Background: Multiple Myeloma (MM) is a B cell neoplasm characterized by the clonal proliferation of plasma cells. Skeletal complications are found in up to 80% of myeloma patients at presentation and are major cause of morbidity.

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Measuring basal neutrophil counts may be considered as an alternative solution in the prediction of infarct size.

Conventional diagnostic nuclear medicine applications have been continuously increasing in most nuclear medicine departments in Turkey, but to our knowledge no one has studied the doses to technologists who perform nuclear medicine procedures. Most nuclear medicine laboratories do not have separate control rooms for technologists, who are quite close to the patient during data acquisition. Technologists must therefore stay behind lead shields while performing their task if they are to reduce the radiation dose received. The aim of this study was to determine external radiation doses to technologists during nuclear medicine procedures with and without a lead shield. Another aim was to investigate the occupational annual external radiation doses to Turkish technologists. Methods: This study used a Geiger-Mü ller detector to measure dose rates to technologists at various distances from patients (0.25, 0.50, 1, and 2 m and behind a lead shield) and determined the average time spent by technologists at these distances. Deep-dose equivalents to technologists were obtained. The following conventional nuclear medicine procedures were considered: thyroid scintigraphy performed using 99m Tc pertechnetate, whole-body bone scanning performed using 99m Tc-methylene diphosphonate, myocardial perfusion scanning performed using 99m Tcmethoxyisobutyl isonitrile, and 201 Tl (thallous chloride) and renal scanning performed using 99m Tc-dimercaptosuccinic acid. Results: The measured deep-dose equivalent to technologists per procedure was within the range of 0.13 6 0.05 to 0.43 6 0.17 mSv using a lead shield and 0.21 6 0.07 to 1.01 6 0.46 mSv without a lead shield. Also, the annual individual dose to a technologist performing only a particular scintigraphic procedure throughout a year was estimated. Conclusion: For a total of 95 clinical cases (71 patients), effective external radiation doses to technologists were found to be within the permissible levels. This study showed that a 2-mm lead shield markedly reduced the external dose to technologists. The doses to technologists varied significantly for different diagnostic applications. Consequently, the estimated annual dose to a technologist performing only a particular scintigraphic procedure is very different from one type of procedure to another. The results of this study should help in determining the rotation time of technologists in different procedures and differences in their individual techniques.

ultipl myelom (MM) B lenfositlerin matür formu olan plazma hücrelerinin kontrolsüz ve monoklonal artışıyla karakterize bir hastalıktır. Hastaların çoğunda malign plazma hücrelerinden salgılanan monoklonal karakterde ve genellikle immunoglobulin (Ig) G veya IgA komponenti içinde bulunan paraproteinler serum ve idrarda saptanır. Ö ÖZ ZE ET T Mul tipl mye lom (MM) plaz ma hüc re le ri nin kon trol süz ve klo nal ar tı şı ile ka rak te ri ze ma lign bir B hüc re has ta lı ğı dır. İmmu nog lo bu lin M (IgM) mye lom ise tüm MM has ta la rı nın %0.5'in den daha azın da iz le nen na dir bir len fop ro li fe ra tif has ta lık tır. MM ve Wal dens tröm's mak rog lo bu li ne misi (WM) has ta la rın da iz le ne bi len kli nik ve pa to lo jik bul gu la ra sa hip ola bi len IgM mye lom, MM'nin fark lı bir alt gru bu dur. Bu ne den le IgM mye lom va ka la rı nın WM'den ayı rı mı nı yap mak ge rek klinik se yir ve prog noz, ge rek se te da vi açı sın dan önem li dir. Bu va ka tak di min de, IgM mye lom ta nı sı ko nu lan bir has ta nın kli ni ko-pa to lo jik özel lik le ri li te ra tür eş li ğin de tar tı şıl dı. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Mul tipl mye lom; im müng lo bu lin M; Wal dens tröm mak rog lo bu li ne mi si A AB BS S T TR RA AC CT T Mul tip le mye lo ma (MM)is a B-cell ma lig nancy cha rac te ri zed by un con trol led clo nal pro li fe ra ti on of ma lig nant plas ma cells. Im mu nog lo bu lin M (IgM) mye lo ma is a ra re lymphop ro life ra ti ve di se a se, ac co un ting for less than 0.5% of all MM ca ses. IgM mye lo ma is a dis tinct subt ype of MM, disp la ying cli ni cal and pat ho lo gic fe a tu res of both MM and Wal dens tröm's mac rog lo bu line mi a (WM). It is im por tant to dis tin gu ish bet we en IgM mye lo ma and WM as they ha ve dis tinct cli ni cal co ur ses and prog no ses, and tre at ment stra te gi es are the re fo re dif fe rent. In this ca se re port, the cli ni co-pat ho lo gic cha rac te ris tics of a pa ti ent di ag no sed as IgM mye lo ma are dis cus sed and the li te ra tu re is re vi e wed.

Background: Acute allograft failure which occur intermittently after renal transplantation caused by graft tortion is a very rare entity. We here report highly unusual case of recurrent episodes of acute allograft dysfunction two years after kidney transplantation secondary to ischemic tubular necrosis caused by tortion of renal pedicle due to rotation of the allograft with body movements. Case Presentation: A 55 year-old male patient with living unrelated kidney transplantation for chronic renal failure caused by autosomal dominant polycystic kidney disease had presented recurrent acute deteriorations in renal functions. All laboratory values were within normal limits except elevated serum creatinine levels, acute tubular necrosis in graft biopsy, and detection of pelvic dilatation in renal ultrasonography from time to time. Changes in axis of graft in nuclear medicine scans taken at different times during the same study made us bring to mind the diagnosis of renal pedicle tortion. Renal blood flow measurements with Doppler ultrasonography in different body positions helped to reach the final diagnosis of mobile kidney right on time. The patient is now well after prompt surgical treatment with nephropexy. Discussion: Unfortunately, tortion of allograft once occurred is associated with very high rate of graft loss due to arterial compromise and infarction and it is very difficult to diagnose without high level of suspicion. We discuss the causes of renal allograft tortion and the measures to prevent its occurrence and the methods to diagnose.

Polycythemia vera (PV) is a clonal myeloproliferative disorder characterized by predominantly excessive erythrocyte production. During the course of the disease, bleeding or thrombosis may be observed. In PV patients, the influence of antifibrinolytic activities on development of thrombohemorrhagic complications remains to be elucidated. In the present study, alterations in antifibrinolytic activity of PV patients and the effects of treatments on these alterations were investigated. Newly diagnosed and therapy-naive 22 PV patients were included. Thrombomodulin (TM), plasmin-alpha 2-antiplasmin complex (PAP), plasminogen activator inhibitor-1 (PAI-1) and thrombin activable fibrinolysis inhibitor antigen (TAFIa) levels were measured in all individuals and after phlebotomy and 5-hydroxyurea (5-HU) therapy in PV patients. TM, PAP, PAI-1 and TAFIa values of the patient group were higher than those of the controls. After phlebotomy, no changes were detected in TM, PAI-1 and TAFIa values, but PAP values decreased. On the contrary, 5-HU treatment resulted in a marked decrease in TM, PAI-1, PAP and TAFIa levels. These findings suggested that the changes in antifibrinolytic activity and endothelial dysfunction might be contributed to formation of intravascular thrombosis in PV patients, even though not clinically overt. 5-HU in addition to phlebotomy affects antifibrinolytic activity and may have an influence on diminishing predisposition of thrombosis.