Gulay Durmus Altun

A premature infant with h-type tracheoesophageal fistula demonstrated by scintigraphic technique.

Purpose: Congenital tracheoesophageal fistula (TEF) without esophageal atresia is commonly known as “H” type. This is extremely rare in infants. The rarity of the condition, its nonspecific symptomatology, and limitations in its demonstration by contrast radiology and endoscopy contribute to delays between first presentation and confirmation of the diagnosis. Our aim was to demonstrate a congenital H-type tracheoesophageal fistula by using Tc-99m sulfur colloid scintigraphy. Materials and Methods: A case report. Results: A preterm female infant was born by cesarean section at 34 weeks gestation. After many attempts of feeding, she developed apnea, resolving spontaneously, peroral cyanosis, pallor, hypersalivation, and abdominal distension, even when she was being fed by an orogastric tube. With this complex symptomatology, she was suspected to have an H-type TEF. Because of prematurity and recurrent respiratory problems of the infant and the high risk of aspiration of contrast material during a cineradiographic procedure, and also because of the invasive nature of the endoscopic procedure as well as the requirement of general anesthesia, the diagnosis was made by using Tc-99m sulfur colloid scintigraphy and confirmed at operation. Conclusion: Demonstrating a congenital H-type tracheoesophageal fistula by using radionuclide imaging is an easily applicable technique.

Comparison between semiquantitative interictal Tc-99m HMPAO SPECT and clinical parameters in children with partial seizures

The aim of the present study was to correlate between clinical parameters (age, age of onset, frequency and duration of seizures) and semiquantitative interictal SPECT parameters in children with partial seizures. We obtained 30 patients who had hypoperfusion in interictal SPECT, retrospectively. All patients underwent a detailed clinical examination, electroencephalography (EEG) investigation and brain computerized tomography (CT) and/or magnetic resonance imaging (MRI). Single photon emission computerized tomography (SPECT) studies were evaluated visually and by calculating semiquantitative parameters (the degree (asymmetry index, AI) and extent (number of ROI) of hypoperfusion). Visual analysis detected ipsilateral hypoperfusion in 23 (76%) patients with a unilateral focus and contralateral hypoperfusion in seven patients. We found an inverse correlation between the age at onset of seizure (r = -0.40, P = 0.025), frequency of seizures(but positive correlation; r = 0.77, P = 0.000) and AI. Number of ROIs showed a moderate correlation with the frequency of seizures (r = 0.67, P = 0.000), while correlation of the age at onset of seizures was not significant. This study performed in pediatric patients also suggested that either SPECT parameters may be used for correlating with clinical parameters.

Effects of intraperitoneal melatonin on caustic sclerosing cholangitis due to scolicidal solution in a rat model

BACKGROUND Hydatid disease is a worldwide health problem. Treatment is surgical or percutaneous, using scolicidal agents. Caustic sclerosing cholangitis might develop after the contact of scolicidal agents with the biliary ducts. Melatonin, an antioxidant, anti-inflammatory, and anticarcinogenic agent, might be used in the treatment of caustic sclerosing cholangitis due to its possible preventive effects on fibrosis and cell damage. OBJECTIVE The aim of the study was to investigate the effects of melatonin on an experimentally developed caustic sclerosing cholangitis with scolicidal solution (formalin) in a rat model. METHODS Forty female Sprague-Dawley rats aged 11 to 13 weeks and weighing 250 ± 30 g were randomly assigned to 1 of 4 groups of 10: formalin 5% at 0.5 mL/d + melatonin placebo; formalin placebo + intraperitoneal melatonin 10 mg/kg/d; formalin 5% at 0.5 mL/d + melatonin 10 mg/kg/d; and formalin placebo and melatonin placebo (control). Hepatobiliary function was assessed using dynamic scintigraphy with technetium-99m-mebrofenin on study day 60. The histology of the liver and biliary duct specimens was examined on study day 60. In each group, histopathologic alterations were scored as absent, slight, mild, or severe. RESULTS Mean severity scores for parenchymal necrosis in the liver (P < 0.01), portal fibrosis (P < 0.01), biliary duct proliferation (P < 0.001), cholangitis/ pericholangitis (P < 0.01), hyperemia in the biliary ducts (P < 0.01), and fibrosis (P < 0.01) were significantly lower in rats treated with formalin + melatonin compared with those treated with formalin alone. No significant differences were observed between the 3 treatment groups with respect to t½, a parameter used to assess the secretion function of the hepatocytes. However, the t½ was significantly longer in the treatment groups compared with controls (P < 0.001). CONCLUSION In this experimental study in a rat model of caustic sclerosing cholangitis, the histopathologic and scintigraphic findings suggested that melatonin is effective in attenuating the damage caused by scolicidal agents on the liver and biliary ducts.

Ventricular repolarization changes during thyrotropin releasing hormone test

Abstract We investigated the ventricular repolarization changes during thyrotropin-releasing hormone (TRH) test in 20 euthyroid healthy subjects. TSH elevation was observed in 14 subjects (age: 29±5 years). TSH increased at 20 min (baseline: 1.91±1.18 μU/ml vs. 20 min: 13.7±7.2 μU/ml, P P P

Increased Tc-99m MIBI uptake in atelectatic lung : A pitfall in scintigraphic evaluation of central bronchogenic carcinoma

Tc-99m MIBI accumulation was seen in both tumor and atelectasis in two patients with central bronchogenic carcinoma and in one patient with atelectasis due to tuberculosis. These cases illustrate that Tc-99m MIBI also can accumulate in atelectasis caused by either benign or malignant lung lesions and that this accumulation may overestimate the extent of the tumor or may lead to a misdiagnosis. These potential piffall should be considered in interpretation of Tc-99m MIBI scintigraphy in patients with lung cancer.

Intrathoracic toxic thyroid nodule causing hyperthyroidism with a multinodular normal functional cervical thyroid gland

Radionuclide scintigraphy with I-131 and Tc-99m pertechnetate (99mTc04) has been widely used in detecting toxic nodules. Intrathoracic goiter usually presents as an anterior mediastinal mass. Mostly the connection between intrathoracic mass and the cervical thyroid gland is clearly and easily identified occurring as a result of inferior extension of thyroid tissue in the neck, which is called as secondary intrathoracic goiter. Completely separated, aberrant or in other words primary intrathoracic goiters arise as a result of abnormal embryologic migration of ectopic thyroid closely associated with aortic sac and descend into the mediastinum. Intrathoracic goiters are generally nontoxic nodules existing with mass effect without causing hyperthyroidism. However, mostly reported cases had enlarged thyroid glands in the neck. This report demonstrates the usefulness of I-131 and 99mTc04scintigraphy for detecting intrathoracic goiter causing hyperthyroidism with a normal functioned cervical thyroid gland.

Melatonin administration acutely decreases the diffusing capacity of carbon monoxide in human lungs

Background: Most physiological measurements of the pulmonary diffusing capacity use carbon monoxide (CO) as a tracer gas. Similar to CO, melatonin binds the hemoglobin in the blood. Objective: The present study was designed to assess the effect of exogenous melatonin administration on pulmonary functions including diffusing capacity for carbon monoxide (DLCO) in healthy subjects. Methods: The study was performed in a randomized, double-blind, placebo-controlled manner. DLCO was measured in 22 healthy male volunteers (age 18–25 years) who were randomized to melatonin (n = 11) and placebo administration (n = 11). At baseline, DLCO, alveolar volume (VA) and other spirometric parameters such as forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and maximal voluntary ventilation (MVV) were measured. DLCO was then corrected for the hemoglobin concentration. Measurements were repeated in a double-blind fashion 60 min after the administration of melatonin (1 mg) or placebo. Results: DLCO was significantly decreased (39.31 ± 4.75 vs. 34.82 ± 6.18 ml/min/mm Hg) 60 min after the melatonin administration (p = 0.01), while FEV1, FVC, FEV1/FVC, PEF and MVV values did not demonstrate significant differences. Placebo administration did not result in significant alteration in any of these parameters. Conclusions: In healthy subjects, oral administration of melatonin acutely influences the DLCO without affecting other pulmonary function test results. We conclude that melatonin may have a reducing effect on the DLCO in the lungs.

Irbesartan has a masking effect on dipyridamole stress induced myocardial perfusion defects.

Background and aimThe angiotensin II type 1 (AT1) receptor antagonist irbesartan is used for the treatment of hypertension, but its anti-ischaemic effect is not yet known. Our aim was to assess the effect of irbesartan administration on the diagnostic yield of 99mTc sestamibi single photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) after dipyridamole stress. MethodsOur study group consisted of 13 patients (11 men and two women; mean age, 53.3±10.6 years; body mass index, 26.9±3.3 kg·m−2) with angiographically documented CAD. All patients underwent 9mTc sestamibi SPECT studies at rest, before (STRESS-1) and 2 weeks after irbesartan (150 mg daily) administration (STRESS-2) at dipyridamole stress. The extent and severity of defects were analysed by using visual and quantitative 99mTc sestamibi SPECT. ResultsThe mean summed stress score was significantly higher during the STRESS-1 study than the STRESS-2 study (13.2±7.4 vs. 11±7.4, P=0.003). The mean size of perfusion defects at stress was significantly larger for the STRESS-1 group than the STRESS-2 group (17.8%±2.85% vs. 15.3%±2.95%, P=0.01). ConclusionOur study showed that the AT1 receptor blocker irbesartan reduces the extent and severity of 99mTc sestamibi perfusion defects after dipyridamole stress in patients with CAD. Irbesartan may alter coronary blood flow reserve. The continued use of irbesartan before stress myocardial perfusion SPECT has a masking effect on stress induced myocardial perfusion defects. For this reason AT1 receptor blockers must be stopped before stress myocardial perfusion scintigraphic examinations.

Radioprotective Effects of Amifostine, L-Carnitine and Vitamin E in Preventing Early Salivary Gland Injury due to Radioactive Iodine Treatment

OBJECTIVE Standard treatment of differentiated thyroid cancer includes total thyroidectomy and high-dose Radioactive Iodine Therapy (RIT) for ablation of remnant thyroid tissue. When administered systemically, RIT can cause radiation-induced damage in non-targeted normal tissues. The aim of the present study was to compare the protective effects of amifostine (AMI), LCarnitine (LC), and Vitamin E (EVIT) against high dose radioactive iodine treatment induced Salivary Gland (SG) damage using SG scintigraphy and histopathological examination. METHODS Forty adult guinea pigs were studied. Twenty guinea pigs receive 555-660 MBq 131Iodine intraperitoneally (IP) to ablate the thyroid and impair the parenchymal function of the SGs. The animals were divided into eight groups as follows: (1) Group 1 (control): 1 mL IP PS (physiological saline); (2) Group 2: single dose of 200 mg/kg IP AMI one hour prior to 1 mL IP PS; (3) Group 3: 200 mg/kg IP LC and 1 mL IP PS for 10 days; (4) Group 4: 40 mg/kg intramuscular (IM) EVITand 1 mL IP PS for 10 days; (5) Group 5: IP RIT after premedication; (6) Group 6: Single dose of 200 mg/kg IP AMI one hour prior to RIT and IP RIT after premedication; (7) Group 7: IP RIT after premedication and 200 mg/kg IP LC for 10 days starting one day before RIT; and (8) Group 8: IP RIT after premedication and 40 mg/kg IM EVIT for 10 days starting one day before RIT. Scintigraphy was performed 1 month after treatment. SGs were examined by light microscopy and a histopathological scoring system was used to assess the degree of SG damage. RESULTS There were significant differences in the body weight and thyroid hormone levels between the groups after treatment. CONCLUSION The individual use of AMI, LC and EVIT for radioprotection yield different levels of protection against radioactive iodine treatment injury in SGs; however, none of the agents could provide absolute protection at the doses administered in this experimental model.

18F-Fluorodeoxyglucose positron emission tomography/computed tomography findings of pancreatic hemangiopericytoma

A 42-year-old woman with a large pancreatic tumor had undergone 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging. Moderate metabolic activity was detected on the head of the pancreas. The tumor was resected and it was histopathologically diagnosed as malign pancreatic hemangiopericytoma (HPC). HPC is a rare soft tissue sarcoma. The tumor is considered aggressive with high rates of local recurrence and metastasis regardless the localization. Herein, we present the imaging characteristics of HPC with 18F-FDG PET/CT.