Tumor characteristics of lung cancer in predicting axillary lymph node metastases. / Características tumorales del cáncer de pulmón para predecir metástasis en los ganglios axilares.

OBJECTIVE: In lung cancer, axillary lymph node metastases (ALM) are rare, and according to the 8th grading system, it is classified as M1b disease. The aim of this study is to evaluate1) the presence of ALM and2) the effect of the primary tumors characteristics on the development of ALM. METHODS: We performed a descriptive cross-sectional study, with retrospective revision, to identify ALM. RESULTS: There were 157 patients included in this analysis: ALM (63 patients) and control group (94 patients). The presence of extrathoracic lymph node, contralateral pulmonary parenchymal and distant metastasis and all SUVmax values were significantly higher in the study group versus the control group (P<0.05). The SUVmax value of the primary tumor was not a predictor of ALM. According to the primary histopathologic diagnosis, small cell lung cancer was found to cause ALM development 3.4 times as much as squamous cancer (SQC) (OR: 3.40 [95% CI 1.3-10.20], P=0.029) and adenocarcinoma group was found to cause ALM development 4 times as much as SQC (OR: 4.02 [95% CI 1.73-9.34], P=0.001). The likelihood of developing ALM was significantly higher in tumors located in the central and upper lobe versus the lower lobe. CONCLUSION: The finding of ALM on PET/CT images, the necessity of histopathologic confirmation is determined according to the results of primary tumor localization, primary tumor histopathology, M stage on PET/CT imaging, localization of ALM according to primary tumor, and N stage on PET/CT imaging.

Radioiodine-induced kidney damage and protective effect of amifostine: An experimental study.

BACKGROUND: Ablative radioiodine-131 ((131)I) therapy is used in the standart treatment procedure of thyroid carcinoma and procedures using (131)I represent the majority of Nuclear Medicine therapeutic procedures. The principal route of (131)I excretion after the administration of (131)I is the urine. Amifostine is an organic thiophosphate ester prodrug and the kidney concentrations of the active metabolite WR-1065 are about 100 times higher than tumour concentrations. To our knowledge, there is no published data in literature presenting acute effect of radioiodine on renal tissue during high dose I-131 radioiodine treatment (RIT). Additionally, it is not known whether amifostine takes role in this process. MATERIALS AND METHODS: In this study, 50 healthy female Wistar albino rats, weighing 200-250 g and averaging 16 weeks old were utilised. The rats were randomly divided into ten groups. 1- Sham group (n=5), 2- Amifostine group (n=5): rats pretreated with 1 cc amifostine (200 mg/kg) by intraperitoneal injection, 3- Radioactive iodine first day group (RI-1) (n=5): rats treated with 1 cc oral 185 MBq radioactive iodine-131 and sacrification performed after 1(st) day, 4- Amifostine + Radioactive iodine first day group (A+RI-1) (n=5): rats pretreated with amifostine (200 mg/kg) by intraperitoneal injection and rats treated with 5mCi radioactive iodine-131 and sacrification performed after 1(st) day. 5- Radioactive iodine third day group (RI-3) (n=5), 6- Amifostine + Radioactive iodine third day group (A+RI-3) (n=5), 7- Radioactive iodine fifth day group (RI-5) (n=5), 8- Amifostine + Radioactive iodine fifth day group (A+RI-5) (n=5), 9- Radioactive iodine seventh day group (RI-7) (n=5) and 10- Amifostine + Radioactive iodine seventh day group (A+RI-7) (n=5). The renal cast formation and tubular damage are evaluated by a pathologist in a blinded manner. RESULTS: Ablative radioiodine-131 therapy induced renal tubular damage was significantly higher in the radioactive iodine fifth day group (RI-5) when compared with the Sham group (p=0.01) and Amifostine group (p=0.01). CONCLUSIONS: A marked ablative radioiodine-131 induced renal toxicity was seen at fifth day of the therapy after a single RIT application and the main histopathological change was tubular damage. Amifostine have protective effects against ablative radioiodine-131 therapy and this effect is significant at fifth day of the therapy.

Pulmonary microvascular permeability and gas exchange in patients with syndrome X.

AIM: This clinical study was planned to assess pulmonary microvascular permeability in patients with Syndrome X (SX) by using a functional imaging tool, technetium-99m-diethyltriaminepentaaceticacid ((99m)Tc-DTPA) lung clearance scintigraphy, and the pulmonary functions test, which includes diffusion capacity of the lung for carbon monoxide (DLCO). METHODS: The study population consisted of 22 non-smoker subjects divided into two groups. First group comprised 12 patients (4 male, 8 female, mean age: 48±4 years, range 36 to 65) with SX. Ten healthy subject (4 men, 6 female, mean age: 45±3 years, range 34 to 58) were served as control group. Volumetric pulmonary functions, including DLCO were also performed before lung scintigraphy. Alveolar epithelial permeability was assessed by measuring the pulmonary clearance of an inhaled (99m)Tc-DTPA using a gamma camera. RESULTS: Spirometric data was comparable in both groups. Although volumetric pulmonary measurements were similar, DLCO values of SX patients were lower than those in control (20.9±1.7 ml/min/mmHg vs. 27.8±1.3 ml/min/mmHg, p=0.002). The mean clearance rate of (99m)Tc-DTPA in control subjects was 106±6 min, and this value was lower than patients with SX (179±19 min; p=0.0001). CONCLUSION: We conclude that lung is a target organ for SX. The pulmonary gas exchange and microvascular permeability, which is measured by (99m)Tc-DTPA scintigraphy, are restricted without change of volumetric pulmonary functions in patients with SX.

Scintigraphic evaluation of small intestinal transit in the streptozotocin induced diabetic rats.

AIM: Small intestine (SI) transit in the streptozotocin (STZ) induced diabetic rats were examined by using 99mTc-mebrofenin scintigraphy. MATERIALS AND METHODS: Wistar albino rats (mean body weight: 220±12 g) were studied for both control (n=10) and diabetes mellitus (DM) (n=10) groups. Diabetes was induced by a single intraperitoneal injection of streptozotocin (50 mg kg(-1) body weight. SI transit time was assessed by measuring arrival times of 99mTc-mebrofenin from duodenum to caecum. RESULTS: The mean transit time of 99mTc- mebrofenin was 67.8±11 min in control group. The mean transit time of SI was prolonged in STZ induced diabetic animals with (111.9±12.5, p=0.01). There was significant correlation between small intestinal transit time and blood glucose level (r: 0.73, p=0.01). CONCLUSION: We observed that SI transit was prolonged in diabetic animals using 99mTc- mebrofenin, and additionally this technique is a readily available method for the detection of transit abnormalities in animal experiment.

High bone mineral density in loaded skeletal regions of former professional football (soccer) players: what is the effect of time after active career?

OBJECTIVES: Physical exercise is an important factor in the acceleration and maintenance of bone mineral density (BMD). Football is an impact loading sport and some studies demonstrate its site specific, bone mass increasing effect. We compared BMD at different skeletal regions in a group of former professional football players and in normal control subjects and evaluated the effect of demographic factors and time after active career on BMD. METHODS: Twenty four former football players <70 years old who had retired from professional football at least 10 years previously and 25 non-athletic controls were recruited. The demographic characteristics, activity levels, and dietary habits of all subjects and the chronological history of the footballers' professional careers were noted. BMD was measured by DEXA at the calcaneus and distal tibia and at the lumbar spine, proximal femur, and distal and proximal radius, and compared between groups. Stepwise multiple linear regression analysis was used to determine the probable predictors of BMD in former football players. RESULTS: In former players BMD values were found to be significantly higher at the lumbar spine, femur neck, femur trochanter, distal tibia, and calcaneus, but not at Ward's triangle (femur) or the distal and proximal radius regions compared with controls. Time after active career was the only independent predictor of BMD at the lumbar spine, proximal femur (neck, trochanter, and Ward's triangle), and distal tibia. CONCLUSIONS: Former footballers had higher BMD at weight loaded sites and time after active career seemed to be an important factor in determining BMD.

The effect of aminophylline administration on 99mTc-MIBI lung and liver uptake in patients with or without myocardial ischemia.

This work aims to analyze the influence of aminophylline in the pulmonary and hepatic uptake of 99mTc-methoxyisobutil isonitrile (99mTc-MIBI). 72 patients were studied and a myocardial perfusion (MPS) single photon emission computed tomography (SPECT) with 99mTc-MIBI was carried out after the administration of dipyridamole. According to the MPS, the patients were classified into 2 groups: Group A: 45 patients without myocardial ischemia and Group B: 27 with ischemia. Each group was divided into 2 subgroups according to whether they had (I) or had not (II) received intravenous aminophylline. The dipyridamole was administered for 4 minutes at a dose of 0.56 mg/kg. If the patients presented any complication, intravenous aminophylline was administered. At 30 minutes p.i., planar images were obtained during a scintigraphy in the interior projection after the injection of 99mTc-MIBI. The regions of interest in the heart, hepatic cupula, and most active area of the left lung were outlines and the activity rates were calculated: lung/heart (LHR) and liver/heart (LivHR). No statistically significant differences were observed in the uptake of 99mTc-MIBI between subgroups I and II. However, the LHR rates in both subgroups were significantly lower in the patients with normal myocardial perfusion than in the patients with ischemia: LHR group A1 vs B1: 0. 32 +/- 0.08 vs 0.36 +/- 0.06, p = 0.03; group AII vs BII 0.31 +/- 0. 07 vs 0.35 +/- 0.07, p = 0.01 respectively. In conclusion, the administration of aminophylline, after the infusion of dipyridamole for MPS, does not modify the pulmonary or hepatic uptake of 99mTc-MIBI.

Efecto de la administración de aminofilina en la captación de 99mTc-MIBI en hígado y pulmón en pacientes con o sin isquemia de miocardio / The effect of aminophylline administration on 99mTc-MIBI lung and liver uptake in patients with or without myocardial ischemia*

El objetivo del trabajo es analizar la influencia de la aminofilina en la captación pulmonar y hepática de 99mTc-metoxi-isobutyl-isonitrilo (99mTc-MIBI). Se han estudiado 72 pacientes en los que se practicó tomogammagrafía (SPECT) de perfusión miocárdico (MPS) con 99m Tc-MIBI tras la administración de dipiridamol. Según la MPS se clasificaron los pacientes en 2 grupos. Grupo A: 45 pacientes sin isquemia miocárdica y Grupo B: 27 pacientes con isquemia. Cada grupo fue dividido en 2 subgrupos según hubieran (I) o no (II) recibido aminofilina intravenosa.El dipiridamol se administró durante 4 min a una dosis de 0,56 mg/kg. Si los pacientes presentaban cualquier complicación se administraba aminofilina intravenosa. A los 20 min p.i. del 99mTc-MIBI se registró una gammagrafía planar en proyección anterior. Se delimitaron regiones de interés en corazón, cúpula hepática y la zona más activa del pulmón izquierdo y se calcularon los índices de actividad: pulmón/corazón (LHR) e hígado/corazón (LivHR). No se observaron diferencias estadísticamente significativas en la captación de 99mTc-MIBI entre los subgrupos I y II. Sin embargo los índices LHR en ambos subgrupos fueron significativamente menores en los pacientes con perfusión miocárdica normal que en los pacientes con isquemia: LHR grupo AI vs BI: 0,32 ñ 0,08 vs 0,36 ñ 0,06, p = 0,03; grupo AII vs BII 0,31 ñ 0,07 vs 0,35 ñ 0,07, p = 0,02 respectivamente). En conclusión, la administración de aminofilina, tras la infusión de dipiridamol para MPS no modifica la captación pulmonar ni la hepática de 99mTc-MIBI. (AU)