The role of positron emission tomography in the management of pancreatic cancer

The role of positron emission tomography (PET) and PET/computed tomography (CT) in the assessment of a patient presenting with cancer of the pancreas is discussed in the overall context of the management of this condition. The clinical limitations persist, with many patients presenting late with unresectable disease and poor prospects for novel drug therapies. PET and PET/CT are best at diagnosing and staging but are relatively inefficient in the detection of nodal disease. The detection of late disease manifestations such as metastatic spread is often of little clinical consequence. PET/CT may be considered as a first-line imaging investigation but evidence for this approach needs to accrue. Overall detection sensitivity at diagnosis varies between 90% and 95% and specificity from 82% to 100%, whereas for staging, sensitivity data vary from 61% to 100% and specificity data from 67% to 100%.     

Distribution of Helicobacter pylori cagA, cagE, oipA and vacA in different major ethnic groups in Tehran, Iran

Background and Aim:  There are geographical variations in Helicobacter pylori virulence genes; cagA , cagE , vacA and oipA . The present study compared the distribution of these genotypes in major ethnic groups residing in Tehran, Iran and their association with clinical outcomes.
Methods:  A total of 124 H. pylori -positive patients living in Tehran were enrolled in this study. The ethnic distribution was 74 Persians, 33 Turks and 17 other ethnics including Kurds, Lurs, Afghanis and Arabs. The presence of the cagA , cagE and oipA genes and vacA alleles (signal [s] and middle [m] region) were determined by polymerase chain reaction (PCR) from H. pylori DNA.
Results:  The cagA -positive status was predominant in all three ethnic groups (e.g. 65% in Persians and 73% in Turks). In contrast, the cagE -positive status was less than half in Persians (47%) and Turks (30%), whereas it was 77% in other ethnicities ( P  = 0.008). The predominant vacA genotypes were s1 and m1 in all three ethnic groups (e.g. 68% in Persians and 70% in Turks were s1). There was no significant association between cagA and cagE status or vacA genotypes and clinical outcomes. The oipA -positive strains were more common in non-ulcer dyspepsia (NUD) (63%) than in peptic ulcer patients (15%) ( P  = 0.001) in Persians, but the association was not observed in other ethnic groups.
Conclusion:  There are some differences in the H. pylori genotypes among the ethnic groups in Iran. However, none of these markers seemed to be clinically helpful in predicting the clinical presentation of a H. pylori infection in Iran.     

Quadricuspid aortic valve with ascending aortic aneurysm: report of a case and discussion of embryological mechanisms

Congenital quadricuspid aortic valves (QAVs) are rare phenomena. They are often associated with aortic insufficiency and significant morbidity. A QAV with an associated ascending aortic aneurysm is extremely rare, and these conditions might have a shared embryonic etiology. We describe the case of a patient with a QAV associated with aortic aneurysm. Pertinent literature on the QAV is reviewed, and embryological factors that may contribute to its pathogenesis are discussed.     

Analysis of the acetabulum anterior cover

PURPOSE: The false profile X-Ray view as described by Lequesne, allowing the measurement of the anterior cover of the acetabulum, is a slantwise view obtained by a 65 degrees inclination of the pelvis on the radiographic plate.The errors introduced by this radiological measurement of the anterior cover are evaluated. MATERIALS AND METHODS: An anatomical and radiological analysis is conducted on 20 acetabula. The anterior cover is measured on the bone and the A point, the anterior extremity of the acetabular roof, is plumbed. Each pelvis is imaged following the Lequesne method. The VCA angle is measured with the radiological point A described by Lequesne and with the metallic point A as reference. RESULTS: The difference between the anatomical and radiological values of the anterior cover is an average by 11 degrees and undervalues the anatomical value. The deviation is reduced by the application of a trigonometrical formula. A difference between the radiological localisation of A point described by Lequesne and the metallic marker is pointed out. This difference increases when the acetabulum becomes dysplasic. CONCLUSION: The acetabular anterior cover measured with the radiological incidence described by Lequesne undervalues the real value. Moreover, the error increases when the acetabulum is dysplasic.     

Surrogate markers of immunity to Leishmania major in leishmanin skin test negative individuals from an endemic area re-visited

BACKGROUND: In the screening of vaccine candidates it is important to select candidates that evoke immune responses associated with protection. Valid surrogate markers against human leishmaniasis are still lacking. METHODS: A controlled injection of live Leishmania known as leishmanization, (LZ), was used to evaluate vaccine (alum-precipitated autoclaved Leishmania major with BCG) efficacy and more accurately define surrogate markers of immunity to leishmaniasis in humans. Cellular immune responses to this artificial infection were monitored in the volunteers prior to and 9 months post infection. Comparisons were made between those who developed a lesion after infection and those who did not. RESULTS: In the volunteers monitored there was no significant difference in LST, IFNgamma production, or source of IFNgamma between those who developed a lesion and those who did not after LZ, with the exception that ulcer development was associated with an enhanced number of IFNgamma secreting CD4(+) CD45RA(-) (memory) T cells. DISCUSSION: Ulcer development following LZ was lower than anticipated by a pilot study (47% versus 78%) using the same stabilate several years earlier. While this may be an effect of low viability/virulence of the LZ inocula, alternative explanations are also possible. The IFNgamma responses in the study subjects were significantly lower compared to volunteers with previous history of cutaneous leishmaniasis. The findings raise the possibility that the selection of LST-negative volunteers in an endemic area may bias the study towards potentially non/low L. major-reactive volunteers.     

Posttherapy surveillance monitoring of cervical cancer by FDG-PET

PURPOSE: To evaluate the effect of irradiation and chemotherapy for carcinoma of the uterine cervix on posttreatment tumor uptake of the glucose analog (18)F-fluorodeoxyglucose (FDG) imaged by positron emission tomography (PET) and to assess the utility of FDG-PET for surveillance monitoring. MATERIALS AND METHODS: This was a retrospective review of 76 patients with a new diagnosis of carcinoma of the uterine cervix who underwent pre- and posttreatment whole-body FDG-PET. Posttreatment FDG-PET was performed 2.4-10.4 months (median 4.2) after irradiation completion. RESULTS: After treatment, persistent abnormal FDG uptake in the cervix was found in 18% (14 of 76), in the pelvic lymph nodes in 16% (9 of 55), in the paraaortic lymph nodes in 45% (5 of 11), and in the supraclavicular lymph nodes in 75% (3 of 4). Eleven patients developed new sites of increased FDG uptake. In relation to the findings on posttreatment PET, the 2-year progression-free survival rate was 86% for patients with no abnormal FDG uptake at any site and 40% for those with persistent abnormal uptake; there were no survivors at 2 years among patients who developed new sites of abnormal FDG uptake (p <0.0001). A multivariate analysis of prognostic factors demonstrated that any posttreatment abnormal FDG uptake (persistent or new) was the most significant prognostic factor (p <0.0001) for death from cervical carcinoma. CONCLUSIONS: FDG-PET is a valuable tool to evaluate the response of primary cervical carcinoma and lymph node metastasis to treatment and for the surveillance of patients after initial therapy.     

Outcome of FOLFOX and Modified DCF Chemotherapy Regimen in Patients with Advanced Gastric Adenocarcinoma

Objectives: Chemotherapy is used as an indispensable therapy for advanced gastric cancer. Different chemotherapy regimens have been used for this purpose. Toxicity due to the Chemotherapy drugs is one limiting factor. In this study we aim to compare the efficacy and toxicity of two regimens FOLFOX (leucoverin, 5-fluorouracil and oxaliplatin) and modified DCF (mDCF) (docetaxel, cisplatin, and 5-fluorouracil) in patients with advanced gastric adenocarcinoma. Methods: In this analytical cross-sectional study, 47 patients treated with FOLFOX regimen and 57 patients treated with mDCF regimen were recruited, Patients in both groups were compared for demographic findings, response rate, mortality rate, overall survival (OS) and progression free survival (PFS). Results: In FOLFOX and mDCF group, complete response (CR) occurred in 4.3% and 5.3%, partial response (PR) in 42.6% and 29.8%, stable disease in 34% and 52.6% and disease progression in 19.1% and 12.3%, respectively (p=0.25). Overall response rate was 48.9% and 56.1%, respectively. There was no significant difference between two regimens in OS and PFS (p=0.22). mDCF compared to FOLFOX had significantly higher hematologic, gastrointestinal complications, as well as creatinine rise, stomatitis and hair loss, but peripheral neuropathy was significantly lower. Conclusion: The results of current study showed that in patients with advanced gastric adenocarcinoma, FOLFOX regimen compared to mDCF regimen have similar ORR, OS and PFS. Toxicity rate are also lower in FOLFOX group, thus it seems a better regimen for chemotherapy.