PET/CT F-18 FDG scan accurately identifies osteoporotic fractures in a patient with known metastatic colorectal cancer

Positron emissions tomography/computed tomography (PET/CT) scan has been used in many types of cancer to characterize the extent of disease as well as to identify the presence of metastases. However, the utility of PET/CT in patients with both cancer and osteoporosis is less well delineated. In this case, a patient with known metastatic colorectal cancer who was investigated by many forms of conventional imaging for back and pelvic pain was found to have osteoporotic fractures using PET/CT. At the same time malignant disease was excluded.     

The use of a combination of galectin-3 and thyroid peroxidase for the diagnosis and prognosis of thyroid cancer

In this retrospective histologic study, galectin-3 had a sensitivity of 92% (22/24) for papillary thyroid carcinoma and 44% (4/9) for follicular thyroid carcinoma. Thyroid peroxidase (TPO) had a sensitivity of 50% (12/24) for papillary and 11% (1/11) for follicular carcinoma. The combination of galectin-3 and TPO had a sensitivity of 96% (23/24) for papillary and 44% (4/9) for follicular carcinoma. From a prognostic standpoint, of patients whose papillary carcinomas expressed both markers, all became free of disease. Of those whose papillary carcinomas expressed galectin-3 but not TPO, 57% (4/7) became free of disease, 29% (2/7) had persistent disease, and 14% (1/7) had progressive disease. This study confirms previous observations that galectin-3 alone is highly sensitive for papillary carcinoma but not adequately sensitive for follicular carcinoma. TPO alone is not adequately sensitive for the evaluation of any thyroid lesion. The combination of galectin-3 and TPO is complementary as a diagnostic and prognostic tool for patients with papillary carcinoma.     

Closed suctioning system reduces cross-contamination between bronchial system and gastric juices

In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (TrachCare) influences crossover contamination between bronchial system and gastric juices when compared with an open suctioning system (OS). The secondary aims were an analysis of the frequency of ventilator-associated pneumonia (VAP) and an analysis of alteration in gas exchange. Antibiograms were performed from tracheal secretions and gastric juice aspirates on Days 1 and 3 of intubation in 24 patients in a medical intensive care unit. Five cross-contaminations were observed in the OS group on Day 3 versus Day 1; the 5 strains shared common genotypes as determined by random amplification of polymorphic DNA. No cross-contaminations were seen in the CS group (P = 0.037). VAP occurred in 5 patients of the OS group but in none of the CS group patients (P = 0.037). Spao(2) decreased significantly in the OS group compared with presuctioning values--the opposite of the CS group. Whereas presuctioning values were comparable between groups, postsuctioning Spao(2) was significantly higher in the CS group. CS significantly reduced cross-contamination between bronchial system and gastric juices and reduced the incidence of VAP when compared with OS. Hypoxic phases can be reduced by the help of CS.     

Alternative lymphatic pathway after previous axillary node dissection in recurrent/primary breast cancer

OBJECTIVES: The sentinel lymph node approach has almost become the standard procedure of choice in the management of patients with early breast cancer. The status of sentinel nodes, whether or not pathologically involved by cancer cells, represents those of the axillary nodes with a negative predictive value of almost 100%. If the axillary lymphatic nodal drainage is altered, alternative lymphatic pathways and accordingly sentinel node location will be changed. METHODS: In this article, 4 patients are presented, 3 with recurrent breast cancer who had already undergone lumpectomy, axillary node dissection, and radiotherapy in the past and 1 with primary breast cancer after surgical removal of a malignant melanoma on her back and had axillary node dissection on the same side as the breast cancer. These patients underwent lymphoscintigraphy followed by sentinel node localization using the gamma probe and also blue dye injection during surgery. RESULTS: All patients showed alternate lymphatic pathways, 1 had an ipsilateral internal mammary node and crossed lymphatics to a contralateral axillary node, 2 had intramammary sentinel nodes, and 1 had an internal mammary on the same side. Pathologic examination of the intramammary and contralateral sentinel nodes were negative for metastases. Internal mammary sentinel nodes were not biopsied. CONCLUSION: We feel that sentinel node lymphoscintigraphy should be done even in patients who have altered lymphatic pathways resulting from previous axillary node dissection. It allows identifying and biopsy of the sentinel node at its new unpredicted location.     

The male perineal sling: comparison of sling materials

PURPOSE: Urinary incontinence continues to be a significant problem for patients after radical prostatectomy. The male perineal sling is emerging as a safe and effective treatment option for postprostatectomy stress urinary incontinence. We compare the efficacy of porcine dermal collagen and silicone mesh as the sling material. MATERIALS AND METHODS: Of 36 patients with postprostatectomy stress urinary incontinence a porcine dermal collagen sling was placed in 20 and a silicone mesh sling was placed in 16. The sling was placed at the bulbar urethra and secured to 3 titanium bone screws anchored into the medial aspect of bilateral inferior pubic rami. RESULTS: Results at 12 months were compared. In the dermis group 9 (56%) patients were cured of incontinence (no pads daily), 5 (31%) had significant improvement (decrease of 50% or more in pads daily) and 2 (13%) had no change in symptoms. In the silicone mesh group 14 (87%) patients were cured of incontinence and 2 (13%) were significantly improved. Results showed that a previously placed artificial urinary sphincter led to poorer outcomes but a history of radiation therapy did not affect results. The most common complication was temporary urinary retention observed in 1 (5%) patient in the dermis group and 2 (12%) in the silicone mesh group. CONCLUSIONS: Early results demonstrate that the male sling is a safe and efficacious treatment option for postprostatectomy urinary incontinence. This study demonstrates superior outcomes with the synthetic silicone mesh sling compared to the porcine dermal collagen.     

Evaluation of the oesophageal-tracheal double-lumen tube (Combitube) during general anaesthesia

OBJECTIVES: Evaluation of safety and effectiveness of the Combitube during general anaesthesia. PATIENTS AND METHODS: 250 patients undergoing general anaesthesia were enrolled in the study. The respective types and duration of surgery, ease of insertion of the Combitube, and potential complications were recorded. Maximum ventilatory pressures and leak fraction were also evaluated in this study. RESULTS: Duration of surgery varied between 20 and 410 min. More than 96% of the blind Combitube insertions were successful at the first attempt, with a mean time of less than 18 +/- 5 seconds (range 12-24 seconds). In 99% of patients the Combitube worked well, and adequate oxygenation and ventilation was possible. All patients were haemodynamically stable during the entire duration of surgery. In all patients, pulse oximetry showed an oxygen saturation of 97 +/- 2% and an end-tidal carbon dioxide of 38 +/- 6 mmHg. Leak fraction, calculated as a fraction of the inspired volume, did not increase to more than 5% up to a ventilation pressure of 40 cm H2O. Superficial laceration occurred in 18 patients (7.2%) without further sequelae. No severe injuries were observed during the study period. CONCLUSION: Ventilation via the Combitube appears to be safe and effective during general anaesthesia. Practice in elective cases is a requirement for successful use in an emergency situation.     

Q fever endocarditis in HIV-infected patient

We describe a case of Q fever endocarditis in an HIV-infected patient. The case was treated successfully with valvular replacement and a combination of doxycycline and hydroxychloroquine. We review the current literature on Q fever endocarditis, with an emphasis on the co-infection of HIV and Coxiella burnetii.     

Reemerging leptospirosis, California

Leptospirosis is a reemerging infectious disease in California. Leptospirosis is the most widespread zoonosis throughout the world, though it is infrequently diagnosed in the continental United States. From 1982 to 2001, most reported California cases occurred in previously healthy young adult white men after recreational exposures to contaminated freshwater. We report five recent cases of human leptospirosis acquired in California, including the first documented common-source outbreak of human leptospirosis acquired in this state, and describe the subsequent environmental investigation. Salient features in the California cases include high fever with uniform renal impairment and mild hepatitis. Because leptospirosis can progress rapidly if untreated, this reemerging infection deserves consideration in febrile patients with a history of recreational freshwater exposure, even in states with a low reported incidence of infection.