Evaluation of brain tumors using dynamic 11C-methionine-PET

The aim of this study is to assess whether dynamic imaging of (11)C-methionine (MET) uptake on positron emission tomography (PET) is useful for the differential diagnosis of brain tumor histology. Regional MET uptake in static brain PET scans from three consecutive phases (5-15, 15-25, and 25-35 min) after intravenous injection were measured in 144 patients with brain tumors. Regions of interest (ROI) were placed in the pituitary gland, confluence, choroid plexus, coronal radiation, brainstem, frontal cortex, parietal cortex, cerebellum, and brain tumors. The standard uptake value (SUV) of the ROIs in the normal brain structures and brain tumors were measured, and the mean MET SUV region/normal frontal lobe cortex uptake ratio (R/N ratio) of the normal brain structures and the maximum MET SUV tumor/normal frontal cortex uptake ratio (T/N ratio) were evaluated semi-quantitatively. There were significant dynamic declines of the mean MET R/N ratio in the normal pituitary gland and confluence; however, there were significant dynamic increases in white matter. Significant dynamic decrease of the maximum MET T/N ratio was seen in meningiomas and oligodendrocytic tumors, whereas significant dynamic increase was seen in glioblastomas and malignant lymphomas. Dynamic changes of MET uptake vary significantly with the normal brain structures and brain tumor histology. These results suggest that MET-PET may be useful in the differential diagnosis of brain tumors.     

Multicenter retrospective study of 132 patients with unresectable small bowel adenocarcinoma treated with chemotherapy

Background. No standard chemotherapy regimen has been established for unresectable or recurrent small bowel adenocarcinoma (SBA). Methods. Clinical courses of 132 patients with unresectable or recurrent SBA who received chemotherapy at 41 institutions in Japan were reviewed retrospectively. Patients were classified into five groups according to first-line chemotherapy regimens: fluoropyrimidine monotherapy (group A), fluoropyrimidine-cisplatin (group B), fluoropyrimidine-oxaliplatin (group C), fluoropyrimidine-irinotecan (group D), and other regimens (group E). Results. The number of patients in each group was as follows: groups A, 60 patients; group B, 17 patients; group C, 22 patients; group D, 11 patients; and group E, 22 patients. Median progression-free survival (PFS) times were as follows: group A, 5.4 months; group B, 3.8 months; group C, 8.2 months; group D, 5.6 months; and group E, 3.4 months. Median overall survival (OS) times were as follows: group A, 13.9 months; group B, 12.6 months; group C, 22.2 months; group D, 9.4 months; and group D, 8.1 months. Patients in group C achieved significantly longer PFS times and substantially (but not significantly) longer OS times than patients in group A. After adjusting for clinical background characteristics, fluoropyrimidine-oxaliplatin therapy was a significant positive prognostic factor for PFS and OS times. Conclusion. The results suggest that fluoropyrimidine-oxaliplatin combination therapy is the most promising first-line chemotherapy regimen for unresectable or recurrent SBA.     

Propofol alone and combined with dexamethasone for the prevention of postoperative nausea and vomiting in adult Japanese patients having third molars extracted

We did a prospective, randomised, double-blind study to evaluate the efficacy and safety of a small dose of propofol alone, and propofol combined with dexamethasone, for the prevention of postoperative nausea and vomiting in adult Japanese patients listed for third molars extractions. One hundred and twenty patients, 55 men and 65 women aged 17-48 years, were given placebo, propofol 0.5mg/kg, or propofol 0.5mg/kg plus dexamethasone 8 mg intravenously at the end of the operation. A standard general anaesthestic was used, including sevoflurane and nitrous oxide in oxygen. Patients' characteristics were comparable in all three groups. The numbers of patients who developed postoperative nausea and vomiting during the 24h after anaesthesia were 8 with propofol (p=0.04), 2 with propofol plus dexamethasone (p=0.001), and 16 with placebo. The antiemetic efficacy of propofol combined with dexamethasone was superior to that of propofol alone (p=0.04). There were no clinically important adverse events. We conclude that a small dose (0.5mg/kg) of propofol combined with dexamethasone 8 mg was more effective than propofol alone for the prevention of postoperative nausea and vomiting in adult Japanese patients having general anaesthesia for extractions of third molars.