Preoperative pelvic MRI and 2-[18F]FDG PET/CT for lymph node staging and prognostication in endometrial cancer—time to revisit current imaging guidelines?

Objective This study presents the diagnostic performance of four different preoperative imaging workups (IWs) for prediction of lymph node metastases (LNMs) in endometrial cancer (EC): pelvic MRI alone (IW1), MRI and [18F]FDG-PET/CT in all patients (IW2), MRI with selective [18F]FDG-PET/CT if high-risk preoperative histology (IW3), and MRI with selective [18F]FDG-PET/CT if MRI indicates FIGO stage ≥ 1B (IW4). Methods In 361 EC patients, preoperative staging parameters from both pelvic MRI and [18F]FDG-PET/CT were recorded. Area under receiver operating characteristic curves (ROC AUC) compared the diagnostic performance for the different imaging parameters and workups for predicting surgicopathological FIGO stage. Survival data were assessed using Kaplan-Meier estimator with log-rank test. Results MRI and [18F]FDG-PET/CT staging parameters yielded similar AUCs for predicting corresponding FIGO staging parameters in low-risk versus high-risk histology groups (p ≥ 0.16). The sensitivities, specificities, and AUCs for LNM prediction were as follows: IW1—33% [9/27], 95% [185/193], and 0.64; IW2—56% [15/27], 90% [174/193], and 0.73 (p = 0.04 vs. IW1); IW3—44% [12/27], 94% [181/193], and 0.69 (p = 0.13 vs. IW1); and IW4—52% [14/27], 91% [176/193], and 0.72 (p = 0.06 vs. IW1). IW3 and IW4 selected 34% [121/361] and 54% [194/361] to [18F]FDG-PET/CT, respectively. Employing IW4 identified three distinct patient risk groups that exhibited increasing FIGO stage (p < 0.001) and stepwise reductions in survival (p ≤ 0.002). Conclusion Selective [18F]FDG-PET/CT in patients with high-risk MRI findings yields better detection of LNM than MRI alone, and similar diagnostic performance to that of MRI and [18F]FDG-PET/CT in all.publishedVersio

The rise in road traffic injuries in Lilongwe, Malawi: A snapshot of the growing epidemic of trauma in low income countries

Introduction: Road traffic injuries (RTIs) and death are a major public health issue worldwide. Unless appropriate action is taken urgently, the burden of RTIs will continue to increase globally. This will be particularly pronounced in developing countries where rapid motorization is likely to continue over the next decades. Malawi is one of these countries with a population of 17.2 million and a Gross National Income per capita of 340 US$. The impact of the rising burden of injury on the health sector is considerable. However, data to demonstrate this development is lacking. Methods: This study is an analysis of data from the Kamuzu Central Hospital (KCH) Trauma Registry. KCH is a 900-bed tertiary care public hospital in Lilongwe, the capital city of Malawi. The KCH Trauma Registry was established to collect patient demographic information, clinical characteristics, and outcome data for all patients presenting to the emergency department with injuries. All patients who presented to the emergency department with injuries between January 2009 and December 2015 were included in the study. Results: A 96,967 patients with injuries between 2009 and 2015 were registered in the KCH Trauma Registry. The mean age of these patients was 23.3 years and 36.8% were children younger than 18 years. 25,193 (26.2%) patients had road traffic related injuries, of these 19,244 (76.4%) were men. There was a 62.4% rise in the number of RTI victims treated at KCH from 2447 in 2009–3975 in 2015. If this trend continues, 7997 patients will be expected to need treatment for RTIs at KCH in 2030, doubling the numbers seen in 2015 in just 15 years. The highest number of injuries occurred in pedestrians (32.3%) and cyclists (28.2%) and continually rose over the years studied. The length of hospital stay for RTIs increased from 6.4 ± 9.1days in 2009 to 15.0 ± 19.4 in 2015. Discussion: There was a rapidly growing burden of RTIs at KCH in Lilongwe, Malawi, between 2009 and 2015, and projections based on our data show that this burden will double by 2030. It is essential that surgical trauma services are scaled up to meet this challenge in Malawi. There is also a large potential for prevention of injuries involving vulnerable road users. Road traffic campaigns should focus on improved driver training, use of lights, pedestrian and cyclist visibility, and vehicle fitness. Standards should include physical separation of pedestrians and vehicles, through raised pavements or separate walk and cycle ways. The absence of a clear strategy to meet the growing epidemic of injuries in Malawi will come at a huge cost to an already strained economy, and the largest portion of the burden of injury will continue to be borne by the poorest segment of the population

Å ville hverandre vel: Forpliktende samhandling om psykisk helse på Romerike - Romeriksprosjektet (2010-2015)

Samhandlingsreformen (Helse- og omsorgsdepartementet, 2009) la føringer for et mer helhetlig og koordinert helse- og omsorgstjenestetilbud. Med finansiering fra Helsedirektoratet ble Romeriksprosjektet opprettet for å iverksette et systematisk og forpliktende samarbeid i psykisk helsearbeid. Samhandling på tvers av tjenester er nødvendig for å få til et bedre samarbeid rundt brukerne. Dette er imidlertid krevende. Denne artikkelen beskriver samhandlingserfaringene sett fra behandlernes side.Syv kommuner, to distriktspsykiatriske sentre (DPS), to ruspoliklinikker (ARA) og tre brukerorganisasjoner på Romerike deltok. FOU psykisk helsevern ved Ahus fikk i oppdrag å evaluere prosjektet. Målet for prosjektet var å tilby mennesker med alvorlige psykiske lidelser og, for noen, samtidige rusproblemer et kvalitetsmessig bedre tjenestetilbud på tvers av tjenester og nivåer. Brukergruppen var sammenfallende med ACT-brukerne (Assertive Community Treatment). Istedenfor å opprette egne team ble det lagt vekt på å prøve ut en samhandlingsmodell innenfor de ressursene som allerede eksisterte i de ulike tjenestene

Å ville hverandre vel: Forpliktende samhandling om psykisk helse på Romerike - Romeriksprosjektet (2010-2015)

Syv kommuner, to distriktspsykiatriske sentre (DPS), to ruspoliklinikker (ARA) og tre brukerorganisasjoner på Romerike deltok. FOU psykisk helsevern ved Ahus fikk i oppdrag å evaluere prosjektet. Målet for prosjektet var å tilby mennesker med alvorlige psykiske lidelser og, for noen, samtidige rusproblemer et kvalitetsmessig bedre tjenestetilbud på tvers av tjenester og nivåer. Brukergruppen var sammenfallende med ACT-brukerne (Assertive Community Treatment). Istedenfor å opprette egne team ble det lagt vekt på å prøve ut en samhandlingsmodell innenfor de ressursene som allerede eksisterte i de ulike tjenestene

Variation in urinary excretion of FDG, yet another uncertainty in quantitative PET

Background The standardized uptake value (SUV) is the most common estimate of metabolic activity used in clinical positron emission tomography (PET). Several biological and technological factors influence the accurate SUV calculation. Purpose To assess another potential source of variability of the SUV, the variations in urinary excretion of fluorodeoxyglucose (FDG). Material and Methods Twenty patients with various malignancies scheduled for PET/CT with 18F-FDG were included in the present study. The activity in urine voided immediately before image acquisition was measured and decay corrected. An estimation of FDG content in the urinary bladder was made during imaging, and the two components of urinary FDG were added. The urinary output of FDG, and the quantity of FDG divided by the time to measurements, was estimated. Results The excretion of FDG in urine was between 5.7% and 15.2% of injected dose (decay corrected), and from 0.06% to 0.3%/min after injection, a five-fold difference in clearance. Conclusion About 10% of injected dose is excreted in urine at 70 min post injection, but the urinary FDG excretion was found to be highly variable, yet another uncertainty affecting the SUV measurements

A prospective study on cancer risk after total hip replacements for 41,402 patients linked to the Cancer registry of Norway

Background Concerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. Several different materials, metals and fixation techniques are used in joint prostheses and different types of articulation can cause an increased invasion of particles or ions into the human body. Methods Patients with THR registered in the Norwegian Arthroplasty Register during 1987–2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular components). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender and if the patient had additional THR-surgery in the same or the opposite hip. The study follows the STROBE guidelines. Results Comparing patients with THR to the general population in Norway we found no differences in cancer risk. The overall SIR for the THR-patients after 10 years follow-up was 1.02 (95% CI: 0.97–1.07). For cemented THR, the SIR after 10 years follow-up was 0.99 (95% CI: 0.94–1.05), for uncemented, 1.16 (95% CI: 1.02–1.30), and for hybrid 1.12 (95% CI: 0.91–1.33). Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk for cancer (hazard ratio: HR = 1.24, 95% CI: 1.05–1.46, p = 0.009) when compared to patients with cemented THRs after 10 years follow-up. Stratified by gender the increased risk was only present for men. The risk for patients with hybrid THRs was not significantly increased (HR = 1.07, 95% CI: 0.85–1.35, p = 0.55) compared to patients with cemented THRs. Conclusions THR patients had no increased risk for cancer compared to the general population. We found, however, that receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding