Nuclear medicine procedures and the evaluation of male sexual organs: a short review

Sexuality consists of three aspects that are interrelated and inseparable, biological, physiological and social. The biological aspect considers the individual's capability to give and to receive pleasure. In consequence, it covers the functionality of the sexual organs and the physiology of human sexual response cycle. Diagnostic imaging modalities, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) have been used to evaluate clinical disorders of the male reproductive system. PET and SPECT procedures basically involve the administration of a radiopharmaceutical that has a higher uptake in a specific tumor or tissue. The aim of this brief review is to present some radiopharmaceuticals that have been used in the clinical evaluation of the male sexual organs (testes, prostate, seminal vesicles, penis) related with male sexuality. This information could be useful in better understanding the male sexual response cycle, as well as the sexual disorders, when considering the male sexual organs and the pelvic floor. Moreover, the findings obtained with PET and SPECT imaging could help to evaluate the efficacy of clinical results of therapeutic procedures. In conclusion, the knowledge from these images could aid in better understanding the physiology of the different organs related with sexuality. Furthermore, they could be important tools to evaluate the physiological integrity of the involved organs, to improve clinical strategies and to accompany the patients under treatment

How I treat splenomegaly in myelofibrosis

Symptomatic splenomegaly, a frequent manifestation of myelofibrosis (MF), represents a therapeutic challenge. It is frequently accompanied by constitutional symptoms and by anemia or other cytopenias, which make treatment difficult, as the latter are often worsened by most current therapies. Cytoreductive treatment, usually hydroxyurea, is the first-line therapy, being effective in around 40% of the patients, although the effect is often short lived. The immunomodulatory drugs, such as thalidomide or lenalidomide, rarely show a substantial activity in reducing the splenomegaly. Splenectomy can be considered in patients refractory to drug treatment, but the procedure involves substantial morbidity as well as a certain mortality risk and, therefore, patient selection is important. For patients not eligible for splenectomy, transient relief of the symptoms can be obtained with local radiotherapy that, in turn, can induce severe and long-lasting cytopenias. Allogeneic hemopoietic stem cell transplantation is the only treatment with the potential for curing MF but, due to its associated morbidity and mortality, is usually restricted to a minority of patients with poor risk features. A new class of drugs, the JAK2 inhibitors, although also palliative, are promising in the splenomegaly of MF and will probably change the therapeutic algorithm of this disease

Cadaver models for cardiac arrest: A systematic review and perspectives

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Laparoscopic adrenalectomy in children: experience of the GECI in 16 cases

Background: Conventional adrenalectomy usually necessitates a large incision. In some cases, laparoscopic adrenalectomy offers a less aggressive solution to the patient's problem. Patients and Methods: Laparoscopic adrenalectomy for clearly defined lesions was performed in five girls and nine boys with a mean age of 9 years. The indication was incidental discovery in four patients, hypertension in six (two of whom had von Hippel Lindau syndrome), Cushing's disease in two, and gynecomastia or premature puberty in one patient each. The lesion was on the right side in five patients and the left side in six and was bilateral in three. The mean diameter was 35 mm. The urinary concentrations of vanillylmandelic acid and homomandelic acid were normal in five patients with neurogenic tumors and elevated in five patients with pheochromocytoma. An anterior transabdominal approach was used in nine patients and a lateral retroperitoneal approach in seven. Results: The operating time ranged from 35 to 320 minutes. There were three conversions to open surgery (20%). There were no perioperative or postoperative complications. Histologic examination revealed 13 benign lesions (7 pheochromocytomas, 3 ganglioneuromas, 2 cortical adenomas, and 1 hyperplasia), 1 malignant lesion (N-Myc-negative neuroblastoma, which was removed after conversion to open surgery), and two indeterminate lesions. Of the latter lesions, one was an N-Myc-negative gangioneuroblastoma, and the other was an adrenocortical tumor that was treated initially by local excision and 1 month later by total adrenalec via an open approach. There were no tumor remnants in the specimen. All patients are alive without evidence of recurrence with follow-up of 6 months to 4 years. Conclusions: The laparoscopic approach should be reserved for well-defined lesions <0.5 cm that are probably benign, although the nature of the lesion can be difficult to define preoperatively. The indications can be extended to stage I nonsecreting neuroblastoma in some situations and, for some surgeons, to tumors of stage IV or V. There seems to be no age or weight limit. A left-sided lesion usually is resected via a lateral retroperitoneal approach and a right-sided lesion by an anterior transperitoneal approach, but the details of the technique with the anatomy and the surgeon's experience. Oncologic principles must be respected, and the rate of conversion to open surgery is high

Graves-Basedow disease goiter: a model of Bax-Bcl2 regulated apoptosis.

This study demonstrates the involvement of a Bax-Bcl2-dependent apoptotic process in Graves-Basedow thyroid disease, a pathological condition known for its spontaneously oscillating evolution. A continuous series of 86 cases of surgically treated Graves' thyroid was evaluated for apoptotic cell content identified by histological criteria and confirmed by terminal desoxynucleotidyl transferase-mediated desoxyuridine triphosphate nick end-labeling (TUNEL). A significant correlation was found between tissue features of Graves' disease (epithelial hyperplasia, cellular hypertrophy, colloid content) and the amount of apoptotic cells. No correlation was found with lymphocytic infiltrates. Significantly, 11 cases (about 12% of the series) with high-level apoptosis displayed the typical features of active Graves' disease over all tissue sections. In contrast, cases with no detectable apoptosis exhibited regressive tissue features of Graves' disease. An intermediate group of cases was characterized by tissue heterogeneity with hyperactive foci, rich in apoptosis, alternating with regressive areas lacking apoptosis. In this group the participation of apoptosis to the remodeling of Graves' thyroid parenchyma, in a tight balance with cell proliferation, was best illustrated. Moreover, the thyroid follicle by accumulating apoptotic cells and bodies, allowed a tentative chronological ordering of apoptosis steps in correlation with Bax-Bcl2 tissue distribution and cellular pattern. Our observations suggest that the initiation of apoptosis corresponds to a loss of cellular cohesion, a drop in Bcl2 expression, and a delocalization of Bax from a putative Golgi storage location to a mitochondrial distribution.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe