Heterogeneous 68Ga-Prostate-Specific Membrane Antigen Uptake in the Left Upper Abdomen: Mesenchymal Tumor.

A 50-year-old man with recently diagnosed prostate adenocarcinoma was referred for whole-body Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for staging. Apart from some nonspecific findings, Ga-PSMA PET/CT revealed large soft tissue mass in the left upper abdomen showing heterogeneous tracer uptake. Histological examination of the mass was interpreted as gastrointestinal/extragastrointestinal stromal tumor by pathologists. Prostate-specific membrane antigen is considered specific for prostate cancer cells, although PSMA activity has been described in many other benign or malign conditions. That is why PSMA uptake in uncommon locations for prostate cancer metastasis must be considered for second malignancies or other benign conditions.

The role of F-18 FDG PET/CT in differentiating benign from malignant pulmonary masses and accompanying lymph nodes.

INTRODUCTION: The aim of this study was to evaluate the usefulness of SUVmax and lesion size to differentiate benign and malignant lesions of the lung and accompanying mediastinal lymph node on F-18 FDG PET/CT imaging. MATERIALS AND METHODS: A retrospective analysis was carried out on 100 patients with suspected lung cancer who were recommended for PET/CT scans for diagnosis and staging. The results of the SUVmax, lesion size and patient's age were compared with histopathology which was considered to be the 'gold standard' and sensitivity and specificity were calculated respectively. Lymph nodes greater than 1 cm in patients with benign pathology were evaluated and the SUVmax values were recorded. RESULT: Of the 100 patients, 38 were found to have benign, whereas 62 had malignant on histopathology. The SUVmax was significantly more elevated in malign masses (13.1 ± 6.4) than in benign masses (8 ± 5.7) (p< 0.05). The dimensions of malignant masses (4.5 ± 2.5 cm) were larger than benign ones (3 ± 1.6 cm) (p< 0.05). SUVmax of 7.6 was determined as the cut-off value, while the sensitivity and specificity were 82% and 55% respectively. The sensitivity was 87% and specificity was 45% for the lesion sizes in differentiation of the malignant and benign lesions. CONCLUSIONS: There are significant overlaps between benign and malignant lesions and specialists must be aware of the various pathological conditions that can give false positives and negatives.

Efficacy of 18F-2-fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computerized Tomography for Bone Marrow Infiltration Assessment in the Initial Staging of Lymphoma.

OBJECTIVE: Currently 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) is being successfully used for staging and follow-up of Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Various studies have demonstrated that PET/CT effectively detects bone marrow involvement (BMI) and is concordant with bone marrow biopsy (BMB) findings, thus it is deemed as a complementary method. This study was aimed to evaluate18F-FDG-PET/CT efficiency for detection of BMI in HL and NHL. METHODS: The study included 172 lymphoma cases who were admitted to Akdeniz University Medical School Department of Nuclear Medicine for initial staging with PET/CT. Visual and semiquantitative assessments were performed for PET/CT scan findings of the cases. The maximum standard uptake (SUVmax) value was the quantitative parameter used for 18F-FDG-PET scan. In visual assessment, bone marrow metabolic activity that is greater than the liver was considered as pathologic. For semiquantitative assessment, regions of interest were drawn for SUVmax estimation, which included iliac crest in cases with diffusely increased metabolic activity and the highest activity area in cases with focal involvement. BMB was considered as the reference test. RESULTS: On visual assessment of all the cases, PET/CT was found to yield 31% sensitivity and 85% specificity rate for detection of BMI. On visual assessment of HL cases, sensitivity rate was determined as 80%, and specificity as 78%, while in NHL cases the corresponding values were 24% and 90%, respectively. On semiquantitative assessment of HL cases, considering SUVmax≥4, sensitivity was found as 80% and specificity as 68%. In NHL patients, considering SUVmax≥3.2, sensitivity rate was detected as 65% and specificity as 58%. CONCLUSION: In this study, a moderately high concordance was observed between PET/CT and BMB findings. PET/CT appears to be a significant method for detecting BMI. Although PET/CT is not a substitute for BMB, we suggest it can be used as a guide to biopsy site and a complementary imaging technique for BMB.

68Ga-PSMA Uptake by Dermatofibroma in a Patient With Prostate Cancer.

Prostate-specific membrane antigen (PSMA) is a typ. 2 transmembrane protein that is highly expressed in prostate cancer cells. Ga-PSMA PET/CT imaging is a modality used to determine the extent of prostate cancer. Various other neoplasias may also express PSMA, which appears as Ga-PSMA uptake in PET/CT imaging. A 71-year-old man with prostate cancer underwent Ga-PSMA PET/CT imaging for restaging after having an elevated prostate-specific antigen level. Subcutaneous lesions showing focal PSMA uptake were detected, one of which was excised. The histopathologic diagnosis was dermatofibroma.

Role of Tc-99m pertechnetate for remnant scintigraphy, post-thyroidectomy, and serum thyroglobulin and antithyroglobulin antibody levels in the patients with differentiated thyroid cancer.

AIM: Postoperative scanning may help to identify patients with differentiated thyroid cancer (DTC); however, low dose I-131 can lead to stunning and suboptimal response to ablative therapy. The aim of this retrospective study is to compare postablative I-131 scintigraphy with post-thyroidectomy Tc-99m pertechnetate scintigraphy, serum thyroglobulin (Tg) and antithyroglobulin antibody (TgAb) levels in patients with DTC. METHODS: Patients who had undergone surgical thyroidectomy for DTC were evaluated retrospectively. All patients had undergone Tc-99m pertechnetate and postablative I-131 scans. Serum Tg and TgAb levels were measured in all subjects. Preablative pertechnetate scans of the thyroid bed were viewed blindly and then directly compared with postablative I-131 scans and Tc-99m pertechnetate scintigraphy was compared with serum Tg and TgAb levels. RESULTS: One hundred and seventy-four patients (146 women, 28 men) with a mean age of 48.7 ± 13.1 (range 12-84) years who had undergone surgical thyroidectomy for DTC were evaluated retrospectively. Of 174 patients, 6 (3%) had negative I-131 and also Tc-99m pertechnetate scintigraphy results. Of the remaining 168 positive I-131 scans, 131 (75%) were positive in at least one site on the pertechnetate scan, 19 (11%) were considered to have equivocal uptake and 18 (11%) were negative. For the per-site analysis, pertechnetate sites were considered to be accurately determined if they showed concordant uptake at sites that correlated precisely with those seen on the postablation I-131 scans. There were a total of 356 positive foci on I-131 scans. Of these, 273 foci (77%) were unequivocally positive on pertechnetate scintigraphy, 41 (11%) showed equivocal uptake and 42 (12%) foci could not be detected. There were statistically significant differences (p < 0.0001) between the negative and positive foci in terms of Tg levels on pertechnetate sites. CONCLUSIONS: A positive pertechnetate scan is, therefore, sufficient to guide progression to I-131 ablation in most patients. Pertechnetate scintigraphy may be of particular benefit if it is considered desirable to avoid use of I-131 in post-thyroidectomy remnant imaging. Tg level is an important parameter in the detection of remnant thyroid tissue in patients with DTC.

Comparison of Cystatin C and ß-Trace Protein Versus 99mTc-DTPA Plasma Sampling in Determining Glomerular Filtration Rate in Chronic Renal Disease.

