Clinical significance of metabolic superscan in patients with hyperthyroidism

BACKGROUND: Hyperthyroid patients commonly complain of generalized bony aches, which are frequently overlooked due to the more prominent symptoms of cardiovascular and nervous disturbances. Hyperthyroid patients are expected to have abnormal bone metabolism as part of the generalized hypermetabolic status. The aim of this study is to verify the presence of metabolic bone superscan in association with the hypermetabolic stats in various groups of hyperthyroidism. Secondly, to correlate these superscan features with the various laboratory results in hyperthyroid patients. MATERIAL AND METHODS: Forty-five hyperthyroid patients confirmed by clinical and laboratory results were enrolled in this work. In all patients, a 99mTc-pertechnetate thyroid uptake scan was acquired. On a different day, total body bone scan was acquired three hours post IV injection of 555-925 MBq of 99mTc-MDP. Serum FT3, FT4, TSH, Ca++, alkaline phosphatase (AP) and parathyroid hormone (PTH) were monitored in all patients as markers of thyroid and bone metabolism. Ten cases with no thyroid diseases were included as a control group. Patients with thyroiditis or long history of antithyroid drugs for more than one year were excluded from the study. RESULTS: The patients were subdivided into three groups: Graves´ disease (GD) (n = 30), toxic nodular goiter (TNG) (n = 10) and autonomous toxic adenoma (AT) (n = 5). The TSH for the whole group was significantly suppressed compared to the control group with higher suppression in the Graves´ disease group than in the TNG or AT groups. 99mTc-pertechnetate uptake values in the Graves´ disease group were significantly higher than the TNG and AT groups (p < 0.05). Metabolic superscan (MSS) was noted in 90% of the Graves´ cases, 20% in TNG and in none of the AT group. There were no significant differences regarding Ca+, AP and PTH between the Graves´ and non-Graves´ groups (p > 0.05). CONCLUSIONS: Disturbances in bone metabolism are more prevalent in Graves´ disease than in other types of hyperthyroidism. The addition of the bone scan to the diagnostic work up of patients with Graves´ disease is a sensitive indicator for metabolic bone changes and could help in the future management and follow up for this group of patients

Assessment of diagnosis of inflammatory breast cancer cases at two cancer centers in E gypt and T unisia

The diagnosis of inflammatory breast cancer ( IBC ) is largely clinical and therefore inherently somewhat subjective. The objective of this study was to evaluate the diagnosis of IBC at two centers in N orth A frica where a higher proportion of breast cancer is diagnosed as IBC than in the U nited S tates ( U . S .). Physicians prospectively enrolled suspected IBC cases at the National Cancer Institute ( NCI ) –  C airo, E gypt, and the I nstitut S alah A zaiz ( ISA ), T unisia, recorded extent and duration of signs/symptoms of IBC on standardized forms, and took digital photographs of the breast. After second‐level review at study hospitals, photographs and clinical information for confirmed IBC cases were reviewed by two U . S . oncologists. We calculated percent agreement between study hospital and U . S . oncologist diagnoses. Among cases confirmed by at least one U . S . oncologist, we calculated median extent and duration of signs and S pearman correlations. At least one U . S . oncologist confirmed the IBC diagnosis for 69% (39/50) of cases with photographs at the NCI ‐ C airo and 88% (21/24) of cases at the ISA . All confirmed cases had at least one sign of IBC (erythema, edema, peau d'orange) that covered at least one‐third of the breast. The median duration of signs ranged from 1 to 3 months; extent and duration of signs were not statistically significantly correlated. From the above‐mentioned outcomes, it can be concluded that the diagnosis of a substantial proportion of IBC cases is unambiguous, but a subset is difficult to distinguish from other types of locally advanced breast cancer. Among confirmed cases, the extent of signs was not related to delay in diagnosis. The diagnosis of inflammatory breast cancer ( IBC ) is largely clinical and therefore inherently somewhat subjective. The objective of this pilot study was to evaluate the diagnosis of IBC at two centers in N orth A frica, where a higher proportion of breast cancer is diagnosed as IBC than in the U nited S tates ( U.S. ). The diagnosis of a substantial proportion of IBC cases at the study centers was unambiguous, but a subset was difficult to distinguish from other types of locally advanced breast cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97479/1/cam448.pd

Minimizing Construction-Related Security Risks During Airport Expansion Projects

Airport expansion projects often require the presence of construction personnel, material, and equipment near airport secure areas/facilities, leading to an increase in the level of risk to airport security. Construction planners and airport operators need to carefully study this challenge and implement active measures in order to minimize construction-related security breaches and comply with all relevant Federal Aviation Administration guidelines. This paper presents the development of an advanced multiobjective optimization model for planning airport construction site layouts that is capable of minimizing construction-related security breaches while simultaneously minimizing site layout costs. The model incorporates newly developed criteria and performance metrics that enable evaluating and maximizing the construction-related security level in operating airports. The model is developed using a multiobjective genetic algorithm, and an application example is analyzed to demonstrate the use of the model and its unique capability of generating a wide spectrum of optimal trade-offs between construction-related airport security and site layout costs. © 2008 ASCE

