Intravenous Heroin Abuse and Acute Myocardial Infarction: Forensic Study.

OBJECTIVE: The purpose of this study was to investigate chronic intravenous heroin abuse and its potential to induce acute myocardial infarction (AMI). It also aims to examine the causative factors and the incidence of heroin-induced myocardial infarction. MATERIAL AND METHODS: The hearts of 113 intravenous heroin abusers were studied for a duration exceeding 3 years. The parameters studied included sex, age, time of intravenous heroin abuse, medical history, and body and heart weight. Macroscopic histological studies of the heart were also performed. RESULTS: The histological examination revealed only 1 case of AMI. The victim was an intravenous heroin abuser for the last 7 years. The age and the medical history of the victim do not act as dissuading factors for the potential of an AMI. CONCLUSIONS: The incidence of heroin-induced myocardial infarction is rare, and the actual mechanism remains unclear. The increased heart weight in relation to the increased thickness of the heart walls may be an aggravating factor, and thus, it is a fact that should be investigated.

Serum levels of fetuin-A in patients with coronary artery disease. Corellation with SPET myocardium scintigraphy.

OBJECTIVE: Fetuin-A is an acidic glycoprotein produced in the liver, as an inhibitor for cysteine protease. Its gene is founded in chromosome 3 (3q27). It is involved in various physiological and pathological conditions. These include vascular decalcification, bone metabolism, insulin resistance, protease function control, neurological illnesses and multiplication of breast cancer cells. Vascular calcifications predict cardiovascular disease which can be a major cause of death. So, fetuin-A is a potent circulating calcification inhibitor. Studies on individuals with clinical cardiovascular disease supported that lower levels of fetuine-A are released with coronary artery circulation (CAC) and the function of the heart valve. Our aim was to evaluate fetuin-A values of the patients with coronary artery disease, as a prognostic factor of the disease, in correlation with SPET myocardium scintigraphy. PATIENTS AND METHODS: We studied 40 patients, 25 male and 15 female, with a mean age 48±8 years (range 36 to 69), with coronary heart disease. All were subjected to myocardium scintigraphy, in the Nuclear Medicine Department of University Hospital of Alexandroupolis. Simultaneously, blood samples were drawn for the determination of fetuin-A. Serum fetuin-A levels were measured by a commercially available sandwich ELISA (Epitope Diagnostics, Inc., San Diego, CA). RESULTS: The average values of fetuin-A range between 140-297mg/L, as it is derived from the current bibliography and our laboratory tests. In normal individuals, pathological values were considered to be under 140mg/L. Twenty five patients with positive SPET imaging for myocardium necrosis (scars) had low fetuin values (45-148mg/ L), 10 of them passing away within 6 months, while the rest of them were showing an encumbered clinical condition (P<0.005). Ten patients with reversible ischemia showed relatively low values (125-302mg/L) (P<0.005). Five patients with a normal myocardiac scintigraphic imaging showed normal values of fetuin-A (165-508mg/L) (P<0.005). CONCLUSIONS: Patients with myocardium necrosis demonstrated very low values of fetuin. Patients with ischemia show low amounts while patients with negative Scintigraphy for ischemia showed normal results of fetuin. The 10 patients that passed away in 6 months showed very low amounts of fetuin. Fetuin-A is supported to be a reliable prognostic factor in monitoring patients with coronary heart disease.

The role of copeptin in patients with subarachnoid haemorrage.

OBJECTIVE: Subarachnoid haemorrhage is responsible to a great extend for the death rate of patients who are hospitalised in intensive care units (ICU) with haemorrhage. The early detection of its severity plays an important role for the resulting health of the patients. Neurohormone Copeptin is the C-end of pro-arginine vasopressin in plasma has been used as a prognostic marker in a number of various illnesses (acute myocardial infarction, heart and renal failure, acute dyspnoea, intracerebral and subarachnoid haemorrhage, ischaemic stroke, liver cirrhosis, acute pancreatitis). However, its prognostic value in subarachnoid haemorrhage has yet to be valued. The aim of our study was to evaluate copeptin plasma values of patients with subarachnoid haemorrhage hospitalised in the ICU, as a prognostic factor for the severity of this disease. PATIENTS AND METHODS: We studied 32 patients, 21 male, 11 female, (average age 59±7 years), who were hospitalised in the ICU of Univ. Hospital of Alexandroupolis. Plasma Copeptin values were measured in the Nuclear Medicine Laboratory, with the Radioimmunoassay (RIA) method. The appropriate kit, from Phoenix Pharmaceuticals Inc. (USA), was used. STATISTICAL ANALYSIS: The x(2) student test was used for statistical analysis. RESULTS: The cut-off value of copeptin ranged between 0.4-4.4 pmol/L. 19 patients showed gradual increase of copeptin values, (125-578 pmol/L), with a bad prognosis of the illness (P<0.005). Four of them with extremely high copeptin values died. Decrease of copeptin values for the rest 15 patients were correlated with the improvement of their clinical condition (P<0.005). Eleven patients appeared to have high values, followed by the gradual decrease by a range of 85-12pmol/L, and had a good prognosis of the condition. Two patients with normal values demonstrated to have a good clinical condition. CONCLUSION: Patients with a gradual increase of copeptin values showed to have bad prognosis of the disease. Four with extremely high copeptin values passed away, while patients with a gradual decrease or a normal amount of copeptin values had good prognosis. It is supported that copeptin values are a reliable prognostic factor in monitoring patients with intracranial haemorrhage.

A prospective, non-randomized, no placebo-controlled, phase Ib clinical trial to study the safety of the adipose derived stromal cells-stromal vascular fraction in idiopathic pulmonary fibrosis.

INTRODUCTION: Regenerative medicine and particular adult stem cells represent an alternative option with several fruitful therapeutic applications in patients suffering from chronic lung diseases including idiopathic pulmonary fibrosis (IPF). Nevertheless, lack of knowledge regarding the origin and the potential of mesenchymal stem cells (MSCs) to differentiate into fibroblasts has limited their use for the treatment of this dismal disease. PATIENTS AND METHODS: To this end, we conducted a phase Ib, non-randomized, clinical trial to study the safety of three endobronchial infusions of autologous adipose derived stromal cells (ADSCs)-stromal vascular fraction (SVF) (0.5 million cells per kgr of body weight per infusion) in patients with IPF (n=14) of mild to moderate disease severity (forced vital capacity -FVC>50% predicted value and diffusion lung capacity for carbon monoxide-DLCO>35% of predicted value). Our primary end-point was incidence of treatment emergent adverse events within 12 months. Alterations of functional, exercise capacity and quality of life parameters at serial time points (baseline, 6 and 12 months after first infusion) were exploratory secondary end-points. RESULTS: No cases of serious or clinically meaningful adverse events including short-term infusional toxicities as well as long-term ectopic tissue formation were recorded in all patients. Detailed safety monitoring through several time-points indicated that cell-treated patients did not deteriorate in both functional parameters and indicators of quality of life. CONCLUSIONS: The clinical trial met its primary objective demonstrating an acceptable safety profile of endobronchially administered autologous ADSCs-SVF. Our findings accelerate the rapidly expanded scientific knowledge and indicate a way towards future efficacy trials.

Stem cell therapy for idiopathic pulmonary fibrosis: a protocol proposal.

