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Celiac disease (CD) is an immune-mediated systemic disorder triggered by gluten and related prolamins in genetically predisposed individuals. Here, we described a case of a 31-year-old Caucasian woman who exhibited cerebellar and psychiatric dysfunctions. The patient underwent single-photon emission computed tomography (SPECT-CT) before and after a gluten-free diet (GFD). There was an improvement in cerebellar perfusion accompanied by a remission of cerebellar manifestations. The maintenance of the psychiatric manifestations was related to the persistence of the hypoperfusion in the frontal lobes. The patient’s psychiatric symptoms did not change after 4 months under a GFD in the hospital. To our knowledge, this is the first case that shows the relationship between improvement in cerebellar perfusion and remission of cerebellar clinical manifestations in a CD patient under a GFD.

Background To evaluate the use of retrograde endovascular internal iliac artery preservation (REIIAP) technique for treating aortoiliac aneurysms. Methods We reviewed our database for all patients with aortoiliac aneurysms who underwent REIIAP technique between April 2004 and April 2014. Patients underwent implantation of an Apollo aortomonoiliac (Nano Endoluminal, Florianopolis, Brazil), contralateral implantation of a Viabahn stent graft (Gore Medical, Flagstaff, AZ) positioned from the external iliac artery into the internal iliac arteries as a bridging stent and femorofemoral bypass. The outcomes that we evaluated included technical success, operative mortality and morbidity, endoleak, aneurysm diameter, bridging stent occlusion, and reintervention during follow-up. Results A total of 21 patients (19 men, mean age 73 ± 2.3 years) were identified. Technical success was achieved in all cases, and none of the patients died during the follow-up (mean follow-up 52 ± 38.5 months). Type IB endoleak was diagnosed in 2 patients, bridging stent occlusion was diagnosed in 1 patient, and reintervention was required for 2 patients. Diameter regression was observed in the aorta ( P = 0.15), left common iliac artery ( P = 0.37), and right common iliac artery ( P = 1.22). Conclusions This study demonstrates the feasibility of the REIIAP technique presenting high success rate and similar complication rates compared with other therapeutic options during follow-up. These results demonstrated that it is a useful option for selected patients with aortoiliac aneurysms unfit for other techniques.

It has been suggested that technetium-99m (99mTc)-anti-tumour necrosis factor alpha (TNF-α) scintigraphy (SCI) may be a useful diagnostic tool in Graves' ophthalmopathy (GO). This study evaluated whether orbit total radioactivity uptake on SCI could be used to predict corticosteroid therapy (CorT) responses in active-GO patients. A longitudinal study of patients with active GO defined by Clinical Active Score (CAS) >3/7 was done. Clinical, laboratory and SCI evaluations were performed at baseline and 3 months after concluding intravenous CorT. SCI (planar and tomographic) was assessed after intravenous injection of 10 mCi of 99mTc-anti-TNF-α. Orbits and cerebral hemispheres were defined as regions of interest (ROIs) to enable orbit/hemisphere ROI-ratios of total radioactive uptake. ROI-ratios were considered positive at >2·5. Average total radiation uptake (TRU) was also determined for each orbit (AVGROI ). Clinical, laboratory and SCI data were compared between responders (CAS became inactive) and non-responders to CorT (18 patients). At baseline, AVGROI were higher in active OG orbits (67·3 cps) than in inactive ones (33·6 cps; P

The aim of this study was to describe the use of (99m)Tc-anti-TNF-α scintigraphy for detecting inflammation of the sacroiliac joints in a patient with non-radiographic axial spondyloarthritis. A 47-year-old female patient, non-smoker and non-drinker, complained of a low back pain inflammation, which began 4 years before her condition have exacerbated to morning stiffness and anterior uveitis in the last 6 months. Initially diagnosed as mechanical low back pain, she irregularly took non-steroidal anti-inflammatory drugs and corticosteroids, without significant long-lasting results. Radiographic findings were negative. There was increased uptake of (99m)Tc-anti-TNF-α in an area corresponding to the topography of ileum and sacroiliac right joint upon (99m)Tc-anti-TNF-α scintigraphy. Magnetic resonance imaging (MRI), the most used image diagnosis tool, showed minimum impregnation of gadolinium in the right sacroiliac joint and at the iliac face of the inferior third of the right sacroiliac joint. We suggest that (99m)Tc-anti-TNF-α can facilitate early diagnosis of patients with non-radiographic axial spondyloarthritis. More studies are now ongoing.

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Approximately 16 million first-ever strokes occur each year, leading to nearly 6 million deaths. Nevertheless, currently, very few therapeutic options are available. Cell therapies have been applied successfully in different hematological diseases, and are currently being investigated for treating ischemic heart disease, with promising results. Recent preclinical studies have indicated that cell therapies may provide structural and functional benefits after stroke. However, the effects of these treatments are not yet fully understood and are the subject of continuing investigation. Meanwhile, different clinical trials for stroke, the majority of them small, nonrandomized, and uncontrolled, have been reported, and their results indicate that cell therapy seems safe and feasible in these conditions. In the last 2 years, the number of published and registered trials has dramatically increased. Here, we review the main findings available in the field, with emphasis on the clinical results. Moreover, we address some of the questions that have been raised to date, to improve future studies.

We evaluated the outcome of the retrograde endovascular hypogastric artery preservation (REHAP) technique for the treatment of complex aortoiliac aneurysms (AIAs). Perioperative and long-term outcomes were assessed for 12 patients (mean age 77 years, range 64–86 years) who underwent elective endovascular AIA repair via aortouniiliac endografting and REHAP between January 2004 and January 2011. Preoperative images obtained by computed tomography were used for planning. Postoperative images were obtained one and six months after surgery, and once a year thereafter. Technical success was achieved in all cases. No patients exhibited endoleak related to the endoprosthesis, occlusion of implanted components, hip and/or buttock claudication, or colon or spinal cord ischemia during follow-up. This hybrid procedure illustrates the potential of REHAP in the treatment of AIA cases.

Aims: To assess the biodistribution of bone marrow mononuclear cells (BMMNC) delivered by different routes in patients with subacute middle cerebral artery ischemic stroke. Patients & methods: This was a nonrandomized, open-label Phase I clinical trial. After bone marrow harvesting, BMMNCs were labeled with technetium-99m and intra-arterially or intravenously delivered together with the unlabeled cells. Scintigraphies were carried out at 2 and 24 h after cell transplantation. Clinical follow-up was continued for 6 months. Results: Twelve patients were included, between 19 and 89 days after stroke, and received 1-5 × 10 8 BMMNCs. The intra-arterial group had greater radioactive counts in the liver and spleen and lower counts in the lungs at 2 and 24 h, while in the brain they were low and similar for both routes. Conclusion: BMMNC labeling with technetium-99m allowed imaging for up to 24 h after intra-arterial or intravenous injection in stroke patients.

OBJECTIVE: Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions. METHODS: A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results. RESULTS: The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%. CONCLUSIONS: The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.

About 20% of patients with abdominal aortic aneurysms have associated iliac aneurysms. Distal sealing during the endovascular treatment of aortic-iliac aneurysms is a challenge that has led to the emergence of several technical options to achieve this goal over the years. Internal iliac artery embolization is associated with the risk of ischemic complications, such as gluteal necrosis, lower limb neurological deficit, colonic ischemia, impotence and gluteal claudication. This article summarizes the technical options for endovascular treatment of aortoiliac aneurysms with different approaches to preserving the patency of internal iliac arteries.

