Biomedical subjects

Kostas Perisinakis

Publications and source records attributed to Kostas Perisinakis.

At least 19 recordsLinked to original sources

PubMed2006

Dosimetric characteristics of a 16-slice computed tomography scanner.

Standard CT dose measurements were performed on a Siemens Sensation 16 scanner. CT dose indices, free-in-air (CTDI(F)) and weighted (CTDI(W)), were measured in all available axial and helical beam collimations of the head and body scanning modes. The effect of tube current, high voltage, rotation time, beam collimation and pitch on the CT doses was investigated. CT doses increased as a power function of high voltage. The kVp exponent n varied with beam collimation from 2.7 to 3.1 for CTDI(W), and from 2.4 to 2.6 for CTDI(F). Automatic change of the focal spot size increased radiation doses up to a factor of 1.18. Measured small-focus CTDI(W) values differed from those displayed at the console from -24 to 14%. Peripheral doses in the head phantom were higher compared to the body phantom by a factor of 1.5 to 2. Central doses are 2.7 to 4.1 times higher. Differences in beam collimation resulted in 50% variation in the CTDI(W) in the body phantom and 60% in the head phantom. In conclusion, our study has confirmed the great impact of technique factors and acquisition parameters on CT doses. The provided comprehensive dosimetric data will facilitate the dose-effective use of the scanner studied.

Computer Simulation↗

PubMed2006

Clearance of technetium-99m-DTPA and HRCT findings in the evaluation of patients with Idiopathic Pulmonary Fibrosis.

BACKGROUND: Clearance of inhaled technetium-labeled diethylenetriamine pentaacetate (99mTc-DTPA) is a marker of epithelial damage and an index of lung epithelial permeability. The aim of this study was to investigate the role of 99mTc-DTPA scan in patients with Idiopathic Pulmonary Fibrosis (IPF). Our hypothesis is that the rate of pulmonary 99mTc-DTPA clearance could be associated with extent of High Resolution Computed Tomography (HRCT) abnormalities, cell differential of bronchoalveolar lavage fluid (BALF) and pulmonary function tests (PFTs) in patients with IPF. METHODS: We studied prospectively 18 patients (14 male, 4 female) of median age 67 yr (range 55-81) with histologically proven IPF. HRCT scoring included the mean values of extent of disease. Mean values of these percentages represented the Total Interstitial Disease Score (TID). DTPA clearance was analyzed according to a dynamic study using a Venticis II radioaerosol delivery system. RESULTS: The mean (SD) TID score was 36 +/- 12%, 3 patients had mild, 11 moderate and 4 severe TID. Abnormal DTPA clearance half-time (t1/2 < 40 min) was found in 17/18 (94.5%) [mean (SD) 29.1 +/- 8.6 min]. TID was weakly correlated with the DTPA clearance (r = -0.47, p = 0.048) and with % eosinophils (r = 0.475, p = 0.05). No correlation was found between TID score or DTPA and PFTs in IPF patients. CONCLUSION: Our data suggest that 99mTc-DTPA lung scan is not well associated with HRCT abnormalities, PFTs, and BALF cellularity in patients with IPF. Further studies in large scale of patients are needed to define the role of this technique in pulmonary fibrosis.

Aged↗

PubMed2006

Fluoroscopically assisted surgical treatments of spinal disorders: conceptus radiation doses and risks.

STUDY DESIGN: A series of anterior-posterior and lateral fluoroscopic exposures at 5 spinal levels were performed on anthropomorphic phantoms simulating the 3 trimesters of gestation. OBJECTIVES: To provide normalized data for the determination of conceptus dose specific to gestational stage and treated spinal level. To estimate the conceptus radiation dose and risk associated with typical fluoroscopically guided spinal treatments performed on the pregnant patient. SUMMARY OF BACKGROUND DATA: To our knowledge, there are no available data on conceptus doses and radiogenic risks resulting from fluoroscopically guided spinal surgery of the expectant mother. METHODS: Direct measurement of conceptus doses from simulated fluoroscopic projections involved in orthopedic surgery at different spinal levels for the 3 trimesters of gestation with use of anthropomorphic phantoms and thermoluminescent dosimetry. Estimation of conceptus radiation risks from a typical pedicle screw fixation and kyphoplasty procedure using the experimentally derived data. RESULTS: Conceptus doses from fluoroscopically guided spinal treatments are smaller than 4 mGy during all gestational stages, provided that the conceptus lies outside the primarily irradiated region. The associated risks of fatal cancer during childhood and congenital malformation on its progeny are at least 2 and 1500 times, respectively, lower than the spontaneous incidence rates. When the embryo is primarily irradiated, mean conceptus dose can be as high as 105 mGy from a nonoptimized exposure. At least 35 minutes of fluoroscopy are required for the induction of deterministic effects. CONCLUSIONS: Individual dose assessment is paramount in every pregnancy. Variations in fluoroscopy practices and gestational stage significantly affect fetal doses.

Computer Simulation↗

PubMed2006

Radiation dose and risk from fluoroscopically guided percutaneous transhepatic biliary procedures.

PURPOSE: To estimate radiation dose and associated risks after fluoroscopically guided percutaneous transhepatic biliary (PTB) drainage and stent implantation procedures. MATERIALS AND METHODS: Organ and effective doses, normalized to dose-area product (DAP), were estimated for PTB procedures with use of a Monte Carlo transport code and an adult mathematical phantom. Exposure parameters from 51 consecutive patients were used to determine average examination parameters for biliary drainage and stent implantation procedures. Thermoluminescent dosimeters were used in an anthropomorphic phantom to verify Monte Carlo calculations. Radiation-induced cancer and genetic risks were estimated. RESULTS: The results consist of doses normalized to DAP so patient dose from any technique and x-ray unit can be easily calculated for left and right biliary access and for separate or combined biliary and metallic stent implantation sessions. A good agreement was found between Monte Carlo-calculated data and data derived from thermoluminescent dosimetry. The average effective dose varied from 1.8 to 5.4 mSv depending on procedure approach (left vs right access) and procedure scheme. A maximum effective dose of 13 mSv was estimated for 30 minutes of fluoroscopy. CONCLUSIONS: Doses delivered to patients undergoing PTB procedures are comparable to those that arise from computed tomography protocols. Radiation-induced cancer risk may be considerable for young patients undergoing PTB drainage and stent implantation procedures.

Adult↗

PubMed2006

Normalized dose data for upper gastrointestinal tract contrast studies performed to infants.

The aim of the current study was to (a) provide normalized dose data for the estimation of the radiation dose from upper gastrointestinal tract contrast (UGIC) studies carried out to infants and (b) estimate the average patient dose and risks associated with radiation from UGIC examinations performed in our institution. Organ and effective doses, normalized to entrance skin dose (ESD) and dose area product (DAP) were estimated for UGIC procedures utilizing the Monte Carlo N-particle (MCNP) transport code and two mathematical phantoms, one corresponding to the size of a newborn and one to the size of a 1-year-old child. The validity of the MCNP results was verified by comparison with dose data obtained in physical anthropomorphic phantoms simulating a newborn and a 1-year-old infant using thermoluminescence dosimetry (TLD). Data were also collected from 25 consecutive UGIC examinations performed to infants. Study participants were (a) 12 infants aged from 0.5 to 5.9 months (group 1) and (b) 13 infants aged from 6 to 15 months (group 2). For each examination, ESD and dose to comforters were measured using TLD. Patient effective doses were estimated using normalized dose data obtained in the simulation study. The risk for fatal cancer induction was estimated using appropriate coefficients. The results consist of tabulated dose data normalized to ESD or DAP for the estimation of patient dose. Conversion coefficients were estimated for various tube potentials and beam filtration values. The mean total fluoroscopy time was 1.26 and 1.62 min for groups 1 and 2, respectively. The average effective dose was 1.6 mSv for group 1 and 1.9 mSv for group 2. The risk of cancer attributable to the radiation exposure associated with a typical UGIC study was found to be up to 3 per 10 000 infants undergoing an UGIC examination. The mean radiation dose absorbed by the hands of comforters was 47 microGy. In conclusion, estimation of radiation doses associated with UGIC studies performed to infants can be made using the normalized dose data provided in the current study. Radiation dose values associated with UGIC examinations carried out to infants are not low and should be minimized as much as possible.

Body Burden↗

PubMed2006

The effect of z overscanning on radiation burden of pediatric patients undergoing head CT with multidetector scanners: a Monte Carlo study.

