[Evaluation of parental view toward dental treatment under general anesthesia in Isfahan]

The rate of parental attitude and view toward the treatment modality of child is the one of the most important factors of the treatment. The aim of this study was the evaluation of parental view and attitude toward dental treatment under general anesthesia. In this descriptive cross sectional study, the participants, were parents whose children had recently undergone dental treatment under general anesthesia. The parents were given two self-administered questionnaire inquiring about their reasons and view toward the dental treatment under general anesthesia. Statistical analysis was performed by using Mann Whitney, Crosstab and Correlation tests. Our results showed that more than 80% of parents have moderate to high satisfaction about practice. Dentist's refer was the first reason for this treatment modality followed by relatives recommendation. More than 45% of parents indicated that lack of child fear was the most important advantage of this type of treatment. From parent's point of view previous sever pain experience and fear that transferred from relatives were the most important reason for child's fear from dental treatment. According to these results; most of parents satisfied with their child's dental treatment under general anesthesia, so promotion of social knowledge about dental treatment under general anesthesia could improve children's dental care and oral hygiene

Assessment the diagnostic accuracy of sentinel lymph nodes lymphoscintigraphy using technetium-99m phytate in breast cancer

Technetium-99m phytate [[99m]Tc-ph] is a readily available radiopharmaceutical and has been suggested as a suitable agent for sentinel lymph node [SLN] detection. In this study, the diagnostic accuracy and false-negative rate of radionuclide SLN mapping using [99m]Tc-ph were investigated. Forty three women [mean age 52.3 years, range 31-74 years], who all had been diagnosed with breast cancer were enrolled in the study. All patients had no palpable axillary lymph nodes and had not undergone exploratory tumor resection or any drug treatment, previously. [99m]Tc-ph was injected peri-tumorally at four sites. Following SLN scintigraphic imaging, the patients were operated. Intraoperatively SLN were detected by a scintillation probe and a blue dye technique. Modified radical mastectomies with radical axillary dissection were performed with excision of the lymph nodes, to evaluate the accuracy of the SLN technique. Intraoperative scinti-mapping identified SLN in 40 of the 43 patients [detection rate: 93%]. Scintigraphically, none of the patients had internal mammary drainage or contralateral axillary involvement. The blue dye detection rate in 23 patients under study was 87% and all lymph nodes detected by the blue dye technique were also detected as "hot" spots in the lymphoscintigraphy. Using pathology as the gold standard, the sensitivity and negative predictive value of scintigraphic lymphatic mapping in detection of SLN by [99m]Tc-ph were 90% and 90.9%, respectively. The same values for blue dye lymphatic mapping were 84.6% and 77.7%, respectively. [99m]Tc-ph used for SLN mapping is readily available, has low cost and gives better results than the blue dye technique. Long-term follow-up is required to assess accurately the incidence of failure in patients with negative SLN and the overall diagnostic accuracy and efficacy of the SLN mapping using [99m]Tc-ph as the radioactive tracer

[Association between serum leptin and adiponectin and bone mineral density in 40-60-year-Old postmenopausal women]

Osteoporosis is the most common metabolic bone disease, which leads to a decrease in bone mass and disorders in its structure. Leptin and adiponectin are hormones secreted from the adipose tissue. The objective of this study was to determine association between serum leptin and adiponectin and bone mineral density in postmenopausal women 40-60 years old. This cross-sectional study included was 85 postmenopausal women, 40-60 years old. Samples of fasting blood were taken from the women in order to determine the serum concentrations of leptin and adiponectin, and bone mass density [BMD] was measured by the DXA method in two areas, i.e., L2-4 and the femoral neck. 4.5 kg/m2, respectively. There was a significant inverse relationship between +/- 5.4 years and +/- 29.4. The means +/- SD of age and body mass index [BMI] of the subjects were 52.4 the serum leptin level and BMD in the L2-4 area [p=0.02]. The data also showed a negative association between the serum adiponectin level on the one hand, and the BMD of the femur [p=0.03] and the bone mineral content [BMC] of the vertebral column [p=0.03] on the other. Leptin and adiponectin have inverse associations with the bone mineral density