BACKGROUND: Idiopathic pulmonary fibrosis represents a lethal form of progressive fibrotic lung disorder with gradually increasing incidence worldwide. Despite intense research efforts its pathogenesis is still elusive and controversial reflecting in the current disappointing status regarding its treatment. PATIENTS AND METHODS: We report the first protocol proposal of a prospective, unicentric, non-randomized, phase Ib clinical trial to study the safety and tolerability of the adipose-derived stem cells (ADSCs) stromal vascular fraction (SVF) as a therapeutic agent in IPF. After careful patient selection based on functional criteria (forced vital capacity-FVC > 50%, diffuse lung capacity for carbon monoxide-DLCO > 35% of the predicted values) all eligible subjects will be subjected to lipoaspiration resulting in the isolation of approximately 100- 500 gr of adipose tissue. After preparation, isolation and labelling ADSCs-SVF will be endobronchially infused to both lower lobes of the fibrotic lungs. Procedure will be repeated thrice at monthly intervals. Primary end-point represent safety and tolerability data, while exploratory secondary end-points include assessment of clinical functional and radiological status. RESULTS: Preliminary results recently presented in the form of an abstract seem promising and tantalizing since there were no cases of clinically significant allergic reactions, infections, disease acute exacerbations or ectopic tissue formation. In addition 6 months follow-up data revealed a marginal improvement at 6-minute walking distance and forced vital capacity. CONCLUSIONS: Adipose tissue represents an abundant, safe, ethically uncontested and potentially beneficial source of stem cells for patients with IPF. Larger multicenter phase II and III placebo-controlled clinical trials are sorely needed in order to prove efficacy. However, pilot safety studies are of major importance and represent the first hamper that should be overcome to establish a rigid basis for larger clinical trials.

(99m)Tc-DMSA scintigraphy diagnosing crossed renal ectopia with fusion in a three years old boy.

A 3 years old boy with a history of surgery for orchidopexy was admitted to our hospital with fever and abdominal pain. Clinical examination and laboratory investigations revealed urinary tract infection with renal involvement. Ultrasonography demonstrated a solitary left kidney and raised the suspicion of a fusion anomaly. Voiding cystography disclosed grade III vesicoureteral reflux and technetium-99m dimercaptosuccinic acid scintigraphy revealed right to left crossed renal ectopia with fusion (L-shaped kidney). The patient is undergoing standard follow-up for the early detection of possible renal complications. In conclusion, L-shaped kidney is a rare entity and the (99m)Tc-DMSA scintigraphy played an important role on timely diagnosis.

The role of nuclear medicine in the diagnosis of common and specific diabetic infections.

Infections are usually detected in diabetes mellitus. They may be divided into: common infections such as fungal infections, pulmonary tuberculosis, pneumonia, bacteraemia, urinary tract infections, and diabetic foot infections and specific infections. The latter occur almost exclusively in diabetes and include rhinocerebral mucormycosis, malignant external otitis, emphysematous pyelonephritis, perirenal abscess, emphysematous cystitis and emphysematous cholecystitis. Radionuclide tests are decisive in the diagnosis and localisation of foot osteomyelitis, as well as the distinction of osteomyelitis from other conditions, notably Charcot osteoarthropathy. Technetium-99m methylene disphosphonate and labelled leukocyte bone scans are the main imaging techniques employed, while emerging techniques include single-photon emission tomography/computed tomography (CT) and positron emission tomography/CT. Nuclear medicine is also useful in the diagnosis and follow-up of specific infections in diabetes like, malignant external otitis, rhinocerebral mucormycosis, acute pyelonephritis, renal papillary necrosis and cholecystitis. The main indications of nuclear medicine tests are diabetic foot osteomyelitis, malignant external otitis, rhinocerebral mucormycosis and renal infections.

Iotandium-111 pentetreotide scintigraphy and CT scans after 3 years in the follow-up of patients with malignant melanoma.

Somatostatin receptor scintigraphy (SRS) has been used for the detection of neuroendocrine tumors. Melanoma is a malignant tumor of melanocytes, considered to derive from the neural crest. As the prognosis of melanoma is very poor, early detection of the disease, of recurrences and of distal metastases, is important. The aim of our study was to evaluate the clinical impact of indium-111-diaethyleno triamino pentaacetic acid-d-phe1-octreotide ((111)In-DTPA-octreotide or octreoscan or (111)In-O) in the management of melanoma patients after first diagnosis and first surgery and during three years of follow-up. We have studied 35 patients 20 female and 15 male, with histological proven melanoma. Scintigraphic images with single photon emission tomography gamma-camera (Millenium GE-USA) were performed after the administration of 220MBq (111)In-O. The scintigraphic data were compared to axial computerized tomography (CT). Patients were followed for 3 years after the initial diagnosis and surgery. Our results showed that during the 3 years follow-up period, 26/35 patients had a clinical recurrence. Twenty of them had positive (111)In-O scans with 56 lesions mainly metastatic, while 6 had negative scans. The CT scans showed only 31/56 lesions. In conclusion, SRS with (111)In-O, for diagnosing metastases from malignant melanoma, showed a sensitivity and specificity of 87% and 94% respectively and within the 3 years of follow-up, the stage of melanoma and surgical strategies were modified by 48% and 32%, respectively. Twenty five tumor sites, unsuspected by CT were visualized by (111)In-O.

