Acute Airway Obstruction: An Unusual Presentation of Posttransplant Lymphoproliferative Disorder in a Renal Transplant Recipient

Posttransplant lymphoproliferative disorder is a life-threatening complication after solid-organ transplants. In adults, recipients of heart transplants have the highest risk, whereas renal transplant recipients have the lowest risk among all solid-organ transplants. The most common site for posttransplant lymphoproliferative disorders are gastrointestinal tract followed by the graft itself. Airway involvement in posttransplant lymphoproliferative disorder is rarely encountered. We report a case of a 26-year-old renal allograft recipient who presented to the emergency room with airway obstruction necessitating an emergency tracheostomy. Imaging revealed a left tonsillar mass extending into the nasopharynx and retropharyngeal space causing complete oropharyngeal occlusion. Endoscopic biopsy from nasopharyngeal mass showed a diffuse large B-cell lymphoma and was Ebstein-Barr virus positive. Reduction in immunosuppression and treatment with posttransplant lymphoproliferative disorder-1 risk-stratified approach resulted in complete remission.

Role of Textural Analysis of Pretreatment 18F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Response Prediction in Esophageal Carcinoma Patients

Introduction

Positron emission tomography/computed tomography (PET/CT) is routinely used for staging, response assessment, and surveillance in esophageal carcinoma patients. The aim of this study was to investigate whether textural features of pretreatment 18F-fluorodeoxyglucose (18F-FDG) PET/CT images can contribute to prognosis prediction in carcinoma oesophagus patients.

Materials and Methods

This is a retrospective study of 30 diagnosed carcinoma esophagus patients. These patients underwent pretreatment 18F-FDG PET/CT for staging. The images were processed in a commercially available textural analysis software. Region of interest was drawn over primary tumor with a 40% threshold and was processed further to derive 92 textural and radiomic parameters. These parameters were then compared between progression group and nonprogression group. The original dataset was subject separately to receiver operating curve analysis. Receiver operating characteristic (ROC) curves were used to identify the cutoff values for textural features with a P < 0.05 for statistical significance. Feature selection was done with principal component analysis. The selected features of each evaluator were subject to 4 machine-learning algorithms. The highest area under the curve (AUC) values was selected for 10 features.

Results

A retrospective study of 30 primary carcinoma esophagus patients was done. Patients were followed up after chemo-radiotherapy and they underwent follow-up PET/CT. On the basis of their response, patients were divided into progression group and nonprogression group. Among them, 15 patients showed disease progression and 15 patients were in the nonprogression group. Ten textural analysis parameters turned out to be significant in the prediction of disease progression. Cutoff values were calculated for these parameters according to the ROC curves, GLZLM_long zone emphasis (Gray Level Zone Length Matrix)_long zone emphasis (44.9), GLZLM_low gray level zone emphasis (0.006), GLZLM_short zone low gray level emphasis (0.0032), GLZLM_long zone low gray level emphasis (0.185), GLRLM_long run emphasis (Gray Level Run Length Matrix) (1.31), GLRLM_low gray level run emphasis (0.0058), GLRLM_short run low gray level emphasis (0.005496), GLRLM_long run low gray level emphasis (0.00727), NGLDM_Busyness (Neighborhood Gray Level Difference Matrix) (0.75), and gray level co-occurrence matrix_homogeneity (0.37). Feature selection by principal components analysis and feature classification by the K-nearest neighbor machine-learning model using independent training and test samples yielded the overall highest AUC.

Conclusions

Textural analysis parameters could provide prognostic information in carcinoma esophagus patients. Larger multicenter studies are needed for better clinical prognostication of these parameters.

Role of textural analysis parameters derived from FDG PET/CT in differentiating hepatocellular carcinoma and hepatic metastases

INTRODUCTION

Texture and radiomic analysis characterize the tumor's phenotype and evaluate its microenvironment in quantitative terms. The aim of this study was to investigate the role of textural features of 18F-FDG PET/computed tomography (CT) images in differentiating hepatocellular carcinoma (HCC) and hepatic metastasis in patients with suspected liver tumors.

