Use of titanium spiral tacks for long-term oophoropexy before pelvic irradiation.

BACKGROUND: Ovarian transposition before planned pelvic irradiation can preserve ovarian function in young patients with pelvic malignancies. The transposed ovaries are fixed to the posterolateral abdominal wall. We described the use of a titanium spiral tack as a fixation device and compared it with other methods of oophoropexy. METHODS: Medical and surgical records of all consecutive patients who underwent oophoropexy in our institution between 2007 and 2013 were reviewed. Demographic and clinical data were summarized; follicle-stimulating hormone values, recorded; and imaging scans, reviewed. RESULTS: Oophoropexy was performed in 30 patients: 28 with cervical carcinomas and 2 with pelvic sarcomas. The procedure was done through laparoscopy in 13 patients and through laparotomy in 17. Titanium spiral tack was used for ovarian fixation in 14 patients, Vicryl suturing in 14, and in 2 cases the ovaries were pulled up through a retroperitoneal tunnel and fixed to the peritoneum with sutures. Titanium spiral tack fixation took a few seconds to perform. There were no immediate intraoperative or postoperative complications. Ovarian function was preserved in 15 patients (7/14 with spiral tack, 6/14 with sutures, and in both patients with retroperitoneal tunneling). Postoperative imaging results showed that all ovaries retained their extrapelvic location for a median period of 11.6 months (range, 2.3-63 months). CONCLUSIONS: Spiral tack is a simple, reliable method for oophoropexy before pelvic irradiation. Its efficacy is comparable with that of suture fixation, with the added advantage of ultrashort operative time. It is therefore worth considering as an alternative to suturing.

A novel high-sensitivity rapid-acquisition single-photon cardiac imaging camera.

UNLABELLED: This study described and validated a new solid-state single-photon gamma-camera and compared it with a conventional-SPECT Anger camera. The compact new camera uses a unique method for localizing gamma-photon information with a bank of 9 solid-state detector columns with tungsten collimators that rotate independently. METHODS: Several phantom studies were performed comparing the new technology with conventional-SPECT technology. These included measurements of line sources and single- and dual-radionuclide studies of a torso phantom. Simulations were also performed using a cardiothoracic phantom. Furthermore, 18 patients were scanned with both the new camera and a conventional-SPECT camera. RESULTS: The new camera had a count sensitivity that was 10 times higher than that of the conventional camera and a compensated spatial resolution that was moderately better. Dual-radionuclide studies using a phantom show the further potential of the new camera for a 2-tracer simultaneous acquisition. Two-minute clinical studies with the new camera and 11-min studies with the conventional camera qualitatively showed good-to-excellent image quality and improved myocardial edge definition for the new camera. CONCLUSION: These initial performance characteristics of a new solid-state single-photon gamma-camera offer great promise for clinical dynamic SPECT protocols, with important implications for applications in nuclear cardiology and molecular imaging.

Non-[18F]FDG PET in clinical oncology.

PET is an exquisitely sensitive molecular imaging technique using positron-emitting radioisotopes coupled to specific ligands. Many biological targets of great interest can be imaged with these radiolabelled ligands. This review describes the current status of non-18-fluorodeoxyglucose PET tracers that have a potential clinical effect in oncology. With the help of these tracers, knowledge is being acquired on the molecular characterisation of specific tumours, their biological signature, and postinterventional response. The potential role of these imaging probes for tumour detection and monitoring is progressively being recognised by clinical oncologists, biologists, and pharmacologists.

Myocardial perfusion abnormalities early (12-24 h) after coronary stenting or balloon angioplasty: implications regarding pathophysiology and late clinical outcome.

OBJECTIVE: We prospectively examined the prevalence of reversible perfusion defects on very early (12-24 h) thallium-201 single photon emission computed tomography (SPECT) scintigraphy after angiographically successful percutaneous coronary intervention (PCI) by stenting and/or stand-alone balloon angioplasty and the predictive value of these defects for late target lesion revascularization (TLR). PATIENTS AND METHODS: 83 consecutive patients undergoing PCI for 88 lesions (38 balloon angioplasties, 50 stents) underwent very early (12-24 h) SPECT thallium-201 scintigraphy at rest and following administration of 0.7 mg/kg intravenous dipyridamole after PCI. Univariate and multivariate clinical, procedural and scintigraphic correlates of target lesion revascularization during long-term follow-up were examined. RESULTS: Coronary stenting achieved a larger immediate post-PCI minimal luminal dimension (2.7 +/- 0.4 vs. 2.1 +/- 0.4 mm, p < 0.001) and less residual stenosis (4 +/- 12 vs. 19 +/- 11%, p < 0.001) than stand-alone balloon angioplasty. Nonetheless, early reversible perfusion defects were similarly present in the territory supplied by 36% of stented lesions and 32% of lesions treated by balloon angioplasty (NS). Of 81 lesions (76 patients) available for long-term clinical follow-up, TLR was performed in 11% of the stent group and 14% of the balloon angioplasty group (NS). By multivariate logistic regression analysis, diabetes mellitus was the only predictor of late TLR (p < 0.05). The type of intervention (balloon or stent) predicted neither early perfusion defects nor late TLR. CONCLUSIONS: Early 201-thallium SPECT scintigraphy was abnormal in a third of patients treated by stand-alone balloon angioplasty or by stent placement. The very early SPECT scintigraphic findings did not differentiate between balloon and stent and did not predict late TLR.