Veteran player tips the scale — V/Q SPECT-CT proves decisive in blunt chest trauma. Case report and brief literature review

A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options.A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options

Three Generations of Participation Rights in European Administrative Proceedings

This paper develops a conceptual framework for analyzing the development of participation rights in Community administration from the early 1970\u27s to the present day. Procedural rights can be divided into three categories, each of which is associated with a distinct phase in Community history and a particular set of institutional actors. The first set of rights, the right to a fair hearing when the Commission inflicts sanctions or other forms of hardship on individuals, first emerged in the 1970\u27s in the context of competition proceedings and later in areas such as anti-dumping and structural funds. This phase was driven by the Court of Justice and an English, and to a lesser extent, German conception of the value of a fair hearing. The rise of transparency in the 1990\u27s-- the requirement of openness in all Community institutions, including administration--marks the second stage. The drive for transparency was led by certain member countries with longstanding traditions of open government--the Netherlands, Denmark, and Sweden--as well as the European Parliament. The most recent phase in the development of process rights is the debate on whether and under what conditions, individuals, firms, and their associations, billed civil society, should take part in Community legislative and rulemaking proceedings. The Commission and now the Convention on the Future of Europe have been the keenest proponents of giving citizens and their associations a right to participate in rulemaking and legislative proceedings. Civil society participation is then critically examined. Representation--not expertise or good management practices--is the only justification for allocating power, within the Community policymaking process, to individual citizens and their organizations. Yet there is no consensus in Europe, where republican, corporatist, and liberal traditions continue to flourish, on the legitimacy of representation outside of political parties and the electoral process. Without wider consensus, I conclude that associational participation in Community policymaking should not be entrenched and that the Commission should, in mediating the informal influence of civil society actors, act in awareness of its innate institutional bias toward liberal interest group pluralism

Inflammation and ovarian cancer – current views

Ovarian cancers pose the greatest challenge for gynecological oncology. They are a heterogeneous, rapidly progressing and highly lethal group of malignancies and their etiology is still poorly understood. Among many hypotheses, explaining the pathogenesis of malignant tumors, chronic inflammation seems to play a significant role, which was proved in cervical, hepatic and esophageal cancers. The processes of inflammation and carcinogenesis are very much alike. Their similarity was experimentally confirmed by epidemiological, immunological, biochemical and genetic studies. Additionally, this view is supported by indirect epidemiological and clinical evidence linking ovarian cancer with pelvic inflammatory disease, endometriosis or polycystic ovary syndrome. Chronic inflammation is a key factor in the pathogenesis of these illnesses. Moreover, ovulation involving repeated damage and repair of the ovarian surface epithelium is in fact an inflammatory process. In this review, we focus on the role of inflammation in cancer initiation, promotion and progression with special emphasis on the ovarian cancer. We discuss the potential involvement of the fallopian tubes, endometriosis and microenvironment of tumors represented by cytokines, chemokines, growth factors and various enzymes that destroy the extracellular matrix. Considering that molecular biology is currently rapidly evolving, we focus on the function of the mammalian target of rapamycin (mTOR) kinase and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in the pathophysiology of inflammation and cancer

Right ventricle outflow tract stenting as a method of palliative treatment of severe tetralogy of Fallot

We present the case of a 3-month-old infant with tetralogy of Fallot (ToF) with pulmonary artery hypoplasia, critical right ventricle outflow tract (RVOT) obstruction and the presence of major aortopulmonary collateral arteries (MAPCA) and CATCH 22 syndrome. Due to anatomical conditions (severe pulmonary artery hypoplasia), the patient was not qualified for palliative operative treatment Blalock-Taussig shunt. We conducted catheterization with an attempt of balloon plasty and stent implantation into the right ventricle outflow tract and main pulmonary artery. Successful stent implantation into the right ventricle outflow tract was performed. The stent created a 4.1 mm diameter channel and allowed for unrestricted blood flow from the right ventricle to the pulmonary arteries. After the procedure we observed an increase in blood saturation of up to 89%. Control echocardiography revealed blood flow through the stent to the pulmonary arteries with a pressure gradient of 45 mm Hg. There were neither rhythm nor conduction disturbances in the control ECG after the procedure. After 6 days of observation the patient was discharged from our department. We conclude that successful stent implantation into the RVOT in patients with ToF and hypoplastic pulmonary arteries improves their clinical condition, increases pulmonary blood flow by physiological means and leads to an improvement of pulmonary artery development before surgical treatment

Feasibility of myocardial perfusion imaging studies in morbidly obese patients with a cadmium-zinc-telluride cardiac camera

BACKGROUND: A novel cardiac SPECT camera with cadmium-zinc-telluride (CZT) based technology has a fixed array of semiconductor detectors paired with pinhole collimators focused on the heart. Image acquisition in obese patients can be challenging because of much smaller detector field of view compared to conventional gamma cameras. The aim of this study was to evaluate the impact on high body mass on the feasibility of CZT myocardial perfusion imaging (MPI). The additional aim was to investigate the mechanism of the banana-shaped/obesity artifact, as referred to in literature, and to attempt at simulating it on a phantom study. MATERIAL AND METHODS: Study group consisted of 43 patients with morbid obesity (BMI ≥ 40 kg/m2). All these patients underwent myocardial perfusion imaging on both CZT cardiac camera and general purpose SPECT/CT gamma camera. Control group consisted of all patients who underwent myocardial perfusion imaging on CZT camera throughout one calendar year and whose BMI was lower than 40 kg/m2. In this group, all repeated studies were re-analyzed for estimating the frequency of heart mispositioning in the camera field of view. The number of studies performed was 1180. A static cardiac phantom was used to simulate a banana-shaped artifact. A series of phantom acquisitions during which the phantom position was altered in the camera field of view was performed. RESULTS: In control group, 3.7% of all cardiac scintigrams required repetition, 18.9% of which were repeated due to wrong heart positioning; median BMI in this group of patients was 36.0. A banana-shaped artifact was observed in one female patient with BMI 36.0. In morbid obesity group, 32.6% of the studies were non-diagnostic with “truncation effect” on Scan Quality Control (QC). Median BMI in patients with diagnostic scans was 42.0, while in patients with not acceptable quality control test it was 45.0 (p < 0.05). Banana-shaped artifacts were observed in 5 non-diagnostic studies. In a phantom study an artifact of banana shape was obtained when gantry was distant from the phantom and target was on the edge of the camera field of view and was slightly truncated. CONCLUSIONS: Problem with heart mispositioning during imaging on the CZT camera affects less than 1% of all performed studies. Morbid obesity is not a contraindication to perform myocardi

ST-segment elevation in the recovery phase of nuclear exercise stress test with 99mTc-sestamibi in a patient with critical RCA stenosis and subtle systolic dysfunction in speckle tracking imaging

An asymptomatic Caucasian male patient underwent coronaryartery disease diagnostics. Standard exercise treadmilltest was inconclusive, and Holter ECG study didn’t show anysignificant abnormalities. Considering the high risk of ischemicheart diseasenuclear exercise stress test was performed,which revealed ST-segment elevation in the recovery phase ofthe treadmill exercise test. Single photon emission computedtomography (SPECT/CT) showed myocardial perfusion abnormalitiesin the inferior and lateral walls of the left ventricle. Furthermore,speckle tracking imaging showed subtle left ventricle dysfunction. Finally critical stenosis in the second segment ofright coronary artery was diagnosed in coronary angiography