Gammagrafía paratiroidea con 99mTc-MIBI: valor complementario de la paratohormona en el aspirado y análisis histopatológico de los tipos de células en los adenomas paratiroideos / Complementary role of parathormone washout test to 99mTc-MIBI parathyroid scintigraphy and histopathologic analysis of cell types in parathyroid adenomas

Objetivo: La gammagrafía paratiroidea (GP) puede ser negativa o equívoca (N/E) en un número considerable de casos con alta sospecha clínica y bioquímica de adenoma de paratiroides (AP). Los objetivos de este estudio fueron investigar el papel complementario de la determinación de paratohormona en punción con aguja fina (PTH en PAAF) con la GP en pacientes con hiperparatiroidismo primario (HPTP) y evaluar los aspectos histopatológicos de los AP en comparación con los resultados de GP. Material y métodos: Fueron incluidos en el estudio 38 pacientes con HPTP remitidos para realizar GP. Diecisiete pacientes tuvieron resultados gammagráficos y ecográficos concordantes con AP (grupo A). Veintiún pacientes con GP N/E pero sospecha de AP en la ecografía formaron el grupo B. Se realizó PTH en PAAF en todos los pacientes y todos fueron operados. Se extirpó un adenoma en cada uno de ellos y en todos los casos se establecieron las características histopatológicas. Resultados: El tamaño del tumor en la ecografía fue mayor en aquellos pacientes cuyos adenomas se vieron en la GP (p<0,001). Los porcentajes de células principales, oxífilas y claras en AP no fueron estadísticamente diferentes entre los grupos. El nivel de paratohormona sérica y PTH en PAAF no fueron estadísticamente significativos entre los grupos A y B (p=0,095 y p=0,04, respectivamente). Conclusión: Aunque no existe un valor umbral definitivo, la sensibilidad de la GP aumenta con el tamaño de la lesión. Mientras que el contenido de células principales y oxífilas tiende a reducirse en los AP con GP N/E EP, la tasa de células claras aumenta sustancialmente. La combinación de GP con la ecografía y la PTH en PAAF aumenta la sensibilidad de detección y localización de los AP

Objective: Parathyroid scintigraphy (PS) can be negative or equivocal (N/E) in a considerable number of cases with highly suspicious clinical findings and biochemical results for parathyroid adenoma (PA). The aims of this study were to investigate the complementary role of parathormone washout test (PWT) to PS in patients with primary hyperparathyroidism (PHPT) and evaluate histopathologic aspects of PAs in comparison with PS results. Material and methods: Thirty-eight patients with PHPT referred for PS were included in the study. Seventeen patients had both scintigraphic and ultrasonographic findings concordant with PA (Group A). Twenty-one patients having N/E PS, but suspected lesions for PA on ultrasonography (US) formed Group B. PWT was performed for all patients and they underwent the surgical intervention. An adenoma was removed in all patients and the histopathologic cell characteristics were established. Results: The tumor size on US was larger in those patients whose adenomas were seen on the PS (P<.001). The percentages of chief (or principal), oxyphilic and clear cells in PAs were not statistically different between the groups. Serum parathormone level and PWT were not statistically significant between Group A and Group B (P=.095 and P=.04, respectively). Conclusion: Although there is not a definitive threshold value, the sensitivity of PS increases with lesion size. While chief cell and oxyphilic cell content of PAs tend to deplete in N/E PS, clear cell rate increases substantially. Combining PS with both US and PWT increases the sensitivity of detection and localization of PAs

Complementary role of parathormone washout test to 99mTc-MIBI parathyroid scintigraphy and histopathologic analysis of cell types in parathyroid adenomas. / Gammagrafía paratiroidea con 99mTc-MIBI: valor complementario de la paratohormona en el aspirado y análisis histopatológico de los tipos de células en los adenomas paratiroideos.

OBJECTIVE: Parathyroid scintigraphy (PS) can be negative or equivocal (N/E) in a considerable number of cases with highly suspicious clinical findings and biochemical results for parathyroid adenoma (PA). The aims of this study were to investigate the complementary role of parathormone washout test (PWT) to PS in patients with primary hyperparathyroidism (PHPT) and evaluate histopathologic aspects of PAs in comparison with PS results. MATERIAL AND METHODS: Thirty-eight patients with PHPT referred for PS were included in the study. Seventeen patients had both scintigraphic and ultrasonographic findings concordant with PA (Group A). Twenty-one patients having N/E PS, but suspected lesions for PA on ultrasonography (US) formed Group B. PWT was performed for all patients and they underwent the surgical intervention. An adenoma was removed in all patients and the histopathologic cell characteristics were established. RESULTS: The tumor size on US was larger in those patients whose adenomas were seen on the PS (P<.001). The percentages of chief (or principal), oxyphilic and clear cells in PAs were not statistically different between the groups. Serum parathormone level and PWT were not statistically significant between Group A and Group B (P=.095 and P=.04, respectively). CONCLUSION: Although there is not a definitive threshold value, the sensitivity of PS increases with lesion size. While chief cell and oxyphilic cell content of PAs tend to deplete in N/E PS, clear cell rate increases substantially. Combining PS with both US and PWT increases the sensitivity of detection and localization of PAs.

Evaluation of predictor variables of diagnostic [18F] FDG-PET/CT in fever of unknown origin.

BACKGROUND: Fever of unknown origin (FUO) is defined as an illness having fever which lasts at least 3 weeks of duration and is higher than 38.3 ºC on several measurements. The causes are infections, malignancies, noninfectious inflammatory diseases and miscellaneous. If [18F]FDG-PET/CT helps the final diagnosis, it is called contributory. The aim of the study is to evaluate the predictor variables effecting a contributory PET/CT for the diagnosis. METHODS: This is a retrospective cohort study conducted between June 2006 and May 2015 including 76 patients. The evaluated predictor variables are age, sex, ESR, CRP, fibrinogen, ferritin, albumin, haemoglobin level, platelet count, total leukocyte count, neutrophil percentage, lymphocyte percentage, ALP, LDH, ALAT, ASAT, GGT, total bilirubin, CK, RF, ANA, urinanalysis, chest radiography, abdominal US, lymphadenopathy, duration of fever, comorbid diseases and previous therapies. RESULTS: ESR (P=0.001), CRP (P=0.001), fibrinogen (P=0.009), lymphopenia (P<0.001), neutrophilia (P<0.001), ferritin (P<0.001), leukocytosis (P=0.003), duration of fever before PET/CT (<3 months) were found to be statistically significant for positive contribution of PET/CT results to the diagnosis. CONCLUSIONS: [18F]FDG-PET/CT is helpful and contributory for the diagnosis of FUO in patients having higher levels of CRP, ESR, ferritin, fibrinogen, leukocytosis, neutrophilia and shorter durations of fever (<3 months).

The efficacy of mesenchymal stem cell transplantation in caustic esophagus injury: an experimental study.

Introduction. Ingestion of corrosive substances may lead to stricture formation in esophagus as a late complication. Full thickness injury seems to exterminate tissue stem cells of esophagus. Mesenchymal stem cells (MSCs) can differentiate into specific cell lineages and have the capacity of homing in sites of injury. Aim and Methods. We aimed to investigate the efficacy of MSC transplantation, on prevention of esophageal damage and stricture formation after caustic esophagus injury in rats. 54 rats were allocated into four groups; 4 rats were sacrificed for MSC production. Group 1, untreated controls (n: 10). Group 2, membrane labeled MSCs-treated rats (n: 20). Group 3, biodistribution of fluorodeoxyglucose labeled MSCs via positron emission tomography (PET) imaging (n: 10). Group 4, sham operated (n: 10). Standard caustic esophageal burns were created and MSCs were transplanted 24 hours after. All rats were sacrificed at the 21st days. Results. PET scan images revealed the homing behavior of MSCs to the injury site. The histopathology damage score was not significantly different from controls. However, we demonstrated Dil labeled epithelial and muscle cells which were originating from transplanted MSCs. Conclusion. MSC transplantation after caustic esophageal injury may be a helpful treatment modality; however, probably repeated infusions are needed.

The efficacy of bioceramics for the closure of burr-holes in craniotomy: case studies on 14 patients.

PURPOSE: Bioceramics are currently in use to cover bone defects in orthopedics and craniofacial surgery. But their compatibility and efficacy in cranium were not investigated in detail. The aims of this study were to produce, characterize, and assess the biocompatibility and osteointegration of Si-HA, Si-Sr-HA, HA-Wollastonite, and HA-Wollastonite-Frit bioceramics. METHODS: Bioceramics were implanted into the burr holes of 14 craniotomy patients who were followed up from three to 24 months. Radiologic and scintigraphic examinations were performed. RESULTS: Osteoblastic activity quantified by scintigraphy increased from 6.865 to 22.991±1.682 from four to eight months in the HA-Woll group. Adding fritt into HA-Woll decreased osteoblastic activity at 10 months. Si-Sr-HA displayed significantly higher osteoblastic activity when compared to the craniotomy site at 12 months. The scintigraphic ratio of the bioceramic implanted regions to the craniotomy sites varied between 1.10 and 1.57. Osteoblast formation and establishment of the trabecular pattern of bone was observed in the surroundings of bioceramics in two patients. CONCLUSION: These bioceramics can be safely used to cover the burr holes of craniotomy patients, as well as to close the cranial bone defects.

