Brain-Included 18F FDG PET/CT acquisition protocol: cancer-specified clinical impact of newly-diagnosed brain metastasis in extra-cerebral cancer patients

Background: Evolution of individualized radiosurgical therapeutic methods for brain metastasis as an ominous prognostic finding may encourage a more extensive application of neuroimaging in patients with extracerebral cancer. The aim of the present study was to investigate the added value of brain-included 18 F FDG PET/CT acquisition protocol based on primary cancer type and clinical indication

Materials and Methods: A retrospective review was performed on 3945 18 F FDG PET/CT reports of patients with extra-cerebral cancer underwent brain-included PET/CT study. Cerebral lesions suggestive of brain metastasis were subsequently verified by MRI, MRI+MRS, surgical pathology and a 1-year clinical formal follow up. The detection rate of new brain metastasis and related impact on disease status were then investigated in each cancer type based on clinical indication

Results: Of a total 3933 eligible patients, 44 [1.12%] were finally verified to have new cerebral metastasis. The most common primary sources were lung cancer [19/385, 4.93%], cancer of unknown primary [CUP] [5/168, 2.97%] and breast cancer [8/468, 1.71%]. The most common clinical indications were initial staging [17/44, 43.1%] and restaging [19/44, 36.4%]. Change in disease status occurred in 12 out of 44 patients [27.3%], more frequently occurred in lung cancer [n=4], in all indications and breast [n=3] cancers at restaging [n=7, 43.8%]

Conclusion: PET/CT acquisition protocol study may be best optimized based on the type of primary cancer and timing of evaluation. Brain-included field of view may be recommended for lung cancer regardless the clinical indication, cancer of unknown primary and breast cancer at restaging

Diagnostic performance of F-18 FDG PET/CT in patients with cancer of unknown primary: additional benefit over CT-based conventional work up

Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary [CUP] as an appropriate imaging tool in early phase of initial standard work up

Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated

Results: Sixty-two patients with mean age of 62 [30 men, 32 women], PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway

Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation

[Survey of serum fat-soluble vitamins, zinc, copper and selenium levels in patients with cystic fibrosis]

Cystic fibrosis [CF] is a genetically disease with different respiratory and gastrointestinal organ involvement. Because of gastrointestinal tract involvement, patients have mal-absorption for vitamins and mineral elements; for example vitamin A, D, E and trace elements such as Selenium [Se], Zinc [Zn] and Copper [Cu] have low serum level in CF patients in different studies. The goal of this study is to define relation between serum level of this elements and severity of respiratory and gastrointestinal tract involvement in these patients. This cross sectional study performed on 39 cystic fibrosis patients admitted in pediatric ward of Masih Daneshvari hospital, Tehran, Iran. Serum levels of Vitamin A, D and E, Selenium, Zinc and Copper deficiency were studied. Serum level of Vitamin A and D were lower than normal values. Also, 3 cases [7.68%] had serum level of Zinc lower than normal values. CF patients are susceptible to have deficiencies of fat soluble vitamins and trace elements such as Selenium and Zinc because of mal-absorption. It seems that a perfect diet and nutritional components are helpful in prevention of these problems

Mediastinal lymphangioma in a child

We report a case of a male child with a cystic mass in his left side of the neck with extension to the mediastinum. This article highlights the clinical and paraclinical findings and management of these cases. In conclusion, it is necessary to evaluate the mediastinum for extension of the cyst in cases with cystic hygromas of the neck. Surgical resection of the tumor through a cervical incision can be considered

[Occurrence pulmonary tuberculosis in a patient with Bernard soulier syndrome: a case report]

Bernard soulier syndrome [BSS] is a rare congenital bleeding disorder characterized by thrombocytopenia. BSS causes bruising, epistaxis, gingival bleeding, menorrhagia, post partum bleeding, gastrointestinal bleeding and post traumatic hemorrhage, but there is no report of hemoptysis in BSS. A 14 year-old girl was referred to our center due to massive hemoptysis. Her chest x-ray revealed complete collapse of the right lung. Rigid bronchoscopy was preformed and the intrabronchial clots were removed. Smear and culture of direct sputum was positive for Mycobacterium tuberculosis. She received anti-tuberculosis treatment. During treatment, she developed a massive vaginal bleeding, because of drug interaction between rifampin and low dose contraceptive [LD], which she had been taking for control of massive menstrual bleeding. Her vaginal bleeding was controlled by platelet infusion and recombinant factor 7 infusion. After 2 months of anti-TB treatment, sputum smear and culture for BK converted to negative. One year after treatment, the pulmonary tuberculosis was completely cured and no hemoptysis occurred. When hemoptysis occurs in patients with Bernard soulier syndrome, we should consider other differential diagnoses, and further diagnostic evaluation is recommended

Primary immunodeficiency in children: report of seven years study

Primary immunodeficiency diseases [PIDs] are a genetically heterogeneous group of disorders that affect distinct components of the innate and adaptive immune system, such as neutrophils, macrophages, dendritic cells, complement proteins, natural killer cells, T and B lymphocytes. These disorders are rare, with an estimated prevalence of 1:10,000 live births. This study aimed at describing the clinical features, disease complications, treatment modalities and overall outcome of patients with Primary Immunodeficiency Diseases [PID] in Masih Daneshvari hospital during a 7-year period [2001-2008]. This was a retrospective study based on the review of patients' medical records. Clinical, laboratory, and epidemiological data including personal and family history were obtained by reviewing records of patients admitted to the Pediatric Pulmonary Ward of NRITLD, a referral center for tuberculosis and lung diseases. The diagnosis was made based on WHO criteria for primary immunodeficiency disorders. Data collected from 59 patients were evaluated and analyzed. There were 35 [59.3%] males and 24 [40.69%] females. The age of patients ranged from 6 months to 14.5 years and the mean age was 7.4 years. Positive family history was detected in 20 [33.9%] cases and parents of 36 patients [61.2%] were consanguineous. Twenty patients [33.9%] had a family history of PID. Phagocytic disorder [57.2%] was the most common form of PID, followed by antibody deficiency [33.7%] and T-cell or combined deficiency [8.2%]. No case of complement deficiency was detected. In this group of under study patients, 2 cases expired as the result of respiratory failure due to drug resistant pneumonia [chronic granulomatous disease cases]. Based on studied results, Phagocytic disorders [57.2%] were the most common disorders among our PID patients. This may be due to the large number of CGD patients referred with the pathologic finding of granuloma misdiagnosed with tuberculosis. Considering the high prevalence of PID in this study, cases with unusual, chronic, severe or recurrent infections should be evaluated for immunodeficiency disorders

correlation of brody high resolution computed tomography scoring system with clinical status and pulmonary function test in patients with cystic fibrosis

To reduce the mortality and morbidity rates of cystic fibrosis [CF] patients, and to have an effective clinical management, it is important to monitor the progression of the disease. The aim of this study was to evaluate the progression of lung disease in CF patients by means of assessing the correlation of the CT scoring system with clinical status and pulmonary function test at the Pediatric Pulmonary Ward of Masih Daneshvari Hospital in 2008. Pulmonary high resolution computed tomography [HRCT] was performed in 23 CF patients using the Brody's scoring system. Morphologic signs as well as the extent and severity of each sign were scored, and the total sore was calculated. The correlation of HRCT scores[total score as well as the score for each parameter] with Shwachman Kuczycki scoring system and pulmonary function test were examined. The study included 9 female and 14 male patients with an age range of 5-23 years [mean: 13.42 years]. Bronchiectasis [100%] and peribronchial wall thickening [100%] were the most frequent CT abnormalities. Mucus plugging, air trapping and parenchymal involvements were respectively seen in 95.7%, 91.3% and 47.8% of patients. The overall CT score for all patients was 57.6 +/- 24.2 [means +/- SD]. The results of pulmonary function test showed a restrictive pattern; however, in 5.3% of the patients PFT was normal. The overall Shwachman-Kulczycki score was 53.48 +/- 13.8. There was a significantly [P=0.015] negative correlation between the total CT score and Shwachman-Kulczycki score; however, there was no significant correlation between total CT score and the results of PFT [P=0.481]. The Brody's scoring system for high resolution computed tomography seems to be a sensitive and efficient method to evaluate the progression of CF, and can be more reliable when we combine the CT scores with clinical parameters

