Therapeutic effect of finasteride through its antiandrogenic and antioxidant role in a propionic acid-induced autism model: Demonstrated by behavioral tests, histological findings and MR spectroscopy.

BACKGROUND: Autism is a clinically defined neurodevelopmental disorder with unknown origin characterized by significant social, communication and behavioral challenges. Although it can be a lifelong condition, treatments can help alleviate symptoms and enhance a patient's quality of life. PURPOSE: We aimed to assess the therapeutic potential of finasteride in autism with biochemical markers, histopathological evaluation, behavioral tests and radiological imaging. MATERIALS AND METHODS: Propionic acid (PPA) was injected intraperitoneally into 20 out of 30 rats for 5 days to establish an autism model. Rats were randomly assigned into four groups: control group (no procedure was applied, n = 10), placebo group (intraperitoneal PPA + 1 ml/kg/day % 0.9 NaCl saline was given via oral gavage for 15 days, n = 10) and treated group (intraperitoneal PPA + 5 mg/kg/day of finasteride was given via oral gavage for 15 days, n = 10). After 4 days of behavioral tests, magnetic resonance spectroscopy (MRS) was performed for measuring creatine and lactate levels. All animals were sacrificed for histopathological examination and biochemical analysis of brain tissue. RESULTS: MDA, NFκB, TNF-α, IL-2, IL-17A and lactate levels in brain homogenates were significantly increased in the placebo group compared to the control group, while Nfr2 levels were decreased; and the levels of all biochemical markers were reversed by finasteride treatment. A significant improvement was observed in autism-like behaviors in rats treated with finasteride compared to the placebo group. Further, the creatine and lactate levels in corpus striatum in MRS, the neuronal counts and glial activity of the hippocampus and cerebellum were closer to the control group in the finasteride-treated group compared to the placebo group. CONCLUSION: Finasteride led significant improvement in autism-like symptoms with its antioxidant effect through Nrf2 modulation in addition to its anti androgen effect.

GnRH and its receptor (GnRH-R) are expressed in the canine placenta and uterus.

In reproductive tissues, GnRH participates in the regulation of cell growth and proliferation by direct binding to the GnRH-R, which is essential for embryo implantation. However, there is no study on the expression and cellular localization of GnRH and GnRH-R in the canine uterus and placenta. Therefore, bitches were ovariohysterectomized 10 to 12 days after mating (vaginal cytology and progesterone measurement), the uteri were flushed, and if embryos were detectable, bitches were allocated to the embryo positive group (E-pos.; preimplantation, n = 5). Other bitches were operated at later stages and, dependent on the gestational age, either allotted to the post-implantation group (Day 18-25 after mating, n = 9), or the mid-gestation group (Day 30-40 after mating, n = 3). Dogs negative in embryo flushing served as controls (E-neg.; controls, n = 5). Samples of the entire uterine wall were taken from the middle of the horn in E-neg. and E-pos. groups, and from placental and interplacental uterine sites in post-implantation and mid-gestation groups. GnRH-R expression was localized at the mRNA and protein levels by immunohistochemistry and in situ hybridization. The expression of GnRH and GnRH-R mRNA was assessed by semiquantitative polymerase chain reaction. Additionally, both GnRH and GnRH-R mRNA were expressed in all tissues examined until mid-gestation. Relative expression of GnRH was higher than that of GnRH-R (P < 0.05). During the post-implantation stage, GnRH-R expression was significantly higher in uteroplacental than in interplacental tissues. In the uterus, GnRH-R stained strongly in the surface and glandular epithelial cells, and seemed to be weaker in myometrium and stroma. Placental signals were predominantly localized in fetal trophoblast cells and to a lesser extent in maternal decidual cells. These findings suggest a local regulatory function of GnRH during early canine pregnancy.

Nuclear medicine techniques for radio-guided surgery of hyperparathyroidism.

In recent years there has been a prominent change in surgical trends from extensive approaches to minimally invasive techniques in hyperparathyroidism. In contrast to classical bilateral exploration methods, minimally invasive parathyroidectomy necessitates an adequate preoperative imaging modality, in order to focus exactly the lesion in interest. (99m)Tc-MIBI, as a highly sensitive and widely available radiopharmaceutical, provides high success rates in terms of preoperative parathyroid lesion localization. Besides preoperative imaging, minimally invasive parathyroidectomy also requires an intraoperative modality which can act as a guide to surgeon. Hand-held gamma probes are simply-operated lesion localization devices which serve as successful intraoperative guides to surgeon. (99m)Tc-MIBI based minimal invasive parathyroidectomy has replaced the traditional 4 gland exploration as the procedure of choice in many institutions with comparable cure rates.

