To use MIBI or not to use MIBI? That is the question when assessing tumour cells

^99mTc-sestamibi (MIBI) is a well-known tumour imaging agent. Its retention within tumour cell mitochondria is related to perfusion and to the magnitude of the electrical gradient, reflecting cell viability. Several internal cell factors modulate this uptake; for example, multidrug resistance membrane proteins (Pgp and MRP1) and anti-apoptotic BCl-2 protein of the outer mitochondrial membrane can limit retention of MIBI. At the early stage of cell apoptosis, the electrical driving forces of MIBI uptake are impaired, and influx and accumulation are reduced. It seems clear that MIBI can be used before treatment to detect drug resistance, assess anti-apoptotic status and predict treatment efficacy. Although it has been suggested that MIBI might be used to monitor tumour response to treatment, MIBI is unable to differentiate tumours with ongoing apoptosis from those developing drug resistance.     

Downregulation of the expression of bone morphogenetic protein 7 in experimental pyelonephritis

Bone morphogenetic protein 7 (BMP 7) is a member of the transforming growth factor (TGF) beta superfamily and is involved in regeneration, repair, and development of specific tissues, for example kidney, gut, lens, and skeleton. BMP 7 has emerged as a renotrophic factor and experimental studies have shown its protective role against fibrotic processes. Tubulointerstitial changes are present in the pyelonephritic kidney which progresses to fibrosis. Renal fibrosis may lead to significant morbidity in the form of hypertension, proteinuria, and loss of renal function. The objective of this study was to investigate BMP 7 expression in experimental acute and chronic pyelonephritis models. Eighteen Wistar rats were injected with 0.1 mL solution containing E. coli ATCC 25922 10¹⁰ cfu mL^–1 into left renal medullae. Six rats were used as a sham group and were given 0.1 mL 0.9% NaCl. Pyelonephritic rats were sacrificed 24 h (group I, n=6), 1 week (group II, n=6), and 6 weeks (group III, n=6) after E. coli injection. Serum creatinine levels were analyzed. Renal tissues were studied histopathologically by use of hematoxylin and eosin and scored for diagnosis of pyelonephritis. BMP 7 expression was studied semiquantitatively by immunohistochemical staining. Acute (group I) and chronic (group II and group III) pyelonephritic histopathological changes were observed in experimental pyelonephritic groups. A gradual decrease in BMP 7 expression was observed in the tubulointerstitial and tubular area of the pyelonephritic kidneys, mildest in the acute pyelonephritic group and most severe in the chronic pyelonephritic 6th week group. A statistically significant difference was observed between tubulointerstitial BMP 7 expression by groups I and III (P=0.017) and by groups III and IV (P=0.000). Tubular BMP 7 expression was statistically significantly different between groups II and IV (P=0.009) and between groups III and IV (P=0.002). The data imply that BMP 7 has a major role in chronic pyelonephritis. Tubulointerstitial and tubular BMP 7 expression also had a significant negative correlation with fibrosis, tubular, atrophy, and vascular changes. Serum creatinine levels of the study group were all normal. We conclude that the decrease in renal BMP 7 expression in experimental chronic pyelonephritis is one of the factors responsible for fibrotic changes in persistent renal damage.     

Sarcoidosis Presenting as Cold Thyroid Nodules: Report of Two Cases

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.     

Delaying the reverse sural flap provides predictable results for complicated wounds in diabetic foot

Defective wounds in diabetic foot are difficult to manage. Several studies reported the use of reverse sural flap in a small number of patients with varying success. We presented our experience with the reverse sural island flap (RSIF) in a series of 37 patients associated with diabetic foot using the delay procedure. The ages of the patients ranged between 36 and 73 years. We did not perform angiographic evaluation to determine the existence of vascular connections between the branches of the peroneal and posterior tibial artery; however, Doppler ultrasound evaluation was done to determine the patency of anterior and posterior tibial arteries, as well as lesser saphenous vein before the operation. The flaps were transferred using a 3-step delay procedure. While all the first and second steps of the operations were done under local anesthesia, the third steps were performed using general anesthesia in 12 and spinal anesthesia in 25 patients. All flaps survived except 4 showing partial necrosis due to venous insufficiency. Delaying the RSIF is a reliable procedure for diabetic foot skin defects.     

