Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland.

Purpose: Evaluation of the benefit of selective venous blood sampling (SVS) for the preoperative identification of parathyroid adenomas with unclear localization in non-invasive diagnostics. Materials and Methods: In a retrospective study, all patients (n = 23) with primary (n = 21) or tertiary (n = 2) hyperparathyroidism were evaluated from 2005 to 2016 at the Hospital Nuremberg-North. These patients all received one (n = 20) or more (n = 3) SVS. 15 patients had one or more previous unsuccessful surgeries (group A), 8 patients received the SVS primarily before the first surgery (group B). Results of SVS were compared with the results of surgery, non-invasive diagnostic procedures and clinical follow up. Results: In 24 out of 26 SVS a significant PTH peak was found. 19 patients underwent surgery after SVS. In 16 of these cases (84 %) the SVS peak was concordant with the intraoperative localization. Thus, SVS of all operated patients had a sensitivity of 94 %. Considering only patients with prior HPT surgery the sensitivity was 89 %. In none of the 26 examinations complications occurred. Conclusion: Our results demonstrate that selective venous blood sampling SVS in cases with unclear imaging of parathyroid adenomas is an effective and low-risk invasive diagnostic method to localize parathyroid adenomas and helps to improve surgical therapy. Key points: • low risk invasive diagnostic procedure to localize parathyroid adenomas• additional step if non-invasive diagnostics are negative or inconclusive• high sensitivity in the detection of parathyroid adenomas Citation Format: • Hader C, Uder M, Loose RWR et al. Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland. Fortschr Röntgenstr 2016; 188: 1144 - 1150.

Recent near-Earth supernovae probed by global deposition of interstellar radioactive (60)Fe.

The rate of supernovae in our local Galactic neighbourhood within a distance of about 100 parsecs from Earth is estimated to be one every 2-4 million years, based on the total rate in the Milky Way (2.0 ± 0.7 per century). Recent massive-star and supernova activity in Earth's vicinity may be traced by radionuclides with half-lives of up to 100 million years, if trapped in interstellar dust grains that penetrate the Solar System. One such radionuclide is (60)Fe (with a half-life of 2.6 million years), which is ejected in supernova explosions and winds from massive stars. Here we report that the (60)Fe signal observed previously in deep-sea crusts is global, extended in time and of interstellar origin from multiple events. We analysed deep-sea archives from all major oceans for (60)Fe deposition via the accretion of interstellar dust particles. Our results reveal (60)Fe interstellar influxes onto Earth at 1.5-3.2 million years ago and at 6.5-8.7 million years ago. The signal measured implies that a few per cent of fresh (60)Fe was captured in dust and deposited on Earth. Our findings indicate multiple supernova and massive-star events during the last ten million years at distances of up to 100 parsecs.

Detection of disseminated tumour cells in the liver of cancer patients.

AIMS: The liver is a common site of metastasis from a variety of solid malignancies. This is due to disseminated tumour cells (DTC) that have spread prior to or during surgery from the primary carcinoma. This article gives a short overview of the data published on the detection of DTC in the liver and describes the commonly used detection methods and respective markers. METHODS: A literature survey was performed in public medical databases comprising the last 15 years with focus on DTC detection in liver tissue of cancer patients. KEY FINDINGS: Although the liver is a preferred site of metastasis, only a few studies have analysed the DTC incidence in inconspicuous liver tissue. The available reports include only patients with pancreatic and colorectal carcinomas. In patients with pancreatic cancer the DTC incidence varied from 5 to 76%. No follow-up data has been reported so far. In patients with colorectal carcinoma hepatic DTC were found in 5-69% of cases. A negative prognostic influence of hepatic DTC was reported in all but one studies with follow-up information. CONCLUSIONS: The detection of DTC in the liver can contribute to identify patients with increased risk who could benefit from an intensified follow-up or new treatment strategies.

Detection of disseminated tumour cells in the liver of colorectal cancer patients.

AIMS: The aim of this study was to assess the incidence and lobar distribution of three surrogate tumour cell markers in biopsies from both liver lobes. PATIENTS AND METHODS: This study comprised 189 patients for whom DNA and/or RNA was available from both liver lobes and who showed at least one positive marker in one liver lobe. Detection of cytokeratin 20 (CK20) and guanylylcyclase C (GCC) was performed by nested reverse transcription-PCR. For detection of K-ras mutations in codons 12 and 13, a PCR-restriction-fragment-length-polymorphism assay was used. RESULTS: The incidence of all markers and their combinations was higher in the smaller left lobe than in the larger right lobe (CK20: 62 vs 38%; GCC: 52 vs 48%; K-ras: 61 vs 39%; CK20+GCC: 61 vs 39%; CK20+GCC and/or K-ras: 61 vs 39%). The marker incidence in the two liver lobes was independent from the location of the respective primary colorectal carcinoma. CONCLUSIONS: The markers CK20, GCC, and K-ras indicating cells shed from the primary CRC were detected more often individually and in combination in biopsies from the smaller left lobe than from the larger right lobe. The site of the primary tumour did not influence the marker incidence in both liver lobes.

