E.A Gencoglu

Tear clearance measurement in patients with dry eye syndrome using quantitative lacrimal scintigraphy.

ObjectiveThe aim of this study was to evaluate the tear clearance in patients with dry eye syndrome using quantitative lacrimal scintigraphy.aterials and MethodsWe investigated 21 patients (42 eyes; 18 women, 3 men; mean age, 63.19 ± 13.33 years) with dry eye syndrome. Additionally, for the sake of comparison, 12 normal subjects of the same age group (24 eyes; 10 women, 2 men; mean age, 68.25 ± 2.63 years) were included. Lacrimal scintigraphy, Schirmer-1 test, BUT, and rose bengal ocular surface vital staining were performed in these cases.Resultsccording to the results of lacrimal scintigraphy, the mean value of Tl/2 was 4.16 ± 1.22 minutes and the mean value of RI was 14.15% ± 2.30% in normal subjects. However, in patients with dry eye syndrome, these values were 20.59 ± 1.97 minutes and 55.64% ± 6.90%, respectively. Consistent with the results of Ophthalmologic tests, the mean Schirmer-1 value was 12.46 ± 2.10 mm, the mean value of BUT was 14.36 ± 3.40 seconds, and the mean staining value of the rose bengal was 1.98 ± 0.80 in normal subjects, whereas these values were 1.36 ± 0.49 mm, 5.46 ± 1.33 seconds, 6.62 ± 0.86, respectively, in patients with dry eye syndrome. When we compared the results of lacrimal scintigraphy and the results of Ophthalmologic tests, an inverse correlation was noted between both the Tl/2 and RI values and both the Schirmer-1 and BUT values in all subjects (p < 0.001). However, there was a greater positive correlation between the rose bengal ocular surface staining value and both the Tl/2 and RI values in all cases (p < 0.001).ConclusionIn the current study, it was concluded that although the lacrimal drainage system was normal, tear clearance was significantly delayed in dry eye patients. With this study, we have shown that quantitative lacrimal scintigraphy, which is an objective, practical, and noninvasive method, appears to be useful for the assessment of the tear clearance in patients with dry eye syndrome.

Evaluation of pediatric liver transplant recipients using quantitative hepatobiliary scintigraphy.

THE first successful liver transplantation was performed in 1963. Since then, advances in surgical technique, immunosuppressive therapy, and treatment of posttransplant complications have dramatically improved the prognosis for patients who undergo this procedure. Further, refinement of preoperative nutritional management and the advent of techniques for reduced-size transplants have made liver transplantation the preferred treatment for pediatric patients with end-stage liver disease. The postoperative period is a critical and uncertain time for pediatric liver transplant recipients because of the possibility of various complications that lead to liver dysfunction. Possible complications include infection, rejection, hepatocyte damage, cholestasis, vascular occlusion, and biliary obstruction. Another important issue is that there may be no accompanying clinical signs when a graft starts to fail. Biochemical testing lacks sensitivity, especially in the early postoperative period. Biopsy is currently considered the only definitive method for identifying liver transplant problems, but this is an invasive procedure. Quantitative, non invasive methods are needed to diagnose graft dysfunction in the early stage. Radionuclide imaging methods may meet these requirements. The aim of this study was to assess the clinical value of serial quantitative hepatobiliary scintigraphy for monitoring graft function in pediatric liver transplant recipients.

Usefulness of hepatobiliary scintigraphy for the evaluation of living related liver transplant recipients in the early postoperative period.

AIM The aim of this study was to investigate the usefulness of hepatobiliary scintigraphy for the evaluation of liver grafts in the early postoperative period in patients receiving liver transplants from living related donors. MATERIALS AND METHODS Fifty-six liver transplant recipients who received grafts from living related donors were included in the study. We examined the hepatobiliary scintigraphies of all patients, which were performed 7 to 10 days after the transplantation. The scintigraphic images were evaluated visually in terms of hepatic parenchymal function and biliary and vascular complications. RESULTS In 44/56 recipients, hepatobiliary scintigraphy was completely normal in the early postoperative period. However, in 6/56 cases, scintigraphy was interpreted to show parenchymal dysfunction. In these patients, histopathologic confirmation by biopsies revealed four cases of hepatocellular damage/cholestasis, one acute rejection, and one cholangitis. In 3/56 patients, hepatobiliary scintigraphy demonstrated a hypoactive area in the liver graft; however, the other areas showed normal function. When the abdominal computed tomography (CT) and CT angiography were evaluated, these hypoactive areas were discovered to be related to minor vascular problems. In 3/56 liver graft recipients whose grafts showed normal parenchymal function scintigraphically, images were interpreted to indicate bile leak because accumulation of tracer was seen at an abnormal physiological site. CONCLUSION Hepatobiliary scintigraphy, which is a noninvasive and objective method, is useful to assess grafts in the early postoperative period among patients who received liver transplants from living related donors.

The efficacy of low and high dose 99mTc-MIBI protocols for intraoperative identification of hyperplastic parathyroid glands in secondary hyperparathyroidism

OBJECTIVE The aim of this study was to compare the efficacy of low- and high-dose (99m)Tc-MIBI protocols for intraoperative identification of hyperplastic parathyroid glands via gamma probe in secondary hyperparathyroidism. MATERIAL AND METHODS This retrospective study was conducted using a prospective database of 59 patients who had undergone radioguided subtotal parathyroidectomy between 2004-2012. The patients were studied in 2 groups. Group 1 (n=31) received 37 MBq (99m)Tc-MIBI intravenously in the surgical room approximately 10 min before the beginning of the intervention and surgery was performed under gamma probe guidance. Group 2 (n=28) received 555 MBq (99m)Tc- MIBI intravenously 2h before surgery, which was also performed under gamma probe guidance. Intraoperative gamma probe findings, laboratory findings, and histopathological findings were evaluated together. RESULTS Using acceptance of the histopathological findings as gold standard, sensitivity and specificity of intraoperative gamma probe for identifying hyperplastic parathyroid glands was 98% and 100%, respectively, in both groups. CONCLUSIONS In the light of these findings, it is concluded that the low-dose (99m)Tc-MIBI protocol might be preferable for intraoperative identification of hyperplastic parathyroid glands in secondary hyperparathyroidism patients because it was observed to be as effective as the high-dose (99m)Tc-MIBI protocol. Furthermore, the low-dose protocol does not have the disadvantages that are associated with the high-dose protocol.

The effectiveness of low-dose versus high-dose 99mTc MIBI protocols for radioguided surgery in patients with primary hyperparathyroidism.

ObjectiveThe aim of this study was to compare the efficacy of low-dose and high-dose 99mTc methoxy isobutyl isonitrile (MIBI) protocols in intraoperative localization of parathyroid adenomas by means of a gamma probe in patients with primary hyperparathyroidism (PHPT). Patients and methodsThe study included 62 patients with PHPT who were divided into two groups. Group 1 consisted of 32 patients who were injected with a low dose (1 mCi) of 99mTc MIBI in the surgical suite 10 min before incision. Group 2 included 30 patients who were intravenously administered a high dose (15 mCi) of 99mTc MIBI 2 h before surgery. With the aid of a gamma probe, intraoperative localization of parathyroid adenomas was performed in both groups of patients who underwent minimally invasive parathyroidectomy. All lesions thought to be parathyroid adenomas were excised and subsequently evaluated histopathologically. ResultsAll parathyroid adenomas in both groups were localized and excised by means of an intraoperative gamma probe. The sensitivity, specificity, and accuracy of low-dose and high-dose 99mTc MIBI protocols in the intraoperative localization of adenomas in patients with PHPT were 100%. ConclusionIn the light of these findings, we conclude that low-dose 99mTc MIBI may be preferred to intraoperative identification of parathyroid adenomas by means of a gamma probe in PHPT patients because it appears to be as effective as high-dose 99mTc MIBI. Moreover, the low-dose protocol does not have the disadvantages of high-dose protocol.

Kolorektal kanser yeniden evrelemesi ve PET/BT

Positron Emission Tomography/Computerized Tomography (PET/CT) is an important assessment method in restaging of oncology patients. Its ability to detect the metabolic/functional changes in patients with colorectal cancer during the early stages, in which morphological changes cannot be documented, is significantly superior to other imaging modalities.Positron Emission Tomography/Computerized Tomography (PET/CT) is an important assessment method in restaging of oncology patients. Its ability to detect the metabolic/functional changes in patients with colorectal cancer during the early stages, in which morphological changes cannot be documented, is significantly superior to other imaging modalities.

Comparison of efficacy of Tc-99m HIG and Tc-99m nanocolloid on sentinel lymph node mapping in patients with breast cancer.

Background and aimThis study compared the effectiveness of Tc-99m human polyclonal immunoglobulin (HIG) and Tc-99m nanocolloid at detecting sentinel lymph nodes (SLNs) with lymphoscintigraphy and an intraoperative γ-probe (IGP) in patients with early breast cancer. MethodsThe study group consisted of 50 women; 25 patients each were given Tc-99m HIG or Tc-99m nanocolloid for lymphoscintigraphy. Then, intraoperative SLN localization with IGP was performed. The results of IGP, lymphoscintigraphy, blue dye injected just before surgery, and pathology were compared. ResultsIn the Tc-99m HIG group, one patient had tumours in both breasts. In two patients, we could not detect SLNs with lymphoscintigraphy, although they were detected with IGP and blue dye. We found SLNs for all tumours with IGP. With the intraoperative blue dye, SLNs were identified for 25 tumours; for one tumour, no SLN was detected with blue dye. In the histopathological examination, 13 tumours showed metastasis in the SLN and in 11 of these 13, there were also metastases in the axilla. One patient had a skip metastasis. In the Tc-99m nanocolloid group, SLNs were identified in 24 patients with lymphoscintigraphy. IGP found SLNs in 24 patients. The blue dye detected SLNs in all patients. On histopathological examination, 10 patients had metastasis in the SLN and there were also metastases in the axilla in all of these patients. ConclusionTc-99m HIG can be used in SLN detection with preoperative lymphoscintigraphy and IGP in early-stage breast cancer patients.

