Erdheim-Chester disease is an uncommon non-Langerhans-cell histiocytosis, due to excessive produc... more Erdheim-Chester disease is an uncommon non-Langerhans-cell histiocytosis, due to excessive production of histiocytes deposited in various organs and tissues in the human body. FDG PET was performed in a 68-year-old man with documented active Erdheim-Chester disease to evaluate the extent of the disease. The patient was previously treated with high-dose subcutaneous Interferon α2b, 1,000,000 units 3 times a week, but treatment was interrupted approximately 5 weeks before evaluation at the National Institutes of Health because of adverse effects of the medication. FDG PET/CT showed lesions were imaged in brain, heart, mediastinum, abdomen, and skeleton.
Objective: To investigate any abnormalities of the menstrual cycle and/or pregnancy in women Ͻ40 ... more Objective: To investigate any abnormalities of the menstrual cycle and/or pregnancy in women Ͻ40 years old who had received radioiodine (I-131) therapy for thyroid cancer. Design: Case-control study. Setting: General military hospital in Athens, Greece. Patient(s): Forty-five women of childbearing age with thyroid cancer that were treated with I-131 from December 1996 to May 2003 were compared to 83 age-matched control females. Intervention(s): The patients' charts were reviewed, and in addition patients were contacted by telephone and asked detailed questions about their previous gynecologic history and any problems after treatment (menstrual cycle and pregnancy). Main Outcome Measure(s): Abnormalities of menstrual cycle and/or pregnancy. Result(s): Overall, 14 of 45 women (31.1%) had menstrual cycle irregularities after treatment. Eight patients (17.8%) had normal menstrual cycles before therapy and six (13.3%) had pretreatment menstrual cycle irregularities that persisted or were exaggerated after therapy. In the control group, 12 of 83 women (14.5%) reported menstrual cycle irregularities. The patients' menstrual cycle and menses irregularities were significantly increased after I-131 therapy (Pϭ.02) compared with the control group and seemed to increase with age. After therapy a total of seven children were borne by 6 of the 45 patients (13.3%). No premature births or miscarriages were noted.
The I-131 whole-body scan is a useful test to investigate the presence of metastatic disease of t... more The I-131 whole-body scan is a useful test to investigate the presence of metastatic disease of thyroid cancer after thyroidectomy. A 53-year-old woman received I-131 4 months after total thyroidectomy for papillary thyroid carcinoma for postsurgical ablation of the residual tumor cells. Whole-body scan demonstrated focal uptake of I-131 in the right iliac fossa that persisted 2 days later even after administration of laxatives. Computed tomography of this area showed only focal bowel scar presumably resulting from a complicated appendectomy 31 years ago. Intestinal adhesions accumulate I-131 and give false-positive activity on whole-body I-131 scans.
In gliomas, germline gene alterations play a significant role during malignant transformation of ... more In gliomas, germline gene alterations play a significant role during malignant transformation of progenitor glialcells,atleastforfamilieswithoccurrenceofmultiple cancers or with specific hereditary cancer syndromes. Scientific evidence during the last few years has revealed several constitutive genetic abnormalities that may influ- encegliomaformation.Thesegermlineabnormalitiesare manifested as either gene polymorphisms or hemizygous mutationsofkeyregulatorygenesthatareinvolvedeither in DNA repair or in apoptosis. Such changes, among others, include hemizygous alterations
European journal of clinical investigation, Jan 31, 2015
Identification of etiology for fever of unknown origin (FUO) is challenging, due to the high rate... more Identification of etiology for fever of unknown origin (FUO) is challenging, due to the high rates of undiagnosed cases. The current diagnostic approach includes initially first line procedures such as general examination and various laboratory tests and basic imaging techniques followed by second line tests such as more advanced imaging techniques including (18) F flurodeoxyglucose positron emission tomography (FDG PET) and tissue biopsies. If no diagnosis is obtained more invasive measures may be in order such as liver biopsy and exploratory laparotomy. This review article is based on the relative published material found on MEDLINE and PubMed up to August 2014. We looked for the terms "fever of unknown origin, FDG PET" in combination with "cancer, infection, autoimmune disease". Several clinical studies have investigated the utility of the FDG PET during the diagnostic approach of FUO. Recent evidence suggests that FDG PET has the advantage of total body imagi...
