Ear-lobe anthropometric signs do not relate to longevity. Ear length relates to age.

Dear Editor, During the last 30 years we are collecting various photographs which showed the face of persons who died at various ages during their lifetime. We so collected more than 235 photographs. After strict selection of these photographs, so that we could see well the ear and the ear-lobe we chose 57 of them and studied the following parameters: the vertical length of the ear till the lobe, the vertical length of the earlobe, the total ear length, the width of the ear-lobe and the area of the lobe, in order to relate them to longevity. All persons were Caucasians from western countries. No persons from Mediterranean countries were included. The above persons were separated into 2 Groups: Group A, 25 persons who lived 38-70 years, and Group B, 32 persons who lived 89-106 years. In both Groups it was more than obvious after calculating the Mean and the Standard Deviation (M±SD) that no relation existed between all above factos and longevity in both groups. In order to confirm the above result we separated both Groups into Subgroups. Subgroup A1 included 9 cases who lived 38-59 years and Subgroup A2 included 16 cases who lived 60-70 years. Subgroup B1 included 25 cases who died at 89-99 years of age and Subgroup B2 included 7 cases who lived 99-106 years. All above parameters were still unrelated to longevity. We noticed that the length of the total ear although unrelated to longevity was related to age till the age of 99 years. In Subgroups A1 and A2 the M±SD was 1.20±0.41cm and 1.48±0.42cm, respectively and in Subgroups B1 and B2 the M±SD of the total ear length was 2.28±0.47cm and 2.32±0.54cm, respectively (Table). The small number of persons studied was a handicap. There seemed to be a relation between total ear length and age till 99 years (Figure). It is known that the ear like all other parts of our body enlarges up to the end of our maturity and later by age. This finding in the present paper covers a wider range of ages as compared to other related papers, i.e. covers the ages of 38-106 years and so seems to be as for this point prototype. Another paper studied ear length up to the age of 41 years.

Circulatory system and neurosciences. Some perspectives in diagnosis and treatment.

This paper aims to describe how radial artery obstruction can support blood circulation in an ischemic area. A dramatic case is described. Furthermore aims to describe that fatigue, atherosclerosis and toxic substances like in alcoholism may reduce blood flow and energy supply in the cortex and other brain areas and thus unconsciously modify our usual civilized behavior. Intense mental and physical fatigue was described as: "vital exhaustion".

Changes in esophageal mucosal morphology and in growth of breast feeding rats fed with milk of low or high temperature.

Dear Editor, This rather original investigation was performed some time ago but is still unpublished. Its aim was to estimate the effect of low or high temperature cow's milk given to breast feeding rats in order to study possible influence of this diet to rats, to their physical growth and also esophageal mucosal pathology. Ten white female Wistar rats, 20 days of age were separated from their mothers and divided in 2 groups of 5 members each. Five of them were fed with milk kept at 42oC by using a special warming device. The other 5 animals were fed with cold milk kept at 4oC during feeding. The duration of feeding was 34 days. Animals were finally sacrificed with a lethal dose of ether. The two groups were examined and compared. The group of rats fed by the warm milk was better grown as indicated by gaining more body weight, being more active and drinking more milk. Specimens were taken from the middle esophagus and after specific treatment were examined under the electronic microscope. We found: In both groups the most impressive finding in esophageal mucosa was an edematous intercellular space in all epithelial layers with many microorganisms in these layers. Acantholysis was often identified while in other areas a keratin transformation was noticed even in the basic layers, while basic membrane was absent. Epithelial cells showed edematous mitochondria and formation of myelin bodies. Degenerative changes and interstitial edema were noticed in the chorio. The above findings suggest that hot milk but not cold milk improves the growth of the rats studied. Cold and also hot milk had a damaging effect on the rats' esophageal mucosa. It is obvious that many options for further research arise related to the range of temperature of food intake that will not cause damage to gastric epithelium.

About an energy functioning by fusion, independently.

An innovative biological energy has been observed related to the eye sight and fusing with another energy over tap water through a small metallic chain. The fused energy has been repeatedly described under standard conditions and it is characteristics vary according to the condition of the eye sight and the water content. This energy may be called: "EFI" (energy functioning, by fusion, independently).

Endless research II. The genomic era. Neohippocratic Medicine.

