FACT effectiveness in primary care; a single visit RCT for depressive symptoms.

BACKGROUND: Patients with depressive symptoms are common in primary care. Brief, simple therapies are needed. AIM: Is a focussed acceptance and commitment therapy (FACT) intervention more effective than the control group for patients with depressive symptoms in primary care at one week follow up?Design and setting: A randomised, blinded controlled trial at a single primary care clinic in Auckland, New Zealand. METHODS: Patients presenting to their primary care practice for any reason were recruited from the clinic waiting room. Eligible patients who scored ≥2 on the PHQ-2 indicating potential depressive symptoms were randomised using a remote computer to intervention or control groups. Both groups received a psychosocial assessment using the "work-love-play" questionnaire. The intervention group received additional FACT-based behavioural activation activities. The primary outcome was the mean PHQ-8 score at one week. RESULTS: 57 participants entered the trial and 52 had complete outcome data after one week. Baseline PHQ-8 scores were similar for intervention (11.0) and control (11.7). After one week, the mean PHQ-8 score was significantly lower in the intervention group (7.4 vs 10.1 for control; p<0.039 one sided and 0.078 two sided). The number needed to treat to achieve a PHQ-8 score ≤6 was 4.0 on intention to treat analysis (p = 0.043 two sided). There were no significant differences observed on the secondary outcomes. CONCLUSION: This is the first effectiveness study to examine FACT in any population. The results suggest that it is effective compared with control, at one week, for patients with depressive symptoms in primary care.

A proof-of-concept study comparing tinnitus and neural connectivity changes following multisensory perceptual training with and without a low-dose of fluoxetine.

Background. This proof-of-concept study investigated a method of multisensory perceptual training for tinnitus, and whether a short, low-dose administration of fluoxetine enhanced training effects and changed neural connectivity.Methods. A double-blind, randomized placebo controlled design with 20 participants (17 male, 3 female, mean age = 57.1 years) involved 30 min daily computer-based, multisensory training (matching visual, auditory and tactile stimuli to perception of tinnitus) for 20 days, and random allocation to take 20 mg fluoxetine or placebo daily. Behavioral measures of tinnitus and correlations between pairs of a priori regions of interest (ROIs), obtained using resting-state functional magnetic resonance imaging (rs-fMRI), were performed before and after the training.Results. Significant changes in ratings of tinnitus loudness, annoyance, and problem were observed with training. No statistically significant changes in Tinnitus Functional Index, Tinnitus Handicap Inventory or Depression Anxiety Stress Scales were found with training. Fluoxetine did not alter any of the behavioural outcomes of training compared to placebo. Significant changes in connectivity between ROIs were identified with training; sensory and attention neural network ROI changes correlated with significant tinnitus rating changes. Rs-fMRI results suggested that the direction of functional connectivity changes between auditory and non-auditory networks, with training and fluoxetine, were opposite to the direction of those changes with multisensory training and placebo.Conclusions. Improvements in tinnitus measures were correlated with changes in sensory and attention networks. The results provide preliminary evidence for changes in rs-fMRI accompanying a multisensory training method in persons with tinnitus.

A proof-of-principle study of the short-term effects of 3,4-methylenedioxymethamphetamine (MDMA) on tinnitus and neural connectivity.

Background: This study was conducted to investigate the short-term behavioural and neurophysiological effects of 3,4-methylenedioxymethamphetamine (MDMA) on tinnitus perception.Methods: A double-blind randomized controlled cross-over design. Part 1. Behavioural measures of tinnitus following 30 mg MDMA or placebo administration (N = 5 participants) and Part 2. Behavioural measures of tinnitus and correlations between pairs of apriori regions of interest (ROI) using resting-state functional magnetic resonance imaging (rs-fMRI) before and after 70 mg of MDMA or placebo (N = 8 participants).Results: The results to MDMA were similar to placebo. For the 70 mg dose, there was a significant reduction after 4 h in annoyance and ignore ratings. RsMRI showed decreased connectivity compared with placebo administration between the left hippocampal, right hippocampal, left amygdala and right amygdala regions, and between the right posterior parahippocampal cortex and the left amygdala after two hours of 70 mg MDMA administration. Increased connectivity compared to placebo administration was found post MDMA between the right post-central gyrus and right posterior and superior temporal gyrus, and between the thalamus and frontoparietal network.Conclusions: Following 70 mg of MDMA two tinnitus rating scales significantly improved. There was, however, a placebo effect. Compared with placebo the rsMRI following the MDMA showed reductions in connectivity between the amygdala, hippocampus and parahippocampal gyrus. There is sufficient proof of concept to support future investigation of MDMA as a treatment for tinnitus.

