Laparoscopic anterior hemifundoplication improves key symptoms without impact on GE in children with and children without neurodevelopmental delays.

AIM: We investigated the impact of laparoscopic anterior hemifundoplication on gastric emptying (GE) and specific symptoms in children with and children without neurodevelopmental delays gastroesophageal reflux. Scintigraphic and ultrasonographic GE measurements were correlated. PATIENTS AND METHODS: Twenty-six children (mean age 7 ± 6.1 years), of whom 14 were neurodevelopmentally delayed, were evaluated prospectively before 3 and 6 months after laparoscopic anterior hemifundoplication. All of the patients underwent clinical assessments, interviews, and 24-hour pH monitoring. Key symptoms were evaluated using a 5-point Likert scale. Gastric emptying was assessed by Tc-99m-DTPA-scintigraphy and ultrasonography. RESULTS: All of the children had significant catch-up growth after fundoplication, which was more pronounced in the neurologically normal children (P < 0.05 vs impaired), in line with a decrease in the use of omeprazol (mean 0.93 ± 0.7 mg · kg(-1) · day(-1) before and 0.06 ± 0.18 mg · kg(-1) · day(-1) at 6 months after operation; P < 0.001). The 24-hour pH monitoring normalized in all of the children, and the mean severity of the key symptoms such as vomiting, choking, and pain was significantly reduced (P < 0.001). Scintigraphic GE parameters, such as the elimination rate/minute, gastric half-emptying time (t1/2), gastric residual activity (RA), and duration of the initial merging time, were not altered significantly by the operation (P > 0.05). Ultrasonographic evaluations confirmed these results [positive correlation with scintigraphy for t1/2 (P = 0.006) and RA (P = 0.01)]. The symptoms evolution and GE were uncorrelated (P > 0.01). There were no significant differences between children with and children without neurodevelopmental delays. CONCLUSIONS: Laparoscopic anterior hemifundoplication achieves an excellent symptomatic outcome without affecting GE in children with and children without neurodevelopmental delays.

The first scintigraphic detection of tumor necrosis factor-alpha in patients with complex regional pain syndrome type 1.

Tumor necrosis factor (TNF)-alpha has been identified as a pathogenic factor in many immunologically based diseases and complex regional pain syndrome (CRPS). In this case series, we used radiolabeled technetium anti-TNF-alpha antibody to scintigraphically image TNF-alpha in 3 patients with type 1 CRPS. The results show that TNF-alpha was localized only in affected hands of patients with early-stage CRPS. No uptake was seen in clinically unaffected hands and late-stage CRPS. Our findings support the growing evidence for neuroimmune disturbance in patients with CRPS and may have important further implications for specific anticytokine treatment in patients with CRPS.

Nonossifying fibroma can mimic residual lymphoma in FDG PET: additional value of combined PET/CT.

A 12-year-old girl was diagnosed with Hodgkin's lymphoma and underwent conventional cross-sectional imaging for initial staging. Chemotherapy was given according to standard pediatric protocols. At the end of therapy, an F-18 FDG PET/CT examination was performed to evaluate the therapeutic response. The scan demonstrated focal uptake of FDG in the right distal femur and residual lymphoma was taken into consideration. However, findings in the coregistered CT scan were consistent with nonossfiying fibroma, a common benign skeletal lesion. Combined PET/CT imaging can be helpful to identify benign bone lesions mimicking metastatic or residual disease in F-18 FDG PET as illustrated by this case.

Renal metastases from follicular thyroid cancer on SPECT/CT.

In well-differentiated thyroid carcinoma, only a subset of patients develop distant metastases, predominantly to the lungs and the skeletal system. Only a few cases of metastatic spread to the kidneys are described in the literature. We report the case of a 64-year-old woman with a long history of follicular thyroid cancer who developed renal metastases. The lesions were detected with I-131 scintigraphy, SPECT/CT and thin-collimated contrast-enhanced CT. Subsequent surgery and histopathologic analysis of the renal lesions confirmed the diagnosis.

Oncogenic osteomalacia: exact tumor localization by co-registration of positron emission and computed tomography.

UNLABELLED: In oncogenic osteomalacia, the causative tumor is almost always difficult to find. A novel diagnostic approach is presented that facilitates a precise and rapid localization of the associated lesion by PET-CT co-registration using the radiotracer (68)Ga-DOTANOC. INTRODUCTION: Oncogenic osteomalacia (OOM) is an uncommon disorder characterized by hyperphosphaturia, hypophosphatemia, decreased vitamin D(3) serum levels, and osteomalacia. The paraneoplastic syndrome is exclusively driven by a small somatostatin receptor (sst)-positive tumor that produces phosphatonins, proteins that cause renal phosphate loss. OOM can be cured completely on tumor removal. However, the exact tumor localization is the most challenging step, because the lesion is notoriously difficult to detect by common imaging techniques. MATERIALS AND METHODS: A 60-year-old woman complained of severe pain in her back and chest wall, muscle weakness, and reduced physical activity for >1 year. She suffered a metatarsal fracture and presented with hyperphosphaturia and hypophosphatemia. OOM was suspected, and a meticulous search for the tumor was initiated by conventional imaging techniques, sst-mediated imaging using (111)In-octreotide scintigraphy, and (68)Ga-DOTANOC-based positron emission tomography (PET)-CT co-registration. (68)Ga-DOTANOC is a novel radiopharmaceutical compound in which the somatostatin analog octreotide is modified at position 3, chelated with DOTA, and complexed with (68)Gallium. (68)Ga-DOTANOC has an improved affinity to sst2 and sst5 relative to other radiopeptides. RESULTS: Whereas common imaging techniques such as CT failed to localize the tumor, (111)In-octreotide scintigraphy was able to detect the lesion, but only PET-CT using (68)Ga-DOTANOC revealed the exact tumor localization in the right femoral head. On tumor resection, the well being of the patient improved significantly, and biochemical parameters returned to normal. CONCLUSIONS: (68)Ga-DOTANOC-based PET-CT is a novel and powerful approach to detect sst-positive tumors in a timely manner and to provide highly resolved images facilitating the development of a therapeutic strategy.

Regional and transient ischemia/reperfusion injury in the liver improves therapeutic efficacy of allogeneic intraportal hepatocyte transplantation in low-density lipoprotein receptor deficient Watanabe rabbits.

BACKGROUND/AIMS: Hepatocyte transplantation has the potential to become an alternative to organ transplantation for the treatment of hereditary liver disease. Currently used hepatocyte transplantation techniques are often not sufficient for phenotypic correction. In a pre-clinical model we investigated the effect of regional transient ischemia reperfusion injury and repeated infusions of allogeneic hepatocytes on LDL cholesterol levels in LDL receptor deficient hyperlipidemic Watanabe rabbits. METHODS: A catheter was surgically inserted into the inferior mesenteric vein. Blood supply to the right liver lobe was transiently interrupted. Nine infusions of 2.5x10(7) adult allogeneic hepatocytes from white New Zealand rabbits were applied over a period of 2 months. RESULTS: Compared to pretreatment levels LDL cholesterol decreased significantly in Watanabe rabbits with transient ischemia reperfusion injury and repeated hepatocyte transplantation (-42+/-3%). Repeated hepatocyte transplantation without transient ischemia reperfusion injury decreased LDL cholesterol levels only moderately (-11+/-4%). LDL receptor messenger RNA and proteins were detected in hepatocyte transplanted liver but not in the liver of sham treated animals. CONCLUSIONS: Our data indicate that transient ischemia reperfusion injury of the recipient liver is safe and significantly improves the therapeutic efficacy of allogeneic hepatocyte transplantation in hyperlipidemic rabbits with congenital LDL receptor deficiency.

Intraportal infusion of 99mtechnetium-macro-aggregrated albumin particles and hepatocytes in rabbits: assessment of shunting and portal hemodynamic changes.

BACKGROUND: Partial correction of metabolic liver disease by hepatocyte transplantation requires infusion of a large number of cells into the portal vein. Uncontrolled infusion of cells leads to extrahepatic shunting. Obstruction of the sinusoidal space may result in hemodynamic changes and impairment of liver function. METHODS: Catheters connected to a port were placed into the caudal mesenteric vein of rabbits. After injection of 99mtechnetium-macroaggregated albumin (99mTc-MAA) surrogates or 99mTc-MAA/hepatocyte (Hc) mixtures (1:125), shunting into the lung was scintigraphically monitored. Volume flow (mL/min) and maximum velocity of the portal vein were recorded by color-coded Doppler ultrasound during intraportal application of 2.5 x 10(7) MAA particles, 2.5 x 10(7) isolated hepatocytes, and saline solution without particles or cells. RESULTS: 99mTc-MAA particles (2.5 x 10(7)) or equivalent MAA/Hc mixtures were completely retained in the liver. With additional application of 2.5 x 10(7) particles, shunting into the lung was observed in two animals of the MAA group. All animals in the hepatocyte group have received 5 x 10(7) MAA/Hc mixtures, and three of these received 10(8) mixtures without shunting. Maximum velocity and volume flow increased with saline infusion. Hepatocyte suspended in the same volume blunted the increase observed in the control group, but parameters remained normal. Liver enzymes increased after hepatocyte application but returned to normal values within 5 days. CONCLUSIONS: Sinusoidal uptake capacity for hepatocyte or MAA particles varies at a wide range in normal rabbits. Scintigraphic monitoring of transplanted cells allows efficient monitoring of cell translocation into the lungs. No significant impairments of portal hemodynamics and liver function were detected.

Positron emission tomography with [(18)F]FDG in the diagnosis of Creutzfeldt-Jakob disease (CJD).

The aim of this study was to explore the sites of metabolic changes with [(18)F]2-fluoro-2-desoxy-D-glucose (FDG) and positron emission tomography (PET) in patients with Creutzfeldt-Jakob disease and to correlate the findings with clinical symptoms. Static [(18)F]FDG-PET studies of eight patients with the diagnosis of confirmed or probable CJD were retrospectively analysed by two physicians from departments of nuclear medicine independently with a strong interrater agreement (kappa=0,98). The clinical data of the patients, based on a standardized evaluation by physicians from the German Creutzfeldt-Jakob disease surveillance study, was correlated with the PET findings. [(18)F]FDG-PET shows widespread hypometabolism in CJD. All patients had a reduction of cerebral glucose metabolism in at least one temporal or parietal region. Additionally in 7 of our own 8 cases and 3 of 4 cases from the literature the occipital lobe, the cerebellum or the basal ganglia were involved. These findings differ from typical patterns of hypometabolism in Alzheimer's disease and other neurodegenerative disorders. In two thirds of the cases the distribution was markedly asymmetric. Myoclonus was present in five out of our eight own cases. Our data suggest that myoclonus might correlate with metabolic impairment of contralateral parietal and temporal lobes. In three of four patients with visual symptoms FDG uptake was reduced in the visual cortex bilaterally. Typical hyperintensities on MRI were only found in two of the eight cases at the time of PET-studies. Our results demonstrate that [(18)F]FDG-PET appears to be a sensitive investigation in CJD and could be useful to differentiate CJD from other neurodegenerative disorders.