Effect of alpha-tocopherol on bone formation during distraction osteogenesis: a rabbit model.

PURPOSE: The purpose of this study was to evaluate the effects of alpha-tocopherol on distraction osteogenesis. MATERIALS AND METHODS: Right tibias of 30 New Zealand white rabbits were distracted at a rate of 0.5 mm/day for 20 days with a circular external fixator. Experimental group rabbits (n = 15) were administered i.m. 20 mg/kg/day alpha-tocopherol for 30 days. Radiographic examinations were performed at the 20th, 30th and 40th days. Bone scintigraphy was performed at the 5th and 20th days. Serum total antioxidant capacity (TAC) was measured at the 5th and 30th days. All animals were sacrificed and the right tibias of all animals were harvested for histopathologic examination at the 40th day. RESULTS: Radiologic scores were statistically similar at the 20th day. However, the experimental group demonstrated higher radiologic scores at the 30th and 40th days. A scintigraphic baseline study at the 5th day of the study showed statistically similar osteoblastic activities in both groups. However, at the 20th day, osteoblastic activity was significantly higher in the experimental group. Serum TAC values were also significantly higher in the experimental group at the 30th day. At necropsy, histopathologic examination revealed statistically significantly higher scores in the experimental group. CONCLUSION: The results of this study show that alpha-tocopherol has beneficial effects on new bone formation during distraction osteogenesis.

Effects of hyperbaric oxygen therapy on rabbit skeletal muscle during extremity lengthening.

INTRODUCTION: Extremity lengthening through distraction osteogenesis is limited by the surrounding skeletal muscle and neurovascular structures rather than the bone itself. The purpose of this study is to evaluate the effects of hyperbaric oxygen therapy on skeletal muscle during distraction osteogenesis. MATERIALS AND METHODS: Twenty New Zealand white rabbits were randomly divided into two groups. Right tibia of all rabbits was distracted at a rate of 0.125 mm per 6 h (0.5 mm/day) for 10 days with circular external fixator. Experimental group rabbits (N=10) underwent 2.5 ATA hyperbaric oxygen therapy for 2 h everyday for 20 days, control group rabbits (N=10) did not receive any corresponding treatment. Skeletal muscle perfusion was evaluated with scintigraphy before and after the distraction period. Serum CPK, LDH and AST levels were measured before and after the distraction period. All animals were killed on the 27th day. The right tibias of all animals were removed and tibialis posterior muscle was harvested for histopathologic and histomorphometric assessment with light and electron microscopy. RESULTS: Skeletal muscle perfusion was decreased in the control group in comparison with pre-distraction level (P=0.008). However, no significant decrease was observed in the experimental group (P=0.678). There were no statistical differences in serum CPK, LDH and AST levels between groups (P=0.340, P=0.077, P=0.796). The mean area of the muscle fibers was measured as 398.66+/-9.16 micro2 in the experimental group and 349.44+/-5.76 micro2 in the control group (P=0.000) with light microscopy. Mild fibrosis was observed in connective tissue component of muscle tissue in control group. An average of 26 myofibrils (20-32) was counted in a 16-cm2 unit area in experimental group and 50 myofibrils (35-65) in the control group with electron microscopy. Enlargement in the sarcoplasmic reticulum, degenerative changes in nuclear cytoplasm and increase in myofibril diameter were observed in the control group, which was not observed in the experimental group CONCLUSION: Results of this study suggest that HBO treatment alleviates the detrimental effects of distraction on skeletal muscles and preserves its ultrastructure.

Prospective study of the impact of thyroid hormone replacement on objective voice parameters.

