Surgical Management of Pulmonary Aspergilloma

Records of 59 patients (41 males and 18 females) who underwent 70 operations for pulmonary aspergilloma in a 23-year period were examined retrospectively. Sixty-three operations were for primary treatment of pulmonary aspergilloma, and 7 were for complications of surgery. Twenty-six postoperative complications occurred in 19 patients. Three lobectomies that resulted in bronchopleural fistula were managed by intercostal muscle-flap closure and partial thoracomyoplasty. Two patients died within the first week of surgery. Surgery is the treatment of choice for most patients with pulmonary aspergilloma. Selective bronchial artery embolization is helpful only in combating hemoptysis, and this has been considered a temporary measure in most reports. Thus, open thoracotomy and anatomical resection are recommended as early as possible after the diagnosis is established.

Obstructive Sleep Apnoea, Glucose Tolerance and Liver Steatosis in Obese Women

In this study of obstructive sleep apnoea (OSA), glucose tolerance and liver steatosis in females from an obesity unit, 45 patients (mean age 46.8 years, mean body mass index 39.4 kg/m2, all non-diabetic and alcohol abstainers) underwent nocturnal polysomnography, a 2 h oral glucose tolerance test and abdominal ultrasonography. OSA, defined as an apnoea–hypopnoea index (AHI) of ≤ 10 events/h, was present in 20 patients (44%). Impaired glucose tolerance (IGT) was found in eight patients (40%) with OSA and three patients (12%) without OSA; there was a positive linear relationship between AHI and post-load glucose levels. On multivariate logistic regression analysis, IGT was predicted by OSA independently of age, waist circumference, systolic blood pressure and current smoking. Liver steatosis was present in 37 women (82.2%), of whom six had grade III steatosis. Of the variables tested, IGT was the only predictor of grade III steatosis. In conclusion, OSA is an independent predictor of IGT which, in turn, is associated with severe liver steatosis in an obesity unit-based sample of women.

The incidence of chronic thromboembolic pulmonary hypertension secondary to acute pulmonary thromboembolism

INTRODUCTION

Chronic thromboembolic pulmonary hypertension (CTEPH) is a curable and partially preventable complication, with a substantial incidence, leading to severe morbidity and mortality. The aim of the present study was to find out the incidence of CTEPH secondary to acute pulmonary thromboembolism (PTE) using non-invasive procedures such as ventilation/perfusion (V/Q) scintigraphy and pulmonary multidetector CT (MDCT) angiography in determining the diagnosis of CTEPH.

MATERIALS AND METHODS

The study included a total of 99 patients diagnosed with initial PTE between January 2010 and December 2012. The patients who received anticoagulant therapy at least for three months underwent transthoracic echocardiography (TTE) (n= 85). Thirty one patients with a SPAP value > 30 mmHg and/or an evidence of right ventricular dysfunction in TTE underwent MDCT pulmonary angiography and V/Q scintigraphy. The patients with an evidence of residual chronic thromboembolic signs in MDCT pulmonary angiography and/or segmental perfusion defect(s) in V/Q scintigraphy underwent right heart catheterization (RHC) (n= 7). The mean PAP was measured, and a vasoreactivity test was performed. During RHC, a non-contrast medium was delivered to the pulmonary arteries for pulmonary arteriography imaging.

RESULTS

Among patients diagnosed with PTE, 44 were male and 55 were female. The mean age was 60 ± 17 years. Of these patients, 63.6% had history of at least one additional disease and at least one risk factor for PTE. During diagnosis, 24 subjects were considered having massive, 61 submassive and 14 non-massive PTE. Nineteen (19.1%) patients received thrombolythic therapy. Other 80 (80.8%) patients received standard anticoagulant therapy with an INR value within the therapeutic range. In 79.8% of patients, thromboembolism was bilateral, and it was unilateral in 21.8%. After a minimum of 1 year, and maximum of 2 years follow up five subjects (5.5%) were diagnosed with CTEPH. The univariate analysis showed no association between the development of CTEPH and factors like; age, etiologic risk factors for PTE, receiving thrombolytic treatment, prevalence and type of PTE.

CONCLUSION

Potentially preventabl complication of pulmonary embolism; CTEPH, had a substantial incidence during follow-up.

Isolated carpal scaphoid dislocation

Isolated scaphoid dislocations are very rare. Options for the treatment of dislocation of the scaphoid include closed reduction and casting, closed reduction and percutaneous pinning, and open reduction and ligament repair. We report a case of this rare injury which was treated with open reduction, pinning and ligament repair.

The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients

OBJECTIVE

To assess the prevalence of obstructive sleep apnoea syndrome (OSAS) in AS patients.

METHODS

Thirty-one patients with AS were included in the study. The demographic data, spinal mobility measures and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were recorded for each patient. All participants underwent one night of sleep recording, which was performed using a polysomnography (PSG). Pulmonary function test (PFT) was performed for all subjects and symptoms of OSAS were questioned.

RESULTS

Seven (22.6%) of 31 AS patients had OSAS according to PSG assessments. The mean BMI, disease duration, BASDAI score, neck circumference and occiput-wall distance were higher in patients with OSAS, but the differences were not significant. The mean ages of patients with OSAS were significantly higher than the patients without OSAS. The prevalence of OSAS in patients under the age of 35 years was found to be 6.3%, whereas the prevalence of OSAS in patients at the age of 35 years or over was 40.0% (P = 0.037). The prevalence of OSAS in AS patients with a disease duration <5 years was 11.8% and its prevalence in AS patients with a disease duration of >or=5 years was 35.7% (P = 0.198). PFT was restrictive in 16 (53.3%) patients and obstructive in none.

CONCLUSIONS

The prevalence of OSAS in AS patients is higher than reported in the general population. The diagnosis of OSAS should be kept in mind and OSAS symptoms should be considered especially in AS patients at the age of >or=35 years and in AS patients with a disease duration of >or=5 years.

Obstructive sleep apnoea, cigarette smoking and serum testosterone levels in a male sleep clinic cohort

This study evaluated the impact of obstructive sleep apnoea (OSA) and smoking on total serum testosterone levels in 96 men (mean age 43.3 years; range 25 - 60 years) attending a sleep clinic. Fifty-five men (57.3%) had OSA, defined as an apnoea-hypopnoea index of > or = 15 events/h, recorded during overnight polysomnography, and 42 (43.8%) were current smokers. Mean serum total testosterone levels were significantly lower in OSA subjects (3.4 ng/ml) than in non-OSA subjects (3.9 ng/ml), whereas no significant difference was observed between current smokers and nonsmokers. In a multiple linear regression analysis, serum testosterone was negatively correlated with body mass index and the apnoea-hypopnoea index, but not with age and pack-years of smoking. Our results support previous observations regarding testosterone levels in men with OSA, but, contrary to some earlier reports, there was no positive relationship between smoking and total testosterone in the present cohort.

[Evaluation of the hemodialysis patient with Pittsburgh sleep quality index]

Sleep disturbances such as sleep-onset insomnia, frequent awakening, sleep-maintenance insomnia, and restless legs syndrome are extremely common in hemodialysis patient. Those additional problems to their chronic disease appear to have significant negative effects on quality of life and functional health status. This study was intended to evaluate the sleep quality and to identify of hemodialysis patients. Ninety-four patients on hemodialysis (45 females, 49 males) were admitted into this study. "Pittsburgh Sleep Quality Index" was administered to all patients to evaluate their sleep quality. Their mean age and duration of hemodialysis was 49.7 +/- 16.5 years and 31.5 (3-192) month. Sleep quality was determined as poorer (global score >or= 5) in 65 (69.1%) people. Older people and female incidence were significantly higher in patients with poorer sleep quality (p= 0.044 and p= 0.009 respectively). There was no significant difference in other parameter. Sleep quality and related parameters compared. There was not strong but significant relation between poor sleep quality with age, female gender, and hemoglobin (rs= 0.284 p= 0.006, rs= 0.301 p= 0.003 and rs= -0.216 p= 0.037 respectively). Logistic regression analyses showed independent effects of female gender on poor sleep quality. In conclusion, sleep quality had been impaired in patients with chronic hemodialysis, especially in women. Therefore, evaluation of the sleep quality of hemodialysis patients during clinical practice must be taken into consideration. Being able to find out the related factors with sleep disorders, advanced study supported with polysomnography must be done.

