Multimodality palliative treatment of 111In-pentetreotide negative/123I-MIBG positive metastatic carcinoid - a case report

Patients with carcinoid tumours frequently present with metastatic disease. There are only a few therapeutic options for these patients, and the main goal of palliative treatment is to reduce symptoms and thus to improve quality of life. Current therapy includes surgical resection, hepatic artery embolisation, chemotherapy and somatostatin analogue treatment; however, all these options have limitations. It seems probable that therapeutic modalities based on radiopharmaceuticals may provide better therapy, not only in relation to symptom reduction but may also improve patient survival. In this case report we present a 46-year-old woman with a symptomatic carcinoid, who at the time of diagnosis had liver and abdominal lymph node metastases, the primary tumour being located in the terminal ileum. 111In-pentetreotide scanning was negative, whereas 123I-MIBG scanning showed high avidity in the tumour tissue. After right hemicolectomy, two courses of 131I-MIBG treatment were given (12.95 GBq and 12 GBq, respectively). After the second dose of 131I-MIBG temporary pancytopenia was present. Octreotide therapy was given empirically only for a short time and was stopped because of drug intolerance. The patient underwent tricuspid and pulmonary valve replacement because of her carcinoid heart disease, followed by two courses of embolisation of liver metastases. While 131I-MIBG therapy reduced the patient’s symptoms of flushing and diarrhoea, there has not yet been any effect on tumour response or 5-HIAA production. This case illustrates the multimodality and multidisciplinary approach to such patients.U chorych z rakowiakiem często występują przerzuty. W takich przypadkach istnieje niewiele opcji terapeutycznych. Głównym celem leczenia paliatywnego jest złagodzenie objawów i poprawienie jakości życia. Dostępne obecnie metody terapii obejmują chirurgiczną resekcję zmian nowotworowych, embolizację tętnicy wątrobowej, chemioterapię i stosowanie analogów somatostatyny. Jednak wszystkie te metody mają ograniczenia. Wydaje się, że stosując techniki radiofarmakologiczne można uzyskać najlepsze rezultaty, nie tylko pod względem zmniejszenia objawów, ale również wydłużenia okresu przeżycia. W niniejszej pracy autorzy opisują przypadek 46-letniej kobiety z objawowym rakowiakiem, u której w chwili rozpoznania choroby stwierdzono przerzuty do węzłów wątroby oraz brzusznych węzłów chłonnych. Guz pierwotny znajdował się w końcowym odcinku jelita krętego. W badaniu radioizotopowym z użyciem 111In-pentetreotydu nie wykazano gromadzenia radioznacznika, natomiast w scyntygrafii z użyciem 123I-MIBG stwierdzono zwiększony wychwyt znacznika przez tkanki guza. Po wykonaniu prawostronnej hemikolektomii zastosowano dwa cykle terapii 131I-MIBG (odpowiednio: 12,95 i 12 GBq). Po drugiej dawce 131I-MIBG wystąpiła okresowa pancytopenia. Zastosowano empirycznie terapię okreotydem, jednak przerwano ją po krótkim czasie z uwagi na nietolerancję leku. Chora przebyła zabieg wymiany zastawek trójdzielnej i płucnej z powodu rakowiakowej choroby serca, a następnie 2-krotną embolizację przerzutów wątrobowych. Chociaż terapia 131I-MIBG spowodowała złagodzenie objawów, napadowego przekrwienia skóry i biegunki, jednak nie zaobserwowano zmniejszenia guza ani ograniczenia produkcji 5-HIAA. Opisany przypadek jest przykładem multimodalnego i wielodyscyplinarnego leczenia rakowiaka

Exact Solution of the Isovector Proton Neutron Pairing Hamiltonian

The complete exact solution of the T=1 neutron-proton pairing Hamiltonian is presented in the context of the SO(5) Richardson-Gaudin model with non-degenerate single-particle levels and including isospin-symmetry breaking terms. The power of the method is illustrated with a numerical calculation for $^{64}$Ge for a $pf+g_{9/2}$ model space which is out of reach of modern shell-model codes.Comment: To be published by Physical Review Letter

