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Background: Results from prospective trials have shown higher accuracy of prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) in detection of lymph node metastasis (LNM) compared to conventional imaging., Objective: To evaluate the accuracy of 68 Ga-PSMA-11 PET/CT for LNM detection in patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (PLND)., Design, Setting, and Participants: Between June 2014 and November 2020, 96 patients with 68 Ga-PSMA PET/CT for primary staging underwent RP and extended PLND., Outcome Measurements and Statistical Analysis: The results from 68 Ga-PSMA PET/CT were compared with histologic data from primary PLND in 96 patients. All 68 Ga-PSMA PET/CT scans were centrally reviewed., Results and Limitations: Of 96 patients, 15.6% (n = 15) harbored LNMs. The median prostate-specific antigen at 68 Ga-PSMA PET/CT was 8.0 ng/ml (interquartile range 5.5-11.7). The majority of patients had intermediate- (52.1%) or high-risk disease (41.7%). Biopsy grade group 4 and 5 was present in 22.9% and 15.6%, respectively. The 68 Ga-PSMA PET/CT scans identified eight of 15 patients (53.3%) as LN-positive (true positive). The calculated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 68 Ga-PSMA PET/CT in the detection of LNM were 53.3%, 98.8%, 88.9%, 92.0%, and 91.7%, respectively. The per-patient sensitivity and specificity in the detection of LNMs larger than 2 mm were 61.5% and 98.8%, respectively. The main limitation is the retrospective design of the study., Conclusions: 68 Ga-PSMA PET/CT is accurate in lymph node staging and the results support its use for primary staging of prostate cancer., Patient Summary: We compared prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) findings with histopathology results after extended lymph node dissection and showed that it is accurate in detecting lymph node metastases. Our results support the use of PSMA PET/CT for primary staging of prostate cancer., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: The present study aims to determine the effects of anxiety sensitivity, anxiety level, perceived stress and coping strategies on peritraumatic dissociation in post-earthquake acute stress disorder (ASD) patients., Method: Sociodemographic data form, Beck Anxiety Index (BAI), Perceived Stress Scale (PSS), Anxiety Sensitivity Index-3 (ASI-3), Coping with Earthquake Stress Scale, and Peritraumatic Dissociation Scale (PDEQ) were applied to 477 patients diagnosed with ASD., Results: Anxiety sensitivity cognitive sub-dimension explained 31.5%, anxiety explained 7%, and perceived stress explained 1% of the variation in peritraumatic dissolution development. A moderate positive correlation was determined between peritraumatic dissolution and anxiety, a weak positive correlation was found between peritraumatic dissolution and perceived stress, a weak positive correlation was determined between peritraumatic dissolution and positive thinking, and a very weak negative correlation was determined between peritraumatic dissolution and seeking social support. A moderate positive correlation was determined between peritraumatic dissolution and physical, cognitive and social sub-dimensions of anxiety sensitivity., Conclusion: The most important finding in the study was the fact that the highest contribution to the development of peritraumatic dissolution was by the cognitive sub-dimension of anxiety sensitivity. It could be suggested that individuals with high anxiety sensitivity may experience higher peritraumatic dissolution and these individuals could have a higher risk of PTSD later on.

Depressive symptoms, in addition to positive and negative symptoms, are commonly observed in the course of schizophrenia. These symptoms may cause disability and reduced self-esteem. Disability and lower self-esteem may disrupt the quality of life and lead to social isolation. Demonstrating the relationships among these concepts and correcting possible disturbances may help to augment treatment compliance and improve the prognosis. In this study, the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and the Rosenberg Self Esteem Scale (RSES) were applied along with a sociodemographic data form to 146 patients with schizophrenia. Path analyses were used to demonstrate the direct effect of schizophrenia severity on self-esteem and its indirect effect through disability and depression, the mediating effect of depression in the relationship between schizophrenia severity and disability, and the mediator effect of disability in the bidirectional relationship between self-esteem and depression. Statistically significant results were obtained. In multivariate regression analysis, significant effects on disability were demonstrated for PANSS General Psychopathology subscale, CDSS, and RSES. These data suggest that attention should be focused on concepts such as depression, disability, and self-esteem in schizophrenia patients.

Purpose: Lu-PSMA inhibitor peptide receptor radioligand therapy (RLT) is playing an increasing role in metastatic castration-resistant prostate cancer. We aimed to estimate the absorbed radiation doses for critical organs (eg, kidneys, parotid glands, submandibular glands, and lacrimal glands) of patients treated with 4 to 6 cycles by Lu-PSMA inhibitor RLT, retrospectively, and to evaluate the findings extensively in order to determine the critical organ radiation-absorbed limitations and the number of prospective RLT., Materials and Methods: A total of 51 cycles Lu-PSMA inhibitor RLT in 10 patients was analyzed. Therapies have been applied in 4 to 6 cycles with 8 to 10 weeks' intervals. Dosimetric estimates of kidneys, parotid glands, submandibular glands, and lacrimal glands have been calculated based on MIRD scheme pamphlet no. 16. Regions of interest were drawn with GE Xeleris Functional Imaging Workstation. OLINDA/EXM 1.1 simulation software was used to calculate radiation-absorbed doses., Results: Mean radiation-absorbed doses were 0.70 ± 0.24 Gy/GBq for kidneys, 1.34 ± 0.78 Gy/GBq for parotid glands, 0.94 ± 0.45 Gy/GBq for submandibular glands, and 2.28 ± 1.29 Gy/GBq for lacrimal glands., Conclusions: Due to the critical target organ risks and the optimal therapy doses, patient-specific dosimetry is a deterministic factor in radionuclide therapy. Even when the absorbed kidney doses were above the ICRP critical dose limits in patients who had 4 to 6 cycles of therapy, mortality due to nephrotoxicity has not been observed. Mild increased tolerated radiation dose is acceptable for the patient groups with very low survival rate.

Imaging is critical for primary staging of prostate cancer. Traditional imaging modalities (computerized tomography scan and nuclear medicine bone scans) are limited by their suboptimal diagnostic performance. Recent meta-analyses have demonstrated that nuclear imaging with 68 Ga-labeled prostate-specific membrane antigen ligand ( 68 Ga-PSMA) using positron emission tomography/computed tomography (PET/CT) has higher sensitivity and specificity in this setting compared to conventional imaging techniques. 68 Ga-PSMA PET/CT for whole-body assessment can be used as the sole imaging modality for primary lymph node and bone staging of prostate cancer. PATIENT SUMMARY: There is a rapidly growing body of evidence that nuclear imaging with 68 Ga-labeled prostate-specific membrane antigen ligand using positron emission tomography/computed tomography has a higher detection rate for lymph node and bone metastases in prostate cancer patients. This approach has strong potential to replace conventional techniques in the primary setting in the near future., (Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Purpose: Suicide is an important cause of death in patients diagnosed with obsessive-compulsive disorder (OCD) as well as other psychiatric disorders. Early determining of risk factors provides an opportunity for intervention. The mediating effect of psychological pain (also known as psychache) on suicide has been shown in various disorders but has not been investigated in patients with OCD. In this study, we aimed to show the relationship between psychological pain and other clinical variables and suicide in OCD patients., Patients and Methods: This cross-sectional study consisted of 67 patients diagnosed with OCD according to DSM-5 criteria with no comorbid psychiatric diagnosis who applied to the psychiatric outpatient clinic of Çukurova University Faculty of Medicine and 63 healthy controls. Among the OCD patients, 12 had previous suicide attempts. In addition to the sociodemographic data form, participants filled out the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Psychache Scale (PS), the Beck Scale for Suicidal Ideation (BSIS), and the Hamilton Depression Scale (HDS)., Results: OCD group's median obsession, compulsion, and the total scores of YBOCS, and the mean PS scores were higher than the control group. There was no difference between the sociodemographic variables of OCD patients with and without previous suicide attempts such as age, gender, years of education, place of residence, marital, and occupational status. The median scores of obsession, avoidance, global severity, and indecisiveness subdimensions of YBOCS, the mean BSIS and PS scores, the rates of current aggressive, current contamination, and the past religious obsessions were higher in the suicidal group. There were moderately significant relationships in the same direction between the PS, BSIS, and total YBOCS scores. Multivariate regression analysis demonstrated that only the PS scores predicted previous suicide attempts., Conclusion: Our results demonstrated that current aggressive, current contamination, past religious obsessions, and the higher psychological pain are related to previous suicide attempts in OCD patients. Our regression analysis supports Shneidman's hypothesis: there would be no suicide without psychache. Relieving psychache in OCD patients may reduce suicide attempts even if there is no diagnosis of comorbid depression., Competing Interests: The authors reportno conflicts of interest in this work, (© 2019 Demirkol et al.)

Objectives: The purpose of the study was to evaluate any comorbid psychiatric disorders in patients with chronic pain and to examine the effects of sociodemographic details and the level of somatic sense perception on the severity of these diseases., Methods: In this study, 51 chronic pain patients were evaluated in a consultation with a psychiatrist. Sociodemographic characteristics of the patients, such as age, gender, education level, and marital status were recorded, and Structured Clinical Interview for DSM-IV results were assessed. The patients' chronic pains were classified as idiopathic or secondary to organic etiology. In addition, the Symptom Checklist-90, Somatosensory Amplification Scale (SSAS), Hamilton Depression Rating Scale, and the Hamilton Anxiety Scale (HAM-A) were used., Results: The incidence of psychiatric disorders in chronic pain patients was found to be 74.5%. Somatoform disorders were the most frequently diagnosed, at 37.3%. The rate of depressive and anxiety disorders was, respectively, 29.4% and 23.5%. Comorbid anxiety scores (p=0.019) and SSAS scores (p=0.046) were significantly higher in chronic pain patients with a somatoform disorder. HAM-A scores were found to be significantly higher in patients with depression (p=0.004). A positive and linear relationship was determined between the SSAS score and depression, anxiety, and the severity of mental symptoms., Conclusion: Structured or semi-structured interviews can be performed in pain polyclinics or psychiatric outpatient clinics to determine the level of perception of somatic sensations. This could be beneficial in the treatment of chronic pain and comorbid psychiatric disorders.

Purpose: The purpose of this study was to evaluate whether posterior alveolar bone height affects maxillary sinus septa (MSS) height in dentate and edentulous patients, as determined by cone-beam computed tomography (CBCT)., Materials and Methods: This retrospective analysis enrolled 166 patients (91 men and 75 women) with a mean age of 43.12 ± 15.26 years (range 18-74 years), who had at least one MSS on CBCT images. MSS were categorized into three regions: anterior, middle, and posterior. Patients were categorized as complete or partial posterior edentulous or fully posterior dentate. The maximum vertical diameter of the sinus septa and alveolar bone height was analyzed in sagittal CBCT sections; P < 0.05 was regarded as statistically significant., Results: We found 210 MSS among the patients in this study. Of the 166 patients, 36 had bilateral septa and 4 had three septa. The septa were mainly located in the middle region in the dentate (n = 70; 33.3%) and edentulous (n = 59; 28.1%) patients. The mean septal height was significantly higher in men than in women (P = 0.024). In dentate patients, the mean MSS height was similar among the three regions. In edentulous patients, the anterior mean MSS height (4.96 ± 2.77 mm) was lower than that of the other two regions. There was no statistically significant association between septa and alveolar bone height in any anatomic region, in either group (r = 0.022; P = 0.748)., Conclusions: These results suggest that MSS height is not influenced by alveolar bone height.

Objectives: To investigate the potential relationships between the intensity of tinnitus associated with temporomandibular disorders (TMD) and potential etiologic factors, including age, gender, freeway space, sleep bruxism (SB), joint clicking, and headache., Methods: The sample was comprised of 90 patients without any hearing loss, as confirmed by otorhinolaryngology, who self-reported subjective tinnitus and simultaneous TMD, based on the Research Diagnostic Criteria for TMD (RDC/TMD)., Results: The results showed a positive, weak correlation between the intensity of tinnitus and age (r = 0.225, p = 0.033). The presence of SB and headache were seen in higher proportions in the present sample, at 75.5% (n = 68) and 66.6% (n = 60), respectively., Conclusions: In a population of patients with subjective tinnitus and TMD, no significant associations were found between tinnitus intensity and age, freeway space, SB, clicking presence, and headache, though gender did show a weak correlation with tinnitus intensity.

Unlabelled: Hyper-functioning parathyroid glands with autonomous overproduction of PTH is the most frequent cause of hypercalcemia in outpatient populations with primary hyper-parathyroidism. It is generally caused by a solitary adenoma in 80%-90% of patients. Despite the various methodologies that are available for preoperative localization of parathyroid lesions, there is still no certain preoperative imaging algorithm to guide a surgical approach prior to the management of primary hyper-parathyroidism (P-HPT). Minimally invasive surgery has replaced the traditional bilateral neck exploration (BNE) as the initial approach in parathyroidectomy at many referral hospitals worldwide. In our study, we investigated diagnostic contributions of SPECT-CT combined with conventional planar scintigraphy in the detection of hyper-functioning parathyroid gland localization, since planar imaging has limitations. We also evaluated the efficacy of preoperative USG in adding to initial diagnostic imaging algorithms to localize a parathyroid adenoma., Methods: A total of 256 consecutive surgically naive patients with hyper-parathyroidism diagnosis were included in the following preoperative localization study. The study consisted of 256 consecutive patients with HPT, with a selected 154 patients who had neck surgery with definitive histology reports. All patients had 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) double-phase scintigraphy. The SPECT-CT procedure, combined with standard 99mTc-MIBI planar parathyroid scintigraphy with a pinhole and parallel-hole collimator to evaluate whether the SPECT-CT procedure was able to provide additional information in the localization of the pathology, caused hyper-parathyroidism in both P-HPT and S-HPT., Results: In the 154 P-HPT patients, 168 lesions (142 adenomas including 2 intrathyroidal and 2 double adenoma, 2 carcinoma, and 22 hyperplastic glands (four patients had MEN I, each with four hyperplastic glands)), were found at surgery. SPECT-CT detected more lesions than planar imaging in P-HPT (97.8% vs. 87.6%). SPECT-CT detected all adenomas and increased sensitivity, particularly in small lesions. Regardless of their size, the number of detected hyperplastic glands by SPECT-CT was remarkably higher than planar imaging.

Objective: Until recently, most reports about transmigration have documented that the canine is the only tooth which can migrate to the opposite side of the arch. The goal of the study was to define the transmigration of different types of teeth in people in various regions of Turkey., Study Design: A total of 112,873 panoramic radiographic files from seven different Turkish cities were inspected. The following data were evaluated according to age, gender, number of transmigrant teeth, localization, eruption status, side, unilaterally or bilaterally and associated pathology or dental abnormalities., Results: Of the 112,873 radiographs included in the study, 90 were seen to present as transmigrant in 87 patients, representing 0.079% of the sample. There were only two (0.0017%) transmigrant lateral (TML) teeth and only three (0.0026%) transmigrant premolar (TMP) teeth encountered. The mean age at the time that the transmigrant mandibular teeth were identified was 29.9 years, with a range from 10 to 66 years. Out of the 87 cases, 51 were female and 36 were male, with a male:female ratio of 1:1.41. Transmigrants were more commonly seen unilaterally (96.5%). The most frequent associated pathology was odontoma., Conclusions: Because early detection is vital to prevent complications and ensure more successful treatment, these extensive studies are crucial. In this extensive study, we indicated cases of transmigration of premolar and lateral teeth as a variant. Demographic variables and properties of all transmigrants (TM) were also presented.

In this article, the role of nuclear medicine modalities in assessing myocardial viability and risk stratification in patients with advanced left ventricular (LV) dysfunction are reviewed. Diagnosis of reversible LV dysfunction in patients with heart failure is an important clinical issue. Patients with severe LV dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most form revascularization. It is important to identify viable myocardium in these patients, and nuclear medicine techniques are an excellent tool for this. Single-photon emission computed tomography (SPECT) in combination with myocardial perfusion tracers plays an important role in the identification of tissue viability in myocardial segments. Imaging with positron emission tomography (PET) tracers allow the assessment of physiologic processes such as myocardial oxygen consumption, metabolic rate of glucose utilization, and myocardial blood flow. Metabolic imaging with PET offers regional tissue viability in patients with advanced coronary artery disease and severely impaired LV function.

Objective: Several studies have indicated that the velocity of contrast dye increases after intravenous dipyridamole infusion in patients with a slow-flow pattern (SFP). In this study we compared the results of coronary arteriography and exercise myocardial perfusion single photon emission computed tomography (SPECT) in patients with SFP. We also investigated the changes in myocardial perfusion in patients with abnormal exercise myocardial perfusion SPECT by using a pharmacological stress test with dipyridamole., Design and Patients: This study included 60 patients who revealed SFP in their coronary arteriograms. Slow coronary flow diagnoses were made using the frame count method. A single day rest-exercise technetium-99m hexakis-2-methoxy-isobutyl isonitrile (Tc-99m MIBI; Du Pont Pharma SA, Belgium) SPECT was performed in all patients. Patients who had reversible perfusion defect (RPD) on the exercise SPECT were evaluated with dipyridamole myocardial perfusion scintigraphy. RESULTS Patients with SFP revealed both higher frame counts in native coronary arteries and higher mean frame counts. The coronary frame count was 26.4 +/- 3.5 in control patients and 64.40 +/- 16.64 in patients with SFP, respectively (P < 0.001). Exercise perfusion SPECT showed RPD in 17 patients (group 1), but was normal in 43 others (group 2). There were no statistically significant differences between groups 1 and 2 in frame counts. Myocardial perfusion was normalized in all 17 patients of group 1 after dipyridamole infusion., Conclusions: In patients with SFP perfusion, changes may improve with dipyridamole infusion. This study indicates that this improvement can be shown by dipyridamole SPECT. Furthermore, no correlation was observed between the time needed to fill a native coronary artery and RPD of the myocardium.

Unlabelled: Patients with aortic stenosis (AS) may have classic angina pectoris. The safety of exercise testing in adults with AS is controversial and, in fact, exercise testing in such patients is considered to be contraindicated especially in severe aortic stenosis (SAS). Furthermore, exercise testing has low specificity in uncovering coronary artery disease (CAD) in patients with AS, because the baseline ECG is frequently abnormal. We wished to assess the safety and diagnostic accuracy of dipyridamole stress myocardial perfusion tomography (DMPT) in the detection of CAD in patients with SAS., Methods: The study included 30 patients with SAS (mean aortic valve area 0.57 +/- 0.09 cm(2)). All patients underwent dipyridamole myocardial perfusion scintigraphy (SPECT), coronary arteriography and catheterization, as well as Doppler echocardiography. Myocardial perfusion tomography was applied with (99m)Tc hexakis-2-methoxyisobutyl isonitrile (MIBI) by a single day rest-dipyridamole infusion protocol. Hemodynamic, electrocardiographic and clinical responses were compared with those of 50 control patients without AS., Results: Hemodynamic responses during dipyridamole stress tests demonstrated no significant differences between the controls and the AS patients in the following parameters: systolic blood pressure, heart rate, rate-pressure product or incidence of headache, chest pain, dyspnea, flushing and dizziness. A reversible perfusion defect was observed in 10 patients with DMPT. The existence of coronary lesions was determined by coronary arteriography in 8 of 10 patients (sensitivity 100%, specificity 91%)., Conclusion: The results showed that DMPT is well tolerated, even by patients with SAS and is of high diagnostic value in assessing CAD., (Copyright 2002 S. Karger AG, Basel)