Seawater Splitting for Hydrogen Generation Using Zirconium and Its Niobium Alloy under Gamma Radiation.

Hydrogen production is produced for future green energy. The radiation-chemical yield for seawater without a catalyst, with Zr, and with Zr1%Nb (Zr = 99% Nb = 1%) were (G(H2) = 0.81, 307.1, and 437.4 molecules/100 eV, respectively. The radiation-thermal water decomposition increased in γ-radiation of the Zr1%Nb + SW system with increasing temperature. At T = 1273 K, it prevails over radiation processes. During the radiation and heat radiation heterogeneous procedures in the Zr1% Nb + SW system, the production of surface energetic sites and secondary electrons accelerated the accumulation of molecular hydrogen and Zr1%Nb oxidation. Thermal radiation and thermal processes caused the metal phase to collect thermal surface energetic sites for water breakdown and Zr 1%Nb oxidation starting at T = 573 K.

Importance of combined use of preoperative 18F-FDG PET/CT imaging and intraoperative 18F-FDG handheld gamma probe detection in recurrent papillary thyroid cancer.

Radio-guided surgery using an intra-operative positron emission tomography (PET) probe in recurrent thyroid cancer (RTC) can be a useful method for tumor localization, verification of complete excision and to decrease operation time. We describe a case of RTC whose serum thyroglobulin (Tg) level was 5.6ng/mL. Preoperative fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed two focal abnormalities in the anterior tracheal and right upper mediastinal regions and a handheld gamma probe was used intraoperatively to identify the hot areas seen on PET scan. Postoperative 18F-FDG PET/CT imaging after tumor excision was normal. This case shows that recurrent tumor can be localized correctly using 18F-FDG PET/CT and a surgical gamma probe.

Age-related inflammatory changes in the spine as demonstrated by (18)F-FDG-PET:observation and insight into degenerative spinal changes.

Our aim was to determine whether the inflammatory component associated with age-related degenerative changes in the spine can be assessed by (18)F-fluoro-2-deoxy-D-glucose positron emission tomography ((18)F-FDG-PET). Mean and maximum standardize uptake values (SUV(mean) and SUV(max)) of intervertebral discs and spinous processes were measured in 45 patients who had undergone (18)F-FDG-PET for any clinical indication. Correlations between age and FDG-PET indices (SUV(mean) and SUV(max) of intervertebral discs and spinous processes) were determined. Pearson's correlation coefficients between age and intervertebral disc SUV(mean), between age and intervertebral disc SUV(max), and between age and spinous process SUV(mean) were 0.4821, 0.3946, and 0.5017 (P<0.05), indicating moderate positive correlations between these parameters. However, Pearson's correlation coefficient between age and spinous process SUV(max)was 0.7998 (P>0.05), indicating no correlation between these two parameters. In conclusion, intensity of (18)F-FDG uptake in the intervertebral discs and spinous processes generally increases with aging, which is likely to reflect associated inflammatory processes.

Fine-needle aspiration washout in the diagnosis of cystic parathyroid adenoma.

Cystic parathyroid adenomas are one of the rare causes of neck masses. Due to its rarity, it causes misdiagnosis and wrong treatments and has undesirable consequences. The measurement of parathyroid hormone in fine-needle aspiration washout fluid is a minimally invasive, safe method for the diagnosis of parathyroid cysts and seems to be more useful than Tc-99m sestamibi (MIBI) parathyroid single photon emission computed tomography (SPECT)/CT.

Treatment of Left Ventricular Assist Device Thrombosis: Single-Center Experience.

Heart failure is the one of the biggest health problem in the world. Because of limited donors for heart transplant procedures, the ventricular assist device has become a solution for heart failure therapy. With the increase in number of ventricular assist devices, the incidence of complications has also increased. One of the most important life-threatening complications is ventricular assist device thrombosis. Medical therapy and changes in the ventricular assist device are the main therapy methods for ventricular assist device thrombosis. In this study, we showed our clinical experience with treatment of ventricular assist device thrombosis.

Thrombus resolution and right ventricular functional recovery using ultrasound-accelerated thrombolysis in acute massive and submassive pulmonary embolism.

