Correlation between bone scintigraphy and tumor markers in patients with breast carcinoma.

A characteristic feature of many cancer types is their ability to metastasise to the skeleton. Bone is the most common site of metastatic invasion, after hematogenous spreading of breast cancer. Early detection of bone metastases is mandatory in the evaluation and management of these patients. Bone scintigraphy is commonly performed in detection and evaluation bone metastases. Tumor markers are present in healthy individuals as well as in patients with malignant diseases but in different concentration. Aim of study was to correlate serum levels of tumor marker Ca (15-3), CEA and presence of bone metastases detected by bone scintigraphy. Study included 25 patients with breast cancer, previously surgically treated. All patients underwent whole body scintigraphy. Ca (15-3) and CEA was measured by radioimmunoassay. Presence, number of bone metastases were correlated with Ca (15-3) and CEA levels. Median age of patients included in study was 50 varying from 30 to 67. Bone scintigraphy revealed bone metastases in 16 (64%) patients. A weak correlation was found between number of metastases and level of Ca (15-3) (r=0.139, p=0.254). Significant differences in Ca (15-3) level was found in patient with metastases compared to patients without metastases (chi square 0, p=1.0). Good correlation was found between number of metastases and serum level of CEA. Correlation between level of two tumor markers Ca (15-3) and CEA was a weak (r = 0.096 , p=0.323). Bone scintigraphy is a sensitive diagnostic toll for detecting breast cancer metastases to bone. Serum levels of tumor markes in isolation can not give complete accuracy about bone metastases.

The relationship between the serum prostate specific antigen and whole body scintigraphy in prostate cancer patients after prostatectomy.

BACKGROUND AND AIM: Bone metastases are of the most frequent in prostate cancer. Serum prostate specific antigen--PSA has been suggested as an accurate means of monitoring prostate cancer. Whole body scintigraphy are currently the most widely used diagnostic procedures for metastases to the bone, the most common site of distant tumor spread. Aim of the study was to determinate relation between PSA level, number of metastases and 99mTc- MDP (methyl-diphosponate) uptake in patients with previous prostatectomy for prostate cancer. PATIENTS AND METHODS: Study enrolled 15 patients after previous prostatectomy for prostate cancer (histologically proven). Standard whole body scintigraphy (WBS) was performed 3 hours after intravenous application of 740 MBq 99mTc-MDP. Total PSA was measured by MEIA-Microparticle Enzyme Immunoassay. RESULTS: Group 1: 12/15 (80%) patients were with WBS detected metastases. Correlation of PSA level and number of detected bone metastases was good (r=0.79). Correlation of PSA level and uptake intensity of 99mTc-MDP (score 3) was positive and significant (r=0.706). CONCLUSION: PSA values were highly predictive for WBS results. PSA values correlated well with number of metastases. We propose no WBS in patients with normal PSA level. WBS is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. PSA levels is good and simpler marker for disease progression, but that neither technique in isolation gives complete accuracy.

Role of bone scintigraphy and tumor marker-Ca 15-3 in detection of bone metastases in patients with breast cancer.

Breast cancer is one of the most frequent types of cancer affecting women. After hematogenous spreading of cancer, axial skeleton is most frequently involved. Bone scintigraphy is commonly performed in detection and evaluation of bone metastases. In breast cancer, marker Ca 15-3 is widely accepted in follow-up and detection of disease recurrence. Aim of the study was to correlate levels of tumor marker Ca 15-3 and presence of bone metastases detected by bone scintigraphy. Study included 25 patients with breast cancer, previously surgically treated. All patients underwent total body scintigraphy. Ca 15-3 was measured by radioimmunoassay. Presence, number and location of bone metastases were correlated with Ca 15-3 levels. Bone scintigraphy revealed bone metastases in 16 (64%) patients. 11 (44%) patients with metastases and 1 patient (4%) without scintigraphically visible metastases had elevated Ca 15-3 levels. Significant difference in distribution of metastases was found for spine (t=3.930, p=0.008). Correlation between intensity of radiopharmaceutical uptake and level of Ca 15-3 in patients was positive (r =0.405). A weak correlation was found between number of metastases and level of Ca 15-3 (r=0.139). Significant differences in Ca 15-3 level was found in patients with metastases compared to patients without metastases (chi square 0, p =1.0). Since no significant correlation was found between level of Ca 15-3 and number of metastases, we consider scintigraphy an appropriate method for assessment of bone metastases in breast cancer.