Sentinel lymph node biopsy for melanoma of the head and neck: a multicentre study to examine safety, efficacy, and prognostic value.

Sentinel lymph node biopsy (SLNB) is an accurate staging procedure for malignant melanoma but its use in patients with melanoma of the head and neck has been questioned in the past because of a perceived record of poor safety and accuracy. Technical improvements have sought to redress this. Vital structures and variable lymphatic pathways can make its use in the head and neck challenging. In our study we have examined the data and the experiences of clinicians from University Hospital Southampton and the Royal Surrey County Hospital. We retrospectively analysed the data and case notes of 143 patients who had SLNB to establish its safety, efficacy, and prognostic value. The detection rate of at least one sentinel lymph node was 100%. Nodes positive for metastatic melanoma were found in 20% of patients. Of them, 76% went on to have completion lymphadenectomy. Multivariate Cox regression analysis suggested that positive SLNB was a strong predictor of reduced overall survival for all Breslow-thickness melanomas (HR=3.9, p=0.019) and intermediate melanomas (HR=6.3, p=0.007). It predicted reduced recurrence-free survival for all melanomas (HR=7.4, p<0.001) and was a strong predictor for those of intermediate thickness (HR=8.3, p<0.001). The false negative rate was 9.4% and false omission rate 2.6%. Temporary and permanent morbidity rates were 2.1% and 0%, respectively. SLNB for melanoma in the head and neck is a safe, accurate staging procedure that offers prognostically useful information. The upstaging of disease allows access to trial-based targeted treatments.

Neural plasticity is modified over the human menstrual cycle: Combined insight from sensory evoked potential LTP and repetition suppression.

In healthy women, fluctuations in hormones including progesterone and oestradiol lead to functional changes in the brain over the course of each menstrual cycle. Though considerable attention has been directed towards understanding changes in human cognition over the menstrual cycle, changes in underlying processes such as neural plasticity have largely only been studied in animals. In this study we explored predictive coding and repetition suppression via the roving mismatch negativity paradigm as a model of short-term plasticity (Garrido, Kilner, Kiebel, et al., 2009), and Hebbian learning via visual sensory long-term potentiation (LTP) as a model of long-term plasticity (Teyler et al., 2005). Electroencephalography (EEG) was recorded in 20 females during their early follicular and mid-luteal phases. Event-related potential (ERP) analyses were complemented with dynamic causal modelling (DCM) to characterise changes in the underlying neural architecture. More sustained variability in the ERP response to a change in tone during the luteal phase are interpreted as a delayed habituation of the P3a component in the luteal relative to the follicular phase. The additional increased forward connection strength over tone repetitions compared to the follicular phase suggests that, in this phase, females may be less efficient when processing deviations from predicted sensory input (error). In contrast, there appears to be no reliable change in sensory LTP. This suggests that predictive coding, but not Hebbian plasticity is modified in the mid-luteal compared to the follicular phase, at least at the days of the menstrual cycle tested. This finding implicates the human menstrual cycle in complex changes in neural plasticity and provides further evidence for the importance of considering the menstrual cycle when including females in electrophysiological research.

Proactive multi-modality treatment of Pancreatic Neuroendocrine Tumours (PNETs): Potential survival benefits.