Automated Multi-Objective Optimization System For Airport Site Layouts

Airport construction planners often face the problem of identifying optimal locations for temporary construction facilities on site, as the planned locations of these facilities usually influence important and conflicting planning objectives such as improving the efficiency of construction operations and maintaining safety on site. Careful evaluation of all feasible locations for temporary facilities and the selection of an optimal layout are needed in order to achieve these multiple important objectives. This paper presents the development of a practical automated system to optimize multiple conflicting planning objectives and provide all possible optimal tradeoff solutions among these objectives. The system is implemented and integrated in four main modules: (1) a comprehensive multi-objective optimization engine that integrates and optimizes construction work zone safety, construction-related aviation safety, construction-related airport security, and all relevant site layout costs; (2) a relational database that integrates planning data and stores all the generated optimal solutions; (3) an Input/Output module to facilitate specifying planning and optimization parameters and retrieving the generated optimal site layout solutions; and (4) a visualization module that communicates with external CAD software in order to support the visualization of the generated optimal site layout plans. © 2010 Elsevier B.V. All rights reserved

Assessment of diagnosis of inflammatory breast cancer cases at two cancer centers in Egypt and Tunisia

The diagnosis of inflammatory breast cancer (IBC) is largely clinical and therefore inherently somewhat subjective. The objective of this study was to evaluate the diagnosis of IBC at two centers in North Africa where a higher proportion of breast cancer is diagnosed as IBC than in the United States (U.S.). Physicians prospectively enrolled suspected IBC cases at the National Cancer Institute (NCI) – Cairo, Egypt, and the Institut Salah Azaiz (ISA), Tunisia, recorded extent and duration of signs/symptoms of IBC on standardized forms, and took digital photographs of the breast. After second-level review at study hospitals, photographs and clinical information for confirmed IBC cases were reviewed by two U.S. oncologists. We calculated percent agreement between study hospital and U.S. oncologist diagnoses. Among cases confirmed by at least one U.S. oncologist, we calculated median extent and duration of signs and Spearman correlations. At least one U.S. oncologist confirmed the IBC diagnosis for 69% (39/50) of cases with photographs at the NCI-Cairo and 88% (21/24) of cases at the ISA. All confirmed cases had at least one sign of IBC (erythema, edema, peau d’orange) that covered at least one-third of the breast. The median duration of signs ranged from 1 to 3 months; extent and duration of signs were not statistically significantly correlated. From the above-mentioned outcomes, it can be concluded that the diagnosis of a substantial proportion of IBC cases is unambiguous, but a subset is difficult to distinguish from other types of locally advanced breast cancer. Among confirmed cases, the extent of signs was not related to delay in diagnosis

External validation and recalibration of an incidental meningioma prognostic model - IMPACT: protocol for an international multicentre retrospective cohort study

Introduction: Due to the increased use of CT and MRI, the prevalence of incidental findings on brain scans is increasing. Meningioma, the most common primary brain tumour, is a frequently encountered incidental finding, with an estimated prevalence of 3/1000. The management of incidental meningioma varies widely with active clinical-radiological monitoring being the most accepted method by clinicians. Duration of monitoring and time intervals for assessment, however, are not well defined. To this end, we have recently developed a statistical model of progression risk based on single-centre retrospective data. The model Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and MRI Tests (IMPACT) employs baseline clinical and imaging features to categorise the patient with an incidental meningioma into one of three risk groups: low, medium and high risk with a proposed active monitoring strategy based on the risk and temporal trajectory of progression, accounting for actuarial life expectancy. The primary aim of this study is to assess the external validity of this model. Methods and analysis: IMPACT is a retrospective multicentre study which will aim to include 1500 patients with an incidental intracranial meningioma, powered to detect a 10% progression risk. Adult patients ≥16 years diagnosed with an incidental meningioma between 1 January 2009 and 31 December 2010 will be included. Clinical and radiological data will be collected longitudinally until the patient reaches one of the study endpoints: intervention (surgery, stereotactic radiosurgery or fractionated radiotherapy), mortality or last date of follow-up. Data will be uploaded to an online Research Electronic Data Capture database with no unique identifiers. External validity of IMPACT will be tested using established statistical methods. Ethics and dissemination: Local institutional approval at each participating centre will be required. Results of the study will be reported through peer-reviewed articles and conferences and disseminated to participating centres, patients and the public using social media