UNLABELLED: Glomerular filtration rate (GFR) is the best indicator of renal function. The gold standard for GFR measurement is inulin clearance. However, its measurement is inconvenient, time-consuming, and costly. Thus, in both scientific studies and routine clinical practice nuclear medicine methods ((99m)Tc-diethylenetriaminepentaacetic acid [(99m)Tc-DTPA] and (51)Cr-ethylenediaminetetraacetic acid [(51)Cr-EDTA]) are preferred, and they correlate strongly with inulin clearance. In addition, cystatin C and ß-trace protein have also recently been used for this purpose. In the literature, however, data are limited about the clinical value of cystatin C and ß-trace protein in GFR measurement in chronic renal disease (CRD), and the results have been inconclusive. In this study, we aimed to determine the efficiency of cystatin C and ß-trace protein in the determination of GFR in CRD patients. METHODS: Eighty-four patients with CRD were included in the study (59 men and 25 women; age range, 21-88 y; mean age, 61 y). GFR was calculated using the gold-standard (99m)Tc-DTPA 2-sample plasma sampling method (TPSM) and 2 alternative methods: a formula using cystatin C and a formula using ß-trace protein. The correlation between TPSM and the cystatin C and ß-trace protein methods was assessed, and Bland-Altman analysis was used to graph scatterplots of the differences at a confidence interval of 95% (mean difference ± 1.96 SDs). RESULTS: GFRs calculated using both alternative methods correlated strongly with those calculated using the gold standard. However, the correlation was stronger for the cystatin C method than for the ß-trace protein method, and neither method produced reliably consistent GFRs. CONCLUSION: This study demonstrated that cystatin C and ß-trace protein do not reflect GFR with sufficient accuracy.

Comparison of glomerular filtration rate measurements with two plasma and single plasma sample methods in renal transplant cases with stable renal graft functions.

OBJECTIVE: This study was planned to determine the efficacies of single plasma sample methods (SPSMs) in indicating glomerular filtration rate (GFR) by taking two plasma sample method (TPSM) as reference in the determination of the GFR in cases with clinically stable renal transplantation. METHODS: Ninety-six renal transplantation cases (33 female, 63 male; age interval 18-67, mean age 37.46 ± 11.81 years) progressing stably clinically and as laboratory, with minimum 6 months after transplantation were included in the study. The GFR values of the cases were measured with SPSM and TPSM. RESULTS: It is observed that all SPSMs have a strong correlation with TPSM. Highest correlation was observed between Groth&Aasted SPSM and TPSM GFR (intraclass correlation coefficient: 0.965). In the analyses performed by using the Bland-Altman analysis, GFR values calculated by all SPSMs were concordant to the TPSM which is the gold standard method in 95 % confidence interval (average ± 1.96 standard deviation) and were within the clinically acceptable limits. The narrowest concordance interval was obtained between Groth&Aasted Tc-99 m DTPA SPSM and Tc-99 m DTPA TPSM..Besides, we have obtained the minimum bias and precision value by the Groth&Aasted method. CONCLUSIONS: As a result; we can see that all the SPSMs give reliable results in measuring GFR in cases with renal transplantation; besides, we suggest Groth&Aasted method as the first option.

Clinical value of cystatin C and beta-trace protein in glomerular filtration rate in renal transplant cases with stable renal graft functions: comparison by the 99mTc-DTPA plasma sample method.

AIM: The aim of this study was to investigate the value of cystatin C and beta-trace protein (BTP) levels in determination of the glomerular filtration rate (GFR) by accepting the technetium-99m diethylenetriamine pentaacetic acid (Tc-DTPA) method as the gold standard for GFR measurement in renal transplant patients with stable renal functions and to investigate the value of cystatin C and BTP levels in the determination of GFR in cases with or without renal tubular injury. METHODS: A total of 89 (60 men and 29 women) renal transplant patients aged 19-67 years (mean 38.15 years) with stable graft functions were included in the study. GFR was calculated using three different methods: (a) the Tc-DTPA two plasma sample method; (b) eight different formulas containing cystatin C; and (c) three different formulas containing BTP. In addition, the cases were divided into two groups on the basis of N-acetyl-ß-D-glucosaminidase and ß2 microglobulin levels showing tubular damage. RESULTS: GFR values obtained with cystatin C had a better correlation with the gold standard method compared with those obtained with BTP, and the GFR value obtained with cystatin C had the most reliable consistency. We found that cystatin C provided more accurate results in GFR follow-up in renal transplant patients with no tubular injury compared with those with tubular injury. CONCLUSION: Cystatin C is a good marker of GFR in renal transplant patients, especially in those with no tubular injury; however, BTP is not as good as cystatin C in that regard.

Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI.

BACKGROUND AND OBJECTIVE: Urinary tract infections (UTIs) are common childhood bacterial infections that may involve renal parenchymal infection (acute pyelonephritis [APN]) followed by late scarring. Prompt, high-quality diagnosis of APN and later identification of children with scarring are important for preventing future complications. Examination via dimercaptosuccinic acid scanning is the current clinical gold standard but is not routinely performed. A more accessible assay could therefore prove useful. Our goal was to study procalcitonin as a predictor for both APN and scarring in children with UTI. METHODS: A systematic review and meta-analysis of individual patient data were performed; all data were gathered from children with UTIs who had undergone both procalcitonin measurement and dimercaptosuccinic acid scanning. RESULTS: A total of 1011 patients (APN in 60.6%, late scarring in 25.7%) were included from 18 studies. Procalcitonin as a continuous, class, and binary variable was associated with APN and scarring (P < .001) and demonstrated a significantly higher (P < .05) area under the receiver operating characteristic curve than either C-reactive protein or white blood cell count for both pathologies. Procalcitonin ≥0.5 ng/mL yielded an adjusted odds ratio of 7.9 (95% confidence interval [CI]: 5.8-10.9) with 71% sensitivity (95% CI: 67-74) and 72% specificity (95% CI: 67-76) for APN. Procalcitonin ≥0.5 ng/mL was significantly associated with late scarring (adjusted odds ratio: 3.4 [95% CI: 2.1-5.7]) with 79% sensitivity (95% CI: 71-85) and 50% specificity (95% CI: 45-54). CONCLUSIONS: Procalcitonin was a more robust predictor compared with C-reactive protein or white blood cell count for selectively identifying children who had APN during the early stages of UTI, as well as those with late scarring.

Measurements of tumor size using CT and PET compared to histopathological size in non-small cell lung cancer.

PURPOSE: In this study, we aimed to compare the tumor sizes determined by maximum morphological computed tomography (CT) and functional positron emission tomography (PET) with the histopathological size to determine which method provides the best correlation with the histopathological size in lung carcinoma patients. MATERIALS AND METHODS: Forty lung carcinoma patients (39 males, one female) diagnosed histopathologically from surgical resection materials were included in this retrospective study. The mean age (±standard deviation, SD) of the patients was 67.8±10.3 years with a range of 44 to 81 years. The PET scans were performed within the same week as the CT scan. In the CT scans, the morphological tumor sizes were measured three-dimensionally by the longest transaxial section in the parenchymal and mediastinal screening window. The functional tumor sizes were also measured three-dimensionally in the PET scans. These two measurement values were compared with the histopathological size using Bland-Altman plotting. Bland-Altman plotting was also performed to define the 95% limits of agreement, which was presented as the bias ±1.96 SD. RESULTS: The histopathological sizes were measured in a range of 1.2 to 7.5 cm. The maximum measurement of the tumors on the CT scans showed a lower concordance (mean difference, -0.30) than that obtained from PET, and the SD was found to be larger than the PET (1.96 SD was 3.50 for CT and 2.50 for PET). CONCLUSION: The PET measurements of tumor size were more compatible with the histopathological sizes than the CT measurements in patients with non-small cell lung cancer.

Tc-99m Labeled HMPAO white Blood Cell Scintigraphy in Pediatric Patients.

