Myocardial perfusion in women with systemic lupus erythomatosus and no symptoms of coronary artery disease

BACKGROUND: The aim of the study was to assess myocardial perfusion in women with systemic lupus erythomatosus (SLE) and no symptoms of coronary artery disease (CAD). MATERIAL AND METHODS: Twenty two women with SLE of mean age 40.5 ± 7.2 were enrolled in the study. The average duration time of the disease was from 2 to 19 years, mean 8 ± 4.6 years. The inclusion criterion was the absence of stenocardial symptoms. The myocardial perfusion was studied by using Single Photon Emission Computerized Tomography (SPECT) utilising 99mTc-MIBI ands a triple-head gamma-camera. We also analyzed risk factors of heart ischemic disease in our group. RESULTS: Myocardial perfusion stress scanning showed abnormal perfusion in 12 patients, 54.5% of the whole group, mostly in the anterior wall. At rest hypoperfusion abnormalities were found in 7 individuals. In patients with positive myocardial perfusion, out scanning, risk factors of CAD were more pronounced than in a sub-group with a negative result of myocardial perfusion scanning. CONCLUSIONS: In young women with SLE and no symptoms of coronary artery disease, myocardial pefusion defects may be detected by means of myocardial perfusion scintigraphy. Exercise and resting electrocardiography tests could be not sufficient for CAD diagnosis in women with SLE. The presence of coronary artery disease risk factors in women with SLE could be an indication to perform myocardial perfusion SPECT scanning

The role of sentinel node detection techniques in vulvar and cervical cancer

The sentinel node is the first lymph node that receives the lymph drainage from the primary tumour. The pathological status of the sentinel node should reflect the histopathology of the entire regional lymph drainage area — both vulvar and cervical cancer spread through the lymphatic system. In gynaecological oncology recent studies have confirmed the utility of the sentinel node concept in vulvar and cervical cancer. Three techniques for sentinel node localisation are available. The preoperative lymphoscintigraphy and intraoperative handheld gamma probe detection require the administration of the technetium-99m-labelled colloid around the tumour. The other method is based on the injection of the patent blue dye — during the surgery of the sentinel node because of the dye uptake becomes visible. Following detection, the sentinel lymph node can be removed separately and assessed with ultrastaging and immunohistochemical staining. In the early stages of vulvar and cervical cancer the lymph nodes metastases rate is relatively low — in most cases lymphadenectomy is not necessary. The determination of the regional lymph nodes’ pathological status may limit the extent of the surgical treatment. The sentinel node detection rate is relatively high and depends on the applied technique. This technique may play an important role in the treatment of vulvar and cervical cancer. This paper describes the details of sentinel node identification and reviews the literature

The influence of depth of marker administration on sentinel node detection in cervical cancer

BACKGROUND: Regional lymph node surgical management is an integral part of cervical cancer therapy. In gynaecological oncology, recent studies have confirmed the utility of the sentinel node concept in vulvar and cervical cancer. The method of the marker’s administration is considered to play an important role in sentinel node detection. MATERIAL AND METHODS: 60 patients with cervical cancer (stage IB–IIA) underwent SLN detection during radical abdominal hysterectomy. The patients were randomly divided into two groups: the first group of 30 patients with 0.5–1cm deep marker injection, the second with sub-epithelial marker injection. Gamma-camera scanning, as well as hand-held probe detection was applied. RESULTS: All hot nodes visualised on lymphoscintigraphy were “hot” when using the hand-held gamma probe. Deep marker injection revealed a sentinel node in 27 patients (90%) on both sides, in 3 patients (10%) only on one side. Only 40 (67%) sentinel nodes were blue-stained. Sub-epithelial marker administration revealed a sentinel node on both sides in all 30 patients (100%). In 28 patients (93.3%) the sentinel nodes were radioactive and blue-stained, in one case not-blue stained on either side, in one case blue stained only on one side. CONCLUSIONS: The sentinel node detection rate in cervical cancer is relatively high and depends on the applied technique. The superficial administration of radiocolloid and the blue dye into the cervix provides a higher sentinel node detection rate than deep administration in cervical cancer patients

