Pleuropericardial Cyst Mimicking a Metastasis of Differentiated Thyroid Carcinoma on Whole-Body Iodine-131 Scan: a Case Report.

Post-therapeutic whole-body scan (WBS) with I-131 has been widely used for the follow-up of patients with well-differentiated thyroid cancer (DTC). Although the sensitivity of WBS with I-131 in detection of functioning thyroid tissues is high, its specificity is low. So, a further evaluation is required in cases of unexpected findings. The purpose of the study was to demonstrate that awareness of the potential pitfalls of WBS in DTC, knowledge of physiology and characteristics of radioiodine uptake, and correlation with other imaging modalities are needed to avoid incorrect management of patients with DTC. This is a case report of a 49-year-old woman with an unexpected area of increased I-131 uptake in the posterior lower chest, which was finally diagnosed as a pleuropericardial cyst. Due to the false-positive uptake of I-131 in the chest, an accurate interpretation of the scintigraphic findings should be made.

Regional cerebral perfusion correlates with anxiety in neuropsychiatric SLE: evidence for a mechanism distinct from depression.

The study examined the hypothesis that hypoperfusion in brain areas known to be involved in emotional disturbances in primary psychiatric disorders is also linked to emotional difficulties in systemic lupus erythematosus (SLE) and that these are not secondary to the physical and social burden incurred by the disease. Nineteen SLE patients without overt neuropsychiatric manifestations (non-NPSLE), 31 NPSLE patients, and 23 healthy controls were examined. Dynamic susceptibility contrast MRI was used and cerebral blood flow and cerebral blood volume values were estimated in six manually selected regions of interest of brain regions suspected to play a role in anxiety and depression (dorsolateral prefrontal cortex, ventromedial prefrontal cortex, anterior cingulate cortex, hippocampi, caudate nuclei and putamen). NPSLE patients reported high rates of anxiety and depression symptomatology. Significantly reduced cerebral blood flow and cerebral blood volume values were detected in the NPSLE group compared to healthy controls in the dorsolateral prefrontal cortex and ventromedial prefrontal cortex, bilaterally. Within the NPSLE group, anxiety symptomatology was significantly associated with lower perfusion in frontostriatal regions and in the right anterior cingulate gyrus. Importantly, the latter associations appeared to be specific to anxiety symptoms, as they persisted after controlling for depression symptomatology and independent of the presence of visible lesions on conventional MRI. In conclusion, hypoperfusion in specific limbic and frontostriatal regions is associated with more severe anxiety symptoms in the context of widespread haemodynamic disturbances in NPSLE.

Brain SPECT and perfusion MRI: do they provide complementary information about the tumour lesion and its grading?

AIM: To evaluate the relative and combined utility of 99mTc-tetrofosmin (99mTc-TF) brain single-photon-emission computed tomography (SPECT) and dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) in grading brain gliomas. MATERIALS AND METHODS: Thirty-six patients with clinically suspected brain tumours were assessed by 99mTc-TF SPECT and DSC-MRI. Brain tumour malignancy was confirmed in all patients at histopathology. On both techniques brain lesions were evaluated via visual and semi-quantitative analysis methods (deriving tetrofosmin index [T-index] and relative cerebral blood volume [rCBV] ratios, respectively). RESULTS: 99mTc-TF SPECT showed abnormally elevated tracer uptake in 31/36 patients whereas MRI detected the brain tumour in all patients. Optimal cut-off values of each index for discriminating between low- and high-grade gliomas were obtained through receiver operating characteristic (ROC) analyses. A T-index cut-off of 6.35 ensured 82% sensitivity and 71% specificity for discriminating between high- and low-grade gliomas, whereas a relative rCBV ratio cut-off of 1.80 achieved 91% sensitivity and 100% specificity. Requiring a positive result on either technique to characterise a high-grade glioma was associated with similar specificity and slightly increased sensitivity. CONCLUSION: Both imaging techniques, 99mTF SPECT and DSC MRI, may provide complementary indices of tumour grade and have an independent diagnostic value for high-risk tumours.

Isolated cardiac amyloidosis. Utility of bone seeking tracers scintigraphy in differentiating the subtype of amyloid: A case report.

BACKGROUND: Three types of amyloid are responsible for cardiac amyloidosis. Differentiation of the subtype is critical for the disease progression and the therapeutic decision. RESULTS: Myocardial scintigraphy using Tc-PYP is able to differentiate the cardiac amyloid subtype with high sensitivity and specificity. The myocardial uptake of PYP is higher in patients with TTR amyloidosis. CONCLUSION: Non-invasive tests for the detection of cardiac amyloidosis, like myocardial scintigraphy with bone seeking tracers, can play a major role in the diagnosis progression and therapeutic management of patients with cardiac amyloidosis.

Tuberculosis treatment outcome in Thessaloniki, Greece - a single center study.

BACKGROUND: Greece is one of the few countries in the European Union/European Economic Area, which do not report tuberculosis (TB) treatment outcome. This study aimed to assess treatment outcomes and identify possible intervening factors in patients with TB in Thessaloniki, Greece, over the period 2012-2017. METHODS: All patients diagnosed with TB -excluding rifampicin-resistant/multidrug-resistant (RR/MDR)-TB- during 2015-2017 were included in the study. Data on demographic characteristics, localization, diagnostic methods, resistance, and treatment outcome were recorded and compared to the period 2012-2014. RESULTS: During the period 2015-2017, 82 patients (48 men) with a mean age of 53.8 ± 15.6 years were diagnosed with TB. No significant differences in demographics, microbiological, or treatment characteristics were detected between the two three-year periods, except for the percentage of immunocompromised patients, which was higher during 2015-2017 (15.9 % vs 5.6 %, p =0.029). In the total number of patients, two factors were significantly different between patients with a positive and negative outcome. The percentage of favorable outcome was higher for patients with extrapulmonary compared to pulmonary TB (90.9 % vs 70.5 %, p =0.044). Furthermore, the percentage of immunocompetent patients with a positive outcome was significantly higher in the second treatment period compared to the first (treatment success rate 66.7 % in 2012-2014 vs 84.1 % in 2015-2017, p =0.014). This difference was attributed to the presence of a social nurse who joined the center in 2015. CONCLUSIONS: TB treatment success rate in Greece is below the World Health Organization standards. Interventions such as appropriate multidisciplinary staffing of TB centers may prove valuable in improving TB care in Greece. HIPPOKRATIA 2019, 23(4): 154-159.

Hemodynamic evidence linking cognitive deficits in clinically isolated syndrome to regional brain inflammation.

BACKGROUND AND PURPOSE: To investigate the relation between hemodynamic measurements and memory function in patients with clinically isolated syndrome (CIS). METHODS: Forty CIS patients were administered tests of verbal short-term/working memory and passage learning. Using dynamic susceptibility contrast MRI cerebral blood volume (CBV), cerebral blood flow and mean transit time values were estimated in 20 cerebral regions of interest, placed in normal appearing white matter (NAWM) and normal appearing deep gray matter structures, bilaterally. RESULTS: CIS patients showed significantly impaired scores on working memory and secondary verbal memory that correlated inversely with elevated CBV values in the left frontal and periventricular NAWM, thalamus, right caudate and corpus callosum. CONCLUSIONS: Verbal memory in CIS correlates inversely with elevated CBV values of brain structures involved in memory. As these hemodynamic changes, detected in CIS, are indicative of inflammation, the observed cognitive disturbances may relate to widespread brain inflammatory processes that prevail in early multiple sclerosis.

Intranasal application of vasopressin fails to elicit changes in brain immediate early gene expression, neural activity and behavioural performance of rats.

Intranasal administration has been widely used to investigate the effects of the neuropeptides vasopressin and oxytocin on human behaviour and neurological disorders, although exactly what happens when these neuropeptides are administered intranasally is far from clear. In particular, it is not clear whether a physiological significant amount of peptide enters the brain to account for the observed effects. In the present study, we investigated whether the intranasal administration of vasopressin and oxytocin to rats induces the expression of the immediate-early gene product Fos in brain areas that are sensitive to centrally-administered peptide, whether it alters neuronal activity in the way that centrally-administered peptide does, and whether it affects behaviour in the ways that are expected from studies of centrally-administered peptide. We found that, whereas i.c.v. injection of very low doses of vasopressin or oxytocin increased Fos expression in several distinct brain regions, intranasal administration of large doses of the peptides had no significant effect. By contrast to the effects of vasopressin applied topically to the main olfactory bulb, we saw no changes in the electrical activity of olfactory bulb mitral cells after intranasal vasopressin administration. In addition, vasopressin given intranasally had no significant effects on social recognition or short-term recognition memory. Finally, intranasal infusions of vasopressin had no significant effects on the parameters monitored on the elevated plus maze, a rodent model of anxiety. Our data obtained in rats suggest that, after intranasal administration, significant amounts of vasopressin and oxytocin do not reach areas in the brain at levels sufficient to change immediate early gene expression, neural activity or behaviour in the ways described for central administration of the peptides.

Primary haemangiopericytoma of the parapharyngeal space: an unusual tumour and review of the literature.

Haemangiopericytoma is a rare soft tissue tumour, with great histological variability and unpredictable clinical and biological behaviour. The precise cell type origin is uncertain. One third of haemangiopericytomas occur in the head and neck area, but only a few cases have been reported regarding localization at the parapharyngeal space. Herewith, case is presented of a 54-year-old female, referred to our Department due to a parapharyngeal space tumour with non-specific imaging characteristics. The patient underwent radical excision of the tumour with a trans-cervical sub-mandibular approach. The histolopathologic examination revealed a neoplasm with the characteristic features of haemangiopericytoma. One year later, during the scheduled follow-up, the computerized tomography scan showed no evidence of recurrence or residual disease. The pre-operative evaluation of a haemangiopericytoma must include a thorough imaging evaluation with computerized tomography and magnetic resonance imaging, even if results may not be specific for haemangiopericytoma. Angiography and pre-operative embolization may be performed in cases of large tumours with significant vascularity. The treatment of choice is radical excision. The follow-up includes clinical evaluation every 6 months and annual magnetic resonance imaging for at least 3 years.

The angiogenic switch for vascular endothelial growth factor-A and cyclooxygenase-2 in prostate carcinoma: correlation with microvessel density, androgen receptor content and Gleason grade.

OBJECTIVE: Angiogenesis is essential for tumor growth and metastasis; however, angiogenic factors are not uniformly expressed in prostate carcinoma. Our aim was to determine the expression of vascular endothelial growth factor-A (VEGF-A) and cyclooxygenase-2 (COX-2) in prostate carcinomas in relation to intratumoral microvessel density (MVD), tumor grade and androgen receptor (AR) status. MATERIALS AND METHODS: The expression of AR, VEGF-A and COX-2 was immunohistochemically evaluated in 24 benign prostatic hyperplasia (BPH) and 139 prostate carcinoma cases. MVD was evaluated by CD34 immunostaining. RESULTS: Nuclear AR expression was inversely related to tumor grade (p < 0.001). MVD was strongly related to tumor grade, VEGF-A and COX-2 (p < 0.001 in all comparisons). VEGF-A expression increased with tumor grade (p < 0.01) and was inversely related to stromal AR expression. COX-2 was present in both BPH and prostate carcinoma, but its expression increased with tumor grade (p < 0.01). High-grade neoplasms presented low-to-moderate VEGF staining intensity compared to strong COX-2 expression. CONCLUSIONS: Both VEGF-A and COX-2 expression is positively correlated with tumor grade and MVD. However, in Gleason 8-10 tumors, VEGF expression is moderate while COX-2 immunostaining is intense, suggesting a possible switch in the role of these two angiogenic factors in poorly differentiated neoplasms.

New experimental rabbit animal model for cervical spondylotic myelopathy.

STUDY DESIGN: Cervical spondylotic myelopathy (CSM) represents the most commonly acquired cause of spinal cord dysfunction among individuals over 55 years old. The pathophysiology of the disease involves static and dynamic mechanical factors, which are the result of chronic degeneration. The clinical course of the disease remains unpredictable. In the past, many experimental animal models have been developed to study the cellular and molecular mechanisms underlining the pathophysiology of the disease. OBJECTIVES: To create a new animal model of CSM, which will reproduce the temporal course of the disease and the local microenvironment at the site of spinal cord compression. METHODS: We performed posterior laminectomy to New Zealand rabbits at the level of C7, and a thin sheet (5-7 µm) of aromatic polyether was implanted with microsurgical technique at the epidural space underneath C5-C6 laminae. Motor function evaluation was performed after the operation and once a week thereafter. RESULTS: After 20 weeks, the animals were killed, and the histological evaluation of spinal cord at the site of compression above and below it, using eosin hematoxylin, immonohistochemistry and Kluver-Barrera techniques reveals axonal swelling and demyelination, interstitial edema and myelin sheet fragmentation. Moreover, histological evaluation of C5 and C6 laminae reveals osteophyte formation. CONCLUSION: We believe that this CSM model reproduces the temporal evolution of the disease and creates a local microenvironment at the site of spinal cord compression, which shares the same characteristics with that of human disease.

Evaluation of modal damping factor as a diagnostic tool for osteoporosis and its relation with serum osteocalcin and collagen I N-telopeptide for monitoring the efficacy of alendronate in ovariectomized rats.

Osteoporosis is a metabolic bone disease characterized by reduced bone mass and deterioration of bone microarchitecture. It results from the shift of the osteoblast-osteoclast activity equilibrium in favor of the later. Although, a number of biochemical markers, such as collagen I N-telopeptide (NTx) and osteocalcin (OC), have been used for monitoring bone remodeling, a new, monitoring, non-invasive method, which is based on the measurement of the dynamic characteristic of bone and is known as modal damping factor (MDF), has not been evaluated as a diagnostic tool for osteoporosis. Bisphosphonates, such as alendronate, have an established role in the treatment of osteoporosis. The aim of the present study was, therefore, to evaluate the effects of alendronate on the levels of MDF, serum NTx and OC on osteoporosis induced by ovariectomy in rats. Furthermore, the effects of alendronate on osteoporosis have been histologically evaluated. Fifteen adult female Wistar rats were bilaterally ovariectomized and osteoporosis was histologically confirmed and by the use of peripheral quantitative computerized tomography (pQCT). MDF was applied to assess the bone structural integrity. The serum levels of NTx (37.4+/-0.5 nM bone collagen equivalents, BCE) and OC (111.0+/-8.2 ng/mL) were found to significantly increase following ovariectomy (72.0+/-2.9 nM BCE and 213.5+/-12.1 ng/mL, respectively, p<0.001). As assessed by histology and the levels of NTx and OC in sera, animals treated with alendronate presented a statistically significant deceleration in the progression of the disease in comparison to the no-therapy control group (alendronate group NTx levels: 146.3+/-8.9 nM BCE versus no-therapy control group NTx levels: 265.3+/-14.0 nM BCE, p<0.001, alendronate group OC levels: 205.6+/-18.2 ng/mL versus no-therapy group OC levels: 353.9+/-26.1 ng/mL, p<0.001). Data obtained from the vibration analysis performed illustrated that the change in damping was equal or greater to the change in total and trabecular density, respectively. Damping increased with decreasing bone density, as expected, given that damping accounts for the structural integrity of bone (MDF value before ovariectomy: 0.058+/-0.003 versus MDF value after ovariectomy: 0.098+/-0.003, p<0.001). The higher damping values correspond to more deteriorated structures. In particular, both total and trabecular density were significantly decreased following ovariectomy (total density before ovariectomy: 702.4+/-19.0 versus total density after ovariectomy: 542.2+/-12.8, p<0.001, trabecular density before ovariectomy: 445.3+/-13.0 versus trabecular density after ovariectomy: 396.7+/-8.4, p<0.05). MDF value of the alendronate group (0.07+/-0.002) was significantly lower (p<0.001) as compared to MDF value after ovariectomy (0.098+/-0.003) and that of the no-therapy group (0.1+/-0.004, p<0.001). The administration of alendronate seemed to have no effect on either total or trabecular density, since both parameters continued to decrease (alendronate group total density: 549.4+/-12.3, alendronate group trabecular density: 368.4+/-14.7). However, when this was compared to the no-therapy group, a statistically significant difference of total density at the 0.05 level was observed (no-therapy total density: 464.8+/-9.1). The results of this study suggest that combined measurements of MDF, NTx and OC may be a potential diagnostic tool for osteoporosis and monitoring bone integrity during treatment with bisphosphonates. Furthermore, administration of alendronate showed to offer a critical deceleration in the progression of osteoporosis.

ILK over-expression in human colon cancer progression correlates with activation of beta-catenin, down-regulation of E-cadherin and activation of the Akt-FKHR pathway.

Integrin-linked kinase (ILK) has been implicated in the development and progression of several human malignancies. However, the role of ILK in human colon cancer progression is not well established, neither have its possible in vivo downstream effectors in the disease been identified. We studied, by immunohistochemistry, ILK, beta-catenin, E-cadherin, p-Akt and p-FKHR protein expression in 125 primary colon carcinomas and 45 corresponding lymph node metastases. ILK was expressed in 98.4% of the primary tumours and in 100% of metastatic lesions. The levels of ILK expression correlated strongly with tumour invasion, tumour grade and stage and were significantly higher in metastatic tumours. Activation of beta-catenin, down-regulation of E-cadherin and activation of the Akt-FKHR pathway correlated significantly with both ILK expression and tumour progression parameters. In conclusion, our results suggest that ILK may have an important role in progression of human colon cancer, possibly through in vivo regulation of beta-catenin, E-cadherin and Akt pathways. Our study also provides some evidence implicating p-FKHR in human colon carcinogenesis and ILK signalling.

Palliative treatment of painful disseminated bone metastases with 186Rhenium-HEDP in patients with lung cancer.

AIM: The aim of this study was to determine if patients with lung cancer and metastatic bone pain due to disseminated secondary bone disease, can benefit from the treatment with (186)Re-HEDP and to discuss the criteria useful for selecting those patients. METHODS: Twenty-four patients were included in this study and they received 1295 MBq (186)Re-HEDP. All patients underwent (99m)Tc-MDP bone scan before treatment from which the bone scan index (BSI) was determined (mean=18.7+/-17.1%). Most patients underwent CT scan of the painful areas from which the osteolytic element of their bone lesions as well as possible infiltration of the soft tissues was determined. Patients with predominantly osteolytic metastases at the sites considered to be the origin of pain in the CT scan, were excluded. All patients were under analgesic therapy, 22/24 were taking opiates. Pain was estimated by the visual analogue scale (VAS) before the application of (186)Re-HEDP and over the following 8 weeks. The possible myelotoxicity of (186)Re was assessed. RESULTS: The mean VAS score was 6.9+/-2.5 before the application and 3.2+/-2.6 after therapy. Pain relief was obtained in 23/24 patients. Sixty-two percent of the patients exhibited clinically significant pain relief of at least 3 VAS score. The dosage of opiates was decreased in 77% of the patients and could be discontinued in 4 of them. Myelotoxicity was observed in 1 patient. Ninety-one percent of our patients showed improvement in the parameters that assess the quality of life. CONCLUSION: The application of a standard dose of (186)Re-HEDP in patients with lung cancer and painful disseminated bone metastases has a satisfactory pain alleviating effect. The easy application and very low myelotoxicity are important factors in this group of patients. A better analgesic effect of the (186)Re-HEDP application can be expected if combined estimation of the (99m)Tc-MDP bone scan and the CT scan is used.

Uptake and washout of 99mTcV-dimercaptosuccinic acid and 99mTc-sestamibi in the assessment of histological type and grade in breast cancer.

This study was performed to investigate the relationship between histological type and grade, with the uptake and washout of 99mTc-hexakis-2-methoxyisobutylisonitrile (99mTc-sestamibi, 99mTc-MIBI) and 99mTcV-dimercaptosuccinic acid (99mTcV-DMSA) in breast cancer. Forty-five patients with histologically proven breast cancer had previously been referred for 99mTcV-DMSA and/or 99mTc-MIBI scintimammography. Twenty-five of them underwent both 99mTcV-DMSA and 99mTc-MIBI scintigraphy in a double phase study. Lateral prone and anterior supine images were acquired at 15 and 60 min after administration of 740-925 MBq of each radiotracer. Uptake ratios and retention index were calculated and correlated with histology and grade of malignancy. Histology showed eight different histotypes: 77.7% were infiltrating ductal or lobular carcinomas. Mammography was definitely positive in 32/45, indeterminate in 10 and negative in three cases (sensitivity 71%). 99mTcV-DMSA was true positive in 37/40 (sensitivity 92.5%) and 99mTc-MIBI in 28/30 (sensitivity 93.3%) breast cancers. Uptake ratios were significantly higher in ductal than in lobular carcinomas on 99mTcV-DMSA and 99mTc-MIBI scintigrams at early and delayed phases. Grade II carcinomas had significantly lower values of retention index (rapid washout) than grade III carcinomas. This finding was statistically significant only on 99mTc-MIBI scans and was observed in ductal and lobular carcinomas. The retention index did not show any significant difference between ductal and lobular carcinomas. Uptake ratios were also not statistically different between grade II and III cancers. It is concluded that 99mTc-MIBI and 99mTcV-DMSA uptake in breast cancer is probably related to histological type and may distinguish ductal from lobular carcinomas. To a certain degree, the washout rate may reflect the histological grade, but since grade is not the only factor influencing this phenomenon it should be explored further in conjunction with other parameters by multivariate analysis in order to clarify eventual indirect correlations.

99mTc-(V)DMSA scintimammography in the assessment of breast lesions: comparative study with 99mTc-MIBI.

The purpose of this study was to evaluate and compare the diagnostic accuracy of pentavalent technetium-99m dimercaptosuccinic acid [99mTc-(V)DMSA] and 99mTc-methoxyisobutylisonitrile (MIBI) in the detection of primary breast cancer and metastatic lymph node involvement, and in the clarification of cases with indeterminate mammograms. Forty-one women (mean age+/-SD 55+/-7 years) referred for a suspicious breast lesion on physical examination and/or an abnormal mammogram underwent MIBI and (V)DMSA scintimammography (SMM) at separate sessions (48-h interval). Lateral prone and anterior supine images were obtained at 10 and 60 min after administration of 740-925 MBq of each tracer, in the arm contralateral to the breast lesion. The ipsilateral axillary region was also included in the field of view. The results of SMM and mammography were compared with histological findings. Breast cancer was histologically confirmed in 26 patients (mean diameter+/-SD 2.87+/-1.5 cm). Benign lesions were found in 15 patients (mean diameter+/-SD 2.04+/-2.7 cm). Mammography was definitely positive in 23/26 patients with breast cancer and indeterminate in 3/26 (sensitivity 88.4%). In benign lesions, mammography was true negative in 5/15 cases and indeterminate in 10/15 (specificity 33.3%). Both MIBI and (V)DMSA SMM detected 23/26 breast cancers (sensitivity 88.4%) and were true negative in 14/15 (specificity 93.3%). T/B ratios for breast cancer in MIBI and (V)DMSA scans were similar, and significantly higher than for benign lesions. MIBI correctly diagnosed 12/13 and (V)DMSA 11/13 cases in which the findings of mammography were indeterminate. In addition, (V)DMSA detected seven of eight cases of in situ ductal carcinoma (DCIS) associated with infiltrating carcinomas, while MIBI detected only two of these eight cases. (V)DSMA was also diffusely concentrated in benign lesions complicated by epithelial hyperplasia. Metastatic lymph node involvement was successfully imaged in 15/19 patients with metastatic disease by both agents (sensitivity 78.9%), while true-negative scans were observed in 19/22 (specificity 86.3%) patients with benign or malignant tumours without lymph node metastases. Linear regression analysis revealed a high coefficient of correlation between the (V)DMSA and the MIBI T/B ratios (r=0.8 P<0.001). We conclude that both (V)DMSA and MIBI show an excellent ability to detect breast cancer and its lymph node metastases. (V)DMSA also has a tendency to be diffusely and more intensely localised than MIBI in pre-invasive lesions, such as DCIS or epitheliosis, which are at risk of developing into malignancies. (V)DMSA could therefore provide a useful tool in the diagnosis of such lesions and possibly modify a predefined surgical plan. Finally, we believe that both tracers could offer an alternative method for elucidating nondiagnostic mammograms.

MR imaging of pituitary hyperplasia in a child with growth arrest and primary hypothyroidism.

Magnetic resonance imaging of pituitary hyperplasia has been rarely described in children with primary hypothyroidism. We report a case of pituitary hyperplasia in a child presented with significant growth arrest and laboratory evidence of hypothyroidism. Magnetic resonance imaging revealed symmetrical pituitary enlargement simulating macroadenoma. After thyroid hormone replacement therapy, the child's height increased and pituitary enlargement regressed to normal. Awareness of MRI appearance of pituitary hyperplasia in children with laboratory evidence of hypothyroidism might avoid misdiagnosis for pituitary tumor, which may also manifest as growth disorder, obviating unnecessary surgery.

Immunohistochemical detection of p53, mdm2, waf1/p21, and Ki67 proteins in bone marrow biopsies in myelodysplastic syndroms, acute myelogenous leukaemias and chronic myeloproliferative disorders.

The aim oof this study was to investigate the immunohistochemical expression of p53, mdm2, and waf1/p21 proteins in myelodysplastic syndromes (MDS), acute myelogenous leukaemias (AML), and chronic myeloproliferative disorders (CMPD). Paraffin-sections of bone marrow biopsies from 30 cases of MDS (6 cases of RAEB and RAEB-T) 22 AML (4 cases occurring in the setting of MDS), 16 chronic myeloproliferative disorders (CMPD), and 10 cases without alterations were investigated by immunohistochemistry for p53, waf1/p21, mdm2 and Ki67 proteins. P53 was detected in immature myeloid cells in 6/30 MDS (20%) and in 6/22 AML (27%) while it was not expressed in CMPD. Of the 6 p53 positive AML, 3 occurred as evolution of MDS and 3 were de novo acute leukaemias. Waf1/p21 was detected in 5/22 (23%) AML in immature myeloid cells. Waf1/p21 was also expressed in 18/30 (60%) MDS and 10/16 (63%) CMPD in variable proportion (5-25%) of the mature myeloid cells and megakaryocytes. Waf1/p21 was not detected in immature myeloid cells in MDS and CMPD. Mdm2 protein was expressed in 3/30 (10%) MDS in the immature myeloid cells and in 1/22 AML in blastic cells. The combined immunophenotypes of immature myeloid cells of MDS were: p53+/mdm2+/waf1-: 3, p53+/mdm2-/waf1-: 3, while the immunohistochemical patterns of AML were: p53+/mdm2-/waf1-: 4, p53+/mdm2+/waf1+: 1, p53+/mdm2-/waf1+: 1, p53-/mdm2-/waf1+: 3. Ki67/MIB1 staining was found in at least 30% of immature myeloid cells in MDS and AML and in at least 20% of these cells in CMPD. In conclusion, our results indicate that p53 protein is overexpressed in the myeloid lineage in a proportion of AML and MDS, while is not detected in CMPD and normal bone marrow, p53 expression was much more frequent in AML occurring as an evolution of MDS than in de novo AML. The combined immunophenotypes of p53 positive AML and MDS suggest that p53 overexpression may be due to mutation, in some AML and MDS cases with the p53+/mdm2-/waf1- phenotype. However, it would be also possible that p53 protein accumulation is not related to p53 mutation but to inhibition of p53/mdm2 binding due to mdm2 defects and/or other events related to cell stress signals. On the other hand, waf1/p21 protein overexpression without p53 expression in some AML could be p53-independent and may represent an attempt to control the high proliferation rate which was evidenced by Ki67/MIB1 immunostaining. However, the possibility of p21 to arrest cell-cycle, in these cases of AML, seems to be overridden, suggesting that cell-cycle deregulation may be involved in a proportion of AML.

Tailored low dose three-dimensional CT of paranasal sinuses.

A technique for three-dimensional (3D) computed tomography (CT) of the paranasal sinuses was evaluated. The influence of milliamperage and reconstruction algorithms on image quality was studied in a phantom. Eleven patients with bony abnormalities of the paranasal sinuses underwent CT to assess the clinical impact of 3D CT protocol. Contiguous 1.5-mm sections obtained at 120 kVp/175 mA/1.9 sec can provide 3D images with high diagnostic image quality. This technique offers the advantage of a much lower dose than that of the conventional CT (CCT) examination of paranasal sinuses. Three-dimensional CT protocol of paranasal sinuses is suggested for use for the evaluation of bony abnormalities and for preoperative planning of the above region.