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PURPOSE: Correctly identifying infection in cancer patients can be challenging. Limited data suggest that positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) may be useful for diagnosing infection. To determine the role of FDG-PET in the diagnosis of infection in patients with multiple myeloma (MM). PATIENTS AND METHODS: The medical records of 248 patients who had FDG-PET performed for MM staging or infection work-up revealing increased uptake at extramedullary sites and/or bones and joints that would be atypical for MM between October 2001 and May 2004 were reviewed to identify infections and evaluate FDG-PET contribution to patient outcome. RESULTS: One hundred sixty-five infections were identified in 143 adults with MM. Infections involved the respiratory tract [99; pneumonia (93), sinusitis (six)], bone, joint and soft tissues [26; discitis (10), osteomyelitis (nine), septic arthritis (one), cellulitis (six)], vascular system [18; septic thrombophlebitis (nine), infection of implantable catheter (eight), septic emboli (one)], gastrointestinal tract [12; colitis (seven), abdominal abscess (three), and diverticulitis and esophagitis (one each)], and dentition [periodontal abscess (10)]. Infections were caused by bacteria, mycobacteria, fungi, and viruses. FDG-PET detected infection even in patients with severe neutropenia and lymphopenia (30 episodes). The FDG-PET findings identified infections not detectable by other methods (46 episodes), determined extent of infection (32 episodes), and led to modification of work-up and therapy (55 episodes). Twenty silent, but clinically relevant, infections were detected among patients undergoing staging FDG-PET. CONCLUSION: In patients with MM, FDG-PET is a useful tool for diagnosing and managing infections even in the setting of severe immunosuppression.

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OBJECTIVES: Infective endocarditis (IE) remains a disease associated with high morbidity and mortality. Many epidemiological studies have been reported worldwide; however, data from the Middle East is scarce. Most studies have recently shown a trend towards increasing incidence of Staphylococcus aureus endocarditis and decreasing prevalence of rheumatic heart disease as a predisposing condition. METHODS: We conducted a retrospective review of all recorded cases of IE in adult patients admitted between 1986 and 2001 to the American University of Beirut-Medical Centre. RESULTS: The total number of cases was 91. The mean age was 48 years. Fifty-nine percent of patients had a predisposing cardiac condition, rheumatic heart disease being the most common (33%). Blood cultures were positive in 77.5% of the cases: the most commonly isolated organisms were Streptococcus spp. (51%; of which 57% were viridans streptococci.) and Staphylococcus spp. (36%; of which 72% were S. aureus and 28% were coagulase-negative staphylococci). Transoesophageal echocardiography was performed in 36 patients (40%), of which 32 (89%) showed positive findings. When applying the revised Duke criteria, 82% of the patients were classified as definite and 16.5% as possible endocarditis. Surgery was performed in 32% of cases mostly for valvular regurgitation, followed by heart failure. The complication rate was 69% with congestive heart failure, drug-related toxicities, new valvular regurgitation and systemic embolisation being the most common. The in-hospital mortality rate was 18%. CONCLUSIONS: Unlike data reported from the United States and northern Europe, this study confirms that in Lebanon, a developing country, we continue to have a predominance of streptococci as aetiologic agents in IE, and rheumatic heart disease as the most common underlying heart condition. Application of the revised Duke criteria was useful in confirming the diagnosis of IE.

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RATIONALE: atheromatous stenosis of both renal arteries, or of the artery of a functionally solitary kidney is a frequent cause of renal failure in the elderly. Atheromatous Ischemic Renal Insufficiency (AIRI) can be ameliorated by surgery or angioplasty. However, such procedures can be hazardous in a patient with extensive aortic atheromatous plaques. This justified a study of the validity of Pulsed Doppler (PD), a diagnostic procedure less invasive than renal angiography in AIRI. OBJECTIVES: to evaluate the diagnostic interest of PD in AIRI, using renal angiography as a criterion of adequacy. METHODS: renal arteries PD (Ultramak-4, 3.5 and 5 Mhz probes) followed by renal angiography (Seldinger). "Significant" stenosis = 50% on angiography. "Positive" PD = turbulences and/or acceleration. PATIENTS: 32 patients were investigated for suspected AIRI on the grounds of 1) age greater than 50; 2) atheromatous background and 3) renal insufficiency with no other evident etiology, or rapidly declining GFR in such a patient treated with ACE inhibitors. RESULTS: 16/32 angiographies disclosed significant stenosis of at least 1 renal artery. 56 renal arteries were investigated with both angio. and PD. Prevalence of stenoses was 16/56. PD had 93.7% sensitivity and 55% specificity. Positive predictive value was 45.5% and negative predictive value was 95.7%. Specificity was 80% when PD disclosed acceleration. CONCLUSIONS: negative PD is sufficient argument to reconsider the indication of renal angiography in a high risk pt with suspected AIRI.

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