Nese Torun

Increased Body Mass Index Is Not a Reliable Marker of Good Nutrition in Hemodialysis Patients

Objective. The aim of the study was to assess the body fat (BF) composition in hemodialysis (HD) patients using anthropometry and bioelectrical impedance analysis (BIA) and investigate relationships between BIA-determined BF composition and nutritional parameters in different weight groupings. Design. Cross-sectional study. Setting. A tertiary-care university hospital. Methods. 164 HD patients (M/F: 89/75, mean age: 48.4 ± 15.8 years, mean HD duration: 58.2 ± 42.6 months) were divided into three groups according to body mass index (BMI): normal weight (NW: BMI 18.5–24.9), overweight (OW: BMI 25–29.9), obese (OB, BMI ≥ 30). Biochemical parameters and BF composition using anthropometry and foot-to-foot BIA were compared between three groups. Results. Ninety-six (59%) patients were NW, 40 (24%) were OW, and 28 (17%) were OB. Average mean skinfold thickness (p = 0.005), mid-arm circumference (p = 0.001), BF% (p = 0.001), and fat-free mass (FFM) (p = 0.03) were all significantly greater in the OB group than in the NW group. Compared to the NW patients, the OB group had significantly higher serum levels of glucose (p = 0.03), total cholesterol (p = 0.02), and triglycerides (p = 0.02), but significantly lower serum albumin (p = 0.05) and blood urea nitrogen (p = 0.05). The OB group also had significantly higher white blood cell count (p = 0.002) and serum CRP (p = 0.001) than the NW group. Conclusions. The results suggest that BIA-determined BF composition is correlated with body mass index. In addition, obesity is associated with elevated CRP and white blood cell count and lower serum albumin level in HD patients.

Diffusion-weighted imaging and (18) F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer: Correlation of the apparent diffusion coefficient and maximum standardized uptake values with prognostic factors.

To evaluate the correlations between the apparent diffusion coefficient (ADC) value and the standardized uptake value (SUV) with prognostic factors in breast cancer.

Is PET/CT Necessary in the Management of Early Breast Cancer?

Purpose Advanced imaging methods in early breast cancers are not recommended before surgery. In contrast to the accepted guidelines, some recent studies have shown some benefits with the use of PET/CT in early-stage breast cancer. In this study, we aimed to document the efficacy of PET/CT in detection of distant metastasis as well as other primary cancers. Patients and Methods In this retrospective study, we reviewed the records of all women patients diagnosed with early breast cancer between March 2012 and December 2014. Besides demographics, we recorded the clinical TNM stage, histology of the tumor, and hormone receptor status. As PET/CT imaging is a routine procedure in our center for early breast cancer, tumor size, lymph node status, distant metastasis, and possible other primary malignancies detected by PET/CT were also recorded. Results Of the 419 women included in the study, 24.8% were clinically staged as stage I while the rest were stage II. Distant metastases were detected in 42 patients (10%). The yield of PET/CT in detecting metastasis was significant in stage II patients compared with stage I patients (12.4% vs 2.9%). In subgroup analysis of stage II patients, the performance of PET/CT in detecting metastasis was still evident in stage IIA patients (9.5%). In logistic regression analysis of the significant and near-significant factors (as detected by univariate analysis) effecting PET/CT detected distant metastasis, only nodal status (P = 0.053) was found to be significant. Conclusions We suggest the use of PET/CT in investigating metastasis in axilla positive and clinically stage II early breast cancer patients.

Choroidal Metastasis of Papillary Thyroid Carcinoma Demonstrated on SPECT-CT.

We report a 68-year-old woman with papillary thyroid carcinoma metastasizing to choroid. The choroid metastasis was diagnosed with SPECT-CT and then was treated with high-dose radioactive iodine therapy.

Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging

OBJECTIVE Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. MATERIALS AND METHODS Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). RESULTS The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. CONCLUSION Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients.

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.

An Unusual Gastrointestinal Stromal Tumor Presentain: Breast, Liver and Lymph Node Metastasis

Gastrointestinal Stromal Tumors (GIST) are the common mesenchymal tumors of gastrointestinal tract. They can display benign and malignant clinical behavior. The most common metastasis sites of malignant stromal tumor are liver, peritoneum, lung and bones. Metastasis to breast is extremely rare. Here, we present a case of GIST with liver, bone, lymph node and breast metastasis by reviewing the literature.

A Case of Primary Colon Carcinoma Demonstrated by FDG PET/CT Imaging After Detection of a Solitary Brain Metastasis

The detection of brain metastases as the initial manifestation of colorectal carcinoma without liver or lung involvement is extremely rare. Herein we present a case of a 52-year-old male patient with an unusual presentation of colon cancer, with primary lesions demonstrated by fluorine-18-labeled fluorodeoxyglucose (FDG) Positron-emission tomography/computed tomography (PET/CT) after detection of a solitary brain metastasis. Brain CT images revealed a brain tumor. Histopathologic evaluation indicated metastatic poorly differentiated adenocarcinoma, while his physical examination was normal. The PET/ CT revealed abnormal intense FDG uptake in the right parietal region and in descending colon, with no other abnormal FDG uptake elsewhere in the body. The histopathologic diagnosis of the descending colon lesion revealed moderately differentiated adenocarcinoma. This case indicates that FDG PET/CT imaging may have a positive impact on the evaluation of patients with brain metastasis from an unknown primary.