18F-Choline PET/CT-Positive Lytic Bone Lesions in Prostate Cancer and Accidental Myeloma Detection

ABSTRACT: F-choline PET/CT was performed for suspected prostate cancer relapse in a 67-year-old man with hip pain and a rapid rise in prostate-specific antigen values (1.1 ng/mL). PET imaging showed an area of increased F-choline bone uptake in the right ischium. Coregistered CT images showed a lytic bone lesion. The infrequent CT appearance of a possible prostate carcinoma metastasis led to additional laboratory testing that showed a monoclonal \u3b3-peak and to subsequent biopsy, which revealed a solitary plasmocytoma

Staging non-small lung cancer with positron emission tomography: diagnostic value, impact on patient management, and cost-effectiveness

The aim of this study was to compare two preoperative staging procedures of non-small cell lung cancer (NSCLC): one using positron emission tomography (PET) and one using conventional imaging studies. Accuracy, effects on patient management, and costs were calculated. Four hundred thirteen consecutive patients with NSCLC were prospectively examined with PET and conventional imaging studies. A simulation calculated the costs of the two strategies. The accuracy of PET for metastases was 97.5% versus 84% of conventional imaging (P < 0.001). The accuracy of PET for mediastinal staging was 97%, whereas that of computed tomography was 68% (P < 0.001). The expected number of unnecessary surgeries was 24 for the conventional strategy and 8 for the PET strategy (P = 0.007). The PET strategy was less expensive. This study shows that PET is an economical tool in NSCLC staging (even in the European economic environment), with high accuracy and important management aspects

Facial taping as biofeedback to improve the outcomes of physical rehab in Bell’s palsy: preliminary results of a randomized case–control study

Purpose: This study aimed to investigate the efficacy of taping in association with Kabat rehabilitation to ameliorate the outcomes of Bell’s palsy. Methods: This&nbsp;case–control study was conducted on hospital-outbound patients. 20 patients over 18&nbsp;years affected from Bell’s palsy were recruited at the onset of the disease (&lt; 5&nbsp;days). Patients were simply randomized into two groups. Patients in group A underwent exclusively Kabat rehabilitation, while patients in group B were treated by combining facial taping and Kabat. Facial palsy severity was evaluated with ADS&nbsp;assessment at baseline (T0), 1&nbsp;week (T1), 1 month (T2) and 3 months (T3) after treatment. One-way ANOVA was used to compare ADS scores variance between groups to evaluate differences between the two treatments. Results: Both groups presented statistically significant differences comparing the baseline with the other observational points (within analysis) (p &lt; 0.0001). Patients in group B showed a statistically significant improvement compared to group A (between analyses) (p &lt; 0.0001), especially at T2 (p &lt; 0.01). Conclusions: Facial taping combined with Kabat rehabilitation allowed to reduce the time of recovery and improved the outcomes of Bell’s palsy

The prognostic value of F-18 fluorodeoxyglucose bone marrow uptake in patients with recent diagnosis of multiple myeloma : a comparative study with Tc-99m sestamibi

Purpose: We assessed the prognostic value of F-18 fluorodeoxyglucose (FDG) uptake in the bone marrow of patients with multiple myeloma (MM) in comparison with Tc-99m methoxy-isobutyl-isonitrile (MIBI). Methods: The extent and intensity of FDG and MIBI uptake in the bone marrow of 18 patients with a recent diagnosis of MM were assessed by visual score and by calculating the mean SUV (mSUV) for FDG and the femora/thigh ratio (TG/BKG, [Target/Background ratio]) for MIBI images. These parameters were correlated with clinical indexes of disease using hemoglobin and beta-2-microglobulin levels and plasma cell infiltrate (PCI) percentage. The mean values of the visual score, mSUV, and TG/BKG levels were compared in patients deceased after a relatively short follow-up (n = 9; group A) and in patients with a longer survival or were alive at the end of the study (n = 9; group B). Results: Significant correlations of mSUV and TG/BKG values with PCI percentages and beta-2-microglobulin were found (P < 0.05). The extent of FDG and MIBI bone marrow uptake was greater in patients of group A (P < 0.01). Higher values of mSUV (P < 0.01) and TG/BKG (P < 0.05) were also observed in patients of group A. These results were consistent with the differences (not statistically significant) in hemoglobin, albumin, beta-2-microglobulin levels, and PCI percentages observed in the 2 groups. Conclusion: Our study demonstrates that an increase of FDG bone marrow uptake may predict a more aggressive disease, as much as MIBI uptake. Therefore, an additional analysis of FDG bone marrow images should be performed in patients undergoing PET studies during the initial staging of MM

Thyroid scintigraphy and perchlorate test after recombinant human TSH: a new tool for the differential diagnosis of congenital hypothyroidism during infancy

Purpose: Prompt initiation of l-thyroxine therapy in neonates with congenital hypothyroidism (CH) often prevents the performance of functional studies. Aetiological diagnosis is thus postponed until after infancy, when the required investigations are performed after l-thyroxine withdrawal. The aim of this study was to verify the efficacy and safety of new protocols for rhTSH (Thyrogen) testing during l-thyroxine replacement in the differential diagnosis of CH. Methods: Ten CH patients (15-144 months old) were studied. Seven had neonatal evidence of gland in situ at the ultrasound examination performed at enrolment and received two rhTSH injections (4 \u3bcg/kg daily, i.m.) with 123I scintigraphy and perchlorate test on day 3. Three patients with an ultrasound diagnosis of thyroid dysgenesis received three rhTSH injections with 123I scintigraphy on days 3 and 4. TSH and thyroglobulin (Tg) determinations were performed on days 1, 3 and 4, and neck ultrasound on day 1. Results: rhTSH stimulation caused Tg levels to increase in eight cases. Blunted Tg responses were seen in two patients with ectopia and hypoplasia. Interestingly, in two cases the association of different developmental defects was demonstrated. Perchlorate test revealed a total iodide organification defect in two patients, including one with a neonatal diagnosis of Pendred's syndrome, who were subsequently found to harbour TPO mutations. rhTSH did not cause notable side-effects. Conclusion: These new rhTSH protocols always resulted in accurate disease characterisation, allowing specific management and targeted genetic analyses. Thus, rhTSH represents a valid and safe alternative to l-thyroxine withdrawal in the differential diagnosis of CH in paediatric patients

La cd. legge 'spazzacorrotti'. Croniche innovazioni tra diritto e processo penale

La legge spazzacorrotti predispone l'ennesimo doppio binario, equiparando il corrotto al mafioso, con l'espansione di moduli eccezionali, che introducono regimi procedimentali di tipo investigativo e probatorio, differenziati sulla base del solo titolo di reato. Si affidano, così, al processo finalità preventive con il predominio di illusorie pulsioni panpenalistiche, destinate a risolversi in forme illiberali di mera repressione. L'inasprimento sanzionatorio, la perpetuità delle pene accessorie, l'aggressività delle indagini - attraverso l'uso del captatore informatico e l'ampliamento delle operazioni sotto copertura - delineano un contesto di emergenzialismo, appiattito su presunte esigenze di una politica criminale dell'efficienza, che trascura del tutto l'aspetto positivo della prevenzione generale. La riforma, inoltre, ignora che la prescrizione sia un diritto dell'imputato, lasciando prevalere l'interesse pubblico alla non dispersione del processo, anche al prezzo del sacrificio della presunzione di non colpevolezza. Per questa via, l'imputato diviene prigioniero di una giustizia, non troppo latamente, autoritaria. La convinzione è che la diffusione delle pratiche corruttive, nelle molteplici articolazioni della vita sociale, non possa legittimare la 'caccia' ai corrotti attraverso una normativa speciale, che ciclicamente ritorna con i consueti tratti dell'approssimazione, del rigorismo repressivo e della simbolicità, a detrimento dei diritti inviolabili