Identification of occult metastases of medullary thyroid carcinoma by pentagastrin-stimulated intravenous calcitonin sampling followed by targeted surgery

BACKGROUND: High calcitonin (CT) serum levels suggest metastatic spread in medullary thyroid carcinoma (MTC) after thyroidectomy. In limited disease stages, however, morphological investigations including ultrasound, magnetic resonance imaging (MRI) and 18F-FDG positron emission tomography ([18F]FDG-PET) may often fail to identify exact tumour sites. OBJECTIVE: The aim of the present study was to establish an improved strategy to identify small cervical tumours by combining pentagastrin stimulation with bilateral cervical intravenous CT sampling followed by high-resolution ultrasound. DESIGN AND PATIENTS: Six MTC patients were examined, of whom five patients already had bilateral neck dissection. Five patients had sporadic MTC, and one patient suffered from MEN2a. RESULTS: Retrospective analysis of all patients revealed a highly sensitive positive correlation between an early calcitonin peak (20–40 s after pentagastrin injection) and site of cervical tumour affection. Postinterventional ultrasound examination of the affected regions of the neck revealed suspicious presence; in some cases small lymph nodes of less than 1 cm in size were then surgically excised. On histology, small tumours could be identified in four patients. Postsurgical examination revealed a clear decline of basal serum calcitonin levels in four patients (between −41% and −100%). In two patients CT normalized to baseline levels (< 10 pg/ml) and in another two patients CT rendered to near normal (14 and 17 pg/ml). CONCLUSION: Pentagastrin stimulation-based intravenous catheter sampling may be beneficial in the diagnostic work-up of MTC after thyroidectomy. Our data show that an early calcitonin peak (20–40 s after administration of pentagastrin) helps to identify tumour-affected regions

Imaging features of calcium pyrophosphate deposition (CPPD) disease: consensus definitions from an international multidisciplinary working group.

To develop definitions for imaging features being considered as potential classification criteria for calcium pyrophosphate deposition (CPPD) disease, additional to clinical and laboratory criteria, and to compile example images of CPPD on different imaging modalities. The ACR/EULAR CPPD classification criteria Imaging Advisory Group (IAG) and Steering Committee drafted definitions of imaging features that are characteristic of CPPD on conventional radiography (CR), conventional computed tomography (CT), dual-energy CT (DECT), and magnetic resonance imaging (MRI). An anonymous expert survey was undertaken by a 35-member Combined Expert Committee including all IAG members. The IAG and five external musculoskeletal radiologists with expertise in CPPD convened virtually to further refine item definitions, and voted on example images illustrating CR, CT, and DECT item definitions with ≥90% agreement required to deem them acceptable. The Combined Expert Committee survey indicated consensus on all CR definitions. The IAG and external radiologists reached consensus on CT and DECT item definitions, which specify that calcium pyrophosphate deposits appear less dense than cortical bone. The group developed an MRI definition and acknowledged limitations of this modality for CPPD. Ten example images for CPPD were voted acceptable (4 CR, 4 CT, 2 DECT), and three example images of basic calcium phosphate deposition were voted acceptable to serve as contrast against imaging features of CPPD. An international group of rheumatologists and musculoskeletal radiologists defined imaging features characteristic of CPPD on CR, CT, and DECT, and assembled a set of example images as a reference for future clinical research studies

Causes of rejection of beef bulls in breeding soundness evaluation

The objective of this study was to analyze the rates of rejection in the different steps of the breeding soundness evaluation of beef bulls in the state of Rio Grande do Sul, Brazil. The breeding soundness of 22,113 young and mature bulls of 14 beef breeds, participating in the Program of Reproductive Evaluation (PARTO) was evaluated in the experiment. Data concerning to the causes of rejection in the four steps of the breeding soundness evaluation (general physical examination, genital tract examination, semen evaluation and sexual behavior assessment) were analyzed by the Chi-square test and univariate regression analysis. According to year, general physical examination, genital tract examination and semen evaluation determined the rejection of 0.9% to 2.5%, 5.1% to 7.7%, 1.8% to 5.3%; and 4.2% to 6.7%, 7.3 to 9.3%, and 2.5% to 5.5% of young and mature bulls, respectively. Mature bulls presented higher chances of rejection than young bulls in the general physical examination in every year evaluated; as to the genital tract examination, their chances of rejection were higher in years I and II, but not in year III. In the semen evaluation, there was no difference between the ages assessed in any of the three years evaluated. Sexual behavior assessment accounted for the rejection of 1.9 to 6.0% of the young bulls and 2.9% to 3.9% of mature bulls, in accordance with the years evaluated; in years I and II, mature bulls presented higher rejection rates than young bulls. These results confirm the importance of performing all steps of the breeding soundness evaluation, including the sexual behavior assessment as a work routine, rather than an additional, optional stage of the evaluation, which should be carried out before the breeding season. The results indicate the relationship between bull age and rejection rate in the breeding soundness evaluation