Blood lactate levels in patients receiving first- or secondgeneration antipsychotics

Aim To compare the blood lactate levels between patients with psychotic disorder receiving first- and those receiving second-generation antipsychotics. Methods The study was conducted at the psychiatric inpatient and outpatient clinics of the Split Clinical Hospital from June 6, 2008 to October 10, 2009. Sixty patients with psychotic disorder who were assigned to 6-month treatment were divided in two groups: 30 received haloperidol (first generation antipsychotic) and 30 received olanzapine (second generation antipsychotic). Blood lactate levels, other metabolic parameters, and scores on the extrapyramidal symptom rating scale were assessed. Results Patients receiving haloperidol had significantly higher blood lactate levels than patients receiving olanzapine (P < 0.001). They also more frequently had parkinsonism, which was significantly correlated with both haloperidol treatment at 1 month (P < 0.001) and 6 months (P = 0.016) and olanzapine treatment at baseline (P = 0.016), 3 months (P = 0.019), and 6 months (P = 0.021). Also, patients receiving haloperidol had significant correlation between blood lactate and dystonia at 1 month (P < 0.001) and 6 months (P = 0.012) and tardive dyskinesia at 1 month (P = 0.032). There was a significant difference between the treatment groups in lactate levels at all points from baseline to month 6 (P < 0.001). Conclusion It is important to be aware of the potential effect of haloperidol treatment on increase in blood lactate levels and occurrence of extrapyramidal side effects. Therefore, alternative antipsychotics should be prescribed with lower risk of adverse side effects. Trial identification number: NCT0113946

Blood lactate levels in patients receiving first- or second- generation antipsychotics

Aim To compare the blood lactate levels between patients with psychotic disorder receiving first- and those receiving second-generation antipsychotics. Methods The study was conducted at the psychiatric inpatient and outpatient clinics of the Split Clinical Hospital from June 6, 2008 to October 10, 2009. Sixty patients with psychotic disorder who were assigned to 6-month treatment were divided in two groups: 30 received haloperidol (first generation antipsychotic) and 30 received olanzapine (second generation antipsychotic). Blood lactate levels, other metabolic parameters, and scores on the extrapyramidal symptom rating scale were assessed. Results Patients receiving haloperidol had significantly higher blood lactate levels than patients receiving olanzapine (P < 0.001). They also more frequently had parkinsonism, which was significantly correlated with both haloperidol treatment at 1 month (P < 0.001) and 6 months (P = 0.016) and olanzapine treatment at baseline (P = 0.016), 3 months (P = 0.019), and 6 months (P = 0.021). Also, patients receiving haloperidol had significant correlation between blood lactate and dystonia at 1 month (P < 0.001) and 6 months (P = 0.012) and tardive dyskinesia at 1 month (P = 0.032). There was a significant difference between the treatment groups in lactate levels at all points from baseline to month 6 (P < 0.001). Conclusion It is important to be aware of the potential effect of haloperidol treatment on increase in blood lactate levels and occurrence of extrapyramidal side effects. Therefore, alternative antipsychotics should be prescribed with lower risk of adverse side effects. Trial identification number: NCT0113946

