Characteristics of Chronic Maxillary Sinusitis in Patients With a History of Long-term Bisphosphonate Use

2019 ◽  
Vol 33 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Chi Sang Hwang ◽  
Chunui Lee ◽  
Hee Sung Chae ◽  
Chun Han ◽  
Hyun Woo Yang ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Chronic Rhinosinusitis ◽  
Single Photon ◽  
Maxillary Sinusitis ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Clinical Appearance ◽  
Oroantral Fistula ◽  
History Of

Background Bisphosphonates are widely used as bone stabilizers, which can cause major side effects including bisphosphonate-related osteonecrosis of the jaw (BRONJ) that occurs more frequently in the mandible. Consequently, there is a need for a detailed investigation of BRONJ of the maxilla and, in particular, of involvement of the maxillary sinus. Objective Our aim was to evaluate the characteristic radiologic and clinical manifestations in patients with maxillary sinusitis and a history of long-term bisphosphonate use. Methods Between January 2015 and July 2018, 55 patients with symptoms consistent with chronic rhinosinusitis who underwent a paranasal sinus computed tomography (CT) and had a history of >12 months of bisphosphonate therapy were included in the analysis. Results Radiologically and clinically evident chronic rhinosinusitis was noted in 24 of the 55 patients, of whom more than half (14/24, 58.3%) had BRONJ. The CT studies demonstrated that the maxillary sinus was involved in all 24 patients, characterized by unilateral involvement (70.8%) and bony remodeling in the posterior maxillary region (90.5%). The evidence of osteitis on CT and/or single-photon emission CT was observed in the majority of cases (19/21, 90.5%) and 12 patients (50.0%) had oroantral fistula. However, there were no differences in the clinical appearance of the diseases with respect to the radiologic aspects. Conclusions Besides its well-known effects on the mandible, long-term bisphosphonate use can also affect the maxillary sinus, with typical clinical and radiological manifestations.

Imipramine-Associated Hyperpigmentation

2003 ◽  
Vol 37 (6) ◽  
pp. 825-828 ◽  
Author(s):  
Charles E Dean ◽  
Frank M Grund
Keyword(s):  
Single Photon ◽  
Paranoid Schizophrenia ◽  
White Male ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Early Action ◽  
History Of ◽  
The Brain ◽  
Photon Emission Computed Tomography

OBJECTIVE: To inform clinicians of the potential for severe and persistent facial hyperpigmentation with the long-term use of imipramine. CASE SUMMARY: A 65-year-old white male veteran with a history of paranoid schizophrenia was referred to the psychiatry service by a dentist who thought that the patient was both cyanotic and psychotic. The history and biopsy results indicated the possibility of imipramine-associated hyperpigmentation, only the second reported case in a male patient. The presentation was complex, with a history of neuroleptic exposure and multiple signs of parkinsonism. A brain single photon-emission computed tomography scan demonstrated frontal lobe hypermetabolism and bilateral caudate hypermetabolism, which normalized 14 months later. Despite discontinuation of imipramine, the patient continued to appear cyanotic, leading to worsening social isolation. He became known as “the man with the purple face.” On his rare ventures outside the home, he was embarrassed by sporadic calls to 911 by persons fearing he was ill. DISCUSSION: Although facial hyperpigmentation secondary to the use of phenothiazines has been reported frequently, it is much less common with imipramine, and is very rare in males. Failure to recognize this adverse reaction led to continuing treatment with imipramine and to an apparently irreversible condition. The brain imaging findings have no link with the hyperpigmenting process, but raise questions about neuroleptic-induced metabolic changes in the brain. CONCLUSIONS: Clinicians need to be aware of rare adverse reactions such as hyperpigmentation, and be prepared to take appropriate and early action to prevent such reactions from becoming irreversible.

Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy

1998 ◽  
Vol 89 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Richard B. Schwartz ◽  
B. Leonard Holman ◽  
Joseph F. Polak ◽  
Basem M. Garada ◽  
Marc S. Schwartz ◽  
...  
Keyword(s):  
Survival Rate ◽  
Glioblastoma Multiforme ◽  
Single Photon ◽  
Photon Emission ◽  
High Dose ◽  
Term Survival ◽  
Content Type ◽  
Dual Isotope ◽  
Fine Print

Object. The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. Methods. Studies in which SPECT with 201Tl and 99mTc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99mTc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan—Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I (201Tl ratio < 2 and 99mTc-HMPAO ratio < 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients (201T1 ratio < 2 and 99mTc-HMPAO ratio of ≥ 0.5 or 201Tl ratio between 2 and 3.5 regardless of 99mTc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III (201Tl ratio > 3.5 and 99mTc-HMPAO ratio ≥ 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p < 0.01); however, SPECT grouping was more closely associated with 1-year survival (p < 0.001) and was the only variable significantly associated with long-term survival (p < 0.005). Conclusions. Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.

The Role of Neuroimaging in the Diagnosis and Treatment of Depressive Disorder: A Recent Review

2018 ◽  
Vol 24 (22) ◽  
pp. 2515-2523 ◽  
Author(s):  
Tianbin Song ◽  
Xiaowei Han ◽  
Lei Du ◽  
Jing Che ◽  
Jing Liu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Depressive Disorder ◽  
Diffusion Tensor ◽  
Single Photon ◽  
Rapid Development ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Brain Network ◽  
Emission Computed Tomography ◽  
Resonance Spectroscopy

Depression is a mental disorder with serious negative health outcomes. Its main clinical manifestations are depressed mood, slow thinking, loss of interest, and lack of energy. The rising incidence of depression has a major impact on patients and their families and imposes a substantial burden on society. With the rapid development of imaging technology in recent years, researchers have studied depression from different perspectives, including molecular, functional, and structural imaging. Many studies have revealed changes in structure, function, and metabolism in various brain regions in patients with depressive disorder. In this review, we summarize relevant studies of depression, including investigations using structural magnetic resonance imaging (MRI), functional MRI (task-state fMRI and resting-state fMRI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), brain network and molecular imaging (positron emission tomography [PET] and single photon emission computed tomography [SPECT]), which have contributed to our understanding of the etiology, neuropathology, and pathogenesis of depressive disorder.

scholarly journals Relationships of Pelvic Vein Diameter and Reflux with Clinical Manifestations of Pelvic Venous Disorder

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 145
Author(s):  
Sergey Gavrilov ◽  
Anatoly Karalkin ◽  
Nadezhda Mishakina ◽  
Oksana Efremova ◽  
Anastasia Grishenkova
Keyword(s):  
Single Photon ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Emission Computed Tomography ◽  
Type I ◽  
Pelvic Vein ◽  
Asymptomatic Patients ◽  
Strong Positive Relationship ◽  
Vein Diameter

The causes of chronic pelvic pain (CPP) in patients with pelvic venous disorder (PeVD) are not completely understood. Various authors consider dilation of pelvic veins (PeVs) and pelvic venous reflux (PVR) as the main mechanisms underlying symptomatic forms of PeVD. The aim of this study was to assess relationships of pelvic vein dilation and PVR with clinical manifestations of PeVD. This non-randomized comparative cohort study included 80 female patients with PeVD who were allocated into two groups with symptomatic (n = 42) and asymptomatic (n = 38) forms of the disease. All patients underwent duplex scanning and single-photon emission computed tomography (SPECT) of PeVs with in vivo labeled red blood cells (RBCs). The PeV diameters, the presence, duration and pattern of PVR in the pelvic veins, as well as the coefficient of pelvic venous congestion (CPVC) were assessed. Two groups did not differ significantly in pelvic vein diameters (gonadal veins (GVs): 7.7 ± 1.3 vs. 8.5 ± 0.5 mm; parametrial veins (PVs): 9.8 ± 0.9 vs. 9.5 ± 0.9 mm; and uterine veins (UVs): 5.6 ± 0.2 vs. 5.5 ± 0.6 mm). Despite this, CPVC was significantly higher in symptomatic versus asymptomatic patients (1.9 ± 0.4 vs. 0.7 ± 0.2, respectively; p = 0.008). Symptomatic patients had type II or III PVR, while asymptomatic patients had type I PVR. The reflux duration was found to be significantly greater in symptomatic versus asymptomatic patients (median and interquartile range: 4.0 [3.0; 5.0] vs. 1.0 [0; 2.0] s for GVs, p = 0.008; 4.0 [3.0; 5.0] vs. 1.1 [1.0; 2.0] s for PVs, p = 0.007; and 2.0 [2.0; 3.0] vs. 1.0 [1.0; 2.0] s for UVs, p = 0.04). Linear correlation analysis revealed a strong positive relationship (Pearson’s r = 0.78; p = 0.007) of CPP with the PVR duration but not with vein diameter. The grade of PeV dilation may not be a determining factor in CPP development in patients with PeVD. The presence and duration of reflux in the pelvic veins were found to be predictors of the development of symptomatic PeVD.

scholarly journals Comparison of the Frequency of Detection of Some Radiological Signs in Chronic Maxillary Sinusіtis of Fungal and Non-Fungal Origin

2020 ◽  
Vol 5 (6) ◽  
pp. 202-207
Author(s):  
Ya. V. Shkorbotun ◽  
◽  
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Chronic Rhinosinusitis ◽  
Chronic Sinusitis ◽  
Maxillary Sinusitis ◽  
Biologically Active ◽  
Differential Diagnostics ◽  
Diagnostic Significance ◽  
Fungal Ball ◽  
The One

The one of the most informative method of preoperative diagnosis of fungal paranasal sinuses is computed tomography. The radiological marker that allows to identify chronic sinusitis of fungal origin is an eclipse with hyperintensive inclusions. The sensitivity of this criterion for fungal ball is about 80%. In addition, a sign of recalcitrant chronic sinusitis is the presence of reactive changes in the bone wall of the sinus – "osteitis". The purpose of the work was to study the frequency of radiological signs of osteitis and areas of increased radiological density in the maxillary sinuses of the patients with chronic sinusitis of fungal and non-fungal etiology, to clarify the diagnostic significance of these symptoms in the differential diagnostics. Material and methods. The results of a retrospective study of computer tomography data of 60 people with chronic rhinosinusitis (intraoperative was verified fungal ball in the maxillary sinus space of 30 patients, other 30 patient had no signs of fungal etiology). Results and discussion. In patients with chronic rhinosinusitis of non-fungal nature, hyperintensive inclusions in the sinus were found in 13.3%, and signs of osteitis were detected in 36.7%, which was significantly less common than in patients with fungal processes, 83.3% and 80,0% respectively (p <0,05). The presence of both of the radiological symptoms was observed in 63.3% of patients from the group of chronic rhinosinusitis in the presence of a fungal body in the space of the sinus and in 6.7% of cases the chronic rhinosinusitis of non-fungal etiology. The severity of osteitis according to KOS, in patients with a fungal body in the sinus was 0.71 ± 0.15 points, and 0.55 ± 0.2 points in patients without a fungus. The pathogenesis of osteitis in the cases of sinusitis with fungal origin is a violation of bone trophism, which develops due to periostitis after the influence of biologically active substances secreted by the fungus. The increase of radiation density in areas of osteitis indicates the predominance of osteogenesis over osteolysis in the inflammatory focus of the bone wall of the maxillary sinus. Conclusion. The frequency of detecting radiological signs of osteitis in patients with chronic rhinosinusitis of the maxillary sinus with fungal bodies was 80%, that was comparable to the frequency of detecting hyperintense inclusions in the lumen of the sinus in these patients (83.3%), and was significantly more than in patients with chronic sinusitis nonfungal etiology. The presence of radiological signs of osteitis of the bone wall of the maxillary sinus in computed tomography should be regarded as an additional symptom in the differential diagnosis of maxillary sinusitis of fungal origin

scholarly journals The SPARKLE registry: protocol for an international prospective cohort study in patients with alpha-mannosidosis

2020 ◽  
Author(s):  
Julia Hennermann ◽  
Nathalie Guffon ◽  
Federica Cattaneo ◽  
Ferdinando Ceravolo ◽  
Line Borgwardt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Natural History ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Care ◽  
Clinical Manifestations ◽  
Routine Clinical Care ◽  
Safety Outcomes ◽  
History Of