External re-programmation by a new radionuclidic technique of electronic cerebrospinal fluid valve in case of hydrocephalus.

Hydrocephalus is defined as an abnormal enlargement of the ventricles of the brain due to an excessive accumulation of cerebrospinal fluid (CSF) because of a disturbance of its flow, absorption and/or secretion. The usual method of CSF diversion is a ventriculo-peritoneal shunt. Complications of implanted shunt systems include mechanical failure, shunt pathway obstruction, infection, foreign body (allergic) reaction to implants and CSF leakage along the implanted shunt pathway. These problems are solved with the use of programmable ventricular-peritoneal CSF valves. In this case, we describe a radionuclidic method for the control of successful reprogramming of the CSF valve. Furthermore, we analyze some technical data of such a valve-type are essential for the application of the above technique by nuclear medicine physicians. Scintigraphic evaluation of the electronic V-P drainage valve regulation is a noninvasive, not expensive, rapid and safe method with no complications for the patient and provides a reliable proof of the patency of the V-P shunt.

Hepatobiliary scan in Alagille syndrome; arteriohepatic dysplasia.

Arteriohepatic dysplasia or congenital paucity of interlobular bile ducts - Alagille Syndrome, is a well defined syndrome characterized by five major features, including chronic cholestasis, posterior embryotoxon, butterfly-like vertebral arch defects, peripheral pulmonary artery hypoplasia or stenosis and facial dysmorphy. The disease is very rare. Only three cases have been reported in Greece and none with renal involvement. Hepatobiliary scan was a fundamental tool in the patients diagnosis and therefore we present the following case.

[Correlation of serum prostate specific antigen, the volume and the intravesical prostatic protrusion for diagnosing bladder outlet obstruction in patients with benign prostate hyperplasia].

Benign prostate hyperplasia (BPH) is common in elderly men. Nevertheless, the pathophysiology of low urinary tract symptoms (LUTS) may not be due only to BPH. Many men with LUTS are submitted to unnecessary medications or surgical interventions because their symptoms have not been correctly evaluated. Can diagnostic test such as serum prostate antigen (PSA), performed by nuclear medicine techniques and the trans-abdominal ultrasound determine with high sensitivity whether LUTS is due exclusively to BPH? The aim of the study was to correlate serum PSA, prostate volume (PV), intravesical prostatic protrusion (IPP), uroflowmetry measuring maximal urine flow/sec (Qmax), and the international prostate symptom score (IPSS) questionnaire, to estimate urine bladder outlet obstruction (BOO), in patients with BPH. A hundred and twelve patients with mean of age 72 +/- 8 years and LUTS were studied. All patients were examined according to the IPSS questionnaire, had their serum PSA tested and also Qmax of prostate volume and IPP by trans-abdominal ultrasound were examined. The patients were separated in groups according to serum PSA values (or= 4.1 ng/ml), prostate volume (PV< 20.20-40 and > 20 ml) and the intravesical prostatic protrusion (IPP < 5.5-10.10 mm). There was a statistical correlation between the BOO and: a) PSA (P = 0.004), b) prostate volume with P of < 0.001) and c) IPP = 0.005. On the contrary, there was no statistical correlation between BOO and IPSS, Qmax with P values 0.228 and 0.745 respectively. Receiving operating curve (ROC) showed that patients with a serum PSA value of 1.5-4 ng/ml, IPP of type II and PV 20-40 ml, had a sensitivity of 48% for PSA, of 50% for PV and of 47% for IPP and a specificity of 75%, 47% and 60% respectively. In conclusion, according to the results of this study, a more objective evaluation of BOO, which is exclusively due to BPH, should include, not only PV but also serum PSA values and IPP.

[Serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone versus prostate specific antigen in patients with localized prostate adenocarcinoma who underwent radical prostatectomy. Radioimmunoassays measurements].

The relation of steroid hormones (SH) with carcinogenesis is not well understood. There is a variation of opinions among researchers about the prognostic value of serum SH in patients with localized prostate cancer (PC). The aim of this was to study serum SH in patients with localized PC before and after radical prostatectomy (RP). Seventy patients with mean age 67+/-8 years, were studied. The diagnosis was confirmed by histology after a biopsy. None of the patients was submitted to hormonal treatment or radiotherapy prior to RP. Serum testosterone (TST), dihydrotestosterone (DHT), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were examined prior RP and one year following RP, by radioimmuno assay (RIA) or immunoradiometric assay (IRMA) methods. Based on serum PSA levels before and one year after RP, 66 of the patients did not have biochemical recurrence while 4 patients developed biochemical recurrence due to residual disease and were treated with flutamide and a LH-RH analogue. In the group of 66 patients there was a statistically significant increase in serum TST (P<0.001), LH (P=0.004) and FSH (P<0.001), and statistically significant decrease in serum DHT (P<0.001). In the four patients with biochemical recurrence, TST increased and serum DHT, LH and FSH decreased. In this group the reduction of DHT and LH, FSH were due to treatment with flutamide and a LH-RH analogue respectively. Our findings suggest that after RP increase of serum LH and FSH may have caused an increase in serum TSH and a decrease of serum DHT. If those changes are due to the hypothalamic-pituitary axis it may be that the prostate neoplasm before RP may have secreted a substance that induced a negative feedback to the pituitary gonadotrophin secretion, which was unrelated to varying serum PSA levels.

[Procollagen-I, collagen telopeptide I, CEA, CA 15-3 as compared to bone scintigraphy in patients with breast cancer].

UNLABELLED: The most common metastases of breast cancer (BC) are bone metastases. Serum pro-Iota collagen peptide (PICP) and I collagen telopeptide (ICTP) levels indicate the rate of bone collagen synthesis and bone resorption respectively and therefore indicate metastatic activity in the bone. We have studied the clinical importance of serum PICP and ICTP as well as CA 15-3 and CEA and compared them to bone scintigraphy findings indicating metastases from BC. Ninety seven women of mean age 58+/-8 years with BC were examined. The diagnosis of BC was histologically confirmed. Bone metastases were diagnosed in 68 of them by bone scans performed after the intravenous injection of 925 MBq of technetium-99m methylendiphosphonate, while 29 patients were free from bone metastases. We also examined 52 women of similar age, as controls. Serum PICP, ICTP, CA 15-3 and CEA were measured in both patients and controls. Serum levels of ICTP and CA 15-3 were significantly higher in patients with BC and bone metastases compared to patients without metastases (P<0.05), while PICP and CEA were only marginally higher. A statistically significant correlation was observed between the existence of bone metastases and ICTP serum levels (P<0.05). The sensitivity of PICP, ICTP, CEA and CA 15-3 was 28.1%, 48.6%, 78%, 42% respectively and their specificity was 83.9%, 94%, 65% and 86% respectively. IN CONCLUSION: ICTP and CA 15-3 are the most reliable markers of those studied for the diagnosis of bone metastases in BC. PICP alone or combined with ICTP were not sensitive enough. CA 15-3 showed sensitivity 78% and specificity 86%. When combining CA 15-3, ICTP and CEA the sensitivity and specificity increased to 82% and 96% accordingly.

[Serum levels of S-100b protein after four years follow-up of patients with melanoma].