A patient presenting with spinal cord compression who had two distinct follicular cell type thyroid carcinomas.

A 61-yr-old woman presented with complaints of weakness and pain in her legs. A magnetic resonance imaging showed a 3 x 5.6 x 7.8 cm mass lesion destructing the T1 and T2 vertebral bodies and compressing the spinal cord. The mass was excised surgically. It was follicular carcinoma metastasis of the cervicodorsal region. Then, she underwent a total thyroidectomy. Pathological examination showed two different types of carcinomas in two different focuses; follicular carcinoma in the left lobe and follicular variant papillary carcinoma in the isthmic lobe. After the operation she was given 100 mCi 131I. This is the first report of a patient who had both metastatic follicular carcinoma and follicular variant papillary carcinoma together.

Solitary rib lesions in bone scans of patients with breast carcinoma.

The aetiology of solitary rib lesions detected on bone scans was evaluated retrospectively. Seventy-five patients with breast carcinoma, and each with a solitary hot spot on a bone scan, were included in the study. The aetiology of the solitary rib lesions was determined by using all available clinical, laboratory and radiological data, and was clarified in 65 of the 75 patients, and not clarified in the remaining 10. In 17 of those 65 (26.1%), the aetiology of increased uptake was malignant; while in 48 of the 65 (73.8%) it was benign in origin. Linear lesions were mainly metastatic in origin (seven of nine, 77.7%) whereas focal lesions were mostly benign in origin (46 of 56, 82.19%). In the group of 16 hot spots located at the anterior rib end, 14 (87.5%) were benign, and two (12.5%) were malignant in origin. The relation between mastectomy side and the distribution of anterior and anterior rib end localization of hot spots was also investigated. Twenty-three of 32 rib lesions (71.8%) were on the same side as the surgery. In conclusion, solitary rib lesions on bone scans in patients with breast carcinoma are frequently benign in origin, especially if they are focal and located at the anterior rib end.

Positron emission tomography imaging in evaluation of cancer patients.

Positron emission tomography (PET) is a diagnostic imaging technique that has progressed rapidly from being a research technique in laboratories to a routine clinical imaging modality. The most widely used radiotracer in PET is Fluorine18-fluorodeoxyglucose (F18-FDG), which is an analogue of glucose. The FDG uptake in cells is directly proportional to glucose metabolism of cells. Since glucose metabolism is increased many fold in malignant tumors PET has a high sensitivity and a high negative predictive value. PET with FDG is now the standard of care in initial staging, monitoring the response to the therapy, and management of lung cancer, colonic cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer and breast cancer. Other indications of PET like bone tumor, ovarian cancer and cancer of unknown primary (CUP) has also been discussed in brief. The aim of this review article is to review the clinical applications of PET in various malignancies and only limited number of important studies will be discussed for this effort.

Sentinel lymph node biopsy in the management of breast cancer.

Sentinel node localization is the second most important development in this century after conservative lumpectomy for the treatment of early breast cancer. The sentinel node mapping is a new multidisciplinary approach for staging of axilla in an accurate and less morbid way as compared to axillary node dissection. Sentinel lymph node biopsy in patients with breast cancer has been adopted rapidly into clinical practice. The accuracy of sentinel lymph node biopsy is more than 95%, when performed meticulously (by an experienced multidisciplinary team) with proper patient selection. Sentinel lymph node biopsy is most widely used for both palpable and non-palpable T1 and T2 tumors. Recent studies show application of sentinel lymph node technique in patients with locally advanced breast cancer and after neoadjuvant chemotherapy. Therefore, sentinel lymph node biopsy technique has application in developing countries and other countries where screening for breast cancer is not common and most patients present relatively in advanced stage of the disease. Several aspects of the sentinel lymph node biopsy including technique, case selection, pathologic analysis and accuracy with supportive important studies published in the literature will be discussed in this review.

Detection of inflammatory lymph nodes in rabbits by 99mTc-HIG lymphoscintigraphy.

Tc-Human immunoglobulin G ( Tc-HIG) is a well-known radiopharmaceutical for the evaluation of inflammatory lesions. Recently, it has been demonstrated as a new agent for the visualization of the lymphatic system by our group. Our aim was to investigate the feasibility of detection of inflammatory lymph nodes by Tc-HIG lymphoscintigraphy. Ten adult New Zealand rabbits were used as group A. In a baseline study, 37 MBq Tc-HIG (0.1 ml) was injected into both hind legs of the rabbits, and sequential posterior gamma imaging with the rabbits lying prone was performed at 5, 15, 30, 60, 90 and 120 min using a single-headed gamma camera (Toshiba GCA G01 E). One week later, microorganisms ( ) were injected in a volume of 0.1 ml intradermally into the web space between the second and third toes in the bilateral hind legs of each rabbit in order to obtain inflammation in the popliteal lymph nodes. After 4 days, 37 MBq Tc-HIG (0.1 ml) was injected into the hind legs of the rabbits bilaterally, and sequential posterior gamma imaging was performed as described above (second study). Another group of 10 adult New Zealand rabbits (group B) was injected with the same microorganisms in the right hind legs only. After 4 days, scintigraphic imaging was carried out in the same way as described above (third study). Regions of interest were drawn over the injection sites and popliteal lymph nodes on each image for semiquantitative analysis. Count rates for each were calculated and a decay correction was applied. Time-activity curves were generated to show the percentage retention of radioactivity in each region. After the scintigraphic study, some of the group B rabbits were killed by intravenous injection of pentobarbitone (100-150 mg.kg, and both left and right lymph nodes were removed for microscopic examination. On the scintigrams, lymphatic channels and popliteal lymph nodes were visualized within 15 min. In the second study, bilateral popliteal lymph nodes were visualized more clearly than in the baseline study. The right popliteal lymph nodes of the rabbits were more clearly visualized in the third study. Semiquantitative analysis showed a higher percentage uptake of radioactivity in the right compared to the left popliteal lymph nodes in group B rabbits. Microscopic examination of the tissue sections demonstrated inflammation in the right lymph nodes of group B rabbits. In this preliminary study, it was found that Tc-HIG is a new promising agent for the demonstration and evaluation of inflammatory lymph nodes.

Combined use of bone and bone marrow scintigraphies for the diagnosis of active sacroiliitis: a new approach.

Diagnosis of sacroiliitis (SI) with bone scintigraphy may involve difficulties even with a quantitative approach. The aim of this study was to evaluate the combined use of bone and bone marrow scintigraphies for the diagnosis of active sacroiliitis. Thirty-one patients who were clinically suspected to have SI were included in the study. Bone and bone marrow scintigraphies were done after injections of 740 MBq of 99mTc-MDP (MDP) and 370 MBq of 99mTc-sulfur colloid (SC) respectively with a 2-day interval. Both visual and quantitative assessment of MDP uptake and visual assessment of SC uptake in sacroiliac joints were performed. Also sacroiliac joint radiographic findings for each patient were evaluated and graded from 0 to 4 according to the New York grading system. Patients were divided into 2 groups according to their x-ray findings (Group A: grade 0-2, Group B: grade 3-4). A total of 14 patients (10 bilateral, 4 unilateral) had increased MDP uptake with decreased/normal SC uptake. Twelve of 14 patients had grade 0-2 radiographic changes while only 2 patients had grade 3-4 radiographic changes. Increased MDP uptake with decreased/normal SC uptake is the most common scintigraphic pattern seen in acute phase SI in which radiographic findings are generally found to be normal or slightly changed. In at least in 8 patients the decreased bone marrow uptake of SC was demonstrated, supporting the diagnosis. Although our results did not reveal any significant superiority of bone marrow scintigraphy to bone scan for the detection of active sacroiliitis, combined use of bone and bone marrow scintigraphies was presented as an alternative method to characterize patients with active sacroiliitis.

Exercise-induced left bundle branch block during thallium 201 myocardial perfusion scintigraphy--a case report.

Exercise-induced left bundle branch block (Ex-LBBB) is a rare entity encountered during exercise testing. The authors present a 53-year-old woman who developed intermittent Ex-LBBB asymptomatically during Tl 201 myocardial perfusion scintigraphy. Scintigraphic findings revealed septal-anteroseptal ischemia while the coronary arteriogram appeared normal. False-positive septal-anteroseptal scintigraphic findings suggesting ischemia in patients with persistent left bundle branch block (LBBB) is well known, but since the LBBB in this case was induced by exercise testing and was spontaneously terminated at rest, scintigraphic findings may be attributed to microcirculatory ischemia, which cannot be detected angiographically, as the cause of Ex-LBBB.

Assessment of penile bone graft viability by bone scintigraphy: a case report.

A 20-year-old man, who had penile reconstruction surgery with an iliac bone graft a year ago due to malcircumcision at 6 years old underwent bone scintigraphy in order to detect bone graft viability. The accumulation of 99mTc-MDP in the penile region revealed the viability of the bone graft. This case report shows that bone scintigraphy can be used to assess the viability of a bone graft located inside the penis as well as bone grafts placed elsewhere in the extremities.