F-18 FDG positron emission tomography in primary breast non-Hodgkin's lymphoma.

A 50-year-old woman had an irregular, mobile, firm right breast mass that became progressively larger in the past 3 months that measured 18 x 15 cm at the time of examination. She had no nipple discharge or skin changes. A 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) showed a ring-shaped breast uptake consisting of high peripheral glycolytic activity and a cold center most likely representing necrosis or hemorrhage despite the absence of a history of trauma, surgical intervention, chemotherapy, or radiation to the breast. Whole-body images did not show any evidence of lymph node involvement or distant metastases. These results were confirmed by computed tomography of the chest, abdomen, and pelvis. Cytologic examination of a fine-needle aspiration of the breast mass showed diffuse large B-cell, intermediate grade, non-Hodgkin's lymphoma. Although it occurs infrequently, primary breast lymphoma should be considered in patients with a breast mass that shows a ring-shaped FDG uptake. A PET scan, in contrast to other imagining techniques, offers the advantage of screening the entire body, excluding the presence of metastases, and confirming the primary origin of the breast lymphoma.

On depleted uranium: gulf war and Balkan syndrome.

The complex clinical symptomatology of chronic illnesses, commonly described as Gulf War Syndrome, remains a poorly understood disease entity with diversified theories of its etiology and pathogenesis. Several causative factors have been postulated, with a particular emphasis on low level chemical warfare agents, oil fires, multiple vaccines, desert sand (Al-Eskan disease), botulism, Aspergillus flavus, Mycoplasma, aflatoxins, and others, contributing to the broad scope of clinical manifestations. Among several hundred thousand veterans deployed in the Operation Desert Storm, 15-20% have reported sick and about 25,000 died. Depleted uranium (DU), a low-level radioactive waste product of the enrichment of natural uranium with U-235 for the reactor fuel or nuclear weapons, has been considered a possible causative agent in the genesis of Gulf War Syndrome. It was used in the Gulf and Balkan wars as an armor-penetrating ammunition. In the operation Desert Storm, over 350 metric tons of DU was used, with an estimate of 3-6 million grams released in the atmosphere. Internal contamination with inhaled DU has been demonstrated by the elevated excretion of uranium isotopes in the urine of the exposed veterans 10 years after the Gulf war and causes concern because of its chemical and radiological toxicity and mutagenic and carcinogenic properties. Polarized views of different interest groups maintain an area of sustained controversy more in the environment of the public media than in the scientific community, partly for the reason of being less than sufficiently addressed by a meaningful objective interdisciplinary research.

Medical effects of internal contamination with uranium.

The purpose of this work is to present an outline of the metabolic pathways of uranium isotopes and compounds, medical consequences of uranium poisoning, and an evaluation of the therapeutic alternatives in uranium internal contamination. The chemical toxicity of uranium has been recognized for more than two centuries. Animal experiments and human studies are conclusive about metabolic adverse affects and nephro- toxicity of uranium compounds. Radiation toxicity of uranium isotopes has been recognized since the beginning of the nuclear era, with well documented evidence of reproductive and developmental toxicity, as well as mutagenic and carcinogenic consequences of uranium internal contamination. Natural uranium (238U), an alpha emitter with a half-life of 4.5x10(9) years, is one of the primordial substances of the universe. It is found in the earth's crust, combined with 235U and 234U, alpha, beta, and gamma emitters with respective half-lives of 7.1x10(8) and 2.5x10(5) years. A special emphasis of this paper concerns depleted uranium. The legacy of radioactive waste, environmental and health hazards in the nuclear industry, and, more recently, the military use of depleted uranium in the tactical battlefield necessitates further insight into the toxicology of depleted uranium. The present controversy over the radiological and chemical toxicity of depleted uranium used in the Gulf War warrants further experimental and clinical investigations of its effects on the biosphere and human organisms.

Changes of the corrected Q-T interval in the electrocardiogram of patients with anorexia nervosa.

Thirty patients with anorexia nervosa and 30 controls had an electrocardiogram with the corrected Q-T interval. The aim of the study was to analyse the corrected Q-T interval in patients with anorexia nervosa compared with the findings in the control group, to compare the body mass index between two groups and to measure underlying dispersion of the corrected Q-T interval in each of the 12 ECG leads in both groups. All corrected Q-T intervals were measured in each of the 12 ECG leads and the longest values of three consecutive intervals were used for this analysis. The prolonged corrected Q-T interval was found in 12 out of 30 patients with anorexia nervosa (40%), with the longest mean values of 0.421 s (range, 0.334-0.500 s), and in 2 out of 30 patients of the controls (7%), with the longest mean values of 0.390 s (range, 0.343-0.444 s). The difference was statistically significant (t = 4.453, P < 0.001). Relative risk for prolongation of the corrected Q-T interval in patients with anorexia nervosa was high: 12 compared with control subjects. The longest values of the corrected Q-T interval in both groups, and the longest values of the prolonged corrected Q-T interval in both groups were observed in the anteroseptal leads of the electrocardiograms. The mean serum potassium level in the group with anorexia nervosa was 3.97 and in the control group was 4.15 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Radioprotective agents in medicine.

The diminished probability of strategic nuclear confrontation alleviates some of the global concerns about large numbers of radiation casualties in the event of a nuclear war. As a result of the protection of the environment, the management of smaller numbers of radiation casualties assumes a more predictable and more specific role confined to accidents in nuclear energy projects, industry, technology and science. Recent experience of the consequences of accidents in nuclear power plants, in the field of radiotherapy and in the disposal of radioactive waste and spent fuel, present the medical and scientific communities with formidable problems if such events are to lead to minimal adverse effects on the biosphere. Whereas it is not possible to predict a nuclear or radiation accident, radioprotection is hardly an issue of health science alone, but rather an issue of the strictest quality assurance in all aspects of the utilization of nuclear energy and ionizing radiation. Thus, the medical community concerned with radioprotection will have to confine its emphasis on the management of radiation-induced alterations of the human organism from acute radiation syndromes to the stochastic concepts of chronic alterations of radiosensitive organic systems. Current multidisciplinary research in the field of radioprotection involves all aspects of basic and clinical research ranging from the subatomic mechanisms of free radical formation, macromolecular and intracellular radiation-induced alterations, biochemical and physiological homeostatic mechanisms and organ level manifestations to the clinical management of radiation casualties in a controlled hospital environment. Radioprotective agents, although widely studied in the past four decades and including several thousand agents, have not reached the level of providing the field of medicine with an agent that conforms to all criteria of an optimal radioprotectant, including effectiveness, toxicity, availability, specificity and tolerance. This article discusses the current state of radioprotection in medical therapy, and emphasizes a need for continued research in the area of medical management of radiation casualties from the viewpoint of a realistic probability of nuclear incidents or accidents in the nuclear energy-dependent world at the end of the millennium.

Does any correlation exist between a high plasma digoxin concentration and an electrocardiogram in younger and older patients.

In a group of 152 elderly patients (age range between 65 to 92 years) and 54 patients (aged 35 to 64 years) plasma digoxin level measuring 2.5-6.2 nmol/1 were correlated with the clinical symptoms and the electrocardiogram. The conduction disturbances and arrhythmias as well as the P-R interval, P-T-Q index and corrected Q-T interval in the ECG were analyzed. The clinical symptoms of hypersaturation with digitalis were present in 54.6% of the elderly and 35.2% of the younger patients. Conduction disturbances were found in 42% of the elderly and 22.2% of the younger patients, while arrhythmias appeared in 40.1% of the elderly and 31.5% of the younger ones. 17.8% of the elderly and 46.3% of the younger patients were without these changes. The correlation between P-R interval and high plasma digoxin level in the elderly (p < 0.01) and younger patients (p < 0.05), as well as between the P-T-Q index and high plasma digoxin level in the elderly (p < 0.01) was found. There was no correlation between the corrected Q-T interval and high plasma digoxin level in both groups. No correlation was found between a high plasma digoxin level and serum creatinine level in both groups, neither between a high plasma digoxin level and serum potassium level in both groups. The effect of digitalis has not been shown to be a cause of specific changes in an electrocardiogram neither in the elderly nor in younger patients. However, the association between prolonged P-R interval as well as changes in the P-T-Q index and high plasma digoxin level has been found more often in the elderly than in the younger patients.

Effects of metastatic and non-metastatic mammary adenocarcinoma on tissue distribution of gallium-67 in the rat.

The purpose of this work was to study the effect of metastatic and non-metastatic mammary adenocarcinoma on tissue distribution of gallium-67 (67 Ga) citrate in Fischer-344 female rats by the use of gamma counting techniques. The homogenate (0.1 mm) of a sample of metastatic and non-metastatic tumor was implanted by subcutaneous injection in the right footpad of each animal's hind extremity. The animals bearing metastatic tumor were studied 2-24 days and the non-metastatic group 2-30 days after the implantation of tumor homogenate. The control group consisted of four animals and tumor-bearing groups of seven to eight animals at each time point. All animals were injected with 1.11 MBq of 67Ga citrate by intravenous administration and sacrificed in halothane anesthesia 48 h later. The relative tissue uptake data are presented as arithmetical mean value with a standard error and graphically demonstrated as normalized data with respect to control. The results demonstrate that 67Ga citrate uptake was largely unaffected in most organs by the presence of either metastatic or non-metastatic tumor. Gallium-67 uptake, however, was significantly and consistently increased in the popliteal lymph nodes of the ipsilateral extremity of tumor implant in the metastatic group. No difference was observed in the non-metastatic tumor group. The findings of this experimental work indicate that the host reaction to the tumor does not modify the gallium uptake characteristics in the normal tissues of tumor-bearing animals.

The preexcitation syndrome: epidemiological and genetic study.

A sample of 4210 subjects of both sexes aged 35-54 years was examined, chosen at random from six regions of Croatia. An electrocardiogram at rest was performed in all subjects and changes analyzed by the Minnesota code. A short P-R interval together with a widening QRS complex and a delta wave was found in 0.05%, while 42 (1.0%) of the examinees had a short P-R interval, but only 0.21% were symptomatic. Three years after the first examination 0.06% of the subjects had preexcitation with a delta wave, and in one subject it appeared after three years. 0.35% of the subjects had a short P-R interval after three years but only 0.18% were symptomatic and in 22 (0.65%) it had disappeared in three years. After 13 years these subjects did not appear for an examination, and the short P-R interval did not appear in any of other subjects during this period. There were more short P-R intervals: 3.22% in females and 1.96% in males, but 0.33% only were symptomatic. Antigens of the human leukocyte group A (HLA) system were analyzed in 46 patients: the Wolff-Parkinson-White syndrome was found in 35, while 11 had the Lown-Ganong-Levine syndrome. Antigens of the HLA-A, HLA-B and HLA-DR locuses were determined by the microlymphocytotoxicity method. The results of the frequency of HLA system antigens were compared to the results of the control group of a Croatian population consisting of 175 people. There was an increased frequency of HLA-A9 and HLA-B5 (P = 0.026 and 0.0092) in the investigated population as a whole. The participation of HLA-A3 antigen was significantly less among patients (P = 0.03), while HLA-B14 antigen was not found in patients with preexcitation. Within 10 HLA-DR locuses, HLA-DR7 antigen was rather more frequently present, although this was not statistically significant (P = 0.173).

Poisoning with 2,4-dichlorophenoxyacetic acid treated by hemodialysis.

In this paper four patients are presented who had been poisoned by 2,4-dichlorophenoxyacetic acid (2,4-D). The first patient, aged 51 years, had attempted to commit suicide by taking orally 400 ml of a 40% solution of 2,4-D. He was admitted in a coma, 6.5 h after poisoning. Extracorporal hemodialysis was performed and the course of the illness was satisfactory. The second patient, aged 80 years, had accidentally drunk 100 ml of a 40% solution of 2,4-D. He was admitted in a coma a few hours after poisoning. Hemodialysis and resin hemoperfusion were performed and the course of the illness was satisfactory. Prior to the above therapy the patient had a 2,4-D serum concentration of 177 mg/100 ml. 2,4-D clearance was 56.3 ml/min during this therapy. The third patient, aged 24 years, had drunk 200 ml of a 40% solution of 2,4-D in a suicide attempt, and paraquat poisoning was also suspected. He was admitted 10 h after poisoning and immediately hemodialysis and hemoperfusion were carried out: the course of the illness was satisfactory. On admittance the concentration of 2,4-D in serum was 122.5 mg/100 ml, and clearance was 72.9 ml/min during treatment. The fourth patient, aged 50 years, had accidentally drunk 100-200 ml of a 40% solution of 2,4-D. He was admitted in a coma 3 h after poisoning. Hemodialysis was performed and the course of the illness was satisfactory. On admittance the concentration of 2,4-D in serum was 37 mg/100 ml and clearance was 68.7 ml/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Digoxin-like substance in the serum of uremic patients before and after hemodialysis.

Digoxin concentrations in serum samples were measured before and after hemodialysis of 31 uremic patients (pts) who either never took digoxin or who had not taken digoxin for at least 1 year. False positive digoxin was found in 22 of 31 patients (71%) before hemodialysis and in 14 of 31 patients (45%) after hemodialysis. The concentrations ranged from 0.1 to 0.5 nmol/L, mean value was 0.20 +/- 0.16 before hemodialysis and after hemodialysis ranged 0.1 to 0.4 nmol/L mean value was 0.11 +/- 0.14 nmol/L. The difference before and after hemodialysis is statistically significant. Some of the patients had a constant value before and after hemodialysis. None had a higher value after hemodialysis than they did before. Eight patients, who had positive serum digoxin before hemodialysis with concentrations up to 0.5 nmol/L, became negative after hemodialysis. Our results indicate that a digoxinlike substance in uremic serum could be at least partly dialyzable.

The lack of clinical value of laboratory parameters in predicting outcome in acute renal failure.

In 55 patients with either the oliguric and nonoliguric form of acute renal failure, some laboratory parameters for the analysis of prerenal and intrinsic types of acute renal failure were examined. The parameters were analyzed within 7 days of the clinically known beginning of the illness. The parameters were analyzed as follows: sodium in urine, creatinine urine/plasma ratio, urine osmolality, osmolality urine/plasma ratio, renal failure index, and fractional excretion of filtered sodium. Hemodialysis was performed in 29 of the 55 patients. The oliguric form of acute renal failure was present in 49 of the 55 patients. In relation to renal failure index, prerenal acute renal failure was present in 7 patients and intrinsic acute renal failure in 48. It appears that in patients with a clinical diagnosis of prerenal acute renal failure, the urinary parameters do not separate them from those with acute tubular necrosis. It also appears that in patients with laboratory diagnosis of prerenal acute renal failure (i.e., a RFT less than 1.0), the response to treatment is unpredictable and in fact may have a worse prognosis than in those with a RFI greater than 1.0 (5/7 deaths vs 10/48 deaths).

Effect of ionizing radiation on gastric secretion and gastric motility in monkeys.

The prodromal syndrome of radiation sickness is characterized by nausea and vomiting but the pathophysiology and the treatment of this entity is largely unknown. We investigated this problem by determining the effects of ionizing radiation on gastric function with and without administration of the dopamine antagonist domperidone. We measured gastric electrical control activity (waves per minute), fractional emptying rate (percent per minute), acid output (microequivalents per minute), and plasma levels of immunoreactive beta-endorphin. Twelve conscious, chair-adapted rhesus monkeys were studied twice before, once immediately after, and once 2 days after a single 800-cGy (800 rads) 60Co total body irradiation. In addition to causing vomiting, total body irradiation transiently suppressed gastric electrical control activity, gastric emptying and gastric secretion, while increasing plasma levels of immunoreactive beta-endorphin. Domperidone had no effect on vomiting or gastric function either before or after irradiation, but it significantly increased plasma immunoreactive beta-endorphin.