Search

Abstract We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.

Background: The goal of this study was to evaluate the prevalence of depression and anxiety in patients subjected to myocardial perfusion imaging (MPI) with 99mTc tetrofosmin stress-rest single-photon emission computer tomography (SPECT), and their impact on their cardiological events or disease. material and methods: Patients referred to the Nuclear Medicine Department for 99mTc tetrofosmin myocardial MPI-SPECT were asked to fulfill the Zung Self-Rating Depression Scale (ZDS) and Hamilton anxiety questionnaire (HAQ). Among 213 patients who completed the ZDS and HAQ, 80 patients (59 males and 21 females) were selected for this study because they had no known psychological disease, other disease that could influence psychological status, or use of narcotic drugs. Collected data from MPI and psychological status were subsequently analyzed. results: Among all 80 patients, 52 patients (65%) had abnormal MPI of whom 28/52 (53.8%) exhibited either depression, anxiety or both, and 28 (35%) patients had normal MPI of whom 10/28 (35.7%) had abnormal psychological status. The higher number of patients with abnormal psychological status in association with abnormal MPI was noted predominantly in patients with previously established coronary artery disease. A correlation was also noted between obesity, cardiac heredity and depression or anxiety in patients with abnormal MPI. conclusions: Patients that exhibit depression, anxiety, or both, have high rates of myocardial ischemia, and thus are at risk for subsequent cardiological events. [ABSTRACT FROM AUTHOR]

Technetium-99m- diphosphono-1,2-propanodicarboxylic acid ( 99m Tc-DPD) is currently used in Europe for the diagnosis of cardiac amyloidosis, being able to distinguish light chain (AL) from transthyretin (TTR) type. We are reporting obvious spleen visualization in two patients suffering the first from proven TTR and the second from AL type of cardiac amyloidosis, with myocardial uptake-as anticipated-only in the first one. We raise the hypothesis that a common uptake mechanism exists for the spleen amyloid regardless of the type of the disease (AL or TTR), and is possibly different than the cardiac uptake mechanism.

Technetium-99m ( 99m Tc)-labeled pyrophosphate (PYP) and 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) are currently the most established imaging agents for the diagnosis of cardiac amyloidosis, being able to distinguish light chain (AL) from transthyretin (TTR) type of the disease. We present a pattern of increased uptake in all soft tissues, sparing the organs that are usually most affected.

Purpose: The high energy emissions of 123 I and the suboptimal radius of rotation affect the semiquantitative measurements performed during 123 I-FP-CIT tomographic imaging. An in-house extra low cost striatum phantom with brain and striatum compartments was constructed and was used to study the effects of Triple Energy Window scatter correction (TEW-SC) and radius of rotation on the Specific Binding Ratio (SBR) measurements., Materials and Methods: The phantom compartments were filled with radioactive 123 I solutions with varying concentrations, in a series of experiments. Tomographic images were acquired at six different radii of rotation, with and without TEW-SC and the SBRs were calculated using appropriate regions of interest, as in clinical imaging., Results: SBRs decreased with increasing radius of rotation in both non-SC and TEW-SC images, the decrease being more pronounced in the latter. The application of TEW-SC increases SBR values by 40% on average. A maximum %Recovery of 42.7% of the true SBR value was achieved in the non-SC images, which increased to 64.6% after TEW-SC. Appropriate correction factors (CF) were calculated in order to make the SBR values independent on the radius of rotation, which could be used to correct SBR values obtained from tomographic acquisitions with suboptimal radius of rotation., Conclusion: The use of appropriate CF can provide more consistent SBR values and a more meaningful comparison between SBRs calculated from images acquired at different radii of rotation., (Copyright © 2019 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Introduction: The purpose of this study was to investigate the safety of performing a dipyridamole stress test and to explore the incidence of reversible perfusion defects on myocardial perfusion imaging, five to six days after primary percutaneous coronary intervention (PCI)., Methods: Forty-one patients underwent myocardial perfusion imaging using a dipyridamole stress test, five to six days after primary PCI., Results: Headache, chest pain, and dizziness were the most common side effects seen after dipyridamole administration. All occurrences were mild and short lasting. ST changes on the electrocardiogram were also seen in 12% of patients. Reversible perfusion defects occurred in 17%., Conclusions: This is one of the few studies to investigate patients using a dipyridamole stress test early after primary PCI. We conclude that it is safe to perform myocardial perfusion imaging under dipyridamole administration, just a few days after primary PCI. Additionally, a high incidence (17%) of myocardial perfusion defects was seen in this group of patients. According to our investigational protocol, a second myocardial perfusion imaging examination is scheduled for six months later, in order to clarify how many of these patients suffer from restenosis, or whether the finding was merely due to early endothelial dysfunction.

The incidence of carcinomas in thyroglossal duct cysts is extremely low. The vast majority are papillary carcinomas, with only 14 cases of squamous cell carcinomas reported in the literature. A 78 years old male patient presented with an asymptomatic large mass in his anterior neck, considerably immobile, with inflamed overlying skin. Imaging studies confirmed the cystic nature-doughnut shape of the lesion, giving evidence of malignant infiltration of the surrounding tissues, without lymph node enlargement. Fine needle aspiration was positive for a possible squamous cell malignancy. A wide Sistrunk procedure was performed and the mass was excised along with the strap muscles and the infiltrated overlying skin. Histopathology confirmed the diagnosis of a moderately differentiated squamous cell carcinoma. In conclusion, scintigraphy with (99m)Tc-MIBI showed the characteristic doughnut sign. The rarity of this diagnosis along with differential diagnosis dilemmas are the key points of this presentation.

Currently, in patients with malignant melanoma there is no clear cut-off point of Breslow thickness in order to avoid unnecessary lymph node excision surgery, without missing metastatic nodes. We retrospectively studied a cohort of 64 patients, with pathologically proven malignant melanoma, who underwent lymph node scintigraphy and surgical resection of the sentinel node, during the last two years. The patients were divided into 5 groups: Group 1: Ten patients, mean age 46 ± 6 years (range 40-55 years), with Breslow thickness of the lesion 0.51-0.75 mm. Group 2: Eleven patients, mean age 41 ± 9 years (range 31-61 years), with Breslow thickness 0.76-1mm. Group 3: Twelve patients, mean age 59 ± 12 (41-76 years), with Breslow thickness 1.01-1.25 mm. Group 4: Fourteen patients, mean age 61 ± 8 (38-74 years), with Breslow thickness 1.26-1.5mm. Group 5: Seventeen patients, mean age 56 ± 10 (32-71 years), with Breslow thickness >1.5mm. We found only seven infiltrated sentinel lymph nodes. From these, 3 patients belonged to the 5th group (Breslow>1.5mm), two patients to the 4th group (Breslow 1.26-1.5mm), one patient in the 3rd group (Breslow 1.01-1.25 mm) and one patient to the 2nd group (Breslow 0.76-1mm). Since there was no positive sentinel lymph node in any patient with Breslow thickness less than < 0.75 mm, we conclude that sentinel lymph node biopsy in patients with Breslow thickness less than < 0.75 mm may not be useful and might not be carried out, except in high risk cases such as melanomas with ulceration, high mitotic rate and vertical growth phase.

Patients suffering from differentiated thyroid cancer receive suppressive of TSH thyroxine treatment of long duration. This study was undertaken to determine changes on bone serum markers after administration of recombinant human TSH in differentiated thyroid cancer patients on thyroxine treatment. Forty-five patients undergoing diagnostic evaluation of their disease and 48 matched controls were investigated: two injections of 0.9 mg of recombinant human TSH were given to the patients (on days 1 and 2). Blood samples were collected the day before first injection (day 0) and days 3, 5 and 10 after recombinant human TSH administration. Blood samples were obtained for serum TSH, bone alkaline phosphatase, osteocalcin, osteoprotegerin, receptor activator of nuclear factor kB ligand and bone tartrate resistant acid phosphatase. Recombinant human TSH induced a significant increase in bone alkaline phosphatase on day 3 up to day 10 in postmenopausal women. A statistically significant increase was also observed in serum receptor activator of nuclear factor kB ligand in both men and postmenopausal women on day 3 while on day 10 these values returned to baseline levels. No significant effects were seen in other parameters at any time of the investigation. In conclusion, we demonstrated significant increases in receptor activator of nuclear factor kB ligand and bone alkaline phosphatase after TSH stimulation. The changes in these bone indices were more prominent in the group of postmenopausal women.

We report the unusual case of a 29 -year old woman with emotional instability who presented with acute onset chest pain after severe chronic cough. The chest X-ray and the serological tests were normal but the CT scanning, and the bone scanning revealed multiple bilateral rib stress fractures, caused by severe coughing and physical activity and worsened by the patient's emotional instability.