Evaluation of sentinel node detection in vulvar cancer

BACKGROUND: In vulvar cancer, in a large portion of patients with early stages of the disease, the inguinal lymphadenectomy not only does not influence the overall survival and recurrence rate but may increase the incidence of complications. Sentinel lymph node (SN) detection is a promising technique for detecting groin lymph nodes, which may in future lead to less extensive use of surgical treatment. The aim of the study was to evaluate the feasibility of the sentinel node detection technique in patients with vulvar cancer. MATERIAL AND METHODS: Between the years 2003 and 2005, we performed intraoperative lymphatic mapping on 10 patients with planoepithelial vulvar cancer. In eight cases, vulvar lesion was localized centrally, around the clitoris. The extent of the surgery included radical vulvectomy with bilateral inguinal lymphadenectomy in nine cases and unilateral inguinal lymphadenectomy in one case. For the lymphatic mapping, we employed two detection methods: 99mTc-labelled radiocolloid (activity 35-70 MBq) and blue dye (3-5 ml). Both techniques were used in six cases (60%), blue dye only in three cases and radiocolloid only in one case. RESULTS: In each patient, we detected at least one sentinel lymph node. Sentinel nodes were localized in 14 of 19 operated groins (73.7%); a total of 25 SNs in all. The mean number of SNs for one groin was 1.78. Nodal metastases were found in four cases. In three cases, metastases were detected only in the SN. In one patient, two SNs with metastases were found in one groin and in the contralateral groin (without any SN) there was one unchanged node, which transpired to be metastatic. This can be explained by a complete overgrowth of neoplasm in the lymph node resulting in lymph flow stasis and disabling tracer uptake. In five cases, an SN was found only in one groin ó the first case is described above, in the second case the vulvar tumor was localized laterally, opposite to the groin without any SN. In the remaining three cases, we have used only one method of SN detection. CONCLUSIONS: Lymphatic mapping in vulvar cancer based on the combined detection technique is a highly accurate method after adequate training of the surgeons

Application of rhenium-188 HEDP in bone metastases therapy

Radionuclide bone metastases therapy is a major achievement of nuclear medicine. Development of less radiotoxic and more effective radiopharmaceuticals is therefore a challenge for radiopharmacists and industry. This paper reviews the application of rhenium-188 HEDP as a reactor- or generator-produced nuclide for bone metastases therapy

Radionuclide ventriculography in contemporary cardiological practice in Poland

W niniejszej pracy opisano wentrykulografię radioizotopową pod kątem techniki wykonania i wskazań klinicznych oraz porównano prezentowane w literaturze wyniki pomiarów parametrów hemodynamicznych uzyskiwanych tą metodą i innymi metodami, takimi jak echokardiografia i rezonans magnetyczny. W pracy zamieszczono także wyniki ankiety przeprowadzonej w zakładach medycyny nuklearnej w Polsce, mającej ocenić liczbę wykonywanych wentrykulografii radioizotopowych w ostatnich kilku latach. Wyniki ankiety wskazują na niewielkie zainteresowanie tym badaniem wśród lekarzy klinicystów, pomimo jego zalet.In the paper we described radionuclide ventriculography (MUGA) with special attention to technique, clinical indications and review of papers comparing results of hemodynamic parameters obtained by MUGA and other imaging modalities, such as echocardiography and nuclear magnetic resonance. We also present the results of a questionnaire conducted in nuclear medicine departments in Poland, which was supposed to estimate the number of ventriculographies performed in recent years, proving its small popularity among physicians, despite its advantages

Ciężkie przewlekłe zakrzepowo-zatorowe nadciśnienie płucne po splenektomii z powodu sferocytozy wrodzonej — potrzeba długoterminowego nadzoru i ścisłej współpracy hematologów i kardiologów

We present the case of a 34-year-old female patient with severe pulmonary hypertension diagnosed > 15 years after splenectomy to emphasize the need to monitor patients after splenectomy for the development of chronic thromboembolic pulmonary hypertension (CTEPH). The lack of screening tests for this group of patients, as in the described case, resulted in a serious clinical condition of the patient at the time of diagnosis. Without specialized treatment, the probability of her survival at 5 years was only 10%. Close collaboration between haematologists and cardiologists is mandatory in the management of post-splenectomy patients Life-long surveillance is needed in these patients due to the risk of CTEPH. The development of a screening program for post-splenectomy patients is required.Przedstawiono przypadek 34-letniej pacjentki z ciężkim nadciśnieniem płucnym (PH) zdiagnozowanym ponad 15 lat po splenektomii, aby podkreślić potrzebę monitorowania pacjentów po tym zabiegu pod kątem rozwoju przewlekłego zakrzepowo-zatorowego nadciśnienia płucnego (CTEPH). Jak dotąd, brakuje zaleceń odnośnie do badań przesiewowych u chorych po splenektomii, co w opisanym przypadku skutkowało ciężkim PH u chorej w momencie podstawienia diagnozy. Bez podjęcia specjalistycznego leczenia prawdopodobieństwo jej 5-letniego przeżycia wynosiło zaledwie 10%. Pacjenci po splenektomii wymagają ścisłej współpracy między hematologami i kardiologami oraz stałej obserwacji przez całe życie ze względu na ryzyko wystąpienia CTEPH. Konieczne jest opracowanie programu badań przesiewowych dla pacjentów po splenektomii