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Having in mind the presence of aluminum in industry, as well as in households, we wanted to define changes in the number of erythrocytes and aluminum content in the plasma and erythrocytes following acute aluminum poisoning under experimental conditions. The experiment involved gerbils which received intraperitoneally aluminum chloride solution at a dose of 3.7g per kg of body mass. The experimental group was sacrificed after 24, 48, 72 and 96 hours from the beginning of the experiment by cardiac punction or by abdominal artery punction. The control group was treated with saline, only. The number of erythrocytes and hemoglobin concentration were considerably reduced with respect to the control group, most likely as the result of cell membrane changes and reduced life cycle of erythrocytes. During the experiment, aluminum content in the plasma was increased in the first and second day of the experiment, it started to decline on the third day, while on the fourth day it returned to its original value, which proves again the existence of a special mechanism of "clearance" of aluminum in plasma.

Introduction/Objective. The goal of our research was to evaluate diagnostic and prognostic role of positron emission tomography/computed tomography (PET-CT) in patients previously treated for uterine cancer and compare it to conventional imaging methods (CIM). Methods. We analyzed 37 patients examined on PET-CT for follow-up or suspicion of uterine cancer recurrence, and who were previously treated with surgery and/or chemoradiotherapy. All patients underwent CT or magnetic resonance imaging prior to PET-CT, and were followed-up for at least one year. Results. PET-CT showed sensitivity, specificity and diagnostic accuracy in uterine cancer relapse detection of 96.3%, 70%, and 89.2%, while those values for CIM were 92.6%, 40%, and 78.4 %, respectively. Correlation of PET-CT and CIM findings was 78% (29/37). In 13 out of 25 true positive patients on CIM, PET-CT found greater number of active sites missed by conventional imaging. Positive findings on PET-CT were associated with shorter progression free survival (p = 0.023, logrank test). Conclusion. PET-CT constitutes an important diagnostic method in management of recurrent cancer of uterine corpus, demonstrating high sensitivity and accuracy. In comparison to CIM, PET-CT can discover larger number of active tumor sites, and also shows better specificity. PET-CT positive patients have worse prognosis with shorter progression free survival.

Recurrent disease in post-irradiation patients with cervical cancer is often difficult to delineate on magnetic resonance imaging (MRI), because posttreatment changes can have a similar appearance, and further evaluation is often required. The aims of the study were to evaluate positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG PET-CT) diagnostic role in suspected recurrent cervical cancer after radiotherapy, compare it to MRI, and assess their prognostic impact in these patients.

Introduction/Objective. Nuclear Medicine Section of IAEA has developed the software for dynamic renal scintigraphy, which allows calculation of advanced parameters of drainage: renal output efficiency (OE) and normalized residual activity (NORA). The aim of this study was to validate IAEA software by comparing results of parameters of renal drainage in normal subjects against their established reference values and to assess diagnostic accuracy of OE and NORA in distinguishing between obstruction/unobstruction. Methods. Fifty-five patients with suspected obstruction and 36 kidney donors were investigated. Group A consisted of 24 obstructed kidneys, Group B of 37 kidneys with dilated urinary tract, and Group C of 72 normal kidneys. Forty-minute acquisition was applied. Furosemide was administered after 20 minutes. Post-micturition image was acquired at 50 minutes. The analyzed parameters were as follows: OE at 20 minutes (OE20) and at the end of the furosemide test (OE40), NORA at 20 minutes (NORA20) and after micturition (NORAPM). One-way ANOVA was used for evaluating the differences between the groups. Ability of OE40 and NORAPM to distinguish between obstruction/unobstruction was determined by ROC curve analysis. The sensitivity, specificity, area under the curve, and cut-off values were analyzed. Results. Excellent agreement of our results with established OE and NORA values was found. The difference between the groups was significant for OE20, OE40, NORA20, and NORAPM (p < 0.001). Cut-off values for obstruction were 82% and 0.11 for OE40 and NORAPM, respectively. Conclusion. IAEA software gives reliable analysis of diuretic renography and helps to better diagnose obstruction. IAEA should be encouraged to produce final version of the software and to release it online.

