Importance of nutrition visits after gastric bypass surgery for American veterans, San Francisco, 2004-2010.

INTRODUCTION: Nutrition counseling is important for veterans undergoing gastric bypass surgery. The aim of this study was to explore the relationship between the number of nutrition visits a patient attended and change in body mass index (BMI) after gastric bypass surgery for the veteran population. METHODS: A retrospective study examined veterans (N = 79) who underwent Roux-en-Y gastric bypass surgery from June 2004 through July 2010. Spearman's correlation and multivariate regression analysis were used to analyze data. RESULTS: A significant correlation was found between the number of postoperative nutrition visits and the change in postsurgery BMI at 2 years (Spearman's ρ = 0.21; P = .017). After adjusting for age, sex, and race, the association between postsurgery nutrition visits and BMI change persisted (ß = 0.255; 95% confidence interval, 0.015-0.581; P = .039). CONCLUSION: Veterans with more nutrition visits following Roux-en-Y gastric bypass surgery experienced greater declines in BMI. This finding underscores the importance of the dietitian on the bariatric surgery team.

Atypical Polycystic Kidney Disease as defined by Imaging.

Using age- and height-adjusted total kidney volume, the Mayo Clinic Imaging Classification provides a validated approach to assess the risk of chronic kidney disease (CKD) progression in autosomal dominant polycystic kidney disease (ADPKD), but requires excluding patients with atypical imaging patterns, whose clinical characteristics have been poorly defined. We report an analysis of the prevalence, clinical and genetic characteristics of patients with atypical polycystic kidney disease by imaging. Patients from the extended Toronto Genetic Epidemiology Study of Polycystic Kidney Disease recruited between 2016 and 2018 completed a standardized clinical questionnaire, kidney function assessment, genetic testing, and kidney imaging by magnetic resonance or computed tomography. We compared the prevalence, clinical features, genetics, and renal prognosis of atypical versus typical polycystic kidney disease by imaging. Forty-six of the 523 (8.8%) patients displayed atypical polycystic kidney disease by imaging; they were older (55 vs. 43 years; P < 0.001), and less likely to have a family history of ADPKD (26.1% vs. 74.6%; P < 0.001), a detectable PKD1 or PKD2 mutation (9.2% vs. 80.4%; P < 0.001), or progression to CKD stage 3 or stage 5 (P < 0.001). Patients with atypical polycystic kidney disease by imaging represent a distinct prognostic group with a low likelihood of progression to CKD.

Micronutrient deficiencies in early childhood can lower a country's GDP: The Myanmar example.

Myanmar (Burma) is a developing country in South East Asia. While Myanmar is among the 20 countries where 80% of the world's malnourished children live, its military consumes the majority of the national budget. Children who are malnourished between conception and age two are at high risk for impaired physical and mental development, which adversely affects the country's productivity and growth. Myanmar is facing three major micronutrient deficiencies which are iodine, iron and vitamin A deficiencies. The three micronutrient deficiencies can cost about 2.4% of the country's GDP. Children are the future of Myanmar and persistent micronutrient deficiencies will hamper its economic growth and lower its GDP.

Image guided portal vein access techniques in TIPS creation and considerations regarding their use.

Transjugular intrahepatic portosystemic shunt (TIPS) is a difficult procedure to perform and accessing the portal vein is a very challenging step. There are three broad categories of image guided TIPS creation techniques. Each technique has its advantages and disadvantages. TIPS procedure carries some risk of complications regardless of the guidance technique employed. The technology for TIPS has evolved in parallel with the expanding indications for TIPS. Ultrasound guidance technique offers a safe option, particularly for patients with challenging anatomy. Patient safety should always come first and the US guided technique should be more routinely used. Experience is the main factor in the success of TIPS. Other factors to consider in reducing the all-cause morbidity and mortality are patient selection, patient management and the clinical setting.

Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.

We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT) showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results.

Correction: Aung Zaw Win, Renal Cell Carcinoma Metastasis to the Gallbladder Detected by FDG-PET/CT.

[This corrects the article DOI: 10.14740/jocmr1886w.].

Clinical effectiveness of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography in management of renal cell carcinoma: a single institution experience.

Positron emission tomography (PET) is currently the most advanced technique of metabolic imaging available for tumor diagnosis and follow-up. The aim of this study was to examine the versatility and accuracy of fluorodeoxyglucose (FDG) PET/computed tomography (CT) in the metastasis detection of renal cell carcinoma (RCC). We also compared our findings to other similar studies from the literature. This is the biggest study so far to examine the sensitivity and specificity of FDG PET/CT in the management of RCC. A retrospective review was carried out on all the FDG PET/CT studies done from January 1999 to January 2014 at our institution. Biopsy results were considered the gold standard. For our patients (n = 315) with biopsy results, FDG PET/CT studies exhibited 100% sensitivity, 100% specificity. Our results were better than results achieved by other studies. The use of FDG PET/CT in restaging and metastasis detection of RCC has many advantages, in addition to high accuracy. This imaging technique has great potential in influencing treatment decisions. We recommend the incorporation of FDG PET/CT in routine standard protocols for RCC.

A case of metastatic rectal squamous cell carcinoma initially diagnosed as lung cancer.

Squamous cell carcinoma (SCC) of the rectum is extremely rare with a reported incidence of only 0.025-0.1% of all colorectal tumors. The patient was a 68-year-old man who presented with fatigue, dry cough, shortness of breath, and unintentional weight loss. A chest CT revealed a left suprahilar mass suspected to be lung cancer and an initial diagnosis of primary lung cancer was made. However, fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) exam revealed an intensely hypermetabolic rectal mass which turned out to be rectal squamous cell carcinoma. This is the first report that shows FDG-PET/CT images of rectal squamous cell carcinoma metastasis to the skin, muscle, bone, and lung. Use of PET/CT in the initial diagnosis of non-resectable rectal cancers may avoid unnecessary surgery.

Carcinoma en Cuirasse from Recurrent Breast Cancer seen on FDG-PET/CT.

Our patient was a 36-year-old female diagnosed with Grade II ER+/PR-/Her-2 - ductal carcinoma in situ (DCIS) in the left breast. She underwent left lumpectomy and received treatment with tamoxifen and radiotherapy. Three years later, she presented with multiple diffused skin nodules on the chest and upper left arm. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) exam showed widespread metastasis in the chest, upper left arm, left axillary lymph nodes, and left suprascapular muscle. FDG-PET/CT imaging of breast carcinoma en cuirasse is very rare. FDG-PET/CT is useful in detecting recurrent breast cancer.

Lynch Syndrome Associated Colon Adenocarcinoma Resembling Lymphoma on Fluoro-Deoxyglucose-Positron Emission Tomography/Computed Tomography.

The patient was a 46-year-old Asian male diagnosed with lynch syndrome associated colon adenocarcinoma in the right ascending colon. A presurgical staging 18-fluoro-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) found increased metabolic activity in the cervical, axillary, mediastinal, supraclavicular, para-aortic and mesenteric lymph nodes. This pattern of metastasis was very unusual for lynch syndrome associated colon adenocarcinoma and the involvement of those lymph nodes resembles the pattern of spread of lymphoma. He underwent right hemicolectomy and he was subsequently treated with 12 cycles of folinic acid (leucovorin), fluorouracil (5-FU), irinotecan. A restaging FDG-PET/CT at the end of the chemotherapy showed interval decrease in size and metabolic activity in the affected lymph nodes. FDG-PET/CT is a useful imaging modality in following-up the treatment response in colon adenocarcinoma.

Renal Cell Carcinoma Metastasis to the Gallbladder Detected by FDG-PET/CT.

A 62-year-old male presented to the ER with three episodes of diffuse abdominal pain which occurred after eating. He had a history of renal cell carcinoma (RCC), prostate cancer and bladder cancer. FDG-PET/CT scan showed a hypermetabolic soft tissue density within the fundus of the gallbladder. The patient underwent laparoscopic cholecystectomy and surgical pathology revealed clear cell type RCC. This is the first report that features PET/CT imaging to detect RCC metastasis to the gallbladder. Lesions within the gall bladder and their clinical manifestations can be non-specific and PET/CT can help characterize them. RCC metastasis to the gallbladder is very rare but it should be included in the differential diagnosis, especially in patients with a history of RCC.

