Multiple renal abscesses leading to nephrectomy of the solitary kidney in a young female with type 1 diabetes and history of recurrent urinary tract infections

This report presents the case of a young female suffered for many years from type 1 diabetes, complicated by recurrent urinary tract infections and urosepsis with multiple abscesses which led to right nephrectomy in 2002. The patient was hospitalised in our Department in June 2009 because of urosepsis in the course of multiple left renal abscesses and subsequent acute renal failure requiring hemodialysis. A dramatic decision of removing the solitary kidney was taken, and patient was included in a long-term renal replacement therapy programme in our Centre as a preparation to kidney and pancreas transplantation

Znaczenie przypadkowo rozpoznanego ogniskowego wychwytu 99mTc- sestamibi w tarczycy w trakcie scyntygrafii perfuzyjnej mięśnia sercowego

  Introduction: 99mTc-sestamibi, a radiopharmaceutical widely used in the assessment of myocardial perfusion, can be used as an indicator of thyroid disease due to its oncophilic character. The aim of this study was to establish the usefulness of performing additional examinations of radiotracer uptake in the thyroid gland during standard stress scintigraphy with sestamibi in order to identify thyroid diseases. Material and methods: After a retrospective evaluation of 330 consecutive myocardial perfusion scintigraphies performed in our hospital during one year, 41 patients with a focal accumulation of 99mTc-sestamibi in the thyroid were enrolled in the study. The patients underwent clinical examinations, including thyroid ultrasonography and TSH, fT4, fT3, aTPO, TRAB, calcitonin, and CEA levels. Based on the thyroid ultrasounds, 21 patients were referred for fine-needle aspiration biopsy of the thyroid. Results: An abnormal accumulation of radiotracer in the thyroid was found in 41(12.4%) of 330 patients who underwent stress cardiac scintigraphy. Thirteen (31.7%) of those patients had multinodular euthyroid goitres, 12 (29.2%) had a single thyroid nodule (including two autonomous nodules), 11 (26.8%) had autoimmune thyroid disease, and one (2.4%) had papillary thyroid carcinoma. In 12 (29.2%) with thyroid tracer uptake there was no thyroid pathology. Conclusions: Additional evaluation of radiotracer uptake in the thyroid during standard myocardial perfusion scintigraphy is a valuable tool in the detection of thyroid diseases. The additional or parallel evaluation of radiotracer uptake in the thyroid should be considered during every myocardial scintigraphy. (Endokrynol Pol 2015; 66 (6): 521–525)    Wstęp: 99mTc-sestamibi jest radiofarmaceutykiem stosowanym standardowo między innymi w ocenie perfuzji mięśnia sercowego. Ze względu na właściwości onkofilne może być także wykorzystywany w diagnostyce chorób tarczycy. Celem pracy była analiza przydatności dodatkowej oceny gruczołu tarczowego podczas scyntygraficznej próby wysiłkowej z wykorzystaniem sestamibi do wykrywania chorób tarczycy. Materiał i metody: Po ocenie 330 kolejnych badań scyntygrafii perfuzyjnej serca w Zakładzie Medycyny Nuklearnej WIM wykonanych w okresie od 01.01.2009 do 1.01.2010 do dalszych badań zakwalifikowano 41 chorych, u których rozpoznano ogniskowe gromadzenie 99mTc- sestamibi w tarczycy. Następnie przeprowadzono badanie kliniczne, wykonano USG tarczycy oraz oznaczono stężenie: TSH, fT4, fT3, aTPO, TRAb, kalcytoniny, CEA. Na podstawie wyniku badania ultrasonograficznego tarczycy 21 osób skierowano na biopsję cienkoigłową tarczycy. Wyniki: U 41 (12,4%) z 330 chorych poddanych scyntygrafii serca stwierdzono nieprawidłowe gromadzeniem radioznacznika w tarczycy. U 13 ( 31,7%) z nich rozpoznano wole wieloguzkowe, 12 (29,2%) miało pojedynczy guzek tarczycy ( w tym dwóch chorych guzek autonomiczny), 11 chorych (26,8%) prezentowało autoimmunizacyjną chorobę tarczycy, u jednej (2,4%) znaleziono raka brodawkowatego tarczycy. W 12 przypadkach (29,2%) nieprawidłowego gromadzenia radioznacznika nie potwierdzono choroby tarczycy. Wnioski: Dodatkowa ocena wychwytu radioznacznika w tarczycy podczas standardowej scyntygrafii perfuzyjnej serca jest cennym narzędziem w wykrywaniu chorób tarczycy. W opisie wyniku badania scyntygrafii perfuzyjnej serca powinno się także uwzględniać ocenę wychwytu radioznacznika w tarczycy. (Endokrynol Pol 2015; 66 (6): 521–525)

Difficulties in achieving euthyroid status in a patient with differentiated thyroid cancer after sleeve gastrectomy

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Evaluation of the usefulness of positron emission tomography with [18F]fluorodeoxylglucose performed to detect non-radioiodine avid recurrence and/or metastasis of differentiated thyroid cancer — a preliminary study

Background: About 30% of patients with disseminated differentiated thyroid cancer (DTC) may experience a loss of iodine uptake. It is associated with higher aggressiveness of the tumour and a reduced 10-year survival rate. The diagnosis of non-radioiodine avid DTC metastases remains a diagnostic challenge. A helpful technique for this diagnosis is positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (PET/CT with [18F]FDG). On the other hand, there are still discussions about the clinical value of using exogenous thyroid-stimulating hormone (TSH) stimulation before PET/CT with [18F]FDG. The aim of the study was the assessment of the usefulness of PET/CT with [18F]FDG under TSH suppression and stimulation of TSH performed in the detection of non-radioiodine avid DTC metastases, as well as determination of the thyroglobulin concentration under suppression and stimulation of TSH, which influences the result of PET/CT with [18F]FDG in patients with non-radioiodine avid DTC. Material and methods: Retrospective analysis of 37 PET/CT with [18F]FDG performed in patients with DTC diagnosed and treated at the Department of Endocrinology and Isotope Therapy of the Military Institute of Medicine from January 2018 to July 2020. Of these, PET/CT with [18F]FDG under exogenous rhTSH stimulation was performed in 22 patients and PET/CT with [18F]FDG under TSH suppression in 15 was performed. In all analyzed patients, the result of diagnostic whole-body scintigraphy (WBS) using 80 MBq 131I under rhTSH stimulation was negative, and the concentration of thyroglobulin after stimulation (sTg) was greater than 1.0 ng/mL. Results: In the group of patients examined under TSH suppression, non-radioiodine avid in PET/CT with [18F]FDG were found in 6 out of 15 patients (40%) and in the group of patients examined under rhTSH stimulation in 10 out of 22 patients (45%). The differences between the groups were not statistically significant. The analysis of the receiver operating characteristic (ROC) curves allowed to determine the cut-off point for the positive result of PET/CT performed under TSH suppression with sTg concentration of 11.03 ng/mL. In the group of studies performed under rhTSH stimulation, the cut-off point for sTg was 6.3 ng/mL. There was no statistically significant difference between the baseline thyroglobulin (natTg) and sTg levels and the positive PET/CT result. The administration of rhTSH before the PET/CT examination also had no statistically significant effect on the maximum standard uptake value (SUVmax) of the dominant lesion identified in the PET/CT. Conclusions: 1) PET/CT with [18F]FDG is a useful tool for detection of non-radioiodine avid recurrence and/or metastases of DTC. 2) The concentration of natTg and sTg is highly correlated with a positive result of PET/CT with [18F]FDG. 3) The concentration of natTg is comparable with sTg in predicting a positive result of PET/CT with [18F]FDG. 4) The cut-off point for a positive result of PET/CT for natTg was 1.36 ng/mL and for sTg was 7.05 ng/mL

Re-treatment with [177Lu]Lu-DOTA-TATE or [177Lu]Lu-DOTA-TATE and [90Y]Y-DOTA-TATE of patients with progressive neuroendocrine neoplasm