Abstract Background: Alpha-mannosidosis is a lysosomal storage disorder caused by reduced enzymatic activity of alpha-mannosidase. SPARKLE is an alpha-mannosidosis registry intended to obtain long-term safety and effectiveness data on the use of velmanase alfa during routine clinical care in patients with alpha-mannosidosis. It is a post-approval commitment to European marketing authorization for Velmanase alfa (Lamzede®), the first enzyme replacement therapy for the treatment of non-neurologic manifestations in patients with mild to moderate alpha-mannosidosis. In addition, SPARKLE will expand the current understanding of alpha-mannosidosis by collecting data on the clinical manifestations, progression, and natural history of the disease in treated and untreated patients, respectively.Results: The SPARKLE registry is designed as a multicenter, multinational, noninterventional, prospective cohort study of patients with alpha-mannosidosis, starting patient enrollment in 2020. Patients will be followed for up to 15 years. Safety and effectiveness as post-authorization outcomes under routine clinical care in patients with treatment will be evaluated. The primary safety outcomes are the rate of adverse events (anti-velmanase alfa-immunoglobulin G antibody development, infusion-related reactions, and hypersensitivity). Secondary safety outcomes include the evaluation of medical events, change in vital signs, laboratory tests, physical examination, and electrocardiogram results. The primary effectiveness outcome is a global treatment response rate, evaluated as the individual aggregate of single endpoints from pharmacodynamic, functional, and quality of life effectiveness outcomes; secondary effectiveness outcomes are to characterize the population of patients with alpha-mannosidosis with regard to clinical manifestation, progression, and natural history of the disease. Any patient in the European Union with a diagnosis of alpha-mannosidosis who is willing to participate will likely be eligible for inclusion in the registry. Publications to disseminate scientific insights from the registry are planned. Conclusion: This study will provide real-world data on the long-term safety and effectiveness of velmanase alfa in patients with alpha-mannosidosis during routine clinical care and increase the understanding of the natural course, clinical manifestations, and progression of this ultra-rare disease.

scholarly journals The SPARKLE registry: protocol for an international prospective cohort study in patients with alpha-mannosidosis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Julia B. Hennermann ◽  
Nathalie Guffon ◽  
Federica Cattaneo ◽  
Ferdinando Ceravolo ◽  
Line Borgwardt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Natural History ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Care ◽  
Clinical Manifestations ◽  
Routine Clinical Care ◽  
Safety Outcomes ◽  
History Of

Abstract Background Alpha-mannosidosis is a lysosomal storage disorder caused by reduced enzymatic activity of alpha-mannosidase. SPARKLE is an alpha-mannosidosis registry intended to obtain long-term safety and effectiveness data on the use of velmanase alfa during routine clinical care in patients with alpha-mannosidosis. It is a post-approval commitment to European marketing authorization for Velmanase alfa (Lamzede®), the first enzyme replacement therapy for the treatment of non-neurologic manifestations in patients with mild to moderate alpha-mannosidosis. In addition, SPARKLE will expand the current understanding of alpha-mannosidosis by collecting data on the clinical manifestations, progression, and natural history of the disease in treated and untreated patients, respectively. Results The SPARKLE registry is designed as a multicenter, multinational, noninterventional, prospective cohort study of patients with alpha-mannosidosis, starting patient enrollment in 2020. Patients will be followed for up to 15 years. Safety and effectiveness as post-authorization outcomes under routine clinical care in patients with treatment will be evaluated. The primary safety outcomes are the rate of adverse events (anti-velmanase alfa-immunoglobulin G antibody development, infusion-related reactions, and hypersensitivity). Secondary safety outcomes include the evaluation of medical events, change in vital signs, laboratory tests, physical examination, and electrocardiogram results. The primary effectiveness outcome is a global treatment response rate, evaluated as the individual aggregate of single endpoints from pharmacodynamic, functional, and quality-of-life effectiveness outcomes; secondary effectiveness outcomes are to characterize the population of patients with alpha-mannosidosis with regard to clinical manifestation, progression, and natural history of the disease. Any patient in the European Union with a diagnosis of alpha-mannosidosis who is willing to participate will likely be eligible for inclusion in the registry. Publications to disseminate scientific insights from the registry are planned. Conclusion This study will provide real-world data on the long-term safety and effectiveness of velmanase alfa in patients with alpha-mannosidosis during routine clinical care and increase the understanding of the natural course, clinical manifestations, and progression of this ultra-rare disease.

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