Hypoxia-inducible factor-1α, adrenomedullin and Bcl-2 although expected are not related to increased uptake of fluorine-18-fluorodeoxyglucose in endometrial cancer

OBJECTIVE

To study the relation between SUVmax, hypoxia inducible factor 1α (HIF-1α), angiogenetic factor adrenomedullin (AM) and antiapoptotic factor Bcl-2 in endometrial cancer.

SUBJECTS AND METHODS

Thirthy eight patients who were diagnosed after a preoperative endometrial biopsy with endometrium cancer underwent pre-operative positron emission tomography/computed tomography (PET/CT) utilizing fluorine-18-fluorodeoxy glucose (¹⁸F-FDG). Maximum standardized uptake values (SUVmax) of the primary tumor were measured. After hysterectomy and bilateral salpingo-oophorectomy, microscopic slides of the 38 endometrial adenocarcinoma patients were evaluated by a surgical pathologist to confirm the diagnosis. Immunohistochemical staining for AM, Bcl-2 and HIF-1α was studied.

RESULTS

In all patients, ¹⁸F-FDG uptake was detected. The mean SUVmax of the tumors was 11.8 ± 5.9. Although SUVmax was higher in HIF-1α positive tumors, this finding was not statistically important. No correlation was found between SUVmax and HIF-1α positivity. Mean SUVmax was 6.4 ± 3 and 12.3 ± 1.4 in AM negative and AM positive patients, respectively. Mean SUVmax was 10.6 ± 4.9 and 12.3 ± 1.4 in Bcl-2 negative and Bcl-2 positive patients, respectively. We found no correlation between SUVmax, AM or Bcl-2 expression. Allred scores were not related with SUVmax in regression analysis.

CONCLUSION

Our study in a small number of patients is the first to show that SUVmax, although expected is not associated with HIF-1α, AM or with Bcl-2 in endometrial cancer. Increased uptake of ¹⁸F-FDG in endometrial cancer seems to be independent of HIF-1α and its downstream factors.

Gall bladder visualization in lymphoscintigraphy

BACKGROUND

The aim of this study was to evaluate gall bladder visualization in lymphoscintigraphy of extremities.

METHODS AND RESULTS

Thirteen patients who had prediagnoses of lymphedema and were referred for lower extremity lymphoscintigraphy to our department were retrospectively evaluated. Lower extremity lymphoscintigraphy with Tc-99m sulfur colloid was performed on the patients, and planar images of the lower extremity and abdominal region were taken in early phase and late phase (at the 24th hour) routinely. Lymphoscintigraphy results of eight patients were normal regarding lymphatic flow or lymph nodes; however, additional pathologic tracer accumulations in gall bladder were observed, which disappeared at 24th hour images in three patients. Five patients had various pathologies regarding lymph flow or lymph nodes. However, there were no patients with gall bladder activity except those three patients who had casual anamnesis of fasting prior to the exam.

CONCLUSION

The fasting state of the patients might be the cause of gall bladder visualization during the lymphoscintigraphy of the extremities with sulfur colloid.

Effect of rivastigmine on regional cerebral blood flow in Alzheimer's disease

Cholinesterase inhibitors improve or stabilize cognitive impairment in patients with Alzheimer's disease (AD). The purpose of this study was to detect brain perfusion changes and the effects of rivastigmine, an acetylcholinesterase inhibitor on single photon emission computed tomography (SPECT) before and after treatment. Fifteen patients who fulfilled the clinical criteria for probable AD of mild to moderate severity, as put forth by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association, and as specified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were included in the study. A control group of 15 healthy individuals from the same age and education range was included in the study. Before treatment was begun, Mini Mental State Examination (MMSE) tests were performed on all patients to evaluate cognitive function. All patients underwent baseline SPECT for evaluation of 25 different brain regions. Rivastigmine 3 mg/d was given for the first 4 wk of treatment; the dosage was then increased to 6 mg/d. The MMSE and SPECT were repeated 6 mo after the start of treatment. SPECT findings revealed that rivastigmine did not significantly affect brain perfusion in AD cases except in the inferior frontal lobe, despite stabilization and improvement noted in MMSE scores during treatment. Rivastigmine treatment of patients with AD did not significantly change brain perfusion as seen on SPECT, except in the inferior frontal lobe, but cognitive performance was stabilized or improved during the treatment course. These findings suggest the need for additional, larger studies to investigate the effects of acetylcholinesterase inhibitors on regional cerebral blood flow.

