Laryngo-tracheobronchial amyloidosis: a case report and review of literature.

AMYLOIDOSIS is a benign process which can have systemic involvement. Though larynx is the common site of localized amyloidosis in the head and neck region,1 it was seldom reported with heterochronous implication of bilateral ventricles. Here we report a case of laryngeal amyloidosis heterochronously localized at bilateral ventricles with tracheobronchial involvement. Combined with our experience we reviewed the literature, and discuss the pertinent managements of this condition.

Use of FDG-PET or PET/CT to detect recurrent colorectal cancer in patients with elevated CEA: a systematic review and meta-analysis.

AIM: The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to assess the diagnostic performance of FDG-PET or PET/CT in the detection of recurrent colorectal cancer (CRC) rising in patients with elevated CEA. MATERIALS AND METHODS: The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity and specificity and positive and negative likelihood ratios, and summary receiver-operating characteristic curves in the detection of recurrent CRC in patients with elevated CEA. RESULTS: Eleven studies with a total of 510 patients met the inclusion criteria. One hundred and six patients (106/510 = 20.8%) had true-negative FDG-PET (PET/CT) results in detection of recurrent CRC when rising CEA. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET in the detection of tumor recurrence in CRC patients with elevated CEA were 90.3% (95% CI, 85.5-94.0%), 80.0% (95% CI, 67.0-89.6%), 2.88 (95% CI, 1.37-6.07), and 0.12 (95% CI, 0.07-0.20), respectively. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET/CT in the detection of tumor recurrence in CRC patients with elevated CEA were 94.1% (95% CI, 89.4-97.1%), 77.2% (95% CI, 66.4-85.9%), 4.70 (95% CI, 0.82-12.13), and 0.06 (95% CI, 0.03-0.13), respectively. CONCLUSIONS: Whole-body FDG-PET and PET/CT are valuable imaging tools for the assessment of patients with suspected CRC tumor recurrence based on the increase of CEA.

Functional Olfactory Nerve Regeneration Demonstrated by Thallium-201 Olfacto-Scintigraphy in Patients with Traumatic Anosmia: A Case Report.

Head trauma is one of the most common etiologies of olfactory dysfunction. It is difficult to use either the olfactory function test or magnetic resonance imaging to directly assess the course of damage to olfactory nerves. Thallium-201 (201Tl) olfacto-scintigraphy has been shown to be an able means for objectively assessing the olfactory nerve transport function. It is expected to be used to evaluate olfactory nerve regeneration after damage to the olfactory nerves. However, no such result has been reported. We present a patient who lost his olfactory function after experiencing head trauma. When his olfactory function remained anosmic, a 201Tl olfacto-scintigraphy showed no migration of 201Tl from the nasal mucosa to the olfactory bulb. After treatment with medicines and olfactory training, his olfactory function improved. A second 201Tl olfacto-scintigraphy showed an increased migration of 201Tl from the nasal mucosa to the olfactory bulb.

Transnasal endoscopic repair of acquired posterior choanal stenosis and atresia.

BACKGROUND: There are congenital and acquired choanal atresias and many approaches have been used for their repair. We assessed the clinical effect of power instrument, endoscopic repair of acquired choanal stenosis and atresia. METHODS: Nineteen patients, aged from 32 to 61 years, with acquired choanal stenosis and atresia (from trauma in 5 cases and from radiotherapy after nasopharyngeal carcinoma in 14; 6 bilateral and 13 unilateral cases), underwent transnasal endoscopic repair of choanal stenosis and atresia. No patient had stenting. Antibiotic and local glucocorticoid were administered postoperatively. RESULTS: Eighteen patients remained free of symptoms for 12 - 40 months after the surgery, and the diameter of the neochoana was more than 1 cm after the procedure. One patient required revision surgery and recovered completely with no restenosis at 12 months after the second surgery. There were no postoperative complications. Histology of the resected tissue revealed respiratory epithelial-lined stromal tissue with chronic inflammation, edema and fibrosis, but no tumor cells. CONCLUSIONS: Transnasal endoscopic approach is a useful procedure for the repair of acquired choanal stenosis and atresia: it is highly successful, safe and effective with swift recovery and short time of hospitalization. It is very important in postoperative care to remove any granulation or polyps at the site of the neochoana at that time.

Daily intake of 4-nonylphenol in Taiwanese.

Alkylphenol polyethoxylates (APEO), alkylphenols combined with ethylene oxide, are a class of nonionic surfactants. APEO have been widely used for industrial, agricultural and household applications, and are biodegraded to more persistent and estrogen-active products, namely, nonylphenol (NP), octylphenol (OP), butylphenol (BP), nonylphenol monoethoxylate (NP(1)EO) and nonylphenol diethoxylate (NP(2)EO). This study determined NP levels in commonly consumed foodstuffs to assess daily intake of NP in a Taiwanese population. This study analyzes 318 of samples from 25 types of commonly consumed foodstuffs in northern, central, southern and eastern regions of Taiwan and estimates daily intake of NP in 466 subjects. Moreover, daily NP intake for 3915 additional subjects was estimated by analyzing data from the Nutrition and health survey in Taiwan (NAHSIT). The foodstuff samples were analyzed for five alkylphenol compounds simultaneously by HPLC with fluorescence detection. Additionally, the average compositions of typical foods consumed in Taiwan were investigated. In combination with alkylphenol levels in these foodstuffs, daily intake of NP in Taiwanese was calculated. The average daily intake of NP for the 466 subjects was 28.04+/-25.32 microg/day. Estimated daily intake of NP, based on NP levels in this study as well as the NAHSIT data, was 31.40 microg/day. Rice was the most commonly consumed source of NP, the proportion was 21.46% among daily intake of NP and the following were aquatic products and livestock, which percentage were 17.97% and 17.38%, respectively. Additionally, oysters had the highest NP levels (235.8+/-90.7 ng/g) in four regions of Taiwan, followed by salmon (123.8+/-116.2 ng/g). This study suggested that the average daily NP intake in Taiwan is 4-fold and 8.5-fold higher than daily intake in Germany and New Zealand, respectively and rice was the major source of NP intake.

Clitoral Metastasis From Advanced Cervical Carcinoma on 18F-FDG-PET/CT.

Metastatic tumors of the clitoris from cervical carcinoma are extremely rare. Here, we described a 54-year-old woman with clitoral metastasis from cervical carcinoma demonstrated on F-FDG PET/CT images.

To evaluate the treatment response of locally advanced esophageal cancer after preoperative chemoradiotherapy by FDG-PET/CT scan.

BACKGROUND: This study was designed to gauge the effectiveness of evaluation of tumor response and prognosis by positron emission tomography with 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) before and after preoperative chemoradiotherapy in patients with esophageal cancer. METHODS: Forty-nine patients from October 2008 to September 2012 with locally advanced stage esophageal carcinoma, clinical stage T2-4N0-3M0, who underwent preoperative chemoradiotherapy (pre-CRT) followed by esophagectomy were enrolled in our study. All patients underwent two FDG-PET scans to compare those results with the pathologic results. Metabolic response of the primary tumor by the percentage change of the SUVmax/1 hour (ΔSUV) before and after pre-CRT (ΔSUV was calculated as the difference between pre-CRT SUVmax/1 hour and post-CRT SUVmax/1 hour divided by pre-CRT SUVmax/1 hour at esophageal tumor) was evaluated for overall survival (OS), disease free survival (DFS), local recurrence rate, and distant failure free survival (DFFS). Prognostic factors such as age, different regimen of chemotherapy, pathologic stage, FDG-PET stage, endoscopic esophageal tumor length, and ΔSUV were analyzed. The number of highly suspect malignant lymph nodes was calculated by PET when SUVmax/1 hour ≥2.5 and by surgical removal. Sensitivity and specificity of regional lymph node detection by PET were also recorded. RESULTS: Upon univariate analysis, overall survival rate was related to ΔSUV >60% (p = 0.045), pathological N stage (p = 0.001), and endoscopic total length of esophageal tumor (p = 0.005). The result of FDG-PET scan after pre-CRT had high specificity (96.7%) but low sensitivity (45.8%) in predicting the residual malignant lymph node numbers. The positive and the negative prediction rates were 44% and 96%, respectively. The result of the FDG-PET after pre-CRT showed upstaged in 16 patients (32.6%), downstaged in nine patients (18.3%), and the same stage in 24 patients (48.9%) when compared with the pathologic stage [corrected]. CONCLUSION: The change of SUVmax can be a tool for evaluating tumor response after pre-CRT. There is also a trend of good prognosis in overall survival rate when ΔSUV value is >60%.

18F-FDG PET or PET/CT for detecting extensive disease in small-cell lung cancer: a systematic review and meta-analysis.