BACKGROUND: This study aims to evaluate the efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the treatment of massive and submassive pulmonary embolism (PE). METHODS: We conducted a prospective, observational cohort study of consequtive patients with massive or submassive PE treated with low-dose UACDT using EKOS EkoSonic® system at single center from May 2014 until April 2015. Overall, thirty-eight patients (median age, 64.5 years) were included. The primary safety outcomes were change in right ventricular (RV) to left ventricular (LV) diameter ratio within 24 hours of procedure initiation, at 1- and 6-month follow-up and major bleeding within 96 hours of the procedure initiation. BNP, troponin and D-dimer levels were also measured. RESULTS: The ultrasound-accelerated thrombolytic catheters were bilaterally placed in 25 (65.8%) patients. The median tissue plasminogen activator (tPA) dose for all patients in our study was 21.0 mg and the median infusion time was 15 hours. Measurements before and after treatment showed a decrease in pulmonary artery pressure. The median value of RV/LV diameter ratio decreased from 0.9 (0.7-1.1) at baseline to 0.7 (0-0.97) at 6-month follow-up (P=0.001) and pulmonary artery pressure from 61.4 ±16.7 to 37.2±9.1 mmHg (P=0.001). The median BNP level at baseline was 169 (29-721) pg/mL and 45.5 (0-328) pg/mL at 6 month follow-up (P=0.001). Of 38 patients with PE, one had intracranial hemorrage, one gastrointestinal bleeding and two developed puncture site bleeding. CONCLUSIONS: This prospective study provides alternative treatment option and an addition to the treatment algorithm for the management of pulmonary embolism.

The Application of Virtual Planning and Navigation Devices for Mandible Reconstruction and Immediate Dental Implantation.

Routine reconstruction of subtotal defects of the mandible and orthopedic rehabilitation supported by dental implants is achieved by means of detailed planning and lasts over a year. This article shows the outcomes of single-stage surgical treatment and immediate orthopedic rehabilitation performed with the help of preoperative virtual computer simulation. 3D investigation of pathological and donor sites, virtual simulation of tumor resection, positioning of the dental implants into fibula, virtual flap bending and transfer, virtual bending of fixing reconstruction plates, and fabrication of navigation templates and bridge prosthesis supported by dental implants were done preoperatively. The surgery included tumor resection, insertion of dental implants into fibula, elevation of fibula osteocutaneous free flap, rigid fixation within recipient site, and immediate loading by bridge orthopedic device. On 10-month follow-up, functional and esthetic results were asses as reasonable. Radiography showed dental implants to be integrated and positioned appropriately. We found that successful rehabilitation of the patients with extensive defects of the jaws could be achieved by ablative tumor resection, dental implants insertion prior to flap elevation guided by navigation templates, further osteotomy, modeling of the flap based on navigation template, flap transfer, and rigid fixation within recipient site by prebended plates, with application of prefabricated prosthesis.

The role of FDG PET/CT in detection of distant metastasis in theinitial staging of breast cancer.

BACKGROUND/AIM: We aimed to evaluate the role of FDG PET/CT in the detection of extraaxillary regional nodal/distant metastasis in breast cancer patients and to assess the value of FDG PET/CT for detecting distant metastases in patient subgroups. MATERIALS AND METHODS: A total of 254 patients with breast cancer (248 female, 6 male) who underwent PET/CT for initial staging were enrolled. Patients were divided into four groups: Group 1 consisted of 154 patients diagnosed by tru-cut/core/FNAB, Group 2 comprised 32 patients diagnosed by excisional biopsy, Group 3 included 62 patients who had mastectomy-axillary lymph node dissection, and Group 4 consisted of 6 patients who had axillary lymph node metastasis diagnosed by excisional biopsy. RESULTS: PET/CT detected distant metastasis in 76 of the 254 patients. Of these patients, 21.7% had bone/bone marrow metastasis, 7.1% had lung metastasis, 13% had mediastinal lymph node metastasis, 4.8% had liver metastasis, 9.8% had other organ/system metastasis, and 6% had other lymphadenopathies. According to T staging, the percentages of distant metastasis were as follows: 13.6% of the 66 T1 stage patients, 35.7% of the 129 T2 stage patients, 40% of the 20 T3 stage patients, and 33.3% of the 39 T4 stage patients. CONCLUSION: FDG-PET/CT led to a change in the stage of disease and the treatment approach in newly diagnosed breast cancer patients due to its superiority in detecting extraaxillary regional lymph node metastases and distant metastases.

The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level.

AIM: In the follow-up of differentiated thyroid cancer (DTC) after a successful total-near total thyroidectomy and I-131 ablation therapy, anti-thyroglobulin antibodies (anti-Tg) may be persistently or progressively increased in the patients with an undetectable serum thyroglobulin (Tg) level. In these cases, further investigation was performed to search for recurrence/metastases. The aim of our study was clarifying the role of FDG-PET/CT in detecting recurrence/metastasis in patients with DTC with negative serum Tg and elevated anti-Tg level. MATERIALS AND METHODS: A total of 40 patients (32 female, 8 male; mean age: 43.15 years (22-65); mean age at diagnosis: 39.08 (16-64)) with DTC who had undetectable serum Tg and elevated anti-Tg level after a successful initial therapy were included in the study. All of the patients had serum anti-Tg of >40 IU/ml and underwent FDG-PET/CT to search for recurrence/metastasis. RESULTS: Twenty patients (50 %) had recurrence/metastasis on FDG-PET/CT while the other 20 had no pathologic findings. Of the 20 patients who had positive FDG-PET/CT, 12 had a histopathological final diagnosis of which 11 were true positive (TP) and 1 was false positive (FP). On the other hand, 16 of the 40 patients had a histopathological final diagnosis of which 11/16 had TP, 1/16 FP, 3/16 false negative (FN) and 1/16 true negative (TN) findings by PET/CT. The final diagnosis was made by clinical follow-up in the remaining 24 patients. Of these, 8 patients were PET positive, and in 1 (12.5 %) of 8 patients a decrease in serum anti-Tg level, in 2 (25 %) patients a saw-toothed pattern and in 5 (62.5 %) a progressive increase in the serum anti-Tg level were noted during the follow-up. Of the 16 of 24 patients who were diagnosed by clinical follow-up, in 8 a (50 %) decrease in serum anti-Tg level, in 6 (37.5 %) a saw-toothed pattern, and in 2 (12.5 %) a progressively increased anti-Tg level was seen. Of the 40 patients, 14 (35 %) had a diagnosis of recurrence/metastasis finally, with PET/CT detecting 11 (78.6 %) of them. CONCLUSION: The value of a persistently or progressively increased serum anti-Tg level in the follow-up of DTC in the prediction of recurrence/metastasis is controversial. However, it is reported that FDG-PET can be useful in the detection of recurrence/metastasis. We conclude from the available data that PET/CT can be effectively used in the detection of recurrence/metastasis in the follow-up of patients with DTC and negative serum Tg and a persistently/progressively increased anti-Tg level. Besides, one half of the patients were FDG negative, meaning that further studies are needed to assess the prognostic-clinical value of PET negativity.

The role of FDG-PET/CT in detecting unsuspected and unknown distant metastasis in the initial staging of NSCLC.

BACKGROUND/AIM: Our purpose in this retrospective study was to determine the ratio of unexpected [metastases within the coverage area of thorax computed tomography (CT)] and unknown (metastases out of the coverage area of thorax CT) metastases by positron emission tomography/CT (PET/CT) in patients with newly diagnosed non-small cell lung cancer (NSCLC) who had no defined metastatic lesion, and to investigate the contribution of fludeoxyglucose (FDG)-PET/CT in metastasis staging. MATERIALS AND METHODS: A total of 567 patients (489 males and 78 females, mean age 60.9 ± 10.7 years) were enrolled in this study. Among the 567 patients, a total of 156 patients who underwent PET/CT for metabolic characterization (group 1) and had solitary pulmonary nodules (group la, n = 39) or solitary pulmonary masses (group lb, n = 117) and the remaining 411 patients (group 2) with NSCLC who had PET/CT performed for staging formed the basis of this study RESULTS: In group 1, 5/39 (12.8%) patients with a solitary pulmonary nodule and 29/117 (24.8%) patients with a solitary pulmonary mass had distant metastases. In group 2, 129 patients of 411 (31.4%) had distant metastasis. CONCLUSION: FDG-PET/CT is proven to be an effective method in detection of unsuspected-unknown metastasis, either in patients with solitary pulmonary lesion or in the initial staging of patients with NSCLC.

FDG PET/CT in the detection of metastases in a patient with Tg and 131I WBS negative follicular thyroid cancer.

After a total or near total thyroidectomy and radioiodine ablation therapy for differential thyroid cancer (DTC), routine follow-up methods are (131)I or (131)I whole-body scanning (WBS) as well as serum thyroglobulin (Tg) and anti-thyroglobulin (anti-Tg) levels. We describe a case of a 41-year-old woman with follicular thyroid cancer. Although serum Tg level and (131)I WBS were negative after radioiodine ablation therapy, she had pain around her left medial clavicle. FDG PET/CT was performed for any undetected metastases. FDG PET/CT showed hypermetabolic bone metastases in the left medial clavicle. Biopsy confirmed metastases of the thyroid follicular carcinoma.

Correlation of 18F-fluorodeoxyglucose uptake with histopathological prognostic factors in breast carcinoma.