METHODS

This is a retrospective, single-center study of 30 patients who underwent FDG PET/CT for the characterization of liver lesions or for staging a suspected liver tumor. The histological diagnosis of either primary or metastatic tumor was obtained from CT-guided biopsy, ultrasound-guided biopsy, or surgical removal of a liver lesion. The PET/CT images were then processed in commercially available textural analysis software. Region of interest was drawn over the primary tumor with a 40% threshold and was processed further to derive 42 textural and radiomic parameters. These parameters were then compared between HCC group and hepatic metastases group. Receiver-operating characteristic (ROC) curves were used to identify cutoff values for textural features with a P value <0.05 for statistical significance.

RESULTS

A retrospective study of 30 patients with suspected liver tumors was done. After undergoing PET/CT, the histological diagnosis of these lesions was confirmed. Among these 30 patients, 15 patients had HCC, and 15 patients had hepatic metastases from various primary sites. Seven textural analysis parameters were significant in differentiating HCC from liver metastasis. Cutoff values were calculated for these parameters according to the ROC curves, standardized uptake value (SUV) Skewness (0.705), SUV Kurtosis (3.65), SUV Excess Kurtosis (0.653), gray-level zone length matrix_long zone emphasis (349.2), gray-level zone length matrix_long zone low gray-level emphasis (1.6), gray-level run length matrix_long run emphasis (1.38) and gray-level co-occurrence matrix_Homogeneity (0.406).

CONCLUSION

Textural analysis parameters could successfully differentiate HCC and hepatic metastasis non-invasively. Larger multi-center studies are needed for better clinical prognostication of these parameters.

18F-Labeled Fluoro-2-Deoxyglucose Positron Emission Tomography and Computed Tomography Findings in a Case of Atypical Presentation of Adult Cutaneous T-cell Lymphoma

Adult cutaneous T-cell lymphoma is an uncommon malignancy with poor prognosis and is usually seen in association with human T-cell lymphotropic virus type 1. We present the case of a 25-year-old female who gave a history of extensive whole-body polypoidal cutaneous and bilateral orbital and breast swellings. Biopsy was suggestive of cutaneous T-cell lymphoma and the patient was evaluated with 18F-labeled fluoro-2-deoxyglucose positron emission tomography and computed tomography for initial staging of the disease.

A unique case of anaplastic thyroid carcinoma comprising of two distinct patterns osteoclastic variant and squamous cell carcinoma in separate lobe imitating collision tumor: A case report

Anaplastic thyroid carcinoma with two distinct morphologies in two lobes with no intermixing is very rare and not reported earlier. Furthermore, osteoclastic variant of anaplastic thyroid carcinoma as well as primary squamous cell carcinoma without any differentiated components are also very rare with only few reported cases describing their cytological features. Herein, we are reporting a unique and first case of anaplastic thyroid carcinoma comprising of two distinct patterns osteoclastic variant and squamous cell carcinoma in different lobes in a 55-years-old lady with review of literature.

18F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings in a Case of Metastatic Eccrine Porocarcinoma - An Extremely Rare Malignant Adnexal Tumor

Porocarcinoma is a rare malignant neoplasm of eccrine sweat glands representing 0.005 to 0.1% of all cutaneous tumors. As eccrine porocarcinoma carries a high risk of recurrence and metastases, early diagnosis and management are crucial to lower mortality rate. We present the case of porocarcinoma in a 69-years-old woman who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for staging the disease. PET/CT showed metabolically active multiple cutaneous lesions and also picked up lymph nodal and distant metastases to lungs and breast accurately. PET/CT is useful for accurate staging of the disease and for treatment planning.

Umbilical nodule - A not always innocuous abdominal finding

ABSTRACT

Sister Mary Joseph's nodule is an umbilical nodule found in patients with metastatic abdominal cancers. It is quite rare finding and needs a high index of suspicion for diagnosis. Detection of Sister Mary Joseph's nodule should warrant widespread search for abdominal carcinoma and it universally carries quite poor clinical prognosis. Here, we describe the case of a 28-year-old patient who presented with Sister Mary Joseph's Nodule and was found to have metastatic signet ring cell gastric carcinoma on investigation. A brief discussion about this rare condition is also presented.

Primary Biliary Tuberculosis Masquerading Cholangiocarcinoma in 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Hepatobiliary involvement is a less common manifestation of abdominal tuberculosis. We present the case of a 42-year-old female who presented with fever, abdominal pain, and jaundice of 2 months duration. 18F-fluorodeoxyglucose positron emission tomography/computed tomography done for disease evaluation suggested the likely possibility of cholangiocarcinoma but excision biopsy from periportal lymph node later confirmed a granulomatous etiology and she was successfully treated with antitubercular therapy.

Orbital Plasmablastic Lymphoma: A Rare Variant of Diffuse Large B-Cell Lymphoma Staged and Followed Up by 18F-FDG PET/CT

ABSTRACT

Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B-cell lymphoma which is associated with HIV infection. Recently, it has also been reported in immunocompetent and solid organ transplant patients. PBL commonly presents in extranodal regions such as oral cavity, digestive tract, and skin. Orbital involvement by PBL is extremely rare with only few reports in the literature. We present a case of PBL involving the bilateral orbits in an immunocompetent patient with 1-year follow-up on 18F-FDG PET/CT scan.

18F-Labeled Fluoro-2-Deoxyglucose Positron Emission Tomography and Computed Tomography in a Large Pulmonary Sclerosing Pneumocytoma with Contralateral Lung Metastasis

Pulmonary sclerosing pneumocytoma is an exceedingly rare neoplasm of the lung. These tumors are usually slow growing with a benign disease course but can easily be mistaken for carcinoid tumors or adenocarcinoma in cytology or histopathology specimens. Rare occurrences of metastases have been reported in the literature making ¹⁸F-labeled fluoro-2-deoxyglucose positron emission tomography and computed tomography useful for the evaluation of these tumors.

Role of Ga-68 DOTANOC Positron Emission Tomography/ Computed Tomography Scan in Clinical Management of Patients with Neuroendocrine Tumors and its Correlation with Conventional Imaging- Experience in a Tertiary Care Center in India

Purpose of Study

Aim of the study was to evaluate the role of ⁶⁸Gallium-DOTANOC positron emission tomography/computed tomography (⁶⁸Ga-DOTANOC PET/CT), a pan somatostatin receptor (SSTR) analog in the clinical management of patients with neuroendocrine tumors (NETs) and its correlation with conventional imaging.

Materials and Methods

We retrospectively evaluated 69 patients of known/suspected NETs who underwent ⁶⁸Ga-DOTANOC PET/CT scan for tumor localization (n = 15), stage modification (primary staging, n = 26 and restaging, n = 25) and therapy monitoring (n = 3). We also compared PET scan with conventional imaging as reference standard and evaluated the impact of PET/CT in the clinical management of patients.

Results

The concordant findings on ⁶⁸Ga-DOTANOC PET/CT and conventional imaging seen in 33 and discordant in 36 patients. Among discordant group, disease was upstaged in 32 patients; down staged in 3 patients; no stage change in one patient. PET/CT localized primary tumor in 4 patients. Among patients with raised tumor markers (39/69), PET was positive in 29 and negative in 10 patients. Patients were followed for mean duration of 27 months to assess management. We found strong agreement between positive PET and raised tumor markers (Kappa value = 0.8). Sensitivity and specificity of PET/CT for primary tumor localization, stage modification, and therapy monitoring was >90% (P < 0.05).

Conclusions

Study shows that DOTANOC, a broad spectrum SSTRs binding peptide labeled with Ga-68 in PET/CT scan is an excellent modality in the management of NETs patients.

Incidental lung findings in a COVID-19 patient on 18F-FDG PET/CT done for preoperative evaluation of Marjolin's ulcer-first report from Chhattisgarh

The aim of this case is to illustrate the¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography findings of a patient who was admitted in AIIMS, Raipur, for the preoperative evaluation of Marjolin ulcer and was later diagnosed with COVID-19 infection. Apart from the primary lesion in the right foot and pelvic lymph nodes, the scan revealed mild FDG-avid basal ground-glass opacities in bilateral lung fields with mediastinal and hilar lymph nodal involvement, in an otherwise asymptomatic patient.

Diffuse White Adipose Tissue 18F-FDG Uptake-An Unusual Finding on 18F-FDG PET/CT

ABSTRACT

Brown adipose tissue of cervical, supraclavicular, and paravertebral regions can show increased FDG uptake. But human white adipose tissue (WAT) shows negligible FDG uptake on 18F-FDG PET/CT scan. We present a case of carcinoma cervix treated with concurrent chemoradiation. 18F-FDG PET/CT shows altered biodistribution of FDG with intense FDG uptake throughout the WAT. Later on, patient confirmed taking herbal medication for herpes zoster infection, which could contain corticosteroids, resulting in enhanced WAT uptake of 18F-FDG.

Pulmonary sclerosing pneumocytoma masquerading adenocarcinoma with co-existing BRAF V600E and PTEN mutation

We report a case of a massive primary sclerosing pneumocytoma (PSP) involving the right lower lobe adhering esophagus with small synchronous PSP on the superior segment of the left lower lobe with concurrent mutation for B-RAF proto-oncogene, serine/threonine kinase (BRAF V600E), and phosphatase and tensin homolog (PTEN) gene in a young female. She underwent right lower lobectomy and mediastinal lymph node dissection under single lung ventilation with tumor-free margins on diagnosis-based findings of preoperative computed tomography-guided biopsy and positron emission tomography. Histopathology was suggestive of PSP-papillary variant with concurrent mutation of BRAF V600E and PTEN genes. Post-operative follow-up at four weeks was uneventful. She has to undergo wedge resection for the contralateral disease after six weeks following recovery from the first surgery.

Incidentally Diagnosed Esophago-Pulmonary Fistula on 18F-FDG PET/CT in a Case of Carcinoma Esophagus: A Life-Threatening Emergency

ABSTRACT

Esophago-pulmonary fistulas are very less reported in literature. 18F-FDG PET/CT scan is routinely used for evaluation of patients of carcinoma esophagus. We present a case of carcinoma esophagus with acquired esophago-pulmonary fistula diagnosed on 18F-FDG PET/CT scan.

Membranoproliferative glomerulonephritis: A rare presentation of occult filariasis

Parasitic infections do not usually present with rapidly progressive renal failure but can provoke glomerular lesions which are mostly proliferative. In filarial infection, glomerular involvement is usually mild and transient, and presentation with renal failure is rare. We report occult filariasis presenting as rapidly progressive renal failure due to immune-complex mediated membranoproliferative glomerulonephritis. Our patient responded to treatment with diethylcarbamazine and a short course of steroid. This case highlights the importance of thorough workup to identify the cause and consideration of filariasis in an endemic area.

Utility of 18 F-FDG PET/CT in pre-surgical risk stratification of patients with breast cancer

OBJECTIVE

To determine the correlation between fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) uptake values and clinicopathological prognostic markers using preoperative ¹⁸F-FDG positron emission tomography/computed tomography (PET/CT) in primary breast cancer (BC).

SUBJECTS AND METHODS

One hundred and twelve patients with primary BC were studied prospectively. Pretreatment ¹⁸F-FDG PET/CT was performed. Maximum standardized uptake values (SUVmax) were compared with various clinicopathological variables.

RESULTS

In a univariate analysis, SUVmax correlated well with the following prognostic variables: T stage, absence of progesterone receptor (PR), absence of estrogen receptor (ER), triple negative lesions (ER/PR and Her 2 negative) and high histologic grade. Metastatic lesions and ductal lesions had higher SUVmax than lobular carcinoma. No significant correlation was found between SUVmax,and human epidermal growth factor receptor 2 (Her-2) statusor perineural and lymphovascular invasion. Multivariate analyses showed that breast density, tumor size and PR negativity were significantly correlated with SUVmax (P=0.046 and 0.009, respectively).

CONCLUSION

The pre-treatment tumor SUVmax could be utilized as an independent imaging biomarker of the tumor aggressiveness and poor prognosis. Risk stratification based on this index could play a pivotal role in alteration of treatment planning, such as neoadjuvant chemotherapy (precision oncology).

Unusual presentation of jejunal hemangioma on Tc-99m pertechnetate scan with single-photon emission computerized tomography-computed tomography

Small bowel hemangioma is a rare benign tumor in the pediatric population. The usual presentation of these tumors is melena, anemia, or hematochezia. Our case demonstrates the usefulness of Meckel's/Tc-99m pertechnetate scan with single-photon emission computerized tomography/computerized tomography in diagnosing a vascular lesion in the small bowel in a child presenting with melena, unresponsive to medical management. We present a case of incidentally detected jejunal hemangioma during Tc-99m pertechnetate scintigraphy which would help the nuclear medicine physician and surgeon, to be cognizant of this atypical presentation in their clinical practice.

Role of Cholescintigraphy with Single-Photon Emission Computerized Tomography-Computed Tomography in Detecting Bronchobiliary Fistula: Unusual Complication of a Common Disease

Bronchobiliary fistula (BFF) is an abnormal communication between the biliary tree and airway. A patient usually presents with cough and bilioptysis, and at times, it poses diagnostic and therapeutic challenge. This case demonstrates the usefulness of cholescintigraphy with single-photon emission computerized tomography in diagnosing BFF in case of hydatid cyst of the liver.

Thoraco-Abdominal Duplication Cyst- Role Tc-99m Pertechnetate SPECT-CT Scintigraphy in Localising Ectopic Gastric Mucosa

Thoraco-abdominal duplication cyst, a congenital malformation of the posterior primitive foregut rarely presents with anaemia. Ectopic gastric mucosa is seen in around 20%-30% of the enteric duplication cysts. We report the scintigraphic findings of one such case which helped in final diagnosis and management of the patient.

Oncogenic osteomalacia: role of Ga-68 DOTANOC PET/CT scan in identifying the culprit lesion and its management

OBJECTIVE

The aim of this study was to evaluate the role of ⁶⁸Ga-DOTANOC positron emission tomography (PET)/CT scan in localization of culprit lesion for biopsy and required intervention [surgical excision/radiofrequency ablation (RFA)] in patients with long-standing oncogenic osteomalacia (OOM)/tumour-induced osteomalacia.

METHODS

17 patients (8 males and 9 females) underwent ⁶⁸Ga-DOTANOC PET/CT scan. The patients referred with clinical and biochemical evidence of hypophosphatemia and raised fibroblast growth factor-23. Qualitative and semi-quantitative parameters were used to identify culprit lesions.

RESULTS

⁶⁸Ga-DOTANOC PET/CT scan revealed 52 lesions in 17 patients, and 37/52 of these lesions were tracer avid. 26/37 lesions were non-specific focal tracer-avid skeletal lesions (fractures or degenerative changes). 11/37 tracer-avid skeletal lesions present in 9 patients (3 lesions in 1 patient and 1 each in rest of the 8 patients) were highly suspicious for culprit lesions in view of high maximum standardized uptake value (SUV_max) (range 1.5-15.4; mean 7.0 ± 4.6), lesion size (0.9-5.0 cm; mean 3.3 ± 1.5) and associated soft-tissue component. During subsequent imaging with CT/MRI, 7/9 patients showed concordant lesions which were excised or biopsied and histopathologically verified as phosphaturic mesenchymal tumours. Surgical excision was resorted to in most of the detected lesions, and RFA was performed in one patient.

CONCLUSION

There is some overlap in SUV_max between fracture-/bone-associated lesions and culprit lesions with a tendency of most non-culprit lesions to have lower SUV_max and no associated soft-tissue component. In such scenario, intensely tracer-avid, larger non-fracture lesions with soft-tissue component may lead to identification of culprit lesion among multiple lesions. Following detection of culprit lesion, surgical removal is the best treatment. RFA is alternative to surgery in cases where surgery is not possible owing to osteopenia/poor bone health. Advances in knowledge: The main challenge in patients of long-standing OOM is the presence of multiple skeletal lesions (both tumour- or tracer-avid fractures), and it is confusing to identify culprit lesion. This was noted in our study with ⁶⁸Ga-DOTANOC and has not been mentioned in studies performed with ⁶⁸Ga-DOTATATE/TOC PET/CT. In such scenario, ⁶⁸Ga-DOTANOC PET/CT needs to be reviewed and read thoroughly to localize the culprit lesion out of the multiple tracer-avid lesions.

Hypothyroidism in McCune-Albright Syndrome and Role of Bone Scan in Management of Fibrous Dysplasia: An Unusual Case Scenario with Review of Literature

The McCune–Albright syndrome (MAS) is a triad of café-au-lait skin pigmentation, precocious puberty (PP), and polyostotic fibrous dysplasia of bone (FD). In general, FD seems to be the most common component of MAS but very rarely precocious puberty can be found in association with café-au-lait skin pigmentation in the absence of FD (about 1% of the cases). Therefore, a more clinically relevant definition of MAS is fibrous dysplasia of bone (FD) and at least one of the typical hyperfunctioning endocrinopathy and/or café-au-lait spots, with almost any combination possible. Bone scan can be the modality of choice to look for bone disease burden of fibrous dysplasia in most patients of MAS and may change the management accordingly. Most of the cases of MAS reported worldwide are associated with hyperthyroidism, up to best of our knowledge on the basis of literature search in pubmed and Google; no case was reported with hypothyroidism. Herein, we report a 12-year-old girl diagnosed with MAS and associated hypothyroidism. We have also reviewed the MAS related literature.

Gallbladder Visualization on Tc-99m-labeled Red Cell Scintigraphy: A Rare Finding with an Emphasis on Role of Single-photon Emission Computed Tomography/Computed Tomography

Tc-99m labeled red blood cell (RBC) scintigraphy is one of the most sensitive tests to diagnose occult gastrointestinal (GI) bleed. Visualization of gallbladder is a rare finding in this study. Most of the previously reported cases with similar false-positive finding were associated chronic renal failure, anemia, and received multiple blood transfusions. Thus, while interpreting GI bleed scan, a thorough clinical history is of utmost importance to avoid any false-positive findings. Here, we report a case of gallbladder visualization in ^99mTc-RBC scintigraphy confirmed by single-photon emission computed tomography/computed tomography in a patient with chronic renal failure and anemia with failed renal transplant within 3 months.

Imaging in extrapulmonary tuberculosis

Tuberculosis (TB) remains a major global public health problem, with 1.5 million deaths annually worldwide. One in five cases of TB present as extrapulmonary TB (EPTB), posing major diagnostic and management challenges. Mycobacterium tuberculosis adapts to a quiescent physiological state and is notable for its complex interaction with the host, producing poorly understood disease states ranging from latent infection to active clinical disease. New tools in the diagnostic armamentarium are urgently required for the rapid diagnosis of TB and monitoring of TB treatments, and to gain new insights into pathogenesis. The typical and atypical imaging features of EPTB are reviewed herein, and the roles of several imaging modalities for the diagnosis and management of EPTB are discussed.

The role of molecular imaging in diagnosis of deep vein thrombosis

Venous thromboembolism (VTE) mostly presenting as deep venous thrombosis (DVT) and pulmonary embolism (PE) affects up to 600,000 individuals in United States each year. Clinical symptoms of VTE are nonspecific and sometimes misleading. Additionally, side effects of available treatment plans for DVT are significant. Therefore, medical imaging plays a crucial role in proper diagnosis and avoidance from over/under diagnosis, which exposes the patient to risk. In addition to conventional structural imaging modalities, such as ultrasonography and computed tomography, molecular imaging with different tracers have been studied for diagnosis of DVT. In this review we will discuss currently available and newly evolving targets and tracers for detection of DVT using molecular imaging methods.

The common, less common and uncommon examples of exercise ECG

We present three interesting and representative cases of exercise ECGs which were done as part of Stress Myocardial Perfusion study. Aim is to emphasize the point that the stress part of the test should be conducted by an expert in the field and recovery phase ECG records should be analyzed carefully for maximum benefit from this test.

Miliary sarcoidosis with secondary Sjogren's syndrome

We report a case of miliary sarcoidosis with secondary Sjogren's in a 45-year-old male who presented with symptoms of sicca syndrome in the form of dryness of eyes and mouth with parotid swelling. Computed tomography thorax showed mediastinal and hilar lymphadenopathy, bilateral miliary opacities in lung parenchyma. Whole body FDG PET/CT showed involvement of both parotids, liver, diffuse uptake in lungs, mediastinal and retroperitoneal lymph nodes. Patient is on treatment with prednisolone and has responded well.

A rare case of lingual thyroid with hyperthyroidism: A case report and review of the literature

Lingual thyroid is a rare embryological anomaly resulting from failure of normal thyroid tissue to descend from the foramen cecum at base of tongue to its orthotopic location in front of the lower neck. It is a rare anomaly with a reported incidence of 1 in 3000 of the thyroid disorders. Lingual thyroid is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatolalia, upper airway obstruction, and often with hypothyroidism. Hyperthyroidism is extremely rare finding and till now there are very few case reports published. We present here a case of lingual thyroid with hyperthyroidism, which was treated successfully with radioiodine.

Accelerated mineralization of the drug Diclofenac via Fenton reactions in a concentric photo-reactor

The complete mineralization of concentrated solutions of Diclofenac (2-[(2,6-dichlorophenyl) amino] benzene-acetic acid) sodium salt C14H10C12NO2Na was carried out in a concentric cylindrical immersion photoreactor in batch mode operation. Irradiation with a lamp emitting light at 254 nm (400 W) achieved total mineralization of Diclofenac solutions (0.062 mM or TOC 20 mg C l(-1)) in times under an hour. The mineralization was carried out via Fenton photo-assisted treatment. A determination of the solution parameters was carried out to optimize the time of the Diclofenac pretreatment, the type and intensity of the light source, the effect of the concentrations of Fe-ions and the oxidant added in solution and the reactor recirculation rate. Diclofenac disappearance was monitored by high liquid pressure chromatography (HPLC). Concomitantly, the aromatic and aliphatic intermediates were also monitored under low-energy (36 W) light irradiation at 366 nm in order to be able to detect the intermediates by HPLC in the minute time scale. The decrease of the chemical oxygen demand was followed during Diclofenac degradation. The activation energy for the mineralization of Diclofenac was determined to be 4.02 Kcal mol(-1).

Direct quantitative determination of optically active absorbing drugs in human urine by circular dichroism. Simultaneous direct determination of beta-lactam antibiotics and proteins

Over 200 urine samples from 61 subjects were analyzed by circular dichroism spectroscopy. The results proved that this technique can be applied to the direct determination of optically active absorbing drugs in urine of subjects under multiple drug administration, independently of the presence of proteins, which can simultaneously be determined. A list of noninterfering drugs is included. The validity of the present method was confirmed by analysis of variance, the beta-lactam antibiotics ampicillin, cefoxitin, and cephalexin being chosen as model drugs and human albumin as the analytical standard for protein determination. The results demonstrated that the proposed method is accurate and precise, the correlation coefficients being higher than 0.9996. A circular dichroism and HPLC data comparison was successfully performed. The principal advantages of this method are simplicity, quickness, and economy, no derivatization or chromatographic separation steps being needed.

Expression of epidermal growth factor receptor (proto-oncogene c-erbB-1) and estrogen receptor in human breast carcinoma. An immunocytochemical study of 70 cases

In vitro studies have shown that growth factors may mediate the growth stimulatory effect of estrogen in hormone-dependent human breast carcinomas while the constitutive expression of same growth factors might by-pass the need for estrogenic stimulus in hormone-independent neoplasms. We have performed immunocytochemical analysis of the expression of epidermal growth factor receptor (EGF-R or proto-oncogen c-erbB-1) and estrogen receptor (ER) in 70 cases of human breast carcinoma. We found an inverse relationship between the expression of EGF-R and ER (Kendall's tau b = -0.1997, P < 0.03), which prompts us to conclude that ER(-) breast carcinomas may grow in a hormone-independent manner through the over-expression of the proto-oncogene c-erbB-1, which is the receptor for epidermal (EGF) and alpha transforming (TGFalfa) growth factors.