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duminică, 5 august 2012

SPECT/CT Imaging Agent Solves The Problem Of Difficult To Diagnose Cases Of Infectious Endocarditis

When combined with standard diagnostic tests, functional imaging procedures have been shown to reduce the rate of misdiagnosed cases of infectious endocarditis. According to new research published in the August issue of The Journal of Nuclear Medicine, single photon emission computed tomography (SPECT)/computed tomography (CT) with 99mTc-hexamethylpropleneamine oxime-labeled white blood cells (99mTc-HMPAO-WBC) can improve the diagnosis of infectious endocarditis in hard-to-diagnose cases.

Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi or other infectious substances. It affects 2-4 people per 100,000 each year, with 25-50 percent of the cases occurring in patients older than 60 years. Mortality from infectious endocarditis remains high when this condition is undiagnosed and, therefore, not adequately treated.

The diagnosis of infectious endocarditis is becoming progressively more challenging in the past years because of a variety of factors: the indiscriminate use of antimicrobial agents in some clinical settings, the increased number of individuals with predisposing or underlying conditions (i.e., frail and elderly, immune-suppressed persons), and the increasing number of interventional cardiovascular procedures and placement of valve prostheses, intravascular devices and cardiac devices.

"SPECT/CT with 99mT-HMPAO-WBC is a nuclear medicine technique currently used for the management of patients with infection; its application in infectious endocarditis has been restricted to few reports," said Paola A. Erba, MD, lead author of the study. "With this work we aimed to open new perspective for the application of this technique."

Researchers conducted 99mTc-HMPAO-WBC SPECT/CT scans on 131 consecutive patients with suspected infectious endocarditis. Patients with permanent cardiac devices were excluded from the research as the devices might have introduced the infection. Results from the scans were compared to diagnostic tests for standard infectious endocarditis - transthoracic or transesophageal echocardiography, blood cultures and the modified Duke Endocarditis Service criteria, which are recommended for classification.

Of the 131 patients, 97 were found to have uptake indicating infection.The 99mTc-HMPAO-WBC SPECT/CT scan was true-positive in 46 of 51 patients and false negative in 5 of 51 cases (90 percent sensitivity, 94 percent negative predictive value and 100 percent specificity and positive predictor value). In addition, septic embolism was detected in 41 percent of the patients.

"When the results of the 99mTc-HMPAO-WBC SPECT/CT scan were associated with either positive echocardiography or a positive blood culture, no cases of infectious endocarditis went undiagnosed," noted Erba. "This demonstrates the added value that 99mTc-HMPAO-WBC SPECT/CT scans can provide to assist physicians in their diagnosis and treatment decisions. Cardiologists and infectivologists dealing with infectious endocarditis should consider using 99mT-HMPAO-WBC when they are facing difficult situation."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our heart disease section for the latest news on this subject. Authors of the article “Added Value of 99mTc-HMPAO-Labeled Leukocyte SPECT/CT in Characterization and Management of Patients with Infectious Endocarditis”include Paola A. Erba, Elena Lazzeri, Martina Sollini and Giuliano Mariani, Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy; Umberto Conti, Laboratory of Echocardiography, Cardiology Unit, Azienda Ospaedaliero-Universitaria Pisana, Pisa, Italy; Roberta Doria, Carlo Tascini and Francesco Menichetti, Infectious Disease Department, Azienda Ospaedaliero-Universitaria Pisana, Pisa, Italy; Salvatore M. De Tommasi, Cardiology Department, Azienda Ospaedaliero-Universitaria Pisana, Pisa, Italy; Francesco Bandera, Cardiovascular Department “E Malan,” IRCCS Policlinico San Donato Milanese, Milan, Italy; A.J.O. Dierckx, Nuclear Medicine and Molecular Imaging Department, University Medical Center Groningen, The Netherlands; and Alberto Signore, Nuclear Medicine and Molecular Imaging Department, University Medical Center Groningen, The Netherlands and Nuclear Medicine Unit, S. Andrea Hospital, University of Rome, Rome, Italy.
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duminică, 11 decembrie 2011

Potential Breast Cancer Prevention Agent Found To Lower Levels Of 'Good' Cholesterol Over Time

Main Category: Breast Cancer
Also Included In: Cholesterol
Article Date: 10 Dec 2011 - 0:00 PST

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Exemestane steadily lowered levels of "good" cholesterol in women taking the agent as part of a breast cancer prevention study, say researchers at Georgetown Lombardi Comprehensive Cancer Center. Exemestane, an aromatase inhibitor used to treat estrogen receptor-positive breast cancer, is being tested to prevent breast cancer in women at an increased risk of developing the disease.

Georgetown researchers say their findings, presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium (SABCS), suggest that the effect this agent has on blood lipids may prove to be significant for women at high risk for heart disease due to elevated blood cholesterol, although no such effects have been seen yet in patients studied over two years of treatment.

There are two types of cholesterol transported in our blood - HDL and LDL. HDL cholesterol is known as "good" cholesterol, because high levels of it protect against heart attack. LDL cholesterol is known as "bad" cholesterol because it can buildup in the inner walls of the arteries that feed the heart and brain, and lead to atherosclerosis.

"Lower levels of the HDL, the good cholesterol, have been shown to increase the risk of heart attack and stroke. While we found that exemestane lowers good cholesterol levels, the clinical significance of this decrease is unknown," says a study investigator, Margaret Gatti-Mays, M.D. an intern in internal medicine at Georgetown.

The results come from a phase II multi-institutional study of women at increased risk for breast cancer that evaluated the safety and efficacy of exemestane over two years of therapy. The findings, from 31 patients, showed that the absolute change from the baseline HDL level at 3, 12, and 24 months were -8.0 mg/dL, -8.5 mg/dL, and -9.9 mg/dL, respectively. The rest of the lipid panel, including LDL (the bad cholesterol) was relatively unchanged.

"It is notable that both women taking and not taking lipid-lowering medication had decreases in HDL," Gatti-Mays says.

"Lower HDL levels are associated with an increased risk of heart disease, so if a patient has a low HDL level, exemestane may not be the best choice as a breast cancer prevention agent," says the study's senior investigator, Jennifer Eng-Wong, M.D., senior medical director of the Capital Breast Care Center at Georgetown Lombardi Comprehensive Cancer Center.

She adds that other anti-estrogen therapies designed to prevent breast cancer don't appear to lower HDL. "Less data is available on anastrozole and letrozole, which are other aromatase inhibitors, but they do not appear to lower HDL. Conversely, tamoxifen has an overall favorable effect on cholesterol."

"Exemestane has been shown to be an effective therapy in the prevention of breast cancer in postmenopausal women who have an increased risk of developing it. This study adds information that will help individualize care for these women though larger studies are needed to more fully evaluate the impact of exemestane on cholesterol and cardiovascular health," says Gatti-Mays.

The research was conducted at Georgetown and the National Cancer Institute (NCI), and was supported by both institutions, as well as the National Institutes of Health, and Pfizer Inc. (which supplied exemestane). (OVER)

A recipient of the ACCR Scholar-in-Training Award, Gatti-Mays' travel to the SABCS conference was funded by this award which is supported by Susan G. Komen for the Cure. She reports no personal financial interests related to the study.

The 2011 CTRC-AACR San Antonio Breast Cancer Symposium is presented by the Cancer Therapy & Research Center at UT Health Science Center San Antonio, the American Association for Cancer Research, and Baylor College of Medicine.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report: