Estimation of 99mTc-ciprofloxacin accumulation indexes in bone and joint bacterial infections

Background/Aim. 99mTc-ciprofloxacin is a radiopharmaceutical preparation sintetized to improve diagnostic accuracy of bacterial infections in human tissues. It is mostly applied in diagnosis of bone and joint infections. Many papers have confirmed its sensitivity to infection, but newer papers argued its specificity. The aim of this study was to compare the results of visual analysis of scintigrams to semiquantitative calculations of accumulation indexes with the assumption that calculation of indexes would improve the specificity for bone and joint infections. Methods. We examined 40 patients, 25 with confirmed bone and joint bacterial infections and 15 patients with bone and joint diseases without bacterial infection. Scintigraphy was performed 5 minutes, 1, 4 and 24 hours after intravenous (iv) injection of 99mTc-ciprofloxacin. Scintigrams were analyzed visually and by calculation and comparation of accumulation indexes values. Results. Visual sensitivity was 94%, but specificity only 47%. Index calculation achieved much higher specificity (100% after 1, 4 and 24 hours for cut off value of 1.50). All basic index values (5 min) in the patients with infections increased in 24 hours. In 8 patients without infection occurred a slight increase and in 7 patients decrease of basic index values. Conclusion. Calculation of accumulation index values is needed in the use of 99mTc-ciprofloxacin scintigraphy as it is the only way to improve specificity for bacterial bone infections. Visual interpretation of results is sensitive, but not specific due to accumulation of the drug in a high percent of non infected bone and joint lesions

Possibilities of nontoxic autonomous thyroid nodules treatment by percutaneous ethanol injection

Background/Aim. According to the current principles, autonomous functional thyroid nodules are treated by surgery or by radioiodin therapy. Ultrasound guided percutaneous ethanol injection into solid tumors of the soft tissues was a starting point in attempts to treat the thyroid nodules by the same method. The aim of the study was to assess the efficiency of percutaneous injection in treating solitary, nontoxic, autonomous thyroid nodules of up to 15 mL volume. Methods. In 25 patients with solitary nontoxic autonomous thyroid nodules diagnosed by tehnetium-99m scanning as an intensive area having a complete supremacy in the paranodal tissue, an ultrasound guided percutaneous ethanol injection was applied. The procedure was carried out repeatedly once a week until the reduction in nodule size to 50% of the initial size was achieved. Results. An average size of the nodule before curing was 9.68 ± 5.01 mL. An average quantity of the injected ethanol was 9.52 ± 5.08 mL, ie 1.06 ± 0.48 mL/mg of the tissue. The regression of the nodule size in the successfully (Δvol% u = - 57.09 ± 13.75%, p < 0.001) and partly successfully cured (Δvol du = -48.45 ± 14.35%, p < 0.05) was statistically significant compared to the size before the treatment. After ceasing ethanol injection, 18 months later, a further size regression (Δvol% = -79.20 ± 9.89%) compared to the initial one (p < 0.001) was noticed. Soon, after the procedure was finished, a statistically significant concentration increase of Thyroid Stimulating Hormone (TSH) was noticed compared to the initial values (0.18 ± 0.16 vs 0.34 ± 0.31 mU/L, p < 0.01). According to the given criteria, in two female patients satisfactory results were not achieved, but, a year later, in one of them the nodule was not seen by repeated scintigram. The number and frequency of side effects were insignificant. Conclusion. Repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules result in disappearing of authonomy. The regression of the nodule size of more than 50% compared to its initial volume, as well as the increase in concentration of TSH for more than 50% are the signs of a successful treatment

Efekat hlorheksidina na ekspresiju receptor aktivatora NF-kb liganda (RANKL) i osteoprotežerina (OPG) kod ljudi i kućnih ljubimaca

Periodontal disease is a chronic, multi-factorial disease of the tissues supporting the teeth. Periodontitis in companion animals is an almost identical disease to that in humans in terms of disease course and clinical presentation. Receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG) are bioactive molecules that control bone resorption. This study aims to evaluate the effect of Chlorhexidine (CXD) on the RANKL and OPG expressions in gingival crevicular fluid (GCF) collected from subjects with chronic periodontitis. GCF was obtained from subjects with chronic periodontitis.10 subjects (CXD1) rinsed the mouth with 0.12% CXD, 10 subjects (CXD2) utilized 0.20% CXD and the last 10 (PL) used Placebo solution for 7 days. RANKL and OPG concentrations in GCF were measured by enzyme-linked immunosorbent assays ELISA at baseline and after 7 days. Periodontal clinical variables: clinical attachment loss (CAL), probing pocket depth (PPD), papilla-bleeding index (PBI) were evaluated in all groups. After 7 days in CXD1 and CXD2 group RANKL/OPG ratio exhibited a significant decrease (p lt 0.05) in contrast to the PL group where results showed similar values of RANKL/OPG ratio at baseline and after the observation period. RANKL/OPG ratio was positively correlated with PPD, CAL and PBI before and after the observation period in both Chlorhexidine (CXD1, CXD2) groups. In an existing inflammatory response, chlorhexidine reduced the level of periodontal inflammation, which leads to reduction of RANKL/OPG relative ratio. Decrease of RANKL/OPG ratio will apparently induce maintenance of alveolar bone and slow down periodontal tissue breakdown.Parodontopatije su hronična, multikauzalna oboljenja potpornog aparata zuba. Parodontalna oboljenja koja srećemo kod kućnih ljubimaca su prema toku i kliničkoj slici skoro identična onima koje se javljaju kod ljudi. RANKL i osteoprotegerin (OPG) su bioaktivni molekuli koji kontrolišu koštanu resorpciju. Cilj ove studije je evaluacija efekata hlorheksidina na ekspresiju RANKL-a i OPG-a u gingivalnoj tečnosti (GT) uzetoj od pacijenata sa hroničnom parodontopatijom. 10 pacijenata (CXD1) su ispirali usta sa 0.12% CXD, 10 pacijenata (CXD2) su koristili 0.20% CXD i poslednjih 10 pacijenata (PL) su koristili placebo rastvor 7 dana. RANKL i OPG koncentracije u GT su merene ELISA testom na početku i posle sedam dana. Parodontalni klinički parametri CAL, PPD i PBI su evaluirani u svim grupama. Posle 7 dana u CXD1 i CXD2 grupi RANKL/OPG odnos je pokazao signifikantno smanjenje (p lt 0.05) u poređenju sa PL grupom gde su zabaleženi slični rezultati na početku i nakon opservacionog perioda. RANKL/OPG odnos je pokazao pozitivnu korelaciju sa vrednostima PPD-a, CAL-a i PBI-a pre i nakon observacionog perioda u obe eksperimentalne grupe (CXD1, CXD2). U prisutnom inflamatornom odgovoru hlorheksidin je redukovao nivo inflamacije, što je uslovilo redukciju RANKL/OPG odnosa. Rezultati istraživanja dokazuju da koncentracija hlorheksidina ne utiče statistički značajno na smanjenje RANKL/OPG odnosa

Significance of the determination of doppler sonography haemodynamic indices for the assessment of distal perfusion in patients with critical ischemia of lower limbs

Background/Aim: The perfusion of tissue, especially the muscles of the lower limbs (LL), implies the blood flow that carries enough nutrition, energy materials and oxygen. The aim of this study was to determine whether the decreased Doppler sonography parameters, resistance index (RI), and pulsatility index (PI) were significant as indicators of irreversible ischemia of LL. Methods. In 40 patients (mean age 66±14.9 years, 21% women and 79% men) with the signs of critical ischemia of LL, Lariche-Fontaine class III and IV, we performed contrast angiography of the LL arteries, and perfusion scintigraphy of LL using, thallium-201, while we performed Doppler sonography to determine resistance index (RI), as well as pulsatility index (PI). After that, all the patients were treated with vasodilatation using Bergmann's solution within a 10-day period. Following that, all the patients underwent the determination of haemodynamic indices RI and PI applying the methods of Doppler sonography. The obtained values of RI and PI indices revealed no clinical recovery which suggested the irreversibility of critical ischemia (unsuccessful therapy in 100% of the patients), and clinical recovery which suggested the reversibility of the disease (unsuccessful therapy in 80% of the patients). Results. The obtained values of PI = 0-0.3 and RI = 0-0.25 for the examined LL arteries were the indicators of irreversible ischemia. A significant correlation between the values of RI in the distal parts of a. tibialis anterior and posterior was proved, as well as between the decreased perfusion of LL determined by tallium-201 (p < 0.05, r = 0.43), and a tibialis anterior (p = 0.05, r = 0.38). There was, however, no statistically significant correlation between the angiographic values and perfusion scintigraphy of LL. Conclusion. The obtained values of haemodynamic RI and PI indices should be a novel approach for introducing a new criteria for the assessment of reversible and irreversible critical ischemia of LL using the method of Doppler