The early detection of the recurrence and of distant metastases of melanoma can be supported by the detection of S-100 in the serum. In this study we have evaluated the diagnostic significance of the levels of S-100b as a tumor marker in the diagnosis and the follow-up of patients with melanoma. We have studied 27 patients (15 men and 12 women) aged 29-58 years (mean age +/- SD: 46 +/- 11 years) with melanoma in stages I-IV, as shown by histology. The thickness of the tumor was >0.75 mm according to Breslow. Thirty-two healthy individuals 19 men 13 women aged 29-52 years (mean age +/- SD: 44 +/- 9 years) were our control group. Serum samples of S-100b were measured by radioimmunoassay (RIA) every three months during the first and second year, and every six months for the next two years. All patients were operated after the first diagnosis. Our results have shown a cut-off of S-100b values between controls and patients of 0.2 micro g/l. The overall sensitivity and specificity for the diagnosis of melanoma for all stages was 71% and 94% respectively. Patients with recurrence or distant metastases had significantly higher levels of S-100b as compared to those without metastases or recurrence (P<0.05) and to healthy individuals (P<0.05). In 11 patients with elevated serum S-100b levels, after treatment and during the follow up period, these levels were reduced to normal. In conclusion, although the number of our patients was limited, serum S-100b showed after four years of follow up to be useful in stages III and IV of melanoma, in the diagnosis of relapse or metastases and in monitoring the response to treatment.

Single sternal metastasis due to malignant melanoma with unexpected long-term survival: a case report.

Metastases from melanoma have a very poor prognosis for the patient. Single metastatic lesions in the sternum due to melanoma are extremely rare. A rare case of a presternal mass in a 56-year-old patient who had undergone excision for malignant melanoma is presented. Review of the patient's history and surgical resection of a single metastatic soft tissue lesion offer the best chance of long-term survival.

Positive Tc-99m-MIBI scan in a patient with confirmed Paget's disease of bone.

A 46-year-old man was referred to our department for a Tc-99m MDP bone scan after he was admitted to our hospital with diffuse bone pain and the subsequent finding of multiple mixed type (lytic-blastic) lesions on routine x-rays. The Tc-99m MDP scan was highly suspicious for malignancy and, therefore, a Tc-99m MIBI scan was performed, which also revealed abnormal uptake in all regions with increased osteoblastic activity. Clinical chemistry and further workup revealed a highly elevated serum alkaline phosphatase and increased excretion of hydroxyproline in the urine. The presumed diagnosis of Paget's disease of the bone was further confirmed by biopsy.

The role of 99mTc(V)-DMSA scan as compared to 99mTc-MDP and CT scans in imaging the primary tumor and metastases of osteosarcoma.

The oncophilic complex of technetium-99m labeled pentavalent dimercaptosuccinic acid (99mTc(V)-DMSA) has been successfully used for the detection of primary and metastatic medullary thyroid cancer and for imaging various soft tissue tumors like lung, brain and prostate cancer. In this article, the role of 99mTc(V)-DMSA in the diagnosis of the primary tumor and metastases of osteosarcoma patients as compared to the 99mTc-MDP scan and the CT scan was studied. Twenty-eight patients with bone disease were referred to the Nuclear Medicine Department of Saint Savas Oncology Hospital in Athens from the Orthopedics Department of the same Hospital. From them, 18 (Group A) had osteosarcoma, 7 (Group B) osteomyelitis and 3 (Group C) bone fractures. The final diagnosis was made after fine needle aspiration biopsy. All patients were subjected to the 99mTc(V)-DMSA scan, the standard bone scan (99mTc-MDP) and CT scan. Group A patients showed a selective uptake of 99mTc(V)-DMSA in the primary tumor region. No abnormal 99mTc(V)-DMSA uptake was observed in the patients of Groups B and C. The 99mTc(V)-DMSA scan was found to be superior to the 99mTc-MDP and the CT scans in identifying metastases of osteosarcoma. Sensitivity was 100%, 86% and 98% respectively.

[Correlation of procollagen (I) with prostate specific antigen and bone scan for the diagnosis of bone metastases in patients with prostate carcinoma]. / In Process Citation.