The purpose of this study was to conduct a systematic review and meta-analysis of the published literature to evaluate the diagnostic accuracy of fluorine-18 2-fluoro-2-deoxy-D-glucose (F-FDG) PET or PET/computed tomography (CT) in the pretherapeutic staging of patients with small-cell lung cancer (SCLC). The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated the pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and summary receiver operating characteristic curves in the detection of extensive disease (ED) in patients with SCLC. Twelve studies with a total of 369 patients met the inclusion criteria. The pooled estimates of sensitivity, specificity, LR+, and LR- of F-FDG PET or PET/CT for the detection of ED in SCLC were 97.5% [95% confidence interval (CI), 94.2-99.2%], 98.2% (95% CI, 94.9-99.6%), 19.86 (95% CI, 9.79-40.30), and 0.06 (95% CI, 0.03-0.10), respectively. Whole-body F-FDG PET or PET/CT is a valuable imaging tool for the pretherapeutic assessment of ED in patients with SCLC.

A mass resulting from cerebral spinal fluid collection of ventriculopleural shunt: radiographic and radionuclide findings.

A 49-year-old man was brought to our hospital because of lethargy. His medical history was hydrocephalus with ventriculoperitoneal shunt initially. The ventriculoperitoneal shunt was replaced several times owing to malfunction, and it was later replaced with a right-sided ventriculopleural shunt. The chest radiograph revealed a mass at the right lung. The mass was a capsular collection of cerebral spinal fluid (CSF) in the right pleural cavity diagnosed based on radionuclide shuntogram findings.

FDG PET/CT for the preoperative nodal staging of non-small cell lung cancer in a tuberculosis-endemic country: Are maximum standardized uptake values useful?

BACKGROUND: The aim of this study was to determine an optimum standardized uptake value threshold for identifying nodal metastasis in non-small cell lung cancer (NSCLC) patients using Fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) in Taiwan, a tuberculosis-endemic country. The variation in standardized uptake values of nodal metastasis among different NSCLC histological subtypes was also evaluated. METHODS: We retrospectively reviewed 75 NSCLC patients who had received FDG PET/CT before surgery. The diagnostic accuracy of FDG PET/CT for the preoperative nodal staging was evaluated by histopathologic findings. RESULTS: A total of 316 nodal stations were evaluated. The sensitivity and specificity of FDG PET/CT for nodal staging were 58.6% and 81.8%, respectively, using an SUV cut-off of 2.6. With regard to the levels of mean SUVmax in true-positive and false-positive groups, there was no significant difference among different histological subtypes. CONCLUSION: The present study demonstrated that FDG PET/CT for pre-operative nodal staging using SUVmax > 2.6 is a useful tool (with a higher specificity and a higher negative predictive value) to rule out the possibility of metastatic lymphadenopathy in operable patients with NSCLC.

The Value of Changing Position in the Detection of CSF Leakage in Spontaneous Intracranial Hypotension Using Tc-99m DTPA Scintigraphy: Two Case Reports.

Radionuclide Cisternography (RNC) is of potential value in pointing out the sites of cerebrospinal fluid (CSF) leakage in patients with spontaneous intracranial hypotension (SIH). In the current report, we present two patients who underwent RNC for suspected CSF leakage. Both patients underwent magnetic resonance imaging (MRI) and RNC for evaluation. We describe a simple method to increase the detection ability of RNC for CSF leakage in patients with SIH.

Regional cerebral blood flow in patients with carbon monoxide intoxication.

RATIONALE AND OBJECTIVES: Early detection of regional cerebral anomalies in acute carbon monoxide (CO) poisoning by (99m)Tc-hexamethylprophylene amine oxime (HMPAO) brain single photon emission computed tomography (SPECT) imaging has been reported previously. However, SPECT findings varied in these studies because of their small population sizes. In this study, we included 96 patients with acute CO intoxication and analyzed the regional perfusion changes in these patients by means of HMPAO brain SPECT. MATERIALS AND METHODS: Ninety-six patients, aged 4-80 years (mean age 32 years) with acute CO intoxication diagnosed by our emergency department were included in this study. Exclusion criteria included previous cerebrovascular diseases, brain injury, brain surgery and any known neurological and psychological disorders. All patients underwent a brain scan using a dual-head camera and fan-beam collimator 90-120 min after injection of (99m)Tc-HMPAO. Brain SPECT images were obtained for interpretation. RESULTS: Our data suggested that 79 of the 96 patients (82.3 %) had abnormal HMPAO brain images. The predominant site of disease was basal ganglia (52/96 = 54.2 %), followed by temporal lobe (48/96 = 50.0 %), parietal lobe (44/96 = 45.8 %), frontal lobe (30/96 = 31.2 %), occipital lobe (21/96 = 21.9 %) and thalamus (8/96 = 8.3 %). No patients with acute CO intoxication had perfusion abnormalities in the cerebellum. In addition, there was no significant difference in serum COHb levels between patients with abnormal and normal HMPAO brain images. CONCLUSION: (99m)Tc-HMPAO SPECT imaging is a useful tool to detect functional brain injury in acute CO intoxication.

Meta-analysis of the diagnostic performance of [18F]FDG-PET and PET/CT in renal cell carcinoma.

OBJECTIVES: Positron emission tomography (PET) using fluorodeoxyglucose (FDG) is useful for restaging renal cell carcinoma (RCC) and detecting metastatic diseases but is less satisfactory for detecting primary disease. We evaluated whether the integration of computed tomography (CT) scans with the PET system could increase the applicability of FDG-PET for RCC. METHODS: The MEDLINE databases were searched for relevant studies published since 2001. Two reviewers independently assessed the methodological quality of each study identified. We then performed a meta-analysis of the sensitivity and specificity of FDG-PET findings as reported in all the selected studies. RESULTS: Fourteen studies were eligible for inclusion. The pooled sensitivity and specificity of FDG-PET were 62% and 88% respectively, for renal lesions. For detecting extra-renal lesions, the pooled sensitivity and specificity of FDG-PET were 79% and 90%, respectively, based on the scans, and 84% and 91% based on the lesions. The use of a hybrid FDG-PET/CT to detect extra-renal lesions increased the pooled sensitivity and specificity to 91% and 88%, respectively, with good consistency. CONCLUSIONS: For RCC, combining the FDG-PET and CT systems is helpful for detecting extra-renal metastasis rather than renal lesions. The hybrid PET/CT system has comparable sensitivity and specificity with PET in detecting extra-renal lesions of RCC. ADVANCES IN KNOWLEDGE: The FDG-PET and PET/CT systems are both useful for detecting extra-renal metastasis in renal cell carcinoma.

Bacterial biofilms in chronic rhinosinusitis and their relationship with inflammation severity.

AIMS: To identify the presence of bacterial biofilms on mucosal specimens from chronic rhinosinusitis (CRS) patients, and evaluate their relationship with severity of CRS. METHODS: A prospective study of biofilms presence on 24 CRS patients compared with 12 controls was designed. The presence of biofilms was determined by scanning electron microscopy (SEM), and associations with the preoperative Lund-MacKay CT scores, Johansson endoscopic scores, and the history of ESS were assessed. RESULTS: Biofilms were found in 13/24 CRS patients (54.2%) but in only 1/12 controls (8.3%; P<0.01). CRS patients with and without biofilms had similar preoperative Lund-MacKay CT and Johansson endoscopic scores (P>0.05). Patients with revision ESS showed a tendency of higher biofilms incidence (5/7, 71.4%) than those undergoing their first procedure (8/17, 47.1%), but did not reach a significant difference (P>0.05). CONCLUSIONS: The higher incidence of biofilms in CRS patients suggests a role in the pathogenesis of CRS, but no correlation with severity of CRS.

FDG PET or PET/CT for detecting intramedullary and extramedullary lesions in multiple Myeloma: a systematic review and meta-analysis.

AIM: The purpose of the current study was to conduct a systematic review and meta-analysis of the published literature to evaluate the diagnostic accuracy of FDG PET or PET/CT for intramedullary and extramedullary lesions in multiple myeloma. METHODS: The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and summary receiver operating characteristic curves in the detection of intramedullary and extramedullary lesions in multiple myeloma. RESULTS: Fourteen studies with a total of 395 patients met the inclusion criteria. The pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of FDG PET or PET/CT for the detection of extramedullary lesions in multiple myeloma were 96.0% [95% confidence interval (CI), 79.6%-99.9%], 77.8% (95% CI, 40.0%-97.2%), 3.28 (95% CI, 1.29-8.32), and 0.12 (95% CI, 0.03-0.42), respectively. The pooled estimates of sensitivity, specificity, LR+, and LR- of FDG PET or PET/CT for the detection of intramedullary lesions in multiple myeloma were 61.1% (95% CI, 43.5%-76.9%), 94.1% (95% CI, 71.3%-99.9%), 5.73 (95% CI, 1.53-21.40), and 0.43 (95% CI, 0.28-0.65), respectively. CONCLUSIONS: Whole-body FDG PET or PET/CT is a valuable imaging tool for the assessment of patients with multiple myeloma, especially for the appraisal of extramedullary involvement.

A systematic review and meta-analysis of pretherapeutic lymph node staging of colorectal cancer by 18F-FDG PET or PET/CT.

The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to evaluate the diagnostic performance of fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) PET in the pretherapeutic assessment of nodal staging in patients with colorectal cancer (CRC). We conducted a systematic MEDLINE search of articles in the published literature (last update, February 2012). Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity, specificity, summary receiver operating characteristic curves, and summary likelihood ratios. A total of 409 patients from 10 studies were analyzed. The pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 18F-FDG PET [PET/computed tomography (CT)] in the detection of pretherapeutic lymph node involvement in patients with CRC were 42.9% [95% confidence interval (CI): 36.0-50.0%], 87.9% (95% CI: 82.6-92.0%), 2.82 (95% CI: 1.96-4.07), and 0.69 (95% CI: 0.62-0.78), respectively. There is no solid evidence to support the routine clinical application of 18F-FDG PET (PET/CT) in the pretherapeutic evaluation of lymph node status in patients with CRC. However, 18F-FDG PET (PET/CT) could be used to strengthen the possibility of suspected metastatic lymph nodes detected by other imaging modalities.

Clinical value of FDG PET or PET/CT in urinary bladder cancer: a systemic review and meta-analysis.

AIM: The purpose of the current study was to conduct a systemic review and meta-analysis of the published literature to evaluate the diagnostic accuracy of FDG PET or PET/CT in urinary bladder cancer. MATERIALS AND METHODS: The authors conducted a systematic MEDLINE search of articles published between January 2000 and December 2010. Two reviewers independently assessed the methodological quality of each study. We conducted a meta-analysis of pooled sensitivity and specificity in detecting primary and metastatic lesions of bladder cancer. RESULTS: Six studies met the inclusion criteria. The pooled sensitivity and specificity of PET/CT for primary lesion detection of bladder cancer were 0.90 (95% CI: 0.70-0.99) and 1.00 (95% CI: 0.74-1.00), respectively. The pooled sensitivity and specificity of FDG PET or PET/CT for staging or restaging (metastatic lesions) of bladder cancer were 0.82 (95% CI: 0.72-0.89) and 0.89 (95% CI: 0.81-0.95), respectively. CONCLUSION: The diagnostic accuracy of FDG PET or PET/CT is good in metastatic lesions of urinary bladder cancer. Due to the small number of patients and limited number of studies analyzed, the diagnostic capability of FDG PET or PET/CT in detection of primary bladder wall lesions could not be assessed.

Comparison of two approaches to the surgical management of juvenile nasopharyngeal angiofibroma stages I and II.

OBJECTIVE: Our study was designed to compare two surgical approaches that are currently employed in the treatment of nasopharyngeal angiofibroma stages I and II. STUDY DESIGN: Retrospective chart review to compare outcomes in 11 patients who underwent endoscopic resection with outcomes of transpalatal excision in 13 patients with juvenile nasopharyngeal angiofibroma (JNA) at our department between 1992 and 2008. SETTING: Academic otorhinolaryngologic referral centre. SUBJECTS AND METHOD: Twenty-four patients were divided into two groups according to the surgical technique used. The transpalatal approach was followed for 13 patients, whereas the transnasal endoscopic approach was adhered to for 11. The outcome variables of intraoperative blood loss, length of hospital stay, complications, and rate of recurrence were analyzed. RESULTS: Compared to the transpalatal surgery group, the transnasal endoscopic group had less intraoperative blood loss (375 ± 27 mL vs 635 ± 41 mL), the mean duration of surgery was significantly shorter (115.7 ± 7.6 minutes vs 141.5 ± 9.8 minutes), and there was a lower occurrence of complications (1 patient vs 6 patients) and a shorter length of hospital stay (4 ± 1.0 days vs 6 ± 1.5 days), but there was no significant difference in the rate of recurrence. CONCLUSION: In JNA stages I and II, the transnasal endoscopic approach is clearly a good alternative to the transpalatal approach.