188 Re Tailor Made Skin Patch for the Treatment of Skin Cancers and Keloid: Overview and Technical Considerations

The incident of non-melanoma skin cancer and keloid is increasing and is associated with pain, itch and discomfort. Several methods have been used for the treatment but are associated with high recurrence rate. Tailor made Rhenium-188 (188Re) skin patch is convenient, non-invasive and safe method for the treatment. The recurrence is not noted during follow up period of more than three years

Amebic Liver Abscess With Intra-Biliary Rupture

The case of a large amebic liver abscess with an atypical presentation is reported. High output bile drainage persisted after ultrasound guided percutaneous catheter drainage because of a preexisting communication of the abscess with the right hepatic ductal system. The abscess was managed successfully by surgical evacuation and internal drainage into a defunctioned jejunal loop

Tubarial salivary glands on PSMA ligands based PET imaging and post 177Lu PSMA therapy scan: reiterating its importance

68Ga-PSMA PET/CT has been routinely utilized in patients with intermediate to high-risk category prostate carcinoma for staging, biochemical recurrence and before planning the PSMA radioligand therapy (RLT). 177Lu-PSMA RLT has also been approved by FDA as a novel treatment modality in metastatic carcinoma prostate patients who have failed to other lines of treatment. The non-target organs like salivary and lacrimal glands have shown to have high physiological PSMA uptake on PSMA PET/CT. Recently, strong uptake of PSMA ligand has also been noted in the dorsal wall of the nasopharynx in the region of torus tubarius on PSMA PET/CT, which has led to the identification of new pair of salivary gland structures called “tubarial salivary glands”. The clinical significance of these distinct anatomical structures lies in the fact these structures might be involved in a variety of immune related, inflammatory disorders, malignancies and could be a probable organ at risk during radiotherapy in case of head and neck malignancies, causing adverse effects to the patient

Detection of Renal Vein and Inferior Vena Cava Thrombosis from Renal Cell Carcinoma by F-18 FDG PET/CT in Two Patients

Tumour thrombosis is a relatively rare complication of solid cancers, with occult inferior vena cava(IVC) tumour thrombosis having a reported incidence rate of 0.11%. Renal cell carcinoma(RCC) has a propensity to extend as tumour thrombus into the renal vein and IVC. The preoperative assessment for the presence and extent of renal vein and IVC tumour thrombus is important for planning appropriate surgical resection. There are reports having described the diagnosis of tumour thrombosis by Fluorine-18 fluorodeoxyglucose positron emission tomography and Computed tomography (F-18 FDG PET/CT). We present two cases, one with right RCC showing renal vein and IVC tumour invasion and another left RCC with renal vein, IVC and hepatic vein thrombosis detected using FDG PET/CT

Detection of Renal Vein and Inferior Vena Cava Thrombosis from Renal Cell Carcinoma by F-18 FDG PET/CT in Two Patients

 Tumour thrombosis is a relatively rare complication of solid cancers, with occult inferior vena cava(IVC) tumour thrombosis having a reported incidence rate of 0.11%. Renal cell carcinoma(RCC) has a propensity to extend as tumour thrombus into the renal vein and IVC. The preoperative assessment for the presence and extent of renal vein and IVC tumour thrombus is important for planning appropriate surgical resection. There are reports having described the diagnosis of tumour thrombosis by Fluorine-18 fluorodeoxyglucose positron emission tomography and Computed tomography (F-18 FDG PET/CT). We present two cases, one with right RCC showing renal vein and IVC tumour invasion and another left RCC with renal vein, IVC and hepatic vein thrombosis detected using FDG PET/CT

FDG PET/CT in the Evaluation of Late Manifestation of Adrenal Metastasis after Radical Nephrectomy in Patients with Renal Cell Carcinoma: A Report of Four Cases and Review of Literature

