Yavuz Narin

Scintigraphic evaluation of early osteoblastic activity in extraction sockets treated with platelet-rich plasma.

PURPOSE The aim of this study was to investigate the early effect of platelet-rich plasma (PRP) on osteoblastic activity during the healing process of soft tissue impacted mandibular third molar extraction sockets by means of bone scintigraphy. PATIENTS AND METHODS Twelve patients with bilaterally soft tissue impacted mandibular third molars were included in the study. The impacted right and left mandibular third molars were surgically extracted in the same session. PRP was administered randomly into the extraction sockets in the study (S) group whereas the extraction sockets in the control (C) group were left without PRP treatment. Scintigrams were obtained in the first and fourth weeks after surgery to evaluate the osteoblastic activity within extraction sockets in both groups. RESULTS Scintigraphic findings of postoperative first and fourth weeks did not show significantly increased osteoblastic activity between S group and C group (P > .05). However, the osteoblastic activity in both groups significantly increased in postoperative week 4 in comparison to week 1 (P < .05). CONCLUSION The application of PRP alone into soft tissue impacted mandibular third molar extraction sockets failed to increase the osteoblastic activity in postsurgical weeks 1 and 4 in comparison to non-PRP-treated sockets.

Gallbladder and gastric motility in patients with idiopathic slow-transit constipation.

Objective Idiopathic slow-transit constipation (STC) has been suggested to be a pangastrointestinal motility disorder. We investigated scintigraphically whether motility in the gallbladder and stomach was impaired in slow-transit constipation. Methods Twenty-four patients with STC were studied. Colon transit time, gallbladder motility, and solid-phase gastric emptying were measured by scintigraphy. Results Gallbladder dysmotility was observed in 8 of 18 (44.4%) patients. Mean gallbladder ejection fraction was 41.6 ± 13.6% (range, 16.3–67.0%). Gastric emptying was delayed in 9 of 18 (50%) patients. Mean solid-phase gastric half-emptying time was 75 minutes. STC may be associated with impaired function of other gastrointestinal organs. Approximately half of patients with STC presented gallbladder or gastric dysmotility. Conclusion STC may not be a pure colonic abnormality; it may be a component of a pangastrointestinal tract motility disorder involving several organs.

The visualization of granulomatous disease with somatostatin receptor scintigraphy

In-111 labeled pentetreotide scintigraphy was applied to three patients with proven granulomatous disease (two with sarcoidosis, one with tuberculosis). All revealed accumulation of ln-111 labeled pentetreotide in the granulomatous lesions, which was considered to be due to the presence of activated lymphocytes in these regions. This method may be of value in assessing the activity and extent of sarcoidosis and tuberculosis.

Use of CA15-3, CEA and prolactin for the primary diagnosis of breast cancer and correlation with the prognostic factors at the time of initial diagnosis

The main goals of the clinical use of tumor markers are to evaluate the adequacy of the treatment, monitor recurrence and follow up response to the treatment applied. For this purpose a baseline level for the commonly used tumor marker must be known at the time of initial diagnosis, before any therapy, in order to compare with the tumor marker levels which will be obtained after the treatment and during the clinical follow-up. The aim of this study was to investigate the correlation, if there is any, of the baseline levels of CA15-3, CEA and prolactin (PRL) in patients with breast cancer with the most commonly used prognostic factors, i) the presence of distant metastasis, ii) the presence of axillary lymphatic invasion, iii) the number of invaded axillary lymph nodes, iv) tumor size and v) stage of the disease, for breast cancer. Baseline serum CA15-3, CEA and PRL levels of 172 patients with breast masses were determined prior to biopsy. The sensitivity and specificity of baseline CA15-3, CEA and PRL were; 23.2% and 95.3%, 17.4% and 83.7%, 5.8% and 97.6%, respectively. At least one of the three tumor markers was high in 36% (31/86) of the breast cancer patients. Baseline CA15-3 levels were frequently higher than CEA in patients with bone metastasis (60% vs. 20%) and axillary lymphatic invasion (31.8% vs. 25%), and showed a better correlation with the stage of disease. Baseline tumor marker levels showed no statistically significant correlation with either the number of invaded axillary lymph nodes or tumor size. In conclusion, sensitivities and negative predictive values for baseline CA15-3, CEA and PRL were not satisfactory for primary diagnosis of breast cancer. Correlation of baseline CA15-3 was found superior to CEA and PRL in terms of stage of disease, presence of axillary invasion and distant metastasis.

Value of regional cerebral blood flow in the evaluation of chronic liver disease and subclinical hepatic encephalopathy

Aims:  Regional changes in cerebral blood flow in patients with chronic hepatitis, cirrhosis and subclinical hepatic encephalopathy were investigated in the present study using single photon emission computed tomography (SPECT).

The effect of trimebutine maleate on gastric emptying in patients with non-ulcer dyspepsia

The study was designed to investigate the effect of trimebutine maleate, a drug used in both hyperkinetic and hypokinetic motility disorders, on gastric emptying in patients with non-ulcer dyspepsia having prolonged gastric emptying rates and to compare the parameters used for the determination of the lag period observed during the emptying of solid foods from the stomach. Gastric emptying was measured by the radionuclide technique. Twenty normal volunteers and 43 patients with non-ulcer dyspepsia participated in the study. Radionuclide imaging was performed by using a solid meal labeled with99mTc-tin colloid. Of the patients with non-ulcer dyspepsia, 20 had prolonged gastric emptying. They were given three weeks of oral treatment with trimebutine maleate and had their radionuclide gastric emptying study repeated. Treatment with trimebutine maleate resulted in reduction in duration of the lag period and less retention of food at 100 minutes (p < 0.0005). After treatment with trimebutine maleate, no significant difference has been observed in the mean symptom score of patients with prolonged gastric emptying. Among the parameters used for the determination of the lag period, lag period determined by a mathematical equation (TLAG) has been found to be longer than the lag period determined by visual inspection of the images (VLAG) and there was correlation between the two parameters when the lag time was short.

The comparison of dual phase Tc-99m MIBI and Tc-99m MDP scintimammography in the evaluation of breast masses : Preliminary report

The aim of this prospective study was to determine the diagnostic value of Tc-99m MDP scintimammography (SMG) for the detection of breast cancer in patients with breast masses and to compare the results with Tc-99m MIBI scintimammography. Twenty patients, categorized as suspicious, positive or benign for breast cancer according to the mammographic findings were included in the study. Dual phase Tc-99m MIBI and Tc-99m MDP SMG were performed in the prone lateral position within 5 days of each other. Although early and late Tc-99m MIBI SMG showed equal (90.4%) sensitivity, the specificity of late Tc-99m MIBI (87.5%) was found superior to early (62.5%) imaging. The overall sensitivity and specificity of early Tc-99m MDP SMG were 71.4% and 62.5%, respectively. Although late Tc-99m MDP imaging showed 100% specificity, its sensitivity was only 23.8%. In the patients with palpable masses, both early Tc-99m MDP and Tc-99m MIBI showed equal sensitivity (100%), but the sensitivity of early Tc-99m MIBI (37.5%) was found slightly higher than Tc-99m MDP (25.0%) for nonpalpable breast lesions. The sensitivity of Tc-99m MIBI and Tc-99m MDP SMG in detecting metastatic axillary involvement was 66.6% and 50%, respectively. High sensitivity and specificity together with its low cost, easy availability and the possibility of detecting bone metastases seems to make Tc-99m MDP a contributive agent in the evaluation of breast lesions as an alternative to Tc-99m MIBI.

FDG PET/CT appearance of multicentric Castleman's disease mimicking lymphoma

We report a case of a multicentric form of Castlemans disease with multiple lymph nodes showing intense FDG uptake on whole body scan mimicking non-Hodgkins lymphoma. In this report, the patient had multiple cervical, mediastinal, hilar, retroperitoneal and abnormal lymph nodes in the groin. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography was performed before tissue sampling. (18)F-FDG/PET demonstrated multiple areas of increased uptake in cervical, mediastinal, hilar, retroperitoneal and groin lymph nodes, suggesting a generalized disease of the lymphatic system including non-Hodgkins lymphoma. The final diagnosis is based on the histopathological findings of the material obtained from the cervical lymphadenectomy. The histological diagnosis was multicentric plasma cell variant of Castlemans disease. (18)F fluorodeoxyglucose positron emission tomography/computed tomography scan helped to identify the lymph nodes involved throughout the whole body, but did not help to differentiate non-Hodgkins lymphoma. The clinical conclusions and PET/CT findings are described in this report.

Warthin's tumor and I-131 body scan

The authors report a case of histologically proved Warthins tumor of the parotid gland that caused a false-positive result of an 1-131 body scan. Because patients with distant metastases that concentrate 1-131 should receive 1-131 therapy, it is extremely important to prop: erly distinguish false-positive sites of 1-131 localization to avoid unnecessary therapeutic intervention. Warthins tumor should be included in the differential diagnosis when nonphysiologic radioiodine accumulation is encountered in the region of the salivary glands.

Scintigraphic detection of a pleuro-biliary fistula. Post-operative complication of an amebic liver abscess.

A 21 -year-old man, who had an operation for an amebic abscess of the liver 6 months earlier, had fever and was experiencing dyspnea and chest pain. His chest radiograph revealed pleural effusion at the right lung base. A diagnostic thoracentesis was performed and a drainage tube placed. The gross appearance and laboratory analysis of the pleural effusion suggested a biliary fistula associated with his previous operation. A hepatobiliary scan, performed with 5 mCi of Tc-99m EHIDA (Etifenin), demonstrated the presence of a pleuro-biliary fistula, which was then confirmed by a retrograde radionuclide fistulogram and an endoscopic retrograde cholangiograph. Computed tomography and ultrasonography were nondiagnostic