THE ROLE OF TUMOR-SEEKING RADIOPHARMACEUTICALS IN THE DIAGNOSIS AND MANAGEMENT OF ADRENAL TUMORS.

CONTEXT: The variety of tumor-seeking radiopharmaceuticals, which are currently in clinical use, may have a potential role as imaging agents for adrenal gland tumors, due to physiological characteristics of this organ. OBJECTIVE: The purpose of this study was to evaluate the diagnostic potential of 99mTc-HYNIC-TOC, 99mTc(V)-DMSA, and 99mTc-MIBI in the assessment of adrenal tumors, by correlating with imaging findings and histopathologic results. DESIGN: The research is designed as a cross-sectional prospective study. PATIENTS AND METHOD: The study included 50 patients with adrenal tumors (19 hormone-secreting and 31 nonfunctioning) and 23 controls without adrenal involvement. In all patients, single-photon emission computed tomography (SPECT) was performed, using qualitative and semiquantitative analysis. The tumor to non-tumor tracer uptake was conducted by using a region-of-interest technique. Adrenal to background (A/B) ratio was calculated in all cases. RESULTS: 99mTc-HYNIC-TOC scintigraphy showed a high statistical significance between A/B ratios, while other two tracers resulted in a lower sensitivity, specificity and accuracy. Futhermore, 99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumors (the receiver-operating-characteristic curve analysis, A/B ratio cut-off value of 8.40). CONCLUSION: A semiquantitative SPECT analysis showed that 99mTc-HYNIC-TOC is a highly sensitive tumor-seeking agent for the accurate localization of adrenal tumors.

ADIPONECTIN AS A POTENTIAL BIOMARKER OF LOW BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH METABOLIC SYNDROME.

CONTEXT: Adiponectin is an abundant adipokine, which has antiinflammatory, anti-atherosclerotic and vasoprotective actions, and potential antiresorptive effects on bone metabolism. It seems to be directly involved in the improvement and control of energy homeostasis, protecting bone health and predicting osteoporotic fracture risk. OBJECTIVE: To examine the relationship between adiponectin level and bone mineral density (BMD) in post-menopausal women with metabolic syndrome (MetS) and low BMD, and to estimate the prognostic significance of adiponectin in osteoporosis. DESIGN: Clinical-laboratory cross-sectional study including 120 middle-aged and elder women (average 69.18±7.56 years). SUBJECTS AND METHODS: The anthropometric parameters were measured for all examinees. Lumbar spine and hip BMD, as well as body fat percentage, were measured using a Hologic DEXA scanner. In all subjects serum adiponectin concentration was measured by ELISA method. RESULTS: The level of adiponectin was significantly positively correlated with BMD-total, BMD of the lumbar spine and BMD of the femoral neck (r=0.618, r=0.521, r=0.567; p<0.01). Levels of adiponectin and BMD are significantly lower in post-menopausal women with MetS and osteoporosis compared to patients with osteopenia (856.87±453.43 vs. 1287.32±405.21 pg/mL, p<0.01; BMD, p<0.05), and the highest values in healthy examinees. A cut-off value of adiponectin level for osteoporosis/osteopenia was 1076.22/1392.74 pg/mL. CONCLUSIONS: Post-menopausal women with MetS have significantly lower adiponectin level and low BMD compared to healthy examinees. Adiponectin may be an early, significant and independent predictor of developing osteoporosis in women with MetS, especially in post-menopausal period.

Burkholderia cepacia complex in Serbian patients with cystic fibrosis: prevalence and molecular epidemiology.

The Burkholderia cepacia complex (Bcc) organisms remain significant pathogens in patients with cystic fibrosis (CF). This study was performed to evaluate the prevalence, epidemiological characteristics, and presence of molecular markers associated with virulence and transmissibility of the Bcc strains in the National CF Centre in Belgrade, Serbia. The Bcc isolates collected during the four-year study period (2010-2013) were further examined by 16 s rRNA gene, pulsed-field gel electrophoresis of genomic DNA, multilocus sequence typing analysis, and phylogenetic analysis based on concatenated sequence of seven alleles. Fifty out of 184 patients (27.2 %) were colonized with two Bcc species, B. cenocepacia (n = 49) and B. stabilis (n = 1). Thirty-four patients (18.5 %) had chronic colonization. Typing methods revealed a high level of similarity among Bcc isolates, indicating a person-to-person transmission or acquisition from a common source. New sequence types (STs) were identified, and none of the STs with an international distribution were found. One centre-specific ST, B. cenocepacia ST856, was highly dominant and shared by 48/50 (96 %) patients colonized by Bcc. This clone was characterized by PCR positivity for both the B. cepacia epidemic strain marker and cable pilin, and showed close genetic relatedness to the epidemic strain CZ1 (ST32). These results indicate that the impact of Bcc on airway colonization in the Serbian CF population is high and virtually exclusively limited to a single clone of B. cenocepacia. The presence of a highly transmissible clone and probable patient-to-patient spread was observed.

Public transport as a reservoir of methicillin-resistant staphylococci.

AIMS: The aim of this study was to explore the occurrence of methicillin-resistant staphylococci in a large urban public transport system. METHODS AND RESULTS: Samples were taken from hand rails, which passengers hold onto when they are standing. In total, 1400 swabs taken from 55 vehicles (trolleybuses, trams and buses) were examined. As many as 30.1% samples were positive for the presence of methicillin-resistant coagulase-negative staphylococci (MRCoNS), but none for methicillin-resistant Staphylococcus aureus (MRSA). MRCoNS were isolated from all 55 vehicles. Nearly 50% of MRCoNS isolates displayed resistance not only to beta-lactams, but at least to two or more other classes of antimicrobials as well. CONCLUSIONS: This study demonstrated widespread occurrence of MRCoNS on hand rails in public transport vehicles. MRSA was not detected. SIGNIFICANCE AND IMPACT OF THE STUDY: The recovery of methicillin-resistant staphylococci from public transport system implies a potential risk for transmission of these bacteria in an out-hospital environment.

Influence of the incubation atmosphere on the production of biofilm by staphylococci.

Biofilm formation by Staphylococcus epidermidis, Staphylococcus hemolyticus, Staphylococcus sciuri and Staphylococcus aureus in aerobic, anaerobic and CO2 incubation atmospheres was quantified by the modified microtiter plate test. The S. epidermidis and S. aureus strains showed significantly lower biofilm production when grown in a CO2-rich environment compared to that exhibited in aerobic incubation. The amount of biofilm produced by these strains under anaerobic conditions did not differ significantly from the biofilm formation detected in the aerobic incubation. The incubation atmosphere did not affect S. sciuri biofilm formation. Biofilm production by S. hemolyticus isolates was very low regardless of the experimental conditions used.

Significance of inoculum size in biofilm formation by staphylococci.

In the present study the effect of inoculum size, ranging from 10(6) to 1 cell, in biofilm formation by staphylococci was determined by microtiter plate test. The initial inoculum size had a dramatic effect on the quantity of biofilm formed. A decreased number of bacteria in initial inoculum always resulted in a decreased production of biofilm.

Ground red hot pepper agar in the isolation of yeasts of Candida spp.

The purpose of this study was to investigate and determine the value of a novel, simple and inexpensive selective medium for isolation of yeasts of Candida spp. - ground red hot pepper agar (GRHP). The study compared GRHP and Sabouraud dextrose agar (SDA), an insufficiently selective medium routinely used for primary isolation of yeasts. The comparison was based on qualitative and quantitative characterisation of growth of 25 bacterial strains, measurement of growth of 22 yeast strains and testing on clinical specimens. Qualitative tests on bacteria showed either significantly less growth on GRHP than on SDA, or no growth on GRHP. Quantitative tests confirmed these results; the number of colonies of all tested bacterial species and strains on GRHP was significantly lower than on SDA. With regard to the isolation of Candida spp., GRHP had the same properties as SDA. Statistical analysis showed no significant differences in the growth of Candida spp. and strains on the two media. All these results were confirmed by tests on clinical material. The results clearly show that GRHP agar is an economical medium for the isolation of yeasts of Candida spp., with excellent selectivity.