Deformations of the fermion realization of the sp(4) algebra and its subalgebras

With a view towards future applications in nuclear physics, the fermion realization of the compact symplectic sp(4) algebra and its q-deformed versions are investigated. Three important reduction chains of the sp(4) algebra are explored in both the classical and deformed cases. The deformed realizations are based on distinct deformations of the fermion creation and annihilation operators. For the primary reduction, the su(2) sub-structure can be interpreted as either the spin, isospin or angular momentum algebra, whereas for the other two reductions su(2) can be associated with pairing between fermions of the same type or pairing between two distinct fermion types. Each reduction provides for a complete classification of the basis states. The deformed induced u(2) representations are reducible in the action spaces of sp(4) and are decomposed into irreducible representations.Comment: 28 pages, LaTeX 12pt article styl

Implant augmentation: Adding bone cement to improve the treatment of osteoporotic distal femur fractures:A biomechanical study using human cadaver bones

The increasing problems in the field of osteoporotic fracture fixation results in specialized implants as well as new operation methods, for example, implant augmentation with bone cement. The aim of this study was to determine the biomechanical impact of augmentation in the treatment of osteoporotic distal femur fractures. Seven pairs of osteoporotic fresh frozen distal femora were randomly assigned to either an augmented or nonaugmented group. In both groups, an Orthopaedic Trauma Association 33 A3 fractures was fixed using the locking compression plate distal femur and cannulated and perforated screws. In the augmented group, additionally, 1 mL of polymethylmethacrylate cement was injected through the screw. Prior to mechanical testing, bone mineral density (BMD) and local bone strength were determined. Mechanical testing was performed by cyclic axial loading (100 N to 750 N + 0.05N/cycle) using a servo-hydraulic testing machine. As a result, the BMD as well as the axial stiffness did not significantly differ between the groups. The number of cycles to failure was significantly higher in the augmented group with the BMD as a significant covariate. In conclusion, cement augmentation can significantly improve implant anchorage in plating of osteoporotic distal femur fractures

A mixed-mode shell-model theory for nuclear structure studies

We introduce a shell-model theory that combines traditional spherical states, which yield a diagonal representation of the usual single-particle interaction, with collective configurations that track deformations, and test the validity of this mixed-mode, oblique basis shell-model scheme on $^{24}$Mg. The correct binding energy (within 2% of the full-space result) as well as low-energy configurations that have greater than 90% overlap with full-space results are obtained in a space that spans less than 10% of the full space. The results suggest that a mixed-mode shell-model theory may be useful in situations where competing degrees of freedom dominate the dynamics and full-space calculations are not feasible.Comment: 20 pages, 8 figures, revtex 12p

Generalization of Richardson-Gaudin models to rank-2 algebras

A generalization of Richardson-Gaudin models to the rank-2 SO(5) and SO(3,2) algebras is used to describe systems of two kinds of fermions or bosons interacting through a pairing force. They are applied to the proton-neutron neutron isovector pairing model and to the Interacting Boson Model 2, in the transition from vibration to gamma-soft nuclei, respectively. In both cases, the integrals of motion and their eigenvalues are obtained

SU(3) symmetry breaking in lower fp-shell nuclei

Results of shell-model calculations for lower fp-shell nuclei show that SU(3) symmetry breaking in this region is driven by the single-particle spin-orbit splitting. However, even though states of the yrast band exhibit SU(3) symmetry breaking, the results also show that the yrast band B(E2) values are insensitive to this fragmentation of the SU(3) symmetry; specifically, the quadrupole collectivity as measured by B(E2) transition strengths between low lying members of the yrast band remain high even though SU(3) appears to be broken. Results for $^{44,46,48}Ti$ and $^{48}Cr$ using the Kuo-Brown-3 two-body interaction are given to illustrate these observations.Comment: Updated to the published versio

Polymorphisms of genes coding for ghrelin and its receptor in relation to colorectal cancer risk: a two-step gene-wide case-control study

<p>Abstract</p> <p>Background</p> <p>Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor (GHSR), has two major functions: the stimulation of the growth hormone production and the stimulation of food intake. Accumulating evidence also indicates a role of ghrelin in cancer development.</p> <p>Methods</p> <p>We conducted a case-control study to examine the association of common genetic variants in the genes coding for ghrelin (GHRL) and its receptor (GHSR) with colorectal cancer risk. Pairwise tagging was used to select the 11 polymorphisms included in the study. The selected polymorphisms were genotyped in 680 cases and 593 controls from the Czech Republic.</p> <p>Results</p> <p>We found two SNPs associated with lower risk of colorectal cancer, namely SNPs rs27647 and rs35683. We replicated the two hits, in additional 569 cases and 726 controls from Germany.</p> <p>Conclusion</p> <p>A joint analysis of the two populations indicated that the T allele of rs27647 SNP exerted a protective borderline effect (P_trend= 0.004).</p