Despite recent advances in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) using therapeutic hypothermia, at least 30% of the cooled infants will die or have moderate/severe neurological disability. Umbilical cord blood cells (UCBCs), which are readily available at birth, have been shown to reduce sensorimotor and/or cognitive impairments in several models of brain damage, representing a promising option for the treatment of neurological diseases. In this review, we discuss recent preclinical studies that assessed the effects of UCBC transplantation in the Rice-Vannucci animal model of HIE. We also review the possible cell types and mechanisms involved in the therapeutic effect of UCBC transplantation, including neuroprotection, immunomodulation, and stimulation of neural plasticity and regeneration. In addition, we discuss how neuroimaging methods, such as bioluminescence imaging, nuclear-medicine imaging, or magnetic resonance imaging, could be used to evaluate the biodistribution of UCBCs in both preclinical and clinical studies.

Objective. To compare the use of radiolabelled human monoclonal anti-TNF-a scintigraphy with clinical examination and MRI of hands and wrists joints in patients with active RA. Methods. Eight patients with active RA, 28-joint DAS (DAS-28)5 3.2 and a healthy volunteer underwent whole body and hand/wrist scintigraphy after the administration of anti-human TNF-a labelled with technetium-99m ( 99m Tc). One hundred and ninety-eight joints were examined. Patients were also given clinical examinations in addition to MRI of the hands and wrists. Results. Of the 198 joints examined, signs of inflammation were detected by MRI in 49 (24.7%) and by scintigraphy in 48 (24.2%) joints, with agreement between the two methods in 44 joints. In five joints, MRI was positive and scintigraphy negative. In another four joints, scintigraphy was positive and MRI negative for signs of inflammation. MRI and scintigraphy were in agreement for negative results for 145 joints. The sensitivity and specificity of scintigraphy was 89.8 and 97.3%, respectively. When clinical parameters (presence of swelling and tenderness of joints) were compared with the MRI findings, lower correlation coefficients were observed (sensitivity of 59.2% and 65.3%, respectively). Conclusions. Scintigraphy using 99m Tc-anti-TNF-a showed high correlation with the presence of inflammatory signs detected by MRI in the hands and wrists of patients with active RA, and demonstrated a greater sensitivity than clinical examination. These results can assist in better understanding of anti-cytokine therapy and support the achievement of evidence-based biologic therapy.

Cell-based treatments have been considered a promising therapy for neurological diseases. However, currently there are no clinically available methods to monitor whether the transplanted cells reach and remain in the brain. In this study we investigated the feasibility of detecting the distribution and homing of autologous bone-marrow mononuclear cells (BMMCs) labeled with Technetium-99 m ( 99m Tc) in a cell-based therapy clinical study for chronic ischemic stroke. Six male patients (ages 24–65 years) with ischemic cerebral infarcts within the middle cerebral artery (MCA) between 59 and 82 days were included. Cell dose ranged from 1.25 × 10 8 to 5 × 10 8 . Approximately 2 × 10 7 cells were labeled with 99m Tc and intra-arterially delivered together with the unlabeled cells via a catheter navigated to the MCA. None of the patients showed any complications on the 120-day follow-up. Whole body scintigraphies indicated cell homing in the brain of all patients at 2 h, while the remaining uptake was mainly distributed to liver, lungs, spleen, kidneys and bladder. Moreover, quantification of uptake in Single-Photon Emission Computed Tomography (SPECT) at 2 h showed preferential accumulation of radioactivity in the hemisphere affected by the ischemic infarct in all patients. However, at 24 h homing could only distinguished in the brains of 2 patients, while in all patients uptake was still seen in the other organs. Taken together, these results indicate that labeling of BMMCs with 99m Tc is a safe and feasible technique that allows monitoring the migration and engraftment of intra-arterially transplanted cells for at least 24 h.

OBJECTIVES Sentinel lymph node biopsy (SLNB) has been performed for purposes of disease staging. SLN is usually located in the axillary region and internal mammary chain (IMC). Metastasis in internal mammary nodes can be an important prognostic factor and an indication for systemic treatment in patients with small carcinomas. The SLNB technique continues to evolve and the proper radiopharmaceutical injection route remains under discussion. This study evaluated the success rate of deep injection to identify axillary and extra-axillary SLNs and compared the results with superficial injection technique. METHODS Forty-six patients diagnosed with breast cancer (stages I and II) were submitted to radiopharmaceutical injection. Deep injection of technetium-99m-dextran 500 was carried out in 20 patients (group A) and periareolar injection of technetium-99m-phytate was carried out in 26 patients (group B). All SLNs were studied by imprint cytology and hematoxylin and eosin staining. RESULTS SLN identification rate was 76.1% (35 of 46). The SLN identification rate was 75% (15 of 20) for group A and 76.9% (20 of 26) for group B. Axillary SLNs were identified in 65% (13 of 20) of group A and 76.9% (20 of 26) of group B, with no statistical difference (P = 0.75). Extra-axillary SLNs were only identified in group A, and IMC was the principal extra-axillary location. CONCLUSION Deep injection of radiopharmaceutical achieved a good SLN identification rate in axillary and extra-axillary locations and it is an important method for detecting IMC sentinel nodes.

OBJECTIVE. The purpose of this article is to illustrate the feasibility of fused whole-body MRI and PET for the evaluation of patients with cancer.CONCLUSION. MRI has proven to be superior to CT for studying several regions of the body, and PET FDG has become an established diagnostic tool in oncology. Because FDG accumulates avidly in tumor tissue, fusing FDG PET to whole-body MRI allows good anatomy-based evaluation of disease.

O tumor venéreo transmissível canino (TVTC) é descrito na literatura como raramente metastático. Entretanto, métodos acurados para verificação dessa afirmativa não estão disponíveis na rotina veterinária. Neste trabalho utilizou-se a cintilografia com 99mTc-Timina para avaliar a disseminação do TVTC com apresentação cutânea. Houve captação da 99mTc-Timina nos três casos de TVTC estudados. A cintilografia com 99mTc-Timina é uma técnica não-invasiva e promissora para a avaliação do grau de disseminação tumoral em casos de TVTC. Sugerimos o seu uso na Oncologia Veterinária para localização de TVTC.