Thyroid cancer in toxic and non-toxic multinodular goiter

BACKGROUND

Many authors have claimed that hyperthyroidism protects against thyroid cancer and believed that the incidence of malignancy is lower in patients with toxic multinodular goiter (TMG) than in those with non-toxic multinodular goiter. But in recent studies, it was reported that the incidence of malignancy with TMG is not as low as previously thought.

AIM

To compare the thyroid cancer incidence in patients with toxic and non-toxic multinodular goiter.

SETTINGS AND DESIGN

Histology reports of patients treated surgically with a preoperative diagnosis of toxic and non-toxic multinodular goiter were reviewed to identify the thyroid cancer incidence. Patients having a history of neck irradiation or radioactive iodine therapy were excluded from the study.

MATERIALS AND METHODS

We reviewed 294 patients operated between 2001-2005 from toxic and non-toxic multinodular goiter. One hundred and twenty-four of them were toxic and 170 were non-toxic. Hyperthyroidism was diagnosed by elevated tri-iodothyroinine / thyroxine ratios and low thyroid-stimulating hormone with clinical signs and symptoms. All patients were evaluated with ultrasonography and scintigraphy and fine needle aspiration biopsy.

STATISTICAL ANALYSIS USED

Significance of the various parameters was calculated by using ANOVA test.

RESULTS

The incidence of malignancy was 9% in the toxic and 10.58% in the non-toxic multinodular goiter group. Any significant difference in the incidence of cancer and tumor size between the two groups could not be detected.

CONCLUSIONS

The incidence of malignancy in toxic multinodular goiter is not very low as thought earlier and is nearly the same in non-toxic multinodular goiter.

Influence of Electromagnetic Fields and Protective Effect of CAPE on Bone Mineral Density in Rats

BACKGROUND

Most mobile phones emit electromagnetic radiation at 900 MHz or 1800 MHz. An electromagnetic field has some biological effects on the behavior of the cell population of bone. The aim of this work is to evaluate the effects of the radiation emitted by mobile phones on bone mineral density (BMD). The effects of caffeic acid phenethyl ester (CAPE) on the radiation-induced changes were also investigated.

METHODS

In the study, 48 Sprague Dawley rats were used. Rats were divided into five groups as follows: control, irradiated with 900 MHz, irradiated with 900 MHz and treatment, irradiated with 1800 MHz, irradiated with 1800 MHz and treatment groups. The rats in the control group (first group) were left within the experimental setup during 30 min/day for 28 days without radiation exposure. Nine hundred-MHz radiation group was exposed to irradiate both second and third groups for 28 days (30 min/day); 1800-MHz radiation group was exposed to irradiate both fourth and fifth groups for 28 days (30 min/day). Third and fifth groups were also treated by CAPE for 28 days. Treatment groups received 10 microml/kg/day CAPE i.p. before the irradiation. Bone mineral densities were determined in all groups.

RESULTS

BMD was found to be decreased in the irradiated groups and to be increased in the treatment groups.

CONCLUSIONS

The changes were not significant (p >0.05).

Tc-99m nanocolloid scintigraphic imaging of intracranial meningeal extramedullary hematopoiesis in a patient with idiopathic myelofibrosis

Meningeal extramedullary hematopoiesis (EMH) is a rare finding in idiopathic myelofibrosis. Intracranial EMH is typically asymptomatic and sites are usually found by chance. Diagnosis of EMH is difficult, based on clinical circumstances and the use of different diagnostic imaging modalities, such as CT, MRI or radionuclide imaging. We present a case with intracranial medullary hematopoiesis due to idiopathic myelofibrosis diagnosed with Tc-99m nanocolloid scintigraphy. Cranium SPECT images that were performed with Tc-99m nanocolloid showed increased radiotracer uptake in the bilateral parietal, bilateral frontal and left occipital bones and especially in falx cerebri of sinus sagittalis superior. In Tc-99m MDP bone scintigraphy, increased osteoblastic activity in the left frontal and parietal bones, in shoulders, knee and ankle joints, and in both metatarsal bones were seen. After gadodiamid injection, Tl weighted MRI showed diffuse contrast increased in the meningeal areas surrounding the brain. A biopsy of the mass revealed extramedullary hematopoiesis composed of erythroblasts, mature and immature myeloid cells, and megakaryocytes. It was deduced that these described foci of EMH.