Intra-amniotic Chlamydia trachomatis infection.

Chlamydia trachomatis is one of the most prevalent genital pathogens in pregnant women. Ascending, transcervical infection may reach fetal membranes creating chorioamnionitis or amniotic fluid infection. The aim of this study was to examine amniotic fluids obtained during cesarean section for the presence of chlamydial IgM- and IgG-specific antibodies, and for the presence of C. trachomatis antigen. Five of 52 (9.6%) amniotic fluid samples were seropositive. Two of 52 (3.8%) amniotic fluid samples had C. trachomatis antigen in the epithelial cells of the amnion. In conclusion, our data indicate that there is a high rate of transmission of C. trachomatis from mother to infant and that the pathogen can be identified in the amniotic fluid.

[Chlamydia trachomatis infection in newborn infants]. / Infekcija novoredjenceta uzrocnikom Chlamydia trachomatis.

The aim of our study was to examine the frequency of Chlamydia trachomatis infection in newborns by detecting specific antibodies, and to examine the Apgar score and the birth weight of Chlamydia trachomatis-antibody positive children. Fifty-two newborn infants were tested. High serum IgG chlamydial specific antibody titers had 11 (21%) newborns, while high serum IgM titers had 9 (17%) newborns. Our results showed that serum Chlamydia trachomatis-specific IgM antibodies were detected statistically more often in low birth weight newborns (<2500 g) (p < 0.05).

Distribution of calcification in the triangular fibrocartilage region in 181 patients with calcium pyrophosphate dihydrate crystal deposition disease.

PURPOSE: To investigate the occurrence of calcification around the triangular fibrocartilage complex in calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. MATERIALS AND METHODS: The radiographs of 316 wrists in 181 patients with a definite or probable diagnosis of CPPD disease were reviewed to determine the occurrence of calcification in the inferior radioulnar joint cartilage, triangular fibrocartilage, lunotriquetral ligament, lunotriquetral cartilage, and triquetral cartilage. RESULTS: The distribution of calcification in the 316 wrists was as follows: inferior radioulnar joint cartilage, 87 wrists (28%), triangular fibrocartilage, 233 (74%); lunotriquetral ligament, 244 (77%); lunotriquetral cartilage, 167 (53%); and triquetral cartilage, 66 (21%). Forty-nine wrists had calcification in the lunotriquetral ligament or cartilage but not in the triangular fibrocartilage; 30 wrists had calcification in the triangular fibrocartilage but not in the lunotriquetral ligament or cartilage. This difference in prevalence was statistically significant (P = .0429). CONCLUSION: Radiologic diagnosis of CPPD crystal deposition disease in the wrist necessitates careful evaluation of the lunotriquetral ligament as well as the triangular fibrocartilage.

[Mycoplasmas and AIDS]. / Mikoplazme i ejds (AIDS).

Recent findings by a number of investigators suggest the association of mycoplasma and HIV or AIDS. Mycoplasmas have been implicied as a possible cofactor in AIDS pathogenesis. These mycoplasmas include Mycoplasma fermentans, Mycoplasma pirum, Mycoplasma genitalium and Mycoplasma penetrans. These mycoplasmas have been showed to have the capacity to invade cells and to be potent immunomodulators. To better understand the role of mycoplasma infections in AIDS we must continue to learn the fundamental biology of this group of unique organisms so that we may improve our diagnostic techniques in molecular genetics, serology, tissue diagnosis and isolation techniques by culture.

Influence of lipid lateral distribution on the surface charge response of the phosphatidylcholine headgroup as detected using 2H nuclear magnetic resonance.

The effect of lipid lateral distribution on the surface charge response of the phosphatidylcholine headgroup, in bilayers composed of binary mixtures of 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC) and 1,2-dimyristoyl-sn-glycero-3-phosphate (DMPA), was investigated by monitoring the deuterium nuclear magnetic resonance (2H-NMR) spectrum of choline-deuterated phosphatidylcholine as a function of temperature and DMPA concentration. Addition of DMPA at temperatures corresponding to fully liquid-crystalline membranes caused a progressive increase (decrease) in the 2H-NMR quadrupole splitting from POPC-alpha-d2 (POPC-beta-d2), in agreement with the known response of phosphatidylcholine to negative membrane surface charge (Seelig, J., Macdonald, P.M. and Scherer, P.G. (1987) Biochemistry 26, 7535-7541). Lateral phase separation of DMPA-rich domains was induced in these mixtures by lowering the temperature in the range from 60 degrees C to -15 degrees C, and was accompanied by a reversal of the original effects of DMPA on the quadrupole splitting. Analysis of the 2H-NMR spectral response allows one to generate a temperature/composition phase diagram for the POPC/DMPA system. We conclude that 2H-NMR of headgroup-deuterated phosphatidylcholine can be employed to sense and to quantify inhomogeneities in the lateral distribution of charged membrane components.

The lumbar spine: postoperative magnetic resonance imaging.

Persistent low back pain after surgery can be a severe diagnostic and therapeutic problem. By using MRI many causes of this failed back surgery syndrome (FBSS) can be disclosed. MRI is superior to other imaging modalities in this concern. In this article we describe the MR technique, normal and abnormal findings of the postoperative lumbar spine, such as persistent or recurrent disc herniation, epidural scar, spinal stenosis, pseudomeningocele, arachnoiditis, pseudarthrosis, hematoma, and infection.

Concomitant occurrence of subchondral cyst and ruptured anterior crucial ligament at knee joint: new findings by MRI.

The magnetic resonance imaging (MRI) in 4 cases of subchondral cyst at the knee joint region, were acquired from a 1.5 Tesla imager. We found a high incidence of concomitant occurrence of subchondral cysts with a ruptured anterior cruciate ligament (ACL) in all of these cases. The 2 men and 2 women, had an average age of 35. Clinically, they complained of dull knee pain and mild instability. Conventional radiography detected subchondral cysts in 3 of them, while MRI disclosed that all of the subchondral cysts were at the tibial plateau, close to the intercondyloid eminence. To date, MRI is the only imaging modality which can depict the concomitant occurrence of a subchondral cyst and a ruptured anterior cruciate ligament at the knee joint. Whether these subchondral cysts were the consequences of the ruptured anterior cruciate ligaments as one of the causes in addition to synovial fluid intrusion and bony contusion, need further clinical observation and investigation.

The postoperative spine. Magnetic resonance imaging.

MRI is rapidly becoming the imaging modality of choice in the diagnostic assessment of patients with persistent or recurrent symptoms following spinal surgery. It displays the normal postoperative findings as well as most causes of FBSS. MRI can differentiate persistent or recurrent disk herniation from postoperative scar formation with a greater degree of confidence than other imaging modalities. MRI can determine clinically important functional instability when CT and conventional radiography are inconclusive. This can be particularly helpful in evaluating the patient with multiple lumbar surgeries. MRI can also determine the presence of other causes of the FBSS such as lateral spinal stenosis, arachnoiditis, fat graft compression on the thecal sac, and presence of postoperative hematoma or postoperative infection.

Magnetic resonance imaging of the postoperative lumbar spine.

Magnetic resonance (MR) imaging is a powerful diagnostic tool for patients with the failed back surgery syndrome. The multiplanar imaging capability, superior soft-tissue contrast resolution, and excellent tissue characterization are its major advantages. It displays the changes caused by surgical intervention as well as associated postoperative findings, many of which cause the failed back surgery syndrome. Most recently, gadolinium-DTPA-enhanced MR imaging of the spine, combined with noncontrast MR imaging, has shown heretofore unparallelled sensitivity and accuracy.