OBJETIVO: Determinar a acurácia diagnóstica da positron emission tomography (tomografia por emissão de pósitrons)/tomografia computadorizada (PET/TC) com deoxiglicose marcada com flúor-18, conhecida como fluorodeoxiglicose (FDG[18F]), na avaliação de nódulo pulmonar solitário (NPS). MÉTODOS: Análise prospectiva de 53 pacientes consecutivos que realizaram PET/TC para avaliação de NPS, entre março de 2005 e maio de 2007. Destes 32 preencheram os critérios de inclusão. As lesões foram avaliadas quanto a sua localização e tamanho, grau de captação do radiofármaco e o standardized uptake value (SUV, valor padronizado de captação) máximo das lesões. Os achados dos estudos de FDG-PET/TC foram correlacionados com outros preditores de malignidade (idade, sexo, tabagismo, tamanho e localização do nódulo). O diagnóstico definitivo foi estabelecido por confirmação histopatológica ou acompanhamento clínico-radiológico por um período mínimo de um ano. RESULTADOS: Encontrados 14 NPS malignos. Após análise da curva ROC, o SUV de 2,5 foi considerado o melhor ponto de corte que identificou corretamente 13 dos 14 NPS malignos. Os resultados abaixo deste ponto de corte mostraram um exame falso positivo para neoplasia num total de 14. O método semiquantitativo apresentou sensibilidade de 92,9%, especificidade de 72,2%, valor preditivo positivo de 72,2%, valor preditivo negativo de 92,9% e acurácia de 81,2%. Na análise multivariada, apenas a localização do nódulo nos lobos superiores (p = 0,048) e o SUV (p = 0,007) demonstraram significância estatística para malignidade no NPS. CONCLUSÕES: Os dados do estudo mostram que o SUV da FDG[18F] é um bom preditor de neoplasia em nódulos pulmonares e com alto valor preditivo negativo, o que oferece grande segurança em afastar presença de malignidade, indicando sua importância na abordagem diagnóstica do nódulo pulmonar. OBJECTIVE: To determine the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) using fluorine-18-deoxyglucose ([18F]-FDG) for the evaluation of a solitary pulmonary nodule (SPN). METHODS: Prospective analysis of 53 consecutive patients submitted to PET/CT between March 2005 and May 2007 for the evaluation of an SPN. Of those, 32 met the criteria for inclusion in the present study. The lesions were evaluated for location, size, radiotracer uptake and maximum standardized uptake value (SUV). The FDG-PET/TC results were correlated with other predictors of malignance (age, gender, smoking status, nodule size and nodule location). The definitive diagnosis was established through histopathology or through clinical/radiological follow-up for at least one year. RESULTS: Fourteen malignant SPNs were found. Through analysis of the ROC curve, we established an SUV of 2.5 as the most appropriate cut-off point, since it correctly identified 13 of the 14 malignant SPNs. The results below that point revealed one false positive for neoplasia out of a total of 14. The semiquantitative method presented a sensitivity of 92.9%, specificity of 72.2%, positive predictive value of 72.2%, negative predictive value of 92.9% and accuracy of 81.2%. The multivariate analysis showed a statistically significant association with SPN malignancy only for nodule location in the upper lobes (p = 0.048) and SUV (p = 0.07). CONCLUSIONS: The results obtained suggest that the SUV of [18F]-FDG is a useful predictor of neoplasia in SPN, with a high negative predictive value, which allows malignancy to be safely ruled out, showing its relevance in the diagnostic approach to pulmonary nodules.

Introduction The increasing interest in 99m-technetium (99mTc)-labeled stem cells encouraged us to study the 99mTc binding sites in stem cell compartments. Methods Bone marrow mononuclear cells were collected from femurs and tibia of rats. Cells were labeled with 99mTc by a direct method, in which reduced molecules react with 99mTc with the use of chelating agents, and lysed carefully in an ultrasonic apparatus. The organelles were separated by means of differential centrifugation. At the end of this procedure, supernatants and pellets were counted, and the percentages of radioactivity (in megabecquerels) bound to the different cellular fractions were determined. Percentages were calculated by dividing the radioactivity in each fraction by total radioactivity in the sample. The pellets were separated and characterized by their morphology on electron microscopy. Results The labeling procedure did not affect viability of bone marrow mononuclear cells. Radioactivity distributions in bone marrow mononuclear cell organelles, obtained in five independent experiments, were approximately 38.5 % in the nuclei-rich fraction, 5.3 % in the mitochondria-rich fraction, 2.2 % in microsomes, and 54 % in the cytosol. Our results showed that most of the radioactivity remained in the cytosol; therefore, this is an intracellular labeling procedure that has ribosomes unbound to membrane and soluble molecules as targets. However, approximately 39 % of the radioactivity remained bound to the nuclei-rich fraction. To confirm that cell disruption and organelle separation were efficient, transmission electron microscopy assays of all pellets were performed. Conclusions Our results showed that most of the radioactivity was present in the cytosol fraction. More studies to elucidate the mechanisms involved in the cellular uptake of 99mTc in bone marrow cells are ongoing.

Este estudo visa identificar o linfonodo sentinela por meio da injeção exclusiva de radiofármaco periareolar subdérmico em quatro pontos, independente da topografia do tumor. A biópsia do linfonodo sentinela diminui a morbidade no estadiamento da axila. Foram realizadas 57 biópsias do linfonodo sentinela, em pacientes com câncer de mama, prospectivamente, em dois grupos: grupo A (25 pacientes) e grupo B (32 pacientes). Realizamos a injeção do radiofármaco peritumoral no grupo A, e nova técnica periareolar em quatro pontos no grupo B. A biópsia do linfonodo sentinela foi estudada por "imprint" citológico e hematoxilina e eosina, seguida de linfadenectomia axilar no grupo A e nos casos positivos do grupo B. No grupo A foram identificados 88% (22/25) de linfonodos sentinelas, não houve falso-negativo, com sensibilidade e especificidade de 100%; no grupo B foram identificados 96% (31/32) de linfonodos sentinelas e valor preditivo positivo de 100%. O número de linfonodos sentinelas variou de 1 a 7, moda de 1 e média de 2,7, a área de maior captação variou de 10 a 100 vezes. A injeção periareolar em quatro pontos se apresenta como bom método no mapeamento linfático para identificação do linfonodo sentinela. A padronização deste sítio pode ser o de escolha para identificação do linfonodo sentinela, sendo necessário maior número de casos para confirmação destes achados. The aim of this study was to identify the sentinel node by periareolar injection of the radiopharmaceutical in four points, regardless of tumor topography. The sentinel node biopsy reduces morbidity in axillary staging. Fifty-seven sentinel node biopsies were prospectively performed in two groups: group A (25 patients) and group B (32 patients). The peritumoral injection technique was used in group A and the new injection technique in four points was used in group B. The sentinel node biopsies were studied by imprint cytology and hematoxilin and eosin staining followed by axillary lymph node dissection in all patients of group A and only in the positive cases of group B. In group A, 88% (22/25) of the sentinel nodes were identified. There was no false negative case; the sensibility and specificity were of 100%. In group B, 96% (31/32) of sentinel nodes were identified and the status of the axillary lymph nodes showed a predictive positive value of 100%. The number of sentinel nodes varied from 1 to 7, mode of 1 and median of 2.7. The hotspot area was 10 to 100 times the background radiation. The periareolar injection in four points seems to be a good lymphatic mapping method for identification of the sentinel node. We suggest the standardization of this site for injections to identify the sentinel node, although further studies to confirm these findings are necessary.

O objetivo principal deste trabalho é implantar um método de inspeção imparcial e eficiente, visando à utilização segura e correta das radiações ionizantes no campo da medicina nuclear. Este método de inspeção aqui proposto foi aplicado em 113 serviços de medicina nuclear do país, obedecendo a uma freqüência de análise bienal (1996, 1998, 2000 e 2002). Foram estabelecidos 82 itens de radioproteção com pesos para cada item, baseados nos fatores de risco, de acordo com as normas da Comissão Nacional de Energia Nuclear (CNEN) e as recomendações da Agência Internacional de Energia Atômica. Na análise do serviço, cada item de não conformidade com as normas da CNEN gerou uma irregularidade de radioproteção, com seu peso associado. O somatório dos pesos deu a cada serviço uma pontuação final que o classificou dentro de três faixas de valores que determinaram uma tomada de decisão por parte do órgão regulador e fiscalizador: funcionamento sem restrição - menor que 100 pontos; funcionamento com restrição - igual ou maior que 100 e menor que 300 pontos; funcionamento suspenso - igual ou maior que 300 pontos. Para o caso de irregularidades reincidentes, criou-se um fator multiplicativo para a pontuação. A reincidência em qualquer item de radioproteção (irregularidade) teve seu peso multiplicado por 2n, onde n era o número de vezes em que o item encontrava-se irregular. O estabelecimento prévio de itens de radioproteção, com atribuição de pesos para cada item, procurou minimizar os valores subjetivos e pessoais presentes no julgamento e na avaliação técnica das instituições inspecionadas.