Introduction/Objective. Myocardial perfusion imaging (MPI) is clinically useful for the evaluation of coronary artery disease in patients with diabetes mellitus. However, the prevalence of ischemia and its ability to predict future cardiac events is less clear. The aim was to determine the incidence of cardiac events in diabetic patients and the relationship between them and MPI findings. Methods. Two cohorts of patients, 98 diabetics and 100 non-diabetics, with medium- to high-risk of coronary artery disease without previous coronary revascularization, were studied prospectively. All of them were outpatients who underwent 99mTc-sestamibi MPI with dipyridamole. The data about cardiac events were collected during a follow-up period of two years. Results. Cardiac events occurred in 17.3% diabetics and in 8% non-diabetics (p = 0.048). Diabetics had shorter estimated event-free time of 24.7 months (95% CI 23.2–26.2) versus non-diabetics’ estimated event-free time of 28.5 months (95% CI 27.4–29.5) (p = 0.046). The independent predictors of cardiac events were male sex (p = 0.010), previous myocardial infarction (p < 0.001), presence of the symptoms of angina (p = 0.014), and all variables derived from MPI findings. After adjustment for variables derived from MPI findings, the significant predictors in diabetics were the size of stress perfusion defect (p = 0.022), summed stress score (p = 0.011), and summed difference score (p = 0.044). Conclusion. In diabetic patients, the cumulative rate of cardiac events was higher and the event-free survival was worse. MPI could help in prediction of cardiac events in diabetics and the most important predictors were size of stress perfusion defect, summed stress score, and summed difference score.

The aim of the study was evaluation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET/CT) in the detection of active disease in the patients with suspected recurrence of the medullary thyroid carcinoma (MTC).

The aim of investigation was to assess the role of somatostatin receptor scintigraphy in diagnosis and follow-up of pancreatic neuroendocrine neoplasms. Somatostatin receptor scintigraphy was performed with 740 MBq 99mTc-EDDA/HYNIC TOC for diagnosis of primary tumors and follow-up after the therapy. There were 63 true positive, 24 true negative, 4 false positive, and 6 false negative findings. Sensitivity was 91.3 %, specificity 85.7 %, positive predictive value 94.0 %, negative predictive value 80.0 %, accuracy 89.7 %. The SPECT contributed diagnosis in 28 true positive findings. In 32 patients (33 %) somatostatin receptor scintigraphy significantly changed the management of the patients (10 had surgery, in 17 somatostatin analogues, and in 5 peptide receptor radionuclide therapy was introduced). Mean Ki-67 index in true positive patients was 13.8 ±5.0 % while in true negative 7.1 ± 3.4% which is significantly lower at p < 0.05. There was significantly (p < 0.01) higher number of increased chromogranin A values in true positive than in true negative patients (p = 0.000857). Our results confirmed the value of SRS in the diagnosis and follow-up of the patients with pancreatic neuroendocrine neoplasms PanNEN if primary tumors, recurrences or metastases are suspected, as well as for appropriate choice of the therapy.

Background/Aim. Laryngeal carcinomas make 1%–3% of all head and neck malignancies.Treatment outcome and survival rates depend greatly on established stage of the disease. The purpose of this study was to examine the survival of the patients with advanced laryngeal carcinoma depending on gender, age, common risk factors (tobacco and alcohol use), primary tumor localization, histopathological tumor grade, clinical TNM (tumor, node and metastasis) stage and surgical treatment of the disease. Methods. Retrospective study included 252 patients treated surgically for advanced squamocellular carcinoma of the larynx in a threeyear period with five-year follow-up. Patients included in the study were treated primary with surgery, with postoperative radiotherapy and chemotherapy depending on the stage of the disease, intraoperative findings and tumor resection borders. Overall survival and disease-specific five-year survival of patients was calculated for demographical and clinical characteristics of the patients. Results. Overall 5-year survival of patients with operable advanced laryngeal cancer included in the study was 86.14% and disease-specific survival 86.51%. Lower overall and the disease-specific survival was associated with age, higher histological tumor grade and more extensive neck dissections. Conclusion. Primary total laryngectomy results in higher survival outcomes in cases of transglottic T3 and T4a laryngeal tumors. Patients should be informed of the likely increased mortality risks tied to the choice of surgical resection and treatment modality before their decision.

Introduction. Positron emission tomography (PET) with computed tomography (CT) using fluorine- 18-labeled fluorodeoxyglucose (18F-FDG PET/CT) is a hybrid diagnostic method based on the cell’s glucose uptake detection, which correlates with the degree of disease activity. While other diagnostic procedures fail to evaluate functional tissue, 18F-FDG PET/CT can be helpful in discovering active disease in patients with vascular graft infection. Methods. This cohort retrospective study included 22 patients (17 male, five female; aged 61.7 ± 16.1) with suspected vascular graft infection. Blood analyses and CT were performed in all patients. Degree of glucose uptake was evaluated visually and semiquantitatively using maximal standardized uptake value (SUVmax). Findings were considered positive if focal fluoro-deoxyglucose (FDG) accumulation was greater in vascular graft projection than other parts of the blood vessel and liver. Results. The sighs of active disease were found in 19 patients (86%) (16 male, three female) at the level of implanted vascular grafts: six aortobifemoral (27%), four aortoiliac (18.2%), four of abdominal aorta (18.2%), two of thoracic aorta (9.1%), two femoral (9.1%), one femoropopliteal (4.5%) (SUVmax 7.9 + 2.4). Two patients were considered true and one false negative- due to antibiotic usage, which reduces FDG uptake. PET/CT helped in treatment alteration of 12 patients, seven (31.8%) started new medicament therapy, five (22.7%) had a surgical graft replacement. Overall sensitivity of this method is 95%, specificity 100%, positive predictive value 100%, negative predictive value 66.6%, accuracy 95.4%. Conclusion. 18F-FDG PET/CT is a useful diagnostic method in detection of active vascular graft infection with high diagnostic accuracy, which is important in avoiding unnecessary surgery and appropriate therapy planning.

Backround/Aim. Considering the distinct increase in the incidence of oropharyngeal cancer over oral cavity cancers and changing epidemiology with human papilloma virus (HPV) infection emerging as an important risk factor, there is a need to establish better treatment choices in specific groups of patients with oropharyngeal cancer. The aim of this study was to assess the quality of life (QOL) and functional performance and the impact of different demographical data, stage of disease, and treatment type on these parameters in patients with oropharyngeal cancer with successfully achieved locoregional control a year after the treatment. Methods. Study included 87 patients who underwent QOL and functional impairment assessment 12 to 14 months after finished oncological treatment with the following questionnaires: the European Organization for Research and Treatment of Cancer Quality-of Life-Questionnaire-C30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of- Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) and The Karnofsky Performance Scale (KPS). Results. Specific groups of patients had significantly different post-treatment QOL scores. The factors associated with the worse QOL scores were female gender, not being in a partnership, level of education and HPV status. Conclusion. Clinicians should consider socioeconomic factors and HPV status in planning the recovery after treatment of patients with oropharyngeal carcinoma. Gender, education level and employment are the variables that form a certain risk profiles associated with the lower QOL.

