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Objectives: Adrenocortical scintigraphy for patients with primary aldosteronism (PA) without discontinuation or modification of antihypertensive medications is of concern because of drug interference with the renin–angiotensin–aldosterone system. We report the surgical outcomes of patients with PA lateralized with adrenocortical scintigraphy without drug discontinuation or modification. Materials and Methods: We retrospectively reviewed 34 patients with PA with computed tomography (CT)-documented adrenal tumors who had undergoing subsequent I-131-6 β-iodomethyl-norcholesterol (NP-59) single photon emission CT (SPECT)/CT followed by unilateral adrenalectomy according to the results of NP-59 uptake between May 2005 and December 2014. All enrolled patients underwent standard confirmatory tests and lateralization with NP-59 SPECT/CT without discontinuation of existing antihypertensive medications, including spironolactone. The pathological findings, hypertension outcomes, and biochemical changes were reported. The accuracy of NP-59 SPECT/CT without drug discontinuation or modification was also evaluated. Results: None of the 34 enrolled patients (M:F = 16:18) had complications such as a hypertensive crisis, life-threatening hypokalemic event, or cardiac arrhythmia. Pathology disclosed 31 (91%) adenomas and three cases of hyperplasia. Hypertension cure and improvement were observed in 12 (35%) and 18 (53%) patients, respectively. All of the 30 patients (100%) without postoperative use of beta-blockers and with an available postoperative aldosterone/renin ratio achieved a biochemical cure. The positive predictive values of NP-59 SPECT/CT were 91%, 88%, and 100% for the pathological findings, hypertension outcomes, and biochemical changes, respectively. Conclusion: Noninvasive NP-59 SPECT/CT without discontinuation or modification of antihypertensive medications not only provided accurate lateralization and safety but also resulted in a high improvement rate for PA-associated hypertension.

We report the case of a 16-year-old male patient presenting with several mass lesions on the left side of his neck that had been there for weeks. Whole-body (18)F-fluorodeoxyglucose positron emission tomography and computed tomography ((18)F FDG PET-CT) revealed multiple focal areas of increased uptake of fluorodeoxyglucose (FDG) on the left side of the neck, left supraclavicular fossa, left axilla, and mediastinum, simulating the imaging findings of Hodgkin's lymphoma. Subsequent incisional biopsy of lymph nodes in the left supraclavicular fossa with histologic examination confirmed the diagnosis of Kimura disease. The differential diagnoses should include Kimura disease when evaluating regional or generalized lymphadenopathy seen on (18)F FDG PET-CT because it also may show prominent uptake of FDG.

C-phycocyanin (C-PC), found in blue green algae, is often used as a dietary nutritional supplement. C-PC has been found to have an anti-inflammatory activity and exert beneficial effect in various diseases. However, little is known about its mechanism of action. Overproduction of nitric oxide (NO) derived from inducible nitric oxide synthase (iNOS) plays an important role in the pathogenesis of inflammation. The aim of this study was to determine whether C-PC inhibits production of nitrite, an index of NO, and iNOS expression in lipopolysaccharide (LPS)-treated RAW 264.7 macrophages. Our results indicated that C-PC significantly inhibited the LPS-induced nitrite production and iNOS protein expression accompanied by an attenuation of tumor necrosis factor-alpha (TNF-alpha) formation but had no effect on interleukin-10 production in macrophages. Furthermore, C-PC also suppressed the activation of nuclear factor-kappaB (NF-kappaB) through preventing degradation of cytosolic IkappaB-alpha in LPS-stimulated RAW 264.7 macrophages. Thus, the inhibitory activity of C-PC on LPS-induced NO release and iNOS expression is probably associated with suppressing TNF-alpha formation and nuclear NF-kappaB activation, which may provide an additional explanation for its anti-inflammatory activity and therapeutic effect.

A 76-year-old man with previous sigmoid colon resection for adenocarcinoma had low back pain for 2 months. Whole-body bone scintigraphy showed multiple focal Tc-99m methylene diphosphonate (MDP)-avid lesions in both rib cages and 3 lumbar vertebrae, indicating metastases. F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging was performed for further evaluation of this possible metastatic disease and demonstrated the lumbar and costal metastases and several hypermetabolic areas in the pelvic bones, multiple thoracic vertebrae, both shoulders, and the right femur. Histopathologic examination of the right-sided iliac crest, however, revealed multiple myeloma.