OBJECTIVE: (99m)Tc labeled hexamethylpropylene amine oxime (HMPAO) white blood cell (WBC) scintigraphy is a frequently used option for acute infection, particularly in pediatric patients. This scintigraphy is applied to detect sites of infection/inflammation in patients with fever of unknown origin, to find and follow up osteomyelitis, and to detect suspicion of acute appendicitis. The aim of this retrospective study was to evaluate the value of (99m)Tc-HMPAO labeled WBC scintigraphy in pediatric patients. MATERIAL AND METHODS: The study was conducted between January 2006 and December 2008 and included 13 patients (5 boys, 8 girls; mean age 6.9±6.2 years). Those patients who had suspicion of bone infection (n=7), fever of unknown origin (n=3), and suspicion of acute appendicitis (n=3) were evaluated retrospectively. (99m)Tc-HMPAO labeled WBC scintigraphy imaging was performed to all patients. Diagnosis was done according to operation and pathological results or clinical follow-up. RESULTS: (99m)Tc-HMPAO labeled WBC scintigraphy has been found to be true positive in 6 cases, true negative in 6 cases, and false negative in one patient who had fewer unknown origin. The false negative case has been found to have encephalitis with MRI. CONCLUSION: Leukocyte scintigraphy has been described as a useful diagnostic tool in the diagnosis of suspicion of bone infection, fever of unknown origin and suspicion of acute appendicitis. (99m)Tc-HMPAO labeled WBC scintigraphy is a rapid and very accurate method for detecting those pathologies. Our results showed that WBC scintigraphy might be reliably used for diagnosis of suspected bone infection and acute appendicitis, fever of unknown origin, and acute appendicitis, in pediatric patient population. CONFLICT OF INTEREST: None declared.

The Agreement Between Blood Pool - Delayed Bone Scintigraphy and Tc-99m Human Immunoglobulin G (HIG) Scintigraphy in the Determination of the Presence and Severity of Inflammatory Arthritis.

OBJECTIVE: In this study, it was aimed to investigate the agreement between early phase of bone scintigraphy - human immunoglobulin scintigraphy (EPBS-HIG) and late phase bone scintigraphy - HIG (LPBS-HIG) in the determination of the presence and also the severity of inflammatory arthritis. MATERIAL AND METHODS: Twenty-eight patients (23 female, 5 male; between 19 to 80 years of age) with inflammatory arthritis were included in the study. Tc-99m HIG and blood pool/late phase bone scintigraphies were performed in all patients. In scintigraphic examinations, the joints were scored with the degree of accumulation of the radiopharmaceutical by the semiquantitative analysis (0=Background activity, 1=Faint uptake, 2=Moderate uptake, 3=Marked uptake) which is called as visually active joint score as severity index of the disease. To estimate the agreement between EPBS - HIG and LPBS - HIG in the determination of the presence and severity of inflammatory arthritis, 2x2 kappa coefficients were calculated. RESULTS: Our results showed good agreement between EPBS - HIG for the presence of inflammation (kappa: 0.72) but not for the severity of the disease (kappa: 0.29), poor agreement between LPBS - HIG for both the presence (kappa: 0.51) and severity (kappa: 0.01) of inflammatory arthritis. CONCLUSION: The blood pool scintigraphy could be used in the investigation of the presence of inflammatory arthritis because the good agreement with HIG and the lower cost but not for the severity of the disease Conflict of interest:None declared.

Incidental detection of a benign thymoma on Tc-99m MIBI myocardial perfusion study.

UNLABELLED: Technetium-99m methoxy-isobutylisonitrile (Tc-99m MIBI) is a routinely used radiopharmaceutical for myocardial perfusion scintigraphy (MPS). It is also a tumor seeking agent. Here, we present a case of 51 year old male who underwent Tc-99m MIBI myocardial perfusion study due to permanent chest pain after coronary angiography. Abnormal MIBI uptake in the thorax was detected in the raw images. This single finding led to further investigation and thoracotomy proved that the lesion was benign thymoma. Thymomas are often asymptomatic or have a non-specific presentation. They are often detected coincidentally on images performed for any other reasons. We wanted to emphasize that during of MPS, the raw data should always be reviewed as occasionally valuable additional information on noncardiac pathology could be recognized by extracardiac uptake, as in this case. CONFLICT OF INTEREST: None declared.