Pulmonary manifestations of hyper IgE syndrome: case series and literature review

This study aimed to present four children suffering from recurrent pulmonary infections in the context of hyper lgE syndrome. All patients had recurrent pulmonary infections including pneumonia, bronchiectasis, pulmonary abscess and hydropneumothorax. Serum IgE level was greater than 2000 IU/ml in all cases. Microbial cultures showed Staphylococcus aureus and Pseudomonas aeruginosa in two cases. All responded well to the wide spectrum intravenous antibiotics. Extra-pulmonary manifestations included purulent lymphadenitis as well as skin and brain abscesses. Hyper IgE syndrome causes recurrent pulmonary and extra-pulmonary infections which respond fairly well to wide spectrum antibiotic therapy

Role of quantiFERON-TB test in detection of children infected with mycobacterium tuberculosis

Latent TB infection can persist for many years with about 10% lifetime risk of reactivation to active disease. However, in children with latent TB infection, disease develops within 2 years of infection. Recently, a new diagnostic test [QuantiFERON-TB Gold] which measures the production of interferon [IFN] gamma in whole blood upon stimulation with Mycobacterium tuberculosis has been introduced. The aim of this study is to compare the performance of the IFN-gamma assay with tuberculin skin test [TST] for the identification of latent TB infection in children in contact with active TB in the pediatric pulmonary ward. This cross-sectional study was conducted on 100 children, aged 2months-15 years admitted to the Pediatric Ward of Masih Daneshvari Hospital during 2007-2008. Whole blood was collected for measuring Interferongamma using QuantiFERON-TB Gold kit [QFT-Cellestis Comp]. In this procedure, Mycobacterium tuberculosis specific antigens [ESAT-6 and CFP-10] are used. In the present research, 100 children were studied and divided into 3 groups of case [TB], contact and control. PPD test was performed by injecting 0.1 ml of the 5 unit solution [Pasteur Institute of Iran] for all cases. Twenty-eight percent of the contacts, 60% of the cases and 10% of the controls were Afghans; the remaining were Iranians. Smear of the gastric washing [3X] was prepared in contact and case [TB] groups; 30% of the cases [TB] were AFB positive, while all of the contacts had negative smears. History of BCG vaccination during neonatal period and BCG scar were present in all cases. Positive PPD test [PPD >/= 10 mm] was observed in 90% of the cases and 24% of the contacts. PPD test was negative in the control group. Out of 50 contacts, 18 [36%] showed positive QFT test; and of 20 TB patients, 18 [90%] had positive tests. Regarding age, children with positive QFT test belonged to the older age group. To our knowledge, this is the first study to investigate the performance of the whole blood IFN-gamma assay in diagnosing latent TB infection in children in Iran. This study found a fair correlation between the TST and the whole blood IFN-gamma assay in children at high risk of latent TB infection. Our study also highlighted fair and moderate agreement in contact and TB groups respectively between the TST and QFT-TB test in children at high risk for latent TB infection. More studies are required to clarify this relationship

[Pulmonary manifestations of pediatric hyper IgE syndrome]

Hyper IgE syndrome is a rare primary immune deficiency disorder characterized by pulmonary and cutaneous infection, eczema, and elevated serum IgE levels. In this article, 4 patients with hyper IgE syndrome and recurrent pulmonary infection were reported. Four girls with history of recurrent pulmonary infections were worked up and hyper IgE syndrome was diagnosed for them. All patients had recurrent pulmonary infections including pneumonia, bronchiectasis, pulmonary abscess, hydropneumothorax. Serum IgE levels were greater than 2000 Iu/ml in all cases. Microbial cultures showed staphylococcus aureas and pseudomans aeroginosa in two cases. All patients respond well to the wide spectrum intravenous antibiotics. Extra-pulmonary manifestations including purulent lymphadenitis, and skin and brain abcesses were observed. Hyper IgE syndrome causes recurrent pulmonary and extra-pulmonary infections which response fairly well to wide spectrum antibiotic therapy