Relation of Warrick Score and Polysomnographic Parameters in Patients with Interstitial Lung Disease

Background

Obstructive sleep apnea (OSA) is often reported in connection with interstitial lung disease. As yet, there is insufficient data on the association of OSA severity parameters with lung involvement. We purposed to assess the frequency of OSA in our study group and to investigate the relationship between radiological involvement and OSA severity parameters.

Material/Methods

The study included 79 patients with interstitial lung disease who underwent spirometry, a carbon monoxide diffusion test (DLCO), high-resolution computed tomography, and polysomnography. The data were analyzed using SPSS 22 software.

Results

Of the 79 patients, 53 patients (67.1%) had OSA, and there was a negative correlation between DLCO and the mean time spent with oxygen saturation levels below 90% (r=−0.686, P=0.001). The Warrick score was used as an indicator of the extent and severity of pulmonary involvement and was positively correlated with the apnea-hypopnea index, oxygen desaturation index, and the mean time spent with oxygen saturation below 90% (r=0.275, P=0.014; r=0.264 P=0.019; r=0.235, P=0.038).

Conclusions

In our study, a significant relationship was found between the Warrick score and the OSA severity parameters, as determined by polysomnography. Polysomnographic examinations might be useful, especially in patients with a Warrick score greater than 15, to avoid possible complications.

Contribution of ¹⁸Fluorodeoxyglucose positron emission tomography uptake and TTF-1 expression in the evaluation of the EGFR mutation in patients with lung adenocarcinoma

AIM

The aim of this study is to evaluate the diagnostic value of PET-CT scan for the prediction of EGFR mutation status and the contribution of TTF-1 expression to PET-CT scan.

METHODS

We retrospectively studied 218 cases with a diagnosis of pulmonary adenocarcinoma between 2012-2014 which underwent EGFR analysis, TTF-1 and PET-CT before treatment.

RESULTS

The EGFR mutation was present in 28.9% (n= 63) of cases. TTF-1 positivity was 66.9% (n= 105). Standardized uptake value (SUV max) was 16.7 ± 6.8 in EGFR mutant type, 13.8 ± 7.6 in cases having no EGFR mutations. According to our evaluations, high SUVmax is positively correlated with EGFR mutation status. TTF-1 expression in multivariate analysis strengthens the accuracy of detecting an EGFR mutation.

CONCLUSION

PET-CT FDG uptake may, together with TTF-1 expression, help diagnosis in lung adenocarcinoma cases when evaluating for EGFR mutation status.

Immunohistochemical expression of telomerase in patients with non-small cell lung cancer: prediction of metastasis and prognostic significance

AIM

To detect telomerase reverse transcriptase (TERT) expression in tissue and metastatic and non-metastatic lymph node samples from patients with non-small cell lung cancer; to evaluate whether TERT expression is correlated with pathological and clinical features, and/or patient survival times; to determine differences between TERT expression in metastatic and non-metastatic lymph nodes.

PATIENTS AND METHODS

Tumor tissue samples from 17 patients with squamous cell lung cancer and 11 patients with adenocarcinoma diagnosed between 2003 and 2004 were included in this study. All patients were diagnosed at our hospital and had samples stored in the pathology archive. Additionally, dissected lymph node samples, with and without metastases, were studied. Telomerase Gene Tex, Inc, Irvine, CA USA (TERT (2C4) antibody), Universal Kit (Lab Vision, Newmarket, UK) were used for immunohistochemical staining. Statistical analyses were performed using SPSS 17.0 statistical software.

RESULTS

TERT was positive in 18/28 of the samples, regardless of the histological tumor type. There was no significant correlation between TERT expression in lymph nodes with metastasis and clinical stage, histological type, tumor differentiation, or survival time.

CONCLUSION

TERT expression may be used as a target for therapy. It may also be helpful in predicting metastasis but not in predicting survival time.

