Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma.

OBJECTIVE: To quantify radiation exposure and mortality risk from computed tomography (CT) and positron emission tomography (PET) imaging with (18)F-fluorodeoxyglucose ((18)F-FDG) in patients with malignant lymphoma (Hodgkin's disease [HD] or non-Hodgkin's lymphoma [NHL]). METHODS: First, organ doses were assessed for a typical diagnostic work-up in children with HD and adults with NHL. Subsequently, life tables were constructed for assessment of radiation risks, also taking into account the disease-related mortality. RESULTS: In children with HD, cumulative effective dose from medical imaging ranged from 66 mSv (newborn) to 113 mSv (15 years old). In adults with NHL the cumulative effective dose from medical imaging was 97 mSv. Average fractions of radiation-induced deaths for children with HD [without correction for disease-related mortality in brackets] were 0.4% [0.6%] for boys and 0.7% [1.1%] for girls, and for adults with NHL 0.07% [0.28%] for men and 0.09% [0.37%] for women. CONCLUSION: Taking into account the disease-related reduction in life expectancy of patients with malignant lymphoma results in a higher overall mortality but substantial lower incidence of radiation induced deaths. The modest radiation risk that results from imaging with CT and (18)F-FDG PET can be considered as justified, but imaging should be performed with care, especially in children.

Buttressing of the staple line in gastrointestinal anastomoses: overview of new technology designed to reduce perioperative complications.

BACKGROUND: Mechanical stapling devices are widely used in all fields of surgery as they can cut and sew tissue in a quick and easy manner. However, complications like bleeding or leakage at the staple line are frequently encountered and can have devastating consequences. Recent developments have led to the introduction of staple line reinforcement to reduce these complications. METHODS: The literature has been reviewed to find and describe different methods to improve stapled resections and to give an extensive overview of the different staple line reinforcement materials, their properties and indications. RESULTS: Several types of staple line reinforcement are available. Reinforcement of the staple line with membranes of either non-, semi- or absorbable material seems to be effective in minimizing the risk of leakage and bleeding by providing strength to the cut tissue. CONCLUSION: Application of staple line reinforcement material seems a promising technique in preventing leakage and bleeding at the stapled suture line, thus potentially reducing complications of gastrointestinal surgery. More studies are needed to investigate the exact properties, behavior and effects of the staple line reinforcement material.

[The value of integrated PET-CT images in 2 lymphoma patients with skeletal localisations]. / De waarde van gefuseerde PET-CT-beelden bij 2 lymfoompatiënten met skeletlokalisaties.

In two women with Hodgkin's disease, 36 and 34 years of age, the PET-scan showed increased FDG-uptake in regions where the CT-scan did not reveal any abnormalities. Integration of the PET-CT images visualised bone marrow localisations in both patients. One patient underwent a CT-guided bone biopsy that confirmed this localisation. In both cases, the results of the integrated PET-CT images altered the therapy that would have been given on the basis ofthe standard staging technique. Both patients underwent radiotherapy. After 6 months, one patient had no visible lesions. The other patient died due to progression ofthe disease. Integrated PET-CT images can play an important role, not only in the precise classification and staging of lymphoma but also at the start of therapy, as an initial scan, in the evaluation of the response to treatment, and in the early detection of recurrence.