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Prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer is essential for optimal treatment strategy. The current approach of adjuvant or neoadjuvant treatment is based on the molecular subtype. Obesity may have affected chemotherapy response. This study aims to evaluate the relationship between metabolic activity of adipose tissue (AT) and pathological responses to NAC. And to define the association with body mass index (BMI) and metabolic parameters of standardized uptake value (SUV) of adipose tissue measured by positron emission computed tomography (PET/CT).One-hundred and sixteen consecutive patients with stage II and III breast cancer who underwent PET/CT before receiving NAC, were evaluated in the study. Metabolic parameters of visceral adipose tissue (VAT-SUV), subcutaneous adipose tissue (SAT-SUV), and calculated SUV of visceral-to-subcutaneous ratio (V/S-ratio) were regarded. The relationship between SUV of AT and pathologic response was evaluated from medical records retrospectively.Univariate-analysis revealed that good pathological response was significantly associated with clinical stage (P.001), HER-2 positivity (P.001), VAT-SUV (P=.037), VAT-density (P=.043) and V/S-ratio (P=.003). In multivariate-analysis clinical stage, HER-2 positivity and V/S-ratio were found to have statistically effect on pathological response. VAT-volume (P.001), VAT-SUV (P=.016), SAT-volume (P.001) and SAT-SUV (P.001) has positive correlation with BMI value. On the other hand, V/S-ratio (P=.039) and SAT-density (P=.003) has negative correlation with BMI.Metabolic activity of AT is associated with BMI and effected chemotherapy responses. LowV/S ratio was associated with high BMI and poor pathological response to NAC. V/S ratio may be a useful marker for the prediction of NAC responses.

Aim: Radiotherapy plays a significant role in the management of head and neck cancers. However, mucositis and xerostomia are the most common side effects in curative treatment. The aim of this prospective, randomized study is to compare the efficacy of zinc sulphate and amifostine in preventation of radiation induced salivary gland damage in head and neck cancer (HNC) patients using quantitative salivary gland scintigraphy (QSGS). Patients and Methods: Thirty patients with HNC who had received radio±chemotherapy were randomly assigned to receive either zinc sulfate or amifostine. All the patients were once a week during RT for oral mucositis using the Radiation Therapy Oncology Group (RTOG) Acute Radiation Morbidity Scoring criteria, and measurement of body weight. Before and 2 months after treatment, salivary gland scintigraphy was performed. Using the time–activity curves, changes in the maximum uptake (UR) and relative saliva excretion rate (ER) between pre- and post- treatment were calculated. The measurements were statistically compared using paired Mann-Whitney U test. Statistical significance was defined as p < 0.05. Results: The protective effect of zinc sulphate on the salivary glands was similar to amifostine and there were no statistically significant difference in UR, ER results at QSGS, oral mucositis or weight loss between the two groups. Conclusion: The effectiveness of both support therapy was compared and there was no significant difference in efficacy. However, because of the cost difference, the use of the zinc sulphate can be an alternative to amifostine for prevention of xerostomia, oral mucositis and other toxic effects. Further studies with more patients and follow-up are suggested in this regard.

Objective: The purpose of this study was to investigate the efficiency of computed tomography perfusion (CTP), contrast-enhanced computed tomography (CECT) and 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron-emission tomography (PET/CT) in the diagnosis of esophageal cancer. Subjects and Methods: This prospective study consisted of 33 patients with pathologically confirmed esophageal cancer, 2 of whom had an esophageal abscess. All the patients underwent CTP, CECT and PET/CT imaging and the imaging findings were evaluated. Sensitivity, specificity and positive and negative predictive values were calculated for each of the 3 imaging modalities relative to the histological diagnosis. Results: Thirty-three tumors were visualized on CTP, 29 on CECT and 27 on PET/CT. Six tumors were stage 1, and 2 and 4 of these tumors were missed on CECT and PET/CT, respectively. Significant differences between CTP and CECT (p = 0.02), and between CTP and PET/CT (p = 0.04) were found for stage 1 tumors. Values for the sensitivity, specificity and positive and negative predictive values on CTP were 100, 100, 100 and 100%, respectively. Corresponding values on CECT were 93.94, 0, 93.94 and 0%, respectively, and those on PET/CT were 87.88, 0, 93.55 and 0%, respectively. Hence, the sensitivity, specificity and positive and negative predictive values of CTP were better than those of CECT and PET/CT. Conclusion: CTP had an advantage over CECT and PET/CT in detecting small lesions. CTP was valuable, especially in detecting stage 1 tumors.

