Value of autofluorescence bronchoscopy in patients with laryngeal cancer.

BACKGROUND: Patients with squamous cell carcinoma of the head and neck constitute a high risk group for synchronous and metachronous tumours. OBJECTIVE: This study aimed to investigate the usefulness of white light and autofluorescence bronchoscopy in the evaluation of pre-malignant and early neoplastic lesions in patients with laryngeal cancer, who are at high risk of concomitant lung cancer. METHODS: This prospective, cross-sectional study included 30 patients who had undergone total laryngectomy for squamous cell carcinoma of the larynx. The tracheobronchial system was investigated for the presence of pre-malignant and malignant lesions, using a combination of white light and autofluorescence bronchoscopy. Biopsies were obtained from areas with a pathological appearance, and histopathological studies were performed. RESULTS: All patients had a permanent tracheostomy. Light and autofluorescence bronchoscopy indicated that the tracheobronchial system was normal in 11 patients. A total of 27 biopsies was taken from the remaining 19 patients, and revealed invasive squamous cell carcinoma in one patient and pre-malignant changes in six. CONCLUSION: Bronchoscopy is a valuable and practical tool for screening patients at high risk of lung cancer, and requires minimal intervention especially in patients with a permanent tracheostomy. Of the various bronchoscopic techniques becoming available, autofluorescence bronchoscopy shows promise for the detection of pre-invasive malignant changes of the tracheobronchial system in patients previously operated upon for laryngeal cancer.

Renal scintigraphy findings in allograft recipients with increased resistance index on Doppler sonography.

AIM: The measurement of intrarenal resistance indices (RIs) by doppler ultrasound plays an important role in the evaluation of renal transplant recipients. Although an elevated RI was initially considered to be specific for rejection, later studies revealed this parameter as a nonspecific marker of transplant dysfunction. In this study, we analysed Tc-99m DTPA renal scintigraphy findings in patients with increased RI during the early posttransplantation period. METHODS: This study included 22 patients with increased RI on doppler sonography during the first week after transplantation. Twenty-two recipients with uncomplicated early postoperative courses were used as a control group. An RI value >0.7 was considered pathologic. All patients underwent Tc-99m DTPA renal scintigraphy just after doppler sonography. In addition to visual interpretation of images, renogram curves were evaluated for patterns suggestive of acute tubular necrosis and acute rejection. Glomerular filtration rate (GFR) was calculated using computer software. Perfusion time-activity curves were assessed for the presence of peak and plateau patterns to calculate this ratio (P:PL). RESULTS: The mean value for P:PL in patients with increased RI and in the control group were 1.37 +/- 0.33 and 1.53 +/- 0.47, respectively (P < .05). The mean value for GFR was significantly lower in the patient group compared with control subjects. Six patients had normal perfusion and function (27%). Perfusion pattern and renogram changes were suggestive of acute tubular necrosis in 5 patients and acute rejection in 6 patients. These diagnoses were confirmed later with serial scintigraphic changes or biopsy results. Three patients had an accumulation pattern on the renogram suggesting partial obstruction. CONCLUSION: During the early posttransplantation period an increased RI on doppler sonography was seen in both normal functioning grafts and those with allograft dysfunction. Renal scintigraphy with perfusion and renogram patterns highly suggestive of specific allograft pathologies seemed to provide useful information to distinguish early postoperative renal allograft pathologies.

Indicators of acute rejection on Tc-99m DTPA renal scintigraphy.

INTRODUCTION: Specific criteria for diagnosing an acute rejection episode (ARE) are not present on renal scintigraphy. However, a deterioration in renal function observed on serial imaging is suggestive of an ARE during the early posttransplantation period. In this study, we evaluated Tc-99m DTPA renal scintigraphy findings among patients with renal allograft dysfunction. The aim was to define criteria for ARE on a single imaging study alone. MATERIALS AND METHODS: This study included 82 patients with renal allograft dysfunction, each of whom had a specific biopsy-proven pathology. From the background-corrected Tc-99m DTPA renal time-activity curves, the following parameters were computed: the ratio of counts at peak perfusion to that at plateau (P:PL) and the ratio of counts at peak perfusion to that at peak uptake (P:U). The images were inspected visually for excretion patterns and other morphological changes. RESULTS: A specific renogram pattern, that is an increase in perfusion to uptake ratio together with a nearly flat uptake curve and preserved peak/plateau pattern, was observed in 67% of low-grade AREs. In contrast, a flat uptake curve usually occurred together with a loss of peak/plateau pattern in a high-grade ARE. The findings that were highly specific for ARE on visual inspection were little or no collecting system activity, pelvic hypoactivity, and indistinctness of the corticomedullary junction. CONCLUSIONS: Our results indicate that in low-grade ARE, there is decreased filtration relative to perfusion as evidenced by a decrease in the perfusion-to-uptake ratio with loss of a peak/plateau pattern. A hypoactive pelvis with little activity in the collecting systems may be due to edema in the renal interstitium and pelvicalyceal structures.

Comparison of Tc-99m DTPA and Tc-99m MAG3 perfusion time-activity curves in patients with renal allograft dysfunction.

AIM: The perfusion time-activity curve on DTPA renal scintigraphy shows a peak and plateau pattern which is usually absent or less marked when using tubular agents such as MAG3. The exact mechanism that results in this difference between the two tracers is not well understood. A descending pattern on MAG3 has been proposed to be due to decreased extraction. In this study we compared the diagnostic utility of perfusion patterns obtained with DTPA and MAG3 among patients with renal allograft dysfunction. MATERIALS AND METHODS: This study included 48 patients with renal allograft dysfunction and 18 recipients with normal graft function. Every recipient had renal scintigraphy with Tc-99m MAG3 and Tc-99m DTPA 1 day apart. The second phase of the perfusion curve after the initial rise was classified as ascending, flat, or descending. In patients with a descending curve on DTPA study, we calculated the ratio of counts at peak perfusion to that at plateau (P:PL). Impaired perfusion was based on a deterioration of the peak-to-plateau pattern on DTPA and the presence of a flat-descending curve on MAG3. RESULTS: In patients with dysfunction, impaired perfusion was observed in 77% of DTPA and in 54% of MAG3 studies. A flat-descending curve on MAG3 was present in 44% of patients with normal graft function. By MAG3, 67% of acute rejection and 28% of chronic allograft nephropathy (CAN) cases showed deteriorated perfusion. The corresponding values for DTPA were 67% and 94%, respectively. A flat-ascending pattern on DTPA was more frequent in CAN than it was in acute rejection (33% and 17%, respectively). CONCLUSION: The sensitivity of DTPA perfusion pattern for diagnosing dysfunction was significantly greater than that for MAG3. Our results suggest that the major determinant of a curve pattern on DTPA or MAG3 study is the extraction relative to perfusion. Thus for patients with CAN, extraction is higher relative to perfusion, resulting in a lower P:PL ratio or an ascending curve on DTPA. Although the extraction of DTPA is less than that of MAG3, this level of extraction renders DTPA more sensitive to serial changes in renal function and pathophysiological mechanisms related to kidney function.

A very unusual presentation of Niemann-Pick disease type B in an infant: similar findings to congenital lobar emphysema.

The main features of Niemann-Pick disease type B (NPD-B) are enlargement of the liver and spleen, and mild pulmonary involvement. Recurrent respiratory tract infection and progressive decline in pulmonary function are major contributors to morbidity and mortality in this patient group. Massive pulmonary involvement in early life is extremely rare. The most common finding on chest X-rays of NPD-B patients is reticular or nodular infiltration of the lungs. This article describes a very rare presentation of NPD-B in an infant who had suffered recurrent respiratory tract infections. Massive emphysema and marked infiltrative parenchymal changes (infiltration of the parenchyma) were initially attributed to congenital lobar emphysema and its compressive effects. However, NPD was suspected when a lung biopsy showed foamy cells and sea-blue histiocytes were detected in a bone marrow biopsy. The definitive diagnosis was established with an enzyme study for sphingomyelinase.

Cerebral blood flow abnormalities in symptomatic West syndrome: a single photon emission computed tomography study.

BACKGROUND: Infantile spasm (IS) is an age-dependent epileptic encephalopathy of variable etiology. Although IS is well studied, its pathogenesis is unclear. Infantile spasm is usually considered a generalized epilepsy, but recent studies point to focal cerebral blood flow (CBF) abnormalities. METHODS: In six symptomatic IS patients, single photon emission computed tomography (SPECT) with [99Tc]-HMPAO, electroencephalography (EEG), magnetic resonance imaging (MRI)/computed tomography (CT) and their correlation were evaluated. RESULTS: Single photon emission computed tomography showed unifocal (regional) cerebral hypoperfusion in two infants, multifocal (diffuse) cerebral hypoperfusion in three infants and normal perfusion in the other infant. Electroencephalograms obtained in near-time of the SPECT studies showed diffuse abnormalities in five infants with hypoperfusion on SPECT. Cranial MRI/CT showed diffuse and/or localized cerebral lesions in all infants, all of whom had corresponding areas of hypoperfusion on SPECT. In one patient whose spasms were stopped with anticonvulsants, SPECT was normal, in two patients SPECT showed unifocal lesions, while in another three patients whose spasms were decreased but not stopped, SPECT showed multifocal hypoperfusion. CONCLUSIONS: This pilot study may indicate that there are CBF anomalies in symptomatic IS. The degree of CBF may be a predictor of prognosis and multifocal hypoperfusion may be a poor prognostic criteria in IS.

Bronchioloalveolar carcinoma in progressive systemic sclerosis. Report of a case diagnosed by fine needle aspiration cytology.

BACKGROUND: Progressive systemic sclerosis (PSS) is a systemic disorder involving many internal organs, including the lungs. The occurrence of a pulmonary tumor has occasionally been reported, especially in long-standing cases. Bronchioloalveolar carcinoma is the most prevalent histologic type. CASE: A 35-year-old male with a 12-year history of PSS presented with exertional dyspnea and pain in the left side of the chest. Fine needle aspiration cytology (FNAC) showed abundant cellular material with large, monolayered sheets and papillary structures. The neoplastic cells had uniform round to oval nuclei and spacious cytoplasm. Some had intranuclear vacuoles. Phosphotungstic acid-hematoxylin (PTAH) stain revealed structures in the form of prominent cell membranes rimming the free surfaces of the tumor cells. The overall cytologic picture was interpreted as consistent with bronchioloalveolar carcinoma. The patient's condition did not permit surgery. CONCLUSION: In this case the development of bronchioloalveolar carcinoma occurred over a 12-year period following the diagnosis of PSS. This case emphasizes diagnosis of the tumor solely by FNAC. PTAH stain was also helpful in the cytologic diagnosis.

Incidental lung adenocarcinoma in a 20-year-old woman with bronchiectasis.

A case of lung adenocarcinoma in a 20-year-old woman with bronchiectasis is presented. The patient showed no clinical and radiological findings in regard to the carcinoma. The tumor was discovered incidentally in the parenchyma of the lung specimen resected due to chronic bronchiectasis.