O objetivo desse estudo foi avaliar a utilidade do SPECT cerebral interictal na localização do foco epileptogênico em 23 pacientes do Ambulatório de Epilepsias do Hospital Universitário Clementino Fraga Filho (HUCFF/UFRJ), com epilepsia do lobo temporal (ELT) de difícil controle e tomografia computadorizada (TC) do crânio normal, estudando a correlação entre SPECT interictal, eletrencefalograma (EEG) e, em 11 casos, ressonância magnética (RM) do crânio, e comparar os resultados com os de outras seis séries da literatura. Doze (52,2%) pacientes apresentaram SPECT anormal. Entre esses, cinco (41,6% dos SPECTs anormais) apresentaram alteração unilateral ao SPECT do mesmo lado do EEG (hipoperfusão em 4 e hiperperfusão em 1), três (25% dos SPECTs anormais) apresentaram hipoperfusão bilateral ao SPECT e alterações também bilaterais ao EEG e 4 (33,3% dos SPECTs anormais) apresentaram hipoperfusão unilateral ao SPECT e EEG bilateral. A análise estatística fundamentou-se na lógica fuzzy. Os índices de correlação entre SPECT X EEG, SPECT X RM e SPECT X EEG X RM foram altamente significativos, com níveis de significância de 0,01, p < 0,0005 e intervalo de 99% de confiança em todas as correlações. Os estudos de correlação entre as séries estudadas apresentaram resultados semelhantes entre si.

Objective To evaluate the utility of a new multimodal image-guided intervention technique to detect epileptogenic areas with a gamma probe as compared with intraoperative electrocorticography. Materials and Methods Two symptomatic patients with refractory epilepsy underwent magnetic resonance imaging, videoelectroencephalography, brain SPECT scan, neuropsychological evaluation and were submitted to gamma probe-assisted surgery. Results In patient 1, maximum radioactive count was initially observed on the temporal gyrus at about 3.5 cm posteriorly to the tip of the left temporal lobe. After corticotomy, the gamma probe indicated maximum count at the head of the hippocampus, in agreement with the findings of intraoperative electrocorticography. In patient 2, maximum count was observed in the occipital region at the transition between the temporal and parietal lobes (right hemisphere). During the surgery, the area of epileptogenic activity mapped at electrocorticography was also delimited, demarcated, and compared with the gamma probe findings. After lesionectomy, new radioactive counts were performed both in the patients and on the surgical specimens (ex-vivo). Conclusion The comparison between intraoperative electrocorticography and gamma probe-assisted surgery showed similarity of both methods. The advantages of gamma probe include: noninvasiveness, low cost and capacity to demonstrate decrease in the radioactive activity at the site of excision after lesionectomy. Objetivo Avaliar a utilidade de um novo método de intervenção multimodal guiado por imagem, permitindo a detecção de áreas epileptogênicas mediante utilização de gamaprobe em comparação à eletrocorticografia intraoperatória. Materiais e Métodos Dois pacientes sintomáticos com epilepsia refratária realizaram ressonância magnética, videoeletroencefalograma, SPECT cerebral, avaliação neuropsicológica e foram submetidos a neurocirurgia usando gamaprobe. Resultados No paciente 1 as contagens radioativas inicialmente estavam no máximo no giro temporal, cerca de 3,5 cm posterior à ponta do lobo temporal esquerdo. Após corticotomia, o gamaprobe apontou o ponto máximo na cabeça do hipocampo, de acordo com os achados de eletrocorticografia intraoperatória. No paciente 2 as contagens foram máximas na região occipital em sua transição com os lobos temporal e parietal (hemisfério direito). Na cirurgia, a área mapeada da atividade epileptogênica na eletrocorticografia foi também delimitada, demarcada e comparada aos dados do gamaprobe. Após a lesionectomia, procedeu-se uma nova radiocontagem no paciente e na peça cirúrgica (ex-vivo). Conclusão A comparação entre os métodos mostrou acurácia praticamente similar. As vantagens do gamaprobe foram a de não ser invasivo, ser de baixo custo e também ser relevante para mostrar a redução da atividade radioativa no local da exérese.

A cintilografia renal dinâmica possibilita o diagnóstico de complicações observadas nos tecidos transplantados, como desordens na perfusão do órgão, necrose tubular aguda e quadros de rejeição. Empregamos o 99mTc-DTPA neste estudo e correlacionamos os achados cintilográficos e clínicos visando ao diagnóstico de rejeição ou outra forma de complicação no órgão transplantado. Tanto as rejeições quanto as complicações foram avaliadas em relação ao tipo de imunossupressão utilizada. Foram analisados 55 pacientes submetidos a transplante renal entre 1989 e 1999. Todos os pacientes com nefrotoxicidade faziam uso do esquema tríplice de imunossupressão. Neste estudo houve predominância de rejeição aguda, em 40,4% dos casos. Treze dos quinze pacientes cujos doadores eram cadáveres tiveram necrose tubular aguda. Foi observado apenas um caso falso-positivo, em que o exame cintilográfico foi incompatível com a clínica. Sugerimos o uso da cintilografia renal no acompanhamento pós-operatório dos pacientes transplantados. Dynamic renal scintigraphy allows the diagnosis of complications in patients submitted to organ transplantation, such as perfusion abnormalities, acute tubular necrosis and rejection. In this study we employed 99mTc-DTPA scintigraphy to study patients submitted to kidney transplantation. The results obtained and the clinical findings were conjunctly analyzed in order to detect graft rejection or other complications. The type of immunosuppressive scheme used was also correlated with the observed complications. Fifty-five patients submitted to kidney transplantation from 1989 to 1999 were evaluated. All patients with nephrotoxicity received a 3-drug immunosuppressive scheme. In this study, acute rejection was the most frequent complication (40.4%) observed following transplantation. Thirteen of 15 recipients of cadaveric kidney grafts presented acute tubular necrosis. Only one false-positive case was observed when scintigraphy and clinical findings were not concordant. We suggest carrying out renal scintigraphy to follow-up post-transplantation patients.

A oclusão das artérias ilíacas é uma patologia freqüente. Várias opções cirúrgicas existem para o seu tratamento, como a ponte aorto-bifemoral, a ponte femoro-femoral cruzada, o implante de endoprótese e outros. A ponte aorto-bifemoral é considerada o tratamento com melhores resultados. O tratamento endovascular da oclusão das artérias apresenta alta taxa de sucesso e baixo índice de complicações. Realizamos este tratamento em 24 pacientes, com idade média de 61 anos, variando de 39 a 82 anos. A indicação foi claudicação intermitente em 19 pacientes e isquemia crítica em cinco. O fator de risco mais freqüente foi tabagismo em 19 pacientes. A taxa de sucesso técnico na ultrapassagem da lesão foi de 91,7% e a taxa de patência foi de 71% em um ano. Os bons resultados com o tratamento endovascular nas oclusões das artérias ilíacas, com baixas taxas de morbidade e mortalidade, sugerem a inclusão deste procedimento no arsenal terapêutico. Occlusion of the iliac arteries is a common disease. Several surgical options are available to treat them, such as aorto-bifemoral bypass graft, cross femoro-femoral bypass, endoprosthesis implants and others. Aorto-bifemoral bypass graft is considered the treatment that provides the best results. Endovascular treatment for occlusion of the iliac arteries provides high success rates and low incidence of complications. Twenty-four patients, aged between 39 and 82 years (mean 61 years), were submitted to this treatment. Intermittent claudication and critical ischemia were the indications in 19 and 5 patients, respectively. The most common risk factor was smoking (19 patients). The technical success rate of iliac artery recanalization was 91.7% and the patency rate after one year was 71%. The good results achieved with percutaneous recanalization and stenting of occluded iliac arteries, which presents low morbidity and mortality rates, suggest that this procedure should be included among the therapeutic options for the treatment of iliac arteries occlusion.

A 24-year-old man with a cerebral infarct within the left middle cerebral artery (MCA) territory was enrolled in a study to assess the safety of autologous bone marrow mononuclear cell (BMMC) transplantation in patients with ischemic stroke (NCT00473057). His National Institutes of Health Stroke Scale score was 7. Computed tomography (Figure 1A) and technetium-99m ethyl cysteinate dimer (99mTc ECD) single photon emission computed tomography (SPECT) (Figures 1B and 2⇓ and Movie I in the online-only Data Supplement) indicated the location of the infarct. Sixty-seven days after onset of symptoms, the patient underwent BMMC transplantation. Bone marrow blood was aspirated under local anesthesia from both iliac crests and processed to isolate the mononuclear cell fraction. A total of 5×108 BMMCs was suspended into a volume of 10 mL, and 1 mL of the cell suspension was radiolabeled with 99mTc (radioactivity 111 MBq, physical …

Although neurological ailments continue to be some of the main causes of disease burden in the world, current therapies such as pharmacological agents have limited potential in the restoration of neural functions. Cell therapies, firstly applied to treat different hematological diseases, are now being investigated in preclinical and clinical studies for neurological illnesses. However, the potential applications and mechanisms for such treatments are still poorly comprehended and are the focus of permanent research. In this setting, noninvasivein vivoimaging allows better understanding of several aspects of stem cell therapies. Amongst the various methods available, radioisotope cell labeling has become one of the most promising since it permits tracking of cells after injection by different routes to investigate their biodistribution. A significant increase in the number of studies utilizing this method has occurred in the last years. Here, we review the different radiopharmaceuticals, imaging techniques, and findings of the preclinical and clinical reports published up to now. Moreover, we discuss the limitations and future applications of radioisotope cell labeling in the field of cell transplantation for neurological diseases.

Different imaging methods applied in the evaluation of a patient with unilateral active Graves ophthalmopathy (GO) are shown in the present paper. 99mTc-Anti-TNF-α scintigraphy is proposed as a promising method, not yet described, for the diagnosis of active ocular disease. It consists of labeling a human monoclonal antibody directed against TNF-α molecule (adalimumab) with technetium (99mTc). The method is based on the demonstration of TNF-α as one of the cytokines enrolled in the initial active phase of GO development. The method may give the perspective to link diagnosis and therapy, including new target-based modalities.

Background Magnetic resonance imaging (MRI) guided wire localization presents several challenges apart from the technical difficulties. An alternative to this conventional localization method using a wire is the radio-guided occult lesion localization (ROLL), more related to safe surgical margins and reductions in excision volume. The purpose of this study was to establish a safe and reliable magnetic resonance imaging-radioguided occult lesion localization (MRI-ROLL) technique and to report our initial experience with the localization of nonpalpable breast lesions only observed on MRI. Methods Sixteen women (mean age 53.2 years) with 17 occult breast lesions underwent radio-guided localization in a 1.5-T MR system using a grid-localizing system. All patients had a diagnostic MRI performed prior to the procedure. An intralesional injection of Technetium-99m macro-aggregated albumin followed by distilled water was performed. After the procedure, scintigraphy was obtained. Surgical resection was performed with the help of a gamma detector probe. The lesion histopathology and imaging concordance; the procedure’s positive predictive value (PPV), duration time, complications, and accuracy; and the rate of exactly excised lesions evaluated with MRI six months after the surgery were assessed. Results One lesion in one patient had to be excluded because the radioactive substance came back after the injection, requiring a wire placement. Of the remaining cases, there were four malignant lesions, nine benign lesions, and three high-risk lesions. Surgical histopathology and imaging findings were considered concordant in all benign and high-risk cases. The PPV of MRI-ROLL was greater if the indication for the initial MR examination was active breast cancer. The median procedure duration time was 26 minutes, and all included procedures were defined as accurate. The exact and complete lesion removal was confirmed in all (100%) patients who underwent six-month postoperative MRI (50%). Conclusions MRI-ROLL offers a precise, technically feasible, safe, and rapid means for performing preoperative MRI localizations in the breast.

Purpose: The indeterminate form of Chagas disease represents the most common chronic presentation. The aim of this study was to assess cardiovascular autonomic system function with I-123 metaiodobenzylguanidine (MIBG) scintigraphy in chagasic patients with normal or “borderline” electrocardiographic alterations and preserved left ventricular function evaluated by echocardiography. Materials and Methods: A total of 40 chagasic patients and 19 control subjects were included in this study. Patients had normal echocardiogram and chest radiography; no arrhythmias or myocardial ischemia; and normal exercise performance for age, gender, and body mass index. I-123 MIBG scintigraphy was performed and the heart-to-mediastinum (H/M) uptake was used as the primary predictor in the present analysis. The data analysis was performed by using Nonparametric Regression Trees and the Survival Agreement Plot. We included only patients with preserved right and left ventricular function assessed by echocardiographic methods. Results: Variables analyzed in the regression tree were age, sex, 20 minutes and 3 hours H/M uptake after injection of I-123 MIBG, washout rate, and single photon emission computed tomography imaging. The 3 hours H/M ratio was the only significant variable (P 0.001) and for 95% of chagasic patients, this value was less than 2.19. Conclusions: This study presents evidence that cardiac autonomic sympathetic modulation may be affected in chagasic subjects with preserved ventricular function evaluated by echocardiography, especially in those with “borderline” electrocardiogram.

Intravascular delivery of cells has been increasingly used in stroke models and clinical trials. We compared the biodistribution and therapeutic effects of bone marrow mononuclear cells (BMMCs) delivered by intra-arterial (IA) or intravenous (IV) injection after cortical ischemia. For the biodistribution analyses, BMMCs were labeled with 99m Technetium ( 99m Tc). At 2 h, gamma-well counting of the brain and of the other organs evaluated did not show differences between the non-ischemic and ischemic groups or between injection routes, and the organs with the highest uptake were the liver and lungs, with low uptake in the brain. At 24 h, the liver maintained the highest activity, and a marked decrease was seen in pulmonary uptake in all groups. At this time point, although the activity in the brain remained low, the lesioned hemisphere showed greater homing than the contralateral hemisphere, for both the IV and IA ischemic groups. Histological analysis by CellTrace labeling indicated similar homing between both routes in the peri-infarct region 24 h after transplantation and functional recovery was observed in both groups up to 11 weeks after the lesion. In conclusion, transplantation of BMMCs by IA or IV routes may lead to similar brain homing and therapeutic efficacy after experimental stroke.

Aims: To assess the safety and feasibility of intra-arterial transplantation of autologous bone marrow mononuclear cells in patients with middle cerebral artery ischemic stroke within 90 days of symptom onset. Patients & methods: Six patients were included in the study, and they received 1–5 × 108 bone marrow mononuclear cell and were evaluated using blood tests, neurological and imaging examination before treatment, and 1, 3, 7, 30, 60, 90, 120 and 180 days after transplantation. Scintigraphies were carried out 2 and 24 h after the procedure to analyze the biodistribution of labeled cells. Electroencephalogram was conducted within 7 days after transplantation. Results: No patients exhibited any complication or adverse events during the procedure. There was no worsening in the neurological scales until the end of the follow-up. Conclusion: Intra-arterial bone marrow mononuclear cell transplantation is feasible and safe in patients with nonacute ischemic strokes of the middle cerebral artery. Further studies are required to evaluate the efficacy of this therapy.

Since its introduction in 2001, positron emission tomography associated to computed tomography (PET/CT) has been established as a standard tool in cancer evaluation. Being a multimodality imaging method, it combines in a single session the sensitivity granted by PET for detection of molecular targets within the picomolar range, with an underlying submilimetric resolution inherent to CT, that can precisely localize the PET findings. In this last decade, there have been new insights regarding the pathophysiology of atherosclerosis, particularly about plaque rupture and vascular remodeling. This has increased the interest for research on PET/CT in vascular diseases as a potential new diagnostic tool, since some PET molecular targets could identify diseases before the manifestation of gross anatomic features. In this review, we will describe the current applications of PET/CT in vascular diseases, emphasizing its usefulness in the settings of vasculitis, aneurysms, vascular graft infection, aortic dissection, and atherosclerosis/plaque vulnerability. Although not being properly peripheral vascular conditions, ischemic cardiovascular disease and cerebrovascular disease will be briefly addressed as well, due to their widespread prevalence and importance.

Objectives. The aim of this study was to assess the use of anti-CD3, labelled with technetium-99m scintigraphy, for evaluating the joints of patients with RA, juvenile idiopathic arthritis (JIA), OA and gouty arthritis, and to establish the diagnosis parameters for each disease. Methods. We evaluated 2044 joints from 77 patients with rheumatic diseases. The clinical evaluation consisted of laboratory assays; examination for joint inflammation (pain and/or oedema); and for patients with RA, the disease activity score of 28 joints. To evaluate the sensitivity and specificity of 99mTc-antiCD3 in detecting disease activity, patients received an injection of the radiopharmaceutical compound 99mTc-anti-CD3, and underwent a scintigraphy scan 1 h later. Scanning was repeated 3 h later. As a control, after 2 days, the patient was injected with 99mTc-non-specific human immunoglobulins, and scintigraphy scanning performed at 1 and 3 h after the injection. The intensity of uptake and the pattern of activity were defined, and Spearman’s correlation and analysis of variance used for statistical evaluation. Results. Diagnosis criteria were established for 99mTc-anti-CD3 uptake in different diseases. RA and JIA showed joint uptake with progressive increase in late images. Gouty arthritis showed joint uptake with decrease during the late images. Joint uptake was low or absent in patients with OA, although when present the joint uptake decreased during the examination. Conclusion. 99mTc-anti-CD3 scintigraphy is a useful method in the differential diagnosis of rheumatic diseases.

OBJETIVO: Estudar a utilidade da sequência pesada em difusão na diferenciação das lesões mamárias benignas e malignas. MATERIAIS E MÉTODOS: Quarenta e cinco mulheres (idade média de 46,1 anos) com 52 nódulos de mama foram submetidas a ressonância magnética acrescida da sequência difusão. O coeficiente de difusão aparente (ADC) foi calculado através do mapa de ADC obtido pelo uso de cinco valores de b (0, 250, 500, 750 e 1.000 s/mm²). O valor de ADC médio de cada lesão foi correlacionado com achados de imagem e resultados histopatológicos. Valores de ADC de corte, sensibilidade e especificidade da sequência difusão na diferenciação das lesões benignas e malignas foram calculados. P < 0,05 foi considerado estatisticamente significativo. RESULTADOS: O valor de ADC médio foi significativamente menor para as lesões malignas (0,92 ± 0,26 × 10-3 mm²/s) comparado com as lesões benignas (1,50 ± 0,34 × 10-3 mm²/s) (p < 0,0001). A sequência difusão mostrou altas sensibilidade e especificidade (ambas 92,3%) na diferenciação entre lesões benignas e malignas. CONCLUSÃO: A sequência pesada em difusão representa um recurso potencial como coadjuvante da ressonância magnética das mamas na diferenciação das lesões benignas e malignas. Tal sequência pode ser facilmente inserida no protocolo padrão da ressonância magnética das mamas, sem aumento significativo no tempo de exame.

Our purpose was to study the utility of diffusion-weighted MRI in differentiating benign from malignant breast lesions by assessing the best b values.Forty-five women (mean age, 46.1 years) with 52 focal mass breast lesions underwent diffusion-weighted imaging with different b values. The apparent diffusion coefficient (ADC) value of each lesion was calculated from the ADC maps done using five b values (0, 250, 500, 750, and 1,000 s/mm(2)) and using b values of 0 s/mm(2) with each other b value separately (0 and 250 s/mm(2), 0 and 500 s/mm(2), 0 and 750 s/mm(2), 0 and 1,000 s/mm(2)). The mean ADC values were correlated with imaging findings and histopathologic diagnoses. The cutoff ADC value, sensitivity, and specificity of diffusion-weighted imaging to differentiate benign and malignant lesions were calculated in all b value combinations. A p value of0.05 was considered statistically significant.The mean ADC value was significantly lower for malignant lesions compared to benign lesions (p0.0001) in all b value combinations. No statistical difference was seen between the ADC obtained from different b value combinations (p = 0.2581) in the differentiation between benign and malignant lesions. The ADC calculated from b 0 and 750 s/mm(2) was slightly better than the other b value combinations, showing a sensitivity of 92.3% and a specificity of 96.2%.Diffusion-weighted imaging is a potential resource as a coadjutant of MRI in the differentiation between benign and malignant lesions. Such imaging can be performed without a significant increase in examination time, especially because it can be done with lower b values.

