Relationship between primary lesion metabolic parameters and clinical stage in lung cancer

OBJECTIVES

The relation of PET-derived parameters as maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV) with clinical stage in lung cancer and correlation of SUVmax of primary tumor and that of metastatic lesion was studied in lung cancer patients.

MATERIALS AND METHODS

Patients with lung cancer who were referred for FDG PET/CT were included in the study.

RESULTS

PET/CT scans and pathology reports of 168 patients were assessed. A total of 146 (86.9%) of these patients had a diagnosis of non-small cell lung cancer (NSCLC) and 22 (13.1%) had small cell lung cancer (SCLC). Metabolic parameters such as SUVmax, TLG and MTV showed significant differences in all the stages in NSCLC patients (p<0.001). However, after tumors sizes <25 mm were excluded, no significant differences in SUVmax between stages were observed. No significant differences were found between these metabolic parameters and limited or extended disease SCLC. Tumor diameter correlated with primary tumor SUVmax and significant correlations between primary lesion SUVmax and metastatic lesion SUVmax were found.

CONCLUSIONS

Although differences were found regarding indices between stages of NSCLC cases, SUVmax differences between stages seem to be caused by underestimation of SUVmax in small lesions. Other glucose metabolism indexes such as MTV and TLG show promising results in terms of prognostic stratification. Future studies are needed for better understanding of their contribution to clinical cases.

Is QUALIOST appropriate for the patients with orthotopic liver transplantation in measuring quality of life?

The quality of life questionnaire in osteoporosis (QUALIOST) measures the impact of this condition. The purpose of this study was to assess the psychometric properties of QUALIOST among 38 orthotopic liver transplantation (OLT) patients who had been diagnosed with osteoporosis or osteopenia versus 42 control subjects with osteoporosis or osteopenia associated with other conditions. Bone mineral density (gr/cm(2)) measurements were performed by dual-energy X-ray absorptiometry as well as thoracic and lumbar spine radiographs to assess fractures. Reliability studies evaluated by intraclass correlation coefficients (ICC) and internal consistency (Cronbach α). For the validity studies, correlation analysis was performed between this scale and Short Form-36 (SF-36) results. The questionnaire was filled out completely by all the patients with 0.9% and 1.3% of omitted answer rates for OLT and control patients. ICC and Cronbach's α values were good for all domains with values above .90. In both groups we observed significant negative high correlations between the domains of the questionnaire and all SF-36 dimensions (P < .001). At least one vertebral fracture was diagnosed in 17 (44.7%) and 20 (47.6%) patients with OLT and control respectively. The comparison analysis revealed that the scores of QUALIOST of patients with vertebral fracture were significantly higher than those without a fracture in both groups (P < .05). In conclusion, we evaluated the validity and reliability of a scale measuring quality of life in patients who had osteoporosis secondary to OLT. The results showed that the Turkish QUALIOST showed acceptable validity and reliability in these patients.

Evaluation of changes in quality of life among Turkish patients undergoing ventricular assist device implantation

BACKGROUND

Ventricular assist device (VAD) application has become an increasingly common method to treatment end-stage heart failure. In this study we evaluated the effect of VAD implantation upon the quality of life among Turkish patients with end-stage heart failure.

METHODS

Twenty-eight VAD implantation patients included 3 (10.7%) with biventricular support using the Berlin Heart Excor; 15 (53.6%), left ventricular support with the Berlin Heart Excor; and 10 (35.7%), Heartware implantation for left ventricular support. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Short Form 36 (SF-36) Health Questionnaire were used to assess changes in the quality of life (QOL).

RESULTS

Of the 28 patients, 2 were females (7.1%) and 26 were males (92.9%) of overall mean age of 44.6 ± 15.3 years (range, 8-66). Preoperative mean score of MLHFQ was significantly improved at 200.4 ± 147.4 days follow-up (72.8 ± 11.5 vs 13.7 ± 10.5; P < .05). SF-36 physical scores and mental scores were improved postoperatively (physical scores, 20.0 ± 24.4 vs 70.2 ± 19.9; mental scores, 38.4 ± 18.8 vs 73.9 ± 15.7; P < .05). No significant relation was observed between the postoperative scores of questionnaires and type of surgery. More improvement in postoperative MLHFQ scores was seen in patients younger than 45 years of age (P = .027). The severity of chronic heart failure (CHF) regressed from New York Heart Association (NYHA) class IV to NYHA class II in 26 and to NYHA class III in 2 patients (P = .000).

CONCLUSION

The QOL among patients with end-stage heart failure improved dramatically soon after VAD implantation.

Expectant management of preterm premature rupture of membranes remote from term with exiguous amniotic fluid and a prolonged latency period: report of two cases

Management of preterm premature rupture of membranes (PPROM) is a very challenging issue for the obstetricians. We report two cases of PPROM occurring in early gestation remote from term (both < 26 weeks) with exiguous amniotic fluid (amniotic fluid index of < or =2 cm) that were managed successfully by conservative treatment and resulted in a latency period of almost two months. This treatment option might be feasible in carefully selected patients following meticulous evaluation and warrants further research.

Reduced gray matter volume in the frontotemporal cortex of patients with early subacute sclerosing panencephalitis

BACKGROUND AND PURPOSE

Subacute sclerosing panencephalitis (SSPE) is a persistent infection of the central nervous system by the measles virus. Patients in the initial stages of SSPE show behavioral symptoms and usually normal cranial MR imaging findings. We aimed to investigate the gray matter volume changes in patients with early SSPE.

MATERIALS AND METHODS

Seventeen patients with SSPE with normal cranial MR imaging findings and 30 sex- and age-matched control subjects were included in the study. Clinical parameters of the patients were quantified by using a neurologic disability index (NDI) as defined previously. We obtained T1-weighted magnetization-prepared rapid acquisition gradient echo images from the patients and control subjects, and we applied an optimized method of voxel-based morphometry. We performed a cross-sectional analysis to search the gray matter volume differences between the patients and control subjects. The correlation between the gray matter distribution and the duration of symptoms, immunoglobulin G index, and NDI scores was tested.

RESULTS

We found that the cortical gray matter volume of patients was reduced in the frontotemporal regions including the bilateral cingulate cortex and amygdala. There was no correlation between the gray matter distribution of patients and the duration of symptoms or the NDI scores.

CONCLUSIONS

The current study demonstrated gray matter volume reduction in the frontotemporal cortex of patients with SSPE without any apparent lesions on conventional MR imaging. Because the cingulate cortex and amygdala are involved in emotion processing, gray matter loss in these regions may contribute to the development of early behavioral symptoms of SSPE.

Multimodal investigation of fMRI and fNIRS derived breath hold BOLD signals with an expanded balloon model

Multimodal investigation of blood oxygenation level-dependent (BOLD) signals, using both functional near-infrared spectroscopy (fNIRS) and functional magnetic resonance imaging (fMRI), may give further insight to the underlying physiological principles and the detailed transient dynamics of the vascular response. Utilizing a breath hold task (BHT), we measured deoxy-hemoglobin (HbR) and oxy-hemoglobin (HbO) changes via fNIRS and blood oxygen level dependent (BOLD) changes by fMRI. Measurements were taken in four volunteers asynchronously and carefully aligned for comparative analysis. In order to describe the main stimulus in BHT, partial pressure of carbon dioxide (PaCO(2)) parameter was integrated into the balloon model as the driving function of cerebral blood flow (CBF) which led to the development of an expanded balloon model (EBM). During BHT, the increase in HbR was observed later than the BOLD peak and coincided temporally with its post-stimulus undershoot. Further investigation of these transients with a PaCO(2) integrated balloon model suggests that post-stimulus undershoot measured by fMRI is dominated by slow return of cerebral blood volume (CBV). This was confirmed by fNIRS measurements. In addition, the BOLD signal decreased with the increase of the initial level of PaCO(2) derived from EBM, indicating an effect of basal CBF level on the BOLD signal. In conclusion, a multimodal approach with an appropriate biophysical model gave a comprehensive description of the hemodynamic response during BHT.

Increased gray matter density in the parietal cortex of mathematicians: a voxel-based morphometry study

BACKGROUND AND PURPOSE

The training to acquire or practicing to perform a skill, which may lead to structural changes in the brain, is called experience-dependent structural plasticity. The main purpose of this cross-sectional study was to investigate the presence of experience-dependent structural plasticity in mathematicians' brains, which may develop after long-term practice of mathematic thinking.

MATERIALS AND METHODS

Twenty-six volunteer mathematicians, who have been working as academicians, were enrolled in the study. We applied an optimized method of voxel-based morphometry in the mathematicians and the age- and sex-matched control subjects. We assessed the gray and white matter density differences in mathematicians and the control subjects. Moreover, the correlation between the cortical density and the time spent as an academician was investigated.

RESULTS

We found that cortical gray matter density in the left inferior frontal and bilateral inferior parietal lobules of the mathematicians were significantly increased compared with the control subjects. Furthermore, increase in gray matter density in the right inferior parietal lobule of the mathematicians was strongly correlated with the time spent as an academician (r = 0.84; P < .01). Left-inferior frontal and bilateral parietal regions are involved in arithmetic processing. Inferior parietal regions are also involved in high-level mathematic thinking, which requires visuospatial imagery, such as mental creation and manipulation of 3D objects.

CONCLUSION

The voxel-based morphometric analysis of mathematicians' brains revealed increased gray matter density in the cortical regions related to mathematic thinking. The correlation between cortical density increase and the time spent as an academician suggests experience-dependent structural plasticity in mathematicians' brains.

Pulmonary cement embolism: a complication of percutaneous vertebroplasty

BACKGROUND

Percutaneous vertebroplasty (PV) has recently become a very common procedure for vertebral compression fractures. Extravasation of cement, a common event associated with vertebroplasty, may lead to cement emboli in the lungs.

PURPOSE

To determine the frequency of pulmonary cement embolism after percutaneous vertebroplasty.

MATERIAL AND METHODS

Between 2002 and 2006, 128 percutaneous vertebroplasties were performed in 73 patients (56 women and 17 men) in our institution. Postprocedural chest radiographs were obtained for all patients and assessed for the presence of pulmonary cement emboli.

RESULTS

Pulmonary cement embolism was detected on chest radiographs and confirmed with chest computed tomography (CT) in four patients treated with percutaneous vertebroplasty for osteoporotic collapse and one patient treated for multiple myeloma. The imaging finding of pulmonary cement embolism was solitary or multiple fine radiodense lines with occasional branching patterns. The frequency of pulmonary cement embolism was 6.8%.

CONCLUSION

An incidence of pulmonary cement embolism of 6.8% during PV was found. Close clinical follow-up, postprocedural chest radiographs, and chest CT scans, if necessary, are important for the detection of pulmonary cement embolism at an early stage.

A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier

In this experimental study, we aimed to examine the ability of absorbable oxidised regenerated cellulose (Interceed, TC-7, Johnson & Johnson, USA) to inhibit the formation of peritendinous fibrotic adhesions after tendon repair in rats. Both Achilles tendons of 23 female Wistar-Albino rats weighing between 350 and 450 grams were cut and repaired. On the right side, Interceed absorbable adhesion barriers were wrapped around the repaired tendon (group I). On the left, the same procedures were applied except for the Interceed wrapping and these were grouped as control (group II). Animals were sacrificed at postoperative day 28 and macroscopic and histological examination was performed. All the animals survived and no tendon rupture was observed. No wound dehiscence, wound infection or exposure of repaired tendons occurred. Macroscopically, there were three (13.1%) tendons without adhesion formation and 20 (86.9%) tendons with inferior adhesion formation in group I; on the other hand, there were 16 tendons (69.5%) with medium grade adhesion formation and seven tendons (30.5%) with severe peritendinous adhesion formation in group II (control group) (p<0.05). Histologically, adhesion formation was absent in 11 tendons (47.8%) and slight in 12 tendons (52.2%) in group I; while in group II, it was slight in two (8.6%), moderate in 15 (65.2%) and severe in six tendons (26.2%) (p<0.05). Sixteen (69.5%) of 23 tendons in group I and 11 (47.8%) of 23 tendons in group II showed no inflammatory reaction (p<0.05). Nineteen (82.6%) tendons in group I and only one tendon in group II showed excellent to good tendon healing (p=0.00). According to our results, we feel that Interceed may have an intraoperative role to play in the reduction of adhesions after surgical tendon repair. This study suggests that absorbable oxidised regenerated cellulose merits further evaluation as a potential treatment to inhibit the formation of peritendinous adhesions. Rigorous and extensive controlled trials should be undertaken on patients undergoing tendon repair with or without this barrier.

A new classification and guide for surgical treatment of spinal tuberculosis

So far, there is no widely accepted classification system based on objective findings that can serve as a guide in selecting the treatment method for spinal tuberculosis. This retrospective study evaluates patients with spinal tuberculosis (Pott's disease) treated with different surgical procedures. Our aim was to outline a new classification of spinal tuberculosis. A retrospective review of 76 cases (55 male and 25 female patients) of spinal tuberculosis was conducted. Five of the patients were treated medically, and the others who were treated surgically were classified into three types (I, II and III) according to the new classification system for spinal tuberculosis. All 76 patients were classifiable by this new system. The most common complication observed was local kyphosis (maximum 8 degrees) in type-II patients, but none of the patients needed correction. No neurological deterioration was observed in any of the cases. This new classification system helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis. We believe that this new classification system can be used as a practical guide in the treatment of Pott's disease.

Tuberculosis of the lumbar spine: outcomes after combined treatment of two-drug therapy and surgery

This article evaluates complications and treatment results in patients with tuberculosis of the lumbar spine. Eighteen patients with active tuberculosis of the lumbar spine were treated surgically in the orthopedic surgery department at Uludag University School of Medicine between 1993 and 2000. All patients received antituberculosis combination drug therapy (isoniazid and rifampicin) for 9 months. Patients who underwent anterior radical debridement and anterior fusion and/or posterolateral debridement and posterior fusion plus stabilization showed 5-8 degrees correction of local angulation after surgery. The mean loss of correction at final follow-up (mean: 5 years) in anterior or posterior surgery alone was 45%-50%, whereas the corresponding finding for the combined approach was 12%. The combination of two-drug chemotherapy (daily isoniazid and rifampicin for 9 months) and surgery is effective for tuberculosis of the lumbar spine.

Traumatic Nerve Root Avulsion and Pseudomeningocele Diagnosed by Three Dimensional MRI Technique (CISS Sequence)

This case report demonstrates the importance of the CISS sequence, a fast imaging technique in MRI, in case of suspected nerve root avulsion. We present a case of traumatic pseudomeningoceles at T1-T2 root levels with right T2 ventral root avulsion without associated skeletal fracture diagnosed by MRI using the three dimensional CISS technique. A 28-year-old man presented to the Emergency Department following a motorcycle accident. Clinical examination revealed paresis in intrinsic muscles of the right hand. Traumatic pseudomeningoceles at T1-T2 root levels bilaterally with right T2 ventral root avulsion without associated skeletal fracture were diagnosed by three dimensional cervicothoracic MRI with CISS technique.

"Sandwich technique" in the surgical treatment of primary complex fractures of the femur and humerus

In this prospective study, our aim was to determine the clinical and radiographic outcomes of the surgical treatment of primary complex problem femoral and humeral shaft fractures treated by a new technique called "sandwich technique." A total of 45 patients with comminuted, complex and/or osteopoenic fractures of the femur or humerus (30 femoral and 15 humeral fractures) were treated using this technique. The patients were followed up for a mean of 25 months. In 24 (85.7%) of 28 patients with femoral fractures and in 14 (93.3%) of 15 patients with humeral fractures, union was achieved within 3-6 months of the operation (mean: 4.5 months). The total union rate was 88.4%. The pseudoarthrosis rate was 12%. There was no infection or implant failure seen during the follow-up period. The cortical allograft struts can be used to provide collateral support to weakened osteopoenic/osteoporotic bone. This technique provides a union rate of about 88% in osteoporotic and/or complex primary humerus or femur fractures.