[Compliance to CPAP treatment and effects of treatment on anxiety and depression in patients with obstructive sleep apnea syndrome]

Obstructive sleep apnea syndrome (OSAS) causes numerous pathophysiological changes and influences neuropsychological system. Nasal continuous positive airway pressure (CPAP) is the gold standard treatment of OSAS. We aimed to evaluate the compliance of patients with severe OSAS to CPAP treatment and to compare the anxiety and depression scores before and at the 6th month of the treatment. Seventeen patients receiving CPAP treatment for OSAS that continued regular follow-up were accepted to the study. A questionnaire containing questions about demographic features, OSAS symptoms and Epworth sleepiness scale, Beck anxiety scale and depression scale was filled by the patients before and after CPAP treatment. Additionally, information concerning adverse effects of and compliance to CPAP treatment was obtained after CPAP treatment. Mean age of the patients was 48.4 +/- 8.4 (32-63); 14 (82.4%) of them were male and 3 (17.6%) of them were female. Snoring, witnessed apnea and excessive daytime sleepiness symptoms, and Epworth sleepiness scale scores were significantly decreased after CPAP treatment compared with those before treatment. Mean duration of CPAP device use at night was 5.6 +/- 2.1 (2-8) hours. Nine (52.9%) of the patients were using the device regularly every night and 8 (47.1%) of the patients were using it irregularly. The most frequent adverse effect of CPAP treatment was sore mouth, followed by mask discomfort and erythema on the nose. Anxiety and depression scores of the patients were significantly decreased after CPAP treatment compared with those before the treatment. As a conclusion, OSAS patients with high anxiety and depression scores benefit from CPAP treatment.

[Relation between traffic accidents and sleep apnea syndrome in truck drivers]

Obstructive sleep apnea syndrome (OSAS) is a disorder that causes excessive daytime sleepiness. Falling asleep while driving most often occurs during driving on empty roads, long distance drives, and those drives requiring low motor activity, and causes traffic accidents. We aimed to investigate the frequency of OSAS in long distance truck drivers and to evaluate the relation between OSAS and traffic accidents. A questionnaire containing demographic features, health statuses, OSAS symptoms of truck drivers and information about their accidents was filled with face to face interview. Three hundred and sixteen, male, long distance truck drivers were accepted to the study. Of the major symptoms of OSAS, snoring in 52.8%, excessive daytime sleepiness in 25.6%, witnessed apnea in 9.8%, all three symptoms in 2.8% of the drivers was determined. Ninety four of 316 (29.7%) drivers stated that they had traffic accidents. Twenty eight (29.8%) of those accidents caused loss of life. Nineteen (20.2%) drivers with accidents stated that the cause of the accident was falling asleep while driving. Snoring was present in 78.9% of those who had accidents due to sleeping, whereas in 51.5% of those who had accidents with other causes. Neck circumference and years of driving were significantly higher in drivers with accidents than those without. Snoring was significantly higher in those with a neck circumference > or = 42 cm, body mass index > or = 30 and number of accidents > or = 2. As a conclusion, OSAS risk factors and symptoms are commonly present in truck drivers and increases the risk for traffic accidents.

Evaluation of alveolar clearance by Tc-99m DTPA radioaerosol inhalation scintigraphy in welders

OBJECTIVES

The welding process produces metal fumes and gases which may affect respiratory health. Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) dynamic lung scanning is an easy, noninvasive method to assess disorders of alveolar-capillary barrier permeability secondary to epithelial damage. We aimed to investigate the alveolar clearance by Tc-99m DTPA radioaerosol inhalation scintigraphy in welders, to assess additive effects of exposure to welding fumes and cigarette smoking on clearance rate of alveolar epithelium and to determine the correlation between Tc-99m DTPA aerosol lung scintigraphy and spirometric measurements.

METHODS

Nine nonsmoking welders, 9 smoking welders, and a control group of 6 nonsmokers and 6 smokers were accepted to the study. Tc-99m DTPA radioaerosol inhalation scintigraphy was performed in all subjects. Clearance half time (Tl/2) was calculated by placing a monoexponential fit on the curves. Penetration index (PI) was also calculated on the first minute image. Pulmonary function tests of welders and control group were compared.

RESULTS

The mean T1/2 values of Tc-99m DTPA of the nonsmoking welders were significantly higher than those of the nonsmoking control group (82.1+/-24.3 min and 48.1+/-9.7 min, respectively; p = 0.003). The mean T1/2 values of Tc-99m DTPA of the smoking welders were higher than those of the smoking control group (53.3+/-24.5 min and 44.5+/-9.7 min, respectively; p = 0.510). PI of the nonsmoking welders was significantly higher than that of the nonsmoking control group (0.46+/-0.38 and 0.39+/-0.46 respectively; p = 0.004). PI of the smoking welders was significantly higher than that of smoking control group (0.43+/-0.38 and 0.37+/-0.45, respectively; p = 0.019). There was a negative correlation between T1/2 value and FEV1% (r = -0.468, p = 0.016), FVC% (r = -0.442, p = 0.024) and FEF25-75% (r = -0.391, p = 0.048) in the welders and control group. No statistically significant differences were found in the values of the standard pulmonary function tests of any of the subjects.

CONCLUSIONS

Welding seems to decrease alveolar clearance which causes an increase in the penetration index. This was considered to be due to fibrotic changes and increased number of alveolar macrophages induced by welding fumes.

Effects of N-acetylcysteine on the lung histopathology and oxidant-antioxidant status in rabbits exposed to cigarette smoke

We aimed to evaluate the effects of smoking on the histopathology and the oxidant-antioxidant status of lungs and to test the effects of N-acetylcysteine (NAC) on the induced changes. Rabbits were exposed to cigarette smoke (CS) in a glass chamber for one hour daily for one month. An NAC control group was given intraperitoneal NAC only. CS + NAC rats were exposed to smoke and given intraperitoneal NAC. A control group was exposed to clean air only. At the end of one month, animals were sacrificed and lung tissues were examined histopathologically. Blood levels of protein sulfhydryls, carbonyls, prostaglandin F(2alpha) (PGF(2alpha)) and malondialdehyde (MDA) were measured. Intraparenchymal vascular congestion and thrombosis, intraparenchymal hemorrhage, respiratory epithelial proliferation, number of macrophages in the alveolar and bronchial lumen, alveolar destruction, emphysematous changes and bronchoalveolar hemorrhage scores were significantly increased in rabbits exposed to CS compared with the control group. Protein sulfhydryls were significantly decreased; carbonyls, PGF(2alpha) and MDA levels were significantly increased in the smoke exposed rabbits. Administration of NAC to rabbits exposed to CS caused a reduction in the bronchoalveolar hemorrhage score and blood PGF(2alpha) levels. Other parameters were unaffected by NAC. Exposure to CS causes severe histopathological changes and negatively effects the oxidant-antioxidant status in the lungs of rabbits. A low daily dose of NAC has some ameliorative effects on histopathological changes and oxidant-antioxidant status of the lungs in smoke exposed rabbits.

Oxidant-antioxidant status and pulmonary function in welding workers

Welding is a process during which fumes, gases, electromagnetic radiation and noise are emitted as by-products. Metal oxide particles are particularly hazardous components of welding fumes. Welding has been found to be associated with respiratory symptoms and our objective in the present study was to study the effects of welding on pulmonary function and serum oxidant-antioxidant status. Fifty-one welding workers and 31 control subjects were recruited. Face to face interviews were conducted using the respiratory illness questionnaire adapted from the American Thoracic Society with the addition of demographic characteristics, work history and working conditions. Additionally physical examinations and spirometric measurements were performed at workplaces. Thiobarbituric acid reactive substances (TBARS), protein carbonyls, protein sulfhydryls (SH) and erythrocyte reduced glutathione (GSH) levels were measured to evaluate oxidant-antioxidant status in 34 welding workers and in 20 control subjects. No statistically significant differences were observed in age, height, weight, body mass index (BMI), smoking status and annual working durations between welding workers and controls. Coughing, sputting and wheezing were significantly higher in welding workers (p<0.05). When adjusted for age, BMI and smoking status in logistic regression, welding work showed a significant risk for chronic bronchitis (OR: 4.78, 95%CI: 1.30-17.54). Forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) and four parameters of forced expiratory flow (FEF: FEF(25), FEF(50), FEF(75), FEF(25-75)) levels measured in the welding workers were significantly lower than those in the control group (p<0.05). Serum TBARS and protein carbonyl levels were higher in welding workers than those in controls (p<0.001, p<0.05, respectively). On the other hand, total protein SH groups and GSH levels were significantly lower in welders than those in controls (p<0.05, p<0.001, respectively). Pulmonary function tests and oxidant-antioxidant status were found to be negatively affected in welding workers chronically exposed to welding fumes and gases. Preventive measures should be taken to improve the health status of these workers.

[Prevalence of habitual snoring and sleep-disordered breathing in primary school children in Afyonkarahisar]

Obstructive sleep apnea syndrome affects 0.7-3% of children and snoring is an important symptom. We aimed to evaluate the prevalence of habitual snoring and sleep-disordered breathing in primary school students in Afyonkarahisar city. There are 41 primary schools in üç education regions in Afyonkarahisar city. One school from each region was randomly selected and all the students in that school were given a questionnaire. Of the 1100 given questionnaires 786 (71.5%) were filled in adequately and were accepted for evaluation. Of the students 407 (51.8%) were girls and 379 (48.2%) were boys. Mean age was 9.9 +/- 2.0 (7-15). The prevalence of habitual snoring was found as 4.8%. With regard to gender, occasional snoring and habitual snoring was significantly more prevalent than never snoring in boys. The prevalence of sleep disordered breathing symptoms was found to be significantly higher in habitual snorers. Maternal and paternal smoking frequency and passive smoke exposure was more common in habitual snorers but there were no significant differences among the groups. Hyperactivity symptoms were significantly higher in habitual snorers. In our study, school performance was found to be 10.9 folds lower in habitual snorers than non-snorers. We think that questioning the obstructive sleep apnea syndrome symptoms in children and performing diagnostic procedures and treatment when suspected will decrease the morbidity.

[Knowledge and attitude of workers and patrons in coffee houses, cafes, restaurants about cigarette smoke]

A legislation about smoking restriction in all workplaces is under consideration in Turkey. In our study we evaluated the knowledge and attitudes of workers and patrons of cafes, restaurants and coffee houses about smoking ban in their work places. Twenty eight owners, 67 workers and 242 patrons in 12 coffee house, 12 restaurants and 7 cafes were interviewed. A desire to work in a smoke-free workplace was most frequent (79.8%) among coffee house group and 63.9% in cafe group, 57.8% in restaurants group. Smoking ban was most frequently requested by coffee house group and least frequently by cafe group. Coffee house and cafe groups were supposing a decrease in the number of patrons and incomes with such a legislation, whereas restaurant group was thinking that no change will occur. 45.4% of the coffee house patrons stated that they would less frequently visit that workplace in case of a smoking ban, whereas 47.8% of restaurant patrons stated that there would be no change with their frequency to visit there. A desire to work in a smoke-free workplace and requesting a smoking ban for all workplaces were more frequent among nonsmokers. Smokers stated that their frequency to visit those places would decrease in case of a smoking ban, whereas nonsmokers stated an increase in their frequency to visit those places. We think that informing the owners and workers of coffee houses, restaurants and cafes about these facts is very important and would increase the compliance to such a legislation.

Thein vitro antioxidant and antimicrobial activities of the essential oil and methanol extracts ofAchillea biebersteini Afan.(Asteraceae)

The essential oil and methanol extracts from A. biebersteinii Afan. (Asteraceae) were evaluated for their antimicrobial and antioxidant activities in vitro. The oil showed stronger antimicrobial activity than the extracts. Their antioxidant features were also evaluated using diphenyl-1-picrylhydrazyl (DPPH), inhibition of superoxide and hydroxyl radicals and inhibition of the lipid peroxidation assays. Particularly, polar subfraction of the methanol extract showed antioxidant activity. The GC-MS analysis of the oil has resulted in the identification of 23 components; piperitone, eucalyptol, camphor, chrysanthenone and borneol were the main components. Antimicrobial activity tests carried out with the fractions of the oil showed that the activity was mainly observed in those containing eucalyptol and camphor, in particular, followed by borneol and piperitone.

Myocardial indium-111-antimyosin uptake in essential hypertension

AIM

Evaluation of myocardial uptake of (111)In-anti-myosin antibodies in patients with essential hypertension for the verification of our hypothesis that it may increase in stage 1 in the left ventricle as a result of myocardial damage.

PATIENTS, METHODS

Twelve men (mean age: 59+/-2.4 years) suffering from angina like symptoms and essential hypertension in clinical stage 1 according to the JNC-VI criteria were included into the study. These patients showed normal perfusion as revealed by thallium-201 myocardial study and coronary angiography. Left ventricular mass index was determined in echocardiography. Planar antimyosin images were obtained 48 h after the intravenous injection of the tracer. Heart to lung ratios were calculated as a parameter of myocardial tracer uptake using appropriate region of interests; values>1.52 were considered as abnormal.

RESULTS

We observed increased anti-myosin uptake (mean: 1.71+/-0.12) consistent with myocardial damage in 11 of 12 patients. Nine of 12 patients had a left ventricular hypertrophy with left ventricular mass index values (mean: 131 g/m(2)+/-9.48) above 115 g/m(2). Heart to lung ratio was correlated significantly to left ventricular mass index (r = 0.902, p<0.001) and duration of hypertension (r = 0.948, p<0.001).

CONCLUSION

Our results suggest that (111)In-antimyosin imaging may indicate myocyte damage in early phases of hypertensive heart disease.

Physicians' approach to the diagnosis and treatment of tuberculosis in Afyon, Turkey

OBJECTIVE

To evaluate physicians' approaches to the diagnosis and treatment of tuberculosis in Afyon, Turkey.

MATERIAL AND METHODS

A questionnaire on tuberculosis was filled out by 208 physicians (46 specialists and 162 general practitioners).

RESULTS

Bacteriology was the preferred method of diagnosis among 75% (n = 156) of the physicians. For treatment of newly diagnosed tuberculosis, 64.4% prescribed a three-drug and 30.8% a four-drug combination. The combination most often selected was HRE (36.5%). Preferred treatment durations were 9 (38.5%) and 6 (34.6%) months. For patients with treatment failure, 20.2% of the physicians would add a new drug to the existing regimen, while 65.4% would refer the patient to a specialised tuberculosis unit. For the treatment of childhood tuberculosis, 38.5% of the physicians thought a two-drug treatment was adequate. For tuberculosis during pregnancy, 9.7% of the physicians offered treatment after the pregnancy, while 11.5% offered treatment after abortion.

CONCLUSION

The knowledge of the physicians about the diagnosis and treatment of tuberculosis was deemed insufficient. Additional educational resources for physicians may contribute to improvements in tuberculosis control.

Compositions and the in vitro antimicrobial activities of the essential oils of Achillea setacea and Achillea teretifolia (Compositae)

GC-MS analysis of the isolated essential oils from air-dried aerial parts of Achillea setacea and Achillea teretifolia, an endemic taxon, resulted in the identification of 51 constituents (79.8% of the total oil) and 42 constituents (87.1% of the total oil), respectively. Eucalyptol (1,8-cineole) was the major constituent of both oils studied (18.5 and 19.9%, respectively). The antimicrobial activities of the essential oils were individually evaluated against 14 microorganisms. Both oils exhibited inhibitory effects on Clostridium perfringens, Acinetobacter lwoffii and Candida albicans with a range of minimum inhibitory concentration values extended from 0.28 to 2.25 mg/ml. Camphor and their derivatives, borneol, terpinen-4-ol and eucalyptol (1,8-cineol) can be considered as the main antimicrobial constituents of the oils studied.

The prevalence of asthma among secondary school students in Afyon, Turkey

Ethnic origin has been reported to affect the prevalence of atopic diseases in several studies in different parts of the world. The aim of this study was to determine the current and cumulative prevalence of asthma, allergic rhinitis, atopic dermatitis and reactivities to allergen skin prick tests (SPT) among secondary school students in Afyon, Turkey. The data of the first stage were collated through the application of the European Community Respiratory Health Survey Questionnaire on 1,400 students (1,366 were properly completed) registering at various schools in Afyon-Turkey, in the academic year 2000-2001. At the second stage, a physical examination and SPT were performed on 121 students. Of the students within the study group, 53 (3.9%) had experienced an asthma attack within the previous 12 months, 49 (3.6%) had a past history of asthma attacks and 167 (12.2%) reported wheezing attacks within the previous 12 months. The cumulative prevalence of asthma, rhinoconjunctivitis and dermatitis were found to be 7.46%, 8.10% and 3.5%, respectively. A positive SPT reaction to at least one allergen was found in 15.7% of the students. SPT positivity was 11.13% in symptomless students and 20.3% in asthmatic students. In analysis of logistic regression, a history of atopy, as determined in the questionnaire, was seen to be significantly correlated with SPT positivity. The prevalence of self-reported asthma and/or asthma-like symptoms was shown to be lower in students living in Afyon than other countries. Asthma and asthma-like symptoms were found to be significantly more prevalent among students who smoked.

Lipid peroxidation and glutathione peroxidase activity in chronic obstructive pulmonary disease exacerbation: prognostic value of malondialdehyde

Results of recent studies have indicated that during exacerbation of chronic obstructive pulmonary disease (COPD), antioxidant capacity is lower and the levels of lipid peroxidation products are higher than those in age-matched healthy subjects. The aim of this study was to assess the time course of changes in oxidant stress during the treatment of exacerbation of COPD. For this purpose, we measured erythrocyte glutathione peroxidase (GPx) activity and serum levels of the lipid peroxidation product malondialdehyde (MDA) in 18 male patients with acute exacerbation of COPD. Fifteen healthy non-smokers having no history of lung disease served as control subjects. Mean erythrocyte GPx values of patients were 45.54 +/- 9.04 u/gHb on admission and had increased to 72.77 +/- 9.68 by the tenth day of treatment, but still remained lower than those of healthy subjects (83.13 +/- 10.91) (p=0.007). Serum MDA values in patients were Vol. 12, No. 1, 2001 significantly higher (2.68 +/- 1.28 nmol/ml) than those in control subjects (1.04 +/- 0.36 nmol/ml) (p=0.000) and returned to normal values by the tenth day of treatment (1.08 +/- 0.36 nmol/ml) (p=0.766). Erythrocyte GPx values in patients who were current smokers (39.87 +/- 3.82 u/gHb) were lower than those in ex-smokers (49.15 +/- 9.67 u/gHb) (p=0.021). Moreover, serum MDA values in patients who were current smokers (3.32 +/- 1.18 nmol/ml) were higher than those in ex-smokers (1.66 +/- 0.60 nmol/ml) (p=0.007). The results show that oxidative stress in patients with acute exacerbation of COPD is related to higher MDA levels that return to normal conditions during the course of treatment. In conclusion, the results suggest that MDA levels can serve as a marker of prognosis and of the success of treatment of the exacerbation of COPD.

The value of small-bore catheter thoracostomy in the treatment of malignant pleural effusions

BACKGROUND

Malignant pleural effusions can cause severe debilitating symptoms and impair the quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. Large-bore thoracostomy tubes have traditionally been used for drainage and sclerotherapy. More recently, the use of small-bore catheters has been studied.

OBJECTIVES

To assess the efficacy and safety of small-bore catheter (Pleuracan) thoracostomy combined with talc sclerotherapy for palliative treatment of malignant pleural effusions.

METHODS

Between May 1998 and March 2000, 24 consecutive patients presenting at our inpatient clinic were studied. Follow-up radiography at the end of the 1st month (immediate response) and 3rd month (long-term follow-up) after talc pleurodesis was performed to assess the response rates.

RESULTS

Of the 24 patients included, 2 patients did not show lung expansion after pleural drainage. Two patients died within 30 days after talc pleurodesis and 1 did not undergo 30-day postpleurodesis radiography. The remaining 19 patients made up the study group to assess the response rates (8 men, 11 women). Overall response rates of talc pleurodesis via small-bore catheter were found to be 84.2% [complete response (CR): 68.4%, partial response (PR): 15.8%] at 30-day and 78.6% (CR: 57.2%, PR:2 1.4%) at 90-day follow-up, respectively. One patient reported moderate pain during catheter placement. Four patients experienced mild to moderate pleuritic chest pain, shortness of breath, or both within 4 h after instillation. Seven of the 22 patients (31.8%) had a transient fever (< or =39.0 degrees C) 6-24 h after talc instillation that lasted less than 24 h and was successfully treated with acetaminophen. One patient had significant subcutaneous emphysema that resolved in 24 h. Four patients died because of tumor progress (2 patients in the 1st month and 2 patients between 30 and 90 days).

CONCLUSION

Pleurodesis can successfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospective randomized study, comparing this device (Pleuracan) and a 'standard' 16- to 24-french chest drain, should be performed.

Allergic rhinitis in Rosa domescena cultivators: a novel type of occupational allergy?

After the diagnosis of allergic rhinitis due to Rosa domescena was suspected in one subject with skin prick and nasal provocation tests, we recruited all other workers employed in rose cultivation in Yakaören village, Isparta. From May 2000 to July 2000 (exposure period 'time of rose handling'), we studied 600 individuals employed in rose cultivation. A questionnaire was administered by a physician, and skin testing was done by a nurse on 75 individuals suffering from asthma and/or rhinitis. Sera from these 75 subjects were available for immunologic testing. The diagnosis of atopy against rose was based on the presence of work-related symptoms, positive skin prick test (SPT) with rose extracts, and positive RAST. While no subject reported asthmatic symptoms, twenty of them reported either rhino-conjunctivitis, rhinitis or both on exposure to Rosa domescena. Fourteen of these subjects had increased specific IgE levels to Rosa domescena. Eleven (78.5%) also had a positive skin reaction to Rosa domescena. Out of the six negative sera with normal specific IgE levels to rose, only two (33.3%) had positive skin reactivity. No subject had significant daily peak expiratoy flow rate (PEFR) variations. We conclude that exposure to Rosa domescena may represent a risk for allergic rhinitis. The possibility of an occupational rose allergy should therefore be taken into consideration in the subjects working in rose cultivation.

Pulmonary involvement in Behçet's disease: evaluation of 123 I-MIBG retention

Pulmonary involvement in Behçet's disease (BD) is reported to indicate poor prognosis and high mortality. Our aim was to evaluate the pulmonary vascular status in BD. As 123I-meta-iodobenzylguanidine (123I-MIBG) shares the same uptake, storage and release mechanisms as norepinephrine, associated with the functional state of pulmonary endothelium, it may reflect endothelial injury. Twenty-five patients (13 males, 12 females; mean age, 36.44 years) and 12 age-matched controls were included. After intravenous injection of 123I-MIBG, thorax images were taken at 15 min and 4 h. Appropriate regions of interest were drawn, and heart to mediastinum (H/M) ratios and lung retention indices (LRI) were calculated. The difference between the LRI of controls (75.6+/-4%) and patients (87.7+/-10%) was found to be extremely significant (P<0.005). The LRIs of active (92.85+/-12%) and inactive (83.65+/-5%) states of BD were significantly different (P<0.05) from each other. There was no significant difference between the H/M ratios of controls (2.4+/-0.27) and patients (2.39+/-0.31) or between patients in active and inactive disease states. Our study revealed prolonged lung retention of 123I-MIBG in BD, probably reflecting the severity of the disease. In conclusion, 123I-MIBG lung retention is a valuable finding in the evaluation of pulmonary vascular status and may be a potential marker of prognosis in BD.

Changes in the mitochondrial proteome from mouse hearts deficient in creatine kinase

Creatine kinase (CK) is an abundant enzyme, important for maintenance of high-energy phosphate homeostasis in many tissues including heart. Double-knockout CK (DbKO-CK) mice missing both the muscle (MM) and sarcomeric mitochondrial (ScMit) isoforms of CK have recently been studied. Despite a large change in skeletal muscle function in DbKO-CK mice, there is little functional change in the heart. To investigate whether there are specific changes in cardiac mitochondrial proteins associated with the loss of MM- and ScMit-CK isoforms, we have used difference gel electrophoresis (DIGE) to compare mitochondrial proteins from wild-type and DbKO-CK mice. Mass spectrometry fingerprinting was used to identify 40 spots as known mitochondrial proteins. We have discovered that the loss of MM- and ScMit-CK isoforms did not cause large scale changes in heart mitochondrial proteins. The loss of ScMit-CK was readily detected in the DbKO-CK samples. We have also detected a large decrease in the precursor form of aconitase. Furthermore, two mitochondrial protein differences have been found in the parent mouse strains of the DbKO-CK mice.

Penicillin resistance in Streptococcus pneumoniae in Isparta

OBJECTIVE

The first case reports of infection with penicillin-resistant pneumococci were made in Australia in 1967 and South Africa in 1977. Since this time the increasing emergence of penicillin- resistant strains of Streptococcus pneumoniae have been a serious therapeutic problem. Therefore, the aim of the present study was to determine the penicillin resistance of S. pneumoniae strains isolated in the laboratory. The effect of procaine penicillin treatment against these strains was also investigated.

METHODS

Sensitivity testing was done by disc diffusion method using oxacillin discs. Minimal inhibitory concentration (MIC) values were determined in tests with penicillin by the use of E-test (AB Biodisc, Solna, Sweden). Patients were treated with 2 x 800,000 U of i.m. procaine penicillin every 12 h for 10 days.

RESULTS

Thirty-seven strains of S. pneumoniae were isolated from the sputa of adult patients who had pneumonia. Moderately resistant (0.12-1.00 microg/mL) and penicillin-sensitive (< or = 0.06 microg/mL) strains were identified in nine (24.3%) and 28 (75.7%) isolates, respectively. There were no high-level penicillin-resistant strains in the study. There was no therapeutic failure.

CONCLUSION

These results suggest that procaine penicillin may still be useful in the empirical therapy of pneumococcal pneumonia.

Evaluation of dysrhythmia in children with muscular dystrophy

Myocardial involvement and dysrhythmia are common findings with muscular dystrophy and are among the leading causes of death. The authors evaluated rhythm and conduction abnormalities in children with muscular dystrophy by electrocardiography, signal-averaged electrocardiography, and Holter monitoring. Twenty-nine patients (mean age, 8 years) and 29 healthy control subjects were included in the study. Sixty-two percent of patients had electrocardiographic abnormalities defined as deep Q waves in V6, tall R waves in V1, and QRS axis deviation. The cardiomyopathy index was significantly greater in the patient group whereas QT and QTc dispersion values showed no significant difference. Holter monitoring revealed premature atrial and ventricular contractions more frequently than normal. However all were classified as Lown I and II. Mean heart rate was significantly higher in the patient group. The electrocardiograms of 41% of the patients showed late potentials. No relationship with these changes and cardiac function was observed. During the study, one patient died whose cardiomyopathy index was longer and had late potentials detected with signal-averaged electrocardiography. In conclusion, standard electrocardiography, cardiomyopathy index, signal-averaged electrocardiography, and Holter monitoring are valuable and reliable monitoring methods in children with muscular dystrophy.

Detection of complement factor B in the cerebrospinal fluid of patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy disease using two-dimensional gel electrophoresis and mass spectrometry

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary condition with onset in mid-adulthood and is associated with mutations in the Notch-3 gene. (Joutel, A., Corepechot, C., Ducros, A., Vahedi, K., Chabriat, H., Mouton, P., Alamowitch, S., Domenda, V., Cecilion, M., Marechal, J., Vayssiere, C., Cruaud, C., Cabanis, E.A., Ruchoux, M.M. , Weissenvach, J., Bach, J.F., Bousser, M.G. and Tournier-Lasserve, E., Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia. Nature, 383 (1996) 707-710) Ultrastructural examination of the pathology of the cerebral infarcts reveals deposits in the vascular smooth muscle cells of the small arteries of the brain, but there is no obvious indication how the Notch-3 mutations give rise the observed pathology, nor is there any information on the exact nature of the deposits. We have investigated cerebrospinal fluid (CSF) from three CADASIL cases with known mutations in Notch-3 using two-dimensional gel electrophoresis. CSF from these patients was compared to that of six controls. We detected a single spot in the protein maps of patients which was absent from all the controls. In-gel tryptic digestion of this protein followed by mass spectrometric analysis of the tryptic fragments and a database search identified the spot as human complement factor B. These preliminary findings suggest that the alternative complement pathway may play a role in the pathogenesis of CADASIL.

Experimental evaluation of retrograde cerebral perfusion by single photon emission computed tomography technique (SPECT)

BACKGROUND

Protection of the brain is of vital importance during aortic arch aneurysms. In this study efficiency of retrograde cerebral perfusion was evaluated with the use of single photon emission computed tomography technique (SPECT) by using 99mTc hexamethylpropylene amine oxime (HMPAO).

METHODS

Four animals were used. The internal maxillary vein was the site of retrograde cerebral perfusion. The animals were studied after the heart rate and respiration were stopped with the use of the high dose drug administration and the brain was perfused with cold Ringer's lactated solution. After this procedure, 99mTc HMPAO-SPECT study was performed.

RESULTS

In one animal we did not get any cerebral image because of the competent venous valve in the internal maxillary vein. In the remaining animals, normal brain perfusion was achieved.

CONCLUSIONS

99mTc HMPAO-SPECT study documented that blood flow via the retrograde way meets the metabolic demand of the brain. Retrograde delivery of 99mTc HMPAO did not conclude any poorly perfused area in the brain when in given both sides and all parts of the brain can be effectively perfused by cerebral venous system in hypothermic conditions.

D2 receptor imaging with iodine-123-iodobenzamide brain SPECT in infants with hypoxic-ischemic brain injury

The purpose of this study was to evaluate the striatal dopamine D2 receptor density in infants with perinatal hypoxic-ischemic brain injury (HIBI) using 123I-iodobenzamide (IBZM) brain SPECT and to correlate the findings with the severity of HIBI and neurologic outcome.

METHODS

Twenty infants who were diagnosed to have perinatal HIBI were included in this study. They were classified as having mild (n = 6), moderate (n = 10) or severe (n = 4) HIBI according to their neurologic findings at birth using the criteria of Sarnat and Sarnat. Neurologic outcome of these infants was determined by serial neurologic examinations and the Denver developmental screening test; 10 infants recovered without any deficit and the remaining 10 were affected to a degree varying from motor impairment to cerebral palsy. All 20 infants were examined using 123I-IBZM brain SPECT at age 7.8 +/- 2.3 mo. Transaxial slices were obtained 2 hr after intravenous injection of 300 micro ci (11.1 MBq) 123I-IBZM and the activity ratios of striatal to occipital cortex (ST/OC) were calculated.

RESULTS

The mean ST/OC ratios in patients with mild, moderate and severe HIBI (1.219 +/- 0.078, 1.097 +/- 0.069 and 0.813 +/- 0.140, respectively) were significantly different from each other (p = 0.001). The infants who recovered from HIBI without any neurologic sequelae had higher mean ST/OC ratios than the others (1.184 +/- 0.010 versus 0.969 +/- 0.160, p = 0.002).

CONCLUSION

The results of this study show that in infants with HIBI, striatal D2 receptor density decreases as the severity of injury increases. The D2 receptor density is higher in infants who recover without neurologic deficits compared to those who are affected neurologically. Dopamine D2 receptor imaging can be used to assess the severity of HIBI in children.

Technetium-99m-HMPAO brain SPECT in anorexia nervosa

Eating disorders have been redefined in recent years. Brain imaging techniques are useful in demonstrating the association between the morphologic and the functional cerebral changes in these cases. We report 99mTc-HMPAO brain SPECT findings in two patients with anorexia nervosa, before and after the treatment. While the detailed neurologic and laboratory examinations, including EEG and cranial CT, were within normal limits before therapy, SPECT study revealed diffuse bilateral hypoperfusion in frontal, parietal and frontotemporal areas which was more prominent in the left hemisphere. Post-treatment SPECT studies obtained after a clinical remission period of 3 mo showed normal brain perfusion in both patients. The pre- and post-treatment SPECT studies accurately reflect the functional state of the patients, and this technique may be used to follow-up the effect of treatment and predict the clinical response to therapy in patients with eating disorders.

Prolonged lung retention of iodine-123-MIBG in diabetic patients

Iodine-123-MIBG has been introduced as a biochemical marker in assessing pulmonary endothelial cell integrity and myocardial beta-adrenergic sympathetic innervation. The aim of this study was to evaluate 123I-MIBG lung uptake in diabetic patients with and without coronary artery disease.

METHODS

Forty-four nonsmoking patients with normal respiratory function tests were included: 12 diabetics, 11 diabetics with coronary artery disease, 14 nondiabetic patients with coronary artery disease and 7 age-matched controls were imaged with 123I-MIBG and 201Tl scintigraphy. The lung retention of 123I-MIBG, cardiac sympathetic innervation (heart-to-upper mediastinum ratio of 123I-MIBG) and 201Tl lung-to-heart ratio were determined in all cases.

RESULTS

In diabetics with coronary artery disease, significantly prolonged lung retention and decreased cardiac uptake of 123I-MIBG were found. The lung retention of 123I-MIBG was inversely correlated with the heart-to-upper mediastinum ratio in this group. Lung-to-heart ratios of 201Tl were significantly increased in patients with coronary artery disease but there was no significant difference between diabetics and nondiabetics.

CONCLUSION

Prolonged lung retention of 123I-MIBG was associated with decreased cardiac sympathetic innervation in diabetic coronary artery disease patients. It seems that passive pulmonary congestion or cardiac dysfunction itself did not influence 123I-MIBG lung uptake. Increased lung extraction of 123I-MIBG is highly suggestive of ongoing pulmonary endothelial dysfunction together with ischemic events in diabetics.

Arteriovenous shunting in patients with multiple myeloma and high-output failure

High-output cardiac failure is one of the cardiovascular problems associated with multiple myeloma and frequently seen in patients with extensive bone lesions. The purpose of this study was to search arteriovenous shunting in patients with multiple myeloma and cardiac failure.

METHODS

After the exclusion of other causes of congestive heart failure, 11 patients whose cardiac indices were higher than or equal to 4 liter/min/m2 were selected for the study (7 women, 4 men; mean age 59.64 +/- 8.92 yr). All patients had Stage II-III disease and femoral involvement in radiological examination. Arteriovenous shunting was determined by means of intra-arterial injection technique of 99mTc-macroaggregated albumin (MAA) particles. A quantitative analysis of all scans was performed, and the results were correlated with cardiac index.

RESULTS

Mean cardiac index was 4.33 +/- 0.36 liter/min/m2 in the study group. In all cases, arteriovenous shunting was detected (18.70% +/- 17.29%), and inhomogenous, increased radioactivity accumulation was revealed in the femoral region (lesion-to-background ratio 2.71 +/- 2.08). This zone corresponded to the area of infiltration in a radiograph. A significant correlation was found between shunting values and cardiac indices (r = 0.7899, p = 0.004, Spearman). Although all patients had varying degrees of anemia, we did not find such a relationship between the degree of anemia and cardiac index.

CONCLUSION

Arteriovenous shunting within involved skeleton contributes significantly to the development of high-output cardiac failure in multiple myeloma.

201Tl scintigraphy in the evaluation of palpable and nonpalpable breast lesions: correlation with mammography and ultrasonography

AIM

Our goal was to determine the clinical usefulness of Tl-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings.

METHODS

Tl-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of Tl-201. Visual and semiquantitative interpretation was performed.

RESULTS

Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. Tl-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by Tl-201 scintigraphy. The smallest mass lesion detected by Tl-201 measured 1.5 x 1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. Tl-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed Tl-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated Tl-201. Tl-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by Tl-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 +/- 0.38 (mean +/- SD) and 1.48 +/- 0.32 (p > 0.05), 1.87 +/- 0.65 and 1.34 +/- 0.20 (p < 0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p > 0.05).

CONCLUSION

Overall, Tl-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of Tl-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

Difference gel electrophoresis: a single gel method for detecting changes in protein extracts

We describe a modification of two-dimensional (2-D) polyacrylamide gel electrophoresis that requires only a single gel to reproducibly detect differences between two protein samples. This was accomplished by fluorescently tagging the two samples with two different dyes, running them on the same 2-D gel, post-run fluorescence imaging of the gel into two images, and superimposing the images. The amine reactive dyes were designed to insure that proteins common to both samples have the same relative mobility regardless of the dye used to tag them. Thus, this technique, called difference gel electrophoresis (DIGE), circumvents the need to compare several 2-D gels. DIGE is reproducible, sensitive, and can detect an exogenous difference between two Drosophila embryo extracts at nanogram levels. Moreover, an inducible protein from E. coli was detected after 15 min of induction and identified using DIGE preparatively.

Evaluation of pentavalent Tc-99m DMSA scintigraphy in small cell and nonsmall cell lung cancers

AIM

The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma.

METHODS

Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex.

RESULTS

Histopathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 +/- 0.32) and NSCLC (1.43 +/- 0.19) tumour types did not show statistical difference (p > 0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases.

CONCLUSION

Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.

Comparison of indium-111 octreotide and thallium-201 scintigraphy in patients mammographically suspected of having breast cancer: preliminary results

Indium-111 octreotide and thallium-201 scintigraphic studies were compared in 21 patients (16 with palpable and five with non-palpable lesions) suspected of having breast malignancies on the basis of mammography. Early (15 min) and late (3 h) 201Tl (111 MBq) and 4-h and 24-h 111In-octreotide (111-148 MBq) static planar anterior images (matrix 256 x 256) were obtained on separate days. Images were evaluated both visually and quantitatively. Biopsy was performed following the imaging studies. Histopathology revealed 17 breast carcinomas (15 cases of invasive ductal carcinoma, one mucinous adenocarcinoma and one intraductal carcinoma) and four benign breast lesions (two fibroadenomas, one abscess and one case of fat necrosis). The means histopathological tumour size (mean largest diameter) was 3.38 +/- 1.9 cm. 111In-octreotide detected 16 of the 17 breast cancers (94%) while 201Tl detected 13 of them (76%). Both 111In-octreotide and 201Tl missed one non-palpable carcinoma showing only an isolated cluster of microcalcifications on mammography. The smallest tumour size detected by both agents 1.5 x 1.5 cm. Of the four benign lesions, only the breast abscess revealed both 201Tl and 111In-octreotide uptake. 111In-octreotide scan also showed tracer uptake in five of the six patients with histologically proven axillary metastases, while four of these six patients showed 201Tl uptake. The tumour/background (T/B) ratios of late 111In-octreotide and 201Tl images were 1.71 +/- 0.38 and 1.46 +/- 0.30 respectively (P = 0.039). In this preliminary study, 111In-octreotide yielded more favourable results than 201Tl in the detection of breast carcinomas. However, the diagnostic efficacy of 111In-octreotide imaging needs to be investigated in larger patient series.

Tl-201 scintigraphy, mammography and ultrasonography in the evaluation of palpable and nonpalpable breast lesions: a correlative study

PURPOSE

To determine the feasibility of Tl-201 as a tumor localizing agent in palpable and nonpalpable breast lesions, in comparison with mammography and ultrasonography (US), and to evaluate the contribution of these modalities to each other in obviating biopsy.

MATERIALS AND METHODS

Seventy-two palpable and nonpalpable breast lesions were prospectively classified as benign, indeterminate, or malignant according to the sonographic and mammographic criteria and were further analyzed with Tl-201 scanning. These classifications were compared with biopsy results. The sensitivity, specificity, accuracy, false positive and false negative rates (FPR, FNR), negative and positive predictive values (npv, ppv) were calculated for each individual modality and combination of modalities to evaluate the contribution of these three techniques to each other.

RESULTS

Of 72 lesions 52 were histologically malignant and 20 were benign. Overall, mammography was the most sensitive (92%) and Tl-201 was the most specific (75%) of the three modalities. Mammography + Tl combination was the most specific (90%) and accurate (97%) of dual combinations. In mammographically or sonographically indeterminate cases, Tl-201 was much more specific (75% versus 37% for mammography and US) and more accurate (82% versus 36% for mammography and 54% for US) than the other two modalities, and mammography + Tl combination was significantly superior to other dual combinations (87% specific and 91% accurate). Use of Tl-201 scanning as an adjunct to mammography + US combination increased the specificity, ppv, and accuracy rates overall, particularly in mammographically or sonographically indeterminate cases.

CONCLUSIONS

In mammographically and sonographically indeterminate breast lesions thallium scanning may be offered as a third step of investigation to obviate biopsy.

Evaluation of therapy response in children with untreated malignant lymphomas using technetium-99m-sestamibi

The aim of this study was to investigate the relationship between 99mTc-sestamibi accumulation in tumors and response to chemotherapy in children with untreated malignant lymphomas.

METHODS

Twenty-four children with malignant lymphoma (16 with Hodgkin's disease and 8 with non-Hodgkin's lymphoma) were studied with 201Tl and then with 99mTc-sestamibi scintigraphy before any therapeutic intervention. Visual and quantitative interpretation of 201Tl and 99mTc-sestamibi scans were performed. Visual uptake scores > or = 2+ were considered positive studies for 201Tl and 99mTc-sestamibi scintigraphy. Remission rates were evaluated at the end of induction therapy; patients were then followed clinically for 1-2 yr.

RESULTS

All 17 patients who had positive 99mTc-sestamibi scans subsequently had a complete response to chemotherapy; all seven patients who had negative 99mTc-sestamibi scans subsequently had partial or no response to chemotherapy, irrespective of the lymphoma type. The mean tumor-to-background ratios of patients with complete response and with partial or no response were 1.395 +/- 0.2 and 1.031 +/- 0.05 (p = 0.0002), respectively. Thallium-201 scintigraphy results were not related to the response to chemotherapy.

CONCLUSION

Technetium-99m-sestamibi scintigraphy can provide information predicting the response to chemotherapy in patients with malignant lymphoma.

Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery

OBJECTIVE

Surgery can only offer palliation in an attempt to slow the progression of malignant pleural mesothelioma (MPM). We want to assess the effectiveness and safety of pleurectomy/decortication in establishing a tissue diagnosis, and controlling pleural fluid accumulation and symptoms in patients with MPM.

METHODS

We reviewed our pleurectomy results in 100 patients with MPM over a 19 year period. Major symptoms were chest pain, cough and dyspnea, and radiographic findings included pleural mass, pleural fluid and constriction of involved hemithorax.

RESULTS

Approximately two thirds of the patients underwent surgery prior to tissue diagnosis. Eighty-nine patients had stage I and stage II disease, 8 and 81%, respectively. The patients underwent subtotal (44%) or total pleurectomy (56%). The surgical mortality rate was 1% (1/100) and the morbidity rate was 22%. Morbidity included prolonged air leak (n = 12), empyema (n = 6), reaccumulation of pleural fluid (n = 2) and wound infection (n = 2). Palliative results included dyspnea and cough relief in all patients, chest relief in 60 (85%) and pleural fluid control in 52 (96%) patients. Median survival was 17 months in MPM patients.

CONCLUSIONS

We conclude that pleurectomy/decortication safely provides both tissue diagnosis and effective of pleural effusion and symptoms and therefore excellent palliation in patients with MPM.

Brain SPECT evaluation of patients with pure photosensitive epilepsy

This study was performed to determine the utility of 99mTc-HMPAO brain SPECT in evaluating patients with pure photosensitive epilepsy.

METHODS

Seven patients (2 boys, 5 girls), aged 8 to 15 yr (mean 11.1 +/- 2.5 yr), were studied. All patients underwent a detailed neurologic examination, interictal and ictal EEGs, CT and/or MRI and SPECT imaging. The baseline SPECT study was performed during the interictal period and the activation study was performed while the patients were having seizures provoked by watching television.

RESULTS

The baseline SPECT study showed that six of seven patients had relatively hypoperfused regions in their frontal lobes that could involve the neighboring parietal and temporal regions. The activation study revealed that all seven patients had relative hyperperfusion in these brain regions that were relatively hypoperfused in the baseline study. The side-to-side asymmetry indexes for these visually-interpreted rCBF abnormalities ranged from 3% to 6%.

CONCLUSION

The relatively consistent pattern of frontal rCBF alterations suggests that frontal lobe functions were implicated in the evolution of photosensitivity-related seizures in patients with pure photosensitive epilepsy.

Indium-111 octreotide scintigraphy in patients with bone tumours of the extremities

Radiolabelled somatostatin analogues are of potential value in the imaging of somatostatin receptor-positive tumours. Recently, somatostatin receptors have been demonstrated in the osteoblast precursor cells. In this preliminary study, we evaluated the uptake characteristics of indium-111 octreotide in two benign and two malignant bone tumours. Tracer accumulation was observed in all four cases, and overall lesion to background ratio (mean+/-SD) was 2. 74+/-0.84 and 2.98+/-1.49 at 4 h and 24 h, respectively. There was no clear relationship between 111In-octreotide accumulation and the benign or malignant nature of the tumour. In one patient, tracer uptake was inhibited by unlabelled octreotide administration. These results suggest that 111In-octreotide can be taken up by benign and malignant bone tumours. The inhibition of tumour uptake by treatment with cold octreotide supports the concept that specific uptake mechanisms are responsible for 111In-octreotide deposition by bone tumours.

Evaluation of malignant and benign lung lesions with 99Tcm-tetrofosmin

99Tcm-tetrofosmin planar imaging was performed in 30 patients with malignant and benign lung lesions. There were 21 cases of primary lung cancer (10 squamous cell, 5 small cell, 4 adenocarcinoma and 2 large cell) and 9 benign lung lesions (4 pneumonia, 3 tuberculosis, 1 infected bronchiectasis and 1 bronchiectasis obliterans). Anterior and posterior planar thorax images were obtained 30 min after the intravenous injection of 740 MBq (20 mCi) of 99Tcm-tetrofosmin. Visual and quantitative evaluations were performed. For the quantitative evaluation, regions of interest were drawn over the lesioned area (L) and over the contralateral non-lesioned area (N). Of 21 malignant primary lesions; 19 (90%) showed 99Tcm-tetrofosmin accumulation. Four (44%) of the nine benign lung lesions (3 cases of pneumonia and the one case of active tuberculosis) showed uptake. The mean L/N ratios for the malignant and benign lesions were 1.63 +/- 0.29 and 1.64 +/- 0.19, respectively. There were no significant differences (P > 0.05) in the L/N ratios of the malignant and benign lesions or the various histological types of cancer. In conclusion, 99Tcm-tetrofosmin was highly sensitive (90%) in detecting malignant lung lesions, but it had poor specificity (55%).

Combined chemotherapy in pleurectomized malignant pleural mesothelioma patients

A phase II clinical trial of 20 cancer patients who presented with malignant pleural mesothelioma (MPM) between November 1991 and April 1993 was conducted. Of the histologically proven cases, 16 (80%) were epitheloid and 4 (20%) were mixed type MPM. Patients were treated with mitomycin C, cisplatin, and alpha interferon after pleurectomy. Our schedule consisted of 10 mg/m2 mitomycin C i.v. infusion, 50 mg/m2 cisplatin i.v. infusion, 10 mil Ur-alpha interferon i.m. and 10 mil Ur-alpha interferon i.v. infusion on the first day of treatment. Patients were given a mean of 4.5 chemotherapy cycles (range: 2-6). None of the patients showed complete or partial response. Stable disease was observed in 15 patients, while 5 patients had progressive courses. The overall median survival time after chemotherapy was 12 months (range: 3-31 months). Median survival after chemotherapy was 15 months (range: 4-31 months) in the stable disease group (n:15, 75%), and 5 months (range: 3-13 months) in progressive cases (n:5, 25%). The overall survival rates were 55% [95% Confidence Interval (CI):43%-88.8%] at one year and 15% (95% CI:5%-39.1%) at 2 years. Five patients had grade 3 alopecia, three had grade 2 vomiting and nausea, two had grade 2 leukopenia, one had grade 2 cardiotoxicity and another had discoloration on his fingernails. In our multimodal therapy protocol, we found no difference in survival and relapse rates between our combined modal therapy and other single modal therapies in the literature.

99mTc-citrate versus 67Ga-citrate for the scintigraphic visualization of inflammatory lesions

Citric acid was labeled with 99mTc with an efficiency of > 99%. The biodistribution of 99mTc-citrate was studied in mice with turpentine-induced abscesses in comparison to 67Ga-citrate. The max. abscess/muscle concentration ratios were 4.61 +/- 1.92 (3 h) for 99mTc-citrate and 4.76 +/- 2.04 (4 h) for 67Ga-citrate. Arthritis was induced in 10 rabbits by intra-articular injection of ovalbumin Scintigrams obtained 4 days later and at 3 h post-injection of 99mTc-citrate showed increased activity involving the synovium. The max. arthritic/contralateral knee ratio was 3.19 +/- 1.29 (3 h) and 6.47 +/- 3.71 (24 h) for 99mTc- and 67Ga-citrate, respectively. The blood clearance curve of 99mTc-citrate in rabbits was biexponential with a fast (T1/2 = 36 min) and a slow (T1/2 = 18 h) component, compared to mono-exponential clearance of 67Ga-citrate (T1/2 = 23 h). In 10 patients with rheumatoid arthritis whole-body scintigrams and spot images of involved joints indicated localization of the tracer in inflamed tissues. The mean target-to-soft tissue ratios were 3.04 +/- 0.81 and 4.95 +/- 2.56 for 99mTc-citrate and 99mTc-MDP, respectively. Renal clearance of radioactivity was evident from the scintigrams. Our results demonstrated that 99mTc-citrate is effective as a radiopharmaceutical for the visualization of inflammatory lesions and may be preferred to 67Ga-citrate due to the ideal physical characteristics of the radionuclide, easy preparation, low cost, early accumulation and the preference for the renal route of excretion.

The value and limitations of 201Tl scintigraphy in the evaluation of lung lesions and post-therapy follow-up of primary lung carcinoma

In this study 201Tl planar scintigraphy and single photon emission computed tomography (SPECT) were performed in 92 patients with solitary lung lesions in order to distinguish malignant versus benign and metastatic masses and to evaluate the radiotherapy response of 15 primary lung carcinomas. Semiquantitative and quantitative analyses were carried out and the results were compared with histopathological diagnosis. The overall sensitivity, specificity and accuracy of semiquantitative analysis were 56, 71 and 58%, and quantitative evaluations were 88.8, 100 and 92%, respectively. Retention indexes (RI) derived from the early and delayed images were 2.9 +/- 1.3 for primary lung carcinomas, -2.78 +/- 0.9 for benign conditions and -2.3 +/- 1.5 for metastatic pulmonary lesions. 201Tl scintigraphy seems to be a sensitive modality for differentiating malignancies from benign conditions since the difference between those two pathologies is significant. However, this procedure has a limited value in distinguishing metastatic pulmonary lesions from benign pathologies, and in tissue characterization of primary lung carcinomas. On the other hand, a good correlation was observed between 201Tl lung scintigraphy and clinical diagnostic examination during postradiotherapy follow-up of inoperable pulmonary neoplasia.

Technetium-99m-MIBI uptake in benign and malignant bone lesions: a comparative study with technetium-99m-MDP

The potential of hexakis (methoxyisobutylisonitrile) technetium (1) (MIBI) for the imaging of various bone pathologies and for assessment of effectiveness of therapy were investigated in a prospective study. MIBI was evaluated in comparison to MDP bone scans in 73 bone lesions (31 benign, 42 malignant). With MIBI, all but six malignant lesions were clearly visualized and the mean lesion/contralateral (L/C) ratio (2.21 +/- 1.17) was significantly higher than that of benign counterparts (1.26 +/- 0.40) (p less than 0.0005). No such significance was detected on corresponding MDP bone scans (4.86 +/- 3.48 versus 3.11 +/- 1.52). Ten cases with malignant tumor underwent both pre- and post-therapy MIBI evaluation and it was demonstrated that radiotherapy and/or chemotherapy significantly inhibited MIBI uptake. Moreover, post-therapeutic MIBI uptake was a good reflection of the effectiveness of therapy as confirmed by histopathological evaluation. Thus, with a strikingly higher uptake in malignant bone lesions MIBI might have good potential for the detection of malignant bone pathologies as well as for assessing tumor response to therapy.