Low Serum Vitamin D Levels May Contribute to Gastric Dysmotility in de novo Parkinson's Disease.

BACKGROUND AND OBJECTIVES: Gastrointestinal dysfunction is a common non motor symptom in Parkinson's disease (PD). However, the potential association between vitamin D and gastroparesis in PD has not been previously investigated. The aim of this study was to compare vitamin D levels between drug-naive de novo PD patients with normal gastric emptying and those with delayed gastric emptying. METHODS: Fifty-one patients with drug-naive de novo PD and 20 age-matched healthy controls were enrolled in this study. Gastric emptying time (GET) was assessed by scintigraphy, and gastric emptying half-time (T1/2) was determined. The PD patients were divided into a delayed-GET group and a normal-GET group. RESULTS: The serum 25-hydroxyvitamin D3 levels were decreased in the delayed-GET group compared with the normal-GET and control groups (11.59 ± 4.90 vs. 19.43 ± 6.91 and 32.69 ± 4.93, respectively, p < 0.01). In the multivariate model, the serum 25-hydroxyvitamin D3 level was independently associated with delayed gastric emptying in PD patients. CONCLUSIONS: Vitamin D status may be an independent factor for gastric dysmotility in PD. Although the underlying mechanism remains to be characterized, vitamin D status may play a role in the pathogenesis of delayed gastric emptying in drug-naive PD.

Role of PET or PET/CT in the post-therapy surveillance of uterine sarcoma.

OBJECTIVE: To evaluate the clinical accuracy and clinical impact of positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) in detecting and treating tumor recurrence in patients with treated uterine sarcoma. METHODS: Results of 36 patients who underwent PET or PET/CT in post-therapy surveillance of uterine sarcoma were retrospectively assessed. Histopathologic confirmation or clinical/radiological outcome at least 6 months after PET or PET/CT was standard of reference. RESULTS: The 36 patients underwent 48 PET or PET/CT scans as part of post-therapy surveillance. Thirty scans (8 PET and 22 PET/CT) were performed due to suspicion of disease recurrence on CT, whereas 18 scans (4 PET and 14 PET/CT) were performed as part of routine post-therapy surveillance in asymptomatic patients. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET or PET/CT were 92.9%, 100%, 94.4%, 100% and 80%, respectively, in patients with suspected recurrence and 87.5%, 95.5%, 93.3%, 87.5% and 95.5%, respectively, in asymptomatic patients. PET or PET/CT influenced the management of 12 patients (33.3%), by initiation of previously unplanned treatment in 8 patients and by avoidance of previously planned treatment in 4 patients. CONCLUSION: PET or PET/CT was highly effective in discriminating true recurrence in patients with suspected recurrence and was highly sensitive in detecting recurrence in asymptomatic patients. It had impacts on clinical decision making in a high proportion of patients.

Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer.

OBJECTIVE: To compare positron emission tomography/computed tomography (PET/CT) with magnetic resonance imaging (MRI) in the preoperative detection of primary lesions and lymph node (LN) and distant metastases in patients with uterine corpus cancer. METHODS: The patient cohort consisted of 53 women with uterine corpus cancer who underwent preoperative workup, including both MRI and PET/CT scans, and underwent surgical staging, including pelvic and/or paraaortic LN dissection, between October 2004 and June 2007 at Asan Medical Center, Seoul, Korea. Pathologic data from surgical staging were compared with the preoperative MRI and PET/CT results. For area specific analysis, LNs were divided into paraaortic, right pelvic and left pelvic areas. RESULTS: In detecting primary lesions, MRI and PET/CT showed no differences in sensitivity (91.5% vs. 89.4%), specificity (33.3% vs. 50.5%), accuracy (84.9% vs. 84.9%), positive predictive value (PPV) (91.5% vs. 93.3%) and negative predictive value (NPV) (33.3% vs. 37.5%). With MRI, the sensitivity, specificity, accuracy, PPV and NPV for detecting metastatic LNs on LN area-by-area analysis were 46.2%, 87.9%, 83.9%, 28.6% and 94.0%, respectively; With PET/CT, those were 69.2%, 90.3%, 88.3%, 42.9%, and 96.6%, respectively. PET/CT showed higher sensitivity, but it did not reach statistical significance (p=0.250). There were also no differences in specificity, accuracy, PPV and NPV. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV and NPV of PET/CT were 100%, 93.8%, 92.5%, 62.5% and 100%, respectively. CONCLUSION: In patients with uterine corpus cancer, PET/CT had moderate sensitivity, specificity and accuracy in detecting primary lesions and LN metastases, indicating that this method cannot replace surgical staging. The primary benefit of PET/CT is its sensitivity in detecting distant metastases. Because of its high NPV in predicting LN metastasis, PET/CT may also have advantages in selected patients who are poor candidates for surgical staging.