Gastric phytobezoar: an endoscopic technique for removal

Gastric bezoars, especially those of the phytobezoar type, are a rare sequela of gastroduodenal surgery or other uncommon circumstances. When they produce symptoms, removal is always necessary. In the past, treatment has shifted from surgical to non-surgical intervention, of which gastric lavage and/or slow enzymatic dissolution have been attempted. A safe, simple and rapid endoscopic method for the removal of the bezoar has previously been reported by 3 authors. With our two patients there are now ten cases of successful fragmentation of phytobezoars by this technique using a pulsating jet of water through the endoscope. This success recommends the procedure as treatment of choice, and it should be used more widely.     

The value of estrogen and progesterone receptor determinations in advanced breast cancer. Estrogen receptor level but not progesterone receptor level correlates with response to tamoxifen.

Four hundred fifteen patients with metastatic breast cancer with known hormone receptor status received primary treatment with tamoxifen. Measured values for the estrogen receptor (ER, i.e., with estrogen binding) followed a continuous distribution (range, 3 to 1000 fmol/mg of protein). These values correlated positively with age. The response to treatment with tamoxifen correlated with the ER level, with response rates of approximately 80% when the ER level was greater than 30.1 fmol/mg of protein. Two hundred eighteen (218 of 415, 52%) patients had progesterone receptor (PR) values greater than 10 fmol/mg. The PR positivity correlated with the ER level. Patients with PR levels greater than 10 fmol/mg of protein (124 of 226, 55%) had a significantly higher response rate than those with values less than 10 fmol/mg of protein (45 of 189, 24%). However, in a multivariate analysis including both receptor levels, age, site, and number of metastases, only the ER level was significant in predicting the response to treatment with tamoxifen. A quantitative estimation of the ER level thus is the best predictor of response to hormonal treatment with tamoxifen for advanced breast cancer.     

Results of surgical treatment in patients with arachnoid cysts

Summary A retrospective study of 35 patients operated upon for arachnoid cysts during the last 10 years was carried out. In 19 patients treated by craniotomy, membrane resection and drainage into the basal cisterns, clinical improvement could be noted in 13 cases. Correspondingly on the CT-controls the cysts were found to have disappeared in two cases and were reduced in size in seven patients.In 11 patients, however, who were initially treated by a shunting procedure, seven patients became free of symptoms. Postoperative CT-controls showed in three cases a significant reduction of the size of the cyst, which remained unchanged in two other cases.In five patients with the combination of a nonspace-occupying arachnoid cyst and subdural effusions, drainage of the latter only was sufficient to relieve the clinical symptoms.The prominent Endings were the high complication rate of the primary or secondary shunting procedures (48%), as well as the close correlation between the clinical outcome and the postoperative CT-controls.     

Insulinlike growth factor 1 production is inhibited in human sepsis

We studied the response of 14 normal volunteers and five septic patients to a 48-hour course of exogenous biosynthetic human growth hormone (hGH) or placebo. Six normal controls (group 1) received saline, eight normal controls received hGH (group 2), and five septic patients also received biosynthetic hGH (group 3). Urinary urea excretion declined, and splanchnic amino acid uptake was maintained only in group 2 subjects. Septic patients exhibited changes in amino acid and urea dynamics comparable to those of subjects receiving placebo. Insulinlike growth factor 1 (IGF-1) production and plasma concentrations increased in group 2 in a fashion corresponding to the changes in nitrogen exchange, whereas septic patients exhibited no change in IGF-1 level. Therefore, in this septic patient group, exogenous hGH was ineffective in attenuating nitrogen losses and stimulating IGF-1 production. This supports the hypothesis that IGF-1 is a mediator of the anabolic effect of hGH.     

Thyroid uptake neck phantoms are not created equal.

The main purpose of this communication is to alert nuclear medicine departments to the fact that the earlier version of the water phantom grossly overestimates soft-tissue attenuation in the neck, resulting in calculated thyroid uptake values which are significantly overestimated (in hyperthyroid patients we noted uptake values approaching or exceeding 100%). We believe that the solid Lucite phantom (which is the one recommended by IAEA) better approximates the human neck soft tissue overlying the thyroid. Institutions that continue to use the water phantom should be aware that their thyroid uptakes will be relatively elevated and the normal range must be shifted accordingly. Our normal range is 10%-30% uptake of 123I at 24 hr for the Lucite phantom. For the water phantom, the estimated normal range would be 15%-45%. In addition, the phantom type should be considered when comparing uptake results with those from another institution for a particular patient. Also, treatment doses for Grave's disease could be significantly affected, if such doses are calculated by a formula that depends on uptake.