Clinically unrecognized pulmonary aspiration during gastrointestinal endoscopy with sedation: a potential pitfall interfering the performance of 18F-FDG PET for cancer screening

PurposeWe found several cases with unexpected pulmonary abnormalities on the ¹⁸F-FDG PET scan after the gastrointestinal endoscopy with sedation during a compact health check-up course, interfering the interpretations of ¹⁸F-FDG PET scan for cancer screening. The current studies aimed to analyze the incidence and the clinical relevance of this pulmonary finding.Materials and methodsFrom June to December 2009, 127 subjects undergoing the sequential gastrointestinal endoscopy with sedation and ¹⁸F-FDG PET scan within 48 h as part of routine health check-up were retrospectively enrolled in this study. The incidence of abnormal pulmonary findings and their SUV_max of FDG were calculated and correlated with the clinical manifestations.ResultsFive subjects had abnormal ¹⁸F-FDG PET findings but pulmonary symptoms were only found in 2. The SUV_max did not seem to reflect the severity of pulmonary symptoms or the need of intervention. Although the incidence of unrecognized pulmonary aspiration featuring inflammation detected by the ¹⁸F-FDG PET scan was high (3.94%, 5/127), the incidence of events needed intervention remained low (0.79%, 1/127), similar to those previously reported literatures.ConclusionsAlthough higher incidence of pulmonary aspiration in this study, it probably reflects the better sensitivity of ¹⁸F-FDG PET for inflammation. The low incidence of clinical events needed intervention may still reflect the safety of sedation used for gastrointestinal endoscopy. Proper arrangement of the sequential examinations if subjects need both gastrointestinal endoscopy with sedation and ¹⁸F-FDG PET is important to reduce the interference degrading the performance of ¹⁸F-FDG PET in cancer screening, diagnosis or staging.     

A unique finding on gallium-67 scintigraphy: widespread fatal skin manifestations of Pseudomonas sepsis

We report a case of a 25-year-old woman presented with neutropenic fever after chemotherapy for the relapse of acute biphenotypic leukemia. Gallium-67 scintigraphy for the detection of infectious foci demonstrated a unique pattern of numerous foci with intense and varying-sized radioactivity spreading throughout the body. The subsequent skin biopsy and culture proved Pseudomonas infection. Therefore, this unique image, in combination with clinical information, was compatible with cutaneous manifestations of Pseudomonas sepsis. Eventually, the patient died of uncontrolled systemic infection despite the aggressive antibiotic treatment. This case reminded clinicians and nuclear medicine physicians to notice the potentially fatal finding on gallium-67 scan.     

Mimicry of physiological urinary FDG excretion: squamous cell carcinoma of esophagus metastasizing to psoas muscle

Skeletal muscle metastases are rare and usually occur with various malignancies at more advanced stages. FDG PET/CT has been known as a useful tool to detect these lesions because of the character of whole-body scanning and superior contrast between malignant and normal tissues, except in areas with abundant physiological FDG radioactivity, such as the urinary system. We present a patient with esophageal squamous cell carcinoma and an incidental, rare finding of psoas muscle metastasis that was initially omitted because of the similarity of its distribution to physiological urinary FDG excretion in the ureter.     

Unexpected findings on gallium-67 scintigraphy: detection of undifferentiated endometrial stromal sarcoma

We reported an extremely rare case of undifferentiated endometrial stromal sarcoma imaged with gallium-67 scintigraphy. This previously healthy 32-year-old woman presented with cough and dyspnea for days. Unexpectedly, the pathology of the opacity in the right pulmonary hilar region demonstrated metastatic high-grade epithelioid sarcoma. Gallium scintigraphy performed to detect possible origin showed abnormal uptake in the right supraclavicular region, chest region and pelvic region. Computed tomography-guided biopsy of the pelvic mass revealed undifferentiated endometrial stromal sarcoma. This case demonstrated the usefulness of gallium-67 scintigraphy in the detection of the primary disease and the evaluation of the metastatic disease.     

Correlation of digital sensibility and precision of pinch force modulation in patients with nerve repair

The outcome measures for patients following peripheral nerve repairs commonly include muscle strength and sensory assessments. However, no significant discussion exists on the impact of nerve injury on sensorimotor control. The objective of this longitudinal study was to explore the effects of nerve regeneration on the control of pinch force in executing functional tasks. Seven patients with digital or median nerve repairs were assessed by a custom‐designed pinch device and conventional sensory tools at monthly intervals following nerve repair. These tools measured sensibility, maximum pinch strength, and anticipated pinch force adjustments to movement‐induced load fluctuations in a pinch‐holding‐up activity (PHUA). Six force‐related and temporal parameters for sensory measurement were used to determine improvements in pinch performance over time following sensory recovery. The results revealed significant differences in the parameters of peak pinch force, baseline pinch force, force ratio, and the percentage of maximal pinch force output at different points in the course of nerve regeneration. A strong relationship was also found between kinetic data from the PHUA test and the traditional sensibility tests for the nerve repair patients in the present study. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1210–1215, 2011     

Hippocampal neurogenesis after traumatic brain injury is mediated by vascular endothelial growth factor receptor-2 and the Raf/MEK/ERK cascade

Adult neurogenesis occurs in the subgranular zone of the hippocampal dentate gyrus, and can be modulated by physiological and pathological events. We examined the effect of vascular endothelial growth factor (VEGF), and the correlation between VEGF and the Raf/MEK/ERK cascade in neurogenesis after traumatic brain injury (TBI). The expression of VEGF and the phosphorylation level of Raf/MEK/ERK were analyzed by Western blot, and TBI-induced neurogenesis was determined by immunofluorescence labeling and confocal microscopic detection. Hippocampal VEGF began to increase after 12?h, and reached a peak at day 7. Along with the upregulation of VEGF, neurogenesis in the hippocampus also increased. Administration of the VEGF antisense oligodeoxynucleotide, or the VEGF receptor-2 antagonist SU1498 (10?μg, ICV), attenuated the phosphorylation of the MAPK cascade proteins and caused a decrease in neurogenesis in the hippocampus. Similarly, administration of the ERK inhibitor PD98059 (500?ng, ICV) also exhibited a suppressive effect on neurogenesis. Our results indicate that VEGF plays an important role in neurogenesis after TBI, and that the process involves VEGF receptor-2 and the Raf/MEK/ERK cascade.     

Subcutaneous metastases after laparoscopic-assisted partial hepatectomy for hepatocellular carcinoma

We reported an unusual case with subcutaneous seeding of hepatocellular carcinoma 12 months after laparoscopic-assisted partial hepatectomy. A 69-year-old woman with hepatitis-C-related liver cirrhosis was found to have hepatocellular carcinoma on routine sonographic examination. The tumor located superficially in the left lateral segment. She received laparoscopic-assisted partial hepatectomy for the tumor in February 2002. She was uneventful after the surgery and serum α-fetoprotein level dropped from 1217 to 275 ng/mL in 3 months. Serum α-fetoprotein level was found to rise 9 months after surgery and a subcutaneous tumor appeared over the surgical wound 12 months after surgery. Resection of lesion showed hepatocellular carcinoma. To our knowledge, seeding of hepatocellular carcinoma on surgical wound has rarely, if ever, been reported after laparoscopic-assisted surgery. The patient died of disseminated recurrence 20 months after the surgery. This case reminded us the risk of tumor seeding after laparoscopic-assisted partial hepatectomy.     

Prenatal diagnosis of cloacal malformations

Introduction  

Prenatal diagnosis of anorectal malformations currently occurs in 0–15.9% of screened cases. In cloacas, these numbers are unknown. We speculate that some images from prenatal ultrasound studies may suggest the diagnosis of cloaca, but are not recognized because of a lack of suspicion for this diagnosis.