Although many failed surrogate markers are provided in the literature, inflammation may contribute to the outcome of ischemic stroke. In 50 consecutive patients with acute ischemic stroke, in the absence of symptoms and signs of concomitant infection, we evaluated a panel of biomarkers reported to be variably associated with brain ischemia, and correlate their serum level with the brain lesion volume and clinical outcome. Infarct size was calculated on computed tomography (CT) scans by means of the Cavalieri's method. Neurological impairment was scored by using the Glasgow Coma Scale, Glasgow Outcome Scale and National Institutes of Health (NIH) scales at stroke onset and 3-month follow-up. Some markers showed a direct significant correlation with both initial and final NIH scale and with infarct size, particularly tumor necrosis factor alpha (TNF-alpha) (P=0.002), intercellular adhesion molecule-1 (P<0.01) and matrix metalloproteinase-2/9 (P=0.001). In contrast to previous reports, interleukin-6 (IL-6) serum level showed a significant inverse correlation with both final neurological impairment and infarct size (P<0.001). This novel finding allows us suggesting that IL-6, in the context of a complex pro-inflammatory network occurring during stroke, is associated with neuroprotection rather than neurotoxicity in patients with ischemic brain injury.

No abstract

A correct differential diagnosis between benign and malignant lesions is mandatory in patients with solitary pulmonary nodule (SPN). The aim of the present study was to investigate whether 99m Tc-tetrofosmin SPECT may play a role in SPN evaluation. A consecutive series of 111 patients with an uncalcified ≤3 cm (range: 0.8-3 cm) SPN, without definite benign findings and indeterminate at CT, were studied. Within 1 week of CT scan, following 740 MBq of 99m Tc-tetrofosmin i.v. injection, all patients underwent chest SPECT using a rectangular dual head gamma camera with HR collimators. The images were analysed both qualitatively and semiquantitatively by calculating tumor/normal tissue ratio (T/N). All nodules were referred to a definitive diagnosis after scintigraphy: 84/111 nodules resulted malignant (primary lung carcinomas in 59 cases and metastases in 25), whereas 27/111 were benign. SPECT was true positive in 77/84 malignant nodules (overall sensitivity: 91.7%), detecting 55/59 carcinomas (93.2%) and 22/25 metastases (88%), whereas it was false negative in 4 carcinomas (3 adenocarcinomas and 1 squamous cell carcinoma, the latter with necrotic areas; range size: 1.5-2.4 cm) and in 3 metastases (range size: 1.0-1.2 cm). SPECT was true negative in 24/27 benign lesions (specificity: 88.9%) and false positive in 2 hamartomas and in 1 aspecific inflammation (range size: 0.8-2 cm), each with a T/N value ≤1.4. Accuracy, positive predictive value and negative predictive value were 91, 96.2 and 77.4%, respectively. Mean T/N value was significantly higher in malignant than in benign nodules (2.1±0.6 vs. 1.3±0.1, P<0.05), whereas no significant differences were observed between primary lung carcinomas and metastases (2.1±0.6 vs. 1.9±0.6) or in the different histologic types of carcinomas. 99m Tc-tetrofosmin SPECT proved a highly sensitive imaging method in both primary and secondary malignant ≤3 cm SPNs detection, with a high accuracy value in discriminating malignant from benign lesions, also by adding semiquantitative analysis. A larger clinical application of this non-invasive, simple and widely available procedure is thus suggested in SPN management, especially when FDG-PET is not available.