The purpose of this study was to investigate the effect of z overscanning on eye lens dose and effective dose received by pediatric patients undergoing head CT examinations. A pediatric patient study was carried out to obtain the exposure parameters and data regarding the eye lens position with respect to imaged volume boundaries. This information was used to simulate CT exposures by Monte Carlo code. The Monte Carlo N-Particle (MCNP, version 4C2) radiation transport code and five mathematical anthropomorphic phantoms representing newborn, 1-, 5-, 10-, and 15-year-old patient, were employed in the current study. To estimate effective dose, the weighted computed tomography dose index was calculated by cylindrical polymethyl-methacrylate phantoms of 9.7, 13.1, 15.4, 16.1, and 16.9 cm in diameter representing the pediatric head of newborn, 1-, 5-, 10-, and 15-year-old individuals, respectively. The validity of the Monte Carlo calculated approach was verified by comparison with dose data obtained using physical pediatric anthropomorphic phantoms and thermoluminescence dosimetry. For all patients studied, the eye lenses were located in the region -1 to 3 cm from the first slice of the imaged volume. Doses from axial scans were always lower than those from corresponding helical examinations. The percentage differences in normalized eye lens absorbed dose between contiguous axial and helical examinations with pitch=1 were found to be up to 10.9%, when the eye lenses were located inside the region to be imaged. When the eye lenses were positioned 0-3 cm far from the first slice of region to be imaged, the normalized dose to the lens from contiguous axial examinations was up to 11 times lower than the corresponding values from helical mode with pitch=1. The effective dose from axial examinations was up to 24% lower than corresponding values from helical examinations with pitch=1. In conclusion, it is more dose efficient to use axial mode acquisition rather than helical scan for pediatric head examinations, if there are no overriding clinical considerations.

Adolescent↗

PubMed2006

Estimation of effective doses to adult and pediatric patients from multislice computed tomography: A method based on energy imparted.

The purpose of this study is to provide a method and required data for the estimation of effective dose (E) values to adult and pediatric patients from computed tomography (CT) scans of the head, chest abdomen, and pelvis, performed on multi-slice scanners. Mean section radiation dose (dm) to cylindrical water phantoms of varying radius normalized over CT dose index free-in-air (CTDIF) were calculated for the head and body scanning modes of a multislice scanner with use of Monte Carlo techniques. Patients were modeled as equivalent water phantoms and the energy imparted (epsilon) to simulated pediatric and adult patients was calculated on the basis of measured CTDI(F) values. Body region specific energy imparted to effective dose conversion coefficients (E/epsilon) for adult male and female patients were generated from previous data. Effective doses to patients aged newborn to adult were derived for all available helical and axial beam collimations, taking into account age specific patient mass and scanning length. Depending on high voltage, body region, and patient sex, E/epsilon values ranged from 0.008 mSv/mJ for head scans to 0.024 mSv/mJ for chest scans. When scanned with the same technique factors as the adults, pediatric patients absorb as little as 5% of the energy imparted to adults, but corresponding effective dose values are up to a factor of 1.6 higher. On average, pediatric patients absorb 44% less energy per examination but have a 24% higher effective dose, compared with adults. In clinical practice, effective dose values to pediatric patients are 2.5 to 10 times lower than in adults due to the adaptation of tube current. A method is provided for the calculation of effective dose to adult and pediatric patients on the basis of individual patient characteristics such as sex, mass, dimensions, and density of imaged anatomy, and the technical features of modern multislice scanners. It allows the optimum selection of scanning parameters regarding patient doses at CT.

Adult↗

PubMed2005

Fluoroscopically guided implantation of modern cardiac resynchronization devices: radiation burden to the patient and associated risks.

OBJECTIVES: To establish radiation risks for patients undergoing fluoroscopically guided cardiac resynchronization device implantation. BACKGROUND: Cardiac resynchonization therapy (CRT) may be associated with extended fluoroscopic exposure. METHODS: The fluoroscopy time, dose-area product (DAP), exposure parameters, and percentage contribution of the fluoroscopic projections commonly used were recorded in a series of 14 consecutive patients referred for cardiac resynchronization device implantation and compared to corresponding data obtained from a control group of 20 patients who underwent a conventional rhythm device implantation operation. The DAP to peak skin dose, DAP to effective dose, and DAP to gonadal dose conversion factors were determined for biventricular pacing and conventional rhythm device implantation using a humanoid phantom and thermoluminescence dosimetry. RESULTS: The mean total fluoroscopy time and DAP values were 35.2 min and 4,765 cGy cm2, respectively, for biventricular pacing and 8.2 min and 1,106 cGy cm2, respectively, for conventional rhythm device implantation. Patient skin dose from biventricular pacing procedures requiring extended fluoroscopic exposure may exceed threshold dose for the induction of skin effects only if X-ray source-to-skin distance is kept low. The risk values for fatal cancer and severe hereditary disorders, respectively, associated with a typical CRT procedure were 273 per million and 0.2 per million treated patients. CONCLUSIONS: Radiation risks associated with fluoroscopically guided CRT procedures may be considerable. Present data may be used for the estimation of patient radiation risks from CRT procedures performed in other institutions.

Aged↗

PubMed2005

Fluoroscopy-controlled voiding cystourethrography in infants and children: are the radiation risks trivial?

The purpose of this study was to determine the gonadal dose, effective dose and relevant radiogenic risks associated with pediatric patients undergoing voiding cystourethrography (VCUG). Exposure parameters were monitored in 118 consecutive children undergoing VCUG. The entrance surface dose (ESD) was determined by thermoluminescent dosimeters (TLDs). For male patients, the gonadal dose was determined by TLDs attached on the anterior scrotum. For female patients, the gonadal dose was estimated by converting ESD to the ovarian dose. ESD-to-ovarian dose conversion factors were determined by thermoluminescence dosimetry and physical anthropomorphic phantoms representing newborn and 1-, 5- and 10-year-old individuals. The effective dose was estimated by using ESD and data obtained from the literature. The mean fluoroscopy time and number of radiographs during VCUG were 0.73 min and 2.3 for female and 0.91 min and 3.0 for male pediatric patients, respectively. The gonadal dose range was 0.34-5.17 mGy in boys and 0.36-2.57 mGy in girls. The corresponding ranges of effective dosage were 0.12-1.67 mSv and 0.15-1.45 mSv. Mean radiation risks for genetic anomalies and carcinogenesis following VCUG during childhood were estimated to be up to 15 per million and 125 per million, respectively. Radiation risks associated with pediatric patients undergoing VCUG should not be disregarded if such a procedure is to be justified adequately.

Adolescent↗

PubMed2005

Image-guided reconstruction of femoral fractures: is the staff progeny safe?

The potential of adverse effects to progeny caused by preconceptual and fetal exposure to ionizing radiation is an issue of increasing concern to orthopaedic surgeons and assisting staff. Are these fears justified? How effectively is the embryo or fetus protected, and should pregnant staff alter their duties? In this study, an anthropomorphic phantom was exposed fluoroscopically at two geometries common in surgical reconstruction of proximal femur fractures. Scatter radiation was converted to gonadal dose and embryo or fetal dose with and without use of a protective apron. The genetic risk for the orthopaedic surgeon after 10 years of occupational exposure was estimated to be 16,000 times lower than the natural frequency of heritable disease. The excess risk of childhood cancer associated with the dose accumulated during gestation was at least 600 times lower than the corresponding natural frequency. A properly shielded pregnant orthopaedic surgeon is allowed to do 14 hours of hip fluoroscopy during gestation, whereas 2100 hours of fluoroscopy are required for the induction of gross malformation or mental retardation to the growing embryo or fetus. The supplementary dose constraints for pregnant staff provide adequate protection to the unborn child without affecting regular personnel duties.

Dose-Response Relationship, Radiation↗

PubMed2005

Anticipation of radiation dose to the conceptus from occupational exposure of pregnant staff during fluoroscopically guided electrophysiological procedures.

UNLABELLED: Conceptus dose from occupational exposure. INTRODUCTION: A female employee working in the electrophysiology suite has the right to know potential radiation hazards to the unborn child before she is pregnant or before she decides to formally declare her pregnancy. Moreover, the employer of a declared pregnant worker must evaluate the work situation and ensure that the conceptus dose is kept below the maximum permissible level during the remaining gestation period. The aim of this study was to develop a method for conceptus dose anticipation and determination of maximum workload allowed for the pregnant employee who participates in fluoroscopically guided electrophysiological procedures. METHODS AND RESULTS: A C-arm fluoroscopy system, an anthropomorphic phantom, and a radiation meter were used to obtain scattered air kerma dose rates separately for each of the three fluoroscopic projections typically used in the electrophysiology suite. Air kerma to conceptus dose conversion factors for all trimesters of gestation were calculated using Monte Carlo simulation. A formula is presented for the anticipation of the conceptus dose from occupational exposure of pregnant staff during fluoroscopically guided electrophysiological procedures. Normalized data are provided for conceptus dose estimation from occupational exposure of pregnant staff working in any electrophysiology laboratory. A methodology for estimation of maximum workload allowed for each month of the remaining gestation period of a worker who declared her pregnancy is proposed, which ensures that the regulatory dose limits are not exceeded. CONCLUSION: Data presented may be used for the implementation of a radiation protection program designed for pregnant staff working in an electrophysiological suite.

Electrophysiologic Techniques, Cardiac↗

PubMed2005

Reduction of eye lens radiation dose by orbital bismuth shielding in pediatric patients undergoing CT of the head: a Monte Carlo study.

Our aim in the study was to assess the eye lens dose reduction resulting from the use of radioprotective bismuth garments to shield the eyes of pediatric patients undergoing head CT. The Monte Carlo N-particle transport code and mathematical humanoid phantoms representing the average individual at different ages were used to determine eye lens dose reduction accomplished with bismuth shielding of the eye in the following simulated CT scans: (a) scanning of the orbits, (b) scanning of the whole head, and (c) 20 degrees angled scanning of the brain excluding the orbits. The effect of bismuth shielding on the eye lens dose was also investigated using an anthropomorphic phantom and thermoluminescence dosimetry (TLD). Eye lens dose reduction achieved by bismuth shielding was measured in 16 patients undergoing multiphase CT scanning of the head. The patient's scans were divided in the following: CT examinations where the eye globes were entirely included (n=5), partly included (n=6) and excluded (n=5) from the scanned region. The eye lens dose reduction depended mainly on the scan boundaries set by an operator. The average eye lens dose reduction determined by Monte Carlo simulation was 38.2%, 33.0% and <1% for CT scans of the orbits, whole head, and brain with an angled gantry, respectively. The difference between the Monte Carlo derived eye lens dose reduction factor values and corresponding values determined directly by using the anthropomorphic phantom head was found less than 5%. The mean eye lens dose reduction achieved by bismuth shielding in pediatric patients were 34%, 20% and <2% when eye globes were entirely included, partly included and excluded from the scanned region, respectively. A significant reduction in eye lens dose may be achieved by using superficial orbital bismuth shielding during pediatric head CT scans. However, bismuth garments should not be used in children when the eyes are excluded from the primarily exposed region.

Adolescent↗

PubMed2004

Occupational gonadal and embryo/fetal doses from fluoroscopically assisted surgical treatments of spinal disorders.

STUDY DESIGN: Simulation of lumbar spine fluoroscopy used during surgical treatments of spinal disorders on a humanoid phantom and monitoring of the scattered radiation levels. OBJECTIVES: To assess the potential of adverse effects to progeny due to the preconceptual and embryo/fetal exposure to ionizing radiation resulting from the parental occupational exposure to scattered radiation from lumbar fluoroscopy. SUMMARY OF BACKGROUND DATA: There are no available data on embryo/fetal doses resulting from maternal occupational exposure in the orthopedic theater. Besides, studies on staff gonadal doses from fluoroscopically assisted spine surgery are scarce and their results are not generally applicable. METHODS: Lumbar spine anterior-posterior and lateral fluoroscopy were performed on an anthropomorphic phantom. Scattered radiation within the orthopedic theater was recorded at the staff genitals and waist level. Gonadal, abdominal surface, and embryo/fetal doses normalized to the dose-area-product specific to each projection were calculated. RESULTS: If the annual dose limits of occupational exposure are continuously exhausted for 10 years, the resulting radiogenic risk of congenital malformation in infants born to the orthopedic theater staff will be at least two orders of magnitude lower than the corresponding spontaneous probability. The occupational exposure of the pregnant mother bears a negligible contribution to the risk of hereditary effect on the newborn's progeny compared with the natural incidence rate. CONCLUSIONS: Radiogenic genetic and embryo/fetal risks resulting from occupational exposure due to fluoroscopically assisted surgical treatments of spinal disorders are well within tolerance levels provided that rigorous confinement to all pertinent occupational dose constraints is established.

Dose-Response Relationship, Radiation↗

PubMed2004

Patient exposure and associated radiation risks from fluoroscopically guided vertebroplasty or kyphoplasty.

PURPOSE: To derive normalized data for the estimation of effective, gonadal, and peak skin doses to patients undergoing vertebroplasty or kyphoplasty and to investigate the potential for cancer induction, genetic effects, and radiation-induced skin injury after such procedures. MATERIALS AND METHODS: Dose values normalized over dose-area product were determined for all radiosensitive organs and tissues by using a humanoid phantom and thermoluminescence dosimetry separately for anteroposterior and lateral projections. Measurements were obtained for treatments of the fifth, eighth, and 11th thoracic vertebrae and the first, third, and fifth lumbar vertebrae. Total fluoroscopy time and resultant dose-area product from each fluoroscopic exposure were monitored in 11 consecutive patients (seven women and four men) undergoing kyphoplasty. The age range of these patients was 41-78 years, and the mean age was 58 years. RESULTS: Mean total fluoroscopy time for kyphoplasty was 10.1 minutes +/- 2.2 (standard deviation). Mean effective dose to patients from kyphoplasty was 8.5-12.7 mSv, and mean gonadal dose was 0.04-16.4 mGy, depending on the level of the treated vertebra. Skin injuries after kyphoplasty are improbable if source-to-skin distance is 35 cm or more; however, such injuries may occur if the total fluoroscopy time per projection is extended and/or the source-to-skin distance is less than 35 cm during the procedure. CONCLUSION: Patient radiation exposure and associated risks from vertebroplasty or kyphoplasty may be considerable. Data obtained in the current study may be used to establish patient effective dose, gonadal dose, and entrance skin exposure, as well as associated risks, from these fluoroscopically guided surgical treatments of spinal disorders.

Adult↗

PubMed2004

Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion.

STUDY DESIGN: An experimental model for the assessment of patient dose and associated radiogenic risks associated with pedicle screw internal fixation surgical procedures. OBJECTIVES: To provide data for the accurate determination of patient effective dose, gonadal dose, and entrance skin dose from fluoroscopically assisted pedicle screw insertion procedures and to investigate the potential of both stochastic and deterministic radiogenic effects to occur following such procedures. SUMMARY OF BACKGROUND DATA: There is increased concern on radiation exposure of patients undergoing fluoroscopically guided interventional procedures. METHODS: The cumulative screening time and dose area product, for each fluoroscopic projection used, were monitored in 20 patients undergoing pedicle screw internal fixation. The dose absorbed by each radiosensitive organ/tissue was determined from direct measurements obtained using an anthropomorphic phantom appropriately loaded with thermoluminescence dosimeters. RESULTS: An average pedicle screw insertion procedure requires 1.2 minutes and 2.1 minutes of fluoroscopic exposure along anteroposterior and lateral projections, respectively, resulting in a dose area product of 232 cGy cm and 568 cGy cm, correspondingly. Gender-specific normalized data for the determination of effective, gonadal, and entrance skin dose to patients undergoing fluoroscopically guided pedicle screw internal fixation procedures were derived. The effective dose from an average procedure was 1.52 and 1.40 mSv and the gonadal dose 0.67 and 0.12 mGy for female and male patients, respectively. The average radiogenic risks for fatal cancer and genetic defects were 115 and 4 per million of patients treated, respectively. Induction of skin injuries might be induced when fluoroscopy along the lateral projection is highly extended and the source to skin distance is kept low. CONCLUSIONS: Patient dose and radiogenic risks associated with an average pedicle screw internal fixation procedure are tolerable. However, for young patients with complex spinal disorders requiring extended fluoroscopy, radiogenic risks may be considerable. Present data may beused for estimation of effective dose, gonadal dose, and entrance skin exposure and associated radiogenic risks to patients undergoing fluoroscopically guided pedicle screw insertion in any institution.

Adult↗

PubMed2004

Serum level of interleukin-16 in multiple myeloma patients and its relationship to disease activity.

Interleukin-16 (IL-16) is a chemoattractant of CD4+ lymphocytes, and it has been implicated in the pathogenesis of various inflammatory diseases. There is evidence that it may have a role in multiple myeloma (MM). In the present study, we determined the serum level of IL-16 both before and after treatment of MM and related it to inflammatory markers and survival. Forty-eight newly diagnosed MM patients were included in the study. Disease stage was defined using the Durie-Salmon classification system (10 patients were in stage I, 19 in stage II, and 19 in stage III). After standard treatment, 22 patients reached the plateau phase and were re-evaluated. The following serum parameters were measured: IL-16, IL-6, alpha-1 antitrypsin (alpha1AT), and C-reactive protein (CRP). Survival was determined as the number of months elapsed since original diagnosis. The mean +/- SD of serum IL-16 was 343 +/- 195 pg/ml in the pre-treatment MM group and 101 +/- 30 pg/ml in the control group. All measured parameters were higher in the patient group compared to healthy controls. Furthermore, IL-16, IL-6, alpha1AT, and CRP were significantly increased with increasing stage of disease, from stage I to stage III (P<0.01). All parameters decreased significantly following effective chemotherapy (P<0.002). Patients with a high level of IL-16 (>430 pg/ml) displayed an inferior survival time in comparison to those with lower levels of IL-16. In the pre-treatment group, IL-16 correlated with alpha1AT and IL-6 (r=0.374, P<0.01 and r=0.454, P<0.002, respectively). IL-16 may play a role in multiple myeloma; however, further functional studies are required.

Adult↗

PubMed2004

Clinical significance of circulating endothelial adhesion molecules (sE-selectin and sICAM) in untreated multiple myeloma patients.

BACKGROUND: The expression of adhesion molecules is important for the interaction of myeloma cells with the bone marrow microenvironment. In the current study, serum soluble adhesion molecules (sICAM-1 and sE-selectin) were measured in untreated multiple myeloma (MM) patients in relation with other markers of disease activity. MATERIALS AND METHODS: The study group consisted of 67 patients with MM (classified according to the Durie-Salmon classification) and 15 controls. Interleukin-6 (IL-6), sICAM-1 and sE-selectin concentrations were determined by enzyme-linked immunosorbent assay (ELISA). In addition, the monoclonal protein, erythrocyte sedimentation rate (ESR) and hemoglobin (Hb) concentration were also determined. RESULTS: Serum sICAM-1 level increased significantly at advanced stages of MM and was higher in comparison to controls (p<0.01). sE-selectin increased significantly with advancing stage of the disease, but did not differ from controls. IL-6, ESR and M-component were significantly higher and Hb concentrations lower with advancing stage of disease. There was a positive correlation of IL-6 with sICAM-1 and sE-selectin. CONCLUSIONS: We conclude that serum sICAM-1 differs in multiple myeloma patients from normals and together with sE-selectin increase in parallel to increasing stage of disease, which may reflect a dysregulation and possible involvement of these adhesion molecules in myeloma progression.

Adult↗

PubMed2004

Discrimination of hip fractures by quantitative ultrasound of the phalanges and the calcaneus and dual X-ray absorptiometry.

The aim of the current study was to evaluate the ability of different techniques used for the assessment of bone status to discriminate between postmenopausal women with and without hip fracture. Fifty-one postmenopausal women (mean age 64.5 +/- 6.5) who had sustained a low energy hip fracture and 51 age-matched controls (mean age 64.6 +/- 6.0) were studied. Quantitative ultrasound (QUS) assessment was carried out using the Ubis 3000 device capable of measuring broadband ultrasound attenuation (BUA) and speed of sound at the calcaneus (SOSC) and the Sunlight Omnisense device capable of estimating speed of sound at the phalanges (SOSP). Femoral neck bone mineral density (BMD) was assessed using dual X-ray absorptiometry. Correlations between QUS variables ranged from r = 0.35 to 0.72 and between QUS variables and BMD from r = 0.30 to 0.36. BMD was the best discriminator of hip fractures (odds ratio = 3.61, area under curve = 0.824). All QUS variables were significant discriminators of hip fractures with odds ratios ranging from 1.88 to 2.63 and areas under the ROC curves ranging from 0.663 to 0.740. Among the QUS variables, the SOSP showed the best odds ratio and area under curve. Comparison between the areas under the ROC curve did not show any significant difference between SOSP, BUA and BMD. On the contrary, the difference between SOSC and BMD was significant (P < 0.05). In conclusion, BMD and QUS variables investigated in the current study were significant discriminators of hip fractures. The differentiation of the hip fractures by BMD was significantly better than that of BUA measured at the calcaneus. Moreover, BMD discriminated fractured patients better than BUA and SOS(P), although the difference did not reach statistical significance.

Absorptiometry, Photon↗