Prevalence of hepatic granulomas in chronic hepatitis B.

An increasing frequency of hepatic granulomas, up to 10%, in chronic hepatitis C patients is reported, and their presence is considered to be a predictor of treatment success. However, there is only one prevalence study on granuloma in chronic hepatitis B, and its significance for treatment outcome is unknown. We aimed to determine the prevalence of hepatic granulomas in a larger group of chronic hepatitis B patients and to compare their presence with the response to interferon therapy. Biopsy specimens of chronic hepatitis B patients were reevaluated for the presence of hepatic granulomas. All patients with hepatic granuloma were screened for other granulomatous diseases by tuberculin skin test, chest X-ray and computed tomography, venereal disease research laboratory, Brucella agglutination tests, and exposure to hepatotoxic agents. We screened 663 cases of chronic hepatitis B. Hepatic granulomas were found in 10 cases (1.5%). The granulomas could not be ascribed to any other reason. Of the 10 patients with hepatic granulomas, 4 responded to interferon therapy, 2 dropped out, and 4 were nonresponders. We conclude that hepatic granuloma is a rare finding in chronic hepatitis B and its presence does not seem to predict the response to interferon therapy.

[Imaging procedures in gastroenterology]. / Slikovne procedure u gastroenterologiji.

Recent achievements in fields of physics, microelectronical devices and informatical sciences opened huge possibilities of applications in medical specialities. Spread imaging over routine high-resolution instruments continue to be in focus of scientific researches varying from simple staining techniques to most sophisticated photodynamical techniques. Magnetic resonance imaging and computed tomography are radiological specialties, however; we mentioned them for promising achievements in computed data analysis and further improvements of virtual colonoscopy. During the last few years techniques of magnifying endoscopy have been improved including trials with narrow band endoscopy, autoflourescence endoscopy, elastic scattering spectroscopy and laser confocal microscopy. In many indications capsula endoscopy have been applied successfully.

[Liver biopsy and indications]. / Biopsija jetre i indikacije.

Liver biopsy by needle through skin is safe, simple and valuable method for diagnostic evaluation of liver disease. Diffuse parenchymal diseases as cirrhosis, hepatitis, reactions in drugs could be diagnosed with significant accuracy. With increased usage of CT and MRI as well as ultrasound, it is possible to perform aspiration biopsy of isolated changes with thin needles. In this review, most frequent indications and contraindications for that procedure were described.

[Therapy of chronic viral hepatitis B]. / Terapija hronicnog virusnog hepatitisa B.

In chronic HBV infection, studies of outcome have shown that successful antiviral treatment undertaken early in course of diseases, may improve health and quality of life. Aims of treatment are: decrease of aminotransferase level to normal, histological necroinflammatory reduction, sustain loss of HbeAg and HBV DNA, antibodies on Hbe occurrence and loss of HbsAg with complete eradication of viral infection. Three therapeutical options are available: thymosine, lamivudine and standard interferon alpha. In future options, promising results are expecting from pegylated interferon, adefovire and entecavire.

[Therapy of chronic hepatitis C]. / Terapija hronicnog hepatitisa C.

Advantages in diagnostic and treatment of hepatitis C during the last decade have changed the final outcome of disease. Most important improvements were: development of sensitive, specific and standardized tests for hepatitis C nucleic acid identification, combined treatment with ribavirin and alpha interferon, pegylation of alpha interferon and prove that sustained viral response is optimal surrogate for treatment outcome. Combination of pegyinterferon and ribavirin offered the most efficacious and most suitable treatment with SVR between 54-56%. Results are still dependent of viral genotype and viral load. Due to possible side effects appropriate patient seletion is mandatory.

Management of esophageal varices.

The important developments have been made in the field of the portal hypertension and the variceal bleeding. Baverno meeting was organized to make consensus in different terminologies about the portal hypertension. Blockers of beta receptors are still mainstay in primary prophilaxis of variceal bleeding and endoscopic variceal ligation is ultimative. Octreotide and terlipressin are as effective as sclerotherapy in initial hemostasis, in addition, octreotid was after and efficacious in prevention of rebleeding. Endoscopic variceal ligation is showed to be superior to endoscopic sclerotherapy for variceal obliteration, especially sequential and simultaneous ligation. First line of treatment for gastric varices is cyanoacrilate glue. In assessment of variceal eradication and prediction of variceal recurrence endosonography plays important role.