99Tcm sestamibi--a new agent for parathyroid imaging

Parathyroid imaging using 99Tcm sestamibi has been carried out prior to surgery in five patients with hyperparathyroidism and the results compared with a standard preoperative localization technique using 201Tl (thallous chloride). The 99Tcm sestamibi correctly localized all abnormal glands and showed higher parathyroid to thyroid uptake in three of four parathyroid adenomas. Both agents showed localization in a thyroid adenoma. The higher uptake of sestambi and better imaging properties of its 99Tcm radiolabel means that the agent may replace thallium for routine preoperative parathyroid localization.     

Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies.

The accepted radionuclide method for imaging abnormal parathyroid tissue has been the combined use of [99mTc]pertechnetate 201Tl-chloride. Various problems with this approach, however, have suggested the need for an improved parathyroid imaging agent. This study examined the use of 99mTc-sestamibi as a parathyroid imaging agent compared with 201Tl-chloride. Fifty-seven patients were scanned with both 99mTc-sestamibi and 201Tl preoperatively. There were 40 adenomas, of which 37 were localized with 201Tl and 39 with sestamibi. Fifteen patients had hyperplastic glands, of which 29 glands were localized with 201Tl and 32 with sestamibi. Possible differences in uptake of the two agents by thyroid and parathyroid tissue were examined by administering 10 MBq of each agent to patients undergoing surgical exploration and biopsy. Preoperatively 20 patients were studied (13 adenomas and 7 with hyperplasia). Thallium-201 uptake was higher in both the parathyroid and thyroid tissue than sestamibi. However, the uptake per gram of parathyroid tissue of sestamibi was higher than the uptake per gram of thyroid tissue. This was not true for 201Tl. Technetium-99m-sestamibi was at least as effective as 201Tl in parathyroid localization. This may be partly due to a higher target-to-background ratio, but also to the superior physical characteristics of 99mTc.     

General practitioners' satisfaction with and attitudes to out-of-hours services

Background  

In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.     

Current structures of cardiac centers

The "Working Group for Congenital Heart Surgery and Pediatric Heart Surgery" of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) has analysed and recommended structures for congenital heart surgery departments in Germany. The document was worked out according to a similar paper approved earlier by the European Association for Cardio-thoracic Surgery (EACTS). The "Working Group" unifies the majority of cardiac surgeons involved in congenital heart surgery in Germany. Current structures of cardiac centers vary. Therefore the aim of this document is to elucidate additional structural needs for both highly specialized institutions and those for standard care. Specialized centers should allow for treatment of newborns and adult patients with congenital heart disease, include implementation of assist devices and transplantation, possess research facilities and ensure highest standards of education and training. Standard care units do not necessarily need to cater for the above mentioned spectrum. However, the evaluation of quality of care should be given priority in all centers involved in care of patients with congenital heart disease. Data acquisition and transfer must be guaranteed to both the GSTCVS and EACTS in order to ensure national and international comparison of surgical results. This may also give further guidance for improved patient care.     

Patients’ narratives of orthognathic treatment for facial asymmetry: a qualitative study

To explore patients’ experiences of orthognathic treatment for facial asymmetry and their adaptation to facial changes after surgery, we did a qualitative, cross-sectional study of patients after treatment for non-cleft asymmetry at two UK sites. A total of 15 patients aged 19-40 years were approached after being identified using patient databases and clinical notes. Individual and photo-elicitation interviews were conducted covering experiences prior to treatment, during treatment, and after surgery. Interviews were transcribed and thematic narrative analysis undertaken. Participants were largely positive about their orthognathic treatment. The following themes were identified: preoperative (becoming aware, negative impacts of asymmetry, committing to treatment, establishing expectations), pre-surgery orthodontics and inpatient experiences (challenges and coping strategies, preparedness, support, and shared experiences); and postoperative (surgery as ‘worth it’, positive impacts of treatment, adapting to facial change). Undergoing orthognathic surgery was portrayed as a journey involving recognisable narratives (treatment unfinished, threat of liminality, treatment as resolution, and treatment as transformation). Patients’ experiences of facial asymmetry are associated with feeling ‘abnormal’, and negative impacts, and orthognathic treatment for facial asymmetry is worthwhile. Having the feeling that something is ‘wrong’ legitimised by clinicians allows patients access to a recognisable treatment narrative (resolution). Orthognathic treatment is also described as transformation from ‘normal abnormality’ to being ‘normal’. Nevertheless, the associated challenges can be frustrating, particularly if resolution is hard to envisage. Further psychological input could help patients cope with these challenges and the complex process of adapting to facial change.     

Multidrug resistance gene expression and ABCB1 SNPs in plasma cell myeloma

Multi-drug resistance (MDR) leads to impaired treatment efficacy in all forms of malignancy. The main forms of MDR are thought to be mediated by the substrate transporting actions of certain adenosine triphosphate binding cassette (ABC) transport proteins. The genes ABCB1, ABCB4, ABCC1, ABCG2 and LRP1 have been identified as the most prominent contributors to clinically significant MDR. To date, no study has investigated the expression of these genes in plasma cell myeloma (PCM), or attempted to relate their expression to the incidence of relapse and/or stage at presentation. Here, we show that ABCB4 may be a prominent mediator of tumour cell MDR within PCM. Additionally, there are three SNPs (rs1045642, rs2032582 and rs1128503) within the most widely studied of these genes, ABCB1, which have been suggested to have a potential impact on OS in PCM and which may form a haplotype in ABCB1. rs1045642 in ABCB1 appears to be the only SNP affecting OS within the PCM patients studied, with minimal linkage disequilibrium demonstrated between it and rs2032582 and rs1128503.