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The capability of the scintimammography to diagnose subcentimeters sized tumors was increased by the employment of a dedicated gamma camera. The introduction of small field of view camera, based on pixellated scintillation array and position sensitive photomultiplier, allowed to enhance the geometric spatial resolution and contrast of the images due to reduced collimator-tumor distance. The aim of this paper is to investigate the realistic possibility of T1a tumors detection (~5 mm size) by comparing the signal-to-noise ratio (SNR) values obtained by different imagers. To this end, we have utilized a self-designed solid breast phantom with different sized hot spots (tumors). The phantom consists of seven disks with different thickness, molded from resin epoxy activated with [Co.sup.57] isotope. The overlapped disks represent a pendula breast with about 800 cc volume. Hot spots have not wall. One disk has holes to fit the hot spots representing the different sized lesions. The imagers utilized were: a standard Anger Camera and three different cameras based on scintillator array, CsI(TI) or NaI(TI), coupled to position sensitive photomultiplier with different technologies, to make detectors with field of view of 3 and 5 inch. The experimental results are supported by Monte Carlo simulation. It was highlighted how spatial resolution is a predominant element in tumor visibility and how background causes a reduction of the image contrast. All gamma cameras show close results at SNR values less than 10 and a full detectability of 8 mm tumor size. However, the results show the 5 mm tumor size is lower detection limit for all cameras. Index Terms--Biomedical nuclear imaging, photomultipliers, scintilation detectors.

Objectives: Mixed cryoglobulinaemia (MC) is a chronic small-vessel vasculitis. Shortly after the discovery of hepatitis C virus (HCV) in 1989, an association between HCV infection and MC was being increasingly reported, suggesting the potential pathogenetic implication of HCV in most of the cases that had been previously diagnosed as essential MC. A number of studies have pointed out prognostic factors linked to mortality in this disorder. None of them, however, have clarified the impact of HCV discovery on the natural history of the disease. The aim of the present study was to evaluate mortality in MC after the discovery of HCV infection. Methods: We retrospectively collected clinical and serological data in 70 unselected HCV-positive patients being followed up at our unit from 1990. Clinical and prognostic factors linked to poor outcome were evaluated. Results: Chronic hepatitis, renal involvement, and intestinal vasculitis were the most frequent causes of death. Conclusion: Compared to other series, the outcome in our MC seemed to be better. Factors linked to a poor outcome were renal involvement, widespread vasculitis, male sex, and cryocrit. [ABSTRACT FROM AUTHOR]

The incidence of renal flares and the long-term outcome in a group of 33 systemic lupus erythematosus (SLE) patients with diffuse proliferative glomerulonephritis (DPGN) treated with pulse steroids and a short course of pulse cyclophosphamide (CYC) are evaluated. Fifteen patients (45%) experienced a flare of renal disease at some time after the discontinuation of the immunosuppressive (IS) therapy; among these half (24%) were ‘early’ flares occurring shortly after the discontinuation of therapy, and the other half (21%) were ‘late’ flares occurring more than 2 y after the discontinuation of the treatment. Nine patients (27%) showed a poor renal outcome at the end of follow-up. On multiple regression analysis, a younger age and a high activity index (AI) on renal histology were found to be correlated with the occurrence of renal flares. Our results suggest that the combination of pulse steroids with a short course of pulse CYC (six to nine pulses) is effective in both controlling disease activity and in preventing the occurrence of renal flares in DPGN. However, short term IS therapy might not be sufficient to maintain disease control in younger patients with active lesions on renal histology. Such patients might be candidates to receive more prolonged IS treatment. [ABSTRACT FROM AUTHOR]

Aim: To determine whether the European Consensus Lupus Activity Measurement Index (ECLAM) can be used to evaluate disease activity in patients retrospectively from the data provided in their clinical charts. Methods: The ECLAM score was calculated twice in a series of 64 consecutive SLE patients: first for each patient during the course of a standard clinical evaluation (direct-ECLAM), and then one to two weeks later solely on the basis of the data provided in the patient's clinical chart (chart-ECLAM). The scorings for each patient were performed by two different assessors. Results: The direct-ECLAM and chart-ECLAM scores were highly correlated (Spearman's rank correlation coefficient=0.86). The regression line was not significantly different from the identity line (t-test). The Pearson's coefficient was 0.88. The interobserver variability of the chart-ECLAM showed a low inter-rater variability. Conclusion: ECLAM could represent a valid and reliable instrument for the retrospective analysis of disease activity in SLE patients. Lupus (2000) 9, 445–450. [ABSTRACT FROM AUTHOR]

The objective of this work was to evaluate the clinical and serological profiles of patients with undifferentiated connective tissue diseases (UCTD) who had been followed For at least 1 year. The retrospective analysis (1974-95) was based on UCTD patients diagnosed on the basis of clinical manifestations suggestive of a connective tissue disease, and the presence of at least one non-organ-specific autoantibody. A total of 91 patients were evaluated. The condition of 79 remained stable during the follow up, while in 12 the UCTD evolved to systemic lupus erythematosus (SLE) within a mean period of 3 years (min. 1 year, max. 8 years, median 2 years) after the onset of the disease. At baseline none of the variables, considered alone, showed an association with the future development of SLE. Multiple regression analysis, however, suggested that the association of sicca symptoms, Raynaud's phenomenon and/or photosensitivity was inversely correlated with the development of SLE (P = 0.0012, Fisher's exact test). The most common clinical manifestations of UCTD included arthritis, arthralgias, Raynaud's phenomenon, xerostomia, xerophthalmia and leukopenia. The stable UCTD patients showed a simple autoantibody profile characterized by a single autoantibody specificity in 82% of the cases 30% with anti-Ro/SSA alone and 28% with anti-RNP alone. This profile remained stable during the follow up. Anti-RNP antibodies alone correlated with the presence of Raynaud's phenomenon and arthritis (P < 0.001 and P < 0.01, respectively), while anti-Ro/SSA antibodies alone correlated with... [ABSTRACT FROM AUTHOR]

The occurrence of nephritis is considered to be the most important factor influencing the prognosis in systemic lupus erythematosus (SLE). Despite the apparent histological similarity of the lesions, however, patients with diffuse proliferative glomerulonephritis (DPGN) may exhibit different outcomes. A retrospective study was carried out on 81 SLE patients with DPGN to evaluate the prognostic significance of different clinical, serological and histological variables; in particular, 95 renal biopsies were re-evaluated and the activity and chronicity indices for the patients were determined.A positive correlation was observed between the presence of chronic lesions on renal biopsy and a poor renal outcome (<0.001). Moreover, in the repeat biopsies the patients with a poor outcome showed a higher degree of chronic lesions. Active lesions and other clinical and serological parameters did not correlate with the outcome. [ABSTRACT FROM PUBLISHER]