WITHDRAWN: Polymyositis of bilateral upper legs seen on FDG-PET/CT in a patient with rheumatoid arthritis.

This article has been withdrawn at the request of the author and editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Use of NaF-18-Positron Emission Tomography/Computed Tomography in the Detection of Bone Metastasis from Papillary Renal Cell Carcinoma.

We present a case of a 60-year-old white male with a history of papillary renal cell carcinoma (PRCC) status postpartial nepherectomy. He was followed-up annually with abdominal computed tomography (CT) scans to monitor for tumor recurrence. A solitary metastatic bony lesion was detected by CT 4 years after partial nephrectomy and it was confirmed by NaF-positron emission tomography (PET)/CT and magnetic resonance imaging. He underwent external beam radiation therapy (XRT) for solitary metastasis to L1 vertebra. The L1 lesion was treated with XRT, which exhibited no fluorodeoxyglucose activity after the treatment. This is the first case report to mention the use of NaF-18-PET/CT in the detection of bone metastasis from PRCC. Our case once again emphasizes the usefulness of NaF-18-PET/CT in RCC follow-up.

Bilateral diffuse fluorodeoxyglucose uptake in thyroid gland diagnosed by fluorodeoxyglucose-positron emission tomography/computed tomography.

Our patient is a female who was first diagnosed with breast cancer at the age of 23. A follow-up fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) at age 44 revealed diffuse high FDG uptake in an enlarged thyroid gland. Fine-needle aspiration (FNA) of the thyroid mass revealed estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2+ breast cancer. To the best of our knowledge, this is the first case to report breast cancer metastasis to the thyroid in a diffuse pattern on FDG-PET/CT. Bilateral diffuse uptake of FDG in thyroid is the most commonly associated with benign conditions. However, FNA biopsies need to be done to rule out metastatic disease in thyroid lesions with diffuse high FDG uptake, especially for patients with history of cancer.

Factors Affecting Uptake of NaF-18 by the Normal Skeleton.

BACKGROUND: The primary aim of this study was to examine if factors such as renal function, height, weight and age could affect the uptake of sodium fluoride-18 (NaF-18) by the normal bone. This is the first study to examine the possible factors that can influence NaF-18 uptake in the normal bone. METHODS: A retrospective study was done on NaF-18 PET/CT bone scans from January 2010 to May 2012 at our institution. All NaF-18 PET/CT studies used the same clinical protocol. Our excluding criteria were patients with abnormal renal function and patients with past history of cancer and metabolic bone diseases. Spearman's correlation was used to analyze the data. RESULTS: From our study (n = 11 patients), no correlation was found between SUVmax and serum creatinine and between SUVmax and age. However, significant correlations were found between SUVmax and height (cm) and between SUVmax and weight (kg) for thoracic 5, 7, 12 and lumbar 2 vertebral levels. CONCLUSION: Based on our findings, SUVmax values in NaF-18 PET/CT bone scans can vary depending on the patient's height, weight and bone region. This information can be helpful in diagnosing and monitoring bone pathologies and can help explain the clinical findings.

Omental Nodular Deposits of Recurrent Chromophobe Renal Cell Carcinoma Seen on FDG-PET/CT.

We present the case of a 69-year-old male with chromophobe renal cell carcinoma (RCC). Chromophobe RCC accounts for only 4% of renal cancers and it is the least aggressive type. Omental nodular deposits due to RCC metastasis are very rare and it is reported only in more aggressive forms of RCC. This is the first report that shows FluoroDeoxyGlucose - Positron Emission Tomography/Computed Tomgraphy (FDG-PET/CT) images of omental nodular deposits from chromophobe RCC. FDG-PET/CT is becoming very useful in restaging RCC with distant metastases.