 Purpose: Presence of distant metastasis is a strong independent predictor of poor survival in patients with renal cell carcinoma (RCC). Positron emission tomography using F-18 fluorodeoxyglucose (FDG) has been reported to be superior to conventional anatomic imaging modalities for detecting distant metastases from RCC.  Methods: The authors report the findings of four patients who underwent FDG positron emission tomography / computed tomography (PET/CT) at varying periods after radical nephrectomy for RCC.  Results: FDG PET/CT detected increased tracer concentration in the adrenal glands in all four patients and subsequent fine needle aspiration confirmed metastatic RCC. While the adrenal was the only site of metastasis in one patient, additional metastases were detected in lymph nodes and lungs in the others.  Conclusions: RCC metastatic to the adrenal gland is usually a vascular tumour and there is an intrinsic risk of haemorrhage during CT-guided needle biopsy. This small series of cases suggests that FDG PET/CT is a useful non-invasive investigation in identifying malignant adrenal lesions in patients with RCC presenting after nephrectomy

FDG PET/CT in the Evaluation of Late Manifestation of Adrenal Metastasis after Radical Nephrectomy in Patients with Renal Cell Carcinoma: A Report of Four Cases and Review of Literature

Purpose: Presence of distant metastasis is a strong independent predictor of poor survival in patients with renal cell carcinoma (RCC). Positron emission tomography using F-18 fluorodeoxyglucose (FDG) has been reported to be superior to conventional anatomic imaging modalities for detecting distant metastases from RCC. Methods: The authors report the findings of four patients who underwent FDG positron emission tomography / computed tomography (PET/CT) at varying periods after radical nephrectomy for RCC.Results: FDG PET/CT detected increased tracer concentration in the adrenal glands in all four patients and subsequent fine needle aspiration confirmed metastatic RCC. While the adrenal was the only site of metastasis in one patient, additional metastases were detected in lymph nodes and lungs in the others. Conclusions: RCC metastatic to the adrenal gland is usually a vascular tumour and there is an intrinsic risk of haemorrhage during CT-guided needle biopsy. This small series of cases suggests that FDG PET/CT is a useful non-invasive investigation in identifying malignant adrenal lesions in patients with RCC presenting after nephrectomy

Tc-99m-tamoxifen: A novel diagnostic imaging agent for estrogen receptor-expressing breast cancer patients

PURPOSEThe aim of the study was to radiolabel, characterize, and perform in vitro and in vivo assessment of Technetium-99m (Tc-99m) tamoxifen for screening ER expressing lesions in breast cancer patients.METHODSIn this study, tamoxifen has been radiolabeled with Tc-99m via Tc-99m-tricarbonyl core. The characterization and quality control tests of Tc-99m-tamoxifen were performed. In vitro recep- tor binding and blocking studies were performed in both positive control (MCF-7) and negative control cell lines (MDA-MB-231). Normal biodistribution studies were performed in female Wistar albino rats. The pilot clinical studies were performed in 4 ER-expressing breast cancer patients. Of the 4 patients, 1 was on tamoxifen therapy. All 4 patients had also undergone Fluorine-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography/computed tomography.RESULTSTamoxifen was radiolabeled with Tc-99m via Tc-99m-tricarbonyl core with more than 95% radio- chemical yield. Mass spectra showed a peak corresponding to the molecular weight of Tc-99m- tricarbonyl and Tc-99m-tamoxifen. The site of binding of Tc-99m-tricarbonyl with tamoxifen was determined by proton nuclear magnetic resonance. The Tc-99m-tamoxifen showed 30% binding with MCF-7 and only 1%-2% receptor binding with MDA-MB-231 cell lines. Also, the percentage of receptor binding was drastically reduced (up to 72%) when ER was saturated with 50 times the excess molar ratio of unlabeled tamoxifen. In a pilot patient study, Tc-99m-tamoxifen uptake was observed in primary and metastatic lesions. However, no uptake was observed in a patient who was on tamoxifen therapy. The uptake of F-18-FDG was noted in all the patients.CONCLUSIONTamoxifen was radiolabeled with an in-house-synthesized Tc-99m-tricarbonyl core. The radio- labeled complex has been characterized and evaluated for receptor specificity in in vitro and in vivo studies. Also, this is the first clinical study using Tc-99m-tamoxifen for imaging ER. More patients need to be evaluated to further explore the role of Tc-99m-tamoxifen in ER-expressing lesions

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection