FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0.

The aim of this guideline is to provide a minimum standard for the acquisition and interpretation of PET and PET/CT scans with [18F]-fluorodeoxyglucose (FDG). This guideline will therefore address general information about[18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and is provided to help the physician and physicist to assist to carrying out,interpret, and document quantitative FDG PET/CT examinations,but will concentrate on the optimisation of diagnostic quality and quantitative information.

Topical treatments with pimecrolimus, tacrolimus and medium- to high-potency corticosteroids, and risk of lymphoma.

BACKGROUND/AIMS: A potential risk of lymphoma associated with the use of topical calcineurin inhibitors is debated. We assessed the risk of lymphoma among patients treated with topical pimecrolimus, tacrolimus or corticosteroids. METHODS: We conducted a cohort study using health insurance claims data. Cohorts of initiators of topical pimecrolimus, tacrolimus and corticosteroids, along with cohorts of persons with untreated dermatitis and randomly sampled enrollees were identified from January 2002 to June 2006. Lymphomas were identified using insurance claims and adjudicated by medical records review. We adjusted for confounders by propensity score matching. RESULTS: Among 92,585 pimecrolimus initiators contributing 121,289 person-years of follow-up, we identified 26 lymphomas yielding an incidence of 21/100,000 person-years. This incidence of lymphoma was similar to that among tacrolimus users (rate ratio, RR = 1.16; 95% confidence interval, CI = 0.74-1.82) as well as corticosteroid users (RR = 1.15; 95% CI = 0.49-2.72). All three topical treatments were associated with an increased risk of lymphoma compared with the general population (RR(Pim) = 2.89; RR(Tac) = 2.82; RR(Cort) = 2.10) suggesting increased detection of preexisting lymphomas. CONCLUSION: This study did not find an increased risk of lymphoma among initiators of topical pimecrolimus relative to other topical agents during an average follow-up of 1.3 years. Longer-term studies may be needed.

The effect of crank rate strategy on peak aerobic power and peak physiological responses during arm crank ergometry.

The main aim of this study was to determine whether the use of an imposed or freely chosen crank rate would influence submaximal and peak physiological responses during arm crank ergometry. Fifteen physically active men participated in the study. Their mean age, height, and body mass were 25.9 (s = 6.2) years, 1.80 (s = 0.10) m, and 78.4 (s = 6.1) kg, respectively. The participants performed two incremental peak oxygen consumption (VO(2peak)) tests using an electronically braked ergometer. One test was performed using an imposed crank rate of 80 rev x min(-1), whereas in the other the participants used spontaneously chosen crank rates. The order in which the tests were performed was randomized, and they were separated by at least 2 days. Respiratory data were collected using an on-line gas analysis system, and fingertip capillary blood samples ( approximately 20 microl) were collected for the determination of blood lactate concentration. Heart rate was also recorded throughout the tests. Time to exhaustion was measured and peak aerobic power calculated. Submaximal data were analysed using separate two-way repeated-measures analyses of variance, while differences in peak values were analysed using separate paired t-tests. Variations in spontaneously chosen crank rate were assessed using a one-way analysis of variance with repeated measures. Agreement between the crank rate strategies for the assessment of peak values was examined by calculating intra-class correlation coefficients (ICC) and 95% limits of agreement (95% LoA). While considerable between-participant variations in spontaneously chosen crank rate were observed, the mean value was not different (P > 0.05) from the imposed crank rate of 80 rev x min(-1) at any point. No differences (P > 0.05) were observed for submaximal data between crank strategies. Furthermore, mean peak minute power [158 (s = 20) vs. 158 (s = 18) W], time to exhaustion [739 (s = 118) vs. 727 (s = 111) s], and VO(2peak)[3.09 (s = 0.38) vs. 3.04 (s = 0.34) l x min(-1)] were similar for the imposed and spontaneously chosen crank rates, respectively. However, the agreement for the assessment of VO(2peak) (ICC = 0.78; 95% LoA = 0.04 +/- 0.50 l x min(-1)) between the cranking strategies was considered unacceptable. Our results suggest that either an imposed or spontaneously chosen crank rate strategy can be used to examine physiological responses during arm crank ergometry, although it is recommended that the two crank strategies should not be used interchangeably.

FDG-PET maximum standardised uptake value is associated with variation in survival: analysis of 498 lung cancer patients.

We sought to establish the extent to which tumour uptake of [18F]-fluoro2-deoxy-glucose is associated with survival in patients with primary lung cancer. From our analysis of data concerning 498 lung cancer patients, including surgical and non-surgical cases, we conclude that there is a clear association between higher tumour uptake of glucose and worse survival.

Parathyroid imaging: how good is it and how should it be done?

Hypersecretion of parathormone in primary hyperparathyroidism is common, occurring in approximately 1 in 500 women and 1 in 2,000 men per year in their fifth to seventh decades of life. This has been suggested from the literature to be primarily the result of a parathyroid adenoma (80-85% of cases), hyperplasia involving more than 1 gland, usually with all 4 glands being involved (10-15% of cases), or the result, albeit rarely, of parathyroid carcinoma (0.5-1% of cases). Surgical removal of the hypersecreting gland is the primary treatment; this procedure is best performed by a skilled surgeon who would normally find the abnormality in 95% of cases. Imaging, however, should be used to identify the site of abnormality, potentially reducing inpatient stay and improving the patient experience. Functional imaging of parathyroid tissue using thallium was introduced in the 1980s but has largely been superceded by the use of (99m)Tc-labeled isonitriles. The optimum techniques have used (99m)Tc-sestamibi with subtraction imaging or washout imaging. A recent systematic review reported the percentage sensitivity (95% confidence intervals) for sestamibi in the identification of solitary adenomas as 88.44 (87.48-89.40), multigland hyperplasia 44.46 (41.13-47.8), double adenomas 29.95 (-2.19 to 62.09), and carcinoma 33 (33). This review does not separate the washout and subtraction techniques. The subtraction technique using (99m)Tc-sestamibi and (123)I is the optimal technique enabling the site to be related to the thyroid tissue when the parathyroid gland is in the neck in a normal position. If there is an equivocal scan then confirmation with high resolution ultrasound should be used. With ectopic glands, the combined use of single-photon emission computed tomography may then provide anatomical information to enable localization of the functional abnormality. In patients who have had surgical exploration by an experienced parathyroid surgeon in a unit with an experienced nuclear medicine team and negative sestamibi imaging, it is reasonable to image the patient with (11)C methionine. It is debatable whether patients with a high likelihood of secondary hyperparathyroidism should be imaged. The only possible justification for this is to exclude an ectopic site. There is no substitute for an experienced surgeon and an experienced imaging unit to provide a parathyroid service.

Influence of crank rate on the slow component of pulmonary O(2) uptake during heavy arm-crank exercise.

The principal aim of this study was to examine the influence of variations in crank rate on the slow component of the pulmonary oxygen uptake ((.)VO(2)) response to heavy-intensity arm-crank ergometry (ACE). We hypothesized that, for the same external work rate, a higher crank rate would elicit a greater amplitude of the (.)VO(2) "slow component". Eleven healthy males (mean (+/- SD) age, 25 ((+/-6) y; body mass, 89.1 ((+/-10.7) kg; ACE (.)VO(2)(peak), 3.36 ((+/-0.47) L x min(-1)) volunteered to participate. The subjects initially completed an incremental exercise test for the determination of (.)VO(2)(peak) and peak power on an electrically braked arm ergometer. Subsequently, they completed "step" transitions from an unloaded baseline to a work rate requiring 70% of peak power: 2 at a crank rate of 50 r x min(-1) (LO) and 2 at a crank rate of 90 r x min(-1) (HI). Pulmonary gas exchange was measured on a breath-by-breath basis and (.)VO(2) kinetics were evaluated from the mean response to each condition using non-linear regression techniques. In contradiction to our hypothesis, the (.)VO(2) slow component was significantly greater at 50 r x min(-1) than at 90 r x min(-1) (LO: 0.60 +/- 0.30 vs. HI: 0.47 +/- 0.21 L x min(-1); p < 0.05). The mean value for the localized rating of perceived exertion was also higher at 50 r x min(-1) than at 90 r x min(-1) (LO: 16.7 +/- 1.4 vs. HI: 15.2 +/- 1.3; p < 0.05), but there was no significant difference in end-exercise blood lactate concentration. It is possible that differences in muscle tension development and blood flow resulted in a greater contribution of "low-efficiency" type II muscle fibres to force production at the lower crank rate in ACE, and that this was linked to the greater (.)VO(2) slow component. However, other factors such as greater isometric contraction of the muscles of the trunk and legs at the lower crank rate might also be implicated.

Caffeine lowers perceptual response and increases power output during high-intensity cycling.

The aim of this study was to determine the effects of caffeine ingestion on a 'preloaded' protocol that involved cycling for 2 min at a constant rate of 100% maximal power output immediately followed by a 1-min 'all-out' effort. Eleven male cyclists completed a ramp test to measure maximal power output. On two other occasions, the participants ingested caffeine (5 mg. kg(-1)) or placebo in a randomized, double-blind procedure. All tests were conducted on the participants' own bicycles using a Kingcycle test rig. Ratings of perceived exertion (RPE; 6-20 Borg scale) were lower in the caffeine trial by approximately 1 RPE point at 30, 60 and 120 s during the constant rate phase of the preloaded test (P <0.05). The mean power output during the all-out effort was increased following caffeine ingestion compared with placebo (794+/-164 vs 750+/-163 W; P=0.05). Blood lactate concentration 4, 5 and 6 min after exercise was also significantly higher by approximately 1 mmol. l(-1) in the caffeine trial (P <0.05). These results suggest that high-intensity cycling performance can be increased following moderate caffeine ingestion and that this improvement may be related to a reduction in RPE and an elevation in blood lactate concentration.

Mechanically braked Wingate powers: agreement between SRM, corrected and conventional methods of measurement.

In this study, we assessed the agreement between the powers recorded during a 30 s upper-body Wingate test using three different methods. Fifty-six men completed a single test on a Monark 814E mechanically braked ergometer fitted with a Schoberer Rad Messtechnik (SRM) powermeter. A commercial software package (Wingate test kit version 2.21, Cranlea, UK) was used to calculate conventional and corrected (with accelerative forces) values of power based on a resistive load (5% body mass) and flywheel velocity. The SRM calculated powers based on torque (measured at the crank arm) and crank rate. Values for peak 1 and 5 s power and mean 30 s power were measured. No significant differences (P >0.05) were found between the three methods for 30 s power values. However, the corrected values for peak 1 and 5 s power were 36 and 23% higher (P <0.05) respectively than those for the conventional method, and 27 and 16% higher (P <0.05) respectively than those for the SRM method. The conventional and SRM values for peak 1 and 5 s power were similar (P >0.05). Power values recorded using each method were influenced by sample time (P <0.05). Our results suggest that these three measures of power are similar when sampled over 30 s, but discrepancies occur when the sample time is reduced to either 1 or 5 s.

Resection and radiofrequency ablation of multiple liver adenomas secondary to anti-conceptive pills.

A case of multiple hepatic adenomas associated with birth control pills in a 25-year-old female is presented. Her only complaint was abdominal pain, and an elevated alkaline phosphatase was the only laboratory abnormality. The largest adenoma was located in the caudate lobe and was resected. The other two were small, located deep in the right lobe, and treated with radiofrequency ablation. Currently, the patient is asymptomatic and her alkaline phosphatase has returned to normal levels.

Effects of caffeine ingestion on exercise testing: a meta-analysis.

This study used the meta-analytic approach to examine the effects of caffeine ingestion on exercise testing. Forty double-blind studies with 76 effect sizes (ES) met the inclusion criteria. The type of exercise test was classified as endurance, graded, or short-term. In comparison with placebo, caffeine improved test outcome by 12.3 % (95 % CI, 9.1 to 15.4), which was equivalent to an overall ES of 0.41 (95 % CI, 0.31 to 0.51). Endurance exercise significantly improved test outcome (P < 0.05) more than either graded or short-term exercise. When exercise protocol was examined, time-to-exhaustion (Tlim) protocols had a significantly greater (P < 0.05) ES than either the graded or the non-Tlim protocol(s). The results from this meta-analysis confirm the ergogenic effects of caffeine, particularly for endurance testing that use Tlim protocols.

Caffeine is ergogenic after supplementation of oral creatine monohydrate.

PURPOSE: The purpose of this investigation was to assess the acute effects of caffeine ingestion on short-term, high-intensity exercise (ST) after a period of oral creatine supplementation and caffeine abstinence. METHODS: Fourteen trained male subjects performed treadmill running to volitional exhaustion (T(lim)) at an exercise intensity equivalent to 125% VO(2max). Three trials were performed, one before 6 d of creatine loading (0.3 g x kg x d(-1) baseline), and two further trials after the loading period. One hour before the postloading trials, caffeine (5 mg x kg(-1)) or placebo was orally ingested in a cross-over, double-blind fashion. Four measurements of rating of perceived exertion were taken, one every 30 s, during the first 120 s of the exercise. Blood samples were assayed for lactate, glucose, potassium, and catecholamines, immediately before and after exercise. RESULTS: Body mass increased (P < 0.05) over the creatine supplementation period, and this increase was maintained for both caffeine and placebo trials. There was no increase in the maximal accumulated oxygen deficit between trials; however, total VO(2) was significantly increased in the caffeine trial in comparison with the placebo trial (13.35 +/- 3.89 L vs 11.67 +/- 3.61 L). In addition, caffeine T(lim) (222.1 +/- 48.9 s) was significantly greater (P < 0.05) than both baseline (200.8 +/- 33.4 s) and placebo (198.3 +/- 45.4 s) T(lim). RPE was also lower at 90 s in the caffeine treatment (13.8 +/- 1.8 RPE points) in comparison with baseline (14.6 +/- 1.9 RPE points). CONCLUSION: As indicated by a greater T(lim), acute caffeine ingestion was found to be ergogenic after 6-d of creatine supplementation and caffeine abstinence.