Clinical case material

There is no substitute for experience, and illustrations and descriptions of clinical case material can only be considered as a guide to practice. Nevertheless, it is possible to use such material to draw the attention of the interested reader to a number of items which may contribute to faster appreciation of the variety and peculiarities that will be encountered in the performance of the sentinel node detection procedure

Surgical techniques

With the sentinel node technique gaining popularity as an important and minimally invasive staging procedure in surgical oncology, there is renewed interest in the structure and function of the lymphatic system. The lymph nodes are highly specialised immunocompetent organs which are located along the length of lymphatic vessels [1]. Each lymph node is covered by a capsule of dense connective tissue that extends strands called trabecule into the node, dividing it into several compartments. Within the lymph node parenchyma there are two main regions: cortex and medulla. The outer cortex contains many lymphoid follicles, which are regions of densely packed lymphocytes. T lymphocytes and macrophages and follicular dendritic cells which participate in the activation of T cells are located on the outer rim of these lymphoid follicles. The germinal centre is the lighter staining central area of a follicle where B lymphocytes proliferate into antibody-secreting plasma cells [2]

Goodbye paper, electronic pediatric screenings are here

MU Pediatrics Physicians, Nurses and Patient Service Representatives"The American Academy of Pediatrics (AAP) recommends universal developmental surveillance and screening of all infants and young children during well-child visits at 9, 18, and 24 or 30 months. Patient Tools, an electronic screening system, automates developmental and social-emotional screenings allowing clinicians to view results in a patient's medical record. The Patient Tools Project supports: Primary care providers in completing recommended screens accurately and efficiently. A 'paperless' health care system (HIMSS EMRAM Stage 7), known to save time and reduce cost."--Overview

Simultaneous dual-radionuclide myocardial perfusion imaging with a solid-state dedicated cardiac camera

We compared simultaneous dual-radionuclide (DR) stress and rest myocardial perfusion imaging (MPI) with a novel solid-state cardiac camera and a conventional SPECT camera with separate stress and rest acquisitions. Of 27 consecutive patients recruited, 24 (64.5±11.8 years of age, 16 men) were injected with 74 MBq of 201Tl (rest) and 250 MBq 99mTc-MIBI (stress). Conventional MPI acquisition times for stress and rest are 21 min and 16 min, respectively. Rest 201Tl for 6 min and simultaneous DR 15-min list mode gated scans were performed on a D-SPECT cardiac scanner. In 11 patients DR D-SPECT was performed first and in 13 patients conventional stress 99mTc-MIBI SPECT imaging was performed followed by DR D-SPECT. The DR D-SPECT data were processed using a spill-over and scatter correction method. DR D-SPECT images were compared with rest 201Tl D-SPECT and with conventional SPECT images by visual analysis employing the 17-segment model and a five-point scale (0 normal, 4 absent) to calculate the summed stress and rest scores. Image quality was assessed on a four-point scale (1 poor, 4 very good) and gut activity was assessed on a four-point scale (0 none, 3 high). Conventional MPI studies were abnormal at stress in 17 patients and at rest in 9 patients. In the 17 abnormal stress studies DR D-SPECT MPI showed 113 abnormal segments and conventional MPI showed 93 abnormal segments. In the nine abnormal rest studies DR D-SPECT showed 45 abnormal segments and conventional MPI showed 48 abnormal segments. The summed stress and rest scores on conventional SPECT and DR D-SPECT were highly correlated ( r=0.9790 and 0.9694, respectively). The summed scores of rest 201Tl D-SPECT and DR-DSPECT were also highly correlated ( r=0.9968, p<0.0001 for all). In six patients stress perfusion defects were significantly larger on stress DR D-SPECT images, and five of these patients were imaged earlier by D-SPECT than by conventional SPECT. Fast and high-quality simultaneous DR MPI is feasible with D-SPECT in a single imaging session with comparable diagnostic performance and image quality to conventional SPECT and to a separate rest 201Tl D-SPECT acquisition.12 page(s