The EANM guideline for radiosynoviorthesis.

PURPOSE: Radiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain. METHODS: The European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed. CONCLUSION: These guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.

Should we worry about incidental gastrointestinal tract involvement in positron emission tomography/computed tomography as gastroenterologist?

BACKGROUND AND AIM: Positron emission tomography/computed tomography(PET/CT) scans detects benign clinical conditions in addition to malignancy, and this leads to additional investigation and expenditure. The purpose of our study was to assess the endoscopic and histopathologic results of incidental 18F-FDG uptake in the GI tract. PATIENTS AND METHOD: We enrolled 110 patients who underwent gastroscopy/colonoscopy for incidental GI tract involvement in PET/CT. Histopathologic and endoscopic results were compared with FDG uptake level, pattern of uptake(diffuse/focal), and site of involvement. RESULTS: In our study, 52.7% of the patients were male and the mean age was 57±11 years. Among the participants, 47.3% and 52.7% of patients had upper GI tract and colorectal involvement in PET/CT, respectively. Gastritis and colonic polyps were the most common endoscopic diagnoses that caused FDG uptake in the upper and lower GI tract, respectively. Endoscopic evaluation was normal in 23.6% of patients with pathologic FDG involvement. The rates of adenomatous polyps, malignancy, and hyperplastic polyps were 18.5%, 13.6%, and 6.8%, respectively. The mean SUVmax were higher in malignant lesions than in non-malignant lesions (14.3±8.9 vs. 9.3±5.3)(p=0.02). Diffuse or focal FDG involvement patterns on PET/CT did not help to discriminate malignancy in the GI tract. CONCLUSION: Malignancy was detected in only 13.6% of patients with FDG involvement in the GI tract, and the involvement pattern(diffuse/focal) and SUVmax did not differentiate malignancy.

Effect of sodium ascorbate and delayed treatment on the shear bond strength of composite resin to enamel following bleaching.

BACKGROUND: The effect of bleaching on enamel surfaces, as well as exploring methods of preventing the weakening of bond strength of two different adhesives to bleached enamel surfaces. OBJECTIVE: This study compared the shear bond strength (SBS) of two different adhesives on bleached enamel immediately after bleaching, with a 1-week delay, and following application of an antioxidizing agent after bleaching. Materilas and Method: The enamel surfaces of 140 incisors were divided into 14 groups. Two unbleached enamel groups (n = 20) were prepared as negative controls of the Adper Single Bond 2 total-etch and Clearfil Tri S Bond self-etch adhesives. The remaining surfaces were randomly divided into two bleaching groups treated with 35% Beyond Max (n = 60) and 38% Opalescence Xtra Boost (n = 60). Each bleaching group was then divided into two subgroups using the total and self-etch adhesive systems. Specimens were bonded immediately after bleaching, after treatment with 10% sodium ascorbate (SA) gel, or after 1-week of immersion in artificial saliva. All groups were restored with composite resin. After thermocycling, SBS was measured and data were analyzed. RESULTS: In the control groups, there was no statistically-significant difference in SBS between self-and total-etch adhesives. Among all bleaching groups, no statistically-significant differences in SBS were noted, although the SA-treated delayed bonding (1-week) groups had the highest values. The lowest values were noted for the groups bonded immediately after bleaching.

Survival analysis of Y-90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10-year retrospective review.

Despite recent advances including new therapeutic options and availability of primary prophylaxis in haemophiliacs, haemophilic synovitis is still the major clinical problem in significant patient population worldwide. We retrospectively reviewed our 10-year experience with Y-90 radiosynovectomy to determine the outcome in the knee joints of patients with haemophilic synovitis. Between 2002 and 2012, 82 knee joints of 67 patients with haemophilic synovitis were treated with Y-90 radiosynovectomy. The mean age was 16.8 ± 7.8 years (range: 5-39 years). The mean follow-up period was 39.6 ± 25.6 months (range: 12-95 months). Failure of therapy represented re-bleeding after a radiosynovectomy was used as an end point in patient time to progression (TTP) analysis. The median TTP was calculated as 72.0 ± 3.6 months (95% CI 64.8-79.1 months) in Kaplan-Meier analysis. The 1, 3 and 5-year survival rates were 89%, 73% and 63% respectively. Longer TTP (hazard ratio for progression, 2.5; P = 0.00) was evident in patients who have greater reduction in bleeding frequency within 6 months after radiosynovectomy. We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion status of joints and the pretreatment bleeding frequency. We concluded that Y-90 radiosynovectomy in knee joint represents an important resource for the treatment of haemophilic synovitis, markedly reducing joint bleeding and long-term durability, irrespective of the radiographic stage and inhibitor status.

