Subject(s)
Humans , Male , Female , Radioimmunotherapy/instrumentation , Radioimmunotherapy/methods , Yttrium Isotopes , Yttrium Radioisotopes , Lymphoma, Non-Hodgkin/diagnosis , Nuclear Medicine/methods , Nuclear Medicine/trends , Radioimmunotherapy/ethics , Radioimmunotherapy/statistics & numerical data , Radioimmunotherapy/trends , Lymphoma, Non-Hodgkin , Hodgkin Disease/diagnosis , Radiotherapy/trendsSubject(s)
Antibodies, Monoclonal/therapeutic use , Immunoconjugates/therapeutic use , Lymphoma, B-Cell/radiotherapy , Radioimmunotherapy/methods , Yttrium Radioisotopes/therapeutic use , Antigens, CD20/immunology , B-Lymphocytes/immunology , B-Lymphocytes/radiation effects , Contraindications , Drug Administration Schedule , Humans , Immunoconjugates/administration & dosage , Immunoconjugates/adverse effects , Informed Consent , Medical History Taking , Radiotherapy Dosage , Yttrium Radioisotopes/administration & dosage , Yttrium Radioisotopes/adverse effectsSubject(s)
Arthritis, Infectious/diagnostic imaging , Leukocyte Transfusion , Leukocytes , Osteomyelitis/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Exametazime , Adult , Aged , Aged, 80 and over , Arthritis, Infectious/etiology , Arthritis, Infectious/physiopathology , Bone Plates/adverse effects , Chemotaxis, Leukocyte , Child, Preschool , Diabetic Foot/complications , Diabetic Foot/diagnostic imaging , Diabetic Foot/surgery , Discitis/diagnostic imaging , Female , Humans , Joint Prosthesis/adverse effects , Male , Middle Aged , Osteomyelitis/etiology , Osteomyelitis/physiopathology , Postoperative Complications/diagnostic imaging , Prosthesis-Related Infections/diagnostic imaging , Radionuclide Imaging , Spondylitis/diagnostic imaging , Surgical Wound Infection/diagnostic imagingABSTRACT
AIM: Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. MATERIALS AND METHODS: A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. RESULTS: Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. CONCLUSIONS: The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems.
Subject(s)
Carcinoma, Renal Cell/diagnostic imaging , Fluorodeoxyglucose F18 , Kidney Neoplasms/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Humans , Reproducibility of ResultsABSTRACT
Objetivos. El adenocarcinoma de células renales es el tumor sólido renal más frecuente. La tomografía por emisión de positrones (PET) no constituye en el momento actual la prueba de imagen de elección, siendo la tomografía axial computarizada (TAC) el método más adecuado para la valoración de estos pacientes. El objetivo de este estudio es realizar una revisión sistemática, con la que resumir toda la evidencia existente hasta el momento sobre la eficacia y rendimiento diagnóstico de la PET con 18F-fluoro-deoxi-glucosa (FDG) en el diagnóstico de enfermedad primaria, recurrencia y metástasis del adenocarcinoma de células renales. Material y métodos. Para ello se realizó una búsqueda sistemática de la literatura disponible en bases de datos primarias y secundarias (MEDLINE y CANCERLIT), hasta octubre de 2004. Se aplicaron criterios de inclusión y exclusión. Se evaluó su calidad según criterios de Flynn y se obtuvieron los estimadores conjuntos de sensibilidad (S), especificidad (E), cocientes de probabilidad (CP), y odds ratio diagnóstica (ORD) con sus intervalos de confianza del 95 %. Se evaluó la presencia de efecto umbral y se calculó la curva ROC resumen (SROC). Resultados. De los 46 estudios encontrados se seleccionaron 7 según criterios de inclusión/exclusión. De ellos, tres hacían referencia a la PET en el diagnóstico de lesiones primarias, dos a la reestadificación y otros dos a la detección de metástasis. Los 7 estudios cumplían criterios de calidad de Flynn. El valor más alto de S lo encontramos en la reestadificación con S = 0,87 (IC 95 %, 0,75-0,95) y en la detección de metástasis con S = 0,72 (IC 95 %, 0,56-0,85), siendo la E más alta en el diagnóstico inicial E = 0,93 (IC 95 %, 0,86-0,97). Conclusiones. Los resultados de este meta-análisis sugieren que la PET-FDG es capaz de reestadificar y detectar lesiones metastásicas con una S y E aceptables, presentando limitaciones en el diagnóstico de tumores renales primarios. Este rendimiento diagnóstico quizá sea mejorable con la introducción de los nuevos equipos híbridos PET-TAC
Aim. Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. Materials and methods. A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. Results. Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. Conclusions. The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems
Subject(s)
Humans , Tomography, Emission-Computed/methods , Carcinoma, Renal Cell , Kidney Neoplasms , Carcinoma, Renal Cell/diagnosis , Sensitivity and Specificity , Odds Ratio , Confidence Intervals , Kidney Neoplasms/diagnosisABSTRACT
OBJECTIVE: The aim of the study was to analyze the use of Tc-99m-labeled antigranulocyte monoclonal antibody fragment Fab'2 (SMab, Leukoscan) in the diagnosis of acute osteomyelitis and articular prosthesis infection. One hundred seventeen patients (118 studies) have been included, 92 women and 25 men. Thirty-seven had a suspicion of osteomyelitis and 81 with suspicion of infection of a hip (35 patients) or a knee (45 patients) prosthesis. The mean age was 64 years. A 3-phase bone scan and a SMab scan were obtained in all patients. Antigranulocyte scans were obtained within 3 and 8 hours postinjection of 20 mCi (740 MBq) of Tc-99m-labeled antibody. Diagnosis of infection was based on bone biopsy in 8 cases and on at least 2 positive cultures in the remaining cases. Infection was ruled out with negative cultures or 1-year patient follow up with negative C-reactive protein and normal erythrocyte sedimentation rate. RESULTS: Sensitivity, specificity, accuracy, and negative predictive value of Tc 99m-SMab scintigraphy were: 75%, 95%, 87%, and 92% for long bone osteomyelitis and 80%, 89%, 87%, and 91% for articular prosthesis infection, respectively. Positive predictive values were 83% and 63%, respectively. CONCLUSION: Tc-99m-antigranulocyte monoclonal antibody fragment Fab'2 scintigraphy seems to be a useful method in the diagnosis of osteoarticular infection.
Subject(s)
Antibodies, Monoclonal , Hip Prosthesis/adverse effects , Knee Prosthesis/adverse effects , Osteomyelitis/diagnostic imaging , Osteomyelitis/etiology , Prosthesis-Related Infections/diagnostic imaging , Acute Disease , Adolescent , Adult , Aged , Antibodies, Monoclonal, Murine-Derived , Female , Humans , Male , Middle Aged , Osteomyelitis/pathology , Practice Patterns, Physicians' , Prosthesis-Related Infections/pathology , Radionuclide Imaging , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and Specificity , TechnetiumABSTRACT
Cerebral single-photon emission computed tomography (SPECT) is a sensitive technique for the detection of central nervous system (CNS) involvement in systemic lupus erythematosus (SLE). The objective was to determine whether a relationship exists between cerebral hypoperfusion as detected by cerebral SPECT, cumulative tissue damage and the clinical activity of SLE. Cerebral technetium-99m-L,L-ethyl cysteinate dimer (99mTc-ECD) SPECT was performed in two groups of patients: 10 women with SLE (Group A) who had no previous history of major neuropsychiatric (NPS) manifestations and no minor NPS symptoms in the last six months, and 57 unselected women with SLE (Group B). In the same week that SPECT was performed, the SLE disease activity index (SLEDAI), SLICC/ACR damage index, native anti-DNA antibodies (ELISA) and erythrocyte sedimentation rate (ESR) were determined. In Group A, cerebral SPECT showed moderate or severe hypoperfusion (abnormal SPECT) in five patients without NPS symptoms, unrelated to age (mean 24.8 versus 27.8 years) or disease duration (mean 6.8 versus 9 years). Patients with significant cerebral hypoperfusion had greater clinical disease activity (mean SLEDAI 13.6 versus 7.6) (SLEDAI > 7 in 5/5 versus 1/5; Fisher: 0.023; OR: 33; 95% CI: 2.3-469.8) and ESR (mean 43.6 versus 9.8; P < 0.05). In Group B, the mean age of the 57 unselected women with SLE was 37 years (SD 6.3) and the mean duration of the disease was 9.7 years (SD 6.3). Cerebral SPECT revealed normal perfusion or mild hypoperfusion (normal SPECT) in 30 patients (52.6%), and moderate or severe hypoperfusion in 27 (47.4%). Hypoperfusion was unrelated to age, duration of SLE or concentrations of anti-DNA antibodies and C3 and C4 fractions. Patients with significant cerebral hypoperfusion had more active clinical disease (mean SLEDAI 13.92; SD 8.44 versus 4.56; SD 4.15) (Mann-Whitney, P < 0.005), more cumulative tissue damage (mean SLICC 2.66; SD 2.84 versus 1.03; SD 1.51) (Mann-Whitney, P = 0.035), and higher ESR values (mean 28.7; SD 22.5 versus 17.7; SD 13.3) (Mann-Whitney, P = 0.023) than patients with normal SPECT studies. Significant cerebral hypoperfusion was related both to NPS manifestations present at the time of the study (17 of 27, 63% versus 3 of 30, 10%) (OR: 15.3) and cumulative manifestations (19 of 27, 70.4% versus 8 of 30, 26.7%) (OR: 6.5), whether mild (OR: 5.5) or severe (OR: 8.2). In conclusion, cerebral hypoperfusion detected by SPECT in patients with SLE is related to clinical activity (SLEDAI), cumulative tissue damage (SLICC) and concomitant or previous NPS manifestations.
Subject(s)
Cerebrovascular Circulation , Cysteine/analogs & derivatives , Lupus Erythematosus, Systemic/physiopathology , Tomography, Emission-Computed, Single-Photon , Adolescent , Adult , Aged , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Cognition Disorders/physiopathology , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/pathology , Male , Middle Aged , Neuropsychological Tests , Organotechnetium Compounds , Radiopharmaceuticals , Severity of Illness IndexABSTRACT
El Test de Supresion con Dexametasona (TSD) se ha propuesto como un marcador de estado de la melancolia, aunque existen resultados discrepantes seguin los autores. En nuestro trabajo, realizado con 117 pacientes hospitalizados diagnosticados de transtorno afectivo mayor y subclasificados seguin los criterios de Newcastle en endogenos (67) y no endogenos (50), encontramos una mayor frecuencia de respuestas anormales al TSD, en el grupo endogeno, aunque estos resultados no nos permitem afirmar que esta prueba pueda considerarse especifica de la depresion endogena.
Subject(s)
Depression , Depressive Disorder , Depressive DisorderABSTRACT
The results of the overnight 1 mg dexamethasone suppression test (DST) administered to 26 unipolar delusional depressed patients and 47 unipolar non-delusional depressed controls are reported. There were no significant differences between the rates of abnormal responses in the two groups. However, there was a higher percentage of normal responses in the delusional depressive sample with mood incongruency. While 55% of the mood-congruent depressive patients were non-suppressors, only 12% of the depressed patients with mood-incongruent psychotic features had abnormal DST responses.
Subject(s)
Delusions/diagnosis , Depressive Disorder/diagnosis , Dexamethasone , Adult , Delusions/blood , Delusions/psychology , Depressive Disorder/blood , Depressive Disorder/psychology , Diagnosis, Differential , Female , Humans , Hydrocortisone/blood , Male , Middle Aged , Research DesignABSTRACT
We have studied the suppression of plasma cortisol after dexamethasone (1 mg) and the peak post-dexamethasone cortisol values in 84 hospitalized patients with a diagnosis of primary unipolar depression. The non-suppressor responses in the three familial subgroups (Winokur) were: 11/22 in familial pure depressive disorder (FPDD), 21/49 in sporadic depressive disease (SDD) and 1/13 in depression spectrum disease (DSD) (FPDD vs. SDD, p less than 0.05; SDD vs. DSD, p less than 0.05). When considering the peak post-dexamethasone cortisol value, or the 8.30-9.00-hour values, the results in the DSD group were lower than in the other two groups (p less than 0.05). These results suggest a different behaviour of DSD as compared with FPDD and SDD.
Subject(s)
Depressive Disorder/genetics , Dexamethasone , Hydrocortisone/blood , Adrenocorticotropic Hormone/blood , Adult , Depressive Disorder/blood , Depressive Disorder/diagnosis , Female , Humans , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
Prolactin (PRL) serum levels in a group of patients with acute schizophrenia (AS) and in a group of patients with chronic schizophrenia (CS) have been investigated in order to differentiate the dopaminergic sensitivity in response to chlorpromazine (CPZ) treatment. AS patients show both a greater dopaminergic sensitivity to CPZ and a stronger response in PRL secretion to TRH stimulation after a 14-day CPZ treatment.
