A pilot study: ensuring optimal adjustment for determinations of predictive values of preoperative investigations before starting a non-operative management protocol in locally advanced mid-distal rectal cancer

Purpose: Before starting a non-operative-management (NOM) protocol in locally advanced mid-distal rectal cancer, we have conducted a pilot study to find out the predictive value of our preoperative investigations. Methods: Between 2013 and 2017, 35 patients with locally advanced (cT3-4, N-any) primary mid-distal rectal adenocarcinoma were included in the study. We had two groups: Standard long-term chemoradiotherapy (CRT) (Group-1) and CRT + Consolidation chemotherapy (Group-2) groups. Both groups were evaluated regarding clinical (endoscopic-radiological) and pathologic response to neoadjuvant therapy. Each patient's data were prospectively recorded and findings were assessed according to NOM protocol and the clinical decisions recorded. The study was oriented to specify the predictive value of oncology team's hypothetical decisions in determining the right candidate for nonoperative management of rectal cancer. All patients underwent surgery with total mesorectal excision (TME) technique; thus, the hypothetical clinical decisions and pathologic results were compared. Results: The sensitivity and specificity of endoscopy were 57.1% and 87.5%; PPV was 80%, NPV was 70%, and accuracy was 73.3%. The sensitivity of MRI tumor regression grade scoring was 60%, specificity was 90%, PPV was 75%, NPV was 81.8%, and accuracy was 80%. The sensitivity and specificity of the final clinical decision were 80% and 90%; PPV was 80%, NPV was 90%, and accuracy was 86.6% in predicting proper management Conclusion: An institutional adjustment for determinations of predictive values of preoperative investigations is beneficial before the start of nonoperative management protocol

Management of sentinel node re-mapping in patients who have second or recurrent breast cancer and had previous axillary procedures

Background: In patients with recurrent or second primary ipsilateral breast cancer, axillary staging is the key factor in locoregional control and a strong prognostic characteristic. The efficient evaluation of lymphatic drainage of re-sentinel lymph node biopsies (re-SLNBs) has remained a challenge in the management of ipsilateral primary or recurrent breast cancer patients who are clinically lymph node negative. This study explores whether a SLNB for patients with primary or recurrent breast cancer is possible after previous axillary surgery. It evaluates potential reasons for mapping failure that might be associated with patients in this group

The value of Tc-99m tetrofosmin in the imaging of pituitary adenomas

Aim: Magnetic resonance imaging (MRI) and computerized tomography (CT) are used in the diagnosis and follow-up of pituitary adenoma cases. Sometimes, these methods cannot display the post-operative residual tissue. It has been shown that some radionuclides were taken up by the pituitary adenomas. The aim of this study was to evaluate the uptake of the technetium-99m (Tc-99m) tetrofosmin (TF) in the pituitary adenoma and normal pituitary tissue and assess the ability of Tc-99m TF to predict tumor malignancy in pituitary gland. Methods: The patients with pituitary adenoma (7 invasive and 8 non-invasive) were compared with control group (no. 13). Single-photon emission computed tomography (SPECT) imaging of pituitary gland was performed in both groups. Tc-99m uptake indices were evaluated statistically with the use of Mann-Whitney U test. Results: The average tetrofosmin uptake index of pituitary adenoma is 2.44 +/- 1.54 for the patients and 1.69 +/- 0.71 for the control group. Any significant difference was not observed between the groups (p 0.3). The average index was calculated as 3.04 +/- 2.15 for invasive adenomas and 1.92 +/- 0.33 for the non-invasive group, and there was no significant difference between the two groups regarding uptake of the agent (p 0.53). Furthermore, it was determined that the invasive and non-invasive adenomas displayed an uptake of Tc-99m TF similar to normal pituitary tissue. Conclusions: Since the pituitary adenoma and normal pituitary tissue gave similar results regarding Tc-99m TF uptake, it was concluded that this agent would not be useful in the diagnosis of pituitary adenoma

Radionuclide imaging in differential diagnosis of torsion and infections of testis and epididymis revisited(Olgu Sunumu)

Differential diagnosis of acute scrotum especially with acute epididymis and testicular torsion should be made promptly, as testicular torsion is a true surgical emergency of the highest order. In this manuscript, two demonstrative cases introducing with acute scrotum and diagnosed with scintigraphy and color Doppler ultrasonography were presented to recall the knowledge

RADIONUCLIDE IMAGING IN DIFFERENTIAL DIAGNOSIS OF TORSION AND INFECTIONS OF TESTIS AND EPIDIDYMIS REVISITED

Differential diagnosis of acute scrotum especially with acute epididymis and testicular torsion should be made promptly, as testicular torsion is a true surgical emergency of the highest order. In this manuscript, two demonstrative cases introducing with acute scrotum and diagnosed with scintigraphy and color Doppler ultrasonography were presented to recall the knowledge

The role of peritoneal scintigraphy in the detection of continuous ambulatory peritoneal dialysis complications.

While continuous ambulatory peritoneal dialysis (CAPD) offers several advantages over hemodialysis in patients with endstage renal disease, several complications have been recognized. The intraperitoneal instillation of dialysate increases intra-abdominal pressure and consequently predisposes the patient to leaks and herniations through defects in the abdominal wall