Fluorine-18-fluorodeoxyglucose and carbon-11-methionine evaluation of lymphadenopathy in sarcoidosis

Uptake of 18F-fluorodeoxyglucose (FDG) and 11C-methionine (Met) in mediastinum and hilar lymph nodes was studied using PET in 31 patients with sarcoidosis. The aim of our study was to examine whether these different tracers play a differential role in clinical assessment of pulmonary involvement. METHODS: Fluorine-18-fluorodeoxyglucose and 11C-Met PET were administered on different days. The differential absorption ratio of these tracers was calculated for the region of interest with the highest level of activity. Clinical reassessment of sarcoidosis was made at least 1 yr after the first PET examination. In seven patients whose lymph nodes still remained visible by other imagings at the time of reevaluation, the same PET study was performed again. RESULTS: Both FDG and Met were accumulated in the lymph nodes in all but one patient. The FDG and Met uptake ratios in all patients were not correlated, but they could be divided into the FDG-dominant group (FDG/Met uptake ratio > or = 2) and the Met-dominant group (FDG/Met uptake ratio < 2). Within each group, the FDG and Met uptake values were correlated. The rate of improvement assessed by clinical status and chest radiographs was considerably higher in the FDG- (78%) than in the Met-dominant group (33%). In the seven patients of the repeated PET examination, their FDG/Met uptake ratios were generally unchanged after 1 yr. CONCLUSION: The results suggest that the FDG/Met uptake ratio using PET may reflect the differential granulomatous status in sarcoidosis and be a useful tool for pretreatment evaluation.     

Fluorine-18-fluorodeoxyglucose assessment of glucose metabolism in bone tumors

In our study, we investigate the glucose metabolism of various types of bone lesions with 18F-fluorodeoxyglucose (FDG) PET. METHODS: Twenty-six patients showing clinical and radiographic symptoms of a malignant bone tumor were included. Histological examination after the PET study revealed 19 malignant and 7 benign tumors. PET images were corrected for attenuation. Arterial blood samples were taken to establish the input function. The metabolic rate of glucose consumption (MRglc) was calculated for the whole tumor, for the 10 pixels with maximum activity and for contralateral normal muscle tissue. RESULTS: All lesions were clearly visualized with 18F-FDG PET except for a small infarction of the humerus. All the other lesions had increased glucose metabolism compared to surrounding and contralateral muscle tissue. Both maximum and average MRglc for benign, as well as malignant, lesions were significantly higher than for contralateral normal tissue. The maximum and average MRglc were not higher for malignant as opposed to benign lesions. There was a large overlap between the MRglc of benign and malignant lesions. CONCLUSION: Fluorine-18-FDG PET appears suitable to visualize bone tumors. With the quantification of glucose metabolism, it is not possible to differentiate between benign and malignant bone tumors. There does not seem to be a clear correlation between the MRglc and the biologic aggressiveness of the neoplasms.     

Fluorine-18-fluorodeoxyglucose PET identification of cardiac metastasis arising from uterine cervical carcinoma

Cardiac metastasis of uterine cervical carcinoma is rare. We describe a patient with a past history of uterine cervical carcinoma who presented with metastasis to the heart, lungs and distant lymph nodes 3 yr after surgery and chemotherapy. Since the patient complained of chest pain and demonstrated electrocardiogram abnormalities, we performed echocardiography, electron beam CT and MRI, which revealed a tumor in the right ventricular wall. The tumor was assessed by 67Ga scintigraphy and 18F-fluorodeoxyglucose (FDG) PET scanning. The mean differential 18F-FDG uptake ratio of the tumor was 7.9, suggesting malignancy, which was later confirmed by myocardial biopsy. Information about the extent of the tumor and partial necrosis within it was provided by 18F-FDG PET. Although both radionuclide imaging techniques also detected metastatic lesions in the lungs and lymph nodes, 18F-FDG PET scanning detected small lesions more sensitively than 67Ga scintigraphy.     

ATP radionuclide ventriculography; its usefulness for the evaluation of ischemic heart disease

The susceptibility of 45 strains of Neisseria gonorrhoea was studied measuring minimal inhibitory concentrations of five antimicrobials. Results show that 66.7% of strains are resistant to tetracycline and 11.2% to penicillin. All strains were susceptible to ciprofloxacin, ceftriaxone and cefotaxime. This results should prompt to perform surveillance in different areas of Santiago and to establish new therapeutic norms for the treatment of gonococcal infections.     

Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis

The aim of this study was to assess the usefulness of PET with 2-18F-fluoro-2-deoxy-D-glucose (FDG), as compared to immunoscintigraphy (IS) with 99mTc-labeled monoclonal antigranulocyte antibodies (AGAbs), in the detection of chronic osteomyelitis. METHODS: Fifty-one patients suspected of having chronic osteomyelitis in the peripheral (n = 36) or central (n = 15) skeleton were evaluated prospectively with static FDG PET imaging and combined 99mTc-AGAb/99mTc-methylene diphosphonate (MDP) bone scanning within 5 days. FDG PET and IS were evaluated in a blinded and independent manner by visual interpretation, which was graded on a five-point scale of two observers' confident diagnosis of osteomyelitis. Receiver operating characteristic (ROC) curve analysis was performed for both imaging modalities. The final diagnosis was established by means of bacteriologic culture of surgical specimens and histopathologic analysis (n = 31) or by biopsy and clinical follow-up over 2 yr (n = 20). RESULTS: Of 51 patients, 28 had osteomyelitis and 23 did not. According to the unanimous evaluation of both readers, FDG PET correctly identified 27 of the 28 positives and 22 of the 23 negatives (IS identified 15 of 28 positives and 17 of 23 negatives, respectively). The area under the ROC curve was 0.97/0.97 (reader 1/reader 2) for FDG PET and 0.87/0.90 for IS, with a high degree of interobserver concordance (K-values were 0.96 for FDG PET and 0.91 for IS). In the central skeleton, the ROC curve area was 0.98/1.00 for FDG PET and 0.71/0.77 for IS (p<0.05). On the basis of ROC analysis, the overall accuracies of FDG PET and IS in the detection of chronic osteomyelitis were 96%/96% and 82%/ 88%, respectively. With regard to the optimal threshold values, sensitivity and specificity were 100%/97% and 95%/95% with FDG PET, compared to 86%/92% and 77%/82% with IS, respectively. CONCLUSION: In the peripheral skeleton, both FDG PET and combined 99mTc-AGAb/99mTc-MDP scanning are appropriate imaging modalities to diagnose chronic osteomyelitis. FDG PET additionally allows reliable differentiation between osteomyelitis and infection of the surrounding soft tissue. In the central skeleton within active bone marrow, FDG PET is highly accurate and superior to AGAb imaging in the diagnosis of chronic osteomyelitis, which frequently presents as a nonspecific photopenic lesion at scintigraphy with labeled white blood cells.     

Early diagnosis of bronchial cancer: its usefulness

Incidence of and mortality from bronchial carcinoma are reviewed. The advantages of early recognition of the disease and the favourable role of early recognition as a factor in the therapeutic outcome are stressed. Etiologic factors and diagnostic procedures are summarized. The need for a public education program is emphasized.     

The usefulness of Tc-99m HMPAO labeled WBC SPECT in eosinophilic gastroenteritis

Tc-99m HMPAO labeled WBC SPECT was performed in 5 patients with eosinophilic gastroenteritis before and after successful medical therapy. The imaging findings were graded according to the following imaging scheme; grade 0, no uptake; grade 1, uptake < bone marrow; grade 2, uptake < liver; grade 3, uptake > liver. In no patient was the diagnosis made radiologically or with colonoscopy. The sites of involvement were identified with Tc-99m HMPAO WBC imaging in all patients before treatment and the radionuclide imaging studies were all negative after therapy.     

Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases

The aim of this study was to evaluate fluorine-18 fluorodeoxyglucose positron emission tomography ([18F]FDG PET) as a tool for the differential diagnosis of pancreatic carcinoma while taking into account serum glucose level. A group of 106 patients with unclear pancreatic masses were recruited for the study. PET was performed following intravenous administration of an average of 190 MBq [18F]FDG. Focally increased glucose utilisation was used as the criterion of malignancy. In addition, the "standardised uptake value" (SUV) was determined 45 min after injection. Carcinoma of the pancreas was demonstrated histologically in 74 cases, and chronic pancreatitis in 32 cases. Employing visual evaluation, 63 of the 74 (85%) pancreatic carcinomas were identified by PET. In 27 of the 32 cases (84%) of chronic pancreatitis it was possible to exclude malignancy. False-negative results (n=11) were obtained mostly in patients with raised serum glucose levels (10 out of 11), and false-positives (n=5) in patients with inflammatory processes of the pancreas. Thus PET showed an overall sensitivity of 85%, a specificity of 84%, a negative predictive value of 71%, and a positive predictive value of 93%. In a subgroup of patients with normal serum glucose levels (n=72), the results were 98%, 84%, 96% and 93%, respectively. Quantitative assessment yielded a mean SUV of 6.4+/-3.6 for pancreatic carcinoma as against a value of 3.6+/-1.7 for chronic pancreatitis (P<0.001), without increasing the diagnostic accuracy. This shows PET to be of value in assessing unclear pancreatic masses. The diagnostic accuracy of PET examinations is very dependent on serum glucose levels.     

Standardized AgNOR analysis: its usefulness in surgical oncology

Smith-Magenis syndrome (SMS) is a multiple congenital anomalies/mental retardation syndrome associated with deletion of band p11.2 of chromosome 17. The deletion is typically detected by high-resolution cytogenetic analysis of chromosomes from peripheral lymphocytes. Fluorescence in situ hybridization (FISH) has been previously used to rule out apparent mosaicism for del(17)(p11.2p11.2) indicated by routine cytogenetics. We now report mosaicism for del(17)(p11.2p11.2) in a child with SMS. The mosaicism had gone undetected during previous routine cytogenetic analysis. FISH analysis of peripheral lymphocytes as well as immortalized lymphoblasts using markers from 17p11.2 revealed that approximately 60% of cells carried the deletion. To our knowledge, this is the first case of SMS associated with mosaicism for del(17)(p11.2p11.2).     

Perspective for clinical laboratory management and its systematization--effects of the systematization of clinical laboratory management

There are a large number of ideas concerning the systematization of clinical laboratory management. Therefore many types of laboratory systems have been constructed. As our hospital is not large, we adopted a small scale laboratory system. In introducing it, we expected not only an increase in value-added labor productivity by automating laboratory tests, but also an improvement in technologist's cost awareness. Consequently, new system equipment has itself performed the former in many sections, but not the latter. Improvement in cost awareness was caused by the technologist's routine work in managing reagent and material stocks. We found that this soft-type systematization has been more important than the advanced hard-type system.     

DNA flow cytometric study of thymic epithelial tumors with evaluation of its usefulness in the pathologic classification

A DNA flow cytometric study was performed on 64 thymic epithelial tumors using the modified Hedley method with formalin-fixed, paraffin-embedded tissues to evaluate whether ploidy analysis can be a useful aid in differentiating invasive thymoma (IT) from non-invasive thymoma (NT) and in understanding the ploidy pattern of various histologic types of thymic carcinomas (TCs). The IT group was further subdivided into macroinvasive thymoma (macro-IT) and microinvasive thymoma (micro-IT). Six cases were excluded due to a coefficient of variation greater than 6. Aneuploidy with a DNA index greater than 1.05 was found in every group: two of 16 NTs, two of nine micro-ITs, 11 of 13 macro-ITs, and 12 of 20 TCs were aneuploid. However, the proportions of aneuploidy of macro-IT and TC were statistically significantly higher than those of NT and micro-IT (P < .001). Similarly, the DNA indexes of macro-IT and TC were significantly higher than those of NT and micro-IT (P < .004). Therefore, micro-ITs were cytometrically similar to NTs and could be grouped with the NTs. Although ploidy analysis cannot predict whether an individual thymoma is invasive, aneuploidy and a high DNA index would favor a macro-IT, which also has a significantly higher S-phase fraction. Thymic carcinoma and IT cannot be differentiated by DNA flow cytometry. No definite ploidy pattern was observed for various histologic types of TC, but transition from diploid to aneuploid was demonstrated in thymomas undergoing malignant transformation into TC.     