Development of calciphylaxis after long-term steroid and methotroxate use in a patient with rheumatoid arthritis

Calciphylaxis may be considered a small vessel vasculopathy which is generaly associated with end-stage renal disease and hyperparathyroidism. The precise pathogenesis of the disease is not known. It needs sensitizers and challengers to occur. Steroids and immunosuppressive drugs including methotrexate are among those challenger agents. Calciphylaxis in collagen vascular diseases is rare. Only one case in rheumatoid arthritis was recently reported. Here we describe a case of calciphylaxis associated with active rheumatoid arthritis. This patient had active disease despite treatment of steroids and methotrexate for a long time. She died shortly after the diagnosis of calciphylaxis due to sepsis.     

The plateled-derived growth factor level (PDGF) in Hodgkin's disease and non-Hodgkin's lymphoma and its relationship disease activation

The research reported in this paper was designed to study the role of plateled-derived growth factor (PDGF) in Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL). The PDGF levels in 9 patients with HD and 12 NHL and in a control group consisting of 20 people, was measured by ELISA method. The PDGF values in the disease group of 19 patients were raised. The values of PDGF in the control group were 28.977+/-9 pg/ml, but were measured at 147.083+/-54 pg/ml in HD group and 131.487+/-56 pg/ml in NHL group (p < 0.01). The observation of a 5-fold increase in PDGF values in the disease group when compared to the control group suggests that PDGF could itself be considered as a possible factor in the pathogenesis of HD and NHL. In order to support this, there is a need to design additional studies monitoring PDGF in larger number of patients at various stages of the disease.     

MR imaging findings in autoimmune hepatitis: correlation with clinical staging

PURPOSE: To retrospectively evaluate the morphologic and enhancement features of the liver on magnetic resonance (MR) images obtained in patients with autoimmune hepatitis (AIH) and to determine if there is a correlation between MR imaging findings and severity of clinical disease as measured with the Mayo end-stage liver disease (MELD) score. MATERIALS AND METHODS: This study was compliant with the Health Insurance Portability and Accountability Act and approved by the institutional review board. The need for informed consent was waived. Thirty-two patients (29 female and three male patients; mean age, 44 years; age range, 14-69 years) undergoing treatment for AIH underwent unenhanced and gadolinium-enhanced MR imaging. Two radiologists reviewed all cases independently to determine the presence of patchy or heterogeneous liver enhancement, biliary duct changes, lymphadenopathy, and findings of portal hypertension. Fibrosis was graded as mild, moderate, or severe reticular (corresponding to a grading scale of 1-3) or as confluent. Agreement between radiologists was assessed by using kappa coefficients. Mean MELD scores were compared across fibrosis categories by using the Kruskal-Wallis analysis of variance. RESULTS: Of the 32 patients, two (6%) had no imaging findings of cirrhosis. Thirty patients (94%) had reticular fibrosis with a mean grade of 1.8. Six patients had confluent fibrosis, and all six had associated reticular fibrosis. Mild intrahepatic biliary duct dilatation involving the right and left lobes was observed in four patients (12%). Lymphadenopathy was observed in 12% of patients. None of the patients had hepatocellular carcinoma. There was no significant overall association between fibrosis grade and MELD score (P = .36). CONCLUSION: Although fibrosis is a common feature in AIH and is often moderate to severe, no significant correlation between fibrosis grade and MELD score was found.     

Morphologic, functional and behavioral effects of titanium dioxide exposure on nerves

OBJECTIVES: The purpose of this study was to explore morphologic, functional, and behavioral effects of titanium dioxide (TiO(2)) on nerves. MATERIAL AND METHODS: A total of 17 albino rats were used for nerve conduction experiments, hot-plate tests, and histological evaluation. TiO(2) was implanted unilaterally on the sciatic nerves of five rats. Ten days after surgery, test and control nerves were dissected and their signal transduction speeds were quantified by suction electrodes in a bath containing a Tyrode solution. Twelve rats were divided into three equal groups resulting in equal number of nerves (n=8) for TiO(2) implantation, surgical exposure of the nerves, and for use as controls. One week after surgery, hot-plate tests were undertaken for 10 consecutive days to determine response latencies of the nerves. At the termination of the experiments, the nerves were harvested, processed, and examined under a microscope. RESULTS: The signal transduction speeds of TiO(2)-implanted nerves was similar to control specimens (P>0.05). The avoidance responses of TiO(2)-implanted, surgically exposed, and control nerves were comparable (P>0.05). At the cellular level, TiO(2) did not lead to any signs of adverse reactions on nerves. CONCLUSIONS: TiO(2), the main oxide surrounding endosseous titanium implants, does not alter the structure and the function of myelinated nerves.     

Latent autoimmune diabetes mellitus in children (LADC) with autoimmune thyroiditis and Celiac disease

Latent autoimmune diabetes mellitus in adults (LADA) is characterized by clinical presentation as type 2 diabetes mellitus after 25 years of age, initial control achieved with oral hypoglycemic agents for at least 6 months, presence of autoantibodies and some immunogenetic features of type 1 diabetes mellitus. An 8.3 year-old girl was referred to our pediatric endocrinology department because of incidental glucosuria. She did not complain of polyuria, polydipsia, or weight loss. Her body mass index (BMI) was at the 80th percentile. Fasting glucose was 126 mg/dl, and OGTT glucose level at 120 min was 307 mg/dl. Although C-peptide levels were normal, her first phase insulin response (FIR) was lower than the 1st percentile. Anti-insulin antibody (AIA), islet cell antibody (ICA), and anti-glutamic acid decarboxylase (antiGAD) were negative. According to the clinical and laboratory findings, she was diagnosed as having type 2 diabetes mellitus. She was started with oral anti-diabetic treatment for a period of 1 year. Insulin had to be initiated for worsening of HbA1c levels. In the fourth year of follow-up, she was admitted to our hospital with diabetic ketoacidosis although she was on an intensive insulin regimen. At this time, C-peptide levels were low, antiGAD and AIA were positive with HLA DR3/DQ2 haplotype. In addition, her thyroid peroxidase antibody and endomysium antibody were found to be high at follow-up. Small intestinal biopsy revealed celiac disease. This patient may represent the first case of latent autoimmune diabetes mellitus in children (LADC) with autoimmune thyroiditis and celiac disease.     

Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol

Background : Establishment of good analgesia is of major concern in the postoperative period following adenotonsillectomy. The aim of this study was to compare the effects of ketamine, morphine and tramadol on postoperative pain after adenotonsillectomy in children. Methods : Sixty children (age 5–12 years) scheduled for adenotonsillectomy were randomized into four groups to receive intravenously (i.v.) either 0.5 mg·kg^?1 ketamine hydrochloride (K), 0.1 mg·kg^?1 morphine hydrochloride (M), 1.5 mg·kg^?1 tramadol hydrochloride (T) or normal saline (S) in a volume of 4 ml during induction. After tracheal intubation 10 μg·kg^?1·min^?1 ketamine hydrochloride in group K and 0.6 ml·kg^?1·h^?1 saline i.v. in groups M, K and S were infused peroperatively. Postoperative analgesic requirements and side‐effects were recorded. Pain was assessed by the Numeric Rating Scale (NRS) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores. Results : Heart rate increased significantly peroperatively only in group K. NRS at first and fifth minute in group M and at first minute in group T and K and CHEOPS score at first, fifth, 15th and 60th min in group M were found to be significantly lower than in the control group. The time to first analgesic requirement was significantly longer in group M compared with ketamine and the control group. Six children in group M, nine in group T, 11 in group K and 15 in group S needed additional analgesics. Conclusions : Morphine hydrochloride 0.1 mg·kg^?1 i.v. administered during induction of anaesthesia provides efficient pain relief in children undergoing adenotonsillectomy.