OBJECTIVES: Hypothyroidism has long been considered to have an impact on phonation. In this study, objective evaluation of vocal function in women with hypothyroidism was performed in order to characterize potential dysphonia; their subsequent response to thyroid hormone replacement was prospectively studied. It was hypothesized that thyroid hormone replacement therapy in this cohort would have an objectively measurable impact on vocal function. METHODS: Prospectiv evaluation of objective voice parameters and concurrent determination of serum thyroid status was executed both before and after thyroid hormone replacement in a cohort of patients who had had total thyroidectomy. Objective voice parameters before and after treatment were compared. RESULTS: Twenty-four female subjects were recruited over an 18-month period. After surgery, all subjects were hypothyroid (mean thyroid-stimulating hormone level, 81.38 mIU/L; range, 25.26 to 100.00 mIU/L) before replacement. After hormone therapy, their mean thyroid-stimulating hormone level dropped to 1.20 mIU/L (range, 0.28 to 3.83 mIU/L). The mean fundamental frequency significantly increased from a pretreatment average of 223.48 +/- 36.10 Hz to 237.64 +/- 38.81 Hz. Other measured voice parameters (jitter, shimmer, amplitude perturbation quotient, pitch perturbation quotient, noise-to-harmonics ratio, and maximum phonation time) were not affected. CONCLUSIONS: Thyroid hormone replacement therapy following total thyroidectomy has a measurable impact on mean fundamental frequency in female patients. The mechanism of this effect is not known.

Disseminated metastatic disease of osteosarcoma of the femur in the abdomen: unusual metastatic pattern on Tc-99m MDP bone scan.

A 25-year-old patient with osteosarcoma of the right distal femur underwent a bone scintigraphy with Tc-99m methylene diphosphonate (MDP). Whole-body bone scan revealed extensive metastatic disease in the abdominal region. Abdominal computerized tomography confirmed the presence of ascites and calcified masses on the greater omentum and peritoneal surfaces. Here we describe a case of unusual metastatic pattern of an osteosarcoma showing extensive intraabdominal metastases without prominent lung involvement after intensive chemotherapy.

Saving the zone of stasis: is glutathione effective?

One of the main subjects that burn researches are focused on is saving the zone of stasis. There are many molecules that are used for this purpose, but all have their drawbacks. Glutathione is one of the major buffer molecules of the cells and is known to increase the thermo-resistance of the cells. In this study, the effect of the systemic glutathione on the zone of stasis was evaluated. The results showed that glutathione is an effective molecule for saving the zone of stasis. It is well-known cheap, and easy to use.

Unilateral temporary functional stasis in the upper urinary tract caused by "a filled bladder" on Tc-99m DTPA diuresis renography: a teaching case.

A 2-year-old girl with recurrent urinary tract infection having slight left pelvicaliceal dilatation on her renal ultrasound underwent a Tc-99m DTPA diuresis renography. During the excretion phase, a prominent and persisting left pelvicaliceal stasis was noticed even after the diuretic injection. However, it disappeared simultaneously with an uncontrolled micturition. This patient is presented to show the effect of filled bladder on the physiological drainage of urine. Since urine flow in the urinary system is more complicated than simple drainage, a thorough understanding of the physiological basis for diuresis renography and the pitfalls of the technique is required for its appropriate use in the management of patients suspected of urinary tract obstruction.

Fused pelvic kidneys: "hourglass sign" on Tc-99m DTPA diuresis renography.

A 13-year-old girl with fused pelvic kidneys detected on ultrasonographic examination was referred to our department for a diuresis renography to assess urine drainage dynamics and exclude the possibility of urinary tract obstruction. Renal scan demonstrated fused pelvic kidneys functioning normally without obstruction. The authors present this case to demonstrate the diuresis renography findings of the combined position, fusion and rotation anomalies of the kidneys that is a rare congenital anomaly of the urinary tract.

Varices of inferior epigastric veins caused by chronic inferior vena cava obstruction: mimicking normal venous flow pattern on radionuclide venography.

A 21-year-old patient with long-standing inferior vena cava obstruction secondary to idiopathic thrombosis extending from the external iliac veins underwent a radionuclide venography with Tc-99m pertechnetate labeled erythrocytes. The blood pool phase of the study revealed bilaterally distorted inferior epigastric veins mimicking normal venous flow pattern. The authors present this case to discuss the possible alternative routes and the underlying physiopathologic mechanism of this unusual flow pattern in chronic inferior vena cava obstruction.

Uterine doughnut in early proliferating phase: potential pitfall in gastrointestinal bleeding studies.

A 41-year-old woman with rectal bleeding was referred to our department for gastrointestinal (GI) bleeding study. She was in early post-menstrual period and had stable vital signs. A GI bleeding study with Tc-99m SC revealed uterine blush in the pelvis. The shape of activity and quick fading excluded a GI bleeding. To rule out an intermittent bleeding, patient underwent a second bleeding study with Tc-99m RBC. Serial images showed uterine "doughnut" in the pelvis. The activity neither changed in shape nor showed distal movement with time excluding a GI hemorrhage. Uterus in early proliferating phase could be a potential pitfall in GI bleeding studies.