PAGET'S DISEASE OF THE BONE FOUND INCIDENTALLY ON F-18 FDG PET/CT: CLINICAL SIGNIFICANCE AND DIFFERENTIAL DIAGNOSTIC CRITERIA.

Background: Paget Disease (PD) is usually asymptomatic and discovered incidentally, it is known that it is exhibited low to high grade increased F-18 FDG uptake. Aim: In this study, we investigated the distinguishability of FDG PET/CT in incidental PD cases from other bone diseases and at different stages of the disease. Patients and Methods: In this cross-sectional, descriptive study, "Paget" identification associated with PET/CT reports was found in 69 of 18,119 studies (~3.8%). Of the 45 patients (33 males and 12 females) eligible for inclusion in the study, 35.6% had monostotic and 64.4% had polyostotic disease (p>0.5). There was no statistically significant difference in biochemical parameters between groups. Results: According to the radiological appearance of the patients, 36 were in the mixed stage and 9 were in the blastic stage. Only the difference in ALP and creatinine values between the groups was statistically significant. SUVmax, SUVmean and HU values were found to be statistically significantly higher in pagetoid bones compared to control bone lesions. For SUVmax for PD bone lesion we found the 2.55 cutoff point with a sensitivity of 91% and a specificity of 84%. Conclusion: The specific radiological appearance of bone lesions and the evaluation of metabolic activity compared to normal bone seem to help differentiate PD from other lesions. Prospective studies are needed in the differentiation of FDG's disease stage and treatment response evaluation. The ability to differentiate between benign and malignant FDG avid bone lesions in oncological patients' enables appropriate patient management, including avoiding unnecessary additional invasive procedures such as bone biopsy.

Hand explorations are determined by the characteristics of the perceptual space of real-world materials from silk to sand.

Perceiving mechanical properties of objects, i.e., how they react to physical forces, is a crucial ability in many aspects of life, from choosing an avocado to picking your clothes. There is, a wide variety of materials that differ substantially in their mechanical properties. For example, both, silk and sand deform and change shape in response to exploration forces, but each does so in very different ways. Studies show that the haptic perceptual space has multiple dimensions corresponding to the physical properties of textures, however in these experiments the range of materials or exploratory movements were restricted. Here we investigate the perceptual dimensionality in a large set of real materials in a free haptic exploration task. Thirty-two participants actively explored deformable and non-deformable materials with their hands and rated them on several attributes. Using the semantic differential technique, video analysis and linear classification, we found four haptic dimensions, each associated with a distinct set of hand and finger movements during active exploration. Taken together our findings suggest that the physical, particularly the mechanical, properties of a material systematically affect how it is explored on a much more fine-grained level than originally thought.

SURVIVIN POSITIVITY AND PROGNOSTIC FACTORS IN PAPILLARY THYROID CARCINOMAS.

Context: Papillary thyroid carcinoma(PTC)s are the indolent progressive tumours. Survivin is a unique bifunctional protein with cell cycle regulation and apoptosis inhibition. The expression of this protein has been shown to be increased in thyroid tumours correlated with aggressive behavior from well differentiated to anaplastic. Objective: In this study, we aimed to investigate the relationship between immunohistochemically survivin expression and tumour-associated prognostic factors in papillary thyroid carcinomas. Design: In patients with thyroidectomy, we compared the clinicopathological findings and immunohistochemical positivity for survivin. Subjects and Methods: In 109 patients, sex, age, tumour size, histological tumour variant, tumour focality, tumour border pattern, tumour peripheral/intratumoural lymphocytic and stromal response, intraglandular spread, extrathyroideal spread, lymph node metastases, lymphocytic tiroiditis and relationships of these findings with survivin positivity were investigated. Results: When we indicated the tumour size and compared it with survivin expression, tumour size correlates with, survivin expression (p = 0.016). Survivin expression was correlated statistically significant with lymphovascular invasion, without stromal response and with intraglandular extension respectively (p<0.001, p = 0.043, p<0.001). No significant correlation was found between other clinicopathological parameters and survival. Conclusion: Few studies have investigated the relationship of survivin expression with prognosis in thyroid papillary carcinomas and showed that survivin was a poor prognostic marker. If its expression is detected in preoperative cytology smears, it may affects the surgical treatment strategy. When it is detected in the tissue, postoperative radioactive iodine treatment plan may be modified and the need for more aggressive follow-up may be considered.