Annexins (ANXs) are a family of calcium dependent phospholipid binding proteins. Phospholipids such as phosphatidylserine are rapidly exposed on the surfaces of injured endothelial cells, activated platelets, and apoptotic cells in a large number of disorders. In this study, annexin V and XI (ANXV and ANXXI) were individually fused to the C-terminal of staphylokinase (SAK), a fibrin-selective thrombolytic protein, to form chimeras for evaluation of their in-vitro thrombolytic activities. The two chimeras were found to have plasminogen activation activity of comparable efficiency. When the chimeras were challenged under higher concentrations of plasmin for 1 h, hydrolysis of them into moieties was not seen on SDS-PAGE. In two thrombolytic assays, SAK-ANXXI was found to resolve both platelet rich plasma (PRP) clots and platelet poor plasma (PPP) clots with an efficiency similar to that of SAK. However, SAK-ANXV showed significantly reduced efficiency. With regard to anticoagulation ability, SAK-ANXXI was also found to have a stronger effect on dose-dependent extension of clotting time among the four tested proteins. The unique long N-terminal tail of ANXXI, composed of 202 residues, in contrast to the 16 residues of ANXV, probably served successfully to dispatch two moieties to function properly in a complicated microenvironment. Hence, a new option other than the most committed ANXV for the ANX based chimera without elaboration of linker construction is presented.

A 53-year-old man was referred for combined F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging to evaluate a protruding mass in the right anterior neck. PET/CT images showed a level III nodular lesion with intense FDG uptake in the above-mentio

Background We sought to determine whether drinking lemon juice reduces extra-cardiac activity and improves image quality on (99m)Tc-tetrafosmin myocardial single photon emission computed tomography (SPECT). Methods Eighty male patients were enrolled in this study and divided into four groups with 20 patients in each group. Each patient received 259-333 MBq tetrofosmin. Ten minutes after injection no action was taken for group 1 (G1), patients in group 2 (G2) each drank 250 ml of water, patients in group 3 (G3) each drank 250 ml of whole milk, and patients in group 4 (G4) each drank 250 ml diluted lemon juice. Myocardial perfusion imaging without attenuation correction was performed after a 1 day rest-stress protocol. Both rest and stress images were aligned at corresponding slices for comparison. Interfering activity was determined visually on reconstructed images, and the heart-to-liver (H/L) ratios were calculated with planar images at 25-30 min and at 45-50 min. Results Interfering activity was seen in 80% of G1, 70% of G2, 60% of G3, and 35% of G4 (G4 vs. G1, P=0.006) on rest images, and in 70% of G1, 60% of G2, 55% of G3, and 30% of G4 (G4 vs. G1, P=0.014) on stress images at 25-30 min. It was also observed in 60% of G1, 50% of G2, 45% of G3, and 15% of G4 (G4 vs. G1, P=0.006) on rest images, and in 50% of G1, 45% of G2, 40% of G3, and 10% of G4 (G4 vs. G1, P=0.011) on stress images at 45-50 min. The mean H/L ratios of rest images were 0.47+/-0.13 for G1, 0.71+/-0.17 for G2, 0.65+/-0.12 for G3, and 0.93+/-0.23 for G4 at 25-30 min, and 0.63+/-0.14 for G1, 0.73+/-0.14 for G2, 0.85+/-0.25 for G3, and 1.15+/-0.25 for G4 at 45-50 min. On stress images, they were 0.49+/-0.11 for G1, 0.74+/-0.16 for G2, 0.69+/-0.11 for G3, and 0.98+/-0.22 for G4 at 25-30 min, and 0.66+/-0.15 for G1, 0.77+/-0.11 for G2, 0.89+/-0.26 for G3, and 1.21+/-0.19 for G4 at 45-50 min. Conclusion Drinking 250 ml of diluted lemon juice accelerates the transit of tetrofosmin through the liver parenchyma and improves image quality on (99m)Tc-tetrafosmin myocardial SPECT.

When using F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) in the detection of various malignant tumors, those with normal or low metabolic activity may lead to false-negative results. In combination with computed tomography (CT) and anatomic concepts, we successfully identified a patient with renal cell carcinoma, which showed normal FDG uptake on an F-18 FDG PET/CT imaging at the upper pole of the right kidney.

Uterine leiomyoma may cause slightly or moderately increased F-18 fluorodeoxyglucose (F-18 FDG) uptake in the low pelvis. However, severely intense FDG accumulation resulting from the disease is rare. We present a patient with uterine leiomyoma and metastatic clear cell carcinoma from the ovary, whose F-18 FDG positron emission tomography/computed tomography (PET/CT) imaging revealed heterogeneous, slightly increased FDG uptake of the ovarian cancer, but homogeneous, greatly increased FDG uptake of the uterine leiomyoma lesions. These findings suggest that intense FDG uptake in a uterine leiomyoma may be combined with malignancy.

Malignant struma ovarii is a rare disease in gynecology and the optimal treatment regimen for the tumor remains obscure. We present a patient who had malignant struma ovarii with peritoneal implants and pelvic structures and liver metastases shown on posttreat- ment iodine I-131 single-photon emission tomography (SPECT) and low-dose computed tomography (CT). The roles of I-131 ablation in the management of the disease are reviewed and discussed.

In this study, we examined whether PC-09, a new pyridazinone derivative, has antiplatelet activity in vitro and further investigated the possible mechanisms involved. Pretreatment with PC-09 resulted in an inhibition on rabbit platelet aggregation and ATP release induced by arachidonic acid, collagen or thrombin, with the IC(50) values of 5.4 to 76.8 muM. The thromboxane B(2) formation caused by collagen or thrombin was markedly inhibited by PC-09, but there was no alteration in that caused by arachidonic acid. The rise of platelet intracellular calcium level stimulated by aggregation agonists and collagen-induced platelet membrane surface glycoprotein IIb/IIIa expression was also reduced by PC-09. In addition, PC-09 itself significantly increased the cyclic AMP level through inhibiting cyclic AMP phosphodiesterase activity. These findings demonstrate that PC-09 is an inhibitor of platelet aggregation, which may be associated with mechanisms including inhibition of thromboxane A(2) formation, intracellular calcium mobilization and platelet surface GPIIb/IIIa expression accompanied by increasing cyclic AMP level.

Metastatic pulmonary calcification (MPC) characterized by diffuse calcium deposition in the lungs is known to occur in patients with chronic renal failure. However, MPC with pulmonary artery calcification is uncommon and has only been detected in a few patients with severe disorders. A 48-year-old man with chronic renal failure had cough and progressive dyspnea. Ventilation-perfusion (V/Q) lung scans showed multiple large-sized mismatched V/Q defects in the left middle and lower zones of lungs, which was consistent with a high probability of pulmonary embolism (PE). The findings of pulmonary scintigraphy resulted from MPC with pulmonary artery calcification, revealed by simultaneous technetium-99m MDP scintigraphy, low-dose computed tomography, and high-resolution computed tomography (HRCT) of the chest.

A 46-year-old woman had a nonfunctioning lung and pulmonary shunt resulting from trauma. She had shortness of breath when in the erect position but no symptoms when in the supine position. A chest radiograph and computed tomographic scan showed collapse of the left lung, hyperinflation of the right lung, and cardiomegaly. Body position and cardiomegaly are causes of nonuniform pulmonary artery perfusion revealed by quantitative lung scans obtained in different positions. After left pneumonectomy with left pulmonary artery ligation, the clinical symptoms subsided completely.

Purpose: Patients with nephrotic syndrome (NS) have an increased tendency to develop thrombosis and even to progress to pulmonary embolism (PE). This study was performed to determine the incidence of PE in NS with severe hypoalbuminemia and to investigate the possible role of ventilation-perfusion (V/Q) lung scans to evaluate these patients. Methods: Eighty-nine patients with NS (serum albumin concentration < 2 g/dl) and risk factors for PE were studied. In all patients, the probability that PE would develop was assessed based on the results of V/Q lung scans (Xe-133 for ventilation and Tc-99m MAA for perfusion imaging). The lung scans were judged using the modified Prospective Investigation of Pulmonary Embolism Diagnosis criteria. In 25 (28%) patients whose lung scans showed an intermediate or low probability, but for whom there was a strong clinical indication of PE, pulmonary angiography was performed. The patients' clinical symptoms and signs on initial examination were observed. Additional examinations included electrocardiograms, chest radiography, and hematochemical tests such as albumin, blood urea nitrogen, creatinine, cholesterol, triglycerides, fibrinogen, antithrombin III, prothrombin time, and activated partial thromboplastin time. Results: Based on the findings of lung scans, 19 (21%) of the patients were categorized as having a high probability of PE. However, pulmonary angiography found that 10 (11%) other patients had PE despite having lung scan findings categorized as intermediate or low probability of PE. Except for plasma fibrinogen and antithrombin III levels, neither the clinical symptoms and signs, electrocardiogram findings, chest radiograph results, nor values of hematochemical testing were consistent with the occurrence of PE in these 29 patients. Conclusion: The results of this study suggest that PE is not a rare complication in patients with NS, and is usually clinically silent. In this series, the occurrence of PE did not appear to be always correlated with the clinical or hematochemical severity of NS, except for the association with elevated levels of fibrinogen and antithrombin III. When treating the clinical symptoms of patients with NS, physicians should be alert to the possible complication of PE. Serial V/Q lung scans may provide valuable clues in the evaluation of these patients.

A 70-year-old man with possible pulmonary tuberculosis had taken antituberculosis therapy for 2 months. Dyspnea and abdominal fullness developed and he was found to have acute hepatitis. The antituberculosis drugs were discontinued and his liver enzyme levels decreased rapidly within 5 days. The patient died on the fifth day of acute hepatic failure. Bone scintigraphy done on the third day to exclude pulmonary malignancy with bone metastases showed intense hepatic uptake, probably caused by hepatic necrosis.

A 78-year-old female with a previous history of endometrial lymphoma was referred to our hospital for F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging on account of a growing tumor mass in the left eyeball with gradual visual loss for 5 months. The F-18 FDG PET/CT images showed a focal lesion with intense FDG uptake in the left bulbar conjunctiva with intraocular invasion. Excisional biopsy was performed under the impression of a malignant neoplasm, and the pathologic diagnosis confirmed squamous cell carcinoma.

Several causes of bowel visualization on bone scintigraphy have been discussed. Tc-99m MDP whole-body bone imaging was performed on a 38-year-old woman for clinical staging of breast cancer. The bone scintigraphy demonstrated no skeletal abnormality. However, extensive accumulation of radioactivity in the colon was noted. This resulted from the patient drinking her own urine, because some people believe that it is a way to improve their health. To avoid such misleading conditions, thorough history taking, including administration of traditional remedies, special habits, and the habitat of the patient, are necessary before imaging.

A 60-year-old woman with prior right upper lobe lobectomy for adenocarcinoma of the lung was referred for a combined F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging to evaluate an enlarging right cervical node. The F-18 FDG PET/CT images showed a level III nodular lesion with increased FDG uptake in the right neck region. Surgical excision was performed under the impression of metastases. Histopathologic evaluation, however, revealed a schwannoma.

Although increased thyroxine sulfate (T4S) levels have recently been detected in fetal serum and amniotic fluid, changes in patients in a high thyroxine (T4) state remain unclarified. This study was conducted to determine the changes in T4S in thyroid hormone regulation in women receiving suppressive T4 therapy. With a highly sensitive and specific radioimmunoassay, we measured the serum and urinary concentrations of T4S in 16 premenopausal women with benign nodular goiter before and after three months administration of T4 (3.2 micrograms/kg/day). Serum levels of other thyroid hormones were also measured. Significant increases in mean serum T4 levels post-treatment (11.1 vs. 6.6 micrograms/dL pre-treatment; P0.01) were found, although only low T4S levels were detectable in serum both pre- and post-T4 treatment. The mean urinary or creatinine corrected urinary T4S values post-treatment were significantly increased (20 ng/dL or 396 ng/g creatinine vs. 12 ng/dL or 174 ng/g creatinine pre-treatment, P0.01). There was a significant correlation between increased creatinine-corrected urine T4S and increased serum free T4. Our results indicate that the sulfation of T4 may be related to the regulation of thyroid hormone metabolism in T4-treated subjects with relative hyperthyroxinemia.

A 4-year-old boy was hospitalized for anemia. Because he had dark stool after admission, technetium-99m pertechnetate scintigraphy was performed to screen for ectopic gastric mucosa. Incidental accumulation of Tc-99m pertechnetate in the transverse colon was noticed, and it was seen early and then faded, which indicated lesions with increased blood pool but without taking up Tc-99m pertechnetate. The literature has suggested several causes for such a finding, including intussusception, arteriovenous malformations, and tumors. Small intestine x-rays demonstrated an ileocolic intussusception with terminal ileum invagination into the transverse colon and a tumor mass approximately 4 cm in diameter as the leading point. Exploratory laparotomy and excision biopsy confirmed the diagnosis of Burkitt's lymphoma with tumor-induced intussusception.

Several clinical conditions, such as deep vein thrombosis, cerebral infarct, pulmonary infarct, skin ulcers, renal failure, and habitual abortion, are thought to be associated with the antiphospholipid syndrome. The authors describe a 32-year-old woman who had characteristics of the antiphospholipid syndrome including increased immunoglobulin G-cardiolipin antibody titers, iliofemoral vein thrombosis, pulmonary embolism, headache, visual disturbances, and habitual abortion. During hospitalization, she suddenly experienced right-sided weakness. A Tc-99m HMPAO brain scan showed the probability of a transient ischemic attack in the left frontotemporal cortex.

Background To investigate the role of upper extremity radionuclide venography as a potential diagnostic modality in the assessment of venous thrombosis associated with a Port-A catheter. Methods Fourteen symptomatic patients who had received Port-A catheter implantation were enrolled. A dynamic nuclear medicine flow study was performed with intravenous administration of Technetium-99m macroaggregated albumin to both upper extremities. Imaging patterns of the venous system were categorized as patency, partial obstruction, and total occlusion. Results The findings of the dynamic images clearly demonstrated clinical problems. Three patients were free of a definite venous flow change. Three patients had partial obstruction of venous return. A significant cut-off of venous return was demonstrated in 8 patients, and total occlusions were hence diagnosed. All patients underwent this procedure smoothly without any complication. Conclusion These results suggest that upper extremity radionuclide venography is an easily performed and effective method for diagnosing Port-A catheter thrombosis in clinical practice.