18F-FDG-PET/CT in patients with breast cancer and rising Ca 15-3 with negative conventional imaging: A multicentre study

ObjectivesBreast cancer is the second cause of death in women in Europe and North America. The mortality of this disease can be reduced with effective therapy and regular follow up to detect early recurrence. Tumor markers are sensitive in detecting recurrent or residual disease but imaging is required to customize the therapeutic option. Rising tumor markers and negative conventional imaging (US, X-mammography, CT and MR) poses a management problem. Our aim is to assess the role of ¹⁸F-FDG-PET/CT in the management of post-therapy patients with rising markers but negative conventional imaging.Materials and methodsIn the period from January 2008 to September 2009, 89 female patients with breast cancer who developed post-therapy rising markers (serum Ca 15-3 levels = 64.8 ± 16.3 U/mL) but negative clinical examination and conventional imaging were investigated with ¹⁸F-FDG-PET/CT.ResultsTumor deposits were detected in 40/89 patients in chest wall, internal mammary nodes, lungs, liver and skeleton. The mean SUVmax value calculated in these lesions was 6.6 ± 1.7 (range 3.1–12.8). In 23/40 patients solitary small lesion were amenable to radical therapy. In 7 out of these 23 patients a complete disease remission lasting more than 1 year was observed.Conclusions¹⁸F-FDG-PET/CT may have a potential role in asymptomatic patients with rising markers and negative conventional imaging. Our findings agree with other studies in promoting regular investigations such as tumor markers and ¹⁸F-FDG-PET/CT rather than awaiting the developments of physical symptoms as suggested by current guidelines since the timely detection of early recurrence may have a major impact on therapy and survival.     

Ghost ileostomy after anterior resection for rectal cancer: a preliminary experience

Purpose

The aim of this study was to describe and evaluate the feasibility and the eventual advantages of ghost ileostomy (GI) versus covering stoma (CS) in terms of complications, hospital stay and quality of life of patients and their caregivers after anterior resection for rectal cancer.

Methods

In this prospective study, we included patients who had rectal cancer treated with laparotomic anterior resection and confectioning a stoma (GI or CS), in the period comprised between January 2008 and January 2009. Short-term and long-term surgery-related mortality and morbidity after primary surgery (including that stoma-related and colorectal anastomosis-related) and consequent to the intervention of intestinal recanalization (CS group) and GI closure were evaluated. We evaluated hospital stay and quality of life of patients and their caregivers.

Results

Stoma-related morbidity rate was higher in the CS group than in GI group (37% vs. 5.5%, respectively, P?=?0.04). Morbidity rate after intestinal recanalization in the CS group was 25.9% and 0% after GI closure (P?=?0.08). Overall stoma morbidity rate was significantly lower in the GI group with respect to CS group (5.5% vs. 40.7%, respectively, P?=?0.03). CS group was characterized by a significantly longer recovery time (P?=?0.0002). Caregivers and stoma-related quality of life were better in the GI group than in CS group (P?<?0.0001 and P?=?0.0005, respectively).

Conclusions

GI is feasible, characterized by shorter recovery, lesser degree of total, as well as anastomosis-related morbidity and higher quality of life of patients and the caregivers in respect to CS. We suggest that GI (should be evaluated as an alternative to conventional ileostomy) could be indicated in selected patients that do not present risk factors, but require caution for anastomotic leakage for the low level of colorectal anastomosis.     

Minimally invasive computer-assisted approach for cochlear implantation: a human temporal bone study

Computer-assisted navigation systems can now potentially guide the surgeon to the cochlea with a trajectory avoiding the facial nerve through a keyhole approach. Five temporal bone specimens, with 4 titanium screws placed in the mastoid cortex, were studied. Preoperative computed tomographic scan images were loaded on an electromagnetic computer-assisted surgery (CAS) system (Digipointeur, Collin, Bagneux, France). A drill was connected to the CAS to monitor its progression continuously. A conical approach passing through the facial recess and ending in the scala tympani was performed. A 0.5-mm wire was inserted into the cochlea. The keyhole approach was technically feasible in all cases. No facial nerve injury was observed on imaging and dissection control. The wire was positioned in the scala tympani and the position accuracy of the CAS was <0.76 mm on the target in all cases. The CAS system with fiducial markers yielded sufficient precision to allow a minimally invasive approach to the cochlea.     

Genotype–phenotype relationship in three cases with overlapping 19p13.12 microdeletions

We describe the detailed clinical and molecular characterization of three patients (aged 7, 8^4/12 and 31 years) with overlapping microdeletions in 19p13.12, extending to 19p13.13 in two cases. The patients share the following clinical features with a recently reported 10-year-old girl with a 19p13.12 microdeletion: mental retardation (MR), psychomotor and language delay, hearing impairment, brachycephaly, anteverted nares and ear malformations. All patients share a 359-kb deleted region in 19p13.12 harboring six genes (LPHN1, DDX39, CD97, PKN1, PTGER1 and GIPC1), several of which may be MR candidates because of their function and expression pattern. LPHN1 and PKN1 are the most appealing; LPHN1 for its interaction with Shank family proteins, and PKN1 because it is involved in a variety of functions in neurons, including cytoskeletal organization. Haploinsufficiency of GIPC1 may contribute to hearing impairment for its interaction with myosin VI. A behavioral phenotype was observed in all three patients; it was characterized by overactive disorder associated with MR and stereotyped movements (ICD10) in one patient and hyperactivity in the other two. As Ptger1-null mice show behavioral inhibition and impulsive aggression with defective social interaction, PTGER1 haploinsufficiency may be responsible for the behavioral traits observed in these patients.