OBJECTIVE: This study investigated the prognostic value of [18F]-fluorodeoxyglucose (18F-FDG) uptake in breast carcinomas by comparing 18F-FDG PET/computed tomography (CT) images with histopathological and immunohistochemical prognostic factors. METHODS: This study included 136 women and four men with positive biopsy breast carcinomas who underwent 18F-FDG PET/CT imaging for initial staging. Maximum standardized uptake values (SUVmax) and tumour-to-background SUVmax ratios were calculated and compared with histopathological and immunohistochemical tumour characteristics, patient properties and axillary lymph node involvement. Calculations of SUVmax for men were performed separately. RESULTS: For the tumours in women, the mean SUVmax was 10.06±6.91 and the median SUVmax was 9.05 (0.7-35.0). Primary tumour 18F-FDG uptake and tumour-to-background SUVmax ratios were correlated with tumour size (P<0.001), histological type (P<0.001), histological grade (P=0.004), pleomorphism (P=0.010), mitosis count (P<0.001), lymphatic invasion (P=0.009), necrosis (P=0.005), oestrogen negativity (P=0.004), high Ki-67 level (P<0.001), axillary lymph node involvement (P<0.001) and triple negativity (P=0.002). High Ki-67 level (odds ratio=16; 95% confidence interval=1.6-160; P=0.016) and tumour size (odds ratio=4; 95% confidence interval=1.5-11; P=0.007) were determining factors for high 18F-FDG uptake values. Other clinicopathological and immunohistopathological parameters including progesterone receptor (P=0.211), CerbB2 overexpression (P=0.170), perineural invasion (P=0.053), intratumoural calcification (P=0.438), desmoplasia (P=0.112), tubular formation (P=0.768) and age (P=0.675) were not significantly correlated with 18F-FDG uptake. No significant relationship was observed between the tumour/contralateral breast SUVmax ratio and mitotic count, oestrogen receptor status or triple negativity. CONCLUSION: F-FDG uptake may serve as a prognostic indicator for biological behaviour in breast tumours.

An extremely rare complication of congenital heart surgery: interventricular septal hematoma.

We report a rare case of interventricular septal hematoma after patch closure of a perimembranous ventricular septal defect in a 10-month-old infant. Intraoperative transesophageal echocardiography was not performed. Routine transthoracic echocardiography at the 1st postoperative hour showed a huge intramural hematoma causing severe thickening of the ventricular septum. The patient's hemodynamics were stable and surgical revision was not required. The patient recovered well without complication.

Positron emission tomography/computed tomography imaging of brown tumors mimicking multiple skeletal metastases in patient with primary hyperparathyroidism.

Brown tumors of bone are highly vascular, lytic bone lesions representing a reparative cellular process rather than a neoplastic process usually seen in patients with hyperparathyroidism. These tumors can behave aggressively and be destructive. We report a 49-year-old male patient who was admitted to our hospital with a long-term history of right shoulder and right hip pain. Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images. These bone lesions mimicked multiple skeletal metastatic lesions and seemed to be those of the terminal stage of malignancy. PET scan was requested for the evaluation of FDG uptake of these lesions and to search the unknown primary tumor site. Positron emission tomography/computed tomography (PET/CT) images showed multiple hypermetabolic malignant or metastatic FDG avid bone lesions in skeletal system. However the biopsy results revealed no signs of malignancy and laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone, low serum phosphate and parathyroid scintigraphy was performed. Adenoma in the left parathyroid gland was seen with Tc-99m MIBI parathyroid scintigraphy. Pathological results confirmed the diagnosis of parathyroid adenoma. Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging.

Delayed imaging of the pelvis with diluted and filled bladder: a simple and efficient method in FDG PET/CT imaging of bladder carcinoma.

A 53-year-old man with recent diagnosis of urinary bladder carcinoma was referred to our PET/CT unit. There was no sign and symptom other than hematuria. Urinary ultrasound showed a mass lesion at the right wall of the urinary bladder. FDG PET/CT was performed for initial staging. One-hour whole-body PET/CT images were normal, whereas delayed pelvic images with "diluted and filled bladder" demonstrated that intense hypermetabolic lesion at the right lateral wall of the urinary bladder.

Simultaneous excision of ipsilateral nonpalpable multiple breast lesions using radioguided occult lesion localization.

The purpose of this study was to determine the feasibility and effectiveness of ROLL technique for the identification and excision of ipsilateral nonpalpable multiple breast lesions. Between August 2005 and August 2010, eight women, aged 40-61 years, with a radiographic evidence of two separate nonpalpable lesions within the same breast underwent ROLL, as we termed it, double-ROLL. Each lesion was localized with Tc-99m-labeled human serum albumin macroaggregate under ultrasonography or mamography control. A gamma probe was used to guide surgical excisions. There was no radiotracer overlapping or extravasation in any case. Out of the 16 resected specimens, histopathologic examination revealed benign findings in 13 lesions and malignancy in 3. There was no lesion involvement at the surgical margins, and no residuals were detected in any of the benign cases during follow-up. Double-ROLL technique is feasible and safe for the identification and excision of such multiple ipsilateral breast lesions.