The Evaluation of Myocardial Damage in 83 Young Adults with Carbon Monoxide Poisoning in the East Anatolia Region in Turkey

Carbon monoxide (CO) poisoning is the leading cause of death from intoxication. In CO poisoning, it is important to know if there are any symptoms regarding myocardial damage, which are usually unobserved as a result of hypoxia. This study was planned to assess myocardial damage in young healthy patients with CO poisoning. Eighty-three young healthy cases who had been exposed to CO were included in this study. The demographic and clinical characteristics, the origin of CO gas and smoking habits of the patients were recorded. The evaluation of ECG, peripheral ABG, complete blood count and serial cardiac biomarkers (creatine kinase, creatine kinasemyocardial band and troponin I) measurements were performed in all cases. Additionally, echocardiogram (ECHO) and myocardial perfusion single-photon emission computed tomography (SPECT) were performed at the appropriate times in all cases. The mean age of the patients was 27.39 /10.9 years. The main complaint of the patients was loss of consciousness with a 62.7% rate. The average carboxyhaemoglobin level of the patients was 34.49 /15.9%. Sinus tachycardia was present in 26.5% of patients. Diagnostic ischaemic ECG changes were present in 14.4% of patients. In myocardial SPECT, myocardial ischaemic damage was observed in 9 cases, in 6 of whom ECHO findings were also confirmed. Myocar-dial damage due to CO poisoning should not be ignored. If patients are at risk in terms of myocardial damage, further studies, such as ECHO and scintigraphy are needed to determine myocardial damage resulting from CO poisoning. However, in the young adults of the risk group, if the baseline ECG and serial cardiac biomarkers are normal, further studies such as ECHO and scintigraphy, considering the length of exposure and the severity of poisoning, may not be necessary for the evaluation of myocardial damage due to CO poisoning.

The effect of interferon beta 1B on bone mineral density in multiple sclerosis patients

OBJECTIVE

Osteoporosis is a secondary problem in multiple sclerosis (MS) patients. There have been only a few reports about the effect of interferon beta (IFNB) 1b on bone mineral density (BMD). We aimed to determine bone mass in patients using IFNB 1b.

METHODS

We enrolled 17 patients taking IFNB 1b (group I), 15 patients not taking IFNB (group II). We measured the BMD and T scores values and the patients were distinguished as normal, osteopenia and osteoporosis.

RESULTS

In the lumbar spine, there was no difference between groups I and II (p=0.3). In the left femur, no significant difference was detected between groups I and II (p=1). There was an inverse correlation between the BMD at the both regions and the Expanded Disability Status Scale score (r= -0.39, p=0.03; r=-0.52, p=0.002, respectively).

CONCLUSION

IFNB 1b may be used safely in MS patients, even in those undergoing pulse steroid therapies, because IFNB 1b has no effect on BMD.

Parathyroid adenoma presenting as tetraparesia

OBJECTIVE

Parathyroid adenomas (PA) are benign tumors. We report an unusual case of delayed diagnosis of a PA and concomitant Vitamin D deficiency presenting as tetraparesia.

METHODS

A 30-year-woman was admitted to our clinic with an inability to walk. Our examination revealed tetraparesia and common, severe muscular atrophy.

RESULTS

Laboratory investigations showed the following: creatinine phosphokinase (CK): 37 IU/L (15-130), calcium (Ca): 11.5 mg/dL (9-11), phosphorus (P): 1.5 mg/dL (2.5-5), parathyroid hormone (PTH): 736.1 pq/mL (15-65), 25-hydroxyvitamin D (25-OHvit D): 4 ng/mL (11-43), and alkaline phosphatase (ALP): 1029.5 lU (64-300). Parathyroid scintigraphy revealed PA. A year after Vitamin D replacement, the patient's neurological status and laboratory findings improved.

CONCLUSION

We suggest that the physicians always keep in mind the primary hyperparathyroidism (HPT) and concomitant Vitamin D deficiency in the differential diagnosis of hypercalcemia when facing atypical neurological symptoms such as tetraparesia.