FUNDAMENTO: A avaliação da função ventricular esquerda pode ser limitada pela movimentação anômala do septo interventricular, freqüentemente encontrada após cirurgia de revascularização miocárdica (CRM). A validação do Gated SPECT como ferramenta para avaliação da função ventricular nesse grupo de pacientes é escassa. OBJETIVO: Investigamos a concordância e a correlação entre a fração de ejeção do ventrículo esquerdo (FEVE), o volume diastólico final (VDF) e o volume sistólico final (VDF), obtidos pela cintilografia de perfusão miocárdica tomográfica sincronizada pelo eletrocardiograma (Gated SPECT), com os mesmos parâmetros medidos pela ressonância magnética cardíaca em 20 pacientes submetidos à revascularização miocárdica. MÉTODOS: A correlação foi medida pelo coeficiente de correlação de Spearman (ρ), enquanto a concordância foi avaliada por meio da análise de Bland e Altman. RESULTADOS: Houve uma correlação boa entre o Gated SPECT e a ressonância magnética cardíaca nos pacientes após CRM em relação à fração de ejeção do ventrículo esquerdo (ρ = 0,85; p = 0,0001), uma correlação moderada para o volume sistólico final (ρ = 0,51; p = 0,02) e uma correlação insignificante para o volume diastólico final (ρ = 0,13; p = 0,5). Os limites de concordância para FEVE, VSF e VDF foram: de -20% a 12%; de -38 a 54ml e de -96 a 100ml, respectivamente. CONCLUSÃO: A fração de ejeção do ventrículo esquerdo obtida pelo Gated SPECT correlaciona-se de modo confiável com a da ressonância magnética em pacientes submetidos à CRM. Os volumes ventriculares, entretanto, não apresentam uma correlação adequada. BACKGROUND: The assessment of left ventricular function may be impaired by the abnormal interventricular septal motion frequently found after coronary artery bypass grafting (CABG). Studies on the validation of gated SPECT as a tool for the assessment of left ventricular function in this patient group are scarce. OBJECTIVE: We investigated the agreement and correlation between left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) as obtained using electrocardiogram-gated myocardial perfusion scintigraphy (gated SPECT) and cardiac magnetic resonance imaging in 20 patients undergoing coronary artery bypass grafting. METHODS: Correlation was measured using Spearman's correlation coefficient (ρ). Agreement was assessed using Bland-Altman analysis. RESULTS: A good correlation was found between gated SPECT and cardiac magnetic resonance imaging in patients after CABG with regard to left ventricular ejection fraction (ρ = 0.85; p =0.0001), moderate correlation for end-diastolic volume (ρ = 0.51; p = 0.02), and non-significant correlation for end-diastolic volume (ρ = 0.13; p = 0.5). Agreement ranges for LVEF, ESV and EDV were: -20% to 12%; -38 to 54 ml and; -96 to 100 ml, respectively. CONCLUSION: A reliable correlation was found for left ventricular ejection fraction as obtained by gated SPECT and magnetic resonance imaging in patients undergoing CABG. For ventricular volumes, however, the correlation is not adequate. FUNDAMENTO: La evaluación de la función ventricular izquierda puede limitarse por el movimiento anómalo del septo interventricular, frecuentemente encontrado tras cirugía de revascularización miocárdica (CRM). La validación del Gated SPECT como herramienta para evaluación de la función ventricular en ese grupo de pacientes es rara. OBJETIVO: Investigamos la concordancia y la correlación entre la fracción de eyección del ventrículo izquierdo (FEVI), el volumen diastólico final (VDF) y el volumen sistólico final (VSF), obtenidos con la centellografía de perfusión miocárdica tomográfica sincronizada por electrocardiograma (Gated SPECT), con iguales parámetros medidos por medio de resonancia magnética cardiaca en 20 pacientes sometidos a la revascularización miocárdica. MÉTODOS: Se apuró la correlación mediante el coeficiente de correlación de Spearman (ρ), mientras que se evaluó la concordancia por medio del análisis de Bland y Altman. RESULTADOS: Hubo una correlación positiva entre el Gated SPECT y la resonancia magnética cardiaca en los pacientes tras CRM, con relación a la fracción de eyección del ventrículo izquierdo (ρ = 0,85; p = 0,0001), una correlación moderada para el volumen sistólico final (ρ = 0,51; p = 0,02) y una correlación insignificante para el volumen diastólico final (ρ = 0,13; p = 0,5). Los límites de concordancia para FEVI, VSF y VDF fueron: del -20% al 12%; de -38 a 54ml y de -96 a 100ml, respectivamente. CONCLUSIÓN: La fracción de eyección (FE) del ventrículo izquierdo obtenida por el Gated SPECT se correlaciona de modo confiable con la FE de la resonancia magnética, en pacientes sometidos a CRM. Los volúmenes ventriculares, sin embargo, no presentan una correlación adecuada.

Animal and human clinical studies have indicated that bone marrow (BM) mononuclear cell (MNC) therapy for Chagasic Cardiomyopathy (ChC) is feasible, safe and potentially efficacious. Nevertheless, little is known about the retention of these cells after intracoronary (IC) infusion.Our study investigated the homing of technetium-99m ((99m)Tc) labeled BM MNCs and compared it to thallium-201 ((201)Tl) myocardial perfusion images using the standard 17-segment model. Six patients with congestive heart failure of chagasic etiology were included.Scintigraphic images revealed an uptake of 5.4%±1.7, 4.3%±1.5 and 2.3%±0.6 of the total infused radioactivity in the heart after 1, 3 and 24h, respectively. The remaining activity was distributed mainly to the liver and spleen. Of 102 segments analyzed, homing took place in 36%. Segments with perfusion had greater homing (58.6%) than those with decreased or no perfusion (6.8%), p0.0001. There was no correlation between the number of injected cells and the number of segments with homing for each patient (r=-0.172, p=0.774).These results indicate that (99m)Tc-BM MNCs delivered by IC injection homed to the chagasic myocardium. However, cell biodistribution was heterogeneous and limited, being strongly associated with the myocardial perfusion pattern at rest. These initial data suggest that the IC route may present limitations in chagasic patients and that alternative routes of cell administration may be necessary.

Background The detection of sub-clinical breast lesions has increased with screening mammography. Biopsy techniques can offer precision and agility in its execution, as well as patient comfort. This trial compares radioguided occult lesion localization (ROLL) and wire-guided localization (WL) of breast lesions. We investigate if a procedure at the ambulatorial level (ROLL) could lead to a better aesthetic result and less postoperative pain. In addition, we intend to demonstrate the efficacy of radioguided localization and removal of occult breast lesions using radiopharmaceuticals injected directly into the lesions and correlate radiological and histopathological findings. Methods One hundred and twenty patients were randomized into two groups (59 WL and 61 ROLL). The patients were requested to score the cosmetic appearance of their breast after surgery, and a numerical rating scale was used to measure pain on the first postoperative day. Clearance margins were considered at ≥ 10 mm for invasive cancer, ≥ 5 mm for ductal carcinoma in situ, and ≥ 1 mm for benign disease. Patients were subsequently treated according to the definitive histological result. When appropriate, different statistical tests were used in order to test the significance between the two groups, considering a P value < 0.05 as statistically significant. Results WL and ROLL located all the occult breast lesions successfully. In the ROLL group, the specimen volume was smaller and there were more cases with clear margins (P < 0.05). There were significant differences in mean time of hospital stay between WL and ROLL (21.42 vs. 2.56 hours), but not in operative time (39.4 vs. 29.9 minutes). There were significant differences in the subjective ease of the procedures as rated by the patients (cosmetic outcomes and postoperative pain). Conclusion ROLL is an effective method for the excision of non-palpable breast lesions. It enables more careful planning of the cutaneous incision, leading to better aesthetic results, less postoperative symptoms, and smaller volumes of excised tissue.