Diuretic 99mTc DTPA renography in assessment of renal function and drainage in infants with antenatally detected hydronephrosis

Background/Aim. The controversy over the postnatal management of infants with antenataly detected hydronephrosis (ANH) still exists. We presented the results of diuretic 99mTc diethylenetriamine pentaacetic acid (DTPA) renography in 30 infants with the antenatal diagnosis of unilateral renal pelvic dilatation. The aim of this study was to assess the renal function determined by the pattern of drainage and split renal function (SRF) on diuretic renography and to correlate these findings with anteroposterior pelvic diameter (APD) estimated by ultrasonography. Methods. A total of 30 infants with 60 renal units (RU) (25 boys and 5 girls, median age 6.0 months, range 2-24) presented with unilateral hydronephrosis on ultrasound in the newborn period, underwent DTPA diuretic renal scintigraphy (F+15 protocol). The median APD evaluated on perinatal ultrasound was 15 mm (range 5-30). The postnatal associated clinical diagnosis were pelviureteric junction obstruction (PUJ), simple hydronephrosis, megaureter, vesicoureteral reflux (VUR) and posterior urethral valves in 11, 10, 6, 2 and 1 infant, respectively. Images and Tmax/2 after diuretic stimulation on the background subtracted renographic curves were used as the criteria for classifying the drainage as good, partial, and poor or no drainage. The SRF was calculated with the integral method. Results. Good drainage was shown in 36/60, partial drainage in 13/60 and poor or no drainage in 11/60 RU. The SRF >40% was observed in 55/60 RU, with no RU showing SRF lower than 23.5%. In infants with severe ANH the obstruction was not excluded in 94.1%. Conclusion. Diuretic renography in antenatally detected hydronephrosis should be a useful tool in postnatal follow up, especially in differentiating nonobstructive hydronephrosis from obstructive. It is also importanat to assess and monitor the SRF. Our results suggest that even in the presence of partial or no drainage, SRF may not be significantly impaired

Combined bone scintigraphy with 99mTc-MDP and 99mTc-ciprofloxacin in differentiation of hip and knee prosthesis aseptic loosening and infection: A preliminary study

Background/Aim. Although the number of new primary implantation of hip and knee prostheses every year increases, the rate of failed arthroplasty is nearly the same. The main question is whether it is an aseptic instability or instability caused by infection. The aim of this preliminary study was an attempt with combined 99mTc-ciprofloxacin and 99mTc-methylene diphosphonate (MDP) bone scintigraphy to improve diagnostic accuracy in the differentiation of hip and knee prosthesis aseptic loosening and periprosthetic joint infection. Methods. Inclusion criteria of patients for this study were based on suspected periprosthetic joint infection: painful prosthetic joint, restricted joint movements and increased value of erythrocyte sedimentation rate or levels of C-reactive protein. We examined 20 patients with implanted 14 hip and 6 knee prosthesis. All patients also underwent plain radiography of suspected joint. In all patients, three-phase 99mTc-MDP bone scintigraphy was performed. Three to five days after the bone scan, we performed scintigraphy using 99mTc-ciprofloxacin with the calculation of accumulation index. Periprosthetic joint infection was confirmed on the basis of microbiological findings. Results. Periprosthetic joint infection was confirmed in fourteen of twenty observed joints, in five of them the aseptic loosening was present and in one patient’s symptoms were not related to the prosthesis (poor biomechanics of prosthetic joints caused by weaknesses of muscle). Estimated sensitivity/specificity for 99mTc-MDP bone scintigraphy alone were 100/17%; for 99mTc-ciprofloxacin scintigraphy were 85,7/100%. Sensitivity and specificity were 92,3% and 83,3%, respectively for results obtained with combined assessment by both methods. Our study confirmed the high negative predictive value of 99mTc-MDP bone scan. The negative result of bone scan virtually excludes the possibility of periprosthetic infection. On the other hand, positive findings of 99mTc-MDP scintigraphy cannot with certainty confirm the infection. Conclusion. Combined 99mTc-MDP scintigraphy with 99mTc-ciprofloxacin scintigraphy significantly increases the ability of differentiation of aseptic loosening from periprosthetic joint infection