Background: Neuroendocrine neoplasms (NENs) are heterogeneous groups of tumours derived from neuroendocrine cells of the ectoderm or endoderm. They are considered rare, with an estimated incidence and prevalence of 6/100,000 and 35/100,000 respectively, and a noticeable upward trend. Radioligand therapy (RLT) using beta-radiation-emitters combined with somatostatin analogues is an effective and relatively safe treatment method. It is usually used as a second-line therapy in case of progressive disease. Material and methods: In retrospective analysis covering eight years of observation (2015–2023) of patients treated in a single highest-reference NEN centre, a subgroup of 13 who received RLT re-treatment (177Lu or 177Lu/90Y-mixture) was identified. Epidemiological aspects, renal, hepatic, haematological parameters and chromogranin A serum concentration were analysed. Results: The median PFS after the first cycle of RLT was 53.8 months (IQR = 19.3). Directly after the second cycle of RLT disease stabilization and progression was observed in 11/13 (84.6%) and 2/13 (15.4%) patients respectively. After the second cycle of RLT median observation time for the study group was 16.2 months. Eight out of 13 patients were reachable for long-term observation and stabilization was confirmed in 62.5 % (5/8), progression in 12.5% (1/8) and death in 25% (2/8) patients. Median survival time in patients with confirmed death was 7 months. During observation, an increase in creatinine concentration with a decrease in glomerular filtration rate (GFR) was noticed, however, the values were at a statistical trend level (p = 0.056; p = 0.071). The increase of liver parameters was statistically, but not clinically significant. The decrease in albumin concentration and fasting glucose concentration were not significant. An increase in chromogranin A concentration correlated, although not statistically, with the progression of the disease. A statistically significant decrease in the number of all bone marrow cell lines was observed. The first RLT cycle caused a higher decrease in blood parameters than the second. There were no differences in PFS or laboratory parameters depending on the radioligand ([177Lu]Lu-DOTA-TATE vs. [177Lu]Lu-DOTA-TATE/[90Y]Y-DOTA-TATE). Conclusions: In follow-up after RLT re-treatment stabilization was observed in 62.5%, progression in 12.5% and death in 25% of patients. Decrease of glomerular filtration, and bone marrow parameters resulted from the cumulative adverse effect of RLT, the natural ageing process, and the progression of the disease. Side effects were mainly caused by the first treatment cycle. There was no significant influence on the measured parameters, depending on the radioisotope used. Re-treatment of RLT seems to be a reliable and relatively safe method, thus should be considered in patients who underwent one cycle of RLT and responded to the treatment

The Effects of Isopropyl Methylphosphono-Fluoridate (IMPF) Poisoning on Tumor Growth and Angiogenesis in BALB/C Mice

International audienceBackground Acetylcholinesterase (AChE) and cholinergic receptors have an important role in the immune system and angiogenesis. This work evaluated the effects of isopropyl methylphosphonofluoridate (IMPF), an irreversible inhibitor of AChE, on tumor growth and selected parameters associated with tumor angiogenesis. Material/Methods Experiments were performed on male BALB/c mice exposed to IMPF (study group) or saline buffer (control group) and inoculated with L-1 sarcoma; the number of new blood vessels (TIA test) and the level of avb3 integrin (131I-MAb-antib3 assay) were analyzed at seven, 14, or 21 days after implantation of the tumor cells. Results The IMPF poisoning affected tumor angiogenesis (TIA test). There was a statistically significant increase in the number of newly forming blood vessels in the group subjected to IMPF and inoculated with tumor cells. Conclusions This study showed that IMPF had a significant effect on the regulation of lymphocyte-induced angiogenesis and the modulation of angiogenic and pro-inflammatory cytokines secretion. The observed effects suggest involvement of neuronal and/or non-neuronal cholinergic signaling pathway

Effect of isopropyl methylphosphonofluoridate (IMPF) poisoning on selected immunological parameters of angiogenesis

introduction and objective. Acetylcholinesterase (AChE) and cholinergic receptors play an important role in the immune system, including lymphocyte-induced angiogenesis. However, their exact role is not fully understood. The presented work tests the influence of isopropyl methylphosphonofluoridate (IMPF), an irreversible inhibitor of AChE, on selected immune parameters associated with angiogenesis in mice. The levels of VEGF, bFGF, TNF-α, and IFN-γ production were measured, together with the ability of lymphoid spleen cells to induce local GvH reaction after a single dose of IMPF. materials and method. Experiments were performed in male BALB/c mice. Acetylcholinesterase activity in erythrocytes was determined by the Ellman`s procedure. Levels of cytokines were measured in serum using standard commercial ELISA kits. Influence of IMPF intoxication upon angiogenesis was examined by the LIA test, according to the Sidky and Auerbach procedure. results. The results showed a 6- and 8-fold increase in VEGF at days 1 and 7 of the experiment, respectively, as well as a decrease (at days 14 and 21 after administration), followed by a significant increase (day 1) in bFGF levels. A statistically significant decrease in the concentration of IFN-γ was observed throughout all experiments. The maximum decrease in the level of TNF-α was found at days 1 and 7 after administration of IMPF. Additionally, a significant decrease was found in the ability to form new blood vessels following IMPF administration. conclusions. This study revealed that IMPF has a significant effect on the regulation of lymphocyte-induced angiogenesis, which is related with the modulation of angiogenic and pro-inflammatory cytokines secretion. The observed differences suggest a possible derangement of certain elements of the neuronal and/or non-neuronal cholinergic system