Características tumorales del cáncer de pulmón para predecir metástasis en los ganglios axilares / Tumor characteristics of lung cancer in predicting axillary lymph node metastases

Objetivo: En el cáncer de pulmón las metástasis en los ganglios axilares (MGA) son infrecuentes y, según la 8.ª edición del Sistema de estadificación, se clasifican como enfermedad metastásica M1b. El objetivo de este estudio es evaluar: 1) la presencia de MGA; y 2) el efecto de las características de los tumores primarios en el desarrollo de MGA. Métodos: Realizamos un estudio transversal descriptivo, con revisión retrospectiva, para identificar las MGA. Resultados: Incluimos en este análisis a 157 pacientes: MGA (63 pacientes) y grupo control (94 pacientes). La presencia de ganglios extratorácicos, metástasis contralaterales pulmonares parenquimatosas y distantes y todos los valores SUVmáx fueron significativamente más elevados en el grupo de estudio, en comparación con el grupo control (p<0,05). El valor SUVmáx del tumor primario no fue un factor predictivo de MGA. Con arreglo al diagnóstico histopatológico primario detectamos que el cáncer de pulmón de células pequeñas causaba el desarrollo de MGA en una proporción 3,4 veces mayor que el cáncer de células escamosas (OR: 3,4 [IC 95%: 1,3-10,2], p=0,029) y que el grupo de adenocarcinoma causaba el desarrollo de MGA en proporción 4 veces superior que el cáncer de células escamosas (OR: 4,02 [IC 95%: 1,73-9,34], p=0,001). La probabilidad de desarrollar MGA fue considerablemente superior en los tumores localizados en el lóbulo superior que en el lóbulo inferior. Conclusión: Tras el hallazgo de MGA en las imágenes PET/TC, la necesidad de confirmación histopatológica viene determinada con arreglo a los resultados de la localización del tumor primario, la histopatología de este, el estadio M en PET/TC, la localización de MGA con arreglo al tumor primario y el estadio N en PET/TC

Objective: In lung cancer, axillary lymph node metastases (ALM) are rare, and according to the 8th grading system, it is classified as M1b disease. The aim of this study is to evaluate1) the presence of ALM and2) the effect of the primary tumors characteristics on the development of ALM. Methods: We performed a descriptive cross-sectional study, with retrospective revision, to identify ALM. Results: There were 157 patients included in this analysis: ALM (63 patients) and control group (94 patients). The presence of extrathoracic lymph node, contralateral pulmonary parenchymal and distant metastasis and all SUVmax values were significantly higher in the study group versus the control group (P<0.05). The SUVmax value of the primary tumor was not a predictor of ALM. According to the primary histopathologic diagnosis, small cell lung cancer was found to cause ALM development 3.4 times as much as squamous cancer (SQC) (OR: 3.40 [95% CI 1.3-10.20], P=0.029) and adenocarcinoma group was found to cause ALM development 4 times as much as SQC (OR: 4.02 [95% CI 1.73-9.34], P=0.001). The likelihood of developing ALM was significantly higher in tumors located in the central and upper lobe versus the lower lobe. Conclusion: The finding of ALM on PET/CT images, the necessity of histopathologic confirmation is determined according to the results of primary tumor localization, primary tumor histopathology, M stage on PET/CT imaging, localization of ALM according to primary tumor, and N stage on PET/CT imaging

Tumor characteristics of lung cancer in predicting axillary lymph node metastases. / Características tumorales del cáncer de pulmón para predecir metástasis en los ganglios axilares.

OBJECTIVE: In lung cancer, axillary lymph node metastases (ALM) are rare, and according to the 8th grading system, it is classified as M1b disease. The aim of this study is to evaluate1) the presence of ALM and2) the effect of the primary tumors characteristics on the development of ALM. METHODS: We performed a descriptive cross-sectional study, with retrospective revision, to identify ALM. RESULTS: There were 157 patients included in this analysis: ALM (63 patients) and control group (94 patients). The presence of extrathoracic lymph node, contralateral pulmonary parenchymal and distant metastasis and all SUVmax values were significantly higher in the study group versus the control group (P<0.05). The SUVmax value of the primary tumor was not a predictor of ALM. According to the primary histopathologic diagnosis, small cell lung cancer was found to cause ALM development 3.4 times as much as squamous cancer (SQC) (OR: 3.40 [95% CI 1.3-10.20], P=0.029) and adenocarcinoma group was found to cause ALM development 4 times as much as SQC (OR: 4.02 [95% CI 1.73-9.34], P=0.001). The likelihood of developing ALM was significantly higher in tumors located in the central and upper lobe versus the lower lobe. CONCLUSION: The finding of ALM on PET/CT images, the necessity of histopathologic confirmation is determined according to the results of primary tumor localization, primary tumor histopathology, M stage on PET/CT imaging, localization of ALM according to primary tumor, and N stage on PET/CT imaging.

Homozygous LAMC3 mutation links to structural and functional changes in visual attention networks.

The occipital lobe contains a substantial part of the neural machinery involved in visual perception. Mutations in the LAMC3 gene have recently been shown to cause complex bilateral occipital cortical gyration abnormalities. However, to what extent these structural changes impact visual behavior is not known. We recorded responses for two screening test batteries targeting visual function (Leuven - Perceptual Organization Screening Test, Cortical Vision Screening Test) and measured eye fixation performance in a visual attention experiment from a patient with homozygous LAMC3 gene mutation. Using voxel-based morphometry (VBM) we quantitatively assessed the extent of structural changes brought on by the genetic mutation by comparing mean cortical curvature, cortical thickness, and gray matter volume in 34 cortical areas between patient and an age-, sex-, and education-matched control group. Anatomical connectivity between these cortical areas was investigated by a structural covariance analysis. Visual screening-, and behavioral results revealed that the patient's impairments were predominantly in visuo-spatial attention. Consistent with this, VBM and structural connectivity results revealed significant structural changes in cortical regions subserving attentional functions. We conclude that the LAMC3 gene mutation affects cortical areas beyond the occipital lobe and primarily those visual functions that involve heavily distributed networks - such as visuo-spatial attention.