Long-term outcomes in haemophilic synovitis after radiosynovectomy using rhenium-186: a single-centre experience.

Radiosynovectomy has been performed successfully for more than 10 years in our hospital. This study investigated the long-term outcome in the context of time to progression (TTP) analysis and the factors influencing TTP following radiosynovectomy with Re-186 in patients with haemophilic synovitis. Radiosynovectomy performed in 165 joints (81 elbows, 74 ankles, 8 shoulder and 2 hip joints) of 106 patients (median age was 18.0 ± 7.5 years; 91 haemophilia A, 13 haemophilia B and 2 von Willebrand's disease between June 2001 and July 2011. The mean follow-up was 48 months (range: 9-120 months). This study revealed that patients' mean TTP after primary radiosynovectomy was satisfactory for both the ankle and elbow joints. There was no TTP differences between the ankle and elbow joint groups (67 vs. 72 months respectively; P = 0.22). We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion (ROM) status of joints and the pretreatment bleeding frequency. In this study, 18-20% of the treated joints had improved ROM and 82-79% of the treated joints had unchanged ROM after treatment both the ankle and elbow joints respectively. In this report including TTP analysis in the largest series with long-term follow-up, we demonstrated long-term effectiveness of Re-186 radiosynovectomy in haemophilic synovitis. In our experience, the main predictor of outcome following radiosynovectomy is the number of joint bleeding within 6 months after therapy.

Technetium-99m 2-methoxy-isobutyl-isonitrile uptake scintigraphy in detection of the bone marrow infiltration in multiple myeloma: correlation with MRI and other prognostic factors.

Whole-body scintigraphy with Technetium-99m 2-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) has been proposed as a useful method for demonstrating the areas of active bone marrow infiltration in multiple myeloma (MM). In this study, we compared the (99m)Tc-MIBI scan with magnetic resonance imaging (MRI), skeletal X-ray survey, and biochemical markers of disease activity in MM to determine its potential in predicting the extension of the disease. Twenty-four myeloma patients had undergone to the (99m)Tc-MIBI scan. Only two patients showed negative results in the (99m)Tc-MIBI scan; one had clinically active disease, and the other was on remission. MRI was performed to 18 clinically active patients, and 16 of them showed positive myelomatous bone marrow involvement. No significant difference was found between the (99m)Tc-MIBI scan and MRI in predicting the extension of bone marrow infiltration in MM (p = 0.11). (99m)Tc-MIBI scores were correlated with bone marrow neoplastic plasma cell ratio (p = 0.005), serum paraprotein level (p < 0.001), serum lactate dehydrogenase (p = 0.031), and beta-2 microglobulin (p = 0.045). The (99m)Tc-MIBI scan showed disease activity better than the skeletal X-ray survey (x2 = 5.299, p = 0.021). A significant decrease was found in posttreatment (99m)Tc-MIBI scores of the patients with positive overall response (p = 0.016). The (99m)Tc-MIBI scan is a noninvasive test that can show the extension of the disease in MM. It seems that the (99m)Tc-MIBI scan and MRI show extension and intensity of the myelomatous bone marrow infiltration equally well. The (99m)Tc-MIBI scan can be an alternative to MRI when it is not available or if there is any limitations for its usage.

The value of Tc-99m tetrofosmin in the imaging of pituitary adenomas.

AIM: Magnetic resonance imaging (MRI) and computerized tomography (CT) are used in the diagnosis and follow-up of pituitary adenoma cases. Sometimes, these methods cannot display the post-operative residual tissue. It has been shown that some radionuclides were taken up by the pituitary adenomas. The aim of this study was to evaluate the uptake of the technetium-99m (Tc-99m) tetrofosmin (TF) in the pituitary adenoma and normal pituitary tissue and assess the ability of Tc-99m TF to predict tumor malignancy in pituitary gland. METHODS: The patients with pituitary adenoma (7 invasive and 8 non-invasive) were compared with control group (no. 13). Single-photon emission computed tomography (SPECT) imaging of pituitary gland was performed in both groups. Tc-99m uptake indices were evaluated statistically with the use of Mann-Whitney U test. RESULTS: The average tetrofosmin uptake index of pituitary adenoma is 2.44+/-1.54 for the patients and 1.69+/-0.71 for the control group. Any significant difference was not observed between the groups (p 0.3). The average index was calculated as 3.04+/-2.15 for invasive adenomas and 1.92+/-0.33 for the non-invasive group, and there was no significant difference between the two groups regarding uptake of the agent (p 0.53). Furthermore, it was determined that the invasive and non-invasive adenomas displayed an uptake of Tc-99m TF similar to normal pituitary tissue. CONCLUSIONS: Since the pituitary adenoma and normal pituitary tissue gave similar results regarding Tc-99m TF uptake, it was concluded that this agent would not be useful in the diagnosis of pituitary adenoma.

Monitoring the genotoxic effects of radiosynovectomy with Re-186 in paediatric age group undergoing therapy for haemophilic synovitis.

PURPOSE: The aim of this study was to investigate the genotoxic effect on the peripheral blood lymphocytes potentially induced by Re-186 in paediatric age group undergoing radiosynovectomy for haemophilic synovitis, by using chromosomal aberration analysis (CA) and the micronuclei (MN) assay for detecting chromosomal aberrations, as well as the sister chromatid exchanges (SCE) technique for assessing DNA damage. METHODS: Cytogenetic analyses were evaluated in 20 boys (mean age: 13.8 +/- 2.7 years) before, and 2 and 90 days after radiosynovectomy from the peripheral lymphocytes of the patients. Joint retention and extra-articular spread of the radionuclides were evaluated by using quantitative gamma camera imaging. RESULTS: Imaging after radiosynovectomy revealed local lymph node visualization in 8 (40%) patients and hepatosplenic visualization in 3 (15%) patients due to extra-articular leakage of radioactive material. The mean frequency of chromosome aberrations (0.2 +/- 0.4/1000 cells) determined prior to the onset of therapy was not significantly increased in comparison with control values obtained 2 days (0.4 +/- 0.5/1000 cells) and 90 days (0.2 +/- 0.4/1000 cells) after therapy (P = 0.754 and P = 1.0). In the analysis of MN and SCE, when we compare the baseline levels, the mean MN and SCE frequencies were slightly higher in the control analyses performed 2 and 90 days after radiosynovectomy but there were no significant differences between baseline and control levels (chi(2) = 2.621, P = 0.270 and F = 0.573, P = 0.569, respectively). CONCLUSION: The major finding of this study with relatively small sample is that, radiosynovectomy with Re-186 does not seem to induce early genotoxic effects on the peripheral blood lymphocytes in paediatric age group.

Effects of the Nd:YAG laser, air-abrasion, and acid-etchant on filling materials.

The purpose of this study was to determine any inadvertent effects of the neodymium: yttrium-aluminium-garnet (Nd:YAG) laser, air-abrasion, and ortho-phosphoric acid on some conventionally used dental filling materials [amalgam, composite resin, compomer, glass-ionomer cement (GIC), and ceromer], when they were used for purposes of margin etching and assessed according to standard enamel etching parameters using a total of five fillings. The surfaces of the filling materials were polished. One sample from each material group was exposed to laser (at 0.75 J, 15 pps) and air abrasion (with Al-oxide powder, 60 psi) for 2 s and to the 37% ortho-phosphoric acid for 60 s. The exposed materials were examined under Scanning Electron Microscopy (SEM). After laser treatment most specimens showed recrystallized areas, the GIC surface being the most affected. There were some pores and cavities on the amalgam surface following laser treatment. The abraded surfaces showed mechanical abrasions. The acid etchant showed the least effect. During the application of laser or air-abrasion, the adjacent tooth or filling surface must be protected or the dentist must be careful.

Effects of a soil conditioner on some physical and biological features of soils: results from a greenhouse study.

A soil amendment substance-organic bio-stimulator, Terralyt Plus (TP), was used to observe its impact on the properties of clay loam (CL), sandy clay loam (SCL) and sandy loam (SL) soils and the growth of corn (Zea mays indentata L.) and wheat (Triticum aestivum ssp./vulgare Vill. v. lutescens) under greenhouse conditions. The diluted TP solutions (1:500, 1:1000 and 1:2000) were sprayed onto the soil surfaces. The wheat growth increased for CL and SCL with the application of TP at 1:1000. The highest dry weights were detected with 1:500 TP and corn in all the soils. Penetration resistance of CL containing corn increased with increasing TP concentration. TP was also effective in improving the aggregate stability for CL but not for the other soils. Catalase enzyme activity (CEA), soil evolution (SE) and the total aerobic bacterial population (TABP) were significantly increased (P<0.05) by spraying TP at 1:1000 onto CL.

A new silicon-based root canal sealer (Roekoseal-Automix).

This study evaluated the new silicon-based sealer 'Roekoseal-Automix' (RSA) with respect to sealing, bonding capabilities and biocompatibility with rat subcutaneous connective tissue. For the microleakage study, 36 single rooted teeth were instrumented and 30 of these obturated with either Grossman's sealer or RSA using lateral condensation technique (15 of each). Six teeth were not obturated and used as control group. For investigating bonding capability, 10 of the obturated roots with RSA and Grossman's sealer were ground and split longitudinally and examined by scanning electron microscopy (SEM). The RSA was found to seal significantly better than Grossman's sealer. The SEM examination revealed a good bond between RSA and the dentine and between RSA and the gutta-percha. Tissue reaction was evaluated by injecting 0.1 mL RSA into the connective tissue of 21 male Albino-Wistar rats and observing at 24 h, 7 days and 30 days and 30 days. Formation of a new granulation tissue with fibrous tissue adjacent to the material at 30 days. This study found that RSA performed well.

Effects of Nd: YAG laser, air-abrasion and acid-etching on human enamel and dentin.

The effects of the Nd:YAG laser, air-abrasion and acid-etching systems on mineral content and surface morphology of cut dentin and enamel were examined in 10 extracted human teeth. Enamel specimens were lased for two seconds at a fluence of 0.75 J and a frequency of 15 Hz, air-abraded for two seconds with 50 micron Al-oxide and etched for 60 seconds with 37% ortho-phosphoric acid. Dentinal specimens were subjected to the same procedure for half the time. Untreated areas of the same specimens served as the control. Morphologically, the lased dentin showed an apparently melted surface with partial obstruction of the dentin tubules, as well as cracks along the lased surface. Air-abrasion created very irregular surfaces on enamel and dentin. Dentin tubules were observed on the acid-etched dentin samples but not the air-abraded surfaces. The Nd:YAG laser created the most surface irregularity on both enamel and dentin. Laser treatment appeared to alter the chemical structure and surface morphology of the dentin and enamel.

Acquired reactive perforating collagenosis.

Acquired perforating disorder has been recognized as an uncommon distinct dermatosis in which altered collagen is eliminated through the epidermis. Several disorders accompanied by itching and scratching were reported to be associated with reactive perforating collagenosis. A 67-year-old white woman diagnosed as acquired reactive perforating collagenosis with poorly controlled diabetes mellitus and congestive cardiac failure is presented.

Two-dimensional photoelastic stress analysis of traumatized incisor.

In this study, stress of traumatized incisor and the effect of stress on tooth and alveolar bone was studied with two-dimensional photoelasticity. Two homogeneous two-dimensional maxillary central incisor models were prepared. Loads were applied to the labial side of incisal edge and middle third of the crown at angles of 45 degrees and 90 degrees. It was observed that stress was increased on teeth and alveolar bone when load was applied 90 degrees on labial side of incisal edge.

Usefulness of 99mTc-ciprofloxacin (infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy.

UNLABELLED: 99mTc-labeled ciprofloxacin (infecton) has been developed for detecting infectious foci, which localize in high concentrations in living bacteria. Other studies performed with various infections in animals and humans have found that infecton is a promising agent with better specificity for bacterial infections than white blood cell (WBC) scans. In this study, we evaluated the efficacy of infecton scintigraphy for detecting chronic bone and joint infections. METHODS: Fifty-six sites with suspected bone or joint infection were examined with 99mTc-WBC and infecton scans in 51 patients. Of these patients, 21 had prosthetic implant materials. Biochemical, radiologic, and microbiologic data and clinical outcomes also contributed, along with the results from scintigraphic techniques, in determining the presence or absence of infection. Scintigraphic images were produced at 1 and 4 h after injection of 370-400 MBq infecton or 185-200 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO)-WBCs. For each patient, there were at least 2 d and at most 7 d between scintigraphic studies. RESULTS: There were 30 true-positive, 4 false-positive, 20 true-negative, and 2 false-negative results with infecton. With 99mTc-HMPAO-WBCs, the results were 20, 1, 23, and 12, respectively. Values for sensitivity, specificity, and accuracy were 94%, 83%, and 89%, respectively, with the infecton scan and 63%, 96%, and 77%, respectively, with WBC scanning. Differences between the two agents were statistically significant (P < 0.001). Infecton and WBC scan results were in general concordance for 43 of 56 sites (77%). Infecton results for vertebral infections were the most notable findings in this study, despite the limited number of patients with this condition. Infecton scans were positive for hot spots in five of six patients with vertebral osteomyelitis. WBC scans showed photon-deficient areas in four of these same patients and normal distribution in the remaining two patients. CONCLUSION: Infecton is a useful agent for detecting infectious foci in bones and joints. Moreover, the infecton scan seems to be a more powerful tool in diagnosing vertebral infections than WBC scintigraphy.

Effect of CO2, Nd:YAG, and ArF excimer lasers on dentin morphology and pulp chamber temperature: an in vitro study.

This study compared the effect of three laser systems: CO2 (10.600 nm), Nd:YAG (1.064 nm), and ArF excimer (193 nm) lasers on dentin hard tissue and on temperature increases of the pulp chamber. Sixty-six third molar teeth were used and randomly divided into three groups. A class I cavity was made to expose the dentin, and the pulp in the pulp chamber was removed via a hole bored in the cervical area. The pulp chamber was subsequently refilled with silicon grease, and a NiCr/NiSi thermocouple was inserted through the hole into the pulp chamber. The dentin surface was then lased for 30 s at the same settings (3 W, 2 mm spot size, 20 pps) with each laser. The average internal temperature increases were as follows: CO2, 37 degrees C; Nd: YAG, 28 degrees C; and ArF excimer, 1 degrees C. Scanning electron microscopy of the dentin in the occlusal cavity revealed extensive carbonization, isolated balls of recrystallized material, and the presence of smear layer at some dentinal tubule orifices for the CO2 and Nd:YAG lased teeth. Smear layer was also observed for the ArF excimer samples; however, they exhibited far less surface cavities than the others and seemed to undergo little morphological change on the dentin.

Cerebral metastasis of a uterine leiomyosarcoma--case report.

A 38-year-old female presented with sudden neurological deterioration 6 years after an operation and chemotherapy for uterine leiomyosarcoma. An extremely rare metastasis of the uterine leiomyosarcoma to the brain was identified and totally resected. Whole brain irradiation (50 Gy) was given. A recurrence of the metastasis was resected 10 weeks later. She ultimately died of a second recurrence. Aggressive surgical management of cerebral metastasis of uterine leiomyosarcoma may achieve an improved outcome.

The natural history of late diagnosed or untreated growing skull fractures: report on two cases.

Growing skull fractures (GSF) are rare complications of head trauma. Cases after childhood are extremely rare and demonstrate complicated pathological conditions which necessitate extensive treatment. We report on two rare cases of intracranial cysts related to growing skull fractures which are secondary to trauma sustained during childhood, and have been discovered in adolescence.

An investigation of the effect of a desensitizing dentifrice on dentinal tubules in vitro and in vivo.

The effect of Sensodyne dentifrice, which contains strontium chloride hexahydrate, on the occlusion of dentinal tubules was studied in vivo and in vitro. Eight premolar teeth scheduled for extraction for orthodontic purposes were used. Four of the teeth were extracted before Sensodyne application (in vitro). The other four teeth were treated in vivo and then extracted. A patch of enamel was removed from all the teeth to expose the dentinal surfaces, and the smear layer over the exposed area was removed. In the in vivo test, the patients were instructed to brush their teeth for 1 minute, twice a day, for 2 weeks. The teeth were then extracted and kept in distilled water until examined by scanning electron microscope. The in vitro teeth were brushed in the same manner and kept in distilled water between brushings. Most of the in vitro dentinal tubules were found to be open, whereas most of the in vivo dentinal tubules were occluded.

Smooth coronal surface, resin restoration and microleakage.

The space between the resin and the cavity walls has always become interesting to search. The aim of this study was to evaluate any differences on leakage values of Class 5 type resin restorations prepared on surrounding surfaces of the tooth crown. Ninety human teeth were prepared as Class 5 cavities on buccal, lingual, mesial and distal surfaces and were randomly divided into groups for bevelling, groove preparation and as control. The subgroups were arranged as fluoride gel and/or sealant applications. Fluoride gel was applied following the cavity preparations. Sealant was applied over composite resin restorations. Treated teeth were thermocycled and immersed into dye solution for 96 hours. The restorations were evaluated in a stereo-microscope following the sectioning. Bevelling of the cavosurfaces and/or preparation of a groove addition to cavity procedures did not make any difference on the microleakage scores of the restorations done on either surfaces statistically.