Recent aspects of vasculitis and future direction

Vasculitis is pathologically identified as specific cellular inflammation, vessel destruction, and tissue necrosis. Current classifications of vasculitis such as the Chapel Hill Classification (CHCC) and American College of Rheumatology (ACR) guidelines are not sufficiently adequate for clinicians to diagnose vasculitis. The biomarkers that are currently in clinical use such as PR3-ANCA and MPO-ANCA, only help in diagnosing small vessel vasculitis and their sensitivity and specificity are not sufficient. However, recent developments related to the pathogenesis and etiopathogenesis of vasculitis have the potential to contribute to new and improved biomarkers. The determination of diverse roles of ANCA and synergistic effects of infection, genetic, environmental factors and drugs on pathogenesis is quite important. The demonstration of a new autoantibody directed to hLAMP-2 and the resemblance to some microbial structures, in addition to the determination of the possible roles of hepatitis B and C on vasculitis are important findings. These hints may lead to new biomarker developments, providing a better method to diagnose vasculitis. The evidence on T cell immunity as circulatory and lesional will likely contribute to the development of new drugs for vasculitis.

Treatment of endoluminal typical carcinoid tumor with bronchoscopic techniques

Surgical treatment of typical bronchial carcinoid tumors varies from bronkoskopic excision to major resective procedures. Typical carcinoid tumor was detected in 29 year old man patient who were admitted to our clinic with hemoptysis and dyspnea. Typical carcinoid tumor was treated with exsicion after argon plasma coagulation by bronchoscopic techniques. It should not be forgotten that bronchoscopic approach and simple excision is an effective and safe procedure for the treatment of typical bronchial carcinoid tumors in selected cases like polypoid type lesions.

Identification of sentinel lymph node in stage I-II breast cancer with lymphoscintigraphy and surgical gamma probe: comparison of Tc-99m MIBI and Tc-99m sulfur colloid

AIM

To evaluate the efficacy of the surgical gamma probe (SGP) after peritumoral injection of Tc-99m MIBI and filtered Tc-99m sulfur colloid (SC) in sentinel lymph node (SLN) detection in stage I and II breast cancer for deciding on the need for axillary dissection.

MATERIALS AND METHODS

Thirty patients with stage I-II breast cancer had peritumoral injection of Tc-99m MIBI (74 MBq/0.2 mL [2 mCi/0.2 mL] at 4 different locations) and 42 different patients had peritumoral injection of filtered Tc-99m sulfur colloid (50 MBq/0.2 mL [1.3 mCi/0.2 mL] at 4 different locations). Anterior, lateral, and anterolateral spot images were acquired at 10, 30, 45, 60, and 120 minutes and 24 hours are injection in 5 patients. During surgery, counts were obtained from the injection site, affected breast tissue, internal mammary, axillary, and supraclavicular regions and the contralateral side using the gamma probe. Peritumoral blue dye was also injected during surgery. The first lymph nodes with counts at least twice the background tissue and/or with blue dye uptake were surgically isolated. Modified radical mastectomy and axillary dissection were performed.

RESULTS

Histopathologic evaluation was made on SLN and other excised tissues. In the Tc-99m sulfur colloid group, lymphatic drainage and lymph nodes were demonstrated with lymphoscintigraphy in 31 of 42 patients. SLN was detected by SGP in 35 of 42 patients. In the Tc-99m MIBI group, lymphatic drainage and lymph nodes were visualized with lymphoscintigraphy in 23 of 30 patients. SLN was detected in 25 of 30 patients with SGP in this group.

CONCLUSION

In patients with stage I-II breast cancer, SLN could be successfully demonstrated with lymphoscintigraphy and SGP by the peritumoral injection of filtered Tc-99m sulfur colloid and Tc-99m MIBI.

I-131 therapy for thyroglobulin positive patients without anatomical evidence of persistent disease

OBJECTIVE

the aim of this retrospective study was to evaluate the diagnostic relevance of I-131 whole body scan (WBS) performed after second empirical therapeutic doses of iodine-131 (I-131) in thyroglobulin (Tg)-positive thyroid cancer patients without evidence of local and distant metastasis. We also evaluated the efficacy of second empirical therapeutic doses of I-131 in these patients.

METHODS

we retrospectively compared the results of diagnostic I-131 WBS and post-therapy scans of second therapeutic doses of I-131 in 38 patients with detectable Tg while off T4 therapy (TSH>25 mlU/ml). All patients underwent a near-total or total thyroidectomy and I-131 ablation with 75-125 mCi. All of the reported subjects had no prior evidence for detectable disease before second high dose empirical I-131 therapy.

RESULTS

there was almost complete concordance in uptake between diagnostic I-131 WBS and final scans carried out after second I-131 therapy in 22 out of 38 patients. Whereas abnormal foci of new uptake was detected in all of the remaining 16 patients, seven of them were found to have negative diagnostic WBS results. Distant metastases were observed in 3 of 16 subjects and mediastinal uptake was found in 2 of 16 patients in post-therapy scan. During the subsequent follow-up, extending from 8-46 months, 6 out of 16 patients showed normalization of serum Tg levels while off T4. Serum Tg levels were normalized in 3 out of 7 patients who had negative WBS results, increased in one and unchanged in the remaining 3. None of the patients with distant metastases had normalization of Tg levels. Totally, 6 out of 38 showed normalization of Tg levels while off T4 therapy.

CONCLUSION

the empirical therapeutic doses of 1-131 may help in localization of the disease in Tg positive patients without anatomical evidence of persistent disease, but the effect of I-131 therapy on long-term survival is not obvious.

Radioguided surgery in primary hyperparathyroidism

Surgical neck exploration is usually made in primary hyperparathyroidism (PHPT). Localization of the adenoma or detection of hyperplasia may reduce the operation period and limit the extent of the surgery. In this study the effficacy of preoperative Tc-99m MIBI scintigraphy and intraoperative gamma probe was evaluated.

MATERIALS AND METHODS

Six patients with PHPT had preoperative Tc-99m MIBI parathyroid scintigraphy and intraoperative gamma probe (IGP) was used in surgical neck exploration.

RESULTS

Parathyroid adenoma was observed in 2/6 patients on scintigraphy in the right retroclavicular region and the left lobe of the thyroid. Both of them were clearly detected by IGP during the surgery and easily removed by the surgeon in a short time (35 min) with a small incision. Pathologic examination confirmed the parathyroid adenoma. No abnormal MIBI uptake was not observed in scintigraphy in 4/6 patients. Subtotal parathyroidectomy was performed in these patients.

CONCLUSION

Preoperative Tc-99m MIBI scintigraphy and the use of IGP may limit the exploration and also the operation time and reduce surgical complications.

Identification of sentinel lymph node in breast cancer by lymphoscintigraphy and surgical gamma probe with peritumoral injection of scintimammographic agent "99mTc MIbI"

The purpose of this study was to evaluate the efficacy of lymphoscintigraphy and the surgical gamma probe (SGP) with peritumoral injection of 99mTc MIBI in sentinel lymph node (SLN) detection in breast cancer regardless of whether metastatic or not.

METHOD

Thirty patients with T1/ T2 breast cancer had peritumoral injections of 99mTc MIBI (74 MBq/0.2 ml at 4 different locations) at 2, 6 and 24 hours before surgery. Anterior, anterolateral, and lateral spot images were taken at 10, 30, 45, 60 and 120 minutes. Counts were collected from the injection site, affected breast tissue, internal mammaries, axillary and supraclavicular regions, and the contralateral side. Peritumoral blue dye was also injected at surgery. The first lymph nodes with counts twice the background tissue and/or with blue dye uptake were surgically isolated, and histopathological evaluations were made. Modified radical mastectomy was performed on all patients.

RESULTS

23/30 patients had lymph nodes in scintigrams and the sentinel lymph nodes were identified with SGP in 25/30 patients.

CONCLUSION

Lymphoscintigraphy and subsequent SGP detection with peritumoral injection of 99mTc MIBI can be used for identifying SLN in breast cancer.

Bone mineral density and importance of a gluten-free diet in patients with celiac disease in childhood

OBJECTIVES

Celiac disease (CD), a common cause of malabsorption, is known to be associated with disorders of the skeleton, but there are conflicting data about the effect of diet on bone metabolism. The aims of this study were to investigate the prevalence of osteopenia; to identify the relationship between bone mineral density (BMD), serum calcium, and parathyroid hormone levels; and to determine the effect of gluten-free diet on BMD in children with celiac disease.

DESIGN

The study included 32 patients with CD (group 1) and 82 healthy controls (group 2). The patients with CD were evaluated under 2 subgroups, ie, 16 patients with recent diagnosis (group 1a) and 16 patients who follow their diet strictly (group 1b). BMD values and concentrations of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone were determined on entry to the study and at 12 months in celiac patients. These values were compared with those of healthy control participants.

RESULTS

BMD and bone mineral content values in patients with recent diagnosis were found to be significantly lower than the control group. The BMD values in patients with recent diagnosis were significantly increased after a gluten-free diet for 1 year. Osteopenia was found more commonly in patients with recent diagnosis than patients in whom a gluten-free diet had been instituted. At 1-year follow-up, osteopenia was not resolved with the gluten-free diet, and this was especially true in patients without gastrointestinal manifestation. In patients with recent diagnosis (group 1a), the mean calcium level was found to be lower than the patients who follow their diet strictly (group 1b). There was a positive correlation between calcium level and BMD and bone mineral content.

CONCLUSIONS

BMD is almost invariably low in newly diagnosed celiac patients in childhood. We therefore recommend that BMD should be evaluated in patients with CD. Strict gluten avoidance promoted a significant increase in BMD. However, values still remained markedly low after 1 year of follow-up in some patients. These patients should be followed for longer periods of time with yearly BMD evaluation, as 1 year of diet therapy was found to be insufficient for osteopenia to be resolved.

Value of combined 67Ga and 99Tc(m)-human immunoglobulin G whole-body scanning in malignant lymphoma

Human immunoglobulin G labelled with 99Tc(m) (99Tc(m)-HIG) is an agent introduced for the localization of inflammatory lesions. There is also a limited number of reports concerning the uptake of this agent by malignant lesions. The aim of this study was to evaluate the uptake of 99Tc(m)-HIG by lymphoma. Twenty-three patients (five female, 18 male) with known Hodgkin's or non-Hodgkin's lymphoma for a period of 2-6 years (mean 4.2 years) and which, by using computed tomography (CT), showed recurrence, were included in the study. The patients were aged between 32 and 68 years (mean 38 +/- 5 years). No evidence of inflammation or infection was seen in any of these patients. CT, 99Tc(m)-HIG and a 67Ga scan were performed in the same week. CT showed abdominal involvement in 17 patients, pelvic involvement in 11, and thorax involvement in 11. 99Tc(m)-HIG showed higher sensitivity (94.1%) in the abdomen, a similar sensitivity (63.6%) in thorax, but lower (18.1%) in pelvic area than for 67Ga. 99Tc(m)-HIG was found to be more useful for the evaluation of abdominal involvement compared to 67Ga due to gastrointestinal excretion of the latter. The resolution of 67Ga was better than 99Tc(m)-HIG in thorax and pelvis. Using 99Tc(m)-HIG and 67Ga together in lymphoma may increase sensitivity.

Cerebral blood flow abnormalities in symptomatic West syndrome: a single photon emission computed tomography study

BACKGROUND

Infantile spasm (IS) is an age-dependent epileptic encephalopathy of variable etiology. Although IS is well studied, its pathogenesis is unclear. Infantile spasm is usually considered a generalized epilepsy, but recent studies point to focal cerebral blood flow (CBF) abnormalities.

METHODS

In six symptomatic IS patients, single photon emission computed tomography (SPECT) with [99Tc]-HMPAO, electroencephalography (EEG), magnetic resonance imaging (MRI)/computed tomography (CT) and their correlation were evaluated.