Background and objective Most lung cancer (LC) patients have metastatic disease at time of diagnosis, which influence the treatment regimen and is the most important prognostic factor. The main purpose of our study was to evaluate the relationship between cell proliferation (Ki-67 label index), p53, transforming growth factor-β (TGF-β) and lysyl oxidase (LOX), and the metastatic stages of different lung cancers. The secondary aim was to correlate these parameters with the standardized uptake value (SUVmax) of the primary lesion during positron emission tomography-computed tomography (PET-CT). Methods Eighty-five treatment-naive patients with LC were enrolled. All patients were examined with PET-CT. Ki-67, p53, TGF-β and LOX were evaluated histopathologically. Results Small cell lung cancer (SCLC) showed the most intense staining in all parameters. A well-differentiated adenocarcinoma (AC) demonstrated a more diffuse and intense staining than squamous cell carcinoma (SCC). There was no statistically significant relationship between the four parameters and metastases of SCLC and SCC. However, a significant relationship between TGF-β, LOX and metastatic AC was demonstrated with regards to diffusivity and intensity. p53 and Ki-67 did not show a significant relationship. No correlation between SCLC and SCC and SUVmax was found. However, in AC, the diffusivity and intensity of the LOX and p53 staining showed a statistically significant relationship to the SUVmax. Conclusions LOX and TGF-β may play roles in metastatic AC. LOX and TGF-β may become markers of metastatic disease and inhibition could be explored for treatment.

This study was carried out to assess the protective bone-sparing effect of carnitine with anti-inflammatory properties on chronic inflammation-induced bone loss in ovariectomised (OVX) rats. A total of 64 rats were divided into eight groups. Sixteen rats were sham-operated (SH) while the others were ovariectomised (OVX). (1) SH, (2) sham + inflammation (SHinf), (3) OVX, (4) ovariectomy + inflammation (OVXinf), (5) OVX + CAR1, (6) OVX + CAR2, (7) OVXinf + CAR1, (8) OVXinf + CAR2. After the ovariectomy surgery, all the groups (3, 4, 5, 6, 7, and 8) were allowed to recover for two months. Sixty days after the OVX, inflammation was induced by subcutaneous injections of talc in groups 2, 4, 7, and 8. Group 5 and 7 were given 50 mg/kg CAR; Group 6 and 8 were given 100 mg/kg CAR from the 60th to the 80th day. Serum levels of TNF-α, IL-1, IL-6, OP, and OC were assessed to determine inflammation and to evaluate osteoblastic activity. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry in femur bones of rats. Carnitine administration was able to restore BMD up to values measured in both the OVX and the SH animals. The serum levels of TNF-α, IL-1β, and IL-6 were increased significantly in the OVXinf rats compared with the SH group. In OVX rats, inflammation which is evaluated by serum cytokine levels exacerbated this bone loss, as supported by values of BMD of the total femur. The two different doses of carnitine reduced bone loss and improved inflammatory biomarkers.

Objective To examine whether (1) levels of urinary kidney injury molecule-1 (KIM-1), a transmembrane protein and biomarker for renal tubular damage, increase in children with of vesicoureteral reflux (VUR), and (2) if KIM-1 predicts the grade of renal scarring in children with VUR. Methods The study included 59 VUR patients with renal scarring, 5 VUR patients without renal scarring and 25 healthy controls aged 1 to 17 years. Dimercaptosuccinic acid scans were performed for determination of scarring and graded by 3 independent, blinded pediatric urologists for renal scarring according to the Randomized Intervention for Children with VUR study criteria. Spot urine samples were obtained. Urinary KIM-1 and creatinine levels were measured and the KIM-1/creatinine ratio was calculated. Results Urine geometric mean KIM-1 levels (ng/mg creatinine) were significantly higher in VUR patients than in healthy controls ( P = .018). Although the correlation between VUR grade and geometric mean KIM-1 levels was not significant, a positive correlation was found for scarring grade and geometric mean KIM-1 levels ( r = .30, P = .02). When the patients were divided by subgroups according to scarring grade (group I, grade 1; group II, grades 2 and 3; group III, grade 4), the log KIM-1 in group III was significantly higher than in group I ( P = .004). Conclusion Urinary KIM-1 levels might be used as a noninvasive marker, particularly in showing severe scarring in children with VUR.

Background/aim: Accurate measurement of glomerular filtration rate (GFR) in the evaluation of renal functions in potential kidney donors is associated with important outcomes for both the donor and recipient. We intended to determine the efficacy of various methods while estimating GFR in potential living kidney donors. Materials and methods: Fifty-three potential kidney donors (31 females, 22 males; mean age: 50.1 years) were included in this study. GFR was estimated simultaneously using the following methods: Gates? method, Cockcroft?Gault (CG) and modification of diet in renal disease (MDRD) prediction equations, and the two-plasma sample (TPS) technique. Using TPS as the reference method, the estimations of GFR with the other methods were compared with that of TPS. Results: The mean ± SD GFR was 86.43 ± 11.37 mL min?1 1.73 m?2 with TPS. GFR values calculated using Gates? method and MDRD 1, MDRD 2, reexpressed MDRD, and CG prediction equations were 105.25 ± 16.12 mL min?1 1.73 m?2, 114.63 ± 32.51 mL min?1 1.73 m?2, 113.2 ± 35.23 mL min?1 1.73 m?2, 104.23 ± 23.12 mL min?1 1.73 m?2, and 99.35 ± 20.01 mL min?1 1.73 m?2, respectively. While there was a strong statistically significant correlation between the TPS and Gates' methods, moderate correlation was found between TPS and the MDRD 1, MDRD 2, and reexpressed MDRD prediction equations. Conclusion: Our results indicated that the performance of Gates' method in total GFR estimation was better than the prediction equations in potential kidney donors.

Background/aim: Isotretinoin is an effective drug utilized in the management of acne vulgaris and is known to cause dry mouth. In this study, we aimed to evaluate this effect of isotretinoin on the salivary gland function in patients with acne vulgaris using technetium-99m (Tc-99m) pertechnetate imaging of the salivary glands. Materials and methods: The study population consisted of 28 patients with acne vulgaris (6 males and 22 females, mean age 20.2 ± 2.3 years), who were treated with isotretinoin for 6 months. We performed radionuclide imaging of the salivary glands pretreatment and at months 3 and 6 of treatment. After 185 MBq (5 mCi) of Tc-99m pertechnetate was intravenously administered, imaging of the salivary glands was performed over a 25-min period. We measured the following glandular function parameters for the parotid and submandibular salivary glands via time-activity curves: uptake ratio, maximum accumulation, and ejection fraction. Results: Statistically significant differences were observed in the values obtained at months 3 and 6 of treatment, compared with the pretreatment values. Conclusion: This study demonstrated that radionuclide imaging of the salivary glands can clearly show the glandular functions that are affected by drugs such as isotretinoin.

Vesicoureteral reflux (VUR) is a well-recognized condition in the pediatric population, but is less well described in the adult population, and its prevalence decreases with increasing age. We describe the case of a 53-year-old male with nonfunctional kidney in which accumulation of radioactivity was observed in the ureter and renal pelvis owing to VUR, which was detected by technetium-99m diethylenetriamine pentaacetic acid dynamic renal scintigraphy.

The aim of this study was to evaluate the possible favorable effect of desloratadine-montelukast combination on salivary glands (SG) function in patients with allergic rhinitis (AR) using SG scintigraphy. The study population consisted of 64 patients with AR and 28 healthy controls: 14 males and 14 females, with mean age 32.3±8.6 years. The patients were divided into two groups: the untreated patients group of 32 patients, 16 males and 16 females, mean age 28.5±5.4 years and the treated group, who received the standard clinically recommended oral dose of montelukast 10mg/d and desloratadine 5mg/d for 6 weeks. This group consisted of 32 patients, 16 males and 16 females, mean age 38.3±8.4 years. All patients and healthy controls underwent SG scintigraphy. After the intravenous injection of technetium-99m pertechnetate, ((99m)Tc-P), dynamic SG scintigraphy was performed for 25min. Using the time-activity curves, the following glandular function parameters were calculated for the parotid and the submandibular SG: uptake ratio, maximum accumulation and ejection fraction. Results showed SG hypofunction. All functional parameters obtained for the untreated patients and for the desloratadine-montelukast treated patients were significantly lower than those in healthy controls (P0.05). There was no statistically significant difference between treated and untreated patients (P0.05). In conclusion, our study showed that hypofunction of SG was present in all patients with AR. This hypofunction, as tested by semi-quantitative SG scintigraphy, and also the quality of life did not improve after treatment with montelukast and desloratadine.

Most lung cancer (LC) patients have metastatic disease at time of diagnosis, which influence the treatment regimen and is the most important prognostic factor. The main purpose of our study was to evaluate the relationship between cell proliferation (Ki-67 label index), p53, transforming growth factor-β (TGF-β) and lysyl oxidase (LOX), and the metastatic stages of different lung cancers. The secondary aim was to correlate these parameters with the standardized uptake value (SUVmax) of the primary lesion during positron emission tomography-computed tomography (PET-CT).Eighty-five treatment-naive patients with LC were enrolled. All patients were examined with PET-CT. Ki-67, p53, TGF-β and LOX were evaluated histopathologically.Small cell lung cancer (SCLC) showed the most intense staining in all parameters. A well-differentiated adenocarcinoma (AC) demonstrated a more diffuse and intense staining than squamous cell carcinoma (SCC). There was no statistically significant relationship between the four parameters and metastases of SCLC and SCC. However, a significant relationship between TGF-β, LOX and metastatic AC was demonstrated with regards to diffusivity and intensity. p53 and Ki-67 did not show a significant relationship. No correlation between SCLC and SCC and SUVmax was found. However, in AC, the diffusivity and intensity of the LOX and p53 staining showed a statistically significant relationship to the SUVmax.LOX and TGF-β may play roles in metastatic AC. LOX and TGF-β may become markers of metastatic disease and inhibition could be explored for treatment.

Chronic renal failure and its treatment can induce oral health problems and salivary glands dysfunction. The purpose of this study was to assess salivary glands function in patients with kidney transplantation using technetium-99m pertechnetate ((99m)Tc-P) salivary glands scintigraphy. We prospectively studied 34 patients with kidney transplantation (30 males and 4 females,mean age 39.76±11.6 years) and 28 healthy controls (12 males and 16 females, mean age 36.1±9.5 years). Salivary gland scintigraphy was performed nearly 4.4±2.9 years after successful kidney transplantation. Dynamic salivary glands scintigraphy was performed during 25min after the intravenous administration of 185MBq of (99m)Tc-P. Time-activity curves and glands functional parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation of the radionuclide, and excretion fraction. Statistical analysis of the functional parameters showed no significant differences between patients with kidney transplantation and healthy controls (P0.05). In conclusion, this study showed that using (99m)Tc-P salivary gland scintigraphy, salivary glands function of patients with successful kidney transplantation do not differ statistically from those in healthy controls.

A 55-year-old woman presented to the emergency department with a 3-week history of progressive fatigue and dyspnea and recurrent hemoptysis. A contrast-enhanced computed tomographic (CT) image of her chest showed multiple arteriovenous malformations (AVMs), with the largest in the posterior left upper lobe (Figs 1A, 1B; * pulmonary AVMs; FA feeding artery; DV drainage vein; AO aorta; PT pulmonary trunk). In the CT scan of the patient’s liver, axial early arterial phase image showed abnormal perfusion as a result of the AVM (Fig 2A; AO aorta; IVC inferior vena cava; the AVM in the falciform ligament between the braces; arrows show the focal telangiectasis). A maximum-intensity-projection reconstructed sagittal image showed a small telangiectasis and the early opacification of left hepatic vein caused by the presence of intraparenFig 1.

The present study gives a detailed report of a patient with atypical Cogan's syndrome with uveitis and sensorineural hearing loss. Cogan's syndrome is characterized by nonsyphilitic interstitial keratitis and audiovestibular dysfunction. This syndrome can be divided into two groups, typical and atypical, based on the presence of interstitial keratitis. It may sometimes be associated with systemic vasculitis. Fluoro-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) scanning was used to investigate the presence of vasculitis. With FDG-PET/CT scanning, there is no pathological involvement in the walls of the arteries; thus the patient is protected from aggressive and long term immunosuppressive treatment's side effects. Hence, we can conclude that FDG-PET/CT may play an important role in excluding the presence of vasculitis.Çalışmamızda sensorinöral işitme kaybı ve üveiti olan atipik Cogan sendromlu bir hastayı detaylı bir şekilde ele aldık. Cogan sendromu nonsifilitik interstisyel keratit ve odiovestibuler disfonksiyon ile karakterize bir hastalıktır. Interstisyel keratitin varlığına göre Cogan sendromu tipik ve atipik olmak üzere iki gruba ayrılabilir. Bu sendroma bazen sistemik vaskülit eşlik edebilir. Fluoro-D-glucose-positron emission tomografi/bilgisayarlı tomografi (FDG-PET/BT) taraması sistemik vaskülit varlığının araştırılması amacı ile kullanılabilir. Bu amaçla hastaya yapılan FDG-PET/BT taraması ile arter duvarlarında patolojik bulgu saptanmadı. Böylece hasta uzun süreli ve agresif immünsüpresif tedavinin yan etkilerinden korunmuş oldu. Vaskülit varlığını dışlamada FDG-PET/BT taramasının önemli bir yeri olduğunu söyleyebiliriz.

We report a case of a patient with hepatocellular carcinoma (HCC) who presented with back pain related to bone metastasis. HCC metastasizes by hematogenous and lymphatic routes commonly to the lungs, regional lymph nodes, kidney, bone marrow and adrenals. In this extremely rare case, the patient had no known liver disease, but presented with liver lesions and multiple bone lesions involving vertebrae, ribs, pelvic bones and left femur with associated expansile soft-tissue components. These bone lesions were first detected from a positron emission tomography scan. Pathological examination of biopsy material taken from the left eighth rib confirmed metastatic HCC. In conclusion, if a patient has expansile osteolytic bone lesions, bone metastasis from HCC should be included in the differential diagnosis.