculated according to the descriptive statistics using Student's test, Chi-square test F-test and Leven's test. The results segregated according to geographic areas were tested by means of analysis of variance using the linear model. The final results of the programme are presented in the next papers.

The results of epidemiological studies concerning iodine deficiency and goiter in Poznan Region (Poznan coordinating center).

The studies concerning iodine deficiency and occurrence of goiter, being a fragment of the program covering different parts of Poland, included 2620 children of age between 7 and 12 years attending randomly chosen schools situated in towns and villages of Poznan, Pila, Leszno, Konin, Kalisz, Bydgoszcz and Zielona Góra districts. Among the children studied, 1009 children (522 boys and 487 girls) attended town schools, and 1611 (774 boys and 837 girls) country schools. All children were subjected to anamnesis by using a standard questionnaire. Also physical examination of the thyroid aimed at the evaluation of size and morphology of the gland was carried out by palpation (according to the obligatory WHO scale) and by ultrasonography. Urine samples were taken from the majority of children for the determination of urinary excretion of iodine. In 736 (28.1%) of the studied children an enlargement of the thyroid was found. Among these children 253 are inhabitants of towns (this number represents 27.8% of all urban children studied) and 483 are inhabitants of villages (30% of all rural children studied). In 92.7% of cases the goiter could be classified as type IB according to WHO and in 56 cases it was of nodular character. There was a clear relation between the incidence of goiter and the age of the children studied. Frequency distribution of goiter in the individual age groups was as follows: for urban children--21.8% in age group of 7-8 years, 23.5% in age group of 9-10 years and 29.7% in age group 11-12 years, and for rural children the corresponding values were 21.1%, 30.2% and 38.2%. Mean urinary iodine excretion was 96 micrograms/L (median 84 micrograms/L) for urban children, and 87 micrograms/L (median 64 micrograms/L) for rural children. Among 2620 answers concerning the use of iodized salt in the household, only 980 (37.1%) were positive. In towns, the use of iodized salt declared about 41% of families and in villages about 35%. Altogether, among 736 cases of goiter, 464 are children not using iodized salt. Only in 272 cases goiter appeared despite the use of iodized salt. The data concerning family occurrence of goiter and the type of iodized salt used can be treated as approximate because of subjective character. According to the results obtained, the region covered by the study falls according to the WHO and ICCIDD classification to the category of an area of mild iodine deficiency requiring more intensive iodine prophylaxis.