RESULTS

Single photon emission computed tomography showed unifocal (regional) cerebral hypoperfusion in two infants, multifocal (diffuse) cerebral hypoperfusion in three infants and normal perfusion in the other infant. Electroencephalograms obtained in near-time of the SPECT studies showed diffuse abnormalities in five infants with hypoperfusion on SPECT. Cranial MRI/CT showed diffuse and/or localized cerebral lesions in all infants, all of whom had corresponding areas of hypoperfusion on SPECT. In one patient whose spasms were stopped with anticonvulsants, SPECT was normal, in two patients SPECT showed unifocal lesions, while in another three patients whose spasms were decreased but not stopped, SPECT showed multifocal hypoperfusion.

CONCLUSIONS

This pilot study may indicate that there are CBF anomalies in symptomatic IS. The degree of CBF may be a predictor of prognosis and multifocal hypoperfusion may be a poor prognostic criteria in IS.

Palliative analgesic effect of Re-186 HEDP in various cancer patients with bone metastases

The clinical picture of bone metastases is manifested by pain and loss of mechanical stability. Standard treatment options for bone metastases include external beam radiotherapy and the use of analgesics. Due to a large number of lesions in many patients, the use of radionuclide therapy with beta emitters may be preferable. Re-186 hydroxyethylidene diphosphonate (Re-186 HEDP) is one of the radiopharmaceuticals suitable for palliative treatment of metastatic bone pain. The aim of this study was to investigate palliative and side effects of Re-186 HEDP in patients with different types of cancers.

MATERIAL & METHOD

Thirty one (17 male, 14 female) patients with various cancers (10 prostate, 10 breast, 4 rectum, 5 lung, 2 nasopharynx) and bone metastases were included in the study. Therapy was started with a fixed dose of 1295 MBq of Re-186 HEDP. If necessary, the same dose was repeated at least 3 times after an interval of 10-12 weeks; A total of 40 standard doses were given; 6 patients received repeated doses (3 doses in 3 patients, 2 doses in 3 patients). The patients with bone marrow suppression were excluded from the study. The pain relief was assessed the Eastern Cooperative Oncologic Group (ECOG) and the Karnofsky status index. All patients were evaluated with standard evaluation forms filled in daily for a maximum of 10 weeks.

RESULTS

The mean response rate was 87.5% in patients with breast and prostate cancer, 75% in patients with rectum cancer and 20% in patients with lung cancer. The overall response rate was 67.5%. The palliation period varied between 6 and 10 weeks, with a mean of 8.1+/-1.3 weeks. The maximal palliation effect was observed between the 3rd and 7th weeks. No serious side effects were seen except mild hematologic toxicity.

DISCUSSION & CONCLUSION

It is concluded that Re-186 HEDP is a highly effective agent in the palliation of metastatic bone pain in patients with prostate, breast and rectum cancer, but not effective in lung cancer. On the other hand, Re-186 seems to be a good alternative to Sr-89 because of its preferable physical characteristics (such as short half life and gamma energy emission), low side effect profile, early response and repeatability.

False-positive results obtained with stress myocardial SPECT in patients with right bundle branch block

PURPOSE

Right bundle branch block (RBBB) is a conduction defect that often is accompanied by nonspecific patient symptoms. The objective of this study was to evaluate the false-positive results obtained with TI-201 myocardial SPECT in patients with RBBB.

METHODS

Thirty-one patients (24 men, 7 women; age range, 35 to 78 years; mean age, 39 +/- 14 years) had nonspecific chest pain and electrocardiograph-proved RBBB, normal results of echography, and normal results of coronary angiography. None of them had a previous history or evidence of myocardial infarction. All patients underwent stress-rest TI-201 myocardial SPECT; 24 had normal images but 7 showed hypoperfusion in the inferolateral segments, both visually and quantitatively.

RESULTS

TI-201 myocardial perfusion scintigraphs must be evaluated carefully in RBBB because false-positive results are likely to occur as a result of functional changes produced by dissynchronous activation between the ventricles.

Brain SPECT findings in long-term inhalant abuse

This study evaluates brain perfusion in long-term inhalant abusers of toluene, acetone, benzene and derivatives. Ten patients in the age range 16-18 years (mean, 17.3+/-0.67 years), who had been inhalant dependent for a mean period of 48.3+/-6.2 months, but who had stopped using inhalants for 1-11 months (mean, 5.4+/-2.1 months), and ten controls (mean age, 17.3+/-0.67 years) were included in the study. Psychiatric tests, biochemical tests and Tc-99m-hexamethylpropyleneamine oxime (Tc-99m-HMPAO) brain single photon emission computed tomography (SPECT) were performed on all patients. Brain SPECT images were evaluated qualitatively and quantitatively. The mean IQ level was found to be 84 (by psychological tests). Brain SPECT showed non-homogeneous Tc-99m-HMPAO uptake and hypoperfusion areas in all patients (five left temporal, one right temporal, two left temporal plus bilateral parietooccipital, one biparietal and one left temporoparietal). Seven patients had hyperperfused foci (unifocal in five patients and multifocal in two patients). Six hyperperfused foci were in a parietal and one in a temporoparietal location. This study suggests that inhalant dependents exhibit serious abnormalities in brain SPECT images, including hypo-hyperperfusion foci and non-homogeneous uptake of the radiopharmaceutical. A further study with a larger number of patients and long-term follow-up may help to reach a more specific conclusion.

In-111 platelets used in evaluation of emboli and thrombi in patients with cerebrovascular accident

Studies with In-111 platelets were conducted to evaluate pulmonary embolus, deep vein thrombus and cardiac thrombus. This study aimed to evaluate active thrombi and possible new emboli in patients with cerebrovascular accident (CVA) in the first 24 hours by using autologous In-111 platelets. Twenty-five patients were included in the study. Carotid artery thrombi observed in 10 patients with this technique were confirmed by Doppler ultrasonography. Intracranial thrombi appearing in 3 cases were verified by X-ray computed tomography (CT). Scintigraphy of 8 patients who showed findings suggesting CVA in CT revealed no abnormal accumulation. This was attributed to the possibility that they were small in size, deep in location and/or were also quite aged. Abnormal accumulations observed in the lungs of 3 patients and in the mediastinum and pelvis in one patient were verified by other radiological methods. In-111 platelet study was found to be useful in patients with CVA to evaluate the active thrombi and possible emboli in the early period before clinical symptoms appeared.

Functional imaging in reading epilepsy: a case report

Reading epilepsy is an uncommon epileptic syndrome preferentially related to the temporoparietal region of the language dominant hemisphere. We report ictal and interictal brain perfusion SPECT images in a 28-year-old woman who was reading epilepsy.

Evaluation of gastrointestinal involvement of Behçet's disease by nuclear medical techniques

To evaluate the value of nuclear medicine procedures in the diagnosis of gastrointestinal involvement of Behcet's disease in asymptomatic patients, Tc-99m human immunoglobulin (HIG) and Tc-99m leucocyte (LC) whole body scintigraphies were performed on 30 patients with major symptoms of the disease. Comparison of the results with other diagnostic techniques showed that Tc-99m HIG whole body scanning can be a useful diagnostic aid before the disease becomes clinically active in the gastrointestinal system.

Evaluation of cardiac functions in patients with thalassemia major

It is known that a blood transfusion is necessary for survival in patients with thalassemia, but it may cause myocardial dysfunction due to myocardial siderosis as in other organs. The aim of this study was to evaluate myocardial perfusion by means of stress thallium scanning (MPS) and left ventricular functions by rest radionuclide ventriculography (RNV). Twenty-one patients at ages 9-16 (mean 12.1 +/- 3.2) who have been diagnosed with thalassemia for 4-15 years (mean 12.7 +/- 4.8) were included in the study. They had blood transfusions 78-318 times (mean 162.1 +/- 71). MPS and RNV was performed within two days after the any transfusion. MPS showed ischemia in 3 patients and normal perfusion in 18 patients. RNV revealed normal systolic parameters (wall motion, EF, PER, TPE) but diminished diastolic parameters (TPF, PFR) compared with normal values (p < 0.05). We conclude that ischemia or fixed defects may be seen in stress MPS as a result of cardiac involvement in patients with thalassemia. But, RNV is an important and preferable test for the early detection of subclinic cardiomyopathy. RNV may therefore show diastolic abnormalities before the systolic abnormalities show up.

Tc-99m dextran and Tc-99m HIG findings in patients with ulcerative colitis

PURPOSE

Various radionuclide methods have been studied for the evaluation of the disease activity and extent of ulcerative colitis and other protein-losing enteropathies. Recently, Tc-99m dextran and Tc-99m human immunoglobulin (HIG) have been used to detect inflammation and protein loss into the intestine, but only a few studies have been reported with these agents.

MATERIALS AND METHODS

In this study, Tc-99m dextran and Tc-99m HIG were used to evaluate disease activity and extent in patients with ulcerative colitis. These agents were used in 12 patients with active disease and in five patients in remission, and five healthy control participants also were included.

RESULTS

Large bowel activity was detected in 11 of the 12 patients with active ulcerative colitis using Tc-99m dextran and in 10 patients using Tc-99m HIG. Fifty-eight bowel segments were found to be active with endoscopy, 39 with Tc-99m dextran, and 31 with Tc-99m HIG. No intestinal activity was detected in the control participants. Grade 1 activity localization in the large bowel was detected in three patients with ulcerative colitis in remission using Tc-99m dextran and in one patient using Tc-99m HIG.

CONCLUSION

Tc-99m dextran is more sensitive for detecting disease activity and extent than is Tc-99m HIG.

Postoperative goitre recurrence rate in Turkey

A study was conducted on the incidence of postoperative nontoxic goitre in 206 patients. The mean period of postoperative observation was 7.8 years. The recurrence rate was 30.7% in the 26 patients to whom thyroxine was administered regularly and at doses of 0.15 mg/day or more in the postoperative period, and 46.9% in the 32 patients who received thyroxine regularly at low doses (0.10 mg/day). In contrast, recurrence rate was 71.4% in the 49 patients in whom use of thyroxine was irregular and 81.8% in the 99 patients who received no thyroxine. The recurrence rate was markedly reduced in the patients who used thyroxine regularly at doses of 0.15 mg/day or more as compared with those who used it irregularly or not at all. It was concluded that in Turkey, where iodine deficiency is a major contributory factor of the prevalence of goitre, postoperative administration of thyroxine is necessary in order to reduce the postoperative recurrence rate.

Parasternal lymphoscintigraphy using 99Tcm-dextran

99Tcm-dextran was evaluated as a lymphoscintigraphic agent in 10 normal volunteers and 24 patients with breast cancer. 99Tcm-dextran (0.5-1 mCi) in a volume of 0.1-0.2 ml was injected into the posterior rectus sheath in the subcostal site on one side. Scintigrams were obtained at 2-2.5 h after injection and the injection was repeated on the other side. The final image was taken at 4.5-5 h after the first injection. The normal distribution of lymph nodes and anatomical variations in scintigraphic images were first determined in normal subjects. In the patient group, eight scintigrams were evaluated as pathological and the rest as normal. In the 25 women whose lymphoscintigrams were normal the mean number of parasternal nodes visualized was six (range: 3-11). Bilateral symmetrical or asymmetrical chain was observed in 20 subjects (80%) and unilateral chain in five subjects (20%). There was cross-drainage in five subjects (20%). Supraclavicular lymph nodes were visualized in 11 subjects (44%). Varying abnormal images were obtained in eight patients. Our results are in good agreement with those reported in the literature, using radiocolloids. It is concluded that 99Tcm-dextran is a promising agent and may well replace radiocolloids because of the simplicity of the labelling procedure, stability of the label, easy availability and low cost.