BACKGROUND/OBJECTIVES: Primary and metastatic pancreatic neuroendocrine tumours (PNET) can be treated with combination of surgery, locoregional and systemic therapy. Survival benefits from individual treatments have been well reported, however, the combined outcome from multimodal treatments are not well described in the literature. We report outcomes in a cohort of PNET patients treated with proactive, multimodality therapy. METHODS: 106 patients were identified from a single tertiary referral centre prospective database. Outcomes of treatment were studied, with the primary end point being death from any cause. RESULTS: Median follow-up was 71 months and overall 5-year survival of 62%. In patients with stage I-III disease (51 patients) estimated 5-year survival was 90%. Median survival in patients with stage IV disease was 51 months with an estimated 5-year survival of 40% in this group. A total of 80 patients (75%) had surgery of which 16% suffered complications requiring intervention. There was no perioperative mortality. CONCLUSIONS: This study demonstrates that proactive multimodal treatment is safe and may confer a survival benefit to patients in this cohort compared to historical data.

Adjuvant hepatic intra-arterial iodine-131-lipiodol following curative resection of hepatocellular carcinoma: a prospective randomized trial.

BACKGROUND: The purpose of the present study was to determine whether intrahepatic injection of (131)I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC). METHODS: From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4-6 weeks after curative resection of HCC with complete recovery (52: Lipiodol, 51: Control). Follow-up was every 3 months for 1 year, then every 6 months. Primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively, both of which were evaluated by the Kaplan-Meier technique and summarized by the hazard ratio (HR). The design was based on information obtained from a similar trial that had been conducted in Hong Kong. RESULTS: The Lipiodol group showed a small, and nonsignificant, improvement over control in RFS (HR = 0.75; 95 % confidence interval [95 % CI] 0.46-1.23; p = 0.25) and OS (HR = 0.88; 95 % CI 0.51-1.51; p = 0.64). Only two serious adverse events were reported, both with hypothyroidism caused by (131)I-lipiodol and hepatic artery dissection during angiography. CONCLUSIONS: The randomized trial provides insufficient evidence to recommend the routine use of (131)I-lipiodol in these patients.

Non-graduate and graduate entry medical students attitudes to psychiatry.

OBJECTIVE: Graduate entry medical students' views of psychiatry may differ from those of school leavers. This study hypothesised that (i) exposure to a psychiatry attachment is associated with a positive change in attitudes towards psychiatry in both graduate entry and non-graduate entry students, (ii) graduate entry students exhibit a more positive attitude to psychiatry compared to non-graduate entry students and (iii) graduate entry students are more interested in a career in psychiatry than non-graduate entry students. METHODS: In this study 247 medical students (118 females and 129 males) completing their psychiatry rotation were invited to complete questionnaires examining career choice, attitudes to psychiatry and career attractiveness for a range of specialties including surgery, medicine, general practice and psychiatry before and after their psychiatry attachment. Questionnaires were distributed prior to commencement of their attachment and redistributed on the final day of the attachment. RESULTS: Of the 165 participants in the study, 75 students entered medicine via the traditional route (without a primary degree), 49 entered via the graduate entry programme and 41 had a primary degree. Overall, medical students displayed positive attitudes towards psychiatry. However, while there was an improvement in attitudes towards psychiatry and the career attractiveness of psychiatry on completion of the rotation, no differences were found between graduate and non-graduate entry students. Psychiatry and general practice had lower ratings for career attractiveness than other specialities. No significant changes were found in the first and second choice of specialty. CONCLUSION: Our results show that improvements in attitude and career attractiveness do not necessarily correlate with increased choice of psychiatry as a specialty. Graduate entry has been considered a possible opportunity for increasing recruitment in psychiatry but our results suggest that this may not be the case. Follow-up studies are required to determine whether career attractiveness correlates with future career choice.

Clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors.

The present study investigates risk factors for onset of Clostridium difficile-associated diarrhoea, specific ribotype and environmental spore contamination in a District General Hospital in South East England. C. difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of C. difficile toxin from faecal specimens by enzyme immunoassay (Health Protection Agency, Southampton). The isolates were tested for various antimicrobial susceptibilities by E-test. Cases were assessed for prior antibiotic use and followed up for clinical outcomes. Controls were matched for age, sex, ward, length of stay and comorbidity to identify any antibiotic risk factors using conditional logistic regression analysis. Environmental sampling on wards was performed with cycloserine-cefoxitin-egg yolk agar. Forty-five percent C.difficile isolates ribotyped as 027, 39% as 106 and 10% as 001. All ribotypes were resistant to ciprofloxacin, erythromycin and cefotaxime but remained susceptible to metronidazole and vancomycin. The crude (death within 28 days) and early (death within 72h) mortalities were 23% and 11% for the 027 strain, whereas for the 106 ribotype they were 11% and 3%, respectively. The case-control study identified ciprofloxacin usage for >7 days as a significant risk factor (adjusted odds ratios of 3.72; 95% CI: 1.38-10.02; P=0.019). Environmental sampling revealed the presence of spores on faecally contaminated equipment such as commodes and bedpan shells, which persisted after cleaning. Ciprofloxacin appears to encourage C.difficile-associated diarrhoea and should be restricted to short courses. Cleaning agents for clinical equipment must have sporicidal activity to prevent cross-transmission.

Iodine-131 therapy for hyperthyroidism prescribed by endocrinologist - our preliminary experience.

INTRODUCTION: Radioiodine (I-131) is a useful therapeutic modality of hyperthyroidism when medical therapy fails. Traditionally, the nuclear physicians undertake the prescription of I-131 therapy. However, endocrinologists are increasingly being recognized for their competence in prescribing individualized doses of I-131 for the treatment of various thyroid disorders. METHODS: In this pilot prospective study, we collaborated with our nuclear medicine colleagues to determine the outcomes of 80 patients with hyperthyroidism who underwent I-131 ablation as prescribed by the endocrinologist. Doses administered were based primarily on thyroid volume with adjustments contingent on adverse factors, and fixed assumptions on target absorbed dose (R) and uptake (U) were used. Seventy-three had Graves' disease (GD) and seven had toxic nodular goitre (TNG) or toxic adenomas (AFTN). Therapeutic success was defined as achievement of hypothyroidism or euthyroidism. RESULTS: 95.9 percent (70 of 73) of GD patients and 85.7 percent (6 of 7) of those with TNG/AFTN achieved successful outcomes after a single dose of endocrinologist-directed I-131 therapy. More than 50 percent of patients became hypothyroid by three months and about two-thirds became hypothyroid by six months post I-131 therapy. CONCLUSION: Our results indicate that the success rate of endocrinologist-directed I-131 therapy exceeds 95 percent with a single dose and compares favourably with nuclear physician-directed therapy outcomes.

Assessing the effect of increasing injection activity for myocardial perfusion imaging in overweight patients.

In our previous publication, we proposed to increase the injection activity for overweight patients. We have now implemented this for our patients, i.e. increasing the activity for patients above 99 kg. In the present study, we audited whether this increased activity for overweight patients improved the myocardial counts effectively and also whether it improved the image quality for these patients. 125 consecutive normal myocardial perfusion studies were included into the study. The total left ventricular myocardial count was calculated, as was the total left ventricular myocardial volume using the Cedar Sinai QPS program. The myocardial count per millilitre of the myocardium (c ml(-1)) was correlated with patient weight using regression analysis. There was no significant difference (p = 0.120) among the mean myocardial counts for patients over 99 kg (n = 40, 1548 c ml(-1)) compared with patients in the 70-79 kg range (n = 26, 1746 c ml(-1)). This indicates that the previously proposed algorithm for adjusting injection activity maintains the count density in the myocardium and should be used for all patients over 99 kg. There was, however, a significant steady decrease with increased weight in the myocardial counts for patients under 100 kg (p<0.001), a range in which injection activity was not adjusted for weight. To correct for this, we now propose that the injection activity should be adjusted for all patients over 80 kg, using the previously proposed algorithm.

Initial experience in use of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in thyroid carcinoma patients with elevated serum thyroglobulin but negative iodine-131 whole body scans.

INTRODUCTION: This study aims to examine the usefulness of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in thyroid carcinoma patients with elevated serum thyroglobulin (Tg) but negative iodine-131 (I-131) whole body scans. METHODS: 17 patients with differentiated thyroid carcinoma who underwent FDG PET/CT scans were reviewed retrospectively over a period of one year from July 2003 to June 2004. All these patients had completion thyroidectomy and subsequently presented with elevated serum Tg but negative post-therapy I-131 whole body scans. Nine of these patients underwent FDG PET/CT in a hypothyroid state, while the remainder underwent FDG PET/CT while on thyroxine replacement. RESULTS: 15 out of 17 PET/CT scans revealed lesions consistent with metastases, giving a sensitivity of 88.2 percent. Four of these patients were amendable to surgical treatment. Two scans were negative. CONCLUSION: FDG PET/CT is a sensitive diagnostic tool to detect radioiodine-negative recurrences/metastases in patients with thyroid carcinoma. Our preliminary results are comparable with published results based on PET.

Detection of thyroid malignancy in a hot nodule by fluorine-18-fluorodeoxyglucose positron emission tomography.

Carcinoma of the thyroid arising in an autonomously functioning or "hot" nodule is uncommon. The majority of thyroid carcinomas present as a "cold" nodule on radionuclide scintigraphy. We report a poorly-differentiated thyroid carcinoma developing in a long-standing "hot" nodule in a 51-year-old Chinese woman. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG PET) showed focal FDG uptake in the thyroid nodule, as well as in the cervical and pulmonary hilar lymph nodes. This case illustrates that the incidence of thyroid carcinoma in a "hot" nodule is not negligible. The role of FDG PET in the differentiation of benign from malignant thyroid nodules is still unclear. In contrast, FDG PET has been shown to have a role in the follow-up of thyroid cancer patients after thyroidectomy and subsequent radioactive iodine-131 (I-131) ablation. It may be useful in the identification and localisation of recurrent cancer foci in patients with elevated thyroglobulin levels but a negative I-131 whole body scan.

Thrombotic thrombocytopenic purpura associated with statin treatment.

Thrombotic thrombocytopenic purpura (TTP) is a rare condition but associated with 90% mortality if left untreated. The diagnosis is usually made when there is thrombocytopenia and microangiopathic haemolytic anaemia, although the full pentad also includes fever, renal impairment, and neurological dysfunction. A variety of underlying causes have been implicated in acquired TTP including bacterial and viral infections, bone marrow and organ transplantation, pregnancy, immune disorders, and certain drugs. To date there is just one case report of TTP associated with statin treatment. The clinical course of a patient who presented with TTP after being started on simvastatin, a HMG-CoA inhibitor, is described.

Tratamiento de lesiones hepáticas tumorales con RENIO188- LIPIODOL. Experiencia en Colombia / Treatment of liver cancer injuries with RENIO188- LIPIODOL. Experience in Colombia

Objetivo: Evaluar pacientes con lesiones tumorales hepáticas, no quirúrgicas, a quienes se les administro Renio 188 -Lipiodol vía transarterial, como alternativa terapéutica.Método: Once pacientes con cáncer de hígado no operable se trataron con dosis entre 170 y 4181 MBq de Renio 188 Lipiodol a través de la arteria hepática. Los pacientes fueron evaluados clínicamente, con test hematológicos, de función hepática y TAC hepático periódicamente.Resultados: El tratamiento con Renio 188 Lipiodol fue bien tolerado . Tres pacientes desarrollaron fiebre leve y un paciente Neumonitis Intersticial que resolvió completamente. En el TAC de control siete pacientes evidenciaron reducción significativa del tamaño de la lesión , 1 sin cambios, 1 progresión y 2 no se han evaluado.Conclusiones: Renio 188 Lipiodol es un tratamiento seguro, la técnica de preparación fácilmente reproducible y se constituye en una alternativa terapéutica para este tipo de pacientes.

Pilot study using technetium-99m pertechnetate sequential radionuclide-sialography to assess salivary gland function in nasopharyngeal cancer patients on radiation therapy.

INTRODUCTION: Nasopharyngeal carcinoma (NPC) is mainly treated by radiation therapy. A common complication of radiotherapy is xerostomia. Direct measurements of the amount of saliva produced using suction cups and volumetric assessments are cumbersome and time-consuming. Sequential radionuclide sialography is a reproducible and convenient method of measuring salivary function. MATERIALS AND METHODS: Patients with newly diagnosed NPC underwent a pilot study using technetium-99m pertechnetate sequential radionuclide sialography to assess their salivary function before and at 3 months post radiation therapy. From the sialography, time activity curves were obtained for analysis of salivary function. The shape of the time activity curve with citric acid stimulation was classified into 4 types according to the degree of radiation-induced dysfunction. RESULTS: All 14 patients had worse (P < 0.005) time activity curves for both parotids and submandibular glands after radiation therapy. All patients with abnormal curves before radiation therapy presented type IV (non-functioning) curve after radiation therapy. A ratio of pre- and post-stimulation counts allowed for quantification of the degree of stimulatory response. We found a significant decrease in Rc before and after radiation therapy for all salivary glands (P < 0.001). The salivary gland to background ratio, which is a reflection of the degree of salivary gland functional uptake, also had a significant reduction after radiation. CONCLUSION: It is feasible to use technetium-99m pertechnetate in the measurement of salivary gland function in nasopharyngeal cancer patients treated with radiation therapy.

Radionuclide therapy of hepatocellular carcinoma.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a common malignancy worldwide. Surgical resection is generally accepted as the first choice treatment of HCC. Many non-surgical techniques have been developed and used for the treatment of inoperable HCC, with limited efficacy. This paper studies the role of radionuclide therapy in the treatment of inoperable HCC and in an adjuvant setting following curative resection of HCC. MATERIALS AND METHODS: Relevant articles published between 1980 and 2002 were reviewed. Articles were identified through a Medline search using the key words hepatocellular carcinoma, iodine-131 (I-131), lipiodol, yttrium-90 (Y-90), rhenium-188 (Re-188), monoclonal antibodies and anti-ferritin. RESULTS: The objective response rate of patients with HCC treated with intra-arterial I-131 lipiodol was 40% to 70% and the median survival was between 6 and 9 months. The efficacy of I-131 lipiodol was similar to transarterial chemo-embolisation, but appears to be better tolerated by patients. A median survival of 9.4 months to 54 weeks was achieved using intra-arterial Y-90 microspheres for the treatment of HCC. Tumours in 4 patients became resectable after treatment. Re-188 lipiodol is a relatively new radiopharmaceutical used for the treatment of HCC. The results of a pilot study have shown Re-188 lipiodol to be a safe and cost-effective radiopharmaceutical for the treatment of HCC via the intra-arterial route. Its efficacy should be subjected to further evaluation. The use of radio-labelled monoclonal antibodies, such as anticarcinoembryonic antigen and antiferritin, for the treatment of HCC has yielded encouraging results but these forms of treatment are largely experimental and limited to a few centres. Intra-arterial treatment using I-131 lipiodol in an adjuvant setting for patients following curative resection of HCC has resulted in improved disease-free and overall survival. The 3-year survival for the treatment and control groups were 86.4% and 46.3%, respectively. CONCLUSION: Radionuclide therapy presents another interesting option for the treatment of HCC amidst the wide array of non-surgical modalities available.

Radionuclide synovectomy and chronic haemophilic synovitis in Asians: a retrospective study.

Radionuclide synovectomy has been identified as the procedure of choice in treating chronic haemophilic synovitis among Caucasian populations. Its effectiveness among East Asians has not been studied. A retrospective study was carried out on 12 Asian haemophiliacs who underwent 12 radionuclide synovectomies. The average follow-up was 30.7 months (range 6-55) for primary procedures. 32P chromic phosphate and 188Re-tin colloid were injected into target joints according to protocol. There was a significant 80% decrease in the median frequency of haemarthrosis from 1.4 per month (range 0.2-7.0) to 0.25 per month (range 0.0-1.8) (P<0.05). Half of the patients had excellent results by 1 year of synovectomy. The median factor usage for target joint haemarthrosis postsynovectomy was 792 units per month (range 0-3209) reduced significantly from a presynovectomy level of 1452 units per month (range 306-7125) (P<0.05). Patients also reported a reduction in joint pain scores, and an improvement in joint mobility and quality of life. The majority of patients were satisfied with the overall outcome of radionuclide synovectomy. Radionuclide synovectomy appears to be effective in reducing the incidence of target joint haemarthrosis and quantity of factor usage for such bleeds among Asians with haemophilic synovitis.

Imaging bacterial infection with (99m)Tc-ciprofloxacin (Infecton).

AIMS: The diagnosis of deep seated bacterial infections, such as intra-abdominal abscesses, endocarditis, and osteomyelitis, can be difficult and delayed, thereby compromising effective treatment. This study assessed the efficacy of a new radioimaging agent, Tc-99m ciprofloxacin (Infecton), in accurately detecting sites of bacterial infection. METHODS: Eight hundred and seventy nine patients with suspected bacterial infection underwent Infecton imaging and microbiological evaluation. The sensitivity and specificity of Infecton in detecting sites of bacterial infection were determined with respect to Centres of Disease Control, World Health Organisation, and Dukes's criteria. RESULTS: Five hundred and seventy four positive and 295 negative images were produced. These included 528 true positives, 46 false positives, 205 true negatives and 90 false negatives, giving an overall sensitivity of 85.4% and a specificity of 81.7% for detecting infective foci. Sensitivity was higher (87.6%) in microbiologically confirmed infections. CONCLUSIONS: Infecton is a sensitive technique, which aids in the earlier detection and treatment of a wide variety of deep seated bacterial infections. The ability to localise infective foci accurately is also important for surgical intervention, such as drainage of abscesses. In addition, serial imaging with Infecton might be useful in monitoring clinical response and optimising the duration of antimicrobial treatment.

Preliminary experience in radionuclide therapy of hepatocellular carcinoma using hepatic intra-arterial radio-conjugates.

INTRODUCTION: In a minority of the cases, resection of hepatocellular carcinoma (HCC) is potentially curative but local recurrence is common. Adjuvant intra-arterial radio-conjugate therapy could potentially reduce the rate of local recurrence and increase disease-free and overall survival. However, in the majority of cases, treatment of HCC is largely palliative. A wide range of palliative treatment options are available and these include external radiation, hepatic intra-arterial chemo-embolisation, systemic chemotherapy and percutaneous ethanol injection. The long-term survival rate is poor. Hepatic intra-arterial radio-conjugate therapy provides a new and promising means of palliation. MATERIALS AND METHODS: We share our initial experience in the treatment of patients with HCC. A total of 32 patients were recruited between October 1999 and June 2001. Group 1 comprised 15 patients who had potentially curative resection of HCC who were treated with Iodine-131 (I131) lipiodol as a form of adjuvant therapy. Group 2 comprised 17 patients with unresectable HCC, 12 of whom were treated with Yttrium-90 (Y90) microspheres and 5 with Rhenium-188 (Re188) lipiodol. The radio-conjugates were administered via the intra-arterial route. RESULTS: Thirteen of the 15 patients in group 1 who were treated with I131 lipiodol following curative resection of HCC were free of disease, 1 patient died and 1 patient who developed recurrence was retreated with Re188 lipiodol and was subsequently free of disease. The 6-month disease-free survival rate was 100% and the 12-month disease-free and overall survival rates were 72% and 85%, respectively. Of the 12 patients in group 2 who were treated with Y90 microspheres for unresectable HCC, 6 had stable disease, 2 showed tumour regression and 4 died. The 6-month and 12-month survival rates were 75% and 66%, respectively. Of the 5 patients in group 2 who were treated with Re188 lipiodol for unresectable HCC, 4 had stable disease and 1 had regression of the right lobe tumour but progression of the left lobe tumour. CONCLUSION: Our results in the adjuvant treatment of patients with I131 lipiodol following curative resection of early HCC and in the palliative treatment of unresectable HCC using Y90 microspheres and Re188 lipiodol are preliminary and not fully conclusive. These preliminary results have to be confirmed in larger groups of patients and by prospective, randomised, controlled trials. This study highlights the preliminary experience in radionuclide therapy of HCC using hepatic intra-arterial radio-conjugates in a local context.