Position statement on the non-invasive diagnosis of patients with ATTR pardiac amyloidosis, endorsed by the Hellenic Society of Nuclear Cardiology, for the Nuclear Medicine practitioners

Cardiac amyloidosis is a rare condition characterized by the accumulation of abnormal proteins called amyloids in the heart tissue. These amyloids can disrupt the normal functioning of the heart and lead to a variety of symptoms and complications.

Vitamin D Levels in Middle-Aged Patients with Obstructive Sleep Apnoea Syndrome

BACKGROUND

Vitamin D (Vit D) insufficiency has been implicated in the pathophysiology of numerous diseases. Obstructive sleep apnoea syndrome (OSAS), a disorder associated with increased cardiovascular and cerebrovascular morbidity, has been associated with decreased Vit D levels, but reports are inconclusive.

AIM

To evaluate the association between serum 25-hydroxyvitamin D [25(OH)D], a marker of Vit D status, with anthropometric and sleep characteristics of OSAS patients and to compare those levels between OSAS patients and non-apnoeic controls.

METHOD

Consecutive subjects who had undergone polysomnography and pulmonary function testing were divided into controls (apnoea-hypopnea index, AHI <5/h) and OSAS group (AHI ≥5/h).

RESULTS

A total of 169 subjects (135 men) were included. OSAS patients (n=139) significantly differed from non-apnoeic controls in terms of age (53.9±12.8 vs. 44.9±12.8 years, p=0.002) and body mass index (BMI) (35.9±6.9 vs. 29.9±6.8 kg/m2, p<0.001). Serum 25(OH)D levels were lower in OSAS patients (17.8±7.8 vs. 23.9±12.4 ng/ml, p=0.019). In OSAS patients, levels of serum 25(OH)D were negatively correlated with sleep stage transitions (r=-0.205, p=0.028), AHI (r=-0.187, p=0.045), oxygen desaturation index (r=-0.234, p=0.011) and percentage of time with oxyhaemoglobin saturation <90% (r=-0.172, p=0.041). In contrast, they were positively correlated with average oxyhaemoglobin saturation during sleep (r=0.179, p=0.033), forced expiratory volume in 1 sec (r=0.207, p=0.037) and oxygen partial pressure (r=0.197, p=0.029).

CONCLUSION

Vit D levels were lower in OSAS patients compared with non-apnoeic controls. Several indices of OSAS severity also correlated with Vit D levels.

Association of occupational exposures and work characteristics with the occurrence of gastrointestinal disorders

BACKGROUND

Work is a daily activity with various conditions, exposures, and habits that may affect health either positively or negatively. Aim of this study was to investigate the relationship between occupational factors and conditions, and the occurrence of gastrointestinal disorders.

METHODS

We enrolled in this study a sample of 891 consecutive individuals, who were examined by standard colonoscopy and gastroscopy and interviewed regarding their working conditions and exposures. Consecutively, data were statistically analyzed to explore possible associations.

RESULTS

Peptic ulcer diagnosis was associated with reports of muscle pain/headache [odds ratio (OR): 3.656, 95 % confidence interval (95% CI): 1.898-7.043], with working in shifts (OR: 2.463, 95% CI: 1.058-5.731), and with the presence of occupational stress (OR: 2.283, 95% CI: 1.162-4.486). Gastritis was associated with muscle pain/headache (OR: 2.258, 95% CI: 1.096-4.652), shift work (OR: 3.535, 95% CI: 1.345-9.29), occupational stress (OR: 2.182, 95% CI: 1.072-4.444), and sedentary work (OR 0.275 lower risk 95% CI: 0.113-0.671). Ulcerative colitis was associated with muscle pain/headache (OR: 6.211, 95% CI: 2.162-17.840) and occupational stress (OR: 6.418, 95% CI: 2.243-18.361), while Crohn's disease diagnosis with muscle pain/headache (OR: 3.554, 95% CI: 1.628-7.759), frequent ordering food at work (OR: 4.928, 95% CI: 2.3-10.559), occupational stress (OR: 3.023, 95% CI: 1.413-6.469), work with intense physical activity (OR: 0.665 lower risk, 95% CI: 0.252-0.758). Colon cancer diagnosis was associated with frequent ordering food at work (OR: 2.739, 95% CI: 1.268-5.916) and occupational stress (OR: 3.175, 95% CI: 1.384-7.286), while stomach cancer diagnosis with ordering food at work (OR: 2.794, 95% CI: 1.154-6.763) and exposure to dust (OR: 5.650, 95% CI: 1.551-20.582). Finally, presence of polyps was associated with ordering food at work (OR: 2.154, 95% CI: 1.135-4.091), and constipation with ordering food at work (OR: 2.869, 95% CI: 1.451-5.672), occupational stress (OR: 2.112, 95% CI: 1.097-4.066), and occupational noise (OR: 0.248, 95% CI: 0.084-0.737).

CONCLUSION

The incidence of the gastrointestinal diseases is affected by occupational exposures and related lifestyle habits. HIPPOKRATIA 2017, 21(2): 74-79.

Estimating life expectancy of the population in Cyprus with the use of life tables

AIM

The aim of this study was to investigate the life expectancy of the Cypriot population between 1986 and 2012.

MATERIAL AND METHODS

We used the data reported in the annual editions of the Statistical Service of Cyprus and constructed life tables of the Cypriot population between 1986 and 2012.

RESULTS

For both genders, and for males and females separately, in the year 1986 life expectancy accounted 74.47, 72.2, and 76.76 years respectively, while in 2012 values increased to about 81.28, 79.02, and 83.50 years respectively. The longitudinal trend of life expectancy is to increase over the calendar years. The largest increase in life expectancy occurred at birth and was approximately seven years for both males and females. Until the age of 55, this gain was approximately six years of life. From age 60 to 65 years, the gain was about five years of life, and in the oldest age groups, the gain was four years of life. The values corresponding to male were lower compared to those corresponding to females, with the exception of the age 0 (at birth).

CONCLUSIONS

A significant increase in life expectancy of the Cypriot population was noted in the period 1986-2012, which was more obvious at younger ages and in females. Hippokratia 2016, 20(2): 99-103.

Single sternal metastasis due to malignant melanoma with unexpected long-term survival: a case report

Metastases from melanoma have a very poor prognosis for the patient. Single metastatic lesions in the sternum due to melanoma are extremely rare. A rare case of a presternal mass in a 56-year-old patient who had undergone excision for malignant melanoma is presented. Review of the patient’s history and surgical resection of a single metastatic soft tissue lesion offer the best chance of long-term survival.

Serum levels of fetuin-A in patients with coronary artery disease. Corellation with SPET myocardium scintigraphy

OBJECTIVE

Fetuin-A is an acidic glycoprotein produced in the liver, as an inhibitor for cysteine protease. Its gene is founded in chromosome 3 (3q27). It is involved in various physiological and pathological conditions. These include vascular decalcification, bone metabolism, insulin resistance, protease function control, neurological illnesses and multiplication of breast cancer cells. Vascular calcifications predict cardiovascular disease which can be a major cause of death. So, fetuin-A is a potent circulating calcification inhibitor. Studies on individuals with clinical cardiovascular disease supported that lower levels of fetuine-A are released with coronary artery circulation (CAC) and the function of the heart valve. Our aim was to evaluate fetuin-A values of the patients with coronary artery disease, as a prognostic factor of the disease, in correlation with SPET myocardium scintigraphy.

PATIENTS AND METHODS

We studied 40 patients, 25 male and 15 female, with a mean age 48±8 years (range 36 to 69), with coronary heart disease. All were subjected to myocardium scintigraphy, in the Nuclear Medicine Department of University Hospital of Alexandroupolis. Simultaneously, blood samples were drawn for the determination of fetuin-A. Serum fetuin-A levels were measured by a commercially available sandwich ELISA (Epitope Diagnostics, Inc., San Diego, CA).

RESULTS

The average values of fetuin-A range between 140-297mg/L, as it is derived from the current bibliography and our laboratory tests. In normal individuals, pathological values were considered to be under 140mg/L. Twenty five patients with positive SPET imaging for myocardium necrosis (scars) had low fetuin values (45-148mg/ L), 10 of them passing away within 6 months, while the rest of them were showing an encumbered clinical condition (P<0.005). Ten patients with reversible ischemia showed relatively low values (125-302mg/L) (P<0.005). Five patients with a normal myocardiac scintigraphic imaging showed normal values of fetuin-A (165-508mg/L) (P<0.005).

CONCLUSIONS

Patients with myocardium necrosis demonstrated very low values of fetuin. Patients with ischemia show low amounts while patients with negative Scintigraphy for ischemia showed normal results of fetuin. The 10 patients that passed away in 6 months showed very low amounts of fetuin. Fetuin-A is supported to be a reliable prognostic factor in monitoring patients with coronary heart disease.

The role of copeptin in patients with subarachnoid haemorrage

OBJECTIVE

Subarachnoid haemorrhage is responsible to a great extend for the death rate of patients who are hospitalised in intensive care units (ICU) with haemorrhage. The early detection of its severity plays an important role for the resulting health of the patients. Neurohormone Copeptin is the C-end of pro-arginine vasopressin in plasma has been used as a prognostic marker in a number of various illnesses (acute myocardial infarction, heart and renal failure, acute dyspnoea, intracerebral and subarachnoid haemorrhage, ischaemic stroke, liver cirrhosis, acute pancreatitis). However, its prognostic value in subarachnoid haemorrhage has yet to be valued. The aim of our study was to evaluate copeptin plasma values of patients with subarachnoid haemorrhage hospitalised in the ICU, as a prognostic factor for the severity of this disease.

PATIENTS AND METHODS

We studied 32 patients, 21 male, 11 female, (average age 59±7 years), who were hospitalised in the ICU of Univ. Hospital of Alexandroupolis. Plasma Copeptin values were measured in the Nuclear Medicine Laboratory, with the Radioimmunoassay (RIA) method. The appropriate kit, from Phoenix Pharmaceuticals Inc. (USA), was used.

STATISTICAL ANALYSIS

The x(2) student test was used for statistical analysis.

RESULTS

The cut-off value of copeptin ranged between 0.4-4.4 pmol/L. 19 patients showed gradual increase of copeptin values, (125-578 pmol/L), with a bad prognosis of the illness (P<0.005). Four of them with extremely high copeptin values died. Decrease of copeptin values for the rest 15 patients were correlated with the improvement of their clinical condition (P<0.005). Eleven patients appeared to have high values, followed by the gradual decrease by a range of 85-12pmol/L, and had a good prognosis of the condition. Two patients with normal values demonstrated to have a good clinical condition.

CONCLUSION

Patients with a gradual increase of copeptin values showed to have bad prognosis of the disease. Four with extremely high copeptin values passed away, while patients with a gradual decrease or a normal amount of copeptin values had good prognosis. It is supported that copeptin values are a reliable prognostic factor in monitoring patients with intracranial haemorrhage.

Lacrimal outflow mechanisms and the role of scintigraphy: current trends

Lacrimal outflow can be compromised by anatomical obstructions or stenoses (nonfunctional epiphora) or by defective lacrimal “pump” function (functional epiphora). Although classic imaging modalities, such as X-ray dacryocystography, computed tomography, or magnetic resonance imaging can effectively evaluate the former, their success is much less in the evaluation of the latter. This is largely due to the fact that forced diagnostic injection of fluid into the canalicular system can overcome partial obstruction sites. On the other hand, lacrimal scintigraphy mimicks “physiological” lacrimal outflow, being performed under pressure gradients present in everyday life. This is why it is considered more suitable for the study of functional epiphora. Furthermore, quantitative lacrimal scintigraphy (with time-activity curves) enables the accurate measurement of lacrimal clearance from the conjunctival fornices and may be used to study the physiology of the lacrimal “pump.” Data obtained from the scintigraphic study of lacrimal outflow may be used to design more effective procedures in the management of functional and nonfunctional epiphora. This is a review article, based on a literature search with emphasis on recent publications and on those supporting interdisciplinary cooperation between ophthalmology and nuclear medicine.

Parathyroid adenoma detected with 99mTc-tetrofosmin dual-phase scintigraphy: a case report

BACKGROUND

Tc-sestamibi is the most frequently used radionuclide agent for the detection of parathyroid adenomas in the clinical setting. However, Tc-tetrofosmin is another such agent that may be used for this purpose. This case report presents the significance and practicality of 99mTc-tetrofosmin for the diagnosis of parathyroid adenomas with probable high p-glycoprotein levels.

