FDG PET/CT in cancer: comparison of actual use with literature-based recommendations.

PURPOSE: The Region of Southern Denmark (RSD), covering 1.2 of Denmark's 5.6 million inhabitants, established a task force to (1) retrieve literature evidence for the clinical use of positron emission tomography (PET)/CT and provide consequent recommendations and further to (2) compare the actual use of PET/CT in the RSD with these recommendations. This article summarizes the results. METHODS: A Work Group appointed a professional Subgroup which made Clinician Groups conduct literature reviews on six selected cancers responsible for 5,768 (62.6 %) of 9,213 PET/CT scans in the RSD in 2012. Rapid Evidence Assessment was applied, using the methodology of systematic reviews with predefined limitations to search PubMed, Embase and the Cochrane Library for articles published in English/Danish/Swedish/Norwegian since 2002. PICO questions were defined, data recorded and quality appraised and rated with regard to strength and evidence level. Consequent recommendations for applications of PET/CT were established. The actual use of PET/CT was compared with these, where grades A and B indicated "established" and "useful" and grades C and D "potentially useful" and "non-recommendable" indications, respectively. RESULTS: Of 11,729 citations, 1,729 were considered for review, and 204 were included. The evidence suggested usefulness of PET/CT in lung, lymphoma, melanoma, head and neck, and colorectal cancers, whereas evidence was sparse in gynaecological cancers. The agreement between actual use of PET/CT and literature-based recommendations was high in the first five mentioned cancers in that 96.2 % of scans were made for grade A or B indications versus only 22.2 % in gynaecological cancers. CONCLUSION: Evidence-based usefulness was reported in five of six selected cancers; evidence was sparse in the sixth, gynaecological cancers. Actual use of PET/CT agreed well with recommendations.

Preoperative ß-cell function in patients with type 2 diabetes is important for the outcome of Roux-en-Y gastric bypass surgery.

The majority of the patients with type 2 diabetes (T2DM) show remission after Roux-en-Y gastric bypass (RYGB). This is the result of increased postoperative insulin sensitivity and ß-cell secretion. The aim of the present study was to elucidate the importance of the preoperative ß-cell function in T2DM for the chance of remission after RYGB. Fifteen patients with and 18 without T2DM had 25 g oral (OGTT) and intravenous (IVGTT) glucose tolerance tests performed at inclusion, after a diet-induced weight loss, and 4 and 18 months after RYGB. Postoperative first phase insulin secretion rate (ISR) during the IVGTT and ß-cell glucose sensitivity during the OGTT increased in T2DM. Postoperative insulin sensitivity and the disposition index (DI) markedly increased in both groups. By stratifying the T2DM into two groups according to highest (T2DMhigh ) and lowest (T2DMlow ) baseline DI, a restoration of first phase ISR and ß-cell glucose sensitivity were seen only in T2DMhigh . Remission of type 2 diabetes was 71 and 38% in T2DMhigh and T2DMlow , respectively. Postoperative postprandial GLP-1 concentrations increased markedly, but did not differ between the groups. Our findings emphasize the importance of the preoperative of ß-cell function for remission of diabetes after RYGB.

[Transanal endoscopic microsurgery. The latest 5 years' experience in Roskilde County]. / Transanal endoskopisk mikrokirurgi. De seneste fem års erfaringer i Roskilde Amt.

INTRODUCTION: Transanal endoscopic microsurgery (TEM) was developed by Gerhard Buess in 1983 as an alternative to traditional transanal surgery. The method has become more and more widespread in the treatment of benign as well as T1 rectum tumours. We have used the method for several years and we present our results in this paper. MATERIALS AND METHODS: Retrospective examination of patient files from consecutive registered patients who underwent TEM in the period June 1999 to November 2004, in all 76 operations on 74 patients. RESULTS: 49 patients had adenomas; both the recurrence and complication rate was 6%. Median follow-up period was 12 months (range 0-57). 15 had a T1 tumour removed; the recurrence rate was 15%. One had a serious complication. Median follow-up period was 12 months (range 3-36). Eight had a T2 tumour removed; the recurrence rate was 16%. One had a serious complication. Median follow-up period was 21 months (range 9-36). Two patients were treated for a T3 tumour as part of palliation. CONCLUSION: Our results are comparative to the largest foreign data. The recurrence rate is on the same level as open as well as laparoscopic surgery and far less than traditional transanal surgery. The complication risks are on the same level as laparoscopic access and far less than open surgery. However, preoperative investigation has to be developed further. Research is needed to clarify if selected patients with T2 cancer could be treated with TEM in combination with radiotherapy.