Gozde Daglioz Gorur

Correlation of Cystatin-C and radionuclidic measurement method of glomerular filtration rate in patients with lung cancer receiving cisplatin treatment

Abstract Objective: Cisplatin is a chemotherapeutic agent which affects renal functions adversely. The best indicator of renal functions is glomerular filtration rate (GFR) measurement. Cystatin-C appears to be a good alternative to existing methods of measuring GFR. However, it is controversial whether Cystatin-C demonstrates GFR correctly for patients receiving chemotherapy. This study aimed to investigate the correlation between GFR values calculated by Cystatin-C based formulas, radionuclidic method (multiple blood sampling) and blood Cystatin-C values in patients with lung cancer, receiving cisplatin treatment in both pre-treatment and post-treatment periods. Materials and methods: Thirty-six patients with lung cancer who were going to receive cisplatin treatment were included in this study. However, the evaluation was performed with 20 patients since 16 of them could not complete the treatment. Blood Cystatin-C values, GFR values calculated via Cystatin-C based formulas, and radionuclidic method were investigated before and after the cisplatin treatment. Results: After treatment significant decreases were detected in GFR values, obtained via radionuclidic measuring method. However, there was no significant difference in Cystatin-C values between pre-treatment and post-treatment periods. Also GFR values obtained by Cystatin-C based formulas were not significantly different in pre-treatment and post-treatment periods. There were meaningful correlations between radionuclidic method and Cystatin-C values and Cystatin-C based formulas before treatment. However, all correlations disappeared after the treatment. Conclusion: GFR values, calculated by Cystatin-C may not be reliable in following renal functions in patients receiving chemotherapy. When reliable monitoring of the renal functions is necessary radionuclidic method may be preferred in these patients.

Sentinel lymph node biopsy with a gamma probe in patients with high-risk cutaneous squamous cell carcinoma: follow-up results of sentinel lymph node-negative patients.

ObjectiveLymphoscintigraphy (LS) and sentinel lymph node biopsy have become the standard of care for melanoma and breast cancer. However, the data on patients with cutaneous squamous cell carcinoma (SCC) are limited. We aimed to evaluate and identify the role of LS and sentinel lymph node biopsy in patients with high-risk cutaneous SCC. MethodsNineteen patients (13 men, six women; 47–87 years of age, mean age 67.5±12.3) with SCC were included in the study. LS was performed on all patients after intracutaneous injection of Tc-99m nanocolloid. Primary lesions and sentinel lymph nodes (SLNs) were excised with the help of a gamma probe. ResultsA total of 26 SLNs and 32 secondary lymph nodes were imaged on LS and were marked. During surgery, 29 SLNs, 21 secondary lymph nodes and three nonactive lymph nodes were excised. In total, 53 lymph nodes were removed surgically. A histopathological study revealed that all lymph nodes were negative for metastasis. Patients were followed up for an average of 41.1±22.2 months (7–80 months). Until the time of data collection, 14 patients were alive and had no regional lymph node or distant metastasis. Local recurrence was seen in only one patient. He was reoperated upon 38 months ago. ConclusionThe feasibility of determining SLNs using LS and an intraoperative gamma probe in patients with cutaneous SCC was shown. Unnecessary elective lymph node dissection and possible complications could be avoided in 19 patients.

Comparison of exercise and pharmacological stress gated SPECT in detecting transient left ventricular dysfunction

ObjectiveTransient left ventricular contractile dysfunction (TLVD) is observed owing to post-exercise stunning in patients with coronary artery disease (CAD). Pharmacological stimulation differs from exercise stress because it does not cause demand ischemia. The aim of this study was to determine whether TLVD could also be seen after pharmacological stress (dipyridamole).MethodsOf the patients in whom gated single-photon emission computed tomography (GSPECT) was performed in our institution from January 2004 to April 2007, 439 subjects with known or suspected CAD were included in the study. GSPECT was performed for all patients following exercise (group I, n = 220) or pharmacological stress (group II, n = 219) according to a 2-day (stress-rest) protocol after injection of Tc-99m methoxyisobutyl-isonitrile (MIBI). Stress, rest, and difference (stress-rest value) left ventricular ejection fractions (SLVEF, RLVEF, and DLVEF) and transient ischemic dilatation (TID) ratio were derived automatically. Summed stress score, summed rest score, and summed difference score (SDS) for myocardial perfusion were calculated using a 20-segment model and a five-point scoring system. An SDS > 3 was considered as ischemic. On the basis of the perfusion findings, patients were subdivided into a normal (group A, n = 216) and ischemia group (group B, n = 223). DLVEF and perfusion scores of all groups were compared. Relationships between DLVEF and perfusion, and between TID ratio and DLVEF were also evaluated.ResultsStress-induced ischemia was observed in 223 of 439 patients (50.8%). In group A, the difference between stress and rest LVEF values was not significant (P = 0.670 and P = 0.200 for groups IA and IIA, respectively). However, LVEF was significantly decreased after stress compared with rest values for group B (P < 0.0001 for groups IB and IIB). TLVD (≤−5% for DLVEF) was observed in 20 of 216 (9%) and 81 of 223 subjects (36%) in patients in groups A and B, respectively (P < 0.0001). In group I, we found TLVD in 46 of 119 (39%) and 12 of 101 (12%) subjects, in patients with and without ischemia, respectively (P < 0.0001). On the other hand, in group II, TLVD was detected in 35 of 104 (34%) and 8 of 115 (7%) patients with and without ischemia, respectively (P < 0.0001). And also, we found significant good correlations between TID ratios and DLVEF values in four subgroups (r = −0.55, r = −0.62, r = −0.59, and r = −0.41; for groups IA, IB, IIA, and IIB, respectively, P < 0.0001 for all).ConclusionsDipyridamole is believed to be less likely than exercise to induce ischemia. However, in this study, TLVD after stress was observed following not only exercise but also pharmacological stress, consistent with ischemia.

FDG PET/CT findings in primary hyperparathyroidism mimicking multiple bone metastases

We present a 40-year-old female patient with a history of generalized bone pain and fatigue for 6 months. Hyperparathyroidism (PTH 1,629 pg/ml, normal range 12–65), parathyroid adenomas, hypophysis adenoma, clinical symptoms for insulinoma, and left adrenal mass were shown in her routine biochemical analysis, radiological, and scintigraphy images. MEN type I was suspected according to these findings. FDG PET/CTwas planned to exclude a malignancy. In fasting state, the patient was injected 370 MBq of FFDG intravenously. After the 1-h waiting period, a whole body FDG PET/CT image of the patient was obtained using an integrated PET/CT camera (Siemens Biograph LSO HIREZ PET/CT scanner, Chicago, IL, USA). The maximum intensity projection image of the FDG PET/CT demonstrated diffusely and multiple foci of increased FDG uptake throughout the skeleton, mimicking multiple bone metastases (a). However, there was no pathological uptake suggesting malignancy. After FDG PET/CT, a whole body bone scan (b) was obtained and showed a diffusely increased uptake in whole skeleton (especially in the calvarium, pelvis, and lower extremities) in a pattern highly suggestive of a hypermetabolic bone disease rather than bone metastases. The patient was than operated on for parathyroid pathology. PTH returned to the normal levels on follow-up of the patients. In patients with hyperparathyroidism, findings in bone scan and FDG PET/CT should be analyzed and reported very carefully [1–5]. References

Pulmonary 18F-FDG microembolism detected on only delayed image in a PET/CT study.

Focal 18F-FDG pulmonary uptake on PET without corresponding abnormality on CT is an incidental and rare finding. This artifact is associated with iatrogenic FDG microembolus as a result of vascular endothelium damage during injection. We present a pulmonary FDG microembolus in a patient evaluated for suspicion of gallbladder cancer not in early (standard 1-hour imaging after FDG injection) but in delayed image. To our knowledge, this is the first case that describes the possibility of FDG microembolism on only delayed image in a PET/CT study.

Gravesʼ Disease in a Patient With Ectopic Mediastinal Thyroid

Abnormalities in the embryologic development and migration of the thyroid gland can result in ectopic thyroid tissue. Ectopic mediastinal goiters are somewhat uncommon developmental anomalies, accounting for less than 1% of all thyroid ectopies. Graves’ disease within mediastinal goiter is a very rare entity, described only in few cases in English literature. Pretracheal thyroidectomy alone does not cure Graves’ disease and can stimulate growth of the ectopic tissue in such cases.

Low radioiodine uptake in congestive heart failure.

ObjectivesOur aim was to compare the radioiodine uptake (RAIU) of congestive heart failure (CHF) patients with that of a control group and investigate the prognostic value. We also assessed correlations of RAIU with other clinical parameters. MethodsA total of 32 CHF patients and 14 controls were included in this study. RAIU was measured at the fourth and 24th hour using an uptake probe. The patients were followed up for a mean period of 32.09±8 months. ResultsThe mean fourth-hour RAIU was 6.28±5.51 and the mean 24th-hour RAIU was 14.43±9.49 in the patient group. The mean fourth and 24th hour RAIUs of the control group were 9.93±1.92 and 22.90±5.89, respectively, which were statistically higher than that of the patient group (P=0.0001 and 0.001, respectively).Cardiac death occurred in nine patients during follow-up. The fourth and 24th hour uptake ratios were statistically significantly lower in the cardiac death group compared with the no-death group (3±2.01 vs. 7.57±5.93 and 7.39±7.34 vs. 17.18±8.9, respectively; P=0.003 and 0.007). On stepwise multivariate Cox regression analyses, only urea proved to be a significant independent predictor of cardiac death (hazard ratio 1.021; 95% confidence interval 1.005–1.037; P<0.008). Significant negative correlations were found between the fourth and 24th hour RAIUs and high-sensitivity C-reactive protein, urea, and creatinine levels, but no correlation was found between RAIUs and estimated glomerular filtration rate. ConclusionCHF patients have lower RAIU values probably because of an expanded iodine pool and prolonged Wolff–Chaikoff effect. Also, patients who died during follow-up had lower RAIU values, but RAIU did not emerge as an independent predictor of death. However, studies with larger patient groups are definitely needed.