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)

In Vivo Evaluation of Teeth Shade Match Capabilities of a Dental Intraoral Scanner.

Intraoral scanners were introduced in order to increase patient comfort and improve dentist lab communication. Acquiring optical impressions of the prepared teeth eliminates the need for conventional impression procedures and improves patient comfort. Intraoral scanner software offers since 2017, color shade determination, by analyzing the tooth shade of the obtained 3D model. In this study we tested the accuracy of an intraoral scanner color selection capabilities compared with a dental spectrophotometer, considered as reference. Statistical differences were found between the two system tested when the results were expressed in both Vita Classical and Vita 3D Master shade tabs codification.

Tumor markers in familial Mediterranean fever and their correlation with the frequency of attacks.

OBJECTIVE: Serum levels of tumor markers can be elevated in several benign diseases affecting the serosal surfaces. Familial Mediterranean fever (FMF) is a genetic disease characterized by acute attacks of fever and inflammation of the serosal membranes. The aim of this study was to examine the levels of tumor markers in FMF patients and their correlation with the frequency of attacks. METHODS: Serum levels of CA 125, CA 19-9, CA 15-3, CA 72-4, CEA, and AFP were measured by ELISA in 36 patients with a definitive diagnosis of FMF (21 males, 15 females, mean age 36.4+/-10.3 yrs) and in 19 healthy controls. RESULTS: Serum levels of all tumor markers were normal in the controls. In FMF patients serum levels of CA 125, CA 19.9, CA 15.3, CEA and AFP were within normal ranges, whereas CA 72.4 was significantly higher than in the controls (p=0.001). Half of the FMF patients showed increased levels of CA 72.4; the mean level was lower in those in complete remission. However, no statistically significant correlation was found between FMF attacks and acute phase reactant levels. CONCLUSION: With the exception of Ca 72.4, serum levels of tumor markers are not affected by changes in inflammatory cytokines levels during FMF attacks.

Elevated serum soluble Fas levels in the various stages of hepatitis C virus-induced liver disease.

We aimed to determine serum soluble Fas antigen (sFas) levels at various stages of hepatitis C virus (HCV)-induced liver disease, and investigate correlations between serum sFas levels and clinical, biochemical and pathologic features. Sixty-five patients were categorized into five groups: 1, chronic active hepatitis C, elevated alanine aminotransferase (ALT), HCV-polymerase chain reaction (PCR) positive; 2, responders to interferon + ribavirin therapy; 3, cirrhosis; 4, chronic hepatitis C, normal ALT, HVC-PCR positive; and 5, sustained responders. Group 6 comprised 15 control individuals. Serum sFas levels were measured by enzyme-linked immunosorbent assay. Significant differences in serum sFas levels were found between the following groups: 1 and 2; 1 and 3; 1 and 4; 1 and 6; and 3 and 6. Serum sFas levels did not correlate with ALT, histological activity or HCV-PCR positivity within group 1. Serum sFas levels appear to increase in advanced stages of HCV-induced liver disease, as a result of host-related immunological factors.

Elevated serum CA 125 concentration in patients with tuberculous peritonitis: a case-control study.

OBJECTIVES: High serum cancer antigen (CA) 125 levels have been shown to be present in patients with ovarian carcinoma, nongynecological cancers, and some benign diseases and have been used as a useful marker for monitoring patients with epithelial ovarian cancer. Although tuberculous peritonitis with elevated serum CA 125 levels is an important diagnostic problem because it may lead to misdiagnosis as ovarian carcinoma and unnecessary laparatomies, the levels of CA 125 in patients with tuberculous peritonitis has not been studied in detail. METHODS: Serum CA 125 levels in 11 consecutive patients (2 males, 9 females) with tuberculous peritonitis admitted to Hacettepe University and 20 healthy adult controls (7 males, 13 females) were studied. RESULTS: Serum CA 125 levels were found to be elevated in all patients with tuberculous peritonitis. The mean level in the study group was 316.6 IU/ml, whereas the level was 13.8 IU/ml in the control group (p < 0.0001). Serum CA 125 normalization showed a very close correlation with the response to antituberculous therapy. CONCLUSIONS: Tuberculous peritonitis must be considered in a differential diagnosis of patients with elevated serum CA 125 concentration. Correct diagnosis may prevent unnecessary laparatomies performed under the assumption of ovarian carcinoma, because it is cured completely by antituberculous therapy. Serum CA 125 level might be used as an effective marker in the diagnosis and follow-up of patients with tuberculous peritonitis.

Superior mesenteric artery syndrome. A case report.

A case of superior mesenteric artery syndrome is reported. A 16-year-old boy with bilious vomiting for six months and weight loss within the previous year is presented. In this symptomatic period, he was fed many dietary formulations. This conservative management failed. Physical examination revealed that he was malnourished. The diagnosis was made by means of an upper gastrointestinal barium study performed through a tube. Gastrojejunostomy was preferred over duodenal mobilization because he had a markedly dilated stomach and enlarged pylorus. The postoperative course was satisfactory.

Treatment of chronic hepatitis C infection with interferon alpha-2a in a Turkish population.

Recombinant interferon (IFN) alpha has been shown to normalize the aminotransferase levels in approximately half of patients with chronic hepatitis C virus (HCV) infection. Twenty four patients with chronic HCV infection were treated with IFN alpha-2a subcutaneously, three times a week for 6 months. All patients responded to IFN therapy with a decrease of alanine aminotransferase (ALT) level. Thirteen out of 24 cases (54.2%) had normal ALT levels at the end of the sixth month of therapy. However, four of these complete responders (30.8%) relapsed during the 12 month follow-up. Relapse was high in the partial responder group (45.5%). Overall relapse rate was 37.5% at 6 months. HCV genotype II, which is associated with a low response rate to IFN was prevalent (85-87%) in our patient population. This study shows that interferon therapy can be effective in reducing transaminase levels in patients with chronic hepatitis C in a population with a high prevalence of HCV type II. The relapse rate after discontinuation of treatment, however, remains a problem.

Helicobacter felis as a cofactor alone or together with stress in cryptosporidial activation in mice.

Cryptosporidiosis is caused by a protozoan parasite, mainly found in animals, which usually results in transient, mild gastroenteritis in humans but can cause severe and prolonged disease in immunocompromised individuals. Immunocompetent mice, naturally infected with Cryptosporidium muris, were used to investigate the effects of inoculation with Helicobacter felis and of stress on the activity of the C. muris infection, as indicated by histopathological examination of their stomachs. The results indicate that both H. felis inoculation and/or stress activate C. muris and cause gastric inflammation. The extent of the activation of C. muris depends on the duration of the stress.

Impaired lipopolysaccharide-induced interleukin-1-beta production in patients with anti-hepatitis C virus antibody-positive chronic liver disease.

The aim of our study was to determine the role of cytokine interleukin-1-beta (IL-1-beta) in patients with chronic hepatitis C virus (HCV) infection. Twenty-eight patients with chronic HCV infection were studied and compared with 18 healthy subjects. IL-1-beta levels were measured with an enzyme-linked immunosorbent assay in plasma and in supernatants of peripheral blood mononuclear cells (PBMC) incubated alone or in the presence of lipopolysaccharide (LPS). No IL-1-beta was found in plasma or unstimulated PBMC supernatants. The mean LPS-induced IL-1-beta production was 20.0 +/- 4.0 ng/ml in patients with chronic HCV infection and 29.4 +/- 3.7 ng/ml in the control group. The patients had significantly lower levels of LPS-induced IL-1-beta than the control group (p < 0.00001). No difference in LPS-induced IL-1-beta production was found in patients in relation to the histologic diagnosis (p > 0.05). There was no correlation between LPS-induced IL-1-beta production and serum alanine aminotransferase levels in patients with chronic HCV infection (r = 0.37, p > 0.05). Although limited to a small number of cases, our results suggest that LPS-induced IL-1-beta production by PBMC is impaired in patients with chronic HCV infection.