Ozgur Karacalioglu

Prospective Study of the Impact of Thyroid Hormone Replacement on Objective Voice Parameters

Objectives: Hypothyroidism has long been considered to have an impact on phonation. In this study, objective evaluation of vocal function in women with hypothyroidism was performed in order to characterize potential dysphonia; their subsequent response to thyroid hormone replacement was prospectively studied. It was hypothesized that thyroid hormone replacement therapy in this cohort would have an objectively measurable impact on vocal function. Methods: Prospective evaluation of objective voice parameters and concurrent determination of serum thyroid status was executed both before and after thyroid hormone replacement in a cohort of patients who had had total thyroidectomy. Objective voice parameters before and after treatment were compared. Results: Twenty-four female subjects were recruited over an 18-month period. After surgery, all subjects were hypothyroid (mean thyroid-stimulating hormone level, 81.38 mIU/L; range, 25.26 to 100.00 mIU/L) before replacement. After hormone therapy, their mean thyroid-stimulating hormone level dropped to 1.20 mIU/L (range, 0.28 to 3.83 mIU/L). The mean fundamental frequency significantly increased from a pretreatment average of 223.48 ± 36.10 Hz to 237.64 ± 38.81 Hz. Other measured voice parameters (jitter, shimmer, amplitude perturbation quotient, pitch perturbation quotient, noise-to-harmonics ratio, and maximum phonation time) were not affected. Conclusions: Thyroid hormone replacement therapy following total thyroidectomy has a measurable impact on mean fundamental frequency in female patients. The mechanism of this effect is not known.

Comparison of Tc-99m EC and Tc-99m DTPA captopril scintigraphy to diagnose renal artery stenosis.

PURPOSE Although, captopril scintigraphy is a well established method to detect renovascular hypertension, the optimal radiopharmaceutical for this test remains to be determined. Recently, Tc-99m ethylenedicysteine (Tc-99m EC) appeared as an alternative agent for captopril scintigraphy. The aim of this study was to compare the diagnostic accuracy of Tc-99m EC with Tc-99m DTPA, which is a well-established renal radiopharmaceutical for the captopril test. METHODS Nineteen hypertensive patients who had various degrees of renal artery stenosis on angiography were included in the study. All patients had baseline and captopril Tc-99m EC and Tc-99m DTPA scintigraphy within a 1-week period. The results were compared with angiography and in eight patients with changes in blood pressure after revascularization. The images were interpreted without knowledge of the angiography and revascularization data as low, intermediate, or high probability for hemodynamically significant renal artery stenosis, which was defined as an area of stenosis exceeding 50%. RESULTS Tc-99m EC and Tc-99m DTPA study results were in agreement in 16 of the 19 patients. In two patients with branch artery stenosis, Tc-99m EC was definitely superior to Tc-99m DTPA and correctly identified the probability of stenosis on scintigraphy. On kidney analysis, Tc-99m EC had a slightly greater diagnostic sensitivity compared with Tc-99m DTPA (79% vs. 68%; P > 0.05 by the chi-squared test) but equal specificity (93% for both agents). Both Tc-99m EC and Tc-99m DTPA showed the same accuracy in predicting the outcome after revascularization in all but one patient with branch artery stenosis, in whom Tc-99m EC accurately predicted a successful outcome of the intervention but Tc-99m DTPA did not. Tc-99m EC had better renal uptake in patients with decreased renal function and provided more dramatic evidence of renogram changes after captopril intervention, which resulted in more confident interpretation. CONCLUSIONS There is no significant difference between Tc-99m EC and Tc-99m DTPA captopril scintigraphy for detecting renal artery stenosis. However, because of the better imaging characteristics and more confident interpretation provided by the dramatic changes in the degree of renogram abnormality after captopril intervention, Tc-99m EC captopril scintigraphy should be used, particularly in patients with decreased renal function or branch artery stenosis.

Uterine doughnut in early proliferating phase : Potential pitfall in gastrointestinal bleeding studies

A 41-year-old woman with rectal bleeding was referred to our department for gastrointestinal (GI) bleeding study. She was in early post-menstrual period and had stable vital signs. A GI bleeding study with Tc-99m SC revealed uterine blush in the pelvis. The shape of activity and quick fading excluded a GI bleeding. To rule out an intermittent bleeding, patient underwent a second bleeding study with Tc-99m RBC. Serial images showed uterine “doughnut” in the pelvis. The activity neither changed in shape nor showed distal movement with time excluding a GI hemorrhage. Uterus in early proliferating phase could be a potential pitfall in GI bleeding studies.

The efficacy of bioceramics for the closure of burr-holes in craniotomy: Case studies on 14 patients

Purpose Bioceramics are currently in use to cover bone defects in orthopedics and craniofacial surgery. But their compatibility and efficacy in cranium were not investigated in detail. The aims of this study were to produce, characterize, and assess the biocompatibility and osteointegration of Si-HA, Si-Sr-HA, HA-Wollastonite, and HA-Wollastonite-Frit bioceramics. Methods Bioceramics were implanted into the burr holes of 14 craniotomy patients who were followed up from three to 24 months. Radiologic and scintigraphic examinations were performed. Results Osteoblastic activity quantified by scintigraphy increased from 6.865 to 22.991±1.682 from four to eight months in the HA-Woll group. Adding fritt into HA-Woll decreased osteoblastic activity at 10 months. Si-Sr-HA displayed significantly higher osteoblastic activity when compared to the craniotomy site at 12 months. The scintigraphic ratio of the bioceramic implanted regions to the craniotomy sites varied between 1.10 and 1.57. Osteoblast formation and establishment of the trabecular pattern of bone was observed in the surroundings of bioceramics in two patients. Conclusion These bioceramics can be safely used to cover the burr holes of craniotomy patients, as well as to close the cranial bone defects.

Prediction of response to revascularization in patients with renal artery stenosis by Tc-99m-ethylenedicysteine captopril scintigraphy.

The aim of the present study was to assess the predictive value of captopril scintigraphy with the new renal agent99mTc-ethylenedicysteine (99mTc-EC) for post-interventional improvement in blood pressure. Twelve patients who had persistently high blood pressure with previous demonstration of various degrees of renal artery lesion on angiography were included into the study. Baseline and captopril scintigraphies were performed on the same day at 4 hour intervals after the injection of 74 and 296 MBq of99mTc-EC, respectively. All patients had percutaneous transluminal angioplasty (PTA), and improvement in blood pressure was evaluated 3–6 months after the intervention.99mTc-EC captopril scintigraphy successfully predicted a positive or negative outcome in 11 of 12 patients. In one patient with captopril induced renal function deterioration, scintigraphy failed to predict post-interventional response. Our preliminary findings showed that99mTc-EC captopril scintigraphy can be used to determine patients who will benefit from revascularization.

Disseminated metastatic disease of osteosarcoma of the femur in the abdomen: unusual metastatic pattern on Tc-99m MDP bone scan.

A 25-year-old patient with osteosarcoma of the right distal femur underwent a bone scintigraphy with Tc-99m methylene diphosphonate (MDP). Whole-body bone scan revealed extensive metastatic disease in the abdominal region. Abdominal computerized tomography confirmed the presence of ascites and calcified masses on the greater omentum and peritoneal surfaces. Here we describe a case of unusual metastatic pattern of an osteosarcoma showing extensive intraabdominal metastases without prominent lung involvement after intensive chemotherapy.

Combined Tc-99m MDP and Tc-99m labeled RBC imaging in a case of Maffucci's syndrome.

AbstractMaffuccis syndrome is characterized by multiple enchondromas combined with hemangiomas and less commonly lymphangiomas. The extent of skeletal involvement is variable in this rare nonhereditary syndrome, but the most frequent sites of enchondromas are the metacarpals and the phalanges of th

Varices of inferior epigastric veins caused by chronic inferior vena cava obstruction: Mimicking normal venous flow pattern on radionuclide venography

A 21-year-old patient with long-standing inferior vena cava obstruction secondary to idiopathic thrombosis extending from the external iliac veins underwent a radionuclide venography with Tc-99m pertechnetate labeled erythrocytes. The blood pool phase of the study revealed bilaterally distorted inferior epigastric veins mimicking normal venous flow pattern. The authors present this case to discuss the possible alternative routes and the underlying Physiopathologic mechanism of this unusual flow pattern in chronic inferior vena cava obstruction.

Unilateral temporary functional stasis in the upper urinary tract caused by "a filled bladder" on Tc-99m DTPA diuresis renography : a teaching case

A 2-year-old girl with recurrent urinary tract infection having slight left pelvicaliceal dilatation on her renal ultrasound underwent a Tc-99m DTPA diuresis renography. During the excretion phase, a prominent and persisting left pelvicaliceal stasis was noticed even after the diuretic injection. However, it disappeared simultaneously with an uncontrolled micturition. This patient is presented to show the effect of filled bladder on the physiological drainage of urine. Since urine flow in the urinary system is more complicated than simple drainage, a thorough understanding of the physiological basis for diuresis renography and the pitfalls of the technique is required for its appropriate use in the management of patients suspected of urinary tract obstruction.

Fused pelvic kidneys: “hourglass sign” on Tc-99m DTPA diuresis renography

A 13-year-old girl with fused pelvic kidneys detected on ultrasonographic examination was referred to our department for a diuresis renography to assess urine drainage dynamics and exclude the possibility of urinary tract obstruction. Renal scan demonstrated fused pelvic kidneys functioning normally without obstruction. The authors present this case to demonstrate the diuresis renography findings of the combined position, fusion and rotation anomalies of the kidneys that is a rare congenital anomaly of the urinary tract.