The usefulness of celite-activated thromboelastography for evaluation of fibrinolysis

PURPOSE: Although thromboelastography is useful for measuring both coagulability and fibrinolysis, it takes about two hours to measure all parameters including fibrinolytic rate. The present study aimed to investigate the usefulness of celite-activated thromboelastography (TEGc) to evaluate fibrinolytic status in non-cardiac surgery. METHODS: Whole blood samples were obtained from 30 patients for non-cardiac surgery, and used for measurements of both native TEG (TEGn) and TEGc. The final concentration of 1% (w/v) celite was used for TEGc. RESULTS: Time for measurement of the fibrinolytic rate (FR) of TEGc in patients (56.7 +/- 4.0 min) was less than half that of FR of TEGn (123.3 +/- 15.6 min) (P < 0.05), suggesting a more rapid assessment of fibrinolytic status. A linear relationship was observed between FR values of TEGc and those of TEGn (r = 0.93, P < 0.0001), suggesting the usefulness of the fibrinolytic parameter of TEGc. CONCLUSION: TEGc is a useful technique for a more rapid assessment of fibrinolytic status.     

Technetium-99m labeled somatostatin and analogs: synthesis, characterization and in vivo evaluation

Technetium-99m complexes of somatostatin and analogs were synthesized following the introduction of sulfhydryl groups with 2-iminothiolane (Traut's Reagent). In rats the complex was taken up by the liver, kidneys, adrenals, lungs and the pancreas. Analysis of urine samples of treated rats showed that the radiochemicals have reasonably good in vivo stability. This implies that the complexes may be potentially useful for biochemical characterization of somatostatin receptors and also in scintigraphic detection of somatostatin receptor positive tumors, especially for metastatic deposits in patients on somatostatin therapy.     

Transesophageal echocardiography in mitral prosthesis dysfunction: usefulness and limitations in the evaluation of mitral insufficiency

This study was performed to test the usefulness of transesophageal echocardiography in the diagnosis and assessment of pathological mitral regurgitation in patients with mitral valve prostheses. Doppler color flow imaging by transesophageal echocardiography was compared to the transthoracic echocardiography and angiographic and surgical assessment. We analyzed the influence of the spatial configuration of the jet on the semiquantitative assessment of mitral regurgitation. We studied 71 patients with prostheses in mitral position which were submitted for transesophageal echocardiography examination. 51 of these patients were found to have a pathological prosthetic regurgitation that was confirmed in 21 cases by left ventriculography and in 4 during cardiac surgery. Transesophageal echocardiography Doppler color flow imaging identified a regurgitant jet in 31 patients (60.7%). There was complete agreement with the quantitative assessment of regurgitation by angiography or surgery in 36% of the cases. All patients with prosthetic insufficiency observed by angiography or during cardiac surgery were confirmed by transesophageal echocardiography. Complete agreement in grade of severity by transthoracic echocardiography was found in 84% of cases. There was a difference in grade of severity of mitral regurgitation in only 4 patients. Regurgitant jets were classified by transesophageal echocardiography color Doppler in two groups: free jets and impinging wall jets. 21 cases presented a free jet and 31 excentrically directed impinging wall jet of mitral regurgitation. There was complete agreement with hemodynamic assessment of severity in all patients with regurgitant free jets (11/11). In presence of jet wall there was understimation of mitral regurgitation in 28.5% (4/13).(ABSTRACT TRUNCATED AT 250 WORDS)     

Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these, 21 (19% of total group) had one or several bone metastases confirmed by biopsy (n = 8) or radiographic techniques (n = 13). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC.     