Extended staging results from the detection of isolated tumor cells in the liver of colorectal cancer patients.

Liver metastasis, as well as local recurrence, are delineating factors of postoperative survival in patients suffering from colorectal cancer. We set up a PCR-RFLP assay to detect K-ras mutated cells in liver tissue as an indicator of possible isolated tumor cells (ITC) or micro-metastasis at the time of surgery. Sixty-four patients with K-ras codons 12 or 13 mutated colorectal cancer were clinically diagnosed for liver metastasis, as well as by PCR-RFLP assay of DNA from liver biopsies. Macro-metastasis was observed in the liver of 7 patients (11%), with no additional evidence of ITC. Likewise, in the liver of 14 patients (22%) only ITC, but no macro-metastasis was detected. In another 7 patients (11%) there was both, ITC and macro-metastasis. No macro-metastasis or ITC were found in 36 patients (56%). Thus, the PCR-RFLP assay added 14 cases (22%) with potential liver-metastasis to the 14 cases (22%) detected by clinical diagnostic means. T and N status were related to the refined detection and extended classification of liver involvement. We conclude that clinical and PCR-RFLP methods supplement each other and can increase the detection of cases with liver involvement, if applied together.

Sensitive detection of K-ras mutations augments diagnosis of colorectal cancer metastases in the liver.

Postoperative survival of colorectal cancer patients is often delineated by metastases spreading to the liver. Current clinical diagnostic procedures are unable to discover micrometastases in this organ. Our aim was to develop a diagnostic tool for detecting micrometastases that are present at the time of surgery. Therefore, a PCR-RFLP assay was set up tracking point mutations of the K-ras oncogene at codons 12 and 13, based on mismatch primers and restriction enzymes BstXI and XcmI. The detection limit of this assay was one mutant in one million wild-type cells. One hundred forty-two patients with colorectal carcinoma were screened for these mutations in tissue samples from their tumor, proximally adjacent mucosa, and liver. Of these, 67 patients (46%) were positive for a K-ras mutation, of which 58 had codon 12 and 9 had codon 13 mutations. No patient without a K-ras-positive tumor showed a mutation in mucosa, but 11 patients with a K-ras-positive tumor (11 of 58; 19%) were found to bear a K-ras mutation in their mucosa, and in 21 patients (21 of 64; 33%), a K-ras mutation was detected in liver tissue. Sequencing of all mutated samples revealed a 92% confirmation of PCR-RFLP results. In summary, the assay is a useful tool for detecting K-ras codon 12 and 13 mutations and allows early proof of molecular determinants of liver metastases. Such knowledge will improve the staging of colorectal cancer patients and could beneficially influence their prognosis if followed by an effective therapy.

Sampling technique influences the detection of K-ras mutations in normal appearing mucosa of colorectal cancer patients.

Based on three colorectal cancer cell lines with specified K-ras status, a sensitive PCR-RFLP assay was established detecting one K-ras mutant among 106 wild-type cells. Using this assay for tissues of 124 colorectal cancer patients, 59 tumor (46%) and 11 mucosa samples (9%) were found to harbor a K-ras mutation. When using the same scalpel for collecting tumor and mucosa tissues (group A), 18% of the patients had a matching K-ras mutation in both tissues, but this coincidence was seen in 3% of patients only, when separate scalpels were used (group B). Thus we conclude that the sampling technique used for collecting specimens is a major contributor to the detection of K-ras mutations in normal appearing mucosa when a highly sensitive detection technique is used.

Ammonium urate urolithiasis in the rat with portocaval shunt--some aspects of mineral metabolism and urine composition.

In the male rat the effects of portocaval shunt (PCS) on mineral metabolism (fractional intestinal absorption, minerals in serum, in bone, in kidney, and in urine) and the effects on urinary constituents were studied. PCS induced a degree of hyperparathyroidism and the formation of ammonium acid urate urinary tract stones. These phenomena were associated with elevated uric acid, ammonium, urinary pH, as well as with elevated supersaturation of urine with struvite, and to a lesser degree with ammonium acid urate. It is suggested that in the rat PCS interferes with both parathyroid gland function and urinary nucleation of ammonium acid urate.