Radiolabeled leukocyte imaging in inflammatory bowel disease: a prospective blinded evaluation

BACKGROUND/AIMS: Nuclear medicine scintigraphies have been reported to assist in making the diagnosis of inflammatory bowel disease. This work aimed to assess the role of radiolabeled leukocyte scintigraphy for the diagnosis of suspected inflammatory bowel disease. METHODOLOGY: Forty-six adult patients were referred for labeled leukocyte scintigraphy for the evaluation of active abdominal pain. The patient population included inpatients and outpatients, with known or suspected inflammatory bowel disease. The nuclear medicine staff was blinded to the patient's specific complaints. RESULTS: The labeled leukocyte scintigraphy was positive in 11 of the 15 patients eventually determined to have Crohn's disease. Four of the 15 were false negatives. All four of the ulcerative colitis patients had normal scans. There were no false-positive scans. The positive predictive value was thus 100%, the negative predictive value was 77%, and the sensitivity and specificity were 58% and 100% respectively for Crohn's disease. CONCLUSIONS: We found radiolabeled leukocyte scintigraphy helpful in prospective, blinded assessments of patients with non-stricturizing or non-fistulizing forms of Crohn's disease. Scintigraphy may be more justified for reassessments rather than in making an initial diagnosis. The scans were of value in Crohn's disease but not for ulcerative colitis.     

Effect of Dibutyryladenosine 3′:5′-Cylic Monophosphate on Growth and Differentiation in Caulobacter crescentus

Caulobacter crescentus goes through a series of morphological changes during its life cycle, including the coincident expression of synthesis of flagella, pili, and receptor sites for DNA bacteriophage. Upon transfer of a mixed population of cells to medium containing lactose as the sole carbon source, these changes were blocked for about 20 hr until beta-galactosidase activity became apparent. The addition of dibutyryl cyclic AMP to the blocked cultures brought about the resumption of cell differentiation, growth, and the appearance of beta-galactosidase activity within 1 hr. Unlike Escherichia coli, the intracellular and extracellular concentrations of cyclic AMP in C. crescentus did not vary under several growth conditions, including catabolite repression. It would appear, therefore, that although there is an effect of cyclic AMP on the induction of beta-galactosidase and differentiation in C. crescentus, regulation of these processes occurs without consistent changes in the cellular level of this nucleotide.     

Oxidative stress is closely associated with insulin resistance in genotypes 1 and 3 chronic hepatitis C

Background

Chronic hepatitis C (CHC) infection is associated with insulin resistance and with oxidative stress, but the relationship between the two has not been thoroughly examined.

Purpose

To evaluate the association between insulin resistance and oxidative stress in CHC patients.

Method

In 115 CHC patients (68 with genotype 1 and 47 with genotype 3), the relationship between the serum concentration of malondialdehyde (MDA), a marker of oxidative stress and insulin resistance as defined by the homeostasis model (HOMA-IR) was examined.

Results

There was no significant difference in MDA levels between genotype 1- and genotype 3-infected subjects (12.882 vs. 12.426 ng/mL, p = 0.2). By univariate analysis, factors associated with HOMA-IR in both genotypes were oxidative stress as measured by MDA (p = 0.002), body mass index (BMI), portal activity, and fibrosis. Genotype-specific differences in HOMA-IR association were steatosis and triglycerides (TG) for genotype 1, and age and glutathione (GSH) for genotype 3. In a stepwise multiple linear regression analysis in both genotypes, MDA was a significant and independent predictor of HOMA-IR (p = 0.04). As expected, BMI and fibrosis were likewise independently correlated to HOMA-IR. In addition, MDA levels were higher (p < 0.001) and GSH levels were lower (p = 0.023) in insulin-resistant subjects compared to their insulin-sensitive counterparts.

Conclusions

It is concluded that in CHC, oxidative stress is an independent predictor of HOMA-IR, irrespective of virus genotype. Further studies on the role of oxidative stress in the development of insulin resistance in CHC are warranted.     

Economic assessment of pressure sore prevention using a computerized mattress system in patients with spinal cord injury

Purpose. To assess the economic profitability of a new computerized mattress system in patients with spinal cord injuries (SCI) by comparison with two other alternatives, as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention.

Method. The cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis.

Results. A foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositionings, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositionings, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost. In this case, less than 20 New Israeli Shekels (NIS) per day spent on the equipment save NIS 45 per day in labor costs.

Conclusions. The economic evaluation indicates that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. In addition, other possible alternative pressure management systems should be examined, and additional research may be needed to determine the optimal combination of such systems for a spinal cord rehabilitation department.     

Efficacy of i ablation therapy using different doses as determined by postoperative thyroid scan uptake in patients with differentiated thyroid cancer

PURPOSE: The optimal dose of I(131) for ablation of functioning residual thyroid tissue after surgery is controversial. The current study was conducted to determine the optimal dose of I(131) for remnant postoperative ablation. A review of the literature is included. METHODS AND MATERIALS: A total of 238 patients with papillary and follicular carcinoma were treated with I(131) for ablation of a postoperative thyroid remnant. The I(131) dose was based on the 24-h percentage of neck uptake in the postoperative thyroid scans. Patients with < 5% uptake received a median of 85 mCi; 6-10% uptake, a median of 80 mCi; 11-15% uptake, a median of 60 mCi; 16-20% uptake, a median of 50 mCi; and > or =21% uptake, a median of 30 mCi. The ablation results were compared with the prognostic factors. RESULTS: Complete ablation was observed in 40 (92%) of 43 patients receiving 85 mCi, in 31 (94%) of 33 who received 80 mCi, in 39 (95%) of 41 who received 60 mCi, in 51 (93%) of 55 who received 50 mCi, in 37 (94%) of 39 who received 30 mCi, and in 18 (96%) of 19 who received 30 mCi. The overall successful ablation rate was 94% (95% confidence interval, 89-100%). CONCLUSION: Our findings suggest that patients with differentiated thyroid cancer can be treated with doses of I(131) according to the percentage of neck uptake of postoperative total body scan, with high complete ablation rates, without exposing patients to higher dose levels of I(131).     

Chlamydia pneumoniae community-acquired pneumonia: A review of 62 hospitalized adult patients

Summary In a prospective study,Chlamydia pneumoniae was identified as the etiological agent in 62 (17.9%) of 346 adult patients hospitalized over the course of one year for community-acquired pneumonia at the Soroka Medical Center in Beer-Sheva, Israel. The diagnosis ofC. pneumoniae infection was based on serological testing of antibodies by the MIF technique. In 43 of these patients (69.4%), at least one other etiological agent, in addition toC. pneumoniae for community-acquired pneumonia was identified.Streptococcus pneumoniae was identified in 34 patients withC. pneumoniae (54.8%), as an additional causative factor in infection. Community-acquired pneumonia patients withC. pneumoniae were significantly older than non-C. pneumoniae patients (p=0.03), had a higher APACHE II score on admission (p<0.05), a higher rate of positive blood cultures (p=0.02), and longer periods of hospitalization (p=0.022). Seven patients with pureC. pneumoniae infection recovered, despite treatment which is not considered to be specific forC. pneumoniae. It was concluded thatC. pneumoniae is a common etiological agent for community-acquired pneumonia in our region, particularly in the elderly, and is characterized by a high rate of concomitant infections with other pulmonary pathogens. No specific clinical or radiological pattern was discerned that could distinguish betweenC. pneumoniae community-acquired pneumonia and non-C. pneumoniae community-acquired pneumonia.

---

Ambulant erworbene Pneumonien durchChlamydia pneumoniae: Übersicht über 62 stationär behandelte erwachsene Patienten

Zusammenfassung Unter 346 im Rahmen einer prospektiven Studie erfaßten Patienten mit ambulant erworbener Pneumonie fanden sich 62 Fälle (17,9%), bei denenChlamydia pneumoniae als der verantwortliche Erreger identifiziert wurde. Die Studie lief über einen Zeitraum von einem Jahr am Soroka Medical Center in Beer-Sheva, Israel. Die Diagnose basierte auf dem serologischen Nachweis von anti-C. pneumoniae Antikörpern mit der MIF-Technik. Bei 43 dieser Patienten fand sich mindestens noch ein zusätzlicher Erreger (69,4%). Bei 34 Patienten wurdeStreptococcus pneumoniae isoliert (54,8%). Patienten mit einerC. pneumoniae-Infektion waren signifikant älter als Patienten, bei denenC. pneumoniae nicht der Erreger war (p=0,03), diese Patienten hatten außerdem bei Einweisung einen höheren APACHE Score (p<0,05), häufiger positive Blutkulturen (p=0,02) und mußten länger stationär behandelt werden (p=0,022). Obwohl keine erregerspezifische Behandlung vorgenommen worden war, erholten sich 7 Patienten, die an einerC. pneumoniae Pneumonie erkrankt waren. Wir schließen aus den Daten, daßC. pneumoniae in unserer Region ein häufiger Pneumonieerreger ist, der vorwiegend ältere Personen befällt. Typischerweise besteht eine hohe Rate an Begleitinfektionen mit anderen Pneumonieerregern. Wir fanden kein spezifisches radiologisches Muster oder klinische Konstellationen, die eine Unterscheidung zwischenC. pneumoniae-Pneumonie und Pneumonien anderer Ätiologie ermöglichen würden.

     

Corneal endothelial pumping in the presence of insulin and GABA

Glucose, in presence of GABA and insulin causes complete temperature reversal and survival for 7·5 hr of the corneal endothelial fluid pump.