Comparison of low-dose and standard-dose helical CT in the evaluation of pulmonary nodules

The purpose of this study was to investigate the diagnostic accuracy of low-dose helical computed tomography by comparing the number of nodules detected at low- and standard-dose CT. The prospective study included 25 patients who were referred to CT scan for the assessment of pulmonary metastases. All patients underwent CT examinations at both standard- (200 mA, 120 kV, collimation 5 mm, table feed 10 mm per rotation) and low-dose (50 mA, 120 kV, collimation 5 mm, table feed 10 mm per rotation). The number of nodules detected at each protocol was recorded. The size of the nodules was measured electronically and categorized as <3, 3–4.9, 5–6.9, 7–9.9, and ≥10 mm. Finally, the nodules detected at only standard- or low-dose CT were assessed for the underlying causes of discrepancy. In 25 patients, 533 nodules were detected at standard-dose, whereas 518 nodules were observed at low-dose CT. There were no statistically significant differences in the number of nodules detected at standard- or low-dose CT (p>0.05). Four hundred ninety-one (87.7%) nodules were detected at both standard- or low-dose CT, 42 (7.5%) nodules were observed only at standard-dose CT, and 27 (4.8%) nodules were seen only at low-dose CT. The sensitivity of low-dose CT was 92.5% for all nodules, 88.1% for nodules <5 mm, and 97.4% for nodules ≥5 mm. No significant image artifact interfering with nodule detection was observed at low-dose CT. The low-dose CT protocol used in this study provided images of adequate quality; thus, it can be used reliably in the detection or exclusion of pulmonary nodules. Electronic Publication     

The value of tartrate resistant acid phosphatase (TRAP) immunoreactivity in diagnosis of hairy cell leukemia

Hairy cell leukemia (HCL) is a rare chronic B-cell lymphoproliferative disorder characterized by splenomegaly, pancytopenia, and circulating atypical lymphocytes with circumferential cytoplasmic projections. We investigated the specificity and the sensitivity of anti-TRAP antibody immunoreactivity in 57 cases of HCL. We found that there is a statistically highly significant difference between TRAP immunoreactivities of the study and the control groups, and HCL can be diagnosed by TRAP immunoreactivity in bone marrow trephine biopsy materials with a specificity of 98.27 % and a sensitivity of 100%.     

The use of transdermal fentanyl in chronic non-malignant pain

Twelve non-malignant pain patients were followed-up for pain, improvement in the quality of life, satisfaction for pain therapy and side effects for a mean of 95.25 days with the use of transdermal fentanyl (TDF). During this period a mean of 32.04 mg/gr TDF was used. While the score of pain at rest was decreased by 52.6%, mean pain score on movement was decreased by 45.2% (p= 0.002). Quality of sleep improved and impairment of daily living by pain was decreased significantly (p= 0.002). Satisfaction by the pain therapy was 83.3% and the most common side effect was nausea (16.8%). TDF may be a good alternative in the therapy of chronic non-malignant pain if patients were selected carefully.     

A simple position to provide better imaging of upper ureteral stones close to the crista iliaca during extracorporeal shock wave lithotripsy using the Siemens Lithostar

OBJECTIVE: The fluoroscopic image from the second plan (oblique) tube of an upper ureteral stone close to the crista iliaca may be superimposed on the pelvic bones during SWL using the Siemens Lithostar with the patient in the prone position. This creates difficulty in imaging and targeting of the stone and can necessitate using ureteral catheters before treatment and/or intravenous contrast injection during SWL. We describe a very simple, yet effective method for easier visualization of the stone under this circumstance. METHODS: Between March 1992 and February 2003, we treated 1561 patients with ureteral stones by SWL with the Siemens Lithostar. The stones were localized in the upper ureter in 841. The image of the stone from the second plan (oblique) tube was superimposed on the pelvic bones in 221 in whom visualization of the stone was hardly possible with the standard prone position. By simply rotating the patient 180 degrees on the table, the superimposition of the image of the stone on the pelvic bone was obviated. This resulted in easier and better imaging of the stone during SWL. It also allowed for a clear and superior image to the treating physician during SWL. The energy and shock waves, utilization of anesthesia, number of treatment sessions, auxiliary measures, and complications were noted. Stone load was recorded in square centimeters (cm(2)). Patients were evaluated by intravenous urogram or KUB and ultrasonography when stone-free or CIRF (nonobstructive and noninfectious insignificant fragments < or =4mm) status was noted at the fluoroscopic control 2 to 4 weeks after the last session. Final CIRF decision was made 10-12 weeks after the last session. SWL was regarded as failure if no fragmentation was noted after the 3rd session. Therapy was continued if fragmentation was noted. RESULTS: The median age was 40 (range 5-85). The mean stone burden was 0.8 (range 0.24-2.9) cm(2). No indwelling ureteral stents were placed in any patients before and during treatment. The mean number of shock waves and energy used for the entire patient population was 2007 and 17.5kV, respectively. The median and average treatment session was 1 and 1.7, respectively. A total of 196 patients (89%) were rendered stone-free. Clinically insignificant residual fragments were present in 18 (8%). SWL was unsuccessful in 7 (3%) patients. These stones were removed by ureterorenoscopy. Intravenous contrast administration was not used to facilitate stone targeting during SWL. Anesthesia, in the form of analgesic sedation, was used in 7 (3%) patients. We did not observe any complications and adverse effects. CONCLUSIONS: The technique described hereby does not have an affect on coupling; it only provides a superior image of the stone to the treating physician. We advocate its application in all patients with upper ureteral stones close to the crista iliaca when the fluoroscopic image of the stone from the second plan (oblique) tube is superimposed on pelvic bones during SWL in prone position.     

Occupational asthma, eosinophil and skin prick tests and serum total IgE values of the workers in a plant manufacturing rose oil

This study was aimed to determine the rate of occupational asthma (OA) in workers at a rose extracting plant. Specific clinical tests of 52 workers, randomly chosen from four local rose extracting plants, were statistically compared with the test results of 30 local control subjects of similar age and sex as the plant workers, but who had never worked in such a plant. There were no significant differences in pulmonary function tests (FVC, FEV1, FEV1/FVC, PEFR) between the control and test groups. Significantly higher serum total IgE values (p < 0.0001) were observed for the test subjects (239.08+/-240 IU/ml) compared to the control subjects (81.33+/-61.45 IU/ml). There were also significant differences (p < 0.0001) in the number of eosinophils between the control and test groups, with corresponding mean values of 2.28+/-2.75% and 0.73+/-1.72%, respectively. A specifically prepared skin prick test using a rose allergen (Rosa domescena) was positive for 53.84% in the test subjects whereas only 5.33% positive test results were seen in the control group. We have demonstrated the involvement of Rosa domescena pollen in occupational allergy, through IgE-mediated hypersensitivity. It was concluded that the workers of a rose oil extracting plant are more susceptible to the rose pollens.     

Influence of haematological parameters before coronary angioplasty on subsequent restenosis

OBJECTIVES: Restenosis is the major limitation of coronary interventions occurring in nearly a third of the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with no single, definite predictor demonstrated in an individual patient. Platelets are known to play an important role in the pathogenesis of subsequent restenosis. METHODS AND RESULTS: In a prospective study, follow-up coronary angiographies were performed in 102 consecutive patients with stable angina who underwent a successful PTCA for single-vessel coronary artery disease. Demographics, baseline lipid profiles (total cholesterol, HDL- and LDL-cholesterol, triglycerides) and haematological parameters (red cell, white cell and platelet counts, haemoglobin concentration, haematocrite %, mean platelet volume, platelet mass and fibrinogen levels) were compared between patients with and without restenosis. In the restenosis group, mean platelet volume (8.82 +/- 0.78 fl vs. 8.13 +/- 0.64 fl, p < 0.001), white cell count (8673 +/- 322 x 10(3)/microl vs. 7513 +/- 232 x 10(3)/microl, p < 0.01) and fibrinogen level (4.2 +/- 1.4 g/l vs 3.6 +/- 1.1 g/l) were significantly higher. The relative odds for developing angiographically defined restenosis were 2.49 times greater in diabetics (p = 0.11) and 2.54 times greater in men (p = 0.13). It is 1.43 times greater in patients with higher fibrinogen levels (p = 0.16). But, the relative odds for developing restenosis were 10.43 times greater in patients with larger pre-procedural mean platelet volumes (p < 0.01). CONCLUSIONS: There was a positive correlation between mean platelets volume and loss in luminal diameter between post-angioplasty and follow-up angiographies (r = +2.345, p = 0.01). There was no association between restenosis and haemoglobin, haematocrit, red cell count, white cell count, platelet count, platelet mass and plasma fibrinogen level. The development of restenosis after successful coronary angioplasty may be mainly influenced by the platelet size.     