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The new positron emission tomography (PET/CT) methods for neuroendocrine tumors detection are presented and compared with classic, conventional methods. Conventional methods use a gamma scintillation camera for patients with neuroendocrine tumor imaging, after intravenous injection of one of the following radiopharmaceuticals: 1) somatostatin analogues labeled with indium-111 (111In-pentetreotide) or technetium-99m (99mTc-EDDA/HYNIC-TOC); 2) noradrenaline analogue labeled with iodine-131 or -123 (131I/123I-MIBG); or 3) 99mTc(V)-DMSA. Contemporary methods use PET/CT equipment for patients with neuroendocrine tumor imaging, after intravenous injection of pharmaceuticals labeled with positron emitters [fluorine-18 (18F), galium-68 (68Ga), or carbon-11 (11C)]: 1) glucose analogue (18FDG); 2) somatostatin analogue (68Ga-DOTATOC/68Ga-DOTATATE/68Ga-DOTANOC); 3) aminoacid precursors of bioamines: [a) dopamine precursor 18F-DOPA (6-18F-dihydroxyphenylalanine), b) serotonin precursor 11C-5HTP (11C-5-hydroxytryptophan)]; or 4) dopamine analogue 18F-DA (6-18F-fluorodopamine). Conventional and contemporary (PET/ CT) somatostatin receptor detection showed identical high specificity (92%), but conventional had very low sensitivity (52%) compared to PET/CT (97%). It means that almost every second neuroendocrine tumor detected by contemporary method cannot be discovered using conventional (classic) method. In metastatic pheochromocytoma detection contemporary (PET/ CT) methods (18F-DOPA and 18F-DA) have higher sensitivity than conventional (131I/123I-MIBG). In medullary thyroid carcinoma diagnostics contemporary method (18F-DOPA) is more sensitive than conventional 99mTc(V)-DMSA method, and is similar to 18FDG, computed tomography and magnetic resonance. In carcinoid detection contemporary method (18F-DOPA) shows similar results with contemporary somatostatin receptor detection, while for gastroenteropancreatic neuroendocrine tumors it is worse. To conclude, contemporary (PET/CT) methods for somatostatin receptor detection (68Ga-DOTATOC/-NOC/-TATE) in neuroendocrine tumors are much more sensitive (almost twice) and more accurate than conventional. Therefore the classical methods should be urgently replaced by contemporary methods.

Detection of inflammation/infection still remains great clinical problem. That is why nuclear medicine procedures still play a significant role regarding this issue. There has been attempts for detection of infection/inflammation using 67Ga-citrate, 99mTc/111 In labeled white blood cells, 99mTc/111In labeled human immunoglobulin, 99mTc labeled antigranulocyte antibodies (whole or fragments), 99mTc labeled antibiotic, 99mTc nanocolloid as well as different other radiopharmaceuticals. However, there has not been discovered the ideal one. Recently, 18F-FDG PET begins to play a significant role.

Dopamine, norepinephrine and serotonin are biogenic amines which are transmitters of the central nervous system. The effects of ischemia on the brain parenchyma depends on many factors, such is the mechanism of blood flow interruption, velocity of the occurring blood flow interruption, duration of an ischemic episode, organization of anatomical structures of the brain blood vessels etc., which all influence the final outcome. During interruption of the brain circulation in experimental or clinical conditions, neurotransmitter metabolism, primarily of biogenic amines, is disturbed. Many researches with various experimental models of complete ischemia reported a decrease in the content of norepinephrine, dopamine and serotonin in the CNS tissue. It was proven that hyperglycemia can drastically increase cerebral injury followed by short-term cerebral ischemia. Considering the fact that biogenic amines (dopamine, norepinephrine and serotonin) influence the size of neurologic damage, as well as the fact that in hyperglycemic conditions infarct size (from the morphological aspect) is larger relative to normoglycemic status, the intention was to evaluate the role of biogenic amines in occurrence of damage in conditions of hyperglycemia, i.e. in the case of brain apoplexia in diabetics. Analysis of biogenic amines metabolism in states of acute hyperglycemia, as well as analysis of the effects of reversible and irreversible brain ischemia on metabolism of serotonin, dopamine and norepinephrine, showed that acute hyperglycemia slows down serotonin, dopamine and norepinephrine metabolism in the cerebral cortex and n. caudatus. Brain ischemia in normoglycemic animals by itself has no influence on biogenic amines metabolism, but the effect of ischemia becomes apparent during reperfusion. In recirculation, which corresponds to the occurrences in penumbra, release of biogenic amines is uncontrolled and increased. Brain ischemia in acute hyperglycemic animals increases the release of biogenic amines regardless of ischemia duration (5 or 15 minutes). This effect is more apparent during recirculation. Acute hyperglycemia makes brain tissue more sensitive even to ischemia which last shorter, i.e. reversible ischemia.

Papillary thyroid carcinoma (PTC) is generally considered an indolent cancer. However, patients with cervical lymph node metastasis (LNM) have a higher risk of local recurrence. This study evaluated and compared four machine learning (ML)-based classifiers to predict the presence of cervical LNM in clinically node-negative (cN0) T1 and T2 PTC patients. The algorithm was developed using clinicopathological data from 288 patients who underwent total thyroidectomy and prophylactic central neck dissection, with sentinel lymph node biopsy performed to identify lateral LNM. The final ML classifier was selected based on the highest specificity and the lowest degree of overfitting while maintaining a sensitivity of 95%. Among the models evaluated, the k-Nearest Neighbor (k-NN) classifier was found to be the best fit, with an area under the receiver operating characteristic curve of 0.72, and sensitivity, specificity, positive and negative predictive values, F1 and F2 scores of 98%, 27%, 56%, 93%, 72%, and 85%, respectively. A web application based on a sensitivity-optimized kNN classifier was also created to predict the potential of cervical LNM, allowing users to explore and potentially build upon the model. These findings suggest that ML can improve the prediction of LNM in cN0 T1 and T2 PTC patients, thereby aiding in individual treatment planning.

Objective: Positron emission tomography/computed tomography using fluorine-18 fluoro-deoxyglucose ( 18 F-FDG PET/CT) is not routinely used for diagnosis of testicular carcinoma. Unlike CT which cannot confirm with certainty the nature of the lesions, especially in post-therapy setting, 18 F-FDG PET/CT detects active disease by showing increased glucose metabolism within the lesions., Aim: Determination of 18 F-FDG PET/CT usefulness in detection of seminoma, therapy response evaluation and comparison to CT findings and tumor marker levels., Material and Methods: Eighty-two men (age 39.8±10.1) after orchiectomy and histopathological confirmation of seminoma were included in this study. Indications for 18 F-FDG PET/CT were initial staging, restaging after chemo/radiotherapy with positive/uncertain CT, suspected recurrence on CT, elevated tumor markers. All patients had clinical follow-up of up to 8 years (median 33.5) after the first 18 F-FDG PET/CT examination. Degree of metabolic activity was analyzed visually and semi-quantitatively using maximum standardized uptake value(SUVmax)., Results: Fluorine-18-FDG PET/CT was true positive in 36 patients (43.9%) with average SUVmax of 7.9±4.8.Recurrence was mostly found in retroperitoneal lymph nodes and distant metastases in lungs, bones, liver. Six findings were false positive and 3 false negative. Sensitivity, specificity, accuracy of 18 F-FDG PET/CT were 92.3%, 86.0%, 89.0% and of CT 60.8%, 66.6%, 63.4%. Pearson Chi-square test showed statistically significant difference between the results of 18 F-FDG PET/CT and CT (P=0.016). Significant correlation was found between positive 18 F-FDG PET/CT findings and levels of LDH (P=0.043), while non-significant between AFP, β-hCG (P>0.05)., Conclusion: Fluorine-18-FDG PET/CT was superior to CT in evaluation of therapy response, active disease in residual tissue and normal size lymph nodes, as well as when CT was negative and tumor markers were elevated. Elevated lactate dehydrogenase (LDH) contributes to positive 18 F-FDG PET/CT findings.