Značenje kvantitativnog scintigrama kosti u prognostici zaraštanja prijeloma

Studies of fracture healing are aimed at differentiating normal from delayed bone union. Delayed union, nonunion with the development of pseudarthrosis, and infection are complications of fracture healing. In the present study, quantitative analysis by three-phase bone scintigraphy was evaluated in the early prognosis of the course of fracture healing, to assess its potential in the early detection and therapy of healing complications. In 105 patients with long bone fractures, three-phase bone scintigraphy was performed early (day 4-7), and 3 weeks, 3 months and 6 months of injury. Based on clinical, laboratory and radiological findings, patients were retrospectively divided into four groups of normal healing, pseudarthrosis, delayed union, and healing with infection. The region of interest method was used to analyze all three scintigraphy phases, i.e. perfusion, vascular space image, and static scintigram at 3 h of injection. Comparison of impulse count in the fracture area with the contralateral, intact side produced a relative index for each step of three-phase scintigraphy. Infection at the fracture site can be suspected on the basis of perfusion index in the earliest stages following injury. Delayed bone union can also be predicted very early, within three weeks of injury, by use of perfusion index. Quantitative analysis of the vascular space phase and late static scintigrams can contribute to the diagnosis of complications, however, only in later stages of disease, which in part limits their clinical relevance. Three-phase bone scintigraphy is a valuable study when expecting problems in the process of bone union.Ispitivanje zarastanja prijeloma ima za cilj razlikovanje normalnog od usporenog zarastanja kosti. Odloženo zarastanje, nezarastanje s razvojem pseudoartroze te infekcija komplikacije su zarastanja prijeloma. S ciljem što ranijeg otkrivanja, a time i ranije terapije komplikacija, željeli smo ispitati mogućnosti kvantitativne analize troetapne scintigrafije kosti u ranoj prognozi tijeka zarastanja prijeloma. U 105 ispitanika s prijelomima dugih kostiju učinjena je troetapna scintigrafija kosti neposredno nakon traume (4.-7. dan nakon traume), te 3 tjedna, 3 i 6 mjeseci nakon traume. Ispitanici su na osnovi kliničkih, laboratorijskih i radioloških nalaza retrospektivno podijeljeni u četiri skupine: normalno zarastanje, pseudoartroza, odloženo zarastanje i zarastanje uz infekciju. Metodom regije interesa (ROI) analizirali smo sve tri faze scintigrama: perfuziju, snimku vaskularnih prostora, te statički scintigram 3 sata nakon injiciranja. Uspoređujući broj impulsa područja frakture s kontralateralnom, zdravom stranom dobili smo relativne indekse (RI) za svaku fazu troetapne scintigrafije. U najranijim stadijima nakon povrede moguće je, na temelju indeksa perfuzije, posumnjati na infekciju na mjestu frakture. Odloženo zarastanje također se može predskazati indeksom perfuzije vrlo rano, unutar tri tjedna od prijeloma. Kvantitativna analiza faze vaskularih prostora i kasnih statičkih scintigrama može doprinijeti dijagnostici komplikacija, ali u kasnim fazama bolesti, što donekle umanjuje njihovo kliničko značenje. Troetapna scintigrafija kosti vrijedna je pretraga u slučajevima kada se očekuju problemi zarastanja kosti

Diagnostic Pitfalls in Parathyroid Gland Cytology

The aim of this study is to establish possibilities of using cytology in the diagnosis of parathyroid gland adenoma. 475 patients, all suspected to have parathyroid gland disease, were examined over a three-year period (from 1 of January 2006 to 31 of December 2008) in the Clinical Department of Nuclear Medicine and Radiation Protection, University Hospital Center Zagreb, Croatia. Ultrasound guided fine needle aspiration biopsy (UG-FNAB) of suspected occurrences determined by ultrasound was done. Samples obtained by UG-FNAB were air-dried and stained using the May-Grünwald- -Giemsa (MGG) staining procedure. PTH levels were determined in all punctate and sera obtained on the day of UG- -FNAB. Samples adequate for cytological analysis were obtained from 288 patients, while 187 punctates did not contain epithelial elements. The parathyroid hormone (PTH) analysis was made for all punctates. The adenoma was diagnosed via morphological characteristics in 71 out of 288 punctates that were proven adequate for cytological analysis. Increased PTH levels were later on established in all diagnosed adenomas. All patients with cytology-based diagnosis of parathyroid gland adenoma were sent to surgery, and the cytological diagnosis was confirmed by pathohistology. In three cases, the parathyroid gland adenoma was established by pathohistology, although in these cases the cytological diagnosis was negative. The cytological diagnosis of parathyroid gland adenoma can be considered reliable in 96% of cases, provided that the echosonographic structure and localisation of the punctured node is noted, and assuming that material adequate for cytological analysis is obtained by FNAB. Possible pitfalls are oncocytic types of parathyroid adenoma, intranuclear inclusions and papillary formation of epithelial cells, and cystic degeneration of nodules. These errors can be avoided by defining the PTH level on the same punctate

Assessment Tools in Early Detection of Osteoporosis in Dentistry

Osteoporoza, široko rasprostanjena i učestala koštana bolest odmakle životne dobi, obilježena je gubitkom koštane mase i dotrajalošću mikroarhitekture koštanoga tkiva, uz posljedično slabljenje tvrde koštane strukture te povećanje rizika pojave prijeloma. U radu su navedeni sistemski i lokalni čimbenici odgovorni za gubitak koštanoga tkiva čeljusti. Najčešći sistemski čimbenici povezani s gubitkom koštane mase čeljusti, su osteoporoza, bubrežne bolesti, hormonski poremećaji, prehrana, ali i utjecaj različitih lijekova na koštanu strukturu. Od lokalnih čimbenika povezanih s gubitkom kosti čeljusti navode se kronične parodontne bolesti, rani gubitak zuba te nepovoljan učinak protetskog nadomjeska na bezubi dio grebena. U svrhu procjene gubitka koštane strukture čeljusti primjenjuju se različite metode, od kojih najčešće apsorpciometrija x-zraka (DXA), kvantitativna kompjuterska tomografija, intraoralna mikrodenzitometrija, indeks SCORE te procjena debljine i kvalitete donjeg kortikalnog ruba mandibule. Kvantitativna i kvalitativna procjena koštanoga tkiva čeljusti od iznimnog je značenja za sva područja stomatologije – od parodontologije do endodoncije i stomatološke protetike, posebice u stomatološkoj implantologiji. U tijeku planiranja buduće implantološke terapije važno je procijeniti stanje kosti čeljusti, odnosno njihovu kvalitetu i kvantitetu te, uzimajući u obzir navedene sistemske i lokalne čimbenike povezane s gubitkom koštane mase, ispravno postaviti indikacije za daljnje liječenje.Osteoporosis, one of the major skeletal diseases in older age, is characterised by low bone mass and microarchitectural deterioration with a resulting increase in bone fragility and hence susceptibility to fracture. In this review we analyse the systemic and local factors associated with oral bone mass loss. Systemic factors most often correlated with the oral bone mass loss include osteoporosis, renal diseases, hormonal disorders, diet and the impact of different drugs on the bony structure. Chronic periodontal disease, early loss of teeth or the effect of inadequate prosthodontic appliance on the residual ridge are the local factors associated with mandibular bone loss. Different assessment tools for the assessment of mandibular oral bone loss have been proposed, such as DXA absorptiometry, quantitative computed tomography, intraoral microdensitometry, SCORE index and the assessment of the thickness and quality of the mandibular inferior cortical border. Qualitative and quantitative assessment of the mandibular bony structure is of great importance in all fields of dentistry – from periodontology to endodontics and prosthodontics, especially in dental implantology. It is important to make the correct indication prior to dental implant therapy, and taking into account the systemic and local factors mentioned above, assess both the actual quality and quantity of the mandible

CT urography: principles and indications

CT urografija (CTU) je slikovna metoda specifično prilagođena oslikavanju i procjeni gornjeg mokraćnog sustava i mokraćnog mjehura. Visoka dijagnostička točnost u detekciji primarnih i recidivnih tumora urotela, razlikovanje malignih od benignih lezija, karakterizacija anatomskih varijacija i malformacija te procjena relevantnih patomorfoloških promjena u okolnim tkivima čine CT urografiju vrijednom metodom za oslikavanje mokraćnog sustava. Hematurija, inicijalna procjena proširenosti i praćenje tumora gornjeg mokraćnog sustava i mokraćnog mjehura najvažnije su indikacije za CTU. „Triple phase” i „split bolus” tehnike su najčešće korišteni CTU protokoli koje sačinjavaju nativna, nefrografska i ekskretorna faza, dobivene skeniranjem regije tri ili dva puta. CTU protokoli skeniranja su dizajnirani s ciljem ostvarivanja najbolje kvalitete slike te optimalne distenzije i opacifikacije mokraćnog sustava uz najmanju moguću dozu zračenja, u rasponu od 5 – 15 mSv, što je usporedivo s dozama zračenja intravenske urografije. Detaljna anamneza, klinički pregled i analiza urina ključni su za pravilan probir pacijenata i ciljani odabir CTU protokola, te su ujedno najučinkovitiji način poboljšavanja dijagnostičke točnosti i smanjivanja doze zračenja CT urografije.CT urography (CTU) is an imaging method tailored specifically for the evaluation of the upper urothelial tract and urinary bladder. High diagnostic accuracy in detecting primary and recurrent urothelial tumours, their differentiation from benign lesions, anatomic variation and malformation characterization, and evaluation of important pathology in the surrounding tissues, renders CTU a valuable imaging study of the urothelial tract. Haematuria, initial staging and post treatment follow up of upper urinary tract and bladder malignancies are the most important indications for CTU. Triple phase and split bolus techniques are most commonly used CTU protocols that consist of a non-contrast, nephrographic, and excretory phase, obtained by three or two acquisitions. CTU scanning protocols are tailored to achieve adequate image quality with optimal opacification and distension of the urinary tract at the lowest achievable radiation dose within the range of 5-15 mSv, comparable to the doses of intravenous urography. Detailed patient history, clinical examination, and urine analysis are essential for proper patient selection and targeted CTU protocol, which are the most important tools for increasing diagnostic accuracy and lowering patient radiation dose of CT urography

Scintigrafija z indij-111-DTPA-oktreotidom pri bolnikih s karcinoidom

Background. The aim of the study was the evaluation of clinical utility and comparison of 111 In-DTPA- octreotide receptor scintigraphy (SRS) with conventional imaging modalities (CIM) in the detection of carcinoid tumor. Patients and methods. Fourteen patients with pathohistologically proven diagnosis of carcinoid tumor and one patient with clinical suspicion of carcinoid tumor were investigated by SRS. SRS was performed for localization of primary tumor, recurrence or estimation of spread of the disease after CIM had been completed. Whole body scans and single photon emission computed tomography (SPECT) were acquired 6 and 24 h after the application of radiopharmaceutical. The intensity of nonspecific radiopharmaceutical uptake in the bowel was assessed semiquantitatively by a score using whole body scans. Results. The evaluation was done for patients and for tumor sites. The sensitivity, specificity, and positive and negative predictive values for patient evaluation were 89 %,100 %,100 % and 80 %, respectively for both CIM and SRS, whereas for tumor sites, these parameters were 69 % 100 %,100 % and 82 % for CIM, and 88%,100%,100% and 92 % for SRS. Intensity score of nonspecific 111In-octreotide bowel accumulation was 0.92 and 2.01 for 6 and 24h scans respectively (p < 0.01). Conclusion. 111In-octreotide scintigraphy should be included in the diagnostic algorithm for the patients with clinical suspicion of carcinoid and for the assessment of patients with proven carcinoid tumor.Izhodišča. Študijo smo izvedli z namenom, da ocenimo klinično uporabnost scintigrafije somatostatinskih receptorjev z indij-111-DTPA-oktreotidom (SRS) ter jo primerjamo s konvencionalnimi načini slikovne preiskave pri bolnikih s karcinoidom. Bolniki in metode. Štirinajst bolnikov s patohistološko potrjenimkarcinoidom in enega bolnika s klinično ugotovljenim karcinoidom smo preiskali s SRS. Preiskavo SRS smo izvedli po konvencionalni slikovni preiskavi in z njo poskušali lokalizirati primarni tumor in ugotoviti ponovitev ali razsoj bolezni. Scintigrafijo celotnega telesa in računalniško tomografijo z emisijo posameznih elektronov (SPECT) smo opravili 6 in 24 ur povbrizganem radiofarmacevtskem sredstvu. Intenzivnost nespecifičnega kopičenja radiofarmacevtskega sredstva v črevesu smo ocenili semikvantitativnos scintigrafijo celotnega telesa. Rezultati. Intenzivnost kopičenja smo ocenili glede na bolnike in glede na lokalizacijo tumorja. Pri bolnikih je občutljivost znašala 89%, specifičnost 100%, pozitivne in negativne napovedne vrednosti pa so bile 100% in 80% tako pri konvencionalnem načinu slikovne preiskave kot pri SRS. Pri ocenjevanju lokalizacije tumorja sobili zgornji parametri naslednji: slikanje celotnega telesa: občutljivost 69%, specifičnost 100%, pozitivne in negativne napovedne vrednosti 100% in 82%SRS: občutljivost 88%, specifičnost 100%, pozitivne in negativne napovedne vrednosti 100% in 92%. Intenzivnost nespecifičnega kopičenja 111-indija-oktreotida v črevesju je bila pri slikah, posnetih po 6. urah 0,92 in pri slikah, posnetih po 24 urah, 2,01 (p < 0,01). Zaključki. SRS bi morala biti vključena v diagnostični algoritem pri bolnikih, pri katerih je bil karcionoid ugotovljen le klinično in tudi pri bolnikih s potrjeno diagnozo karcionoida