Impact of p53 and Ki-67 in predicting recurrence and progression of superficial (pTa and pT1) urothelial cell carcinomas of urinary bladder

In predicting the aggressive behavior of bladder tumors, the histopathological characteristics of grade and invasive stage are of principal importance. However, for predicting tumor recurrence and progression, these are sufficient only to a limited extent, particularly in the case of superficial (pTa and pT1) urothelial cell carcinomas. New prognostic factors are therefore needed to avoid either insufficient or excessive treatment. In this retrospective study, we investigated the prognostic value of the p53 and Ki-67 immunoreactivity indices. The present study included 118 superficial urinary bladder tumors consisting of 58 recurrent and 60 non-recurrent cases. Twenty of the recurrent tumors progressed into a higher grade and/or invasive stage. Paraffin immunohistochemical analysis was carried out using anti-p53 and anti-Ki-67 antibodies on the initial tumor tissues. We concluded that there is a highly significant relationship between the p53 and Ki-67 immunoreactivities and the histological grade and pathological stage of the tumors (P < 0.0001). We observed a significant relationship between the presence of recurrence and progression and the p53 immunoreactivity index (P < 0.01 and P = 0.017, respectively) and Ki-67 immunoreactivity index (P < 0.0001 and P = 0.046, respectively). Positivity for p53 and Ki-67 can demonstrate the risk of recurrence (p53: sensitivity = 76%, specificity = 58%; Ki-67: sensitivity = 86%, specificity = 48%) and progression (p53: sensitivity = 80%, specificity = 46%; Ki-67: sensitivity = 85%, specificity = 36%; ). We believe that both of these immunohistochemical markers can be considered valuable in addition to classical histopathological prognostic parameters for predicting recurrence and progression risks.     

Sex hormone metabolism in prostate cancer cells during transition to an androgen-independent state

The progression of prostate cancer during androgen deprivation therapy is a serious clinical problem. Little is known, however, about the mechanisms behind the transition of the disease to an androgen-independent stage. In the present report, we provide evidence of substantial changes in both estrogen and androgen metabolism during the transition of cultured prostate cancer LNCaP (lymph node carcinoma of the prostate) cells. The results of enzyme activity measurements performed using HPLC suggest that, related to the transition, there exists a remarkable decrease in the oxidative 17 beta-hydroxysteroid dehydrogenase (17HSD) activity, whereas the reductive 17HSD activity seems to increase. Relative quantitative RT-PCR revealed that the decrease in oxidative activity largely coincided with the remarkable decrease in the expression of the HSD17B2 gene. Furthermore, the present data suggest that the observed increasing activity of 17HSD type 7 could lead to the increased intracellular production of 17 beta-estradiol during disease progression. This was supported by the cDNA microarray screening results, which showed a considerable overexpression of several estrogen up-regulated genes in the LNCaP cell line variant that represents progressive prostate cancer. Because 17HSDs critically contribute to the control of bioavailability of active sex steroid hormones locally in the prostate, the observed variation in intraprostatic 17HSD activity might be predicted to be crucially involved in the regulation of growth and function of the organ.