18-Fluorodeoxyglucose imaging with positron emission tomography and single photon emission computed tomography: cardiac applications

The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with extensive viable myocardium, patients with predominantly scar tissue should be treated medically or evaluated for heart transplantation. Among the many viability tests, noninvasive assessment of cardiac glucose use (as a marker of viable tissue) with F18-fluorodeoxyglucose (FDG) is considered the most accurate technique to detect viable myocardium. Cardiac FDG uptake has traditionally been imaged with positron emission tomography (PET). Clinical studies have shown that FDG-PET can accurately identify patients with viable myocardium that are likely to benefit from revascularization procedures, in terms of improvement of left ventricular (LV) function, alleviation of heart failure symptoms, and improvement of long-term prognosis. However, the restricted availability of PET equipment cannot meet the increasing demand for viability studies. As a consequence, much effort has been invested over the past years in the development of 511-keV collimators, enabling FDG imaging with single-photon emission computed tomography (SPECT). Because SPECT cameras are widely available, this approach may allow a more widespread use of FDG for the assessment of myocardial viability. Initial studies have directly compared FDG-SPECT with FDG-PET and consistently reported a good agreement for the assessment of myocardial viability between these 2 techniques. Additional studies have shown that FDG-SPECT can also predict improvement of LV function and heart failure symptoms after revascularization. Finally, recent developments, including coincidence imaging and attenuation correction, may further optimize cardiac FDG imaging (for the assessment of viability) without PET systems.     

Laparoscopic secondary antireflux procedure after PEG placement in children

Background: This study investigates the feasibility of performing a subsequent laparoscopic antireflux procedure after former placement of a percutaneous endoscopic gastrostomy (PEG). Methods: Between 1997 and 1998, five patients with a gastrostomy in place presented with an indication for laparoscopic antireflux procedure due to persisting vomiting. Results: All patients were managed laparoscopically with a four-trocar technique. Conclusions: Primary PEG placement has no adverse effects on a later secondary antireflux procedure. In some cases, four rather than five trocars can be used. Received: 7 December 1999/Accepted: 7 March 2000/Online publication: 29 August 2000     

Severe insuffiency of the aortic and tricuspidal valves associated with pergolide use

A 58-year-old woman with Parkinson's disease was treated with high-dose pergolide for 10 years. After the addition of citalopram, a selective serotonin reuptake inhibitor, to treat an anxiety disorder, she developed cardiac decompensation that was most likely related to typical pergolide-related fibroproliferative abnormalities of the tricuspidal, aortic and mitral valves, without cardiomyopathy or coronary heart disease. The aortic and tricuspidal valves were replaced with prosthetics and pergolide was switched to ropinirol. At a control visit after one year, patient's heart function was stable. Pergolide is an ergot-derived dopamine agonist used in the treatment of Parkinson's disease and restless-legs syndrome. In 2002, it was first associated with heart-valve defects. Patients treated with pergolide should be monitored for clinical signs of heart-valve failure. If there is no evidence of heart-valve defects, then regular monitoring of cardiac function is indicated. In case of indications of heart-valve failure pergolide should be discontinued. In some cases the heart-valve abnormalitites are reversible.     

Esophago-pharyngeal diverticulum: a case report

The Authors report a case of Zenker's diverticulum seen and treated at the University Department of Surgical Sciences of the University of Foggia. The treatment of this condition is invariably surgical and consists in a diverticulectomy combined with a lengthwise extramucosal myotomy. This latter technical adjunct, however, would not appear to be accepted by all Authors. Other techniques have been proposed for the treatment of this condition, but no confirmation of their efficacy exists in the literature. Mortality fluctuates in the various case series, from 0.45% to 8.1%, and the morbidity varies from 5.3% to 40%. The risk of postoperative complications is always present, but can be reduced if the patient undergoes a thorough preoperative investigation.