The great progress of genetics research, during 2015-2017, will certainly influence all medical specialties including nuclear medicine. In nuclear medicine there are still problems to solve as to differentiate between infection, inflammation and cancer etc. Furthermore, in dosimetry and radiation protection there are worldwide problems. It has been reported that 64 Cu-cetuximab immune-PET represented EGFR expression levels in ESCC tumors and that 177 Lu-cetuximab radioimmunotherapy effectively inhibited the tumor growth. Recent important research findings and few related suggestions for further research are mentioned related to Gastroenterology, Neohippocratic Medicine, the Respiratory System, Neurology and the Hayflick phenomenon. Perhaps we now live in the genetics transformation era, the Genomie's Era.

Cauda equina syndrome. An emergency, some unexpected severe symptoms and conservative treatment.

An 83 years old physician, doing only office work and no exercise, presented with cauda equine, due to a large intervertebral disk hernia between L1-L2 vertebrae, after an unorthodox movement. He also had a facet syndrome, a muscular spasm in the gluteus, a small fracture in the periphery of the body of the L2 vertebra and pain in the L4-L5, due to a previous vertebral hernia five years ago. All L1-L5 left lateral area was painful. He felt an unbearable pain. He also had a degree of paralysis of the gastrointestinal (GI) and the genitourinary system. He could not take analgesics or anti-inflammatory drugs per os because of the paralysis of the GI system. His pain was relieved only by intramuscular injections of parecoximbe (a cyclooxigenase-2 inhibitor, COX-2). The disc hernia was treated without surgery. After 43 days in bed, he was able to start exercising in order to treat muscles' atrophy.

An endless research for 2016.

In a moment of reflection of the past year of 2015, as to what we have achieved in medical research and what we need to do in the future we realize that although we have performed an enormous progress in medical research in the past we still have to do much more. In nuclear medicine there are many problems to solve like, how can we differentiate between infection, inflammation and cancer or between lymphomas and adenocarcinomas. In bone scans we need to differentiate traumatic lesions acute or chronic and lesions from another origin. Dosimetry and radiation burden is another problem. In HJNM we have previously published related papers. Not to mention radiation sickness due to modern atomic or hydrogen bombs. Labeling antibodies and genetic material is another issue. Additionally, in general medical knowledge is still unable to solve many unknown, difficult or tragic problems of our lives, like cancer, some viral infections, research in immunology, collagen diseases, genetics, radiation treatment, psychological disorders, anesthetics, the Hayflick phenomenon, hypertension, asthma, the function of the gastrointestinal tract, infectious diseases, physical exercise, all of which are briefly mentioned. We hope that even under the present financial problems and considering that almost 90% of medical truth is still unknown, our research in 2016 will be very important. In this paper we also discuss means for a more genuine and effective research.

Morning and night gastric emptying half-time differed more than 220% in two young healthy adults.

OBJECTIVE: It is important to know normal GEHT of a specific meal taken at specific hours and at specific physical and biological conditions in order to better evaluate abnormal GEHT. It seems that it is more specific to study as we have done in the present paper GEHT in the same individual of a certain meal administered at two different hours, i.e. in the morning and at night. Thus, we avoided many errors and issues. SUBJECTS AND METHODS: We studied 2 healthy individuals, one male 26 years old and one female, 19 years old, who received the same French toast meal at 08.00 and 23.00. RESULTS: The GEHT for the morning and the night test for the male individual (P.F.) were 55min and 125min, respectively. For the female individual (K. F.) the GEHT were ∼70min and ∼120min, respectively. For both individuals GEHT differed more than 220% between the morning and night tests. CONCLUSION: We noticed a more than 220% delay of the GEHT in a normal young man and a normal young woman when they received a French toast meal at 23.00h as compared to the same meal at 08.00h. The female had 58% more delayed in GEHT at night as compared to the GEHT of the male individual.

Medical deontology, meetings, journals, candidacy for higher posts and how to better enjoy life.

Unfortunately, today few physicians care about medical deontology and medical ethics, that is how to behave and respect others when exercising our medical profession. Some of us may not show the care and kindness we should show towards our students or the due respect to our senior colleagues. Occasionally, when examining our patients we may not pay the proper attention to their problems, being tired from work overload. Another issue of deontology is medical meetings. Do they offer us enough knowledge or mainly pleasure? Is our curriculum vitae comprised by useful to society and to medicine original or confirmatory research work? Few examples to illustrate what the situation is at present are included in this paper. Our financial success in practice should not compete with the "old" Hippocratic oath and ideals. The pursuit of happiness in our life is not achieved through untruthfulness, dishonesty or only high financial status. "The Lancet"mentioned long ago (1969; September 27; 681-4) a phrase by John Keats: "Truth is beauty‥this only exists on Earth and this is what we need to know".

Diagnosing atherosclerosis makes Nuclear Medicine a tissue imaging modality.

Atherosclerosis can be identified by fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) and is associated with cardiovascular events and all-cause mortality. Inflammation and classification appear jointly in the formation of atherogenesis. Arterial calcification has been also determined by CT, by (18)F-FDG PET and also in the last few years by (18)F-sodium fluoride (NaF) PET. Beheshti et al, have introduced a new concept for the detection of early molecular and cellular calcification in the atherosclerotic plaques of the heart and aorta, based upon the concept of global disease burden, which had been employed earlier using (18)F-FDG PET. Fluorine-18-NaF uptake in the heart and aorta increased significantly with advancing age. In a screening study involving 1,825 individuals, CT coronary artery calcification (CAC) was found to be common in healthy middle-aged individuals with a low Heart Score and, on the contrary, high-risk subjects very frequently did not have CAC. It is obvious that atherosclerosis appears early in life and also that the actual limits of atherosclerosis related to serious cardiovascular events should be determined by more research, since atherosclerosis is not the only cause of these episodes. It is possible that (18)F-NaF PET/CT may provide information about ongoing active molecular calcification in the plaque before calcification as a cause of cardiovascular episodes is detectable. Global molecular cardiovascular calcification, before becomes macroscopically visible, before it can be identified by CT, may be assessed by nuclear medicine procedures. (18)-NaF PET/CT is the first non-invasive imaging method to identify and localize high risk coronary plaque, a new frontier in nuclear cardiology. The above nuclear medicine diagnostic technique is a major and historical new application, for the diagnosis and the study of cardiovascular diseases, by which a certain tissue per se can be identified.

Medical Deontology towards medical students, our colleagues and our patients. About meetings, medical journals, candidacy for higher posts and the "silent" society.

Unfortunately, today very few care about medical deontology-ethics that is about how to behave and respect others when we exercise our medical duties. Perhaps we do not show our real care and kind leadership to our students. We do not very much respect our medical colleagues. We are often tired to spend much time examining patients. We attend medical meetings for pleasure or because our expenses are covered by pharmaceutical firms. We write unimportant papers in order to have a rich curriculum. We consider the Impact Factor of a journal as awarded only to underline the importance of a letter to the Editor we publish in a prestigious journal. We refrain from useful research. We are not always truthful in publishing the results of our research. Many such examples are included in this paper. Overall, we go for a financial success disregarding the "old" Hippocratic ideas and oath. We are supposed to seak for life-happiness. Instead, we feel guilty, inconvenient as to our social behaviour and unhappy. "The Lancet" mentioned long ago (1969) a phrase by John Keats: "Truth is beauty...this only exists on Earth and this is what we need to know".

Errors inducing radiation overdoses.

There is no doubt that equipments exposing radiation and used for therapeutic purposes should be often checked for possibly administering radiation overdoses to the patients. Technologists, radiation safety officers, radiologists, medical physicists, healthcare providers and administration should take proper care on this issue. "We must be beneficial and not harmful to the patients", according to the Hippocratic doctrine. Cases of radiation overdose are often reported. A series of cases of radiation overdoses have recently been reported. Doctors who were responsible, received heavy punishments. It is much better to prevent than to treat an error or a disease. A Personal Smart Card or Score Card has been suggested for every patient undergoing therapeutic and/or diagnostic procedures by the use of radiation. Taxonomy may also help.

Acute radiation syndrome and chronic radiation syndrome.

Acute radiation syndrome (ARS) or sickness or poisoning or toxicity is induced after a whole body exposure of men to high doses of radiation between 1-12Gy. First symptoms are from the gastrointestinal system, which together with bone marrow are the most sensitive parts of our body. Chronic radiation syndrome (CRS) may be induced by smaller than 1Gy radiation doses or after a mild form of ARS. Prophylaxis and treatment suggestions are described. In cases of ARS, a large part of the exposed population after proper medical care may survive, while without medical care this part of the population will be lost. Prophylaxis may also save another part of the population.

Prostatic specific antigen and bone scan in the diagnosis and follow-up of prostate cancer. Can diagnostic significance of PSA be increased?

Prostate cancer (PC) is currently the most frequently diagnosed cancer in males and constitutes a major health issue in developed countries. On the other hand, the majority of PC cases are considered clinically not significant and certainly not lethal. These discrepancies highlight the need for the early detection of especially those cases that have aggressive features and call for early and radical intervention. The clinical use of prostatic specific antigen (PSA) towards this end is recognized as inadequate since PSA is prostate specific, but not a PC specific marker, as it is known to increase in other prostate diseases such as benign hyperplasia, inflammations, transrectal ultrasound examination, biopsy and after transurethral prostatectomy. However due to lack of other more specific markers, digital rectal examination combined with serum PSA are suggested for PC screening and diagnosis. With regard to advanced disease where bone involvement is the rule, nuclear medicine bone scan using radioactive bisphosphonates such as technetium-99m methylene-diphosphonate is quite common and reliable technique for detecting and monitoring bone metastases. The major advantage of nuclear scintigraphy is its ability to reveal bone metastases significantly earlier than the conventional X-ray imaging techniques. PSA density, velocity, doubling time and free to total PSA ratio increase the significance of serum PSA in diagnosing PC. The combination of an increased PSA (>20ng/mL) and a high biopsy Gleason score (>8) enhances the possibility of bone metastases (P<0001) and mandates a bone scan. In conclusion, serum PSA testing is currently recommended in symptomatic PC patients for disease staging and treatment monitoring and in asymptomatic selected population groups aged more than 50 years. It is reasonable to suggest that PSA density, velocity, doubling time and free to total PSA ratio or combining PSA with Gleason score shall greatly increase PSA specificity in detecting PC cases. Radioisotopic bone scan by SPET or PET can demonstrate osseous metastases at later stages of PC, but should also be applied in cases falsely considered as an early stage of PC, for better staging and for periodic follow-up of the disease.

[Medical behavior (deontology) towards our students, our colleagues, our patients and the society].

In this paper we try to describe the importance of a dignified behavior of the physician to his students, colleagues, patients and the society. We come to the conclusion that even if the other party is not showing the best of behavior, the physician has not only the responsibility and the duty but it is very much for his own interest to show a dignified and useful behavior to others. This is the main route for having a good reputation which will help him better exercise his medical duties and offer him personal happiness. Jeremy Bentham, an English judge and philosopher formed the Greek word deontology to mean correct behavior stating that this behavior is morally useful and a source of pleasure. The codes of Hammurabi, of the Indian Ayr Veda, of the Egyptians, the teaching of Aristotle, Hippocrates and others also describe medical deontology.

Medical radiation exposure and accidents. Dosimetry and radiation protection. Do we only benefit the patient?

This article presents and discusses new information on the old Hippocratic moto of "...not to harm but to benefit the patient". Some radiation accidents are due to medical errors. Millions of medical tests exposing radiation are performed every day worldwide increasing and sometimes exceeding the annual permissible dose administered to the general population. Public authorities are now seriously concerned about medical radiation overused. In U.S.A. both the House of Representatives and the Food and Drug Administration have recently delt with this problem. Others and we have suggested before and the International Atomic Energy Agency now proposes: a "Smart Card" for every individual who receives medical radiation. In this card the amount of medical radiation administered will be recorded. It is time to issue rules for protection of the public from medical radiation overdose.

Furosemide for the diagnosis of complete or partial ureteropelvic junction obstruction.

Facticious accumulation of the radiopharmaceutical in the urinary draining system as shown by routine renal tests, like technetium- 99m-diethylenetriamine pentacetic acid, technetium-99m-mercaptylacetyltriglycine or technetium-99m-glucoheptonate renograms can be re-evaluated by administering a diuretic, like furosemide (FS) and obtaining post FS dynamic and static images. Urinary tract obstruction can thus be identified. Partial urinary tract obstruction, the effectiveness of stenting, the effectiveness of obstruction correcting surgery and retroperitoneal lymph nodes, may be diagnosed after FS induced diuresis. However, factors like loss of the compliance of the renal pelvis or the ureter, low renal function, renal immaturity in neonates and full or neurogenic bladder limit the diagnostic effectiveness of FS. Diuretic enhanced Doppler sonography and dynamic contrast-enhanced magnetic resonance imaging can also be used for the evaluation of partial or complete urinary tract obstruction. The FS induced diuresis procedure is compared to other related diagnostic techniques.

Can we increase our life span? The role of nuclear gerontology.

Elderly people, those above 60 or 65 years old differ from younger people in many ways. Nuclear medicine can play a role in the diagnosis of diseases of the elderly and thus help, in social adjustment and in care for the elderly people. The question is why adult stem cells have a certain limit of reproduction, since their DNA in a normal physical environment can theoretically live very much longer. The elderly are prone to suffer more diseases than the young. It is important that the elderly should use water soluble and not lipid soluble drugs. There are many more to write about the elderly. We have tried to be brief in order to show the importance of using nuclear medicine in gerontology. Let us mention here that the word gerontology means in greek "talk about the elderly" (gerontas is the old man and logy is to talk about). Elderly people are a large part of our society and we do have every reason, every interest and responsibility to keep this part of our society healthy, useful and productive.