Distinguishing post-treatment changes from recurrent disease in cholangiocarcinoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Three-dimensional techniques for radiotherapy have expanded possibilities for partial volume liver radiotherapy. Characteristic, transient radiographic changes can occur in the absence of clinical radiation-induced liver disease after hepatic radiotherapy and must be distinguished from local recurrence.</p> <p>Case presentation</p> <p>In this report, we describe computed tomography changes after chemoradiotherapy for cholangiocarcinoma as an example of collaboration to determine the clinical significance of the radiographic finding.</p> <p>Conclusion</p> <p>Because of improved three-dimensional, conformal radiotherapy techniques, consultation across disciplines may be necessary to interpret post-treatment imaging findings.</p

Post-traumatic composite graft fingertip replantation in both adults and children

Composite graft fingertip replacement (CGFR) can maintain digital length and a normal nail complex when microvascular replantation of traumatically amputated fingertips is unfeasible. However, there remains reluctance to perform CGFR in adults owing to perceived poor outcomes compared with children, despite a lack of supporting evidence. We report CGFR outcome in adults and children. A prospectively collated patient information database identified CGFR attempts over five consecutive years. Patient demographics and co-morbidities, injury mechanisms and details (including Ishikawa levels), timing of surgical interventions and outcomes were documented. One hundred thirty-one CGFRs were attempted in 130 patients (106 in children under 16). Ishikawa amputation level or CGFR outcome was not documented in 21 excluded cases. Despite a significant association between adulthood and smoking, complete or partial graft survival was excellent in both adults and children (86% and 89%, respectively). Adults and children were significantly more likely to sustain laceration and crush injuries, respectively. These results challenge the near-universal scepticism held against CGFR in adults. Partial graft survival can appear discouraging when mummified eschar conceals regenerating tissue beneath. We emphasise the importance of patience in the clinical management of fingertip injuries treated by CGFR with two representative cases where the graft was considered ‘completely necrotic’ but ultimately survived to generate normal nail growth with an excellent cosmetic and functional result

Evaluation of a 99mTc-labeled AnnexinA5 variant for non-invasive SPECT imaging of cell death in liver, spleen and prostate.

Item does not contain fulltextPURPOSE: We investigate radio-labeling and pharmacokinetics of a new AnnexinA5 variant (HYNIC-cys-AnxA5) and then assess its utility for the non-invasive detection of cell death in liver, spleen and prostate. METHODS: AnnexinA5 binds to phosphatidylserine expressed on the surface of apoptotic and necrotic cells. Contrary to other AnnexinA5 variants, the new cys-AnxA5 allows for site-specific conjugation of a hydrazinonicotinamide-maleimide moiety and subsequent radio-labeling with (99m)Tc at a position not involved in the AnxA5-phosphatidylserine interaction. Distribution of (99m)Tc-HYNIC-cys-AnxA5 was studied in rats, both invasively and via SPECT/CT. Cycloheximide was used to induce cell death in liver and spleen, whereas apoptosis in the prostate was induced by castration. RESULTS: HYNIC-cys-AnxA5 was efficiently and reproducibly labeled with (99m)Tc. Blood clearance of radioactivity after iv-injection was adequately described by a two-compartment model, the renal cortex representing the main site of accumulation. Cycloheximide treatment resulted in increased accumulation of intravenous-injected (99m)Tc-HYNIC-cys-AnxA5 in liver and spleen over controls, which correlated well with TUNEL staining for cell death in corresponding tissue sections. However, the increase in TUNEL-positive prostate epithelial cells observed following castration was not paralleled by greater (99m)Tc-HYNIC-cys-AnxA5 accumulation. CONCLUSION: (99m)Tc-HYNIC-cys-AnxA5 appears a suitable tracer for assessment of cell death in liver and spleen, but not prostate