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Surgery and iodine-131 therapy are the primary approaches to the management of differentiated thyroid cancer. Treatment can be optimized by the evaluation of patients' clinical risk and the selection of appropriate diagnostic studies. [ABSTRACT FROM AUTHOR]

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Immunophenotype (IPT) and cytogenetics are essential for diagnosis, risk stratification, and management for ALL., Objectives: Evaluating the burden of immunophenotypic and cytogenetic profile of pediatric ALL patients., Materials and Methods: A descriptive cross-sectional study was conducted on 100 patients of ALL (1-18 completed years) attending a tertiary-care center in Kolkata, Eastern India., Results: Ninety-six percent of patients had B-cell ALL (94.00% pre-B ALL and 2.00% Pro-B ALL) and 4.0% had T-ALL. 60% B-cell ALL were CD19/CD10 positive, 10% were CD79a positive, 9% were only CD19 positive, and 7% were only CD10 positive. Thirty-three percent of T-ALL were CD3+, whereas 22% were positive each for CD4 and CD7. 51.0% of patients had diploid, 46.0% hyperdiploid, and 3.0% hypodiploid karyotype. Among hyperdiploids, 98% had good prednisolone response and 89% had measurable residual disease (MRD) <0.01., Conclusion: The most commonly diagnosed ALL by IPT was pre-B ALL. Among the detectable cytogenetic abnormalities, t(12; 21) ETV6-RUNX1 was the most common. ZNF-384 gene arrangement was also detected in our study. t(12;21) ETV6-RUNX1 had a good treatment response, while t(9;22) BCR-ABL, t(1;19) TCF3-PBX1, iAMP-21, MLL gene rearrangement, and ZNF-384 gene arrangement had poor treatment response in terms of MRD., (Copyright © 2024 Copyright: © 2024 Indian Journal of Public Health.)

Ferrocene (Fc), a classical organometallic complex, has found potential applications in ligand design, catalysis, and analytical, biological, medicinal and materials chemistry. In recent years, the use of Fc as a building block in supramolecular chemistry has emerged. The molecular shape, size, and hydrophobicity of Fc make it an ideal guest for a variety of macrocyclic host molecules to form stable host-guest complexes. The vertical distance (3.3 Å) between two cyclopentadienyl rings and molecular "ball bearing" property in Fc support the formation of intramolecular π-π stacking, H-bonding and metallophilic interactions between two appropriate substituents in 1, n '-disubstituted ferrocenes. Along with these molecular features, the rigidity along with rotational flexibility, redox reversibility and oxidation-triggered tunable hydrophobicity of Fc have led to its use as an exotic building block for the development of a wide range of supramolecular assemblies such as smart molecular receptors, intricate metal-organic assemblies, supramolecular polymers, and gels including out-of-equilibrium assemblies and metal nanoparticle assemblies. This review highlights the concepts behind the design and development of these assemblies, where the Fc unit has a direct and defined role in their formation and function. The use of Fc in supramolecular assembly is still a relatively young field and set to be the subject of increasing research interest towards the development of fascinating supramolecular structures with tailored properties and programmable functions towards applications in materials and biological sciences.

This study comparing the different parameters of children suffering from multisystem inflammatory syndrome in children (MIS-C) in Kolkata, India, during the two waves (July, 2020-January, 2021 and April-July, 2021) showed that the second wave had a higher propensity of Kawasaki disease (KD)-like presentation, cardiac affection and pediatric intensive care unit admission, and increased incidence of use of steroids for treatment.

Objectives: To assess the risk factors of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) and to evaluate the performance of the three Japanese risk-scoring systems, namely the Kobayashi, Egami, and Sano scores in predicting IVIG resistance among the Indian patients., Methods: Prospective observational study on children admitted with KD at Institute of Child Health, Kolkata, over a period of 16 months, from January 2019 to April 2020. The study included 70 KD patients all of whom were treated with IVIG. Clinical parameters, laboratory variables, and risk scores were compared between the IVIG-responsive and the IVIG-resistant groups., Results: A total of 31.4% were IVIG non-responders. Skin rash was found to be significantly associated with IVIG-resistant KD. The IVIG-resistant group had higher total bilirubin, lower albumin, higher CRP levels, and higher ALT and AST levels. High Kobayashi score, high Egami score, and high Sano score were significantly associated with IVIG resistance, individually. Sano score had the highest sensitivity (81.8%) and Kobayashi score had the highest specificity (77.1%) in our cohort., Conclusion: The presence of skin rash, high total bilirubin, high CRP, high AST, high ALT, and low albumin were important predictors of IVIG resistance in our population. Among the three scores, Sano score is the most reliable in identifying potential non-responders to IVIG. But Sano score lacked good specificity. Therefore, Indian KD patients may need an exclusive scoring system to predict non-responsiveness to IVIG so that a more aggressive therapy can be instituted at the earliest. Key points • Early prediction of IVIG-resistant KD is necessary to limit cardiac injuries. • Sano score has high sensitivity to predict IVIG resistance in Indian population., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Extraordinary self-healing efficiency is rarely observed in mechanically strong hydrogels, which often limits the applications of hydrogels in biomedical engineering. We have presented an approach to utilize a special type of graphene oxide-based crosslinker (GOBC) for the simultaneous improvement of toughness and self-healing properties of conventional hydrogels. The GOBC has been prepared from graphene oxide (GO) by surface oxidation and further introduction of vinyl groups. It has been designed in such a way that the crosslinker is able to form both covalent bonds and noncovalent interactions with the polymer chains of hydrogels. To demonstrate the efficacy of GOBC, it was incorporated in a conventional polyacrylamide (PAM) and polyacrylic acid (PAA) hydrogel matrix, and the mechanical and self-healing properties of the prepared hydrogels were investigated. In PAM-GOBC hydrogels, it has been observed that the mechanical properties such as tensile strength, Young's modulus, and toughness are significantly improved by the incorporation of GOBC without compromising the self-healing efficiency. The PAM-GOBC hydrogel with a modulus of about 0.446 MPa exhibited about 70% stress healing efficiency after 40 h. Whereas, under the same conditions a PAM hydrogel with commonly used crosslinker N , N '-methylene-bis(acrylamide) of approximately the same modulus demonstrated no self-healing at all. Similar improvement of self-healing properties and toughness in PAA-GOBC hydrogel has also been observed which demonstrated the universality of the crosslinker. This crosslinker-based approach to improve the self-healing properties is expected to offer the possibility of the application of commonly used hydrogels in many different sectors, particularly in developing artificial tissues., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background: Post-COVID multisystem hyperinflammatory syndrome in children (MISC) has clinical and laboratory similarities with Kawasaki disease (KD). Inflammatory markers like C-reactive protein (CRP), interleukin 6 (IL6) as well as N-terminal probrain natriuretic peptide (NT-proBNP) are elevated in both. This study attempts a comparative analysis of the 3 markers in an attempt at early differentiation for planning appropriate management., Methodology: This analytical study conducted at the Institute of Child Health, Kolkata, India compared the levels of the above 3 markers at admission between 72 patients with KD, 30% of whom had coronary artery lesions (CALs) collected over a period of 18 months (Jan 2017-June 2018), with 71 MISC patients over a period of 6 months (July 2020-December 2020). The non-parametric Mann-Whitney U test was used to test for similarity in distributions of the samples of CRP, NT-proBNP and IL6 in KD and MISC patients using correction factor for similar ranks. The 3 parameters were compared using receiver operating characteristic (ROC) curve analysis., Results: Mean IL6 value in KD was 83.22 pg/mL and in MISC 199.91 pg/mL, which was not found to be statistically significant (P = .322 > .05).However mean NT-proBNP (914.91 pg/mL) with CRP level (96.32 mg/L) in KD was significantly lower (P < .05 for both cases) than that in MISC (9141.16 pg/mL and 145.66 mg/L respectively). ROC analysis showed NT-proBNP has the best sensitivity and specificity in predicting MISC., Conclusion: NT-proBNP and CRP are significantly higher among MISC patients; ROC analysis shows levels >935.7 pg/mL and >99.55 mg/L respectively might act as a guide to differentiate between them., (© 2021 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Arsenic is a highly carcinogenic environmental contaminant. Curcumin, the bioactive component of turmeric, exhibits therapeutic efficacy against several chronic inflammatory and infectious diseases. The present study was carried out to investigate the impact of arsenic on eye lens and evaluate the ameliorative potential of curcumin against arsenic toxicity. Gene expression analysis of α, β, and γ-crystallins and fatty acid profile of lens tissues of arsenic-exposed Labeo rohita was examined and the protective effect of curcumin as diet supplement was evaluated. Curcumin-supplemented diet was prepared at 1.5% and 3% and fed to four groups of fish for 7 days prior to arsenic exposure (at 5 ppm and 15 ppm) for 15 days. Gene expression analysis showed downregulation of α and β-crystallins in the eye lens of arsenic-exposed groups (fed basal diet), whereas the groups fed a curcumin-supplemented diet showed insignificant alterations. Similarly, fatty acid fingerprint of lens lipids arsenic-exposed group exhibited reduction in saturated fatty acid and docosahexaenoic acid (DHA) content. However, in 3% curcumin-supplemented diet-fed and arsenic exposed group group, fatty acid profile remained unchanged. Interestingly, concentration of one non-fatty acid, an antioxidant compound (phenol 2,4-bis 1,1 dimethyl; PD) that was identified in the GC-MS fingerprinting through NIST library (version 2.2, 2014), decreased in response to arsenic exposure which was restored to normal level in curcumin-supplemented groups proving the therapeutic potential of curcumin. The findings of the study suggest that curcumin has a protective effect on eye lens against arsenic toxicity.

The mechanical performances of hydrogels are greatly influenced by the functionality of cross-linkers and their covalent and non-covalent interactions with the polymer chains. Conventional chemical cross-linkers fail to meet the demand of large toughness and high extensibility for their immediate applications as artificial tissues like ligaments, blood vessels, and cardiac muscles in human or animal bodies. Herein, we synthesized a new graphene oxide-based two-dimensional (2D) cross-linker (GOBC) and exploited the functionality of the cross-linker for the enhancement of toughness and stretchability of a poly(acrylic acid) (PAA) hydrogel. The 2D nanosheets of GO were modified in such a way that they could provide multifunctional sites for both physical and chemical bonding with the polymer chains. Carboxylic acid groups at the surfaces of the GO sheets were coupled with the acrylate functional groups for covalent cross-linking, while the other oxygen-containing functional groups are responsible for physical cross-linking with polymers. The GOBC had been successfully incorporated into the PAA hydrogel and the mechanical properties of the GOBC cross-linked PAA hydrogel (PAA-GOBC) were investigated at various compositions of cross-linker. Seven times enhancement in both toughness and elongation at break has been achieved without compromising on the modulus for the as-synthesized PAA-GOBC compared to the conventional N , N '-methylenebis(acrylamide) (MBA) cross-linked PAA hydrogel. This facile and efficient way of GO modification is expected to lead the development of a high-performance nanocomposite for cutting-edge applications in biomedical engineering., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

A combination of strong load-bearing capacity and high swelling degree is desired in hydrogels for many applications including drug delivery, tissue engineering, and biomedical engineering. However, a compromising relationship exists between these two most important characteristics of hydrogels. Improving both of these important properties simultaneously in a single hydrogel material is still beyond the satisfactory limit. Herein, we report a novel approach to address this problem by introducing a silica-based bi-functional 3D crosslinker. Our bi-functional silica nanoparticles (BF-Si NPs) possess amine groups that are able to offer pseudo-crosslinking effects induced by inter-cohesive bonding, and acrylate groups that can form conventional covalent crosslinking in the same hydrogel. We fabricated polyacrylic acid (PAc-Si) and polyacrylamide (PAm-Si) hydrogels using our BF-Si NPs via free radical polymerization to demonstrate this concept. Incorporation of the BF-Si crosslinkers into the hydrogels has resulted in a large enhancement in the mechanical properties compared to conventional hydrogel crosslinked with N , N '-methylene bisacrylamide (MBA). For instance, tensile strength and the toughness increased by more than 6 times and 10 times, respectively, upon replacing MBA with BF-Si in polyacrylamide hydrogel. Moreover, the hydrogels crosslinked with BF-Si exhibited a remarkably elevated level of swelling capacity in the aqueous medium. Our facile yet smart strategy of employing the 3D bi-functional crosslinker for combining high swelling degree and strong mechanical properties in the same hydrogels can be extended to the fabrication of many similar acrylate or vinyl polymer hydrogels., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

The concept of threshold condition factor (Fulton), beyond which more than 50% of the female fish population may attain readiness for spawning coined as pre-spawning fitness (K spawn50 ), has been proposed in the present article and has been estimated by applying the non-parametric Kaplan-Meier method for fitting survival function. A binary coding strategy of gonadal maturity stages was used to classify whether a female fish is "ready to spawn" or not. The proposed K spawn50 has been generated for female Mystus tengara (1.13-1.21 units), M. cavasius (0.846-0.945 units), and Eutropiichthys vacha (0.716-0.799 units). Information on the range of egg parameters (fecundity, egg weight, egg diameter) expected at the pre-spawning stage was also generated. Additional information on species-specific thermal and precipitation window (climate preferendum) within which K spawn50 is attained was also generated through the LOESS smoothing technique. Water temperatures between 31 and 36 °C (M. tengara), 30 and 32 °C (M. cavasius), and 29.5 and 31 °C (E. vacha) and monthly rainfall between 200 and 325 mm (M. tengara), > 250 mm (M. cavasius), and around 50 mm and between 350 and 850 mm (E. vacha) were found to be optimum for attainment of K spawn50 . The importance of parameterization and benchmarking of K spawn50 in addition to other conventional reproductive biology parameters has been discussed in the present article. The purposes of the present study were fulfilled by generating baseline information and similar information may be generated for other species replicating the innovative methodology used in this study.

In this study, a hierarchical nano/microfibrous chitosan/collagen scaffold that approximates structural and functional attributes of native extracellular matrix has been developed for applicability in skin tissue engineering. Scaffolds were produced by electrospinning of chitosan followed by imbibing of collagen solution, freeze-drying, and subsequent cross-linking of two polymers. Scanning electron microscopy showed formation of layered scaffolds with nano/microfibrous architechture. Physicochemical properties of scaffolds including tensile strength, swelling behavior, and biodegradability were found satisfactory for intended application. 3T3 fibroblasts and HaCaT keratinocytes showed good in vitro cellular response on scaffolds thereby indicating the matrices, cytocompatible nature. Scaffolds tested in an ex vivo human skin equivalent wound model, as a preliminary alternative to animal testing, showed keratinocyte migration and wound re-epithelization-a prerequisite for healing and regeneration. Taken together, the herein proposed chitosan/collagen scaffold, shows good potential for skin tissue engineering., (Copyright © 2013 Wiley Periodicals, Inc., a Wiley Company.)

In this study, chitosan-PEO blend, prepared in a 15 M acetic acid, was electrospun into nanofibers (~78 nm diameter) with bead free morphology. While investigating physico-chemical parameters of blend solutions, effect of yield stress on chitosan based nanofiber fabrication was clearly evidenced. Architectural stability of nanofiber mat in aqueous medium was achieved by ionotropic cross-linking of chitosan by tripolyphosphate (TPP) ions. The TPP cross-linked nanofiber mat showed swelling up to ~300% in 1 h and ~40% degradation during 30 day study period. 3T3 fibroblast cells showed good attachment, proliferation and viability on TPP treated chitosan based nanofiber mats. The results indicate non-toxic nature of TPP cross-linked chitosan based nanofibers and their potential to be explored as a tissue engineering matrix., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The tribological properties of alumina ceramic are excellent due in part to a high wettability because of the hydrophilic surface and fluid film lubrication that minimizes the adhesive wear. Such surfaces are further modified with bioactive glass/ceramic coating to promote direct bone apposition in orthopedic applications. The present communication reports the biomimetic coating of calcium hydroxyapatite (HAp) on dense (2-3% porosity) alumina (alpha-Al(2)O(3)) substrate (1cm x 1cm x 0.5 cm), at 37 degrees C. After a total period of 6 days immersion in simulated body fluid (SBF), at 37 degrees C, linear self-assembled porous (pore size: approximately 0.2 microm) structures (length: approximately 375.39 microm and width: 5-6 microm) of HAp were obtained. The phenomenon has been demonstrated by self-assembly and diffusion-limited aggregation (DLA) principles. Structural and compositional characterization of the coating was carried out using SEM with EDX facility, XRD and FT-IR data.

Fluoride contamination of drinking water can disrupt male gametogenesis and steroidogenesis and induce testicular oxidative stress. Treatment of rats with sodium fluoride at the dose of 20 mg/kg/day for 28 days resulted in significant diminution of testicular Delta5,3beta-hydroxysteroid dehydrogenase (HSD) and 17beta-hydroxysteroid dehydrogenase (HSD) activities and low plasma levels of testosterone, follicular stimulating hormone (FSH) and leutinizing hormone (LH). Spermatogenesis inhibited after sodium fluoride treatment has been assessed here by the quantification of different generation of germ cells like spermatogonia A (ASg), preleptotene spermatocyte (PLSc), midpachytene spermatocyte (MPSc) and step 7 spermatid (7Sd) at stage VII of seminiferous epithelial cycle. Furthermore, fluoride treatment was associated with low activities of testicular, prostatic and epididymal catalase (CAT), superoxide dismutase (SOD) and peroxidase along with elevation of malondialdehyde (MDA) and conjugated dienes (CD) in those tissues. Co-administration of calcium and Vitamin-E with fluoride resulted in a significant recovery from testicular disorders and oxidative stress in the testis and male accessory sex organs. The results of this study demonstrate that fluoride exposure, at the dose available in drinking water in contaminated areas, led to inhibition of testicular gametogenesis and steroidogenesis in association with oxidative stress in the testis and male accessory sex organs, which are protected significantly by dietary agents like Vitamin-E and calcium.

Nuclear medicine is directly involved in both the diagnosis and treatment of benign thyroid disease, which requires an understanding of the pathophysiology and management of thyroid disorders in addition to expertise in nuclear methodology. Thyroid uptake and imaging, the principal nuclear tests in thyroid disease, may be used as follows: (1) Differential diagnosis of hyperthyroidism: A very low thyroid uptake suggests destructive ("subacute") thyroiditis, a self-limited disorder, whereas a normal or elevated uptake is consistent with toxic nodular goiter and Graves' disease. Scintigraphic characteristics also help differentiate between nodular and Graves' disease. (2) Function of thyroid nodules: Fine-needle aspiration biopsy with cytological examination (FNAB) is used routinely to assess for malignancy in thyroid nodules. Scintigraphy may be of assistance before FNAB. "Hot" nodules are generally benign and do not require FNAB, while "cold" nodules may be malignant. (3) Differential diagnosis of congenital hypothyroidism: Scintigraphy combined with ultrasound examination may be used to identify such conditions as thyroid agenesis, dyshormonogenesis, and incomplete thyroid descent. Treatment of Graves' disease and toxic nodular disease with (131)I may require greater clinical involvement and decision analysis compared with thyroid uptake and imaging. The following aspects of treatment are particularly important: (1) Risk: Radioiodine treatment may occasionally aggravate hyperthyroidism, Graves' ophthalmopathy, and airway obstruction caused by large, nodular goiters. Alternative treatments, including the temporary use of antithyroid drugs, and surgery for nodular goiters, may be considered. (2) Radioiodine dose: Cure of hyperthyroidism with a single (131)I treatment is desirable, though not always possible. Such factors as a large goiter, severe hyperthyroidism, and prior propylthiouracil therapy, may contribute to treatment failure. (3) Informed consent: A detailed discussion with the patient regarding the clinical risks, outcomes, and side effects of (131)I is a critical component of successful management.

Unlabelled: We compared the diagnostic sensitivities of (123)I and (131)I whole-body imaging in differentiated thyroid cancer., Methods: Twelve thyroidectomized patients (3 previously treated with (131)I) were studied. After a period of thyroid hormone withdrawal, whole-body imaging was performed approximately 24 and 72-96 h after administration of 74-185 MBq (2-5 mCi) (123)I and 111-185 MBq (3-5 mCi) (131)I, respectively., Results: Both (123)I and (131)I revealed residual thyroid tissue, present in 9 patients. (131)I detected metastases in 5 studies of 4 patients. In 4 of 5 studies, (123)I missed metastases shown by (131)I in 8 body regions including the neck, mediastinum, lungs, and bone and detected 3 other sites of metastasis only in retrospect. No lesion was better seen with (123)I than with (131)I., Conclusion: Although (123)I is adequate for imaging residual thyroid tissue, it appears to be less sensitive than (131)I for imaging thyroid cancer metastases.

Purpose: Recombinant human thyroid-stimulating hormone (rhTSH) may be used in lieu of thyroid hormone withdrawal for the evaluation of thyroid cancer. Scintigraphy using the existing rhTSH protocol is performed 48 hours after I-131 administration. The authors investigated the feasibility of whole-body imaging at 72 hours and evaluated thyroid tissue uptake at 48 to 144 hours., Methods: Thirty-two patients who previously had thyroidectomy for thyroid cancer were examined. Whole-body imaging was performed routinely at 48 and 72 hours after I-131 administration. Thyroid tissue was visualized in 12 patients, and large foci were imaged for as long as 144 hours. Activity ratios for thyroid tissue to background were determined for 10 patients., Results: Whole-body images at 48 and 72 hours were comparable, generally with lower background activity at 72 hours, and thyroid tissue was well visualized at all times after 48 hours. Thyroid tissue-to-background activity ratios at 72 to 144 hours were equal to or greater than those at 48 hours in 9 of 10 patients., Conclusions: Recombinant human TSH-aided whole-body scintigraphy is possible 72 hours after I-131 administration, adding flexibility and convenience to the existing protocol and permitting confirmation of findings at 48 hours. Tracer uptake in thyroid tissue persists at later times. Therefore, rapid clearance of background activity appears to be the primary cause of the previously reported decrease in radioiodine retention in euthyroid persons receiving rhTSH.

Unlabelled: Penile scintigraphy with [99mTc]pertechnetate/99mTc-RBCs was performed in patients with sickle cell disease patients who had priapism to assess the role of this imaging procedure in directing the clinical management of these patients., Methods: Fifteen studies were performed in 13 patients who were treated according to a protocol not dependent on the imaging results. The scintigraphic findings of penile vascular perfusion (stagnant or nonstagnant patterns) were collated retrospectively with the form of treatment needed for relief of the condition., Results: Four of five patients with the nonstagnant perfusion pattern responded to analgesics and intravenous hydration. Four of eight patients with the stagnant pattern did not require any aggressive interventions such as corporeal aspiration/irrigation, intracorporeal epinephrine or glans-cavernosa shunt., Conclusion: Whereas the nonstagnant scintigraphic finding appeared to be a favorable indicator for conservative treatment, the stagnant finding was apparently noncontributory. In addition, no correlation was found between these two types of scintigraphic patterns and the subsequent sexual potency of these patients.

We report five pediatric cases that illustrate the methodologic pitfalls and limitations of diuretic renography in suspected ureteropelvic junction obstruction. False-positive studies may be related to such avoidable flaws in methodology as premature diuretic administration, inadequate diuretic dose, and bladder distension, or to recent pyeloplasty. False-negative results may occur despite optimum technique, necessitating a follow-up study for confirmation.

Diuretic renography has proved to be a reliable, noninvasive test for the diagnosis of upper urinary tract obstruction. False positive and false negative results may occur but can be minimized by careful attention to technique. The timing of diuretic administration, state of hydration, and furosemide dosage appear to be the key methodologic variables.

A patient with a nontender testicular mass had sonographic abnormalities compatible with but not entirely typical of a chronic torsion. His scintigraphic studies, done on the same day as ultrasonography and 1 month later, revealed only findings consistent with a very mild subsiding scrotal inflammatory process. On surgical exploration and pathologic examination, it was found that he had an organizing infarct of the testicle secondary to torsion. The clinical history, diagnostic studies, and microscopic slides of the surgical specimen were reviewed. It appeared that tissue granulation and lipogranulomatous changes in the epididymis, known histologic sequelae to the unusually prolonged testicular torsion of 2-3 months, produced scintigraphic findings different from those which have been described for a late or an atrophic torsion.

Previously developed consensus algorithms expressing a suggested radiologic workup for the diagnostic related groups (DRGs) specified by the prospective reimbursement policy have proven to be useful tools for investigating radiologic decision making and the resulting economic implications. The mathematical equations for determining diagnostic and therapeutic costs for two alternative algorithms for suspected acute cholecystitis are formulated. Illustrative examples and graphic displays are given regarding how such algorithms and equations are useful in finding answers to questions about the appropriate diagnostic workup, time, and cost. Exploration of the effect of different parameter values on the choice of the appropriate algorithm is illustrated.

The first synthesis of 131I-19-iodocholesterol had a 10-25% radiochemical impurity that was not iodide ion. This impurity has been identified as 6beta-131I-iodomethyl-19-nor cholest 5(10)-en-3beta-ol (NP-59) and has been synthesized. Tissue distribution studies with 131I-NP-59 in rats and dogs revealed a higher adrenal uptake and adrenal-to-tissue ratios compared to 131I-19-iodocholesterol, probably less in vivo deiodination, and superior adrenal images. A high uptake was seen in the adrenal medulla in addition to that in the cortex. Iodine-131-NP-59 is being evaluated for the early detection of adrenal-cortical disorders and as a potential scanning agent for detecting structural abnormalities of the adrenal medulla.

The hepatic clearance of Tc-99m labeled iminodiacetic acid (IDA) compounds is believed to be impaired in patients with severe hyperbilirubinemia. Competitive inhibition of hepatocyte uptake of IDA by bilirubin has been demonstrated in vitro, but not by clinical scintigraphy. We present a patient with Crigler-Najjar syndrome without evidence of hepatobiliary damage, who demonstrated normal uptake and excretion of Tc-99m DISIDA despite a serum indirect bilirubin level in excess of 30 mg/dl. It is therefore suggested that a markedly elevated serum bilirubin level per se does not inhibit hepatic uptake of Tc-IDA and does not preclude clinically useful scintigraphic examination.

The rare traumatic condition of intra-articular dislocation of the patella in a 12-year-old boy is described, suffered in a fall, when he landed in a hole with his knee bent. Closed reduction by manipulation under general anesthesia failed because the upper pole of the patella was locked deeply in te intercondylar space. Operative reduction using a parapatellar incision in which the patella was levered into position without opening the capsule was followed by functional recovery.

A surprisingly good functional result was achieved by open reduction in a 26-year-old woman with a neglected traumatic dislocation of the hip of fourteen months' duration. After six years the patient was completely symptom-free with a good range of movement and no radiologic evidence of avascular necrosis of the head of the femur. Review of the literature failed to reveal good long-term functional results, with supporting radiographs, of a similar case.

We have reported tissue distribution studies in rats and dogs with a new adrenal imaging agent. 131I-6beta-iodomethyl-19-nor-cholesterol (NP-59). This agent concentrated five times higher in the adrenal cortex than 131I-19-iodocholesterol without increased concentration in non-adrenal tissues. We now report in 34 patients, the findings on scintigraphy with NP-59 compared with angiograms and/or adrenal vein hormone levels and histopathology, including 13 patients with hypercortisolism, 12 with primary aldosteronism, 2 with low renin hypertension, 5 with catecholamine excess, 1 with a liver metastasis from an aldosterone producing adrenal cortical carcinoma, and 1 with anaplastic adrenal cortical carcinoma. NP-59 adrenal cortical uptake was more rapid and intense and background activity was less prominent, allowing earlier and more definite interpretation of images than was possible with 131I-19-iodocholesterol.

Tissue distribution studies were performed in rats and dogs at five time intervals between 10 min and 24 hr after the intravenous injection of one of the following radiolabeled adrenocortical enzyme inhibitors: 3H-amino-glutethimide, 125I-3-iodoaminoglutethimide, 3H-SKF-12185, 125I-3-SKF-12185, 3H-metyrapone. 3H-metyrapol. 3H-amphenone B, and 3H-SU-10603. In rats, 3H-SKF-12185 showed the highest uptake in the whole adrenal (3.5% kg dose/gm at 1 hr). In dogs, 3H-metyrapol showed the highest uptake in the adrenal cortex (9% kg dose/gm at 1 hr), and the peak cortex-to-liver concentration ratio was 57 at 2 hr. These peaks uptakes were comparable to those obtained with the conventional iodocholesterols, but they were reached much earlier, with elimination of most of the adrenal radioactivity by 24 hr. These properties would permit the use of 123I as the label and a higher tracer dose, resulting in a higher photon flux. Thus, the radiolabeled enzyme inhibitors show promise as adrenal-scanning agents, with a markedly shortened scanning procedure, a lower absorbed radiation dose, and better resolution.

Two cases of unstable hemipelvic fractures with internal rotation displacement successfully treated by outward (external lateral) rotation and continuous skeletal traction by wires passed through the crest of the ilium are described. X-rays show both patients before and 2 years after treatment.

A tissue distribution study with 75Se-19-selenocholesterol in rats, rabbits, and dogs showed high adrenal concentrations and good adrenal images. In the dog, higher concentrations were obtained in the adrenal medulla than in the cortex at Days 1 and 7 after dosing. Extraction and thin-layer chromatography of the adrenal lipid in dogs given this compound showed that 75Se in the adrenal is still attached to the steroid moiety. A reduction in production costs is expected from its longer shelf life. Selenium-75-19-selenocholesterol is being evaluated in humans not only for routine use as a adrenal cortex scanning agent, but also for the detection of pheochromocytomas and other sympathetic tissue tumors, especially neuroblastomas.

Forty patients aged 20 years or less who had been treated with 131I after surgery for papillary-follicular thyroid carcinoma were contacted for followup study. Five had died and two were unmarried; the remaining 33 were studied with respect to their subsequent reproductive histories and the health of the offspring. The mean age at the time of the first 131I therapeutic dose was 14.6 years (range 6-20), and the average followup interval, from that first dose until followup, was 18.7 years (range 14-25). The mean total dose of 131I was 196 mCi (range 80-691). The incidences of infertility (12%), miscarriage (1.4%), prematurity (8%), and major congenital anomaly (1.4%) found in this series are not significantly different from those in the general population. Thus, our study offers no overt evidence of genetic damage in children and adolescents treated with high doses of 131I for thyroid carcinoma.

Although radioiodinated cholesterols furnished the first noninvasive imaging of the adrenal glands, it would be desirable to decrease the time for imaging and decrease the radiation dose. The relative tissue distributions of two radiolabeled enzyme inhibitors [3H] metyrapol and I-125-SKF-12185 were studied in dogs and man. Their percentage uptakes and target-to-nontarget ratios were similar. The adrenals of three dogs were imaged sharply at 2 hr after injection with 4--6 mCi of I-131-SKF-12185, confirmed by subsequent imaging with 1 mCi of I-131-6-beta-19-nor cholesterol at 5 days after injection. The use of 1 mCi of I-123-SKF will permit imaging of the adrenals in 1--2 hr and will decrease the radiation dose in the human to 0.76 rads to the adrenal, 0.18 rads to the ovaries and 1.7 rads to the liver.

Gallium-67 citrate scans were obtained in 11 patients considered at risk for extrapulmonary tuberculosis. Radiographic and bacteriologic studies were performed routinely and tissue biopsy selectively. Of five patients with proven extrapulmonary tuberculosis, there were three with renal tuberculosis, one with Pott's disease, and one with peritoneal tuberculosis. The Ga-67 scan correctly predicted presence or absence of active extrapulmonary foci in all 11 patients. Follow-up scans correlated well with clinical response to therapy. The diagnosis of extrapulmonary tuberculosis is often overlooked because of nonspecific symptoms and frequent lack of concurrent lung involvement. Scanning with Ga-67 citrate offers a reliable and simple means of screening patients at risk and of monitoring response to treatment.

A new computer program for adrenal-uptake measurements is presented in which the algorithm identifies the adrenal and background regions automatically after being given a starting point in the image. Adrenal uptakes and results of reproducibility tests are given for patients injected with [131I] 6beta-iodomethyl-19-norcholesterol. The data to date indicate no overlap in the percent-of-dose uptakes for normal patients and patients with Cushing's disease and Cushing's syndrome.