The objective of our study was to evaluate the therapeutic potential of bone marrow mesenchymal stromal cells (MSC) in a rat model of severe chronic liver injury. Fourteen female Wistar rats were fed exclusively an alcoholic liquid diet and received intraperitoneal injections of carbon tetrachloride every other day during 15 weeks. After this period, eight animals (MSC group) had 1 × 107 cells injected into the portal vein while six animals (placebo group) received vehicle. Blood analysis was performed to evaluate alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin before cell therapy and 1 and 2 months after cell or placebo infusion. Fibrosis was evaluated before and 1 month after cell or placebo injection by liver biopsies. Two months after cell delivery, animals were sacrificed and histological analysis of the livers was performed. Fibrosis was quantified by histomorphometry. Biopsies obtained before cell infusion showed intense collagen deposition and septa interconnecting regenerative nodules. One month after cell injection, this result was unaltered and differences in fibrosis quantification were not found between MSC and placebo groups. ALT and AST returned to normal values 2 weeks after cell or placebo infusion, without significant differences between experimental groups. Two months after cell or placebo injection, albumin had also returned to normal values and histological results were maintained, again without differences between MSC and placebo groups. Therefore, under our experimental conditions, MSC were unable to reduce fibrosis or improve liver function in a rat model of severe chronic liver injury. Disclosure of potential conflicts of interest is found at the end of this article.

O objetivo deste estudo foi avaliar o fluxo sanguíneo cerebral no córtex cerebelar (4 sub-regiões) e no córtex pré-frontal, em repouso e durante uma tarefa motora. A amostra foi composta por 8 sujeitos saudáveis, ambos os sexos, entre 23 e 36 anos. O grupo foi submetido a tarefa visuo-motora (memória implícita) que consistia na ação de desviar um submarino de supostas minas que percorriam a tela do monitor. Para avaliar a perfusão, foi utilizado o método de análise semi-quantitativa para imagens de SPECT cerebral - 99mTc-ECD. Os resultados evidenciaram aumento de atividade nas áreas de interesse durante a realização da tarefa. Em conclusão, quatro sub-regiões do córtex cerebelar e ambos os hemisférios do córtex pré-frontal apontaram uma ativação simultânea durante a tarefa. Ainda, e conforme estudos prévios, nossos resultados sugerem um modo de operação em paralelo do sistema nervoso central, no intuito de integrar uma informação sensorial e motora. The objective of the present study was to evaluate the cerebral blood flow in the cerebellar (4 sub-regions) and pre-frontal cortex, when subjects were in rest and during a motor task performance. The sample consisted of 8 healthy subjects, male or female, between 23 and 36 of age. The visuo-motor task _ implicit memory _ requires the subjects to navigate and swerve a graphic submarine from missiles that run on the screen. Semi-quantitative analysis with brain SPECT (99mTc-ECD) was used to evaluate regional perfusion. The results revealed an increased activity in all areas of interest during motor task. In conclusion, four sub-regions of cerebellar cortex and both pre-frontal hemispheres showed a simultaneous activation during task. Moreover, our findings suggest as seen in previous experiments that the central nervous system operates in a parallel fashion, in order to integrate sensory and motor information.

OBJETIVO: avaliar a eficiência da localização e exérese por cirurgia radioguiada de lesões ocultas mamárias utilizando radiofármaco injetado diretamente no interior das lesões ou até dois centímetros destas com posterior injeção de ar como controle radiológico. MÉTODOS: vinte e nove pacientes com 32 lesões mamárias ocultas, detectadas por mamografia ou ultra-sonografia, classificadas como Bi-Rads® 3, 4 e 5 foram incluídas neste estudo observacional com resultados expressos em percentagens. O radiofármaco utilizado foi o macroagregado de albumina marcado com tecnécio-99m (99mTc-MAA) injetado por orientação mamográfica ou guiado por ultra-sonografia. A injeção do radiofármaco foi seguida pela imediata administração de ar, através da agulha da estereotaxia, visando o controle radiológico da injeção do radiofármaco. A biopsia excisional foi feita com o auxílio do aparelho portátil gamma-probe (detector de radiação gama) e a remoção completa das lesões foi verificada pela radiografia das peças cirúrgicas ou por exame por congelação intra-operatório. RESULTADOS: câncer de mama foi encontrado em 10% (1/10) das lesões BI-RADS® 3, em 31,5% (6/19) das BI-RADS® 4 e em 66,6% (2/3) das BI-RADS® 5. As 29 pacientes corresponderam a 32 espécimes, cirúrgicos. O radiofármaco foi corretamente posicionado em 96,8% (31/32) dos espécimes permitindo remoção de 96,8% das lesões mamárias não palpáveis estudadas. A completa remoção da lesão foi demonstrada pela radiografia das peças em 23 casos (71,8%), pelo estudo intra-operatório por congelação em 21,8% (7/32) e por ambos os métodos em 6,2% (2/32). CONCLUSÃO: a cirurgia radioguiada é importante instrumento na remoção de lesões mamárias não palpáveis, tratando-se de método simples, rápido e exeqüível que pode ser implementado na rotina clínica dessas pacientes. PURPOSE: to asses the efficiency of the radioguided localization and removal of occult breast lesions using radiopharmaceuticals injected directly into the lesions or close to them with posterior air injection as a radiological control. METHODS: twenty-nine consecutive patients with thirty-two occult breast lesions detected mammographically or by ultrasound, and categorized 3, 4 and 5 BI-RADS®, were included in this observational study with results expressed in percentages. The radiopharmaceutical used was human serum albumin labeled with 99mTc-HSA injected inside or close to the lesion using mammographic or ultrasonographic guidance. The injection of the radiopharmaceutical was followed immediately by air injection through the needle used for stereotaxis as a radiological control of the radiopharmaceutical placement. The excision biopsy was carried out with the aid of a hand-held gamma-detecting probe and the entire removal of the lesion was verified by X-ray of the surgical specimens or by intraoperative frozen section examination. RESULTS: breast cancer was found in 10.0% (1/10) of the 3 BI-RADS® lesions, in 31.5% (6/19) of the 4 BI-RADS® and in 66.6% (2/3) of the 5 BI-RADS®. The radiotracer was correctly positioned in 96.8% of the specimens (31/32) allowing the removal of also 96.8% of the studied non-palpable breast lesions. To show the entire removal, X-ray was used in 23 cases (71.8%), intraoperative frozen section study in 21.8% (7/32) and both methods in 6.2% (2/32). CONCLUSIONS: radioguided surgery showed to be an important tool in the removal of non-palpable breast lesions, as a simple, fast and feasible method that can be implemented in the clinical routine of these patients.

The immunomodulatory effect of juice obtained from leaves of Kalanchoe brasiliensis (Kb) on zymosan-induced inflammation was investigated. C57Bl10 mice received a subcutaneous injection of 150 Ag zymosan in the footpad. After 7 days, there was an increase in footpad thickness from 176F4 to 236F910 2 mm and in blood flow in the footpad area, monitored by 99m Tc, from 98F4 to 694F59 counts per minute (cpm). Zymosan induced a severe infiltration of leukocytes into the articular tissues and a 13-fold increase in the adjacent popliteal lymph node (PLN) weight. Beginning 2 days after the injection, mice were treated daily for 5 days with different concentrations of lyophilised Kb juice dissolved in water. Treatment with 480 mg/kg/day reduced footpad thickness to 193F510 2 mm, leukocyte infiltration and blood flow to 150F18 cpm in the footpad area. PLN weight in zymosan-injected mice decreased from 6.5F0.5 to 1.5F0.4 mg, similarly to the decrease after treatment with indomethacin (3 mg/kg/day). Flow cytometric analysis of lymph node cells showed an important reduction in B cell number in Kb-treated mice. Treatment over a period of 10 days was also effective at reducing zymosan-induced inflammation, even when started 7 days after injection. These data suggest anti-inflammatory and immunosuppressive effects of K. brasiliensis that may account for its popularity in folk medicine against rheumatic diseases. D 2002 Elsevier Science B.V. All rights reserved.