Cisplatin nephrotoxicity aggravated by cardiovascular disease and diabetes in lung cancer patients.

Ageing lung cancer patients may be at increased risk of Cisplatin (Cp) nephrotoxicity, because of comorbidities leading to accelerated ageing of the kidneys. Therefore, the Cp-induced impairement of renal function was compared between no comorbidity (NC) and hypertension plus ischaemic heart disease (CD) patients or others having diabetes mellitus plus ischaemic heart disease (DMIH). In a preliminary study, glomerular filtration rate (GFR) was measured by clearance of technetium 99m-labelled diethylene-thiamine penta-acetate in 38 lung cancer patients with normal serum creatinine concentration ([creat]). Then, the incidence of nephrotoxicity was analysed retrospectively over 1st-4th cycles of Cp treatment among 242 lung cancer patients with initially normal [creat]. GFR was repeatedly estimated using calculated creatinine clearance. Pre-treatment GFR was 57 ± 3 mL·min⁻¹·m⁻² in those with normal (n = 15) and 42 ± 2 mL·min⁻¹·m⁻² in those with pathologically increased (n = 23) [creat] any time following their 2nd-4th Cp cycle (p < 0.05). The retrospective analysis revealed that Cp-induced nephrotoxicity developed in 7.5% of the NC (n = 80), in 20.9% of the CD (n = 110) and in 30.8% of the DMIH (n = 52) subgroups. Within the overall dropout rate from further Cp chemotherapy, nephrotoxicity was responsible in 14% of NC, 38% in CD and 75% in DMIH patients. A major portion of our ageing lung cancer patients suffered from comorbidities leading to reduced renal resistance to Cp nephrotoxicity.

Parathyroid surgical failures with misleading falls of intraoperative parathyroid hormone levels.

According to earlier reports, a decrease below 50% of baseline of intraoperative PTH levels measured 5 min after resection of the parathyroid adenoma predicts a cure of hyperparathyroidism. To reveal previously unrecognized pitfalls of intraoperative PTH measurements, we reviewed surgical failures in our series of parathyroidectomies combined with intraoperative PTH sampling. PTH measurements were performed in 251 patients with primary hyperparathyroidism (PHPT) between November 1999 and December 2002. PHPT due to parathyroid hyperplasia were found in 8 cases, double parathyroid adenomas in 6 cases, parathyroid carcinoma in 1 case and single parathyroid adenomas in 236 cases, all confirmed by histological examination. Of the 236 cases of single adenomas, initial surgery failed to cure PHPT in 4 patients. In 3 patients a false-positive decrease of intraoperative PTH (from 269 to 40 pg/ml, from 211 to 27 pg/ml, and from 140 to 59 pg/ml) was observed, whereas in the fourth patient a true-negative decrease of intraoperative PTH (from 758 to 401 pg/ml) was mistakenly interpreted as indication for a cure of PHPT. In each of the 4 patients in whom initial surgery failed the intervention included thyroid surgery and reoperative parathyroid surgery resulted in a permanent cure of PHPT. These observations support the possibility that thyroid surgery may compromise the blood supply of parathyroid adenomas resulting in a misleading drop of intraoperative PTH levels. Therefore, a careful evaluation of intraoperative PTH levels and, perhaps, other intraoperative aids such as histological evaluation of frozen sections are recommended when parathyroid surgery is combined with simultaneous thyroid intervention.

[New intraoperative diagnostic methods in parathyroid surgery: intraoperative measurement of parathyroid hormone]. / Mútét alatti új diagnosztikus módszerek a mellékpajzsmirigy-sebészetben: intraoperatív parathormonszint-ellenórzés.

In thirty-seven patients undergoing parathyroidectomy from November 1999 to July 2000 with diagnosis of primary hyperparathyroidism the intraoperative intact parathyroid hormone level were studied. Preoperative samples of blood were taken from a peripheral vein before the beginning the operation. The second sample was taken 5 minutes after removal of parathyroid adenoma. The plasma intact parathyroid hormone concentration was measured by quick IRMA method. The preoperative high PTH levels reduced after excision of adenoma to the mean 18%. 33 patients had normal PTH levels after 5 minutes of removing. The total measuring time of quick PTH assay was about 30 minutes. The QPTH assay was a quantitative adjunct for the surgeon to ensure a successful parathyroidectomy. When the intraoperative QPTH level is not reduced to 50%, then the exploration should be continued and the probability of reoperation is decreased. They propose the application of the routine intraoperative measurement of QPTH level in all parathyroidectomy.

The role of nuclear medicine in inflammatory bowel disease. A review with experiences of aspecific bowel activity using immunoscintigraphy with 99mTc anti-granulocyte antibodies.