Effect of catechol-O-methyltransferase inhibition on brain uptake of [18F]fluorodopa: implications for compartmental modelling and clinical usefulness

The purpose of the experiment was threefold: (a) To find evidence that grasping is body-scaled and thus remains invariant during development; (b) to seek evidence that the body-scaled ratio of cube and hand size serves as a control parameter for the phase transition from one-handed to two-handed grasping by identifying the presence of sudden jump, enhanced variance, multistability, and hysteresis; and (c) to examine whether the stability properties of the observed grasping patterns increase with age. Thirty-three children aged 5, 7, and 9 years old were required to grasp and lift 14 cardboard cubes of different sizes (2.2, 3.2, 4.2, etc. to 16.2 cm diameter). Three conditions were used: (a) an increasing condition with sizes ordered from the smallest size to the largest; (b) a decreasing condition, with the sizes ordered from the largest to the smallest; and (c) twice in a different random order. Video recordings were analyzed and scored for the percentage of one-handed grasps. The results showed that the shift from one-handed to two-handed grasping occurred at the same body-scale ratio between cube size and finger span for all three age groups. Evidence was found for the presence of a sudden jump, enhanced variance, multistability, and hysteresis, indicating that the body-scaled ratio of cube and hand size serves as a control parameter. No change with age for the stability properties of the grasping patterns were observed.     

Clinical usefulness of helical-scanning CT for the evaluation of arteriosclerotic carotid lesions

We examined arteriosclerotic carotid lesions in 76 patients using helical scanning CT (HES-CT), and evaluated the clinical usefulness of this method. A high speed slip-ring X-ray CT system was used. Scanning of the neck was performed for a 30 second period following intravenous bolus injection of non-ionic contrast medium, while couch top movement was 2.0 mm/sec. Multiplannar reconstruction images (MPR-image) and 3-dimensional surface images (3D-image) were reconstructed from the continuous raw data. MPR-images offered axial, coronal and sagittal images in which the lesion could be seen from any direction, and 3D-images that could be freely rotated were obtained by using a track ball and monitor. Eighteen cases were also evaluated by conventional angiography. Excellent HES-CT images were obtained in 73 cases, showing occlusion in 13, stenosis in 34, plaques without calcification in 15 and plaques with calcification in 74 vessels. A good correlation was obtained between HES-CT and angiogram in most cases, and in 6 cases, HES-CT was superior in the detection of stenosis, because it enabled us to observe the lesion from various directions. These results suggested that HES-CT was a minimally invasive, useful diagnostic method for the evaluation of arteriosclerotic carotid disease.     

Immunohistochemical evaluation of thymidylate synthase in gastric carcinoma using a new polyclonal antibody: the clinical role of thymidylate synthase as a prognostic indicator and its therapeutic usefulness

BACKGROUND: Before this study was conducted, the clinical and therapeutic significance of immunohistochemical evaluation of thymidylate synthase (TS) in patients with gastric carcinoma had not yet been clarified. METHODS: TS was immunohistochemically evaluated in 134 gastric carcinomas using anti-TS antibody. TS expression, 11 clinicopathologic variables, and survival were studied, and the correlations among them were investigated. RESULTS: The groups with high and low TS levels consisted of 56 and 78 patients, respectively. Granular cytoplasmic staining patterns of tumor cells were produced by immunohistochemical staining of the gastric carcinoma tissues. The grade of TS staining was significantly correlated with three clinicopathologic variables: depth of invasion, peritoneal metastasis, and stage of the carcinoma (P < 0.05). A univariate analysis revealed that the 5-year survival was significantly better for the low TS group than for the high TS group (P < 0.05): 65.2% for the low TS group and 43.2% for the high TS group. The group with high grade TS staining who received chemotherapy because of the advanced stage of their disease had worse prognoses even if they received adjuvant chemotherapy. A multivariate analysis revealed that four variables (peritoneal metastasis, lymphatic invasion, liver metastasis, and TS staining grade) independently contributed to survival (P < 0.05). The hazard ratio for the group with low grade TS staining was 0.464 compared with the group with high grade staining. CONCLUSIONS: The immunohistochemical evaluation of TS using this anti-TS antibody may be clinically and therapeutically useful in determining the prognosis of gastric carcinoma patients.