Salivary gland function in continuous ambulatory peritoneal dialysis patients by 99mTc-pertechnetate scintigraphy

The purpose of this study was to evaluate the alterations in salivary gland function in patients who receiving continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure (CRF) using technetium-99m pertechnetate ((99m)Tc-P) salivary gland scintigraphy. The study population consisted of 36 CAPD patients (16 males and 20 females, ranging in age from 19 to 73 years, mean age 44.94+/-15.01 years) and 20 healthy controls (11 males and 9 females, ranging in age from 31 to 51 years, mean age 41.25+/-5.62 years). All patients and healthy controls underwent salivary gland scintigraphy. After the intravenous administration of 185MBq of (99m)Tc-P, dynamic salivary gland scintigraphy was performed for 25min. On the basis of the time-activity curves, the following glandular function parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation, and ejection fraction. Our results showed: All functional parameters obtained for CAPD patients were significantly lower than for healthy controls (P<0.05). In conclusion, this study demonstrated that salivary gland function, an important determinant of oral health, is impaired among the CRF patients treated with CAPD compared with healthy controls, as evaluated by (99m)Tc-P salivary gland scintigraphy.

Biosorption of Ga-67 radionuclides from aqueous solutions onto waste pomace of an olive oil factory

The aim of this research was to test the removal of Ga-67 radionuclides from aqueous solutions by biosorption onto waste pomace of an olive oil factory (WPOOF). Batch adsorption studies were performed in order to investigate the temperature, the initial pH of the solution, the stirring speed, the biosorbent dose, and the nominal particle size of the biosorbent in the experimental work. The most effective parameter was found to be the initial pH. A high biosorption yield of 98 was obtained. The equilibrium values were fitted to the isotherm models. The values of DeltaG and DeltaH were calculated to be negative. The adsorption kinetics calculations showed that the kinetics of the biosorption process fitted well to the pseudo-second order rate model.

Evaluation of the genotoxic effects of chronic low-dose ionizing radiation exposure on nuclear medicine workers

INTRODUCTION

Nuclear medicine workers are occupationally exposed to chronic ionizing radiation. It is known that ionizing radiation may have damaging effects on chromosomes. In the present study, we investigated the genotoxic effects of ionizing radiation on nuclear medicine workers. We used two different indicators of genotoxicity methods: sister chromatid exchange (SCE) and micronucleus (MN).

METHODS

The present research was carried out using 21 nuclear medicine workers (11 females and 10 males) during two periods: during normal working conditions and after a 1-month vacation. The radiation dose varied from 1.20 to 48.56 mSv, which accumulated during the occupational exposure time between two vacations. Peripheral blood samples were taken from each subject for two distinct lymphocyte cultures (SCE and MN) in each period.

RESULTS

In nearly all subjects, SCE values increased significantly during radiation exposure compared to the postvacation period (P<.05). Similarly, MN frequencies in most of the subjects increased significantly during radiation exposure compared to the postvacation period (P<.05).

CONCLUSIONS

This study revealed that both SCE and MN frequencies in most of the subjects were significantly higher during exposure to ionizing radiation than after a 1-month vacation period. However, this genotoxic effect was reversible in most of the subjects.

Evaluation by (99m)Tc-pertechnetate scintigraphy of the effect of levocetirizine on salivary glands function, in allergic rhinitis patients

The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary glands function in patients with allergic rhinitis using technetium-99m pertechnetate ((99m)Tc-P) salivary gland scintigraphy. The study population consisted of 67 patients with allergic rhinitis and 31 healthy controls (14 males and 17 females, mean age 30.1+/-6.8 years). The patients were divided into two groups: an untreated patient Group of 32 patients, 17 males and 15 females, mean age 29.9+/-6.5 years and a levocetirizine-treated with 5mg.day(-1) for 4 weeks patient Group, consisted of 35 patients, 16 males and 19 females, mean age 33.5+/-7.8 years. All patients and healthy controls underwent salivary glands scintigraphy. After the intravenous administration of 185 MBq of (99m)Tc-P, dynamic salivary glands scintigraphy was performed for 25 min. By the time-activity curves, the following glandular function parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation, and ejection fraction. Our results showed: All functional parameters obtained for the untreated patient Group were significantly lower than for the levocetirizine-treated patient Group and healthy controls (P<0.05). There was no significant difference in any functional parameters between the levocetirizine-treated patient Group and healthy controls (P>0.05). In conclusion, results of our study indicate that patients with allergic rhinitis treated with levocetirizine showed a significantly higher salivary glands function compared with untreated patients and healthy controls. Levocetirizine treatment showed no side effects on salivary glands function.

Hippophae rhamnoides L. and dexpanthenol-bepanthene on blood flow after experimental skin burns in rats using 133Xe clearance technique

The aim of the present experimental study was to determine and compare the effect of Hippophae rhamnoides L. extract (HRe-1) and of dexpanthenol on the blood flow of a wound region, in rats using xenon-133 ((133)Xe) clearance technique.

METHODS

Burn wounds were made on both thighs of rats and, HRe-1 and dexpanthenol were applied topically on the wound region only in the right thigh for a period of 8 days. The effect of HRe-1 and of dexpanthenol on blood flow of the wound region was assessed before and after their topical application by using the (133)Xe clearance technique.

RESULTS

HRe-1 increased significantly blood flow of the wound region (P<0.05). Dexpanthenol showed a smaller increase in blood flow. In conclusion, our results in rats suggest that HRe-1 increases blood flow of the wound area and can be used for the treatment of skin wound healing, preferably than dexpanthenol.

Scintigraphic evaluation of acute pancreatitis patients with 99mTc-HMPAO-labelled leukocytes

OBJECTIVE

To demonstrate the localization of leukocytes in the pancreas during acute pancreatitis and to evaluate the potential use of 99mTc-HMPAO-labelled leukocytes in the diagnostic assessment of patients with acute pancreatitis.

METHODS

The study was performed with 20 patients (11 females, nine males; ranging in age from 26 to 86 years, mean 55 years). Labelled leukocyte scintigraphy using planar imaging was performed on all patients, seven of whom were also examined by single photon emission computed tomography (SPECT). According to Ranson criteria, 10 patients had mild pancreatitis (group A), six had severe pancreatitis (group B) and four had necrotic pancreatitis (group C). Twelve patients had biliary pancreatitis and the other eight patients had no obvious cause.

RESULTS

All patients of group C, four of group B, two of group A had a positive leukocyte scan. The positive leukocyte scintigraphy value for the detection of a lethal course of acute pancreatitis was 100%; of a severe course, 66.7%; and of a mild course, 20%. These findings are statistically significant (P=0.005 in chi-squared tests result). The results of leukocyte scintigraphy compared with those of CT were also statistically significant (P=0.001 in chi-squared tests). All the patients diagnosed with pancreatic necrosis by CT had a positive leukocyte scan, but only three of 13 patients without pancreatic necrosis that could be detected by computed tomography had a positive leukocyte scan.

CONCLUSIONS

There was a significant correlation between the severity of the disease and leukocyte infiltration. Considering these results, we believe that leukocyte infiltration in acute pancreatitis can be demonstrated rapidly and accurately and by noninvasive 99mTc-HMPAO labelled leukocyte scintigraphy.

Evaluation of the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients by rhinoscintigraphy

OBJECTIVE

The purpose of this study was to assess the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients using rhinoscintigraphy.

METHODS

Twenty patients with allergic rhinitis (12 males and eight females, mean age 37.7 +/- 10.5 years) were evaluated. All the patients received levocetirizine (5 mg x day(-1)) for 4 weeks, and the speed of nasal mucociliary clearance was assessed before and after treatment. Twenty healthy controls (11 males and nine females, mean age 39.4 +/- 7.8 years) were also evaluated.

RESULTS

The clearance values obtained for the treated group before and after treatment were significantly lower than those of the control group (P = 0.0001), but there was no significant difference in clearance speeds before and after treatment in the patient group (P = 0.444).

CONCLUSION

The study demonstrated that levocetirizine did not affect the speed of nasal mucociliary clearance in allergic rhinitis patients, and that nasal mucociliary clearance can easily be evaluated by rhinoscintigraphy.

99mTc-labelled red blood cell single-photon emission computed tomography for the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma

AIM

To confirm the usefulness of blood pool scintigraphy with Tc-labelled red blood cells ((99m)Tc-RBCs) in the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma.

METHODS

A prospective study design was used. (99m)Tc-RBCs were prepared by a modified in-vivo method. After the rapid intravenous injection of 370-740 MBq of (99m)Tc-RBCs, dynamic imaging of 1-min duration was performed. After dynamic imaging, static acquisitions at 5 min (second phase: blood pool phase) and 2 h (third phase: static image) were obtained. In addition, single-photon emission computed tomography (SPECT) imaging was performed at 2 h. SPECT images were obtained using a rotating gamma camera (GE-Starcam 4000 XR/T).

RESULTS

All patients showed no activity in the first phase and mild activity in the second phase (blood pool phase). All patients with juvenile nasopharyngeal angiofibroma showed a prominent increased activity in the third phase and in SPECT images.

CONCLUSIONS

This study shows that blood pool scintigraphy with (99m)Tc-RBC SPECT is very accurate, easy to perform and a suitable alternative to pre-operative and post-operative imaging techniques, including computed tomography scan, magnetic resonance imaging (MRI) and MRI angiography, for the detection of juvenile nasopharyngeal angiofibroma.

99mTc-HMPAO labelled leucocyte scintigraphy in the diagnosis of pelvic inflammatory disease

BACKGROUND

Scintigraphy using leucocytes labelled with 99mTc hexamethylpropyleneamine oxime (99mTc-HMPAO) is widely used for the localization of inflammatory foci and abscesses in cases of acute pelvic inflammatory disease, which is one of the serious health problems of women of child-bearing age. Early diagnosis and effective management of this condition can preserve fertility and prevent serious complications, such as peritonitis and sepsis.

AIM

To evaluate the importance of scintigraphy using 99mTc-HMPAO labelled leucocytes in the early diagnosis of patients with pelvic inflammatory disease.

METHODS

Fifteen women (mean age 29.2+/-8 years, range 25-46 years) with suspicion of pyogenic pelvic inflammatory disease based on gynaecological examinations, clinical findings and blood tests were included in this study. The patients received 555 MBq 99mTc-HMPAO labelled leucocytes, by injection, and were scanned by scintigraphy 0.5-1, 3 and 24 h later in the anterior abdominal projection. Ten of the patients were then evaluated by abdominal or transvaginal ultrasonography, four by computed tomography and two by both ultrasound and computed tomography. The final diagnosis was made by surgical intervention.

RESULTS

Scintigraphy detected pelvic inflammatory disease in five of the patients. In three of them the disease was apparent on the scans taken at 0.5-1 h, and in the other two it was apparent at 3 h. There were no false negative results, and one false positive result. The scan accurately reflected the absence of pelvic inflammatory disease in nine patients showing non-pathological tracer uptake in the lower abdominal region.

CONCLUSION

We showed that scintigraphy with 99mTc-HMPAO labelled leucocytes had a sensitivity of 100%, specificity of 90%, overall accuracy of 93%, positive predictive value of 83%, and negative predictive value of 100%. Therefore, we conclude that 99mTc-HMPAO labelled leucocyte scans provide a rapid and highly accurate method for diagnosing pelvic inflammatory disease in women of child-bearing age. This adds an important contribution to the diagnosis of infection and helps determine further operative or conservative treatment.

Genotoxicity of thallium-201 in patients with angina pectoris undergoing myocardial perfusion study

Thallium-201 (201Tl) has been widely used as a nuclear reagent for myocardial blood flow imaging. The purpose of this study was to investigate genotoxic effects of 201Tl in patients with angina pectoris (n = 21), who had undergone myocardial perfusion imaging. Lymphocytes were isolated from each patient before, and 3, 30 and 90 days after 201Tl administration (111 MBq, 3 mCi) and were analyzed for chromosomal aberrations, sister chromatid exchanges, mitotic index and replicative index. There were significant increases in chromosomal aberrations and sister chromatid exchanges 3 days after 201Tl administration (p < 0.001), although no difference was noted in these values after 30 and 90 days (p > 0.05). Moreover, decreased mitotic index and replicative index were noted after 3 days of 201Tl administration (p < 0.001). These results suggest that the administration of 201Tl for myocardial blood flow imaging may induce genetic damage.

Tc-99m polyclonal human immunoglobulin scintigraphy in brucellosis

The aim of this study was to evaluate the accuracy of Tc-99m polyclonal human immunoglobulin (HIG) scintigraphy for the diagnosis of brucellosis, and to compare its effectiveness in the diagnosis of osteoarticular involvement in comparison with bone scanning. Of 30 patients with brucellosis, Tc-99m HIG detected osteoarticular involvement in 18 (60%) patients, in whom the sacroiliac joints were affected most commonly (n = 13; 72.2%), with statistically predominant bilateral involvement (p < 0.05). By bone scanning, the rate of osteoarticular involvement was 70% (21 of 30 patients), and the joints affected most commonly were sacroiliac (15 of 21 patients; 71.4%). Although bilateral involvement was observed mostly by bone scanning, there was no significant difference between the rate of bilateral and unilateral involvement. The anatomical distribution of osteoarticular complications, as detected by Tc-99m HIG and bone scintigraphy, did not differ significantly. With Tc-99m HIG, orchitis was detected in two patients and paravertebral abscess in one patient. Since bone scanning did not detect these soft tissue complications, Tc-99m HIG scintigraphy might be useful for the detection of both osteoarticular and soft tissue complications resulting from brucellosis.

Effects of sleep deprivation, nicotine, and selenium on wound healing in rats

Effects of sleep deprivation (SD), nicotine, and selenium (Se) on wound healing were studied in 50 male rats (Sprague-Dawley strain). Full-skin-thickness burns were produced in animals. Then, SD, nicotine, and Se administrations were applied to animals in different groups. Wound healing was assessed by pathological analysis of wound by counting fibroblasts, capillary vessels, polymorphonuclear leucocytes (PNLs), and by measuring radiolabeled immunoglobulin G (IgG) amount in wound area by radio-pharmaceutical and immunoscintigraphic procedures. The number of fibroblasts and capillary vessels were higher in control and Se groups than in sleep deprivation and nicotine groups, and the number of PNLs and the radiolabeled polyvalent IgG levels were higher in SD and nicotine groups than in control and Se groups. The results suggest that SD and nicotine may delay wound healing and that Se supplementation may accelerate wound healing by preventing nicotine-induced oxidative stress and lipid peroxidation.

Handedness and bilateral femoral bone densities in men and women

To examine the relation of hand preference to bilateral femoral bone mineral density (BMD), the right and left total and regional (neck, trochanter, intertrochanteric, and Ward's triangle) proximal femur BMDs (g/cm2) were measured using dual-energy X-ray absorbtiometry (DEXA) in 32 right- and 26 left-handed university students. The mean total BMD of the total right-handers and the mean trochanteric BMD of the right- handed males were greater in the left femur than the right femur. Contrarily, the total left-handers had higher mean intertrochanteric BMD in the right side than in the left side. There were negative correlations between R-L BMD differences and Geschwind scores of total, male, and female subjects. The results suggest that femur-BMD may be related to hand preference.

Effects of septoplasty and septal deviation on nasal mucociliary clearance

To evaluate the effect of septal pathology and surgery on nasal mucociliary clearance. A radioisotope method was used to measure the velocity of nasal mucociliary transport. Nasal mucociliary clearance was measured before and after septal surgery using technetium-99m macroaggregated albumin. Fifteen patients (mean age: 20 +/- 8 years; 11 males, four females) were studied pre-operatively, but scintigraphy could be repeated only in 10 patients, 2 months after surgery. A group of 10 healthy volunteers were also studied. The clearance values obtained from the preoperative period (26.25 +/- 9.45 min) were significantly higher than those of the post-operative period (15.05 +/- 6.35 min). The values obtained of control group (13.30 +/- 3.15 min) were not significantly different from the post-operative values of the patient group. Septal deviation affects the mucociliary activity. It is improved by surgery. This study showed that nasal septal deviation reduced the nasal mucociliary activity, and this can easily evaluated with scintigraphy.

99mTc-MDP bone SPECT in evaluation of the knee in asymptomatic soccer players

OBJECTIVE

To evaluate stress fractures in leg (particularly around the knee, tibia, and femur) and knee pathology in active asymptomatic (no symptoms in the preceding month) soccer players.

METHOD

The study included 42 asymptomatic soccer players (21 women, 21 men; age range 19-31 years). Players from seven teams in the major female professional and amateur male soccer leagues were examined by technetium-99m-methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy during the soccer season. Four hours after intravenous injection of 20 mCi (99m)Tc-MDP, standard imaging included anterior planar spot images of the legs, lateral images of the knee, and single photon emission computed tomography (SPECT).

RESULTS

Although the players were asymptomatic, increased tracer uptake, indicating stress fracture, was found in 28 (66%). Most of the stress fractures were in the tibia (62%) and femur (5%). In the 42 subjects (84 legs), 35 sites (42%) showed rupture of the posterior horn of the lateral meniscus and bone bruising of the tibial plateau, 16 sites (19%) showed rupture of the anterior horn of the medial meniscus, 11 sites (13%) showed bone bruising of the lateral femoral condyle, eight sites (10%) showed bone bruising of the medial femoral condyle, and there was avulsion injury to the infrapatellar tendon insertion in the anterior tibia in 34 sites (40%). There were 11 anterior cruciate ligament injuries.

CONCLUSION

Bone SPECT is very accurate, easy to perform, cost effective, may give valuable information before magnetic resonance imaging studies in the detection of meniscal tears, and may be used successfully when magnetic resonance imaging is unavailable.

Differences between right- and left-femoral bone mineral densities in right- and left-handed men and women

To test whether handedness has an asymmetric effect on femur bone mineral density (BMD), the right- and left-proximal femur BMDs were compared in 124 right- and 23 left-handed university students. In the right-handed men, the mean left-femur BMD was significantly greater than the right-femur. In the left-handed men, the mean right-femur BMD was significantly greater than the left-femur. There were no significant differences between BMDs from the right- and left-femurs in women. These results suggest that hand preference may be related to asymmetry in BMD, but only for men.

Evaluation of active and passive transport mechanisms in genital tracts of IUD-bearing women with radionuclide hysterosalpingoscintigraphy

The objective of this study was to evaluate the active and passive transport mechanisms in the genital tracts of copper T-200 intrauterine device (IUD)-bearing women. (Tc-99m)HMPAO-labeled spermatozoa and (Tc-99m)-labeled albumin macrospheres were placed into the vagina at midcycle. Serial scintigraphic images were obtained over a period of 2 h. Migration of spermatozoa and particles in the genital tract and the direction of transport related to dominant follicle were evaluated. While active sperm migration was greatly inhibited, the passive transport of the particles was not affected in IUD-bearing women. The direction of radiolabeled particles and spermatozoa was toward the dominant follicle side. Passive transport was not affected, whereas active transport of spermatozoa was strongly inhibited in the genital tract by the presence of the IUD. However, the direction of active and passive transport related to dominant follicle side was unchanged in IUD-bearing women and was preferentially toward the tube ipsilateral to the dominant follicle.

Assessment of thyroid nodules by technetium-99m-tetrofosmin scintigraphy

Thyroid nodularity is a common finding. The incidence of thyroid cancer in the general population is estimated at 0.1%. Thyroid nodules are evaluated by palpation, ultrasonography, radionuclide scintigraphy and fine-needle aspiration cytology. Routine thyroid scintigraphy is made by using Tc-99m-pertechnetate or the I-131 and I-123 scintigraphic method. Tc-99m-tetrofosmin accumulates in the myocardium, skeletal muscle, liver, spleen breast tissue, kidney and normal and pathological thyroid tissue. We investigated 36 patients (28 females and 8 males) with solitary and/or multiple thyroid nodules. All the patients were euthyroid, and their thyroid nodules were diagnosed by palpation and ultrasound examination. Thyroid scintigraphy was applied by Tc-99m-pertechnetate, then thyroid fine-needle aspiration biopsy was performed. Finally, Tc-99m-tetrofosmin scintigraphy was carried out. Five patients (14.8%) had differential thyroid carcinoma, 23 (63.8%) had thyroid adenoma, 1 (0.02%) had Riedel's thyroiditis and 7 (19.4%) had follicular cyst. We detected 80% uptake in the early phase and 100% in the late phase by Tc-99m-tetrofosmin scintigraphy in the differentiated thyroid carcinoma group. In summary, we claim that Tc-99m-tetrofosmin may be an important scintigraphic method to identify thyroid malignancy from benign thyroid pathologies.

Short-term effects of somatostatin analogue (SMS 201-995) on left ventricular function in healthy persons: a scintigraphic study

Since somatostatin has been reported to have a negative inotropic and chronotropic effect on atria and positive inotropic effect on ventricle, present study was designed to investigate the acute effects of somatostatin analogue SMS 201-995 infusion on the left ventricular function in healthy volunteers. After labeling the autologous red blood cells with 750-1000 MBq 99mTc-pertechnetate, ECG-gated radionuclide ventriculography was performed. Using Fourier analysis of the left ventricular time-activity curve, ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR), time to end-systole (TES) and normalized TES/T values were calculated. Study group consisted of 12 healthy volunteers. Somatostatin analogue SMS 201-995 infusion was given at a rate of 100 micrograms/h during 2h. Baseline, 1st, 2nd h and 4th h imagings were done using the same protocol. Simultaneously heart rate and blood pressure were recorded. The difference between parameters was tested using Kruskall-Wallis test. The mean heart rate, systolic and diastolic blood pressures and did not show any statistically significant change during the somatostatin analogue infusion and 2h later in comparison to baseline values. The mean PER and PFR had a slight decrease at the first hour of infusion, but the change was not significant. However, the significant correlation of PER values with heart rate, EF and TES observed at baseline study were disappeared during the infusion. These results indicate that somatostatin analogue infusion does not appear to change the left ventricular systolic and diastolic function in healthy persons significantly.

Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis

OBJECTIVE

To compare the effects of erythromycin and metoclopramide on gastric emptying and symptoms of gastroparesis in diabetic patients with delayed gastric emptying.

RESEARCH DESIGN AND METHODS

The study group consisted of 13 patients with symptoms of severe gastroparesis and delayed gastric emptying. Gastric emptying was evaluated using a radionuclide method, and gastrointestinal symptoms were scored. The patients were given either erythromycin (250 mg 3 times/day) or metoclopramide (10 mg 3 times/day) in random order for 3 wk, and after a washout period of 3 wk they were crossed-over to the other medication for another 3 wk. Parameters of gastric emptying were assessed before treatment and after both erythromycin and metoclopramide administration.

RESULTS

The half-time of gastric emptying in diabetic subjects was 110 (77-120) min before treatment. At 60 and 90 min, the median value of residual isotope activity was 66.5 (55-83.5) and 55% (43-74.3), respectively. The half-time decreased to 55 min (28.6-115) after 3 wk of treatment with erythromycin and percentages of meal retention in the stomach at 60 and 90 min were 49.9 (38.4-70) and 40.5% (29.7-60), respectively. After taking metoclopramide, the median value of half-time was 67 min (15-115) and percentages of meal retention at 60 and 90 min were 51 (34.5-93.9) and 42% (24-71.2), respectively. When compared with baseline values a significant difference in gastric emptying parameters was found after both erythromycin and metoclopramide. A significant improvement of the total score for gastrointestinal symptoms was observed with both drugs, but this improvement was more pronounced with erythromycin.

CONCLUSIONS

Erythromycin, a macrolide antibiotic and a motilin receptor agonist, appears to stimulate intestinal motility and seems to be an alternative agent for the treatment of gastroparesis caused by diabetic autonomic neuropathy.

Changes in the circulating endothelin and atrial natriuretic peptide levels during coronary artery bypass surgery

To evaluate the behavior of circulating endothelin and atrial natriuretic peptide (ANP) during coronary artery bypass graft (CABG) surgery, blood samples from patients with coronary artery disease (n = 8) were investigated before, during and after operation. Plasma levels of endothelin and ANP were determined using the radioimmunoassay method. Baseline plasma levels were compared to those of normal volunteers (n = 6). Left ventricular function at rest and as a response to isometric exercise was evaluated using radionuclide ventriculography before and after coronary bypass surgery. The mean endothelin value was found to be within normal limits, however the mean ANP value was slightly higher than control. Patients had significantly improved left ventricular systolic and diastolic function after surgery. The mean endothelin level was higher than initial values immediately after extra-corporeal circulation and returned to initial values in two hours. However, ANP values were increased and remained higher than initial values. Baseline endothelin values were negatively correlated with systolic function parameters, whereas endothelin and heart rate had a positive correlation before extra-corporeal circulation. Coronary artery bypass graft surgery may cause an increase in the circulating endothelin level either due to endothelial injury or due to myocardial ischemia and hypothermia. Following surgery, increased endothelin levels returned to normal values immediately.

Scintigraphic evaluation of functional renal reserve using angiotensin-converting enzyme inhibition in patients with type II diabetes mellitus

Acute effects of 20 mg oral enalapril (E), and angiotensin-converting enzyme inhibitor, on renal function and the renin-angiotensin-aldosterone system were investigated in 13 patients with type II diabetes mellitus (8 female, 5 male) and 10 hypertensive controls using a radionuclide method. Plasma glucose control was evaluated with fructosamine (F) determinations. After intravenous administration of 370 MBq 99mTc-DTPA, sequential images were recorded. Glomerular filtration rate (GFR), perfusion index (PI), time to maximum activity and reno index values of the kidneys were calculated. Two days later, renal scintigraphy was repeated after oral administration of E. Plasma levels of renin, angiotensin II and aldosterone were analyzed using RIA. Basal GFR values (mean: 92.6 ml/min) correlated with F (r = 0.364; p < 0.05). In the diabetic group, 5 patients had a decrease in GFR and an increase in PI after oral E. The mean percent change of GFR was 12 +/- 32 for patients and 20 +/- 12 for controls, respectively. Percent change of GFR had a slightly negative correlation with F values (r = -0.51; p < 0.05) and with PI (r = -0.65; p < 0.001). The patients with good metabolic control had an increase in GFR and a decrease in PI indicating an increase in renal blood flow and glomerular filtration. In patients with proteinuria and poorly controlled diabetes, in response to E-induced efferent arteriolar dilation, there is a decrease in GFR and an increase in PI which indicates a fall in filtration and renal blood flow. This glomerular hemodynamic pathology precedes morphological changes due to diabetes.

Scintigraphic evaluation of the short- and long-term renal effects of oral felodipine using technetium-99m-mercaptoacetyl triglycine

The short- and long-term effect of felodipine on renal perfusion and tubular function was investigated using a new renal tubular imaging agent, 99mTc-mercaptoacetyl triglycine (99mTc-MAG3). Twelve patients with essential hypertension (mean age = 49 +/- 8 years) were studied. Renal scintigraphies with 180 MBq 99mTc-MAG3 were performed at baseline, at the 2nd hour following oral administration of 5 mg felodipine and 4 weeks later on 5-10 mg daily felodipine therapy. The time-activity curves of each kidney were obtained following background subtraction. The 99mTc-MAG3 clearance value was measured for each kidney. In addition, perfusion index (PI), reno index, time to maximum, half-maximum and two thirds of maximum activity values of each kidney were calculated. Systolic and diastolic blood pressures were significantly lowered with long-term administration of felodipine (from 159 +/- 12/105 +/- 5 to 141 +/- 11/87 +/- 7 mm Hg, p = 0.01 and p = 0.002, respectively). Heart rate did not change significantly. Initially, a decrease in PI indicating an increase in renal blood flow (from 246 +/- 96 to 194 +/- 54, p = 0.01) was observed, whereas no change was noted during the chronic administration (to 230 +/- 69, p = NS). Total clearance of 99mTc-MAG3 was decreased nonsignificantly following the initial dose of felodipine (from 361 +/- 93 to 351 +/- 91 ml/min, p = NS). During long-term therapy, felodipine did not alter the perfusion and tubular function of the kidneys. Our results indicated that felodipine causes a significant increase in renal blood flow initially, even with a nonsignificant change in systemic blood pressure.

Assessment of changes in regional cerebral blood flow in patients with major depression using the 99mTc-HMPAO single photon emission tomography method

Regional cerebral blood flow was investigated in 14 patients with major depression diagnosed according to the DSM-III-R criteria (six patients with single and eight patients with recurrent episodes) and in ten healthy volunteers. The mean ages of the patients and the controls were 33.5 +/- 2.7 and 31.6 +/- 2.6 years, respectively. The severity of the depression was assessed using the 17-item Hamilton Depression Scale (mean: 23.2 +/- 1.5). None of the patients was under medication. After administration of 500 MBq technetium-99m hexamethylpropylene amine oxime, a single photon emission tomography study was performed and then transaxial, sagittal and coronal slices were obtained. For the semiquantitative analysis of the data, the ratios of the mean counts/pixel to the whole slice were calculated for 24 regions on three consecutive transaxial slices in the orbitomeatal plane. Additionally, left/right and frontal/occipital ratios were calculated. Both sides of the temporal region had a significantly decreased cerebral blood flow (CBF) when compared to the controls. The left/right ratio of the prefrontal region was also significantly lower in the patients than in the controls. The Hamilton score had a negative correlation with blood flow in the anterofrontal and left prefrontal regions. According to our results, regional CBF seems to be decreased in the left prefrontal and in both temporal regions in major depression. The severity of depression is correlated with the reduction in CBF in the regions of the anterofrontal and left prefrontal cortex.

Uterine technetium-99m mercaptoacetyltriglycine and diethylene triamine penta-acetic acid uptake in the scintigraphic evaluation of transplanted kidneys

An anuric 35-year-old woman with a renal transplant underwent serial renal scintigraphy studies to screen the kidney function. A hypervascular pelvic mass in the region of the bladder was identified during technetium-99m mercaptoacetyltriglycine (MAG3) and also during 99mTc diethylene triamine penta-acetic acid (DT-PA) scintigraphy. She was in the secretory phase of the uterine cycle during the study and had no gynaecological problem to explain the radioactivity accumulation. The accumulation of 99mTc-MAG3 mimicking the bladder was considered as uterine activity. To our knowledge, this is the first case of uterine visualization with 99mTc-MAG3.