Purpose: The current study characterized pleural changes induced by talc pleurodesis (TP), based on serial positron emission tomography/computertomography (PET/CT) with F-18 fluorodeoxyglucose (FDG). Materials and Methods: A total of 8 cancer patients who had both TP and PET/CT and no evidence of active pleural involvement after TP were retrospectively evaluated. Maximum standard uptake values, maximum Hounsfield units (HU), and thickness were followed over time. Results: The 8 patients had 25 PET/CT scans performed in an average of 22 months after TP. An increased FDG uptake was associated with an increase in pleural thickness within 5 months after TP, and both parameters showed statistical significance as compared with findings before TP. After 5 months of TP, the standard uptake value appeared to persist or increase further, and the pleural thickening stabilized. The formation of calcification was a slow process and might lag behind the changes in FDG metabolism and pleural thickness. The HU did not change significantly once pleural calcification had been formed. Conclusions: Knowledge of aforementioned pleural changes may help differentiate TP induced pleural inflammation from pleural malignancy and to avoid false-positive interpretation of FDG PET/CT exams.

Abstract. Thyroid stunning is a phenomenon of impaired thyroid tissue function after administration of a therapeutic dose of 131I subsequent to a diagnostic dose of 111- MBq (3 mCi) or greater. The impact of stunning on the clinical outcomes is still not well documented. Aim: The purpose of this study was to investigate the clinical effects of stunning. Methods: Four to six weeks after total or near-total thyroidectomy forty patients with nonmetastatic papillary or follicular carcinoma of the thyroid were evaluated. TSH level should be above 30 mU/L. They were divided prospectively into 2 groups. Group 1: 20 patients underwent 131I ablative therapy without a preliminary 131I diagnostic whole body scan. Group 2: 20 patients underwent 131I ablative therapy after preliminary 131I diagnostic whole body scan. Comparisons of the postablation outcomes were evaluated by chi (2) analysis. Successful ablation required a negative follow-up thyroid scan 6 months after ablation and also thyroglobulin level 1.5 μg/L. Results: Only 30% of patients in the scanned group had the thyroid gland ablated after a single 131I dose, compared with 85% in the non scanned group (P0.005). 30% of patients in scanned group versus 15% in non-scanned group required second therapeutic dose. 40% of patients in scanned group required third therapeutic dose. In contrast no patients received third dose in the non-scanned group. Patients in the scanned group required higher total 131I therapeutic activity (199mCi or 7.36GBq) to ablate the thyroid gland compared to those in the non- scanned group (132 mCi or 4.8 GBq). In analysis of the relation between TSH level and number of patients required single 131I dose, to achieved thyroid remnant ablation, there are 5 patients in the range from 30 to 40 mU/l, 8 patients in the range of 41 to 50 mU/l and 10 patients in the range of 51 to 61 mU/l. The difference in outcome between the scanned and the non- scanned groups demonstrates that the efficacy of 131I ablation is reduced subsequent to the use of 185 MBq (5 mCi) of 131I for diagnostic imaging. Conclusions: this study confirms that thyroid stunning after diagnostic 131I whole body scan affect the clinical outcomes of 131I ablation. We also concluded that the higher the TSH level the greater the number of ablated thyroid remnant after single 131I therapeutic dose.

Objective. To evaluate the value of quantitative SPECT bone scintigraphy in assessment of the healing process of periapical defects after filling with algae- derived hydroxapatite. Methods. Twenty patients were included in the present study. Patients were randomly allocated into two equal groups each comprised 10 subjects. In group A periapical surgery was preformed with FRIOS® Algipore® material was applied in periapical bone defects, in group B periapical surgery was preformed without FRIOS® Algipore® material was applied in periapical bone defects. SPECT bone scintigraphy was done for all patients at one month, three months and five months postoperatively. Osteoblastic activity at the defect site was compared with the activity within the skull (reference) to calculate an osteoblastic activity index (AI). Results. It was found that 11 patients (nine were in study group and two were in control group) showed three distinct phases in relation to the bone activity index. (Phase 1) demonstrates a slow rise of the AI, suggesting increased osteoblastic activity. At three months, maximal activity reached, reflected to (Phase 2). At about five months, bone activity decreased to return toward lower level than baseline values (Phase 3). However, in other nine patients (one was in study group and eight were in control group) at phase 3, bone activity decreased to return toward baseline values and not lower than them. At one month, the difference between the control and the study groups’ activity index was non-significant (P > 0.05). While at the three months, the difference between the control and the study groups’ activity index was significant (P 0.05). At the five months, the difference between the control and the study groups’ activity index was highly significant (P 0.01). Conclusion. We concluded that SPECT bone scan offers a simple, quantitative reproducible, objective, and physiologic approach to studying the osseous regeneration process that occurs after bone grafting procedure. We also concluded that algae–derived hydroxyapatite (FRIOS® Algipore®) is a good bone substitute which accelerates healing process in periapical jaw defects.

Background: We evaluated the significance of the genes, defined as DRB1*04 or DRB1*01, in rheumatoid arthritis (RA) patients. We focused on the role of genetic and serologic markers to predict disease activity and destructive process of joints. Methods: Sixty patients with RA were examined. Radiographic changes were evaluated by (Larsen score) and disease activity was measured by disease activity score 28 (DAS28). The markers analyzed were: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP2) and HLA-DRB1 alleles typed by PCR. Results: In this study, anti-CCP antibodies, CRP, RF and AKA were detected in 83.3%, 56.7%, 71.7% and 52% of patients respectively. HLA-DRB1*01 was found in 45% of patients and 35% of them had one or two HLA-DRB1*04 alleles. According to DRB1*04 subtypes, (DRB1* 0405) was present in of 80% them. For prediction of grade of activity, the independent predictors were anti- CCP (OR 19.6), and DRB1*04 positive allele (OR 5.1). The combination of DRB1*04 + anti-CCP antibodies gave increase in the specificity and positive predictive value to 92% and 90 respectively. As regards to the prediction of radiological joint damage, the independent predictors were HLADRB1* 04, HLA-DRB1*01, RF, and CRP > 18 (OR 5.5, 4.5, 2.5, 2.0 respectively). Conclusion: Our findings suggest that anti-CCP2 is superior to RF for the detection of RA and provided predictive information on joint destruction and disease activity. The presence of RA associated antibodies (ACCP or RF) and/or the SE genes are indicative for a poorer radiological outcome and higher grade of activity.

Background: Owing to the limited soft tissue donor sites in the foot area, the use of microsurgical tissue transfer is frequently becoming mandatory in this area, especially in cases of massive defects due to the common motor vehicle accidents in the territory of Upper Egypt. Free flaps offer a great variety of available tissues to cover larger, multifocal or multistructural defects. They also improve the perfusion of the infected poorly perfused areas. Objectives: In this study, we tried to evaluate foot defects according to their size, shape and site and to determine the general and specific parameters of free tissue transfer to the foot area in concomitance with the patients needs. Materials and Methods: Eleven patients were included in this study. For each patient, complete history was taken, general and local examination, photographic documentation, laboratory investigations, imaging and other investigations were performed. Free flap transfers were applied in all cases as follows: Latissimus dorsi flap in five cases, Rectus abdominis flap in three cases, Scapular flap in one case, Gracilis flap in one case and Radial forearm flap in one case. Results: Nine flaps survived. No infection or donor site complications were recorded. Every patient had the optimum free flap as regards the defect size, site, depth, condition, shape, donor site availability and the recipient vessels condition. Conclusion: The study of the optimum free flap for foot reconstruction in relation to the defect present and patient conditions is crucial to have significant results.

Background: Owing to the limited soft tissue donor sites in the foot area, the use of microsurgical tissue transfer is frequently becoming mandatory in this area, especially in cases of massive defects due to the common motor vehicle accidents in the territory of Upper Egypt. Free ß aps offer a great variety of available tissues to cover larger, multifocal or multistructural defects. They also improve the perfusion of the infected poorly perfused areas. Objectives: In this study, we tried to evaluate foot defects according to their size, shape and site and to determine the general and speciÞ c parameters of free tissue transfer to the foot area in concomitance with the patients needs. Materials and Methods: Eleven patients were included in this study. For each patient, complete history was taken, general and local examination, photographic documentation, laboratory investigations, imaging and other investigations were performed. Free ß ap transfers were applied in all cases as follows: Latissimus dorsi ß ap in Þ ve cases, Rectus abdominis ß ap in three cases, Scapular ß ap in one case, Gracilis ß ap in one case and Radial forearm ß ap in one case. Results: Nine ß aps survived. No infection or donor site complications were recorded. Every patient had the optimum free ß ap as regards the defect size, site, depth, condition, shape, donor site availability and the recipient vessels’ condition. Conclusion: The study of the optimum free ß ap for foot reconstruction in relation to the defect present and patient conditions is crucial to have signiÞ cant results.