UNLABELLED: The diagnosis of inflammatory bowel disease (IBD) needs a complex diagnostic work-up. Beside verifying the disease itself, it is fundamental to assess disease extent and activity and to detect associated complications, to find the most effective treatment and for follow up. Scintigraphy with radiolabelled leukocytes is able to provide a complete survey of the whole intestinal tract, both the small and large bowel, and detects septic complications successfully with negligible risk. Radionuclide procedures are useful in establishing or ruling out IBD in patients with intestinal complaints, in assessing disease severity, and in the evaluation of extraintestinal septic complications. Widely available radionuclide procedures are discussed, i.e. scintigraphy by 111Indium oxime or 99mTechnetium HMPAO labelled white blood cells and immunoscintigraphy with 99mTc anti-granulocyte antibodies. Advantages and disadvantages of all three methods are stressed out. PATIENTS AND METHODS: The immunoscintigraphies with 99mTc anti-granulocyte antibodies (ANTI-GRANULOCYTE(R) BW 250/183) of 27 patients with suspicion of IBD were retrospectively analysed. Planar anterior and posterior images were obtained 4 and 24 h postinjection, respectively. The bowel was divided into six segments and the activity was visually graded with reference to bone marrow in each segments. The scans were compared with the results of radiological and endoscopical investigations. The diagnosis of IBD was proved or ruled out by means of enteroclysis, large bowel enema or endoscopy. RESULTS: In the 27 patients, 74 bowel segments with increased activity were detected. In the case of 30 segments in 16 patients, bowel inflammation was revealed by the other methods (true positives). In the case of 44 bowel segments, no underlying bowel inflammation could be verified, and these activities were regarded as aspecific activity. We could not differentiate between true positive and aspecific activity based on scan pattern or intensity. DISCUSSION: These findings of aspecific bowel activity using imuunoscintigraphy are in contrast with the results of former studies, while the existence of non-specific activity decreases the reliability of the method. Based on the literature and our experiences, we conclude that 99mTc HMPAO labelling should be the method of choice for the investigation of IBD patients.

[Determination of cyclosporin concentration in blood by radioimmunoassay]. / Cyclosporin koncentráció meghatározása vérböl radioimmunoassay-vel.

Cyclosporin A treatment is unimaginable without continuous and periodical monitoring of the blood cyclosporin concentration. One of the best methods for measuring is the radioimmunoassay, because this method makes possible the monitoring of a large number of samples with good sensitivity. The method is suitable for measuring either only the cyclosporin A concentration (specific monoclonal antibody) or the cyclosporin A and its metabolites (nonspecific monoclonal antibody). The use of 125I labelled tracer has several advantages such as increased sensitivity, fast sample counting and so fast measuring of the concentrations.

Continuous monitoring of blood-brain barrier opening to Cr51-EDTA by microdialysis following probe injury.

Continuous detection of the permeability changes of the blood-brain (BB) interface became feasible with the recent development of the cerebral microdialysis technique. Vasogenic brain oedema was induced by the insertion of the dialysis capillary into the cerebral cortex of rats, and blood-brain transfer was measured with Cr51-EDTA as a blood-born tracer. The dialysis capillaries had an upper limit of 500 daltons (MW). Ringer solution was perfused through the dialysis tube. Samples were collected continuously. The permeability coefficient has been calculated from the radioactivity of the serum and of the washing fluid.

[Scintigraphy of the adrenergic nervous system]. / A sympathicoadrenalis rendszer scintigraphiás vizsgálata.

The authors describe their experiences with 100 MIBG scintigraphies. The importance of the examination is stressed in the diagnostics of neuroblastoma in childhood, the determination of the clinical stage and follow-up of the disease. MIBG scintigraphy plays a primary role among the imaging examination procedures aimed at the localization of pheochromocytoma especially in the extra-adrenal, multiplex and malignant diseases. The disturbance of adrenergic innervation in Shy-Drager syndrome is demonstrable with radiopharmacon.

Progesterone and oestradiol levels and cytoplasmic receptor concentrations in the human myometrium at term, before labour and during labour.

Progesterone (P) and oestradiol (E2) cytoplasmic receptor levels in the myometrium of 12 women, who underwent cesarean section at term were determined by means of an exchange assay. Six of the women had an elective cesarean section, and the other six were in active labour when the operation was performed. Both the P and the E2 receptor concentrations were significantly higher in the myometrium of those women who were in labour. The plasma P and E2 levels did not change before labour and during labour. The myometrial E2 concentrations were also similar in both groups. The myometrial P concentration was lower in the labour group, but the difference was not statistically significant. This study is the first which compares the steroid receptor levels at term before labour and during labour in human myometrium, although only the unbound and the cytosol receptor levels were determined. The change of levels in receptor concentrations could be a sign of the decrease of the P dominance in the myometrium during labour.

Comparison of histochemical and biochemical methods in the evaluation of estrogen and progesterone receptor level in human breast cancer. A study of 118 cases.

Unselected surgical specimens from 118 cancerous breasts of female patients were studied by histochemistry for the presence of cellular estrogen (ER) and progesterone (PR) receptors. The receptor tracers used were 17 beta-estradiol-6-carboxymethyl-oxim-bovine serum albumin - fluorescein isothiocyanate and 11 alpha-hydroxyprogesterone-hemisuccinate-bovine serum albumin-tetramethylrodamine isothiocyanate conjugate (Fluoro-CepTM). Out of 118 carcinomas 77 (67%) proved to be positive in the ER and 79 (66%) in the PR test. The histochemical results were compared with the results of the biochemical assay in 70 cases. A positive correlation was found in 57 cases.