Can serum cystatin C reflect the glomerular filtration rate accurately in pediatric patients under chemotherapeutic treatment? A comparative study with Tc-99m DTPA two-plasma sample method.

OBJECTIVE: It was assessed whether cystatin C (cysC) could be used as a marker of glomerular filtration rate (GFR) by considering the technetium-99m diethylenetriamine penta-acetate (Tc-99m DTPA)-two blood sample method (GFRTc-99m DTPA) as the reference in pediatric patients under chemotherapeutic treatment. METHODS: The chemotherapy group (CG) consisted of 31 patients (21 females, 10 males median age: 8.2 years; range: 2-16 years) who had been planned to receive allogenic hematopoietic stem cell transplantation. All patients in the CG received conditioning regimen (includes chemotherapy protocol) before hematopoietic stem cell transplantation. In addition, 21 patients (14 females, seven males median age: 9.5 years; range: 4-16 years) without any chemotherapy (nonchemotherapy group: nCG) were also prospectively investigated. Serum cysC, serum creatinine, GFRTc-99m DTPA, and GFR with a cysC-based formula (GFRcysC) were analyzed. Tubular function was also assessed. RESULTS: Although we found good correlation between GFRTc-99m DTPA and cysC (r = -0.78), GFRTc-99m DTPA and GFRcysC (r = 0.91), cysC and creatinine (r = 0.91) in nCG, the same correlations were poor in CG (r = -0.42, r = 0.43, r = 0.46, respectively). Tubular function was impaired after chemotherapy. Bias+/-1.96 SD values were -6+/-15.7 and -3+/-54.8 ml/min/1.73 m in nCG and CG, respectively. Precision was also better in nCG (10 ml/min/1.73 m) than in CG (27.6 ml/min/1.73 m). CONCLUSION: Serum cysC and GFRcysC cannot reflect GFR accurately in pediatric patients under chemotherapeutic treatment. Tubular cell damage induced by chemotherapeutics could be a responsible factor through the impairment of tubular absorption and metabolism of cysC.

Does gastroesophageal reflux scintigraphy correlate with clinical findings in children with chronic cough?

OBJECTIVE: Gastroesophageal reflux (GER), a common problem during childhood, leads to chronic troublesome symptoms including chronic respiratory symptoms. Therefore, timely diagnostic work-up for GER is essential in children when GER is suspected. In this study, we aimed to establish whether scintigraphic parameters have clinical importance in investigating the reflux in children. METHODS: A total of 72 children older than 7 years with chronic cough of unknown etiology were enrolled for this study. The scintigraphic procedure was performed by using technetium-99m tin colloid (37-74 MBq). Cough and GER scores were used for children who were positive for GER both before and after GER treatment. RESULTS: Of 72 children, 65 children with a mean age of 10.3+/-2.3 (7-19) years had GER on gastroesophageal scintigraphy. Median reflux episode number was 7 (1-14). There was a significantly positive correlation between reflux episode number and cough (r = 0.446, P<0.001) and GER score (r = 0.432, P<0.001). The significant decrease was observed in cough (from 3.5+/-1.9 to 1.6+/-1.3) and GER scores (from 4.1+/-2.5 to 1.3+/-1.1) with GER treatment (P<0.001 for each). CONCLUSION: Scintigraphy should be used for the detection of GER in children who present with chronic cough. Increasing episode number in gastroesophageal scintigraphy might be a predictor for reflux-related symptom severity.

Evaluation of eNOS gene polymorphisms in relation to BMD in postmenopausal women.

OBJECTIVE: The aim of the present study was to evaluate the relations between T(-786)C and Glu298Asp polymorphisms of the endothelial nitric oxide synthase (eNOS) gene and BMD in postmenopausal Turkish women. METHODS: The T(-786)C and Glu298Asp polymorphisms were genotyped by PCR-RFLP method in 311 postmenopausal osteoporotic women (OP) and in 305 age-matched postmenopausal females (CG) with normal BMD. RESULTS: None of the SNPs of the eNOS gene was significantly associated with BMD at the lumbar spine, femoral neck, Ward's triangle and femoral trochanter in the combined group. Mean BMD values were therefore found to be similar across the genotypes in postmenopausal Turkish women. However, there was a significant association between the T(-786)C polymorphism and BMD values at the lumbar spine in the normal control group (P=0.005), and at the femoral trochanter in the osteoporotic patients (P=0.046). The mean value of the lumbar spine BMD in the normal controls was significantly higher in women with the TC genotype of the T(-786)C polymorphism than in women with the TT genotype (P=0.0012). Women with the CC genotype of the T(-786)C polymorphism in the osteoporotic patients had significantly higher BMD value at the femoral trochanter than those with the TC (P=0.018) and TT genotypes (P=0.024). Frequencies of the TC heterozygotes for T(-786)C polymorphism were significantly higher among osteoporotic subjects than normal controls. Also, the CC and TT genotype frequencies of control group were significantly higher than those of the osteoporotic group at the femoral neck. CONCLUSIONS: We conclude that, although the biological role of the nitric oxide synthases is well established, our study does not suggest that eNOS gene polymorphisms, T(-786)C and Glu298Asp, are major contributors to adult bone mineral density in the postmenopausal Turkish women.

No association between bone mineral density and transforming growth factor beta gene T(861-20)-C polymorphism in Turkish postmenopausal women.

The aim of the study was to examine whether the TGF-beta1 T(861-20)-C gene polymorphism might be useful in identifying individuals with increased susceptibility to postmenopausal bone loss within the Turkish women population. T(861-20)-C polymorphism was genotyped in 616 postmenopausal women selected from the Turkish population: 311 postmenopausal osteoporotic women (OP) aged 45-65 years (mean age 58 years) and a control group (CG) of 305 postmenopausal women in the same age range (mean age 53 years) with normal bone mineral density. We have not found any significant differences in the frequency of the individual genotypes between the osteoporotic and control groups. The distribution of the T(861-20)-C genotypes was for Lumbar spine, CC, 74.0% in OP, 75.1% in CG; TC, 24.1% in OP, 23.9% in CG; TT, 1.9% in OP, 1.0% in CG; and for femoral neck, CC, 76.8% in OP, 72.8% in CG; TC, 22.1% in OP, 25.5% in CG; TT 1.1% in OP, 1.7% in CG. T(861-20)-C polymorphism was not found to be associated with bone mineral density in postmenopausal Turkish women. It was argued that this will be a pioneering study for the future research and therapies.

Renal function after hematopoietic stem cell transplantation in children.

OBJECTIVES: The aim of this study was to assess glomerular and tubular renal function after HSCT in children in a prospective trial. METHODS: Renal function was assessed prospectively before HSCT (on day -10), on days +30, +100, and at least 6 months after transplantation in 34 patients (21 females/13 males) with a mean age of 8.2 years. The following parameters were investigated: glomerular filtration rate (GFR) by creatinine clearance (CrCl), cystatin C (CysC)-based formula and plasma clearance of radiolabeled diethylenetriaminepentaacetic acid ((99m)Tc-DTPA), urinary excretion of beta(2)-microglobulin (beta(2)M), beta-N-acetylglucosaminidase (beta-NAG), fractional excretion of sodium (FE(Na)) and fractional tubular phosphate reabsorption (TP/CrCl). RESULTS: Nine patients (26.4%) suffered from acute renal insufficiency within the first 100 days after transplantation. All patients who developed acute renal insufficiency were treated successfully without renal replacement therapy. Age, sex, primary diagnosis, sepsis, veno-occlusive disease, acute graft versus host disease, and use of vancomycin were not significant risk factors for the development of acute renal insufficiency. The medians (99m)Tc-DTPA-based GFR of patients after HSCT showed a statistically significant decrease when compared with pre-transplant values. beta-NAG excretion was significantly elevated in the first 30 days after HSCT. CONCLUSION: Acute and chronic renal impairment can be developed in patients who undergo HSCT even though the pre-transplant renal function is in normal limits and the conditioning regimen does not include TBI. Both glomerular and tubular renal function evaluation should be part of a long-term follow-up in children following HSCT.

Technetium-99m hexamethyl propylene amine oxime-labeled leukocyte scintigraphy at three different times in active ulcerative colitis: comparison with colonoscopy and clinico-biochemical parameters in the assessment of disease extension and severity.

OBJECTIVE: In this study, our objective was to define the usefulness of technetium-99m hexamethyl propylene amine oxime (Tc-99m HMPAO)-labeled leukocyte scintigraphy at three different time points in the assessment of disease extension and severity in patients with active ulcerative colitis (UC). METHODS: Twenty-one consecutive patients (10 women, 11 men; mean age 42.4 +/- 12 years) with active UC were prospectively studied. All patients were diagnosed by colonoscopy and histopathology prior to inclusion. Scintigraphy was performed at 1 h, 2 h, and 4 h after Tc-99m HMPAO-labeled leukocyte injection. Clinic-biochemical activity score, total colonoscopic activity score, and total scintigraphic activity score at 1 h, 2 h, and 4 h were calculated for each patient. RESULTS: Sensitivity, specificity, and accuracy values of Tc-99m HMPAO-labeled leukocyte scintigraphy were calculated as follows, respectively: 1 h imaging 86%, 73%, and 83%; 2 h imaging 89%, 74%, and 86%; 4 h imaging 90%, 58%, and 83% in the detection of active inflammatory segments. Even though no statistically significant difference was found between 1 h, 2 h, and 4 h imaging with respect to the sensitivity, specificity of labeled leukocyte scintigraphy, the largest area under the curve value was found for 2 h imaging. CONCLUSIONS: Tc-99m HMPAO-labeled leukocyte scintigraphy has been found to be correlated well with colonoscopy in the assessment of both the extension and severity of UC. We recommend 2 h scintigraphic imaging because it provides the largest area under the curve value and decreases the number of false-positive results.

Bone metabolism markers and bone mineral density in children with neurofibromatosis type-1.

Some experimental studies suggested that there may be a bone formation defect rather than a disorder in bone resorption in patients NF1. The aim of this study was to determine bone mineral density (BMD) with dual-energy X-ray absorptiometry (DEXA) and investigate specific bone formation and bone resorption and bone turnover markers in children with NF1. Thirty-two children and adolescents (16 boys, 16 girls; 16 prepubertal, 16 pubertal) with NF1 were recruited. Their age ranged from 3 to 17 years. They were compared with matched healthy children. Dual-energy X-ray absorptiometry were applied to 26 patients and 27 controls. Nine of 32 subjects with NF1 had a skeletal abnormality. BMD of the lumbar spine, and femoral neck in NF1 patients significantly decreased compared to that of healthy subjects. They were also significantly decreased in pubertal patients when compared to pubertal controls and in prepubertal patients when compared to prepubertal controls. Patients with skeletal abnormalities were found to have significantly lower level of osteocalcin when compared to patients without skeletal abnormality. Other biochemical markers did not exhibit any difference between the groups. In conclusion, our findings suggest that bone formation markers rather than DEXA could be good predictors of skeletal abnormalities among NF1 patients. However, in our study the number of the NF1 patients with skeletal abnormality and the number of bone formation markers studied were all limited. It is appropriate to perform larger studies with other bone formation markers beside osteocalcin.