Procollagen (I) carboxyterminal propeptide (PICP) is a metabolite of procollagen, a precursor molecule of collagen type I, which accounts for more than 90% of the organic matrix of the bones. Serum PICP levels indicate the rate of bone collagen synthesis and therefore the osteoblastic activity. In this study we evaluate the clinical usefulness of serum PICP as an indicator of bone metastases in patients with prostate cancer in relation to bone scan and to prostate specific antigen (PSA) measurements. We found no similar study in the literature relating these three tests. Seventy-eight patients (median age 63+/-4,3 years) with prostate adenocarcinoma were examined. The diagnosis was confirmed histologically. Bone metastases were diagnosed in 42 (54%) of them assessed by bone scans (Group A), while the remaining 36 patients (46%) had no bone metastases (negative bone scans and X-rays) (Group B). We also examined 21 patients with benign prostate hyperplasia as a control group (Group C). All patients had serum PICP measurements, bone scans with (99m)Tc-MDP and PSA measurements. None of them had a history of disease or of using drugs known to affect bone metabolism. Serum levels of PICP were assayed by a radioimmunoassay (RIA) kit (Orion Cooperation, Farmos Diagnostics, Finland). Serum PSA was also tested by a RIA kit (Tandem-R, Hybritech Inc, USA). PICP levels in Group A were 265+/-89 microg/l, in Group B 128+/-39 microg/l and in Group C patients 110+/-48 microg/l. High levels of PICP above 170 microg/l, were diagnostic of bone metastases with sensitivity 54%, specificity 93% and accuracy 84%. In comparison, PSA levels above 4 ng/ml were also diagnostic with a sensitivity of 68%, specificity of 91% and accuracy 88%. Patients with low levels of PICP, lower than 90 microg/l, n=31, had no bone metastases. The positive prognostic value of bone scan was 74% with a sensitivity of 76%, specificity of 58% and accuracy 71%. Positive bone scans combined with very high levels of PICP and PSA, had positive prognostic value 97%, with sensitivity of 78%, specificity of 96% and accuracy 97%, while bone scans with levels of PICP lower than 170 microg/l, had positive prognostic value of 32%. Levels of PICP and PSA were significantly higher in patients with prostate cancer and bone metastases in comparison to patients with benign prostate hyperplasia (P<0.0001) respectively. Also, levels of PICP and PSA were higher in patients with prostate cancer without metastases as compared to prostate hyperplasia (P<0.0005 and P<0.0001 respectively) (Wilcoxon-Mann-Whitney test). When metastases were more extensive, PICP levels were higher than PSA. It is concluded that PICP as a marker of osteoblastic activity is useful for diagnosing bone metastases of prostate adenocarcinoma but when co-evaluated with PSA and the bone scan, the diagnostic accuracy of these three diagnostic procedures is much higher.

Lacrimal outflow mechanisms and the role of scintigraphy: current trends.

Lacrimal outflow can be compromised by anatomical obstructions or stenoses (nonfunctional epiphora) or by defective lacrimal "pump" function (functional epiphora). Although classic imaging modalities, such as X-ray dacryocystography, computed tomography, or magnetic resonance imaging can effectively evaluate the former, their success is much less in the evaluation of the latter. This is largely due to the fact that forced diagnostic injection of fluid into the canalicular system can overcome partial obstruction sites. On the other hand, lacrimal scintigraphy mimicks "physiological" lacrimal outflow, being performed under pressure gradients present in everyday life. This is why it is considered more suitable for the study of functional epiphora. Furthermore, quantitative lacrimal scintigraphy (with time-activity curves) enables the accurate measurement of lacrimal clearance from the conjunctival fornices and may be used to study the physiology of the lacrimal "pump." Data obtained from the scintigraphic study of lacrimal outflow may be used to design more effective procedures in the management of functional and nonfunctional epiphora. This is a review article, based on a literature search with emphasis on recent publications and on those supporting interdisciplinary cooperation between ophthalmology and nuclear medicine.