F18-FDG coincidence-PET in patients with suspected gynecological malignancy.

PURPOSE: To assess the role of F18-FDG imaging with a dual-head coincidence mode gamma camera (Co-PET) in identifying malignant tumors in patients with a suspicious adnexal mass depicted by conventional imaging methods. MATERIAL AND METHODS: F18-FDG Co-PET was performed preoperatively in 18 women (mean age 56.38 years) with suspected malignant gynecologic tumors according to clinical and abdomino-pelvic/transvaginal ultrasound or computed tomography findings. Exploratory laparotomy was performed in all patients within the 10 days post-F18-FDG Co-PET study, and the definitive diagnosis of the adnexal masses was established by histopathological examination. RESULTS: Histopathological examinations of the surgically excised adnexal masses revealed eight malignant, one borderline, and nine benign neoplastic tumors. Four benign tumors had no F18-FDG uptake, while the remaining five tumors, all leiomyomas, showed mild FDG accumulation. Eight malignant tumors showed intense F18-FDG uptake. Sensitivity, specificity, PPV, and NPV of F18-FDG co-PET in differentiating benign from malign adnexal masses were 88%, 44%, 61%, and 80%, respectively. Tumor to background ratios (T/B) in benign lesions (2.04 +/- 0.27) were significantly lower than in malignant lesions (7.4 +/- 0.99). CONCLUSION: F18-FDG Co-PET is of clinical value when assessing suspicious malignant adnexal masses. False-negative F18-FDG results might arise from borderline disease. Moderate F18-FDG uptake in leiomyomas can result false-positive, but T/B ratios may be helpful in such cases.

Tuberculous peritonitis of the wet ascitic type: clinical features and diagnostic value of image-guided peritoneal biopsy.

BACKGROUND: Abdominal tuberculosis is still a medical problem in developing countries. AIMS: To analyse the clinical, laboratory, ultrasonography and computed tomography findings and to discuss the diagnostic approach of 19 patients with peritoneal tuberculosis. PATIENTS: Nineteen patients diagnosed in our department, with peritoneal tuberculosis (8 female, 11 male; mean age: 47.89 +/- 4.3 years) between 1996 and 2002, were studied retrospectively. METHODS: All clinical, laboratory, radiological findings, and diagnostic methods were reviewed. RESULTS: The most common symptoms and signs of the disease in these patients were abdominal pain, ascites, weight loss and night sweats. On conducting skin test, eight patients (42%) were found to be positive, while all the patients had elevated serum cancer antigen 125 levels, but acid-resistant bacilli could not be demonstrated on the direct preparation. In three patients (15.78%), the ascitic fluid culture was positive. The most common ultrasonographic and computed tomographic findings were ascites, septation in the ascites, peritoneal thickening, mesenteric and omental involvement. An abnormal chest X-ray, suggestive of previous tuberculosis was present in three patients. Diagnosis was made by image-guided percutaneous peritoneal biopsy in 18/19, and by histological examination of biopsy specimens obtained via laparoscopy in 1/19. Laparoscopy was only performed in 1 of the 19 patients due to lack of sufficient material for histological diagnosis by percutaneous biopsy. Of the biopsy specimens, 84% revealed caseating granulomas, while 16% were non-caseating. Acid-fast bacilli were seen on the Ziehl-Neelsen stain in 18 patients. CONCLUSIONS: Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites. Image-guided percutaneous peritoneal biopsy seems to be a sufficient, safe and inexpensive method for diagnosis of peritoneal tuberculosis.

Occupational exposure to hepatitis infection among Turkish nurses: frequency of needle exposure, sharps injuries and vaccination.

The aim of this study was to assess the demographic factors and pattern of injuries sustained by nurses, and to determine the occupational hazard of exposure to hepatitis B (HBV) and C (HCV) viruses among nurses. The study involved 906 hospital-based nurses working in three large hospitals. Between August 2002 and January 2003 a total of 595 practising nurses were accepted for inclusion. The results of questionnaires completed were collated and chi2 and ratios were used for analysis. Of the 595 nurses, 111 (18.7%) had evidence of previous or current HBV infection and 32 (5.4%) of HCV infection. We found that 11.2% of the nurses who had worked for a period of between 0 and 5 years and 37.1% of those who had worked for a period between 16 and 20 years had evidence of HBV or HCV infection. Of the nurses working in surgical clinics, 59.4% had evidence of previous HBV or HCV infection and those working in hospital clinics had an 18.2% infection rate. Of the nurses occupationally exposed to HBV and HCV infections, 22.4% had received sharps injuries from apparatus and 63.6% had suffered needlestick exposure. Findings also showed 2.7% HBsAg positivity and 5.4% anti-HCV positivity. Of the 452 (76%) nurses who faced the occupational hazard of exposure to hepatitis infections, 27.7% (125/452) had not been vaccinated against HBV. Nurses working in our health-care sector are frequently exposed to occupational exposure for HBV and HCV infections. In order to prevent the infection of nurses with hepatitis, we advocate precautions and protection from sharps injuries. A programme of education, vaccination and post-exposure prophylaxis must be implemented.

Assessment of the P-glycoprotein expression by 99mTc-MIBI bone marrow imaging in patients with untreated leukaemia.

The ability of cancer cells to become simultaneously resistant to different drugs is a significant impediment to successful chemotherapy. 99mTc-MIBI has been reported to be a transport substrate for P-glycoprotein (Pgp). The aim of the study was to ascertain the relationship between the degree of 99mTc-MIBI uptake and the level of Pgp expression in patients with newly diagnosed leukaemia. A total of 26 patients (12 female and 14 male; mean age 46.8+/-3.7 years) with newly diagnosed leukaemia were included in the study. None of the patients had been previously treated with chemotherapy. Images were obtained 20 min post-injection of 740 MBq 99mTc-MIBI. Whole-body and planar spot images of the pelvis and thorax were acquired. The uptake of the MIBI in the bone marrow was evaluated using a qualitative and also a quantitative scoring system with determination of the tumour-to-background (T/B) ratios. Flow cytometry was performed for determining the Pgp expression of the blast cells in the bone marrow aspiration samples. There was a statistically significant inverse relationship between the Pgp level in numeric values and both mean qualitative (P<0.001; r=-0.665) and quantitative (P=0.001; r=-0.606) results of 99mTc-MIBI imaging. Both the mean qualitative score and the T/B ratios were higher in patients who were Pgp negative than in those who were Pgp positive (P<0.001 and P<0.001, respectively). These data indicate that an increased level of Pgp expression is correlated with a low accumulation of 99mTc-MIBI in bone marrow of patients with leukaemia. 99mTc-MIBI bone marrow imaging, as a method of functional imaging, can give in vivo information concerning the functional expression of the MDR phenotype in patients with untreated leukaemia.

Tc-99m methoxyisobutylisonitrile bone marrow imaging for predicting the levels of myeloma cells in bone marrow in multiple myeloma: correlation with CD38/CD138 expressing myeloma cells.

The percentage of myeloma cells in bone marrow is subsequently an important index of disease in patients with multiple myeloma (MM). Bone marrow myeloma cells can be detected by strong CD38/CD138 positivity and light scatter characteristics using flow cytometry. The aim of the study was to evaluate the relationship between the degree of Tc-99m methoxyisobutylisonitrile (MIBI) uptake and the percentage of CD38/CD138 expressing myeloma cells in the bone marrow of patients with MM. A total of 15 patients with MM (mean age: 61.7+/-2.4 years; 7 F and 8 M) were included in the study. Tc-99m MIBI imaging was obtained 20 min after injection of 740 MBq Tc-99m MIBI. Planar spot images of the pelvis and thorax were acquired. The uptake of Tc-99m MIBI in the bone marrow was evaluated using a qualitative and also a semiquantitative scoring system for the bone marrow in areas that included the proximal femurs, anterior iliac crest, and sternum. In all patients, flow cytometry was performed for assessing the percentage of CD38/CD138 expressing myeloma cells in the bone marrow samples. There was a statistically significant positive correlation between the percentage of CD38/CD138 expressing plasma cells in bone marrow and both mean qualitative (r=0.689, p=0.005) and semiquantitative (r=0.669, p=0.006) results of Tc-99m MIBI uptake. In conclusion, our results indicate that increased Tc-99m MIBI uptake of bone marrow is related to the percentage of plasma cell infiltration of bone marrow. Tc-99m MIBI bone marrow imaging may be a useful tool for predicting the levels of myeloma cells in bone marrow of patients with MM.

Gastroesophageal reflux in the patients with asthma.

Thirty one patients with asthma (mean age was 44.4 10.7; range 18-63) were investigated for gastroesophageal reflux (GER). The patients were separated into two groups according to presence of reflux and/or nocturnal symptoms. 13 patients had one of the reflux and/or nocturnal asthma symptoms (Group 1), whereas 18 patients had none of them (Group 2). To assess GER patients underwent to scintigraphy with Tc99m. GER was determined 4 of 13 patients in group 1 (30,7 %) and 1 of 18 patients in group 2 (5,5 %). There was significant difference between the group 1 and group 2 in that respect (p < 0,001). The patients with established GER (5 patients) were given Omeprazole (a proton pomp inhibitor) 40 mg daily for 4 weeks following a 2 week placebo period. The patients recorded their daily and nocturnal symptoms of asthma, additional salbutamol use, morning and evening peak expiratory flow rates (PEFR) measurements in a daily chart during placebo and omeprazole treatment without changing their antiasthma treatment. Their PEFR, FEV1 values, daily and nocturnal symptoms and additional beta agonist use did not changed after omeprazole treatment except one. But their reflux symptoms (heartburn and regurgitation) were improved. As a consequence, we suggested that asthmatics which have some complaints of reflux should be searched for GER. Not the respiratory functions but GER symptoms can be improved w

Gastroesophageal reflux in the patiens with asthma

Thirty one patients with asthma (mean age was 44.4 ± 10.7; range 18-63) were investigated for gastroesophageal reflux (GER). The patients were separated into two groups according to presence of reflux and/or nocturnal symptoms. 13 patients had one of the reflux and/or nocturnal asthma symptoms (Group 1), whereas 18 patients had none of them (Group 2). To assess GER patients underwent to scintigraphy with Tc99m. GER was determined 4 of 13 patients in group 1 (30,7 %) and 1 of 18 patients in group 2 (5,5 %). There was significant difference between the group 1 and group 2 in that respect (p < 0,001). The patients with established GER (5 patients) were given Omepprazole (a proton pomp inhibitor) 40 mg daily for 4 weeks following a 2 week placebo period. The patients recorded their daily and nocturnal symptoms of asthma, additional salbutamol use, morning and evening peak expiratory flow rates (PEFR) measurements in a daily chart during placebo and omeoprazole treatment without changing their antiasthma treatment. Their PEFR, FEV1 values, daily and nocturnal symptoms and additional beta agonist use did not changed after omeoprazole treatment except one. But their reflux symptoms (heartburn and regurgitation) were improved. As a consequence, we suggested that asthmatics which have some complaints of reflux should be searched for GER. Not the respiratory functions but GER symptoms can be improved with antireflux treatment (AU)

En 31 pacientes (media de edad: 44,5 ñ 10,7 años) se investigó la posible existencia de reflujo gastroesofágico (RGE). Los pacientes se separaron en dos grupos, de acuerdo con la presencia de síntomas de reflujo y/o síntomas nocturnos. 13 pacientes tenían uno de los síntomas de reflujo y/o de asma nocturna (Grupo 1) mientras que los otros 18 no tenían ningún síntoma (Grupo 2). Para valorar el RGE se efectuó estudio mediante escintigrafía con 99mTc. Se encontró RGE en 4 de los 13 pacientes del grupo 1 (30,7 por ciento) y en 1 de los 18 del grupo 2 (5,5 por ciento). En este respecto, hubo diferencia significativa entre ambos grupos (p < 0,001). A los 5 pacientes con RGE establecido se les administró omeprazol (un inhibidor de la bomba de protones), 40 mg/día durante 4 semanas, seguidas de otras 2 semanas con placebo. Los pacientes anotaron los síntomas diurnos y nocturnos de asma, el consumo de salbutamol, el valor del PEF de la mañana y la noche, mientras tomaron omeprazol o placebo, sin haber cambiado el tratamiento del asma.Ninguno de estos parámetros se modificó al tomar omeprazol, salvo en uno de los pacientes. Sin embargo, mejoraron los síntomas de reflujo (acidez y regurgitación). Como consecuencia, sugerimos que a los asmáticos que tienen algunos signos de reflujo se les debería investigar un posible RGE. Con el tratamiento anti-reflujo, pueden mejorar los síntomas de RGE pero no los respiratorios (AU)

The comparison of the effects of fluticasone propionate and budesonide on clinical indices and on bone mineral density in the asthmatic patients: a one year treatment study.

BACKGROUND: it is well accepted that the inhaled administration of steroids is efficacious and has fewer side effects than the systemic use. Among them fluticasone propionate (FP) has been said to cause the similar antiasthma effect without unfavorable side effect at half the dose of the other ICS. The aim of the study was to compare the effects of FP 500 microg/day and budesonide (BUD) 800 microg/day as a pressurized metered dose inhaler (pMDI) for one year on clinical indices determined by FEV1 and diurnal variation of PEFR (peak expiratory flow rates) and on laboratory indices determined by serum cortisol and bone mineral density (BMD). METHODS: a total of 30 nonsmoking mild to moderate asthmatic patients were recruited the study. 15 patients were given 800 microg/day BUD and 15 patients were given 500 microg/day FP as a pMDI. BMD measurements were done with dual energy X-ray absorbtiometry (DEXA) before and after the treatment at the lumbar area of the spine (L1-4) and left hip (trocanter major, neck of femur, intertrocanteric region and Ward's triangle). 10 patients of BUD group and 13 of FP group completed the study. After a year of treatment period, patients were compared on the basis of clinical indices (FEV1 and variability of PEFR), on serum cortisol levels and on BMD in both groups. RESULTS: after the treatment, variability of PEFR (in BUD group p < 0,01, in FP group p < 0,001) and FEV1 (in BUD group p < 0,05, in FP group p < 0,05) were both improved in the groups. Serum cortisol levels and BMD of the patients in both groups were not changed significantly (p > 0,05). CONCLUSIONS: the results suggested that FP 500 microg/d and BUD 800 microg/d as a pMDI results in a similar antiasthma effect without causing any adverse effect on BMD in mild and moderate asthmatics after one year treatment period.

Diagnostic efficacy of the preoperative lymphoscintigraphy, Ga-67 scintigraphy and computed tomography for detection of lymph node metastasis in cases with ovarian or endometrial carcinoma.

BACKGROUND: To investigate the diagnostic efficacy of preoperative lymphoscintigraphy (LS), Ga-67 scintigraphy (GS) and computed tomography (CT) for detection of lymph node metastasis in patients with endometrial or ovarian carcinoma. METHODS: The results of preoperative LS, GS and CT used to detect lymph node metastasis were compared to the postoperative histopathological results of lymph node dissection materials of a total of 37 patients, including 16 patients with endometrial and 21 patients with ovarian carcinomas. The diagnostic efficacy of these methods for detecting lymph node metastasis were calculated. RESULTS: When the results of all of the patients were taken into account, the preoperative LS, GS and CT were found to have sensitivities of 50%, 20% and 40% and specificities of 51.8%, 96.3%, and 92.6%, respectively, for detection of pelvic lymph node metastasis. The same methods had sensitivities of 27.3%, 27.3% and 72.7% and specificities of 88.5%, 88.5%, 84.6%, respectively, for detecting para-aortic lymph node metastasis in all patients. CONCLUSION: These data suggested that although LS, GS and CT had relatively high specificity, low sensitivity of these imaging methods precluded their routine preoperative use for diagnosis of lymph node metastasis of ovarian or endometrial carcinoma.

The effect of alpha-tocopherol and pentoxyfilline on ischemia-reperfusion induced liver injury in rats.

BACKGROUND/AIM: In the present study our purpose was to investigate the effect of pentoxyfilline, that plays a role in microcirculation and tissue oxygenation, alone and in combination with an antioxidant vitamin E on tissue damage in the rat liver induced by ischemia-reperfusion. METHODOLOGY: Thirty-one albino rats were divided into four groups. Rats in group I (n= 7), group II (n= 8) and group III (n= 8) were given, respectively, pentoxyfilline (25 mg/kg), pentoxyfilline and vitamin E in combination (25 mg/kg and 50 mg/kg, respectively) and equal volume of saline solution intraperitoneally for 7 days. Rats in group IV (n= 8) served as controls and received no treatment. On day 7 ischemia was induced by cross-clamping the hepatic artery, portal vein and left branch of the biliary duct for 30 minutes. Malondialdehyde (MDA) and catalase activity were assessed in tissue sample, and the level of ALT was measured in serum obtained after reperfusion for 30 minutes. Histological examination of tissue sample was also carried out. RESULTS: There was no significant difference in ALT level between three study groups. Group I and group II had significant lower MDA and catalase levels than those of group III. The results of histopathologic examination in group I and group II were better than that of group III. CONCLUSION: Our findings suggested that the treatment of pentoxyfilline alone and in combination with vitamin E decreased liver damage induced by ischemia-reperfusion and that the effect of latter was more effective but the difference between the two treatment patterns was not statistically significant.

Renal involvement in the Laurence-Moon-Bardet-Biedl syndrome: report of five cases.

We report five patients with Laurence-Moon-Bardet-Biedl syndrome (LMBBS) who had renal involvement. Intravenous pyelography showed bilateral or unilateral calyceal clubbing and blunting in all patients. In addition, one patient had a parapelvic cyst in the left kidney and another had bilateral lobulated renal outlines of the fetal type. One patient had a urinary concentrating defect and two patients showed increased fractional sodium excretion. Estimated tubular phosphate reabsorption values were in normal limits in all of five patients. No patient had a urine acidification defect, proteinuria, glycosuria, or hyperaminoaciduria. One patient died from end-stage renal failure. The remaining four patients had normal serum creatinine values and estimated creatinine clearances. 99mTechnetium-diethylenetriamine pentaacetate renal scanning showed prolonged and delayed concentration and delayed excretion in three of the four patients who survived. A focal scar was determined on the left kidney of one of four patients by 99mtechnetium-dimercaptosuccinic acid renal scanning. All LMBBS cases with or without renal symptoms should be routinely evaluated for renal abnormalities. Renal scanning is a valuable method, especially for determining the renal involvement in the early stage of disease.

Value of dobutamine technetium-99m-sestamibi SPECT and echocardiography in the detection of coronary artery disease compared with coronary angiography.

The value of dobutamine echocardiography and 99mTc-sestamibi SPECT imaging was evaluated as a noninvasive diagnostic method for assessing coronary artery disease (CAD). Twenty-seven patients who underwent coronary angiography were submitted to two separate injections of 99mTc-sestamibi, one under control conditions and the other after reaching a peak dobutamine infusion rate. Simultaneous ECG and echocardiographic monitoring was also performed during stepwise dobutamine infusion. Whereas the overall sensitivity and specificity of dobutamine sestamibi SPECT imaging were 94% and 88%, these values for dobutamine ECG and echocardiography were 61%, 55% and 84%, 88%, respectively. When dobutamine echocardiography and 99mTc-sestamibi SPECT imaging were evaluated together, the diagnostic accuracy reaches almost 100%. Dobutamine echocardiography is of value in determining ischemic threshold earlier than clinical symptoms and allows simultaneous evaluation of ventricular performance and contractile function associated with perfusion abnormalities on 99,Tc-sestamibi SPECT imaging. Our experience shows that 99mTc-sestamibi SPECT imaging, when combined with dobutamine echocardiography, is a safe, practical, well tolerated method with high diagnostic accuracy for the evaluation of CAD.

Dobutamine stress radionuclide ventriculography for the detection of coronary artery disease.

Thirty patients were prospectively studied to assess the value of radionuclide ventriculography (RNV) during step-wise dobutamine infusion for the detection of coronary artery disease (CAD). Radionuclide ventriculography was performed under basal conditions and during dobutamine infusion at each 10 micrograms kg-1 min-1 dose increment from 10 to a maximum of 40 micrograms kg-1 min-1. The test response was considered positive if the ejection fraction (EF) decreased by more than 5% or if segmental contraction abnormalities developed. Dobutamine stress testing was well tolerated, no complications and no significant arrhythmia were observed. In nine of 11 patients without CAD, EF increased more than 5% of the rest value and the left ventricular wall motion was normal in 10 of them during dobutamine infusion (specificity 91%). In 18 of 19 patients with CAD, new wall motion abnormalities (WMA) were identified in segments corresponding to the arterial lesions diagnosed by angiography (sensitivity 94%). Ejection fraction response was significantly different in normal subjects and in patients with CAD: 11 +/- 5.9% versus 1.9 +/- 9.5% (P < 0.01). However, abnormal EF response was found in seven of 19 CAD patients and development of new WMA was found to be a more sensitive and specific parameter than EF response for dobutamine RNV. It is concluded that dobutamine RNV is an accurate, widely available and cost-effective test for detecting CAD, especially in patients unable to exercise.