Primary vesicoureteric reflux (VUR) is the most common inherited structural urinary tract disorde... more Primary vesicoureteric reflux (VUR) is the most common inherited structural urinary tract disorder, conforming closely to autosomal dominant transmission. A pair of monozygotic siblings is described exhibiting a remarkably parallel clinical course. VUR grade II was diagnosed in girl A during urinary tract infection at the age of 2 yr; screening of her asymptomatic sister (girl B) revealed the same. Renal cortical scintigraphy unveiled unilateral hypo-dysplasia in both the twins. Despite trimethoprime-sulfamethoxazole prophylaxis, infection recurred in girl A after 7 months, while girl B had a first episode 2 months later that prompted regimen switch to nitrofurantoin. Follow-up at the age of 4 depicted bilateral reflux deterioration; an urodynamics study that followed revealed functional bladder instability in both girls and the oral antispasmodic oxybutynin was initiated with good results. Evaluation for reflux should be prompt in infants with urinary infection. Patient siblings display a higher relative reflux risk, being highest in identical twins. Heredity issues, the impact of age and dysfunctional voiding in the clinical course, and the contribution of nuclear medicine in VUR management are discussed.
Purpose: To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients emp... more Purpose: To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients employing myocardial perfusion imaging (MPI) with Tc-99 m Tetrofosmin -single photon emission computer tomography (T-SPECT).
Paraneoplastic neurological syndromes are immune-mediated effects of cancer that involve the nerv... more Paraneoplastic neurological syndromes are immune-mediated effects of cancer that involve the nervous system and are associated with various anti-neuronal antibodies. They can be associated with several cancers such as lung, gynecologic, thymic, testicular and others, but the diagnosis of cancer often becomes a challenge, since paraneoplastic neurological syndromes usually precede the cancer presentation by months or even years. Furthermore, even when the cancer develops, the tumor size remains small and usually undetectable by conventional diagnostic tests and imaging. Positron emission tomography imaging may be an adjunct to timely diagnosis of the occult malignancy in order to employ the specific cancer treatment. Furthermore, positron emission tomography can assess the extent of the functional abnormality in the brain and monitor its response to treatment.
Multiple sclerosis (MS) may be associated with reduced bone mass and higher frequency of osteopor... more Multiple sclerosis (MS) may be associated with reduced bone mass and higher frequency of osteoporosis. Femoral and spinal bone mineral density (BMD) in 70 ambulatory MS patients (46 females and 24 males) was compared with 100 sex-, age-, and BMI-matched control individuals. BMD was reduced in male patients (lumbar spine 0.976 ± 0.114 g/cm(2) compared with 1.059 ± 0.147 g/cm(2) in controls, p = 0.024, total hip 0.946 ± 0.136 g/cm(2) compared to 1.036 ± 0.118 g/cm(2) in controls, p = 0.008, femoral neck 0.812 ± 0.136 g/cm(2) compared with 0.887 ± 0.135 g/cm(2) in controls p = 0.042), and only in the total hip in female patients (0.88 ± 0.127 g/cm(2) compared with 0.935 ± 0.112 g/cm(2) in controls, p = 0.018). Multivariate analysis demonstrated that the predominantly affected site was the hip. MS patients exhibit increased frequency of low bone mass compared with controls. Further studies should assess the etiologic factors and employ appropriate therapies.
Multiple sclerosis (MS) is associated with reduced bone mass and higher frequency of osteoporosis... more Multiple sclerosis (MS) is associated with reduced bone mass and higher frequency of osteoporosis. Although high-dose short-term intravenous glucocorticoid regimens cause a decrease in bone formation, this effect is usually reversible and osteoporosis in MS patients may be independent of the short-term corticosteroid treatment. Clinical evidence suggests an important role of vitamin D as a modifiable risk factor in MS. Low circulating levels of vitamin D have been found in MS patients, especially during relapses, suggesting that vitamin D could be involved in the regulation of the clinical disease activity. Vitamin D mediates its function through a single vitamin D receptor (VDR). Polymorphisms of the VDR have major effects on vitamin D function and metabolism, and some VDR genotypes have been linked to osteoporosis and MS. Because the safety of high doses of vitamin D has not been established yet, vitamin D hasn't been used in enough doses to increase the serum level to a desired therapeutic target. Future clinical trials should determine the upper limit of vitamin D intake in order to achieve therapeutic benefit in MS patients.