[Assessment of relationship between serum leptin and adiponectin and bone mass with energy intake and nutrients in postmenopause women of 40-60 years old]

Adequate nutrition is crucial for growth and maintenance of the body skeleton health. Nutrients consumed affect leptin and adiponectin levels and bone mass. This study was done to determine the relationship between serum leptin, adiponectin and bone mass with energy intake and nutrients in postmenopausal women, 40-60 years old. The present cross-sectional study was done on 85 postmenopausal women, aged 40-60 years. Samples of fasting blood were taken to determine concentrations of leptin and adiponectin of serum and bone mineral density was measured by the DXA method in the two areas of L2-4 and the femoral neck. Food intake was documented using questionnaires including frequency of food and was analyzed by FP2 Software. Leptin had a negative relationship with energy intake, protein and magnesium and a positive relationship with carbohydrate; there was a positive relationship between adiponectin and energy and carbohydrate. BMD of femur had a negative relationship with energy and carbohydrate, while it had positive relationship with calcium, and there was direct and significant relationship between BMD of the spine and zinc. Increase in consumption of carbohydrate and decrease in consumption of protein lead to increase in leptin. Consumption of calcium and zinc can have a protective effect on bones

Catheter related artifacts on bone scans: report of two cases

Bone scanning using the 99mTc-phosphate analogs is an established diagnostic modality and a commonly requested radioisotope examination for a variety of pathologies involving the skeleton, such as osteomyelitis, bony metastases, and occult fractures. The bone scan is one of the most commonly requested procedure in most nuclear medicine department. The images show areas of increased and decreased activity usually related to the bone turnover. The bone scan is interpreted by evaluating the pattern of radioactive localization in the skeleton and identifying areas of increased uptake [hot spots] or, less frequently, decreased or absent activity [1]. Unfortunately, the findings are most often very nonspecific and do not tell us the exact underlying cause of the abnormal activity. A variety of factors may change the normal distribution of bone-seeking radiopharmaceuticals. Although most of the times these areas of abnormal radiotracer activities are due to true pathologic bone states, however, it is not infrequent that they are caused by technical errors such as urinary contamination, nonuniformity of gamma camera, and attenuation of activity by foreign bodies. These artifactual causes warrant careful attention to prevent unnecessary interventions. In certain conditions, nonosseous structures other than the urinary tract are seen on the bone scan. For example, there may be localized muscle uptake, such as myositis ossificans, or localization in a pleural effusion. Such serendipitous findings may constitute welcome diagnostic information [1]. On the other hand, soft-tissue uptake may at times hamper interpretation of the study by bringing in artifacts that degrade the quality of the images. Therefore, recognition of patterns of nonbony uptake is important for correct identification of artifacts and accurate interpretation of the scan [1]. This paper presents two cases of artifactual causes of odd radiotracer activity in bone scans. In both cases the artifact is at least somewhat related to an indwelling catheter

[Agreement of two methods of planar and SPECT scintigraphy with 99mTc- RBC in detection of liver Hemangioma]

Hemangiomas are the most frequent benign tumors of the liver and detecting them from metastasis or other malignant hepatic tumors is of outmost importance. 99mTc- RBC scan is highly specific and is the method of choice for this differentiation. This scintigraphy is performed in Planar and SPECT modes. These two procedures are in agreement most of the times, however since SPECT is more expensive and time consuming we planned a study to evaluate the agreement of these two methods. Sixty two patients [age range 20-80 yr, mean age 42 yr], 41 female [67%] and 20 male [33%], who were under evaluation for liver mass detected on abdominal ultrasound or CT scan, underwent 99mTc- RBC scan with both Planar and SPECT methods. The data was processed by computer and SPSS software [11.5]. Planar scan was positive in 42% and negative in 59% of cases, while for SPECT study these values were 68.9% and 31.1%, respectively. The Kappa value for planar and SPECT scan results was 48%, and there were 17 lesions [27%] which were detected only by SPECT. SPECT scan defined 35% of the posteriorly located hemangiomas, and 58.3% of hemangiomas smaller than 3 cm, which were not detected by planar scans. Also 75% of patients with multiple hepatic lesions showed more lesions by SPECT as compared to planar scan. Since there is a weak agreement between SPECT and Planar scan, SPECT is considered the more reliable method in diagnosis of liver hemangioma and this is especially true when the hemangioma is of small size, has a posterior location or in cases of multiple lesions

[Myocardial 99m Tc-MDP uptake on the bone scintigraphy in the hemodialysis-associated amyloidosis:a case report]

Amyloidosis is characterized by an abnormal extracellular deposition of amyloid in different organs, where it usually causes some type of dysfunction. Its cause is unknown. Five different types of amyloidosis have been described according to the underlying disease; immunoglobulin amyloidosis, familial amyloidosis, senile systemic amyloidosis, secondary amyloidosis and hemodialysis-associated amyloidosis. We report a case of hemodialysis-associated amyloidosis in a 56-year-old man that radionuclide imaging demonstrated intense uptake of Tc-99m MDP within the myocardium. The diagnosis of amyloidosis was established by analysis of aspirated abdominal fat, although other non- invasive modalities didn't reveal any positive findings. The first clue to the possible presence of amyloidosis in this case was provided by the radionuclide bone scan performed, which revealed intense tracer uptake in the heart suggesting amyloid deposit. We conclude that in cases of extraosseous accumulation of Tc-99 MDP especially as a diffuse pattern of myocardial uptake, a diagnosis of amyloidosis should be considered, in an appropriate clinical setting

[Evaluation of diagnostic role of 99mTc-terofosmin scintigraphy in cold thyroid nodules]

Various radiopharmaceuticals, including 67Ga, 201Tl, and 99mTc-sestamibi have been used to differentiate benign from malignant thyroid nodules. 99mTc-Tetrofosmin, a lipophilic cationic radiotracer, and 99mTc-sestamibi have also been reported to accumulate in thyroid tumors. In this study, we evaluated the role of 99mTc-Tetrofosmin in the differentiation of malignant from benign thyroid nodules. We prospectively studied 108 patients with solitary cold thyroid nodule on 99mTc-pertechnetate scintigraphy [33 malignant and 75 benign] to investigate the diagnostic value of 99mTc-Tetrofosmin scintigraphy. 99mTc-Tetrofosmin scintigraphy was performed 15, 60, and 120 minutes following IV injection of 20 mCi [740 MBq] of radiotracer in the anterior planar mode with a gamma camera equipped with LEAP collimator. The scans were visually analyzed by two experienced nuclear physician. The nodules with late tracer retention [activity more than adjacent thyroid tissue] were classified as positive and nodules without late retention were interpreted as negative for malignancy. Fine needle aspiration [FNA] was performed in all patients in 3-7 days interval. 52 patients were subsequently operated on while 56 patients refused surgery. These 56 patients, however, had at least two negative FNA results. 45 out of 108 nodules show high 99mTc-Tetrofosmin uptake on delayed images; 27 of them were malignant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to be 81.8%, 76.0%, 54.0%, and 90.4% respectively. Accuracy of the test was also determined to be 77.7%. We concluded that 99mTc-Tetrofosmin scintigraphy is a relatively sensitive, but not enough specific, method in diagnosing malignant thyroid nodules. This agent could be of value in the presence of FNA limitations

Response rate to hepatitis B vaccination in patients with chronic renal failure and End-stage-renal-disease: Influence of diabetes mellitus

Hepatitis B vaccination is recommended for all individuals with renal failure. Nevertheless, the response rate for this vaccine in hemodialysis patients is low. This study was designed to determine the response rate to hepatitis B vaccination in chronic renal failure [CRF] and end stage renal disease [ESRD] patients and those factors that influence it. We evaluated antiHBs level after primary vaccination in 32 predialysis and 93 dialysis patients. HBsAg positive patients were excluded. AntiHBs titers were determined in the period of 1 to 6 months after completion of vaccination. Seroconversion [antiHBs >/= 10mIU/ml] was found in 100 patients [80%], but an excellent response [titer>100 mIU/ml] was observed only in 74 [59.2%]. Response rate were 71.9 and 82.8 in predialysis CRF and ESRD patients, respectively, but this difference was not significant [

[Effects of treatment with radioactive iodine on gonadal functions in patients with differentiated thyroid cancer]

Background: The purpose of this study was to evaluate the effect of treatment with radioactive iodine on the function of gonads in males and females with follicular and papillary thyroid carcinoma

Materials and Methods: Consenting patients in the reproductive age were grouped according to the cumulative dose of received radioiodine and followed for at least 12 months. For all men, serum levels of FSH, LH, and testosterone were measured some [53 cases] were also studied by semen analysis. For women, tests for serum levels of LH, FSH, estrogen, and progesterone were performed

Results: Overall, 246 patients [159 females, 87 males] were studied. In 87.4% of men, there was an increase in serum FSH level after radioiodine therapy, in 20.7% of whom the level remained high during follow-up period. The average serum level of FSH after each course of treatment was significantly higher than the level before treatment [p<0.01], and there was a meaningful correlation with the cumulative dose of received iodine [p<0.001]. Reduced number of sperms was shown in 35.8% of male patients, among whom 73.7% also showed reduced motility. In 36.8% of the patients with reduced sperm number [13.2% of the total], this finding was persistent during the follow-up period. Increased level of FSH was correlated with reduced sperm counts in all doses [p<0.005]. There was no significant correlation between serum levels of LH and testosterone with iodine treatment in males [p=0.47]. In women, no significant correlation between gonadal-hypophyseal hormones and treatment with radioactive iodine was found, and there were no signs and symptoms of sexual dysfunction. Infertility was not noticed in any patient and no case of abortion was found

Conclusion: It seems that cells in spermatogonia lineage [in contrast to Leydig cells] are radiosensitive, with the sensitivity related to the cumulative dose of received radioactive iodine. But in the oogonia cell line, the radiosensitivity is insignificant

value of myocardial perfusion imaging in differentiating between idiopathic dilated cardiomyopathy from the ischemic form

Differentiating between ischemic cardiomyopathy [ICM] and idiopathic dilated cardiomyopathy [IDCM] is important as coronary revascularization can improve prognosis in the ischemic subgroup. Due to inherent problems of coronary angiography in patients with depressed ejection fraction [EF] introducing a noninvasive tool to diagnose those who will benefit from angiography seems to be rewarding. We examined usefulness of myocardial perfusion scan in this group of patients. Study was performed on 64 patients [62 male and 2 female] aged 57.1 +/- 6.7y [mean +/- SD] all with dilation of the left ventricular [LV] cavity and ejection fraction less than 40% by echocardiography. Myocardial perfusion scan was performed in stress and rest phases. All the patients had coronary angiography which was used as the gold standard test. On each set of images, heart was arbitrary divided into 17 segments and perfusion abnormality in each segment was scored by a 5 grade scoring system [0-4]. Summed Stress Score was used as the scan criteria to differentiate dilated ischemic from idiopathic cardiomyopathy. Scores more than 17 were considered ischemic, and less than that, idiopathic. Results were compared with angiography. From total 40 cases of ischemic cardiomyopathy [proved by angiography] 39 were correctly diagnosed by scan and only one case was miscategorized as IDCM. All 24 cases of IDCM were correctly diagnosed by scintigraphy. Sensitivity, specificity, positive predictive value, and negative predictive value of myocardial perfusion imaging for discrimination between ischemic and idiopathic dilated cardiomyopathy were 97.5%, 100%, 100%, and 96% respectively. Considering excellent accuracy of myocardial perfusion scan with scoring system in discrimination of ischemic dilated cardiomyopathy from idiopathic dilated cardiomyopathy, this noninvasive test could be considered the main diagnostic test

Dystrophic calcinosis cutis and SLE: the bone scan pattern [case report]

A 21 years old woman presented with a history of SLE and skin lesions on the arms, trunk, and abdomen. The left gluteal region was ulcerated and painful and occasionally extruded a chalky white material. The patient referred from rheumatology department for osteomyelitis assessment. On physical examination the patient had hard, nontender lesions on the proximal arms, lower abdomen and lower back. She had painful, hyper pigmented bullae, plaques, erosions and ulcer on her hands, arms, thighs, knees and especially left gluteal region. All laboratory results including BUN, Cr, Ca, Ph, LFT, were normal except for ESR which was increased. Left gluteal skin biopsy reveals homogenized and sclerotic collagen in the lower dermis with scattered foci of calcification, consistent with calcinosis cutis. The whole body bone scan shows diffuse extra osseous calcification mainly in the arms, lower trunk and thighs. The X-ray findings revealed multiple foci of calcification in the soft tissue compartment of the arms and lower trunk. Focal areas of increased uptake in the ribs and right humerus secondary to osteoporosis and truma were noticed. Calcinosis cutis is a rare presentation of SLE. It is usually seen in CRF and due to electrolyte impairment .In this report however, a case of SLE is presented with extensive calcinosis but normal renal function and lack of any electrolyte imbalance

Studying the specificity of bone SPECT for differentiating malignant from benign lesions in the vertebral column of the patients with a known primary malignancy

Metastatic survey of the patients with known primary malignancies with bone scan is one of the most common studies in nuclear medicine. Unfortunately the conventional planar bone scan has a very low specificity for differentiating benign from malignant lesions especially in the spinal column. In this study, we compared the specificity of SPECT imaging and conventional planar bone scan. We studied 20 patients [12 male and 8 female] with known primary malignancy, which had abnormal increased uptake in the spinal column on the planar images. SPECT of the spine was performed for all of these patients. Lesions of the body and pedicles were considered malignant [45 and 37 lesions respectively] and lesions of the anterior rim of the body, spinal and transverse processes and laminas were considered benign [15, 6, 5 and 2 lesions respectively]. The results of the SPECT were correlated with MRI of the spine or the results of biopsy. 21 out of 24 benign lesions were correctly diagnosed by SPECT imaging. Specificity, positive and negative predictive values of the SPECT were 87.5%, 96.3% and 75% respectively. On the other hand the specificity of the conventional planar imaging was 30%. According to the results of this study, the SPECT imaging of the spinal column can be very useful for differentiating benign from malignant causes of abnormal increased uptake of the spine. Particularly lesions located in the vertebral bodies and pedicles should be considered malignant and lesions of the anterior border of the vertebral bodies as benign degenerative changes

Determination of optimum filter in myocardial SPECT: a phantom study

In myocardial perfusion SPECT imaging, images are degraded by photon attenuation, the distance-dependent collimator, detector response and photons scatter. Filters greatly affect quality of nuclear medicine images Materials and A phantom simulating heart left ventricle was built. About 1mCi of 99mTc was injected into the phantom. Images were taken from this phantom. Some filters including Parzen, Hamming, Hanning, Butterworth and Gaussian were exerted on the phantom images. By defining some criteria such as contrast, signal to noise ratio, and defect size detectability, the best filter can be determined. 0.325 Nyquist frequency and 0.5 Nq was obtained as the optimum cut off frequencies respectively for hamming and hanning filters. Order 11,cut off 0.45 Nq and order 20 cut off 0.5 Nq obtained optimum respectively for Butterworth and Gaussian filters. The optimum member of every filter's family was obtained

Quantitative evaluation of normal uptake of mandibular condyle in bone scan with Tc99m-MDP

Unilateral condylar hyperplasia is the main cause of mandibular asymmetry. Radionuclide bone scanning is a useful procedure for functional evaluation of temporomandibular joint. In this study, 39 patients with normal bone scan and no facial asymmetry were studied. All patients were below 22 years of age. Normal condylar uptake was determined in this group of patients. Right and left condylar uptakes were not completely identical and some difference [Below 10%] between right and left condylar uptake was seen. No significant difference in condylar uptake in male and female patients were observed [P=0.26, alph=0.05]

Tc-99m-MIBI in evaluation of myocardial perfusion

Tc-99m-MIBI is an isonitrile derivative used for evaluation of myocardial perfusion in recent years. In this preliminary report, 7 patients with coronary artery disease are evaluated with Tc-99m-MIBI stress planar and spect studies. Good correlation with coronary angiography is observed in these cases. In view of inherent technical problems present with thallium 201, Tc-99m-MIBI is a good alternative in evaluation of myocardial perfusion