Sakir Berkarda

The relationship between bone mineral density and immobilization duration in hemiplegic limbs

ObjectiveProlonged immobilization in stroke is known to result in hypercalciuria, hypercalcemia, accelerated bone resorption, and osteoporosis. Furthermore, bone mineral loss accelerated with increasing duration of hemiplegia. Although stroke is a common disease that causes sudden immobilization, relatively few investigations of bone metabolism in stroke have been reported. The aim of this study was to investigate the changes in bone mineral density of the forearms and legs related to duration of hemiplegia-induced immobilization after stroke.MethodsForty-one hemiplegic patients with stroke were evaluated. The patients’ age, gender and duration of hemiplegia-induced immobilization were recorded. The measurements of bone mineral density (BMD) in all patients were evaluated with DEXA using the Norland apparatus. The BMD values (g/cm2) were determined by measurements made in the lumbar vertebrae, both forearm and legs (femoral neck and trochanter).ResultsWe found that bone mineral density was decreased in the affected extremities relative to the intact contralateral side on measurements by dual energy x-ray absorptiometry in bones such as forearm, femoral neck and trochanter. There was a significant difference between bone mineral density of paretic and nonparetic forearms and legs. Bone mineral density of the upper limbs was lower than that of the lower limbs. There was a negative correlation between duration of hemiplegia and BMD values.ConclusionsBone mineral loss may be related to the duration of hemiplegia-induced immobilization. Bone mineral loss is accelerated when the duration of hemiplegia is prolonged.

Effects of gender and age on the quantitative parameters of [99mTc]pertechnetate salivary gland scintigraphy in normal subjects.

AimTo assess the effect of gender and age on [99mTc]pertechnetate salivary gland scintigraphy (SGS) in healthy subjects. MethodsThe study population consisted of 93 normal subjects (46 women, 47 men; age range 20–59 years). The subjects were categorized into eight (four female and four male) subgroups according to age decades. Dynamic SGS was performed after intravenous injection of 370 MBq [99mTc]pertechnetate. Anterior salivary gland images were acquired for 30 min. On the basis of the time–activity curves, three functional parameters were calculated for the parotid and submandibular salivary glands: (1) the first minute uptake ratio, (2) the maximum uptake ratio, and (3) the maximum secretion percentage. ResultsFor women, all parotid and submandibular functional parameters had a peak in the fourth decade group. The comparison of four age groups in the female subjects showed significant differences, except for the third versus the fifth decades, at least for one parameter. The number of significant differences was highest in the comparison between the second versus the fourth decades. Among men, the highest values for all parotid and submandibular parameters were in the second decade, except for the first minute uptake ratio in the submandibular gland. The number of parameters that were significantly different among the four age groups in men was lower than in women. The first minute uptake ratio of the submandibular gland had the most significant differences among the groups of male subjects. ConclusionAge and gender differences have a significant effect on salivary gland functions which is more apparent in women than in men.

The relationship between 99Tcm-sestamibi uptake and ultrastructural cell types of thyroid tumours

Although several hypotheses have been suggested regarding the accumulation of 99Tcm-sestamibi in tumours, the exact uptake mechanism is still a matter of discussion. We investigated ultrastructural cell type of thyroid tumours by electron microscopy (EM) and compared them with uptake of 99Tcm-sestamibi. Thyroid scintigraphy with 99Tcm-sestamibi was performed on 25 patients who displayed a cold nodule on previous pertechnetate scintigraphy. Tumour-to-thyroid (T/N) uptake ratio was measured semiquantitatively. Surgery was performed in all patients and cytological evaluations were done by EM. Histopathology revealed six papillary carcinomas, 16 follicular adenomas and three Hurthle cell tumours. Thyroid cells were classified as A and B cells using EM. The cytoplasm of an A cell has the normal amount of mitochondria, whereas cytoplasm of a B cell (mitochondria-rich oxyphilic cell) contains abundant mitochondria. The median T/N ratio on the early scan for an A-cell tumour was 1.21 (range, 0.74-3.2), late T/N ratio was 1.25 (range, 0.72-3.85). The T/N ratio for the B-cell tumours was 1.42 (range, 0.6-3.6) on the early scan and 1.18 (range, 0.64-5.58) on the late scan. There was no statistically significant difference between T/N ratios of A- and B-cell tumour groups. A significant difference was also not seen between early and late T/N ratios. According to our findings, 99Tcm-sestamibi accumulates in thyroid tumours with both A and B cells, therefore these results suggest that the mitochondrial content of tumours is not only responsible for sestamibi uptake and retention.

Evaluation of skeletal muscle metabolism and response to erythropoietin treatment in patients with chronic renal failure using 99Tcm-sestamibi leg scintigraphy.

It is well known that uraemia affects skeletal muscle metabolism. This has been attributed to a variety of causes, including anaemia, vitamin D, carnitine deficiency and hyperparathyroidism. The aim of this study was to ascertain whether 99Tcm-sestamibi leg scintigraphy is useful in the evaluation of skeletal muscle metabolism and the monitoring of treatment response in uraemic myopathy. Forty patients with chronic renal failure and 24 normal controls underwent examination. Fifteen patients with chronic renal failure received erythropoietin treatment. 99Tcm-sestamibi leg scintigraphy was performed in all subjects and in 15 patients after therapy. The calf-to-ankle uptake ratio was calculated by semi-quantitative analysis and normalized to lean body mass. The normalized uptake ratios were significantly different between patients and controls. After erythropoietin therapy, there was a significant increase in the normalized uptake ratios compared with pre-therapy. Our results suggest that 99Tcm-sestamibi leg scintigraphy is useful in the assessment of muscle metabolic abnormalities and the effect of treatment in uraemic myopathy.

The incidence of recurrence and hypothyroidism after radioiodine treatment in patients with hyperthyroidism in Trakya, a mild iodine deficiency area, during the period 1991–2003

ObjectiveThe purpose of this retrospective study was to evaluate the incidence of recurrence and the success of radioiodine treatment (RIT) in the Trakya region of Turkey, an area with mild iodine deficiency, and to compare the effect of dose regimen selection (fixed (FD) or calculated dose (CD)) on treatment success.Material and MethodsThe study sample included 148 patients (40 male, median age 50) treated with radioiodine between the years 1991-2003. Patients were categorized into three diagnostic groups: Graves’ disease (GD) (n = 65), solitary toxic adenoma (TA) (n = 29), and toxic multinodular hyperthyroidism (TMH) (n = 54), and each divided into two subgroups according to treatment method; the first group was treated with a FD of 370 MBq (10 mCi), and the second with CD.ResultsThe largest group was GD (44%), followed by TMH (36%). Median duration of follow-up was 28 months (range 6-147). FD was given to 52.7% of all patients and CD was given to 47.3%. There was a partial difference in the dose regimen between all groups, but did not reach statistically significant levels (FD vs. CD: 65%–35%; 38%–62%; 46%–54%; GD, TA, TMH respectively, p > 0.05). Total cure rate in FD and CD was 46 (59%) and 37 (52.9%), respectively. The rates of hypothyroidism for GD, TA, and TMH groups were 28 (43.1%), 6 (20.7%) and 16 (29.6%), respectively. The incidence of hypothyroidism did not vary significantly between any groups (p > 0.05). At the end of the follow-up period, a total of 104 patients (70.3%) were treated successfully. There was no significant difference in the cure rate between any groups (p > 0.05).ConclusionsThe treatment success in all groups and subgroups did not differ significantly between FD and CD. Our lower cure rate than in previous studies may be related to iodine deficiency. Higher doses of radioiodine may be required to increase final treatment success in endemic goiter areas. If this true, dosimetry and calculated dose regimen would be required in all groups of patients instead of an FD concept. However, our findings should be verified in larger series of patients, with longer follow-up period, and urinary iodine concentration measurements.

Relation between Tc-99m sestamibi uptake and biological factors in hyperparathyroidism

PurposeThe aim of this study was to evaluate the relation between uptake ratios of Tc-99m sestamibi (MIBI) and tumor volume, serum biochemical values (i-PTH, Ca, P) and oxyphil cell content.Materials and MethodsThe study population consisted of 19 patients (2 M, 17 F; mean ± SD: 47 ± 12 y). Anterior planar images of the neck and chest were acquired early (15 min) and triple late phase (1,2 and 3-4 h) after intravenous injections of 740 MBq MIBI. Each of the surgical materials was reviewed retrospectively. The percentage of cell type (chief, oxyphil and clear cells) in the tumors was calculated by light microscopy.ResultsThe uptake ratio obtained from L1 (1 hour) phase was found to be higher than the uptake ratio obtained from early phase, and the difference was statistically significant (1.57 ± 0.34 and 1.43 ± 0.29, p = 0.004, respectively). There was no significant correlation between uptake ratios that were obtained from 4 different imaging phases and lesion volumes, i-PTH levels and calcium levels (p > 0.05). However, there was a significant adverse correlation between L2 and L3 uptake ratios and serum phosphorus values (r = –0.44, p = 0.04 and r = –0.46, p = 0.04, respectively). Additionally, no significant correlation between MIBI uptake ratios of each imaging phase and the laboratory data, volume of lesion or oxyphil percentage volume was found after the multiple regression analysis (E: p = 0.46, r = 0.49; L1: p = 0.24, r = 0.58; L2: p = 0.27, r = 0.57; L3: p = 0.32, r = 0.55, respectively. There was no correlation between gland oxyphil percentage volume and MIBI uptake ratios (p > 0.05).ConclusionThe results of our study show that the optimal imaging times after intravenous injection of MIBI are 15 minutes and 1 hour because of the shorter examination time without loss of diagnostic ability. In the present study, there was no significant correlation between MIBI uptake ratios and increased gland volume, or serum Ca and i-PTH levels. Besides, we think that oxyphil cell content may not have a main effect on MIBI uptake and retention. The fact of an adverse relation between phosphorus and MIBI retention in our study suggests that phosphorus level should be considered prior to MIBI imaging.

The bronchoalveolar epithelial permeability in house painters as determined by Tc-99m DTPA aerosol scintigraphy

Purpose: Isocyanates are highly reactive chemicals used in a number of industries including paints. Therefore, house painters are known to be at risk for occupational exposure to isocyanates. Our objectives in this study were: (1) to investigate the possible effects of isocyanate exposition on the bronchoalveolar epithelial permeability in house painters by using Tc-99m DTPA radioaerosol lung scintigraphy; (2) to assess whether or not some differences exist between asthmatic and non-asthmatic house painters, and (3) to determine the relationship between Tc-99m DTPA radioaerosol lung scintigraphy and the spirometric measurements, and the work duration of house painters.Materials and Methods: Ten non-smoking house painters (28.8±8.8 yrs) and ten healthy volunteers underwent Tc-99m DTPA radioaerosol lung scintigraphy. Following inhalation of radiotracer through a nebulizer for 5 minutes, dynamic scintigrams (1 frame/min, up to 10 min) were taken from both lungs. ROIs were drawn over the both lung area, and time-activity curves were obtained, from which the half-time (T1/2) of Tc-99m DTPA clearance was calculated. Spirometric lung function test was measured in all house painters.Results: Mean T1/2 values (min±SD) were 93.74±32.79 for house painters, and 90.96±40.02 for control subjects. There was no significant difference in T1/2 values of Tc-99m DTPA clearance between house painters and controls, and between asthmatic and non-asthmatic house painters as well. No correlation was observed between T1/2 values of Tc-99m DTPA clearance and spirometric measurements. In house painters, there was a positive correlation between T1/2 values of Tc-99m DTPA clearance and work duration (r=0.73, p=0.016).Conclusions: Our findings indicate that in house painters, occupational exposure to isocyanates has no effect on bronchoal veolar epithelial permeability, and the rate of Tc-99m DTPA clearance shows no difference between asthmatic and non-asthmatic house painters. The positive correlation between the rate of Tc-99m DTPA clearance and work duration needs to be confirmed in larger cohorts.

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.

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.

Glucose-induced alteration of accumulation of organotechnetium complexes accumulation in Pgp-negative tumor-bearing mice.

The biologic and microenvironmental factors determining (99m)Tc sestamibi (MIBI) and (99m)Tc tetrofosmin (TF) uptake in breast tumors are incompletely understood, especially in P-glycoprotein (Pgp)-negative tumors. We analyzed the influence of glucose administration on the uptake and retention of MIBI and TF in Pgp-negative tumor-bearing mice in vivo. Twenty (20) mice bearing Ehrlich ascites tumor cell (EATC) xenografts were divided into four groups: (1) MIBI, (2) MIBI+glucose, (3) TF, and (4) TF+glucose. Glucose was administered (5.0 g/kg body weight) intraperitoreally (i.p.) 1 hour before scintigraphy. There were significant differences between the E-UPR MIBI and MIBI+glucose groups (p = 0.009) and minor differences in L-UPR between these groups (p = 0.04). There was a significant inverse correlation between E-UPR of MIBI and glucose levels (r = 0.71, p = 0.02). Comparing the four groups, the highest E-UPR was obtained in the MIBI group (p = 0.006). Other parameters were not different in the MIBI and MIBI+glucose groups and in the TF and TF+glucose groups. Increased blood glucose level affected the MIBI uptake of tumor tissue, particularly for E-UPR. We suggest that these findings were due to basically decreased blood flow and secondarily decreased extracellular pH. However, glucose administration did not affect TF.