CASE PRESENTATION

A 45-year-old woman was referred to our Nuclear Department with a palpable neck nodule suspicious for parathyroid adenoma. She had no significant medical history or other accompanying symptoms. Blood examination results were normal with the exception of the parathormone level which was high at 167.2 pg/ml. Neck ultrasonography revealed a hypoechoic mass near the lower pole of the thyroid gland. 99m Tc-tetrofosmin dual-phase scintigraphy with early and delayed images was performed and the results supported the presupposition of parathyroid adenoma as shown by increased radiopharmaceutical levels near the lower left thyroid gland on the early image that disappeared on the delayed image. Moreover, TcO4- thyroid scintigraphy results excluded thyroid pathology. Two months after the diagnosis, parathyroidectomy was successfully performed without postoperative complications. The pathology report and clinical response to a gradual decrease of parathormone confirmed the initial diagnosis.

CONCLUSION

We strongly recommend the use of reverse 99m Tc-tetrofosmin scintigraphy as a useful and safe examination technique for the diagnosis of parathyroid adenomas.

Health Professionals' knowledge and attitude towards the Umbilical Cord Blood donation in Greece

BACKGROUND/AIM

In the last years a major emphasis is laid on the Allogeneic Transplantation of Blood Stem Cells from the Umbilical Cord Blood with a simultaneous development of Umbilical Cord Blood bank. The attitude and knowledge of Health Professionals is vital to the success of this attempt as it affects significantly the promotion of Umbilical Cord Blood donation. The aim of present study is the examination of Health Professionals' knowledge and attitudes towards Umbilical Cord Blood in Greece.

MATERIAL AND METHODS

The study was conducted from April 25th 2012 to May 7th 2012. The sample consisted of 109 Health Professionals from 3 provincial hospitals and 2 hospitals in Thessaloniki. In order to collect the data, a questionnaire was used. The questionnaire was designed by the researcher and a group of experts to serve the mission of the present study. From the 130 questionnaires sent, 109 were completely answered (response rate 84%).

RESULTS

Of those who participated to the research, 23.9% were physicians, 34.9% were midwives, and 34.8% were nurses. As far as the Health Professionals' knowledge on the Umbilical Cord Blood is concerned, only 15.6% of the participants declared to be quite or well informed on the collection methods and the usage of Umbilical Cord Blood. The vast majority of the participants (89%), declared that a well-organized program on a continual training is very essential. 93.5% of the participants declared that in the last 5 years received no or very little training regarding the collection, storing and transplantation of Umbilical Cord Blood.

CONCLUSIONS

Although according to a relevant research health professionals are considered by the public as the most credible source of information about Umbilical Cord Blood, their level of knowledge on the usage and storing of Umbilical Cord Blood is inadequate. The present study indicates the necessity of creation or reinforcing of effective programs of continual training with the use of technology (i.e. Internet).

Is there a Role for Spect with (99m)Tc-Tetrofosmin in the Diagnostic Work Up of a Brain Tumor?

Brain MRI is the gold standard for diagnosis of brain tumors. In some cases preoperative MRI cannot predict the grade of malignancy, diagnostic information that could be very helpful to the surgeon. In such cases functional imaging with nuclear medicine techniques may prove quite useful.We present a case of a 58-year-old man with a brain tumor in the parieto-occipital region. Anatomic brain imaging by magnetic resonance imaging was indicative of a low grade astrocytoma. This was followed by planar imaging and single-photon emission computed tomography (SPECT) with (99m)Tc-tetrofosmin which showed increased radiotracer accumulation in the lesion, suggesting a glioblastoma which was histologically confirmed. We think that in the MRI era sometimes a (99m)Tc-tetrofosmin brain scan can contribute to diagnostic workup and improve the final management of the patient.

MEG evaluation of taste by gender difference

Magnetoencephalographic recordings were evaluated in five different states: normal condition, sweet, bitter, sour, and salt taste. Twenty-eight healthy volunteers, 14 male and 14 female, ranging from 12 to 50 years of age, were included in the study. The results showed that, in the normal condition, as well as in the sweet and the bitter taste, the male volunteers exhibited a higher count of low-frequency than high-frequency channels compared to the femal ones; in the case of the sour taste, there was no clear differentiation between the genders; with the salt taste, the female volunteers exhibited a higher count of low-frequency channels whereas there was no clear differentiation in the number of high frequencies between the gender. A discrimination in the spatial distribution of the frequencies provides novel insights into the identification of gender-related taste sensation.

Stem cell therapy for idiopathic pulmonary fibrosis: a protocol proposal

Background

Idiopathic pulmonary fibrosis represents a lethal form of progressive fibrotic lung disorder with gradually increasing incidence worldwide. Despite intense research efforts its pathogenesis is still elusive and controversial reflecting in the current disappointing status regarding its treatment. Patients and Methods: We report the first protocol proposal of a prospective, unicentric, non-randomized, phase Ib clinical trial to study the safety and tolerability of the adipose-derived stem cells (ADSCs) stromal vascular fraction (SVF) as a therapeutic agent in IPF. After careful patient selection based on functional criteria (forced vital capacity-FVC > 50%, diffuse lung capacity for carbon monoxide-DL_CO > 35% of the predicted values) all eligible subjects will be subjected to lipoaspiration resulting in the isolation of approximately 100- 500 gr of adipose tissue. After preparation, isolation and labelling ADSCs-SVF will be endobronchially infused to both lower lobes of the fibrotic lungs. Procedure will be repeated thrice at monthly intervals. Primary end-point represent safety and tolerability data, while exploratory secondary end-points include assessment of clinical functional and radiological status. Results: Preliminary results recently presented in the form of an abstract seem promising and tantalizing since there were no cases of clinically significant allergic reactions, infections, disease acute exacerbations or ectopic tissue formation. In addition 6 months follow-up data revealed a marginal improvement at 6-minute walking distance and forced vital capacity.

Conclusions

Adipose tissue represents an abundant, safe, ethically uncontested and potentially beneficial source of stem cells for patients with IPF. Larger multicenter phase II and III placebo-controlled clinical trials are sorely needed in order to prove efficacy. However, pilot safety studies are of major importance and represent the first hamper that should be overcome to establish a rigid basis for larger clinical trials.

(99m)Tc-DMSA scintigraphy diagnosing crossed renal ectopia with fusion in a three years old boy

A 3 years old boy with a history of surgery for orchidopexy was admitted to our hospital with fever and abdominal pain. Clinical examination and laboratory investigations revealed urinary tract infection with renal involvement. Ultrasonography demonstrated a solitary left kidney and raised the suspicion of a fusion anomaly. Voiding cystography disclosed grade III vesicoureteral reflux and technetium-99m dimercaptosuccinic acid scintigraphy revealed right to left crossed renal ectopia with fusion (L-shaped kidney). The patient is undergoing standard follow-up for the early detection of possible renal complications. In conclusion, L-shaped kidney is a rare entity and the (99m)Tc-DMSA scintigraphy played an important role on timely diagnosis.

Corneal melting after collagen cross-linking for keratoconus: a case report

Introduction

Corneal collagen cross-linking is a rather new technique that uses riboflavin and ultraviolet A light for collagen fiber stabilization in keratoconus corneas. Other than reversible side effects, the preliminary results of corneal collagen cross-linking studies suggest that it is a rather safe technique. In this report, we demonstrate a case of corneal melting after corneal collagen cross-linking for keratoconus corneas associated with an acute inflammatory response.

Case presentation

A 23-year-old Caucasian man with keratoconus cornea stage 1 to 2 underwent uneventful corneal collagen cross-linking treatment according to the Dresden protocol. The next day the patient had intense photophobia, watering and redness of the eye, and his visual acuity was limited to counting fingers. Slit lamp biomicroscopy revealed severe corneal haze accompanied by non-specific endothelial precipitates following an acute inflammatory response. Mild inflammation could be detected in the anterior chamber. Moreover, the re-epithelialization process could barely be detected. His corneal state gradually deteriorated, resulting in descemetocele and finally perforation.

Conclusion

In this report, we present a case of a patient with corneal melting after standard corneal collagen cross-linking treatment for keratoconus corneas following an acute inflammatory response. Despite modifying postoperative treatment, elaboration of all apparent associated causes by the treating physicians and undergoing extensive laboratory testing, the patient developed descemetocele, which led to perforation. Our report suggests that further research is necessary regarding the safety of corneal collagen cross-linking in keratoconus corneas.

Introduction of a new semi-quantitative index with predictive implications in patients with painful osseous metastases after (186)Re-HEDP therapy

AIM

In this study, a new method has been used to predict pain response to (186)Re-HEDP therapy in patients suffering from painful osseous metastases, on the basis of a modified bone scan index and pre-therapy pain scoring.

METHODS

Forty five patients received a total of 73 doses of (186)Re-HEDP during a period of pain relapse without extra-osseous disease progression. All patients were under stable regimen of zoledronic acid, far off other therapeutic manipulations. Imaging studies regarding a modified estimation of bone scan index, were applied; the value of the largest bony lesion (called mBSI), provided that it also corresponded to the most prominent site of osseous pain was taken into account, and a new semi-quantitative index called Double Product Value (DPV), equal to pre-therapy pain score times mBSI was entered in the result analyses, to investigate any possible correlations with response endpoints.

RESULTS

Favourable response occurred in 35/47 evaluated therapeutic doses of (186)Re-HEDP (74.5%; excellent response in 12 doses, 25.5%). Responders had significantly lower DPV (3.4 ± 2.3 vs. 10.2 ± 6.2, P=0.0029, for non-responders). Patients with pre-therapy DPV <or =4, had higher probability for considerably better (HR 2.29; P<0.0001) and excellent (HR 7.46; P=0.009) pain response versus those with DPV>4, and also a longer median period of pain relief (respective mean values 5.9 versus 2.1 months, HR 2.82; P=0.0001).

CONCLUSION

DPV, as developed and implemented in this study proved a valuable and reproducible pre-therapy tool for assessing degree and duration of pain response after (186)Re-HEDP therapy.

The role of nuclear medicine in the diagnosis of common and specific diabetic infections

Infections are usually detected in diabetes mellitus. They may be divided into: common infections such as fungal infections, pulmonary tuberculosis, pneumonia, bacteraemia, urinary tract infections, and diabetic foot infections and specific infections. The latter occur almost exclusively in diabetes and include rhinocerebral mucormycosis, malignant external otitis, emphysematous pyelonephritis, perirenal abscess, emphysematous cystitis and emphysematous cholecystitis. Radionuclide tests are decisive in the diagnosis and localisation of foot osteomyelitis, as well as the distinction of osteomyelitis from other conditions, notably Charcot osteoarthropathy. Technetium-99m methylene disphosphonate and labelled leukocyte bone scans are the main imaging techniques employed, while emerging techniques include single-photon emission tomography/computed tomography (CT) and positron emission tomography/CT. Nuclear medicine is also useful in the diagnosis and follow-up of specific infections in diabetes like, malignant external otitis, rhinocerebral mucormycosis, acute pyelonephritis, renal papillary necrosis and cholecystitis. The main indications of nuclear medicine tests are diabetic foot osteomyelitis, malignant external otitis, rhinocerebral mucormycosis and renal infections.

Satisfaction survey of Greek inpatients with brain cancer

PURPOSE

To investigate brain cancer patients' satisfaction hospitalised in a tertiary care university public hospital in Alexandroupolis, Greece, in order to improve medical, nursing, and organizational-administrative services.

METHODS

This cross-sectional study involved 163 patients having been hospitalised for at least 24 hours. The patients were asked to fill in a satisfaction questionnaire previously approved by the Greek Ministry of Health. Four aspects of satisfaction were investigated (medical, hotel accommodation/ organisational facilities, nursing, global). Using Principal Component Analysis, summated scales were formed and tested for internal consistency using Cronbach's alpha coefficient. The non parametric Spearman's rank correlation coefficient was also used and the threshold p-value for statistical significance (2-sided) was set at 0.05.

RESULTS

The results revealed a high degree of global satisfaction (73.31%), yet satisfaction was higher for the medical (88.88%) and nursing (84.26%) services. Moreover, satisfaction derived from the accommodation facilities and the general organisation was found to be more limited (74.17%). Statistically significant differences (based on various demographic variables) in the participants' global satisfaction were not observed. On the contrary, self-assessment of health status at admission was negatively correlated with medical (r(s)=-0.157, p=0.045) and nursing (r(s)=-0.168, p=0.032) satisfaction. Greek citizenship contributed to bigger satisfaction scores in the accommodation/organisational facilities dimension (r(s)=0.158, p=0.044). Finally, age was positively linked to nursing satisfaction (r(s)=0.181, p=0.02).

CONCLUSION

The present study confirmed in part the results of previously published Greek surveys assessing general patient populations. However, more studies are urgently needed to confirm these findings in a much bigger brain cancer population.

External re-programmation by a new radionuclidic technique of electronic cerebrospinal fluid valve in case of hydrocephalus

Hydrocephalus is defined as an abnormal enlargement of the ventricles of the brain due to an excessive accumulation of cerebrospinal fluid (CSF) because of a disturbance of its flow, absorption and/or secretion. The usual method of CSF diversion is a ventriculo-peritoneal shunt. Complications of implanted shunt systems include mechanical failure, shunt pathway obstruction, infection, foreign body (allergic) reaction to implants and CSF leakage along the implanted shunt pathway. These problems are solved with the use of programmable ventricular-peritoneal CSF valves. In this case, we describe a radionuclidic method for the control of successful reprogramming of the CSF valve. Furthermore, we analyze some technical data of such a valve-type are essential for the application of the above technique by nuclear medicine physicians. Scintigraphic evaluation of the electronic V-P drainage valve regulation is a noninvasive, not expensive, rapid and safe method with no complications for the patient and provides a reliable proof of the patency of the V-P shunt.

Type I collagen biomarkers in the diagnosis of bone metastases in breast cancer, lung cancer, urinary bladder cancer and prostate cancer. Comparison to CEA, CA 15-3, PSA and bone scintigraphy

PURPOSE

In this study we evaluated the clinical usefulness of serum pro-I collagen peptide (PICP) and I collagen telopeptide (ICTP) as indicators of early bone metastases in patients with breast (BC), lung (LC), urinary bladder (UBC) and prostate cancer (PC).

PATIENTS AND METHODS

305 patients were examined. 145 had histologically confirmed BC (92 with bone metastases), 20 UBC (6 with bone metastases), 11 LC (3 with bone metastases) and 129 PC (68 with bone metastases). In BC patients we compared the PICP and ICTP levels with those of CA 15-3, CEA and bone scintigraphy. Patients with LC and UBC had PICP and ICTP measurements, PC patients had serum PICP, prostate specific antigen (PSA) measurements and bone scans. 104 healthy individuals served as controls.

RESULTS

ICTP and CA 15-3 levels were significantly higher in patients with BC and bone metastases in comparison to patients without metastases (p <0.05), while PICP and CEA were only marginally higher. Significant correlation was observed between existence of bone metastases and ICTP levels (p <0.05). The sensitivity of PICP, ICTP, CEA and CA 15-3 was 28.1, 48.6, 42, and 78%, respectively and specificity was 83.9, 94, 65 and 86%, respectively. ICTP and CA 15-3 were the most reliable markers for early diagnosis of bone metastases in BC. PICP alone or with ICTP were not sensitive enough. Only CA 15-3 showed sensitivity 78% and specificity 86%. When combined CA 15-3, ICTP and CEA the sensitivity and specificity increased to 82% and 96%, respectively. Furthermore, PICP and PSA levels were significantly higher in patients with PC and bone metastases in comparison to patients with benign prostate hyperplasia (BPH) (p <0.0001) or in patients with PC without bone metastases (p <0.0005 for PICP and p <0.0001 for PSA). The co-evaluation of PICP and PSA improved the sensitivity (78%), specificity (96%), accuracy (97%) and positive predictive value (97%). In LC patients, ICTP levels differed significantly between patients with and without bone metastases (p=0.025). In UBC patients, PICP levels differed significantly between patients with and without bone metastases (p=0.017).

CONCLUSION

ICTP and CA 15-3 are the most reliable markers for early diagnosis of bone metastases in BC patients. PICP could be useful for diagnosing early bone metastases of PC and combined with PSA and bone scan can be an additional tool in the follow-up of PC patients. For LC patients, ICTP showed a significant difference in the discrimination of patients with and without bone metastases. In UBC patients, PICP showed a significant difference in the discrimination of patients with and without bone metastases.

Iotandium-111 pentetreotide scintigraphy and CT scans after 3 years in the follow-up of patients with malignant melanoma

Somatostatin receptor scintigraphy (SRS) has been used for the detection of neuroendocrine tumors. Melanoma is a malignant tumor of melanocytes, considered to derive from the neural crest. As the prognosis of melanoma is very poor, early detection of the disease, of recurrences and of distal metastases, is important. The aim of our study was to evaluate the clinical impact of indium-111-diaethyleno triamino pentaacetic acid-d-phe1-octreotide ((111)In-DTPA-octreotide or octreoscan or (111)In-O) in the management of melanoma patients after first diagnosis and first surgery and during three years of follow-up. We have studied 35 patients 20 female and 15 male, with histological proven melanoma. Scintigraphic images with single photon emission tomography gamma-camera (Millenium GE-USA) were performed after the administration of 220MBq (111)In-O. The scintigraphic data were compared to axial computerized tomography (CT). Patients were followed for 3 years after the initial diagnosis and surgery. Our results showed that during the 3 years follow-up period, 26/35 patients had a clinical recurrence. Twenty of them had positive (111)In-O scans with 56 lesions mainly metastatic, while 6 had negative scans. The CT scans showed only 31/56 lesions. In conclusion, SRS with (111)In-O, for diagnosing metastases from malignant melanoma, showed a sensitivity and specificity of 87% and 94% respectively and within the 3 years of follow-up, the stage of melanoma and surgical strategies were modified by 48% and 32%, respectively. Twenty five tumor sites, unsuspected by CT were visualized by (111)In-O.

Hepatobiliary scan in Alagille syndrome; arteriohepatic dysplasia

Arteriohepatic dysplasia or congenital paucity of interlobular bile ducts - Alagille Syndrome, is a well defined syndrome characterized by five major features, including chronic cholestasis, posterior embryotoxon, butterfly-like vertebral arch defects, peripheral pulmonary artery hypoplasia or stenosis and facial dysmorphy. The disease is very rare. Only three cases have been reported in Greece and none with renal involvement. Hepatobiliary scan was a fundamental tool in the patients diagnosis and therefore we present the following case.

Comparative efficacies of procalcitonin and conventional inflammatory markers for prediction of renal parenchymal inflammation in pediatric first urinary tract infection

OBJECTIVES

To compare the reliability of procalcitonin (PCT) with conventional laboratory parameters in predicting for renal parenchymal inflammation (RPI).

METHODS

The study cohort consisted of 57 children who were admitted for a first-episode urinary tract infection. All patients underwent measurement of the leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT. RPI was evaluated by technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. If the first DMSA findings were abnormal, another analysis was performed 6 months later. The cutoff points for ESR, CRP, and PCT were established by comparing the areas under their receiver operating characteristic curves. Statistical analysis was performed using 1-way analysis of variance.

RESULTS

Of the 57 children, 27 were diagnosed with RPI on the basis of positive DMSA results. The ESR, CRP, and PCT levels were significantly greater (P < .001) in the patients with RPI than in those without RPI. In contrast, the leukocyte count was the same in both groups (P > .05). PCT was a more sensitive and specific marker for differentiating upper and lower urinary tract infection than ESR and CRP. Persistent lesions at the site of previous RPI were found in 12 patients in the follow-up DMSA analysis, with total regression evident in the remaining 15. The PCT levels were significantly greater in those with persistent renal lesions than in those with total regression (P = .005).

CONCLUSIONS

Serum PCT is a more reliable biologic marker than the ESR, CRP, or leukocyte count for the early prediction of RPI in children with a first episode of urinary tract infection. In addition, the greater the elevation of PCT at admission, the more positive the correlation for subsequent permanent renal damage.

Procalcitonin for the early prediction of renal parenchymal involvement in children with UTI: preliminary results

In order to establish the most reliable marker for distinguishing urinary tract infections (UTI) with and without renal parenchymal involvement (RPI), we recorded the clinical features and admission leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum procalcitonin (PCT) in 57 children (including 43 girls) aged 2-108 months admitted with a first episode of UTI. RPI was evaluated by Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. To establish cut-off points for ESR, CRP, and PCT, we used receiver operating characteristics curves and compared the area under the curve for ESR, CRP, and PCT. Twenty-seven children were diagnosed as having RPI based on positive renal scintigraphy. A body temperature of >38 degrees C, a history of diarrhea, and poor oral intake were more common in patients with RPI. ESR, CRP, and PCT, but not leukocyte count, were significantly higher in patients with RPI (P < 0.001). PCT was more sensitive and specific for the diagnosis of upper versus lower UTI than ESR and CRP. Using a cut-off value of 0.85 ng/ml, PCT had the best performance, with sensitivity, specificity, and positive and negative predictive values of 89%, 97%, 96%, and 91% respectively. Serum PCT is a better marker than ESR, CRP, and leukocyte count for the early prediction of RPI in children with a first episode of UTI.

Association between bone scintigraphy and serum levels of procollagen (I) and PSA in the detection of bone disease in prostate cancer patients

PURPOSE

To evaluate the clinical usefulness of serum procollagen I carboxyterminal propeptide (PICP) and prostate specific antigen (PSA) in relation to bone scan results in Greek patients with prostate cancer (PC).

PATIENTS AND METHODS

108 patients (mean age 58+/-4.3 years; range 42-81) with PC and 52 healthy blood donors as control group were examined for serum PICP and PSA levels. The diagnosis of PC was confirmed histologically. Bone metastases were diagnosed in 68 of the patients with the use of (99m)Tc-MDP bone scan, while 40 patients had no bone metastases. During the one year follow-up new PICP and PSA measurements were obtained along with a new bone scan for all groups studied.

RESULTS

The levels of serum PICP and PSA were significantly higher in patients with PC and bone metastases in comparison to patients with no bone metastases. The sensitivity and specificity of the combination of PICP and PSA were 78% and 96%, respectively.

CONCLUSION

PICP could be useful for diagnosing early bone metastases of prostate adenocarcinoma and in combination with PSA and bone scan can be an additional tool in the follow-up of patients with PC.

Association between bone scintigraphy and serum levels of tumor markers in the detection of bone disease in breast cancer patients

PURPOSE

To evaluate the diagnostic value of bone scan in association with measurements of serum CEA, CA 15-3 and TPA levels in breast cancer (BC) patients.

PATIENTS AND METHODS

From September 1999 to January 2005, 89 women with BC who had undergone bone scintigraphy as part of their follow-up were retrospectively evaluated. Serum tumor markers levels were compared with the results of bone scintigraphy. Patients with positive bone scans were divided into 3 groups: group 1: 1-3, group 2: 4-5, group 3: >5 bone lesions. Serum CEA, CA 15-3 and TPA levels of 7 ng/ml, 35 U/ml and 90 U/I, respectively, were adopted as the upper limit of normal.

RESULTS

Serum CA 15-3 was significantly higher in patients with a positive bone scan (p=0.017). For CEA and TPA, no significant difference was found between patients with and without bone metastases. Twenty-five of 70 patients (36%) with normal CEA had bone metastases. Four of 50 (8%) patients with normal CA 15-3 and 15 of 51 (29%) patients with normal TPA had a positive bone scan. The combination of CA 15-3 with TPA showed 100% sensitivity in detecting bone metastases in all patient subgroups. In all 42 patients without bone metastases, CA 15-3 and/or TPA levels were normal.

CONCLUSION

CA 15-3 but not CEA or TPA is sensitive and specific for the correct determination of bone scintigraphy. CA 15-3 plus TPA represent the best combination in association with bone scanning. However, due to frequent false negative results of all tumor markers, it is not recommended to reject a bone scan on the basis of tumor markers levels.

[Correlation of serum prostate specific antigen, the volume and the intravesical prostatic protrusion for diagnosing bladder outlet obstruction in patients with benign prostate hyperplasia]

Benign prostate hyperplasia (BPH) is common in elderly men. Nevertheless, the pathophysiology of low urinary tract symptoms (LUTS) may not be due only to BPH. Many men with LUTS are submitted to unnecessary medications or surgical interventions because their symptoms have not been correctly evaluated. Can diagnostic test such as serum prostate antigen (PSA), performed by nuclear medicine techniques and the trans-abdominal ultrasound determine with high sensitivity whether LUTS is due exclusively to BPH? The aim of the study was to correlate serum PSA, prostate volume (PV), intravesical prostatic protrusion (IPP), uroflowmetry measuring maximal urine flow/sec (Qmax), and the international prostate symptom score (IPSS) questionnaire, to estimate urine bladder outlet obstruction (BOO), in patients with BPH. A hundred and twelve patients with mean of age 72 +/- 8 years and LUTS were studied. All patients were examined according to the IPSS questionnaire, had their serum PSA tested and also Qmax of prostate volume and IPP by trans-abdominal ultrasound were examined. The patients were separated in groups according to serum PSA values (<or= 1.5 ng/ml, 1.6-4 ng/ml and >or= 4.1 ng/ml), prostate volume (PV< 20.20-40 and > 20 ml) and the intravesical prostatic protrusion (IPP < 5.5-10.10 mm). There was a statistical correlation between the BOO and: a) PSA (P = 0.004), b) prostate volume with P of < 0.001) and c) IPP = 0.005. On the contrary, there was no statistical correlation between BOO and IPSS, Qmax with P values 0.228 and 0.745 respectively. Receiving operating curve (ROC) showed that patients with a serum PSA value of 1.5-4 ng/ml, IPP of type II and PV 20-40 ml, had a sensitivity of 48% for PSA, of 50% for PV and of 47% for IPP and a specificity of 75%, 47% and 60% respectively. In conclusion, according to the results of this study, a more objective evaluation of BOO, which is exclusively due to BPH, should include, not only PV but also serum PSA values and IPP.

[Serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone versus prostate specific antigen in patients with localized prostate adenocarcinoma who underwent radical prostatectomy. Radioimmunoassays measurements]

The relation of steroid hormones (SH) with carcinogenesis is not well understood. There is a variation of opinions among researchers about the prognostic value of serum SH in patients with localized prostate cancer (PC). The aim of this was to study serum SH in patients with localized PC before and after radical prostatectomy (RP). Seventy patients with mean age 67+/-8 years, were studied. The diagnosis was confirmed by histology after a biopsy. None of the patients was submitted to hormonal treatment or radiotherapy prior to RP. Serum testosterone (TST), dihydrotestosterone (DHT), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were examined prior RP and one year following RP, by radioimmuno assay (RIA) or immunoradiometric assay (IRMA) methods. Based on serum PSA levels before and one year after RP, 66 of the patients did not have biochemical recurrence while 4 patients developed biochemical recurrence due to residual disease and were treated with flutamide and a LH-RH analogue. In the group of 66 patients there was a statistically significant increase in serum TST (P<0.001), LH (P=0.004) and FSH (P<0.001), and statistically significant decrease in serum DHT (P<0.001). In the four patients with biochemical recurrence, TST increased and serum DHT, LH and FSH decreased. In this group the reduction of DHT and LH, FSH were due to treatment with flutamide and a LH-RH analogue respectively. Our findings suggest that after RP increase of serum LH and FSH may have caused an increase in serum TSH and a decrease of serum DHT. If those changes are due to the hypothalamic-pituitary axis it may be that the prostate neoplasm before RP may have secreted a substance that induced a negative feedback to the pituitary gonadotrophin secretion, which was unrelated to varying serum PSA levels.

[Serum levels of S-100b protein after four years follow-up of patients with melanoma]

The early detection of the recurrence and of distant metastases of melanoma can be supported by the detection of S-100 in the serum. In this study we have evaluated the diagnostic significance of the levels of S-100b as a tumor marker in the diagnosis and the follow-up of patients with melanoma. We have studied 27 patients (15 men and 12 women) aged 29-58 years (mean age +/- SD: 46 +/- 11 years) with melanoma in stages I-IV, as shown by histology. The thickness of the tumor was >0.75 mm according to Breslow. Thirty-two healthy individuals 19 men 13 women aged 29-52 years (mean age +/- SD: 44 +/- 9 years) were our control group. Serum samples of S-100b were measured by radioimmunoassay (RIA) every three months during the first and second year, and every six months for the next two years. All patients were operated after the first diagnosis. Our results have shown a cut-off of S-100b values between controls and patients of 0.2 micro g/l. The overall sensitivity and specificity for the diagnosis of melanoma for all stages was 71% and 94% respectively. Patients with recurrence or distant metastases had significantly higher levels of S-100b as compared to those without metastases or recurrence (P<0.05) and to healthy individuals (P<0.05). In 11 patients with elevated serum S-100b levels, after treatment and during the follow up period, these levels were reduced to normal. In conclusion, although the number of our patients was limited, serum S-100b showed after four years of follow up to be useful in stages III and IV of melanoma, in the diagnosis of relapse or metastases and in monitoring the response to treatment.

[Procollagen-I, collagen telopeptide I, CEA, CA 15-3 as compared to bone scintigraphy in patients with breast cancer]

The most common metastases of breast cancer (BC) are bone metastases. Serum pro-Iota collagen peptide (PICP) and I collagen telopeptide (ICTP) levels indicate the rate of bone collagen synthesis and bone resorption respectively and therefore indicate metastatic activity in the bone. We have studied the clinical importance of serum PICP and ICTP as well as CA 15-3 and CEA and compared them to bone scintigraphy findings indicating metastases from BC. Ninety seven women of mean age 58+/-8 years with BC were examined. The diagnosis of BC was histologically confirmed. Bone metastases were diagnosed in 68 of them by bone scans performed after the intravenous injection of 925 MBq of technetium-99m methylendiphosphonate, while 29 patients were free from bone metastases. We also examined 52 women of similar age, as controls. Serum PICP, ICTP, CA 15-3 and CEA were measured in both patients and controls. Serum levels of ICTP and CA 15-3 were significantly higher in patients with BC and bone metastases compared to patients without metastases (P<0.05), while PICP and CEA were only marginally higher. A statistically significant correlation was observed between the existence of bone metastases and ICTP serum levels (P<0.05). The sensitivity of PICP, ICTP, CEA and CA 15-3 was 28.1%, 48.6%, 78%, 42% respectively and their specificity was 83.9%, 94%, 65% and 86% respectively.

IN CONCLUSION

ICTP and CA 15-3 are the most reliable markers of those studied for the diagnosis of bone metastases in BC. PICP alone or combined with ICTP were not sensitive enough. CA 15-3 showed sensitivity 78% and specificity 86%. When combining CA 15-3, ICTP and CEA the sensitivity and specificity increased to 82% and 96% accordingly.

Lower Eyelid Laxity in Functional Acquired Epiphora: Evaluation With Quantitative Scintigraphy

PURPOSE

The examination of lacrimal drainage is often based on qualitative criteria. This study uses quantitative scintigraphy to evaluate "functional" epiphora.

METHODS

Thirty-two patients with functional epiphora (no morphologic abnormalities of the conjunctiva and eyelids, a patent nasolacrimal duct on irrigation, and no anatomical stenosis on dacryocystography) were studied (study group, SG). Twenty-two individuals without epiphora were also examined (control group, CG). Fifty microliters of Technetium-99m was instilled into the conjunctival cul-de-sac. Time-activity curves were then constructed, and conjunctival lacrimal clearance (CLC) at 2.5, 5, 7.5, and 10 minutes was calculated. Differences in CLC between the SG and the CG and correlations between CLC and horizontal and median tendon laxity and eyelid length in the SG were examined.

RESULTS

The SG had significantly reduced CLC at 2.5 and 5 minutes, compared with the CG (p = 0.01 and p = 0.04, respectively), whereas respective differences at 7.5 and 10 minutes were not statistically significant. In the SG, CLC at 2.5 and 5 minutes was significantly correlated with horizontal and median tendon laxity. The respective correlation with eyelid length was not statistically significant. Furthermore, in the SG, CLC at 2.5 and 5 minutes was significantly correlated with patient age (p = 0.03 and p = 0.04, respectively). Differences in CLC between men and women were not statistically significant at all intervals.

CONCLUSIONS

The correlation between eyelid laxity and CLC supports the role of the eyelid "pump" in lacrimal drainage. CLC at 2.5 and 5 minutes may be used to decide treatment methods for functional epiphora.

The role of 99mTc(V)-DMSA scan as compared to 99mTc-MDP and CT scans in imaging the primary tumor and metastases of osteosarcoma

The oncophilic complex of technetium-99m labeled pentavalent dimercaptosuccinic acid (99mTc(V)-DMSA) has been successfully used for the detection of primary and metastatic medullary thyroid cancer and for imaging various soft tissue tumors like lung, brain and prostate cancer. In this article, the role of 99mTc(V)-DMSA in the diagnosis of the primary tumor and metastases of osteosarcoma patients as compared to the 99mTc-MDP scan and the CT scan was studied. Twenty-eight patients with bone disease were referred to the Nuclear Medicine Department of Saint Savas Oncology Hospital in Athens from the Orthopedics Department of the same Hospital. From them, 18 (Group A) had osteosarcoma, 7 (Group B) osteomyelitis and 3 (Group C) bone fractures. The final diagnosis was made after fine needle aspiration biopsy. All patients were subjected to the 99mTc(V)-DMSA scan, the standard bone scan (99mTc-MDP) and CT scan. Group A patients showed a selective uptake of 99mTc(V)-DMSA in the primary tumor region. No abnormal 99mTc(V)-DMSA uptake was observed in the patients of Groups B and C. The 99mTc(V)-DMSA scan was found to be superior to the 99mTc-MDP and the CT scans in identifying metastases of osteosarcoma. Sensitivity was 100%, 86% and 98% respectively.

Positive Tc-99m-MIBI scan in a patient with confirmed Paget's disease of bone

A 46-year-old man was referred to our department for a Tc-99m MDP bone scan after he was admitted to our hospital with diffuse bone pain and the subsequent finding of multiple mixed type (lytic-blastic) lesions on routine x-rays. The Tc-99m MDP scan was highly suspicious for malignancy and, therefore, a Tc-99m MIBI scan was performed, which also revealed abnormal uptake in all regions with increased osteoblastic activity. Clinical chemistry and further workup revealed a highly elevated serum alkaline phosphatase and increased excretion of hydroxyproline in the urine. The presumed diagnosis of Paget's disease of the bone was further confirmed by biopsy.

[Correlation of procollagen (I) with prostate specific antigen and bone scan for the diagnosis of bone metastases in patients with prostate carcinoma]

Procollagen (I) carboxyterminal propeptide (PICP) is a metabolite of procollagen, a precursor molecule of collagen type I, which accounts for more than 90% of the organic matrix of the bones. Serum PICP levels indicate the rate of bone collagen synthesis and therefore the osteoblastic activity. In this study we evaluate the clinical usefulness of serum PICP as an indicator of bone metastases in patients with prostate cancer in relation to bone scan and to prostate specific antigen (PSA) measurements. We found no similar study in the literature relating these three tests. Seventy-eight patients (median age 63+/-4,3 years) with prostate adenocarcinoma were examined. The diagnosis was confirmed histologically. Bone metastases were diagnosed in 42 (54%) of them assessed by bone scans (Group A), while the remaining 36 patients (46%) had no bone metastases (negative bone scans and X-rays) (Group B). We also examined 21 patients with benign prostate hyperplasia as a control group (Group C). All patients had serum PICP measurements, bone scans with (99m)Tc-MDP and PSA measurements. None of them had a history of disease or of using drugs known to affect bone metabolism. Serum levels of PICP were assayed by a radioimmunoassay (RIA) kit (Orion Cooperation, Farmos Diagnostics, Finland). Serum PSA was also tested by a RIA kit (Tandem-R, Hybritech Inc, USA). PICP levels in Group A were 265+/-89 microg/l, in Group B 128+/-39 microg/l and in Group C patients 110+/-48 microg/l. High levels of PICP above 170 microg/l, were diagnostic of bone metastases with sensitivity 54%, specificity 93% and accuracy 84%. In comparison, PSA levels above 4 ng/ml were also diagnostic with a sensitivity of 68%, specificity of 91% and accuracy 88%. Patients with low levels of PICP, lower than 90 microg/l, n=31, had no bone metastases. The positive prognostic value of bone scan was 74% with a sensitivity of 76%, specificity of 58% and accuracy 71%. Positive bone scans combined with very high levels of PICP and PSA, had positive prognostic value 97%, with sensitivity of 78%, specificity of 96% and accuracy 97%, while bone scans with levels of PICP lower than 170 microg/l, had positive prognostic value of 32%. Levels of PICP and PSA were significantly higher in patients with prostate cancer and bone metastases in comparison to patients with benign prostate hyperplasia (P<0.0001) respectively. Also, levels of PICP and PSA were higher in patients with prostate cancer without metastases as compared to prostate hyperplasia (P<0.0005 and P<0.0001 respectively) (Wilcoxon-Mann-Whitney test). When metastases were more extensive, PICP levels were higher than PSA. It is concluded that PICP as a marker of osteoblastic activity is useful for diagnosing bone metastases of prostate adenocarcinoma but when co-evaluated with PSA and the bone scan, the diagnostic accuracy of these three diagnostic procedures is much higher.

Strontium-89 chloride in the treatment of bone metastases from breast cancer

Sixty-four patients with painful metastatic breast cancer in bone were treated with 2 MBq/kg of strontium-89 chloride as a single intravenous injection. Patients were followed with records of medication, hematology parameters, serial bone and Sr-89 bremsstrahlung images and with a point pain score scale (10-0). The response was assessed during a 6-month period of follow-up. Fifty-two of 64 patients (81%) showed at least a moderate improvement. Eighteen out of the 52 responders showed a dramatic decrease in bone pain (35%), 21 (40%) presented a satisfactory response and in 13 cases (25%) the response was moderate. Only 12 patients (19%) from the whole group did not feel any improvement on pain palliation. A statistically significant decrease of pretreatment levels of platelets and leukocyte counts was observed after 4-6 weeks of therapy in 50 (70%) patients. Although most patients showed no change in their bone scans after 3 months of treatment, an obvious improvement was observed in 3 of them. Furthermore no additional painful metastases on their bone scintigraphic images were observed. The selective strontium-89 local uptake in metastatic sites was also confirmed directly by bremsstrahlung scans which were absolutely comparable to the respective 99mTc bone scans. Precautions have been taken against Sr-89 contamination from the patients' blood or excretions.