ABSTRACT
PURPOSE: Acromegaly is associated with many comorbidities and increased mortality. The first-line treatment is transsphenoidal surgery. However, many patients also need adjuvant drug treatment after surgery. Somatostatin analog (SSA), which suppresses GH secretion by somatotrophs by binding to the SSTR2 receptor, is the first choice. Nevertheless, 50% of patients are partially or totally resistant to SSA, so predictive factors of response are helpful to individualize drug treatment. 68GaDOTATATE PET/CT has emerged as the gold-standard method in the diagnosis and follow-up of gastroenteropancreatic neuroendocrine tumors, which also express SSTR. Our objective was to evaluate whether 68Ga-DOTATATE uptake (SUV max) at the pituitary region of patients on SSA therapy would be useful as a drug response predictor without the need of tumoral tissue. METHODS: Fifteen acromegalics patients on SSA treatment for at least 6 months were underwent to 68Ga-DOTATATE PET/CT at the nuclear medicine service. There was an SSA complete response group (n = 5), defined as GH < 1 µg/L and IFG-1 in the normal range for gender and age, and a group that did not meet these criteria (n = 10). RESULTS: As a result, we did not find out a significantly higher SUV max in the complete response group (p = 0.0576) to SSA. However, we found a significant inverse relationship between postoperative GH values and the SUVmax at the sella turcica (p = 0.0188), probably reflecting tumor SSTR2 expression. CONCLUSION: Thus, after this initial evaluation, 68GaDOTATATE PET/CT should be better studied to assess its usefulness in the follow-up of acromegalic patients.
Subject(s)
Acromegaly/pathology , Organometallic Compounds/metabolism , Pituitary Neoplasms/pathology , Positron Emission Tomography Computed Tomography/methods , Somatostatin/therapeutic use , Acromegaly/diagnostic imaging , Acromegaly/drug therapy , Acromegaly/metabolism , Adult , Aged , Cross-Sectional Studies , Female , Follow-Up Studies , Hormones/therapeutic use , Humans , Male , Middle Aged , Pituitary Neoplasms/diagnostic imaging , Pituitary Neoplasms/drug therapy , Pituitary Neoplasms/metabolism , Prognosis , Somatostatin/analogs & derivatives , Young AdultABSTRACT
Sixteen patients with lipomyelomeningoceles were operated by microsurgery technics from 1980 to 1991. Patients with lipomyelomeningoceles inappropriately treated or not submitted to treatment will develop significant neurological sequelae. In the authors' opinion, proper management of the patient with spinal lipoma requires early prophylactic resection of the lipoma and untethering of the spinal cord.
Subject(s)
Lipoma/surgery , Meningomyelocele/surgery , Spinal Cord Neoplasms/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Lipoma/complications , Lipoma/diagnosis , Male , Meningomyelocele/complications , Meningomyelocele/diagnosis , Microsurgery , Retrospective Studies , Spinal Cord Compression/etiology , Spinal Cord Neoplasms/complications , Spinal Cord Neoplasms/diagnosisABSTRACT
Thirty eight patients with multiple intracranial aneurysms were studied. They correspond to 19.4% of all aneurysms treated over a twelve year period in the Servidores do Estado Hospital. 89 aneurysms and 4 infundibuli were detected. In 71.0% of the patients, two aneurysms were found; in 18.4%, three aneurysms; and in 10.4%, 4 or 5 aneurysms were observed. Twenty-seven patients were women and 11 men, ranging in age from 16 to 72 (average 47 years old). Subarachnoid hemorrhage was found in 36 patients (86.8%). The operative mortality in this series was 3.5%. We concluded that patients with multiple intracranial aneurysms should have all aneurysms, that can bleed, clipped through standard micro-neurosurgery technics.