CLINICALLY UNDETECTABLE OCCULT THYROID PAPILLARY CARCINOMA PRESENTING WITH CERVICAL LYMPH NODE METASTASIS.

BACKGROUND: Occult papillary thyroid carcinoma presented as isolated cervical lymphadenopathy without clinical and radiologic findings has been rarely reported. CASE REPORT: A 47 years old female patient admitted to otorhinolaryngology clinic with 4X3 cm sized cervical mass. Physical examination of the patient was noted as a nontender, firm, mobile lymph node at right lateral cervical region. There was no inflammatory or infection disease in the history of patients anamnesis and no abnormal value on laboratory tests. Ultrasound screening of the neck detected a lymph node with suspicious features for malignancy. Head and neck examination was normal and there is no evidence of a tumoral mass or nodule in the thyroid gland. Whole body scan of MRI showed no pathologic sign both in the neck and body. Excisional biopsy was performed and revealed a carcinoma with papillary morphology. Immunohistochemical staining features of the tumor confirmed a papillary carcinoma derived from the thyroid gland. Second look USG of the neck and thyroid was performed but it revealed no tumoral mass. The patient underwent total thyroidectomy with right functional and central lymph node dissection. Histological examination of the thyroid gland showed multicentric 2 mm sized, three foci of papillary carcinoma located in bilateral thyroid lobes and metastatic lymph nodes in the right side of the neck. CONCLUSION: A metastatic cervical lymph node can be evidence of a clinically undetected occult papillary thyroid carcinoma. Specific immunohistochemistry staining of specimen may lead to appropriate surgery and progression of carcinoma may be hindered by application of additional RAI therapy.

High bone mineral density in loaded skeletal regions of former professional football (soccer) players: what is the effect of time after active career?

OBJECTIVES: Physical exercise is an important factor in the acceleration and maintenance of bone mineral density (BMD). Football is an impact loading sport and some studies demonstrate its site specific, bone mass increasing effect. We compared BMD at different skeletal regions in a group of former professional football players and in normal control subjects and evaluated the effect of demographic factors and time after active career on BMD. METHODS: Twenty four former football players <70 years old who had retired from professional football at least 10 years previously and 25 non-athletic controls were recruited. The demographic characteristics, activity levels, and dietary habits of all subjects and the chronological history of the footballers' professional careers were noted. BMD was measured by DEXA at the calcaneus and distal tibia and at the lumbar spine, proximal femur, and distal and proximal radius, and compared between groups. Stepwise multiple linear regression analysis was used to determine the probable predictors of BMD in former football players. RESULTS: In former players BMD values were found to be significantly higher at the lumbar spine, femur neck, femur trochanter, distal tibia, and calcaneus, but not at Ward's triangle (femur) or the distal and proximal radius regions compared with controls. Time after active career was the only independent predictor of BMD at the lumbar spine, proximal femur (neck, trochanter, and Ward's triangle), and distal tibia. CONCLUSIONS: Former footballers had higher BMD at weight loaded sites and time after active career seemed to be an important factor in determining BMD.

Contrast sensitivity in obese dyslipidemic patients with insulin resistance.

OBJECTIVE: To evaluate contrast sensitivity in insulin-resistant obese patients and in aretinopathic diabetic patients. METHODS: Contrast sensitivity was measured at 3 letter sizes (44 x 44, 9 x 9, and 5 x 5 mm) in mesopic (5 candela [cd]/m2) and low photopic (85 cd/m2) vision in 20 dyslipidemic obese patients with insulin resistance, 20 age-matched patients with type 2 diabetes mellitus, and 20 aged-matched healthy control subjects. RESULTS: Significant loss of contrast sensitivity at all 3 letter sizes was observed in low photopic vision (at 44 x 44-mm letter size, control vs obese, P<.002, and control vs diabetic, P<.005; at 9 x 9-mm letter size, control vs obese, P<.02, and control vs diabetic, P<.001; and at 5 x 5-mm letter size, control vs obese, P<.05, and control vs diabetic, P<.005) and mesopic vision (at 44 x 44-mm letter size, control vs diabetic, P<.005; at 9 x 9-mm letter size, control vs obese, P<.005, and control vs diabetic, P<.01; and at 5 x 5-mm letter size, control vs obese, P<.005, and control vs diabetic, P<.001) in insulin-resistant obese and diabetic patients. CONCLUSION: The results suggest that an early neurosensory dysfunction may occur without visible vascular involvement and without overt hyperglycemia.