Intense Uptake in Amyloidosis of the Seminal Vesicles on 68Ga-PSMA PET Mimicking Locally Advanced Prostate Cancer.

We report a case of benign senile seminal vesicle amyloidosis demonstrating intense Ga-prostate-specific membrane antigen (PSMA) uptake on PET/CT. A 68-year-old man underwent staging PSMA PET/CT and MRI for biopsy-proven prostate adenocarcinoma. There was an intense focus of Ga-PSMA uptake in the primary malignancy, as well as symmetrical intense uptake in the seminal vesicles bilaterally that was reported as multifocal disease with local invasion. Final histology after radical prostatectomy showed amyloidosis of the seminal vesicles without any evidence of prostate cancer. Care should be taken in the interpretation of seminal vesicle PSMA uptake to avoid overstaging.

Prostate-Specific Membrane Antigen PET/CT Findings for Hepatic Hemangioma.

We report a case of a benign liver hemangioma with intense prostate-specific membrane antigen (PSMA) uptake on Ga PET/CT. A 77-year-old man with prostate adenocarcinoma underwent routine staging with PSMA PET/CT. This revealed an intensely PSMA-avid liver lesion. The known prostate adenocarcinoma was localized and had mild uptake. Diagnostic CT and MRI were characteristic of a hemangioma without interval growth over a 3-month period. PSMA PET/CT is becoming increasingly popular for staging in prostate cancer, and the presence of PSMA uptake in extra-prostatic tumors is being increasingly documented.

Non-physician endoscopists: A systematic review.

AIM: To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal (GI) endoscopy services. METHODS: The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms. Studies were screened against eligibility criteria and for relevance. Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of non-physician endoscopists. These publications included a total of 28883 procedures performed by non-physician endoscopists. RESULTS: The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter. 17/26 studies related to flexible sigmoidoscopies, 5 to upper GI endoscopy and 6 to colonoscopy. All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists. Geographic distribution of publications showed the majority of research was conducted in the United States (43%), the United Kingdom (39%) and the Netherlands (7%). Most studies conclude that after appropriate training nurse endoscopists safely perform procedures. However, in relation to endoscopic competency, safety or patient satisfaction, all studies had major methodological limitations. Patients were often not randomized (21/26 studies) and not appropriately controlled. In relation to cost-efficiency, nurse endoscopists were less cost-effective per procedure at year 1 when compared to services provided by physicians, due largely to the increased need for subsequent endoscopies, specialist follow-up and primary care consultations. CONCLUSION: Contrary to general beliefs, endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite. Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.

Initial experience using the rigid forceps technique to remove wall-embedded IVC filters.

INTRODUCTION: Severely tilted and embedded inferior vena cava (IVC) filters remain the most challenging IVC filters to remove. Heavy endothelialisation over the filter hook can prevent engagement with standard snare and cone recovery techniques. The rigid forceps technique offers a way to dissect the endothelial cap and reliably retrieve severely tilted and embedded filters. By developing this technique, failed IVC retrieval rates can be significantly reduced and the optimum safety profile offered by temporary filters can be achieved. We present our initial experience with the rigid forceps technique described by Stavropoulos et al. for removing wall-embedded IVC filters. METHODS: We retrospectively reviewed the medical imaging and patient records of all patients who underwent a rigid forceps filter removal over a 22-month period across two tertiary referral institutions. RESULTS: The rigid forceps technique had a success rate of 85% (11/13) for IVC filter removals. All filters in the series showed evidence of filter tilt and embedding of the filter hook into the IVC wall. Average filter tilt from the Z-axis was 19 degrees (range 8-56). Filters observed in the case study were either Bard G2X (n = 6) or Cook Celect (n = 7). Average filter dwell time was 421 days (range 47-1053). There were no major complications observed. CONCLUSION: The rigid forceps technique can be readily emulated and is a safe and effective technique to remove severely tilted and embedded IVC filters. The development of this technique across both institutions has increased the successful filter removal rate, with perceived benefits to the safety profile of our IVC filter programme.

Unique nutcracker phenomenon involving the right renal artery and portal venous system.

The nutcracker phenomenon is usually caused by compression of the left renal vein by the superior mesenteric artery anteriorly and the aorta posteriorly, although variations of this anatomy have previously been reported. We observed a nutcracker phenomenon in a 42-year-old female who underwent portal venous phase computed tomography of the body for oncologic workup. She had no documented proteinuria or hematuria. Multiplanar reconstructions demonstrated an enhancing left renal vein draining into the left ovarian vein without draining into the inferior vena cava due to external compression immediately before the renocaval junction. The left renal vein was compressed between the right renal artery and the portal vein. This type of nutcracker has not been previously reported in the literature and represents a new variation.