The assessment of testosterone and radioisotopic index of bone metabolism and bone mineral density in men with testosterone deficiency after one year of testosterone therapy.

BACKGROUND: Testosterone deficiency in men is characterized by typical symptoms of hypogonadism and negative influence on the preservation of bone mass. In this study, we analysed the relationship between testosterone concentration and bone metabolism. Moreover, we assessed the impact of one-year compensation of testosterone deficiency in elderly men on bone metabolism and bone mineral density. Radioisotopic methods of bone metabolism assessment provide new research opportunities. MATERIALS AND METHODS: Men with total testosterone concentration (TT) ≤ 3 ng/ml were included into this study. Patients with disorders or injuries of bone system, elevated prostate-specific antigen (PSA), enlarged prostate, disorders of thyroid and liver, diabetes mellitus or a history of chemotherapy as well as those treated for a long time with antibiotics were excluded from this study. The results of 50 men aged 57.52 ± 6.71 years obtained before the treatment (I test) and after one year of oral testosterone supplementation (test II) were analysed in this study. The following examinations and analyses were performed: interview and physical examination, orthopaedic, neurological and urological consultations, blood biochemistry, determination of hormones levels, assessment of Testosterone Deficiency Syndrome (TDS), densitometric and radioisotope assessment of bone metabolism. Moreover, radioisotopic index of bone metabolism was calculated. Testosterone therapy with oral preparation Undestor Testo Caps (Organon) containing 40 mg of testosterone lasted for 12 months. Statistical analysis was performed using Statistica 12 and Excel 2010 programs. Correlations between results before and after treatment were analysed. RESULTS: After 12 months of treatment, testosterone concentration increased by mean 78% and the level of luteinizing hormone (LH) decreased by 62%. TDS index increased from 0.53 ± 0.21 (in test I) to 1.91 ± 0.60 (in test II). After the therapy this index was significantly higher in all men (p < 0.0001). Moreover, BMD was also improved following therapy, however, the difference between test I and II was statistically insignificant. The greatest change was found in case of IBM (Index of Bone Metabolism). We observed a positive correlation between IBM and BMD before treatment (r = 0.7991), however, its strength decreased after one-year therapy (r = 0.6757). CONCLUSIONS: In our opinion, IBM is more sensitive than other methods of the assessment of changes occurring in bone system under the influence of testosterone therapy. The observed changes in IBM were proportional to changes in testosterone concentration. Testosterone level, TDS and radioisotopic assessment of bone metabolism may be used as prognostic and therapeutic factors of osteoporosis and bone fractures in elderly men.

Radioisotopic assessment of bone metabolism of the operated vertebra after inter-process stabilizer implantation in the lumbar segment of the spine.

INTRODUCTION: Lack of efficacy of pharmacotherapy and physiotherapy in spinal pain syndrome is an indication for intervertebral stabilizer implantation between the processes in the lumbar segment of the spine. MATERIAL AND METHODS: The group consisted of 32 patients qualified after radioisotopic single-photon emission computed tomography/computed tomography (SPECT/CT) examinations with assessment of bone metabolism and mineral density. For comparative purposes, the L2 vertebra was defined as normal. Parameters defined in the area of operated vertebrae were comparable to L2. Imaging examinations and a pain intensity test were performed before and 12 months after the procedure. RESULTS: In SPECT, osteotropic isotope (OI) activity in spinous bodies and processes was close to L2 values. Density assessed in CT of analysed vertebrae was close to L2. In the control examination, activity of OI in spinous bodies and processes was higher in the procedure area. Under the stabilizer, there was a strong positive correlation with the L2 parameters. The differences were statistically significant (p = 0.0002). The increase of OI activity in the elements above the stabilizer was variable. In the control examination, there was higher density of spinous processes and bodies above and under the stabilizer. The difference, compared to the L2 density, was statistically significant. CONCLUSIONS: The radioisotopic method with SPECT/CT allows for the precise assessment of bone metabolism in the spine. After the procedure, a negative correlation was observed between bone metabolism changes and pain intensity test results.

The own method and program of isotope quantitatively assessment of perfusion in muscles of upper limbs (initial report).

BACKGROUND: The issue of blood flow in muscles has been dealt with for many years. However, most often it was assessed qualitatively with standard vascular examinations. The quantitatively perfusion assessment is indispensable in the normal and pathological conditions. Some diseases impair the perfusion mainly in the area of upper limbs. It can be observed in Raynaud's disease, vascular occlusive diseases, neurological disturbances, and thermal injuries. Hyperhidrosis of upper limbs after sympathectomy of thoracic part of sympathetic trunk may bring closer the diagnosis statement. Nuclear medicine has the markers and methods that allow for the assessment of the volume of perfusion in muscles. The aim for creating this method and program was the development of radioisotope method allowing for quantitative assessment of perfusion in muscles of upper limbs. This should lead to calculating the perfusion index and its range of normal values in a greater group of patients and to using this method both in the healthy and pathological conditions. MATERIAL AND METHODS: 20 patients, age 30.4 ± 7.1 years, who underwent following examinations: qualification to the group, medical history, subject examinations, USG of upper limb vessels, anthropometric examinations, biochemical and hormonal blood tests, the assessment of upper limbs with USG Doppler and FMD (flow mediated dilatation), radioisotope examinations with gamma camera BrightView XCT by own program RAPUL (Radioisotope Assessment Perfusion of Upper Limb). Acquisitions were started five minutes after intravenous injection of 99mTc-MIBI (metoxyisobutylnitrite). The whole body scintigram and scintigrams of arm and forearm muscles in A-P projections were taken. RESULTS: In the examined patients, the results of anthropometric, biochemical and hormonal test were within the range of normal values. In radioisotope quantitative assessment of perfusion, perfusion indexes of left arm were 20 < PI(_left) < 11.90 and of the right arm 7.00 < PI(_right) <12.30. The dependency correlation PI(_left) vs. PI(_right) was strong r = 0.92036.The values of perfusion symmetry index (IPS) had a normal distribution and were within the following range: 0.9231 < IPS < 1.1019. CONCLUSIONS: The RAPUL method and program allow for quantitative assessment of perfusion in muscles of upper limbs. Developed program has a high repeatability of results. The results in the bigger group will allow for defining the range of normal values of perfusion index in muscles of upper limbs at rest. These will be diagnostically used both in healthy (sports medicine, military services) and pathological conditions.

Reliability of different radioisotopic techniques in diagnosing solitary hot spots in the spine of patients with malignant neoplasm.

INTRODUCTION: Early diagnosis of spinal metastases is of key importance in further therapeutic management. OBJECTIVES: The aim of the study was to assess the reliability of single-photon emission computed tomography (SPECT) or SPECT and computed tomography (SPECT/CT) in the diagnosis of solitary hot nodules in the spine identified by scintigraphy. PATIENTS AND METHODS: In this retrospective study, 70 patients with neoplastic disease and a solitary nodule detected in the spine were analyzed. Using a SPECT/CT γ-camera, the type and site of the foci in the vertebra were analyzed. Bone scintigraphy, SPECT, and CT were performed. Reliability of the results was assessed depending on the applied technique. RESULTS: In malignant lesions, increased isotope uptake was observed in the vertebral body with the posterior arch (89%), the body and both arches (67%), and the body alone (14%). In benign lesions, increased uptake was observed in the body area or in the joint area. Using SPECT, 25 of 27 cases (93%) of foci were properly classified as malignant. Using SPECT/CT, malignant lesions were observed in 26 of 27 cases (96%). Using SPECT, 19 of 43 cases were identified as benign (44%), and using SPECT/CT, 31 of 43 were identified as benign (72%). The agreement between SPECT and SPECT/CT was higher for malignant lesions (89%) than for benign lesions (67%). The use of CT in SPECT/CT examinations allowed to change the SPECT diagnosis of malignant lesions to that of benign lesions in 50% of the cases. CONCLUSIONS: The criteria used in the diagnosis of solitary nodules in the spine direct the diagnosis largely towards noncancerous lesions. Reliability of positive assessment was significantly lower than that of negative one - 51% in SPECT and 68% in SPECT/CT. A hybrid SPECT/CT camera is more reliable than SPECT alone in the assessment of spinal lesions.

Bone metabolism assessment, bone metabolism index designation and the determination of its normal values range in young healthy women.

BACKGROUND: Bone metabolism assessment requires the determination of bone mass and quality. The bone metabolism was assessed with the modified bone scintigraphy using 99mTc-MDP. The elaboration of radioisotopic method and program allowed for the assessment of bone metabolism, index of bone metabolism assay and definition of its normal values range with the possibility of clinical application. MATERIAL/METHODS: We examined 70 healthy young women with normal BMI, in which bone system was assessed with scintigraphic and densitometric examinations, and bone turnover markers definition together with hormonal and biochemical blood tests were performed. Group exclusion examinations were also performed, including basic, biochemical and hormonal blood tests, bone turnover markers and densitometric examinations with DXA technique. The scintigraphic examinations were performed using a gamma camera after 99mTc-MDP injection. After the application of the BONS method and program, the normal values range was determined with the STATISTICA 8 program. RESULTS: The normal results of basic, biochemical, hormonal and vascular tests were obtained. The examinations of bone turnover markers confirmed the balance between bone formation and bone resorption processes. The normal results of densitometric examinations excluded osteopeny or osteoporosis. The normal values range of IBM in young healthy women was between 84.08 and 105. CONCLUSIONS: The elaborated BONS program and method allow for the quantitative assessment of bone quality and definition of IBM normal values range. The quantitative scintigraphic bone examinations provide an alternative to the bone markers examination for obtaining information about bone metabolism.

Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes.

OBJECTIVE: The objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle. MATERIALS AND METHODS: A total of 100 patients with type 2 DM and an additional cardiovascular risk factor were enrolled in the study. All patients underwent comprehensive ophthalmologic examination, including fundus color photography and fluorescein angiography, and were divided into three groups: group 1 (NoDR): met the inclusion criteria but had no diabetic retinopathy; group 2 (NPDR): had signs of nonproliferative diabetic retinopathy; group 3 (PDR): had signs of preproliferative or proliferative diabetic retinopathy. After collecting general medical history and clinical data, patients underwent heart muscle perfusion studies. All patients followed a 48-h protocol heart muscle perfusion examination in the rest state as well as after the standardized exercise test. Single photon emission computed tomography examination was performed. RESULTS: In the PDR group, the impairment of the heart muscle perfusion at stress and rest was more frequent than in the NPDR and NoDR groups. Analysis of the heart muscle perfusion results for the three groups showed a significant relationship with the severity of microvascular complications observed in eye fundus examinations. CONCLUSIONS: Comprehensive ophthalmologic assessment of the progression of diabetic retinopathy in patients with type 2 DM may be an indicator of heart muscle perfusion disturbance.

Influence of pharmacological treatment on blood flow and muscle perfusion in patients with obliterative atheromatosis assessed with isotopic methods. A pilot study.

BACKGROUND: Most of the methods don't give the comparison between blood flow at rest and after exercise. Nuclear medicine allows for such assessment and determination of muscle perfusion indexes. The aim of the study was the comparison of the radioisotopic assessment of lower limbs perfusion at rest and after exercise in patients with obliterative atheromatosis subjected to combined treatment with the standard vascular examinations. MATERIAL/METHODS: 35 patients with stage II according to Fontaine and claudication distance 30-500 m, subjected to the combined medical treatment were included to the study. Basic examinations, claudication distance measurements, standard vascular examinations, and radioisotopic examinations of lower limbs perfusion with Tc99mMIBI were performed in all patients. RESULTS: After 6 months of therapy the results of perfusion scintigraphy showed that combined pharmacological treatment caused the significant improvement of calf perfusion at rest (p<0.05), which justifies its application in chronic ischemia of lower limbs. Such improvement was not observed while analyzing the results of standard vascular indexes. CONCLUSIONS: The use of perfusion scintigraphy allows for precise definition of the state of the limbs perfusion and shows the improvement of lower limbs perfusion at rest after medical treatment. It is a more precise and sensitive examination, gives more information comparing to the standard vascular examinations, and completes standard vascular diagnostics in patients with obliterative atheromatosis.

The behaviour of bone mineral density and bone metabolism index in young and menopausal women with the consideration of body mass index.

BACKGROUND: The bone fractures in patients with osteopeny have broaden the risk factors by body mass index (BMI) and bone metabolism assessment defined with bone scintigraphy. The aim of the study was to evaluate the behavior of bone mineral density (BMD) and bone metabolism index (IBM) in both young women and those more than 50 years old, as associated with BMI. MATERIAL/METHODS: BMD and IBM were assessed in young women (group 1; n=66) and those after 50 (group II; n=67) with the allowance for BMI (< or =25 kg/cm(2) and >25 kg/cm(2)). Detailed densitometric and radioisotopic examinations were performed in all patients. The results of BMI, IBM and BMD were compared. RESULTS: In women with BMI >25, IBM was insignificantly lower than in women with BMI <25, independent of age (p>0.05). Comparing with the women with normal BMI, there was a slight increase of femoral bone neck and the whole skeleton BMD, thus IBM was insignificantly lower (p>0.05). A powerful positive correlation was observed between IBM and BMD of femoral bone neck and the whole skeleton. With BMI <25, there was a weak positive correlation of BMI and IBM. In young women with BMI >25 there was a powerful positive correlation of BMD and IBM. CONCLUSIONS: Independently of BMI, together with age increase, BMD was lower, yet, the dependency between BMI and BMD was increasing. We showed a strong statistical dependency between BMD and IBM.

Progression of diabetic retinopathy correlated with muscle perfusion disturbances of the lower limbs, with clinically important diagnostic recommendations.

INTRODUCTION: The objective of this study was to investigate the relationship between microvascular and macrovascular disturbances in patients with type 2 diabetes, as shown by results of ophthalmological examination and by vascular and perfusion examinations of the lower limbs. MATERIAL AND METHODS: A total of 85 patients with type 2 diabetes and an additional cardiovascular risk factor were enrolled in the study. All patients underwent complex ophthalmological examination, including fundus colour photography and fluorescein angiography, and were divided into two groups: group I with signs of diabetic non-proliferative retinopathy (NPDR), and group II with signs of diabetic proliferative retinopathy (P/PDR). After collection of the general medical history and analysis of medical data, patients underwent vascular and muscle perfusion examination of the lower limbs. RESULTS: In the P/PDR group, disturbances of lower-limb perfusion were more frequent than in the NPDR group. Analysis of the blood flow and results of lower-limb muscle perfusion for the two groups showed a significant relationship with the severity of microvascular complications observed in examination of the fundus. CONCLUSIONS: Ophthalmological assessment of the progression of diabetic retinopathy in patients with type 2 diabetes is a reliable indicator of the changes in peripheral vessel systems and perfusion defects in the lower limbs.