Meningioma is a common intracranial tumor, originating from the meninges of the skull or spinal c... more Meningioma is a common intracranial tumor, originating from the meninges of the skull or spinal canal. Most meningiomas are benign tumors, however atypical or anaplastic tumors can be found in 6% of cases. Patients with asymptomatic small benign meningiomas can be followed without therapy, but in symptomatic patients complete surgical resection should be performed. For recurrent previously resected tumors re-resection is recommended followed by radiotherapy in selected cases. Antiprogesterone treatment can also be considered in recurrent benign meningiomas. Immunotherapy with interferon-alpha and chemotherapy should be reserved for all cases of recurrent meningiomas (benign, atypical, and malignant) when all the standard therapies have failed or contraindicated.
Background: Polymorphisms of the vitamin D receptor (VDR) gene have been linked to both multiple ... more Background: Polymorphisms of the vitamin D receptor (VDR) gene have been linked to both multiple sclerosis (MS) and osteoporosis. We examined the frequency of the Taq-I and Bsm-I polymorphisms of the vitamin D receptor (VDR) gene in 69 patients with MS and 81 age and sex-matched healthy individuals. Genotyping of Taq-I (rs731236) and Bsm-I (rs1544410) was performed using TaqMan ® SNP Genotyping Assay. All patients and controls had determination of body mass index (BMI), bone mineral density (BMD) and smoking history. Results: The mean age of patients was 39 ± 10.5 years compared to 38.7 ± 10.7 years of the controls (p = 0.86), the BMI was 24.8 ± 4.2 kg/m 2 compared to 25.7 ± 4.8 kg/m 2 of the controls (p = 0.23), the BMD in the lumbar spine 0.981 ± 0.15 compared to 1.025 ± 013 of the controls (p = 0.06) and the total hip BMD was 0.875 ± 0.14 compared to 0.969 ± 0.12 of the controls (p < 0.001). There were no differences of the Taq-I (TT, CT, CC) and Bsm-I genotypes (GG, GA, AA) and allelic frequencies between MS and control individuals. Multivariate analysis also failed to show any association of the Taq-I and Bsm-I polymorphisms and MS or sex, BMI, BMD and smoking history. Conclusions: This study suggests that the Taq-I and Bsm-I polymorphisms of the VDR gene are not associated with MS risk, BMI or BMD in the Greek population studied.
Erdheim-Chester disease is an uncommon non-Langerhans-cell histiocytosis, due to excessive produc... more Erdheim-Chester disease is an uncommon non-Langerhans-cell histiocytosis, due to excessive production of histiocytes deposited in various organs and tissues in the human body. FDG PET was performed in a 68-year-old man with documented active Erdheim-Chester disease to evaluate the extent of the disease. The patient was previously treated with high-dose subcutaneous Interferon α2b, 1,000,000 units 3 times a week, but treatment was interrupted approximately 5 weeks before evaluation at the National Institutes of Health because of adverse effects of the medication. FDG PET/CT showed lesions were imaged in brain, heart, mediastinum, abdomen, and skeleton.
Objective: To investigate any abnormalities of the menstrual cycle and/or pregnancy in women Ͻ40 ... more Objective: To investigate any abnormalities of the menstrual cycle and/or pregnancy in women Ͻ40 years old who had received radioiodine (I-131) therapy for thyroid cancer. Design: Case-control study. Setting: General military hospital in Athens, Greece. Patient(s): Forty-five women of childbearing age with thyroid cancer that were treated with I-131 from December 1996 to May 2003 were compared to 83 age-matched control females. Intervention(s): The patients' charts were reviewed, and in addition patients were contacted by telephone and asked detailed questions about their previous gynecologic history and any problems after treatment (menstrual cycle and pregnancy). Main Outcome Measure(s): Abnormalities of menstrual cycle and/or pregnancy. Result(s): Overall, 14 of 45 women (31.1%) had menstrual cycle irregularities after treatment. Eight patients (17.8%) had normal menstrual cycles before therapy and six (13.3%) had pretreatment menstrual cycle irregularities that persisted or were exaggerated after therapy. In the control group, 12 of 83 women (14.5%) reported menstrual cycle irregularities. The patients' menstrual cycle and menses irregularities were significantly increased after I-131 therapy (Pϭ.02) compared with the control group and seemed to increase with age. After therapy a total of seven children were borne by 6 of the 45 patients (13.3%). No premature births or miscarriages were noted.
The I-131 whole-body scan is a useful test to investigate the presence of metastatic disease of t... more The I-131 whole-body scan is a useful test to investigate the presence of metastatic disease of thyroid cancer after thyroidectomy. A 53-year-old woman received I-131 4 months after total thyroidectomy for papillary thyroid carcinoma for postsurgical ablation of the residual tumor cells. Whole-body scan demonstrated focal uptake of I-131 in the right iliac fossa that persisted 2 days later even after administration of laxatives. Computed tomography of this area showed only focal bowel scar presumably resulting from a complicated appendectomy 31 years ago. Intestinal adhesions accumulate I-131 and give false-positive activity on whole-body I-131 scans.
In gliomas, germline gene alterations play a significant role during malignant transformation of ... more In gliomas, germline gene alterations play a significant role during malignant transformation of progenitor glialcells,atleastforfamilieswithoccurrenceofmultiple cancers or with specific hereditary cancer syndromes. Scientific evidence during the last few years has revealed several constitutive genetic abnormalities that may influ- encegliomaformation.Thesegermlineabnormalitiesare manifested as either gene polymorphisms or hemizygous mutationsofkeyregulatorygenesthatareinvolvedeither in DNA repair or in apoptosis. Such changes, among others, include hemizygous alterations
European journal of clinical investigation, Jan 31, 2015
Identification of etiology for fever of unknown origin (FUO) is challenging, due to the high rate... more Identification of etiology for fever of unknown origin (FUO) is challenging, due to the high rates of undiagnosed cases. The current diagnostic approach includes initially first line procedures such as general examination and various laboratory tests and basic imaging techniques followed by second line tests such as more advanced imaging techniques including (18) F flurodeoxyglucose positron emission tomography (FDG PET) and tissue biopsies. If no diagnosis is obtained more invasive measures may be in order such as liver biopsy and exploratory laparotomy. This review article is based on the relative published material found on MEDLINE and PubMed up to August 2014. We looked for the terms "fever of unknown origin, FDG PET" in combination with "cancer, infection, autoimmune disease". Several clinical studies have investigated the utility of the FDG PET during the diagnostic approach of FUO. Recent evidence suggests that FDG PET has the advantage of total body imagi...
Primary vesicoureteric reflux (VUR) is the most common inherited structural urinary tract disorde... more Primary vesicoureteric reflux (VUR) is the most common inherited structural urinary tract disorder, conforming closely to autosomal dominant transmission. A pair of monozygotic siblings is described exhibiting a remarkably parallel clinical course. VUR grade II was diagnosed in girl A during urinary tract infection at the age of 2 yr; screening of her asymptomatic sister (girl B) revealed the same. Renal cortical scintigraphy unveiled unilateral hypo-dysplasia in both the twins. Despite trimethoprime-sulfamethoxazole prophylaxis, infection recurred in girl A after 7 months, while girl B had a first episode 2 months later that prompted regimen switch to nitrofurantoin. Follow-up at the age of 4 depicted bilateral reflux deterioration; an urodynamics study that followed revealed functional bladder instability in both girls and the oral antispasmodic oxybutynin was initiated with good results. Evaluation for reflux should be prompt in infants with urinary infection. Patient siblings display a higher relative reflux risk, being highest in identical twins. Heredity issues, the impact of age and dysfunctional voiding in the clinical course, and the contribution of nuclear medicine in VUR management are discussed.
Purpose: To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients emp... more Purpose: To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients employing myocardial perfusion imaging (MPI) with Tc-99 m Tetrofosmin -single photon emission computer tomography (T-SPECT).
Paraneoplastic neurological syndromes are immune-mediated effects of cancer that involve the nerv... more Paraneoplastic neurological syndromes are immune-mediated effects of cancer that involve the nervous system and are associated with various anti-neuronal antibodies. They can be associated with several cancers such as lung, gynecologic, thymic, testicular and others, but the diagnosis of cancer often becomes a challenge, since paraneoplastic neurological syndromes usually precede the cancer presentation by months or even years. Furthermore, even when the cancer develops, the tumor size remains small and usually undetectable by conventional diagnostic tests and imaging. Positron emission tomography imaging may be an adjunct to timely diagnosis of the occult malignancy in order to employ the specific cancer treatment. Furthermore, positron emission tomography can assess the extent of the functional abnormality in the brain and monitor its response to treatment.
Multiple sclerosis (MS) may be associated with reduced bone mass and higher frequency of osteopor... more Multiple sclerosis (MS) may be associated with reduced bone mass and higher frequency of osteoporosis. Femoral and spinal bone mineral density (BMD) in 70 ambulatory MS patients (46 females and 24 males) was compared with 100 sex-, age-, and BMI-matched control individuals. BMD was reduced in male patients (lumbar spine 0.976 ± 0.114 g/cm(2) compared with 1.059 ± 0.147 g/cm(2) in controls, p = 0.024, total hip 0.946 ± 0.136 g/cm(2) compared to 1.036 ± 0.118 g/cm(2) in controls, p = 0.008, femoral neck 0.812 ± 0.136 g/cm(2) compared with 0.887 ± 0.135 g/cm(2) in controls p = 0.042), and only in the total hip in female patients (0.88 ± 0.127 g/cm(2) compared with 0.935 ± 0.112 g/cm(2) in controls, p = 0.018). Multivariate analysis demonstrated that the predominantly affected site was the hip. MS patients exhibit increased frequency of low bone mass compared with controls. Further studies should assess the etiologic factors and employ appropriate therapies.
Multiple sclerosis (MS) is associated with reduced bone mass and higher frequency of osteoporosis... more Multiple sclerosis (MS) is associated with reduced bone mass and higher frequency of osteoporosis. Although high-dose short-term intravenous glucocorticoid regimens cause a decrease in bone formation, this effect is usually reversible and osteoporosis in MS patients may be independent of the short-term corticosteroid treatment. Clinical evidence suggests an important role of vitamin D as a modifiable risk factor in MS. Low circulating levels of vitamin D have been found in MS patients, especially during relapses, suggesting that vitamin D could be involved in the regulation of the clinical disease activity. Vitamin D mediates its function through a single vitamin D receptor (VDR). Polymorphisms of the VDR have major effects on vitamin D function and metabolism, and some VDR genotypes have been linked to osteoporosis and MS. Because the safety of high doses of vitamin D has not been established yet, vitamin D hasn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t been used in enough doses to increase the serum level to a desired therapeutic target. Future clinical trials should determine the upper limit of vitamin D intake in order to achieve therapeutic benefit in MS patients.
Meningioma is a common intracranial tumor, originating from the meninges of the skull or spinal c... more Meningioma is a common intracranial tumor, originating from the meninges of the skull or spinal canal. Most meningiomas are benign tumors, however atypical or anaplastic tumors can be found in 6% of cases. Patients with asymptomatic small benign meningiomas can be followed without therapy, but in symptomatic patients complete surgical resection should be performed. For recurrent previously resected tumors re-resection is recommended followed by radiotherapy in selected cases. Antiprogesterone treatment can also be considered in recurrent benign meningiomas. Immunotherapy with interferon-alpha and chemotherapy should be reserved for all cases of recurrent meningiomas (benign, atypical, and malignant) when all the standard therapies have failed or contraindicated.
Background: Polymorphisms of the vitamin D receptor (VDR) gene have been linked to both multiple ... more Background: Polymorphisms of the vitamin D receptor (VDR) gene have been linked to both multiple sclerosis (MS) and osteoporosis. We examined the frequency of the Taq-I and Bsm-I polymorphisms of the vitamin D receptor (VDR) gene in 69 patients with MS and 81 age and sex-matched healthy individuals. Genotyping of Taq-I (rs731236) and Bsm-I (rs1544410) was performed using TaqMan ® SNP Genotyping Assay. All patients and controls had determination of body mass index (BMI), bone mineral density (BMD) and smoking history. Results: The mean age of patients was 39 ± 10.5 years compared to 38.7 ± 10.7 years of the controls (p = 0.86), the BMI was 24.8 ± 4.2 kg/m 2 compared to 25.7 ± 4.8 kg/m 2 of the controls (p = 0.23), the BMD in the lumbar spine 0.981 ± 0.15 compared to 1.025 ± 013 of the controls (p = 0.06) and the total hip BMD was 0.875 ± 0.14 compared to 0.969 ± 0.12 of the controls (p < 0.001). There were no differences of the Taq-I (TT, CT, CC) and Bsm-I genotypes (GG, GA, AA) and allelic frequencies between MS and control individuals. Multivariate analysis also failed to show any association of the Taq-I and Bsm-I polymorphisms and MS or sex, BMI, BMD and smoking history. Conclusions: This study suggests that the Taq-I and Bsm-I polymorphisms of the VDR gene are not associated with MS risk, BMI or BMD in the Greek population studied.
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