A Novel Cause of False-Positive Iodine-131 Whole Body Scintigraphy: Eczema

İyi diferansiye tiroid kanserli hastaların takibinde yaygın olarak kullanılan I-131 tüm vücut tarama sintigrafisinin doğru yorumlanması hastalar açısından büyük önem taşımaktadır. Çünkü, vücut sekresyonlarının bulaşı, artefaktlar, inflamasyon/infeksiyon, nontiroidal neoplazmlar gibi pek çok sebebe bağlı olarak metastazı taklit eden yanlış pozitif görüntüler ortaya çıkabilir ve bu durum hastalara gereksiz ileri tetkik ve tedavi uygulanmasına neden olabilir. Bu açıdan, I-131 tüm vücut tarama sintigrafisinde yanlış pozitifliğe neden olan tüm durumların bilinmesi ve bunların doğru olarak tanınıp patolojik aktivitelerden ayırt edilmesi, optimal sintigrafik değerlendirme için en önemli koşuldur. Bu çalışmada, literatürde ilk kez, I-131 tüm vücut tarama sintigrafisinde yanlış pozitifliğe yol açan yeni bir neden olarak egzama bulunan bir olgu sunulmaktadır. Papiller tiroid kanseri nedeniyle total tiroidektomi ve sol boyun diseksiyonu yapılmıs, lenf nodu metastazı bulunan 73 yasında kadın hastaya 150 mCi I–131 tedavisi verildi. Tedavi öncesi TSH değeri>100mIU/ml (normal değer: 0.30-5 μUI/mL), tiroglobulin 0.15ng/ml (normal değer: 0-75 ng/mL), anti-tiroglobulin 136 ng/ml (normal değer: 0-100 ng/mL) olarak saptandı. Tedavi sonrası 7. günde gama kamera (E-Cam, Siemens, Almanya) ile rutin olarak yapılan I-131 tüm vücut tarama çalışmasında, boyunda sağda daha belirgin olmak üzere orta hattın her iki yanında rezidüel tiroid dokusuna, sublingual bölgede ektopik tiroid dokusuna ait olduğu düsünülen aktivite tutulumları izlendi (Resim 1). Ayrıca, incelemede solda daha belirgin olmak üzere her iki elde palmar yüzde multipl odakta aktivite tutulumu dikkati çekti. Kontaminasyon ihtimaline karşı, hastanın elleri yıkatılarak 24 saat sonra takip görüntüleri alındı, ancak alınan görüntülerde bu tutulumların devam ettiği saptandı (Resim 2). Hastanın yaklaşık 30 yıldır egzama tanısıyla izlendiği ve zaman zaman bu açıdan tedavi gördüğü öğrenildi. Yapılan muayenede, solda daha belirgin olmak üzere her iki elde palmar yüzde kabuklanma evresindeki veziküler lezyonlar gözlendi ve bu alanların sintigrafide artmış aktivite tutulumu görülen bölgelerle uyumlu olduğu tespit edildi (Resim 3). Kemik patolojisi olasılığını ekarte etmek için her iki elin direkt grafisi çekildi, kemiklerde patolojik bulgu saptanmadı (Resim 4). Tüm incelemeler birlikte değerlendirildiğinde I–131 taramada ellerde izlenen fokal aktivite tutulumlarının, egzamaya bağlı yanlış pozitif görüntü olduğu düşünüldü. Sonuç olarak, egzamalı hastalarda vücudun herhangi bir bölgesinde cilt lezyonlarında, muhtemelen inflamasyona bağlı I–131 tutulumunun olabileceği, hastaların sintigrafik görüntüleri değerlendirilirken bu durumun yanlış pozitiflik kaynağı olarak mutlaka göz önünde bulundurulması gerektiği düsünüldü.

Evaluation of the effects of recipient/donor gender on early/late postoperative renal graft functions by renal scintigraphy.

OBJECTIVES We discuss the effects of recipient/donor gender on renal allograft functions using scintigraphic parameters obtained 3 days after renal transplant and 1 year after transplant. MATERIALS AND METHODS This retrospective study included 76 renal allograft recipients (group one, 38 males; group two, 38 females). Patients underwent scintigraphic imaging with Tc-99m DTPA on postoperative day 3 and 1 year after transplant. We used the Hilson perfusion index, maximum renal activity/background activity, ratio of renal activity at 20 minutes to renal activity at 3 minutes, time-to-peak activity, and glomerular filtration rate to measure quantitative parameters. RESULTS On postoperative day 3, the Hilson perfusion index, maximum renal activity/background activity, the ratio of renal activity at 20 minutes to renal activity at 3 minutes, time-to-peak activity, and glomerular filtration rate values for male/female recipients were similar (P = .65, P = .77, P = .38, P = .10, P = .99). The gender of donors was compared with the above-mentioned scintigraphic parameters of the recipients, and no statistically significant differences were found (P = .24, P = .25, P = .44, P = .29, P = .13). At 1-year follow-up, values obtained from group 1 and group 2 recipients were similar. After 1 year, chronic rejection developed in 15.7% of group 1 recipients and in 10.5% of group 2 recipients; acute rejection developed in 21% of group 1 recipients and in 23.6% of group 2 recipients. There were no statistically significant differences between the occurrence of acute rejection and the gender of recipients or donors (P = 1.00, P = .45). CONCLUSIONS We observed no statistically significant differences between renal graft functions and gender of the recipients/donors during the early/late posttransplant period.