Chemotherapy response evaluation in metastatic colorectal cancer with FDG PET/CT and CT scans.

BACKGROUND: [18F]-fluorodeoxyglucose with positron-emission tomography (PET) and computed tomography (CT) scans were used to assess morphological and metabolic tumour response after chemotherapy in metastatic colorectal cancer. PATIENTS AND METHODS: Twenty-five patients were evaluated after 4 courses of chemotherapy (+/-target therapy), and among them 20 patients after 2 courses. Response Evaluation Criteria In Solid Tumors (RECIST) and European Organisazion for Research and Treatment of Cancer (EORTC) criteria were used to evaluate CT and PET respectively. RESULTS: Discrepancies between the two procedures were noted after 4 courses of chemotherapy in patient-based analysis. Two morphologically complete responses (CR) were correlated with metabolic response. Seven morphological partial responses (PR) were evaluated as 3 metabolic PR, 2 CR and 1 progressive disease (PD). Seventeen cases of morphologically stable disease (SD) were evaluated as 3 metabolic CR, 13 PR and 1 PD. These discrepancies were confirmed in lesion-based analysis. Perfect concordance was noted between metabolic responses obtained after 2 and 4 cycles. CONCLUSION: Morphological and metabolic imaging does not permit concordant therapeutic assessment in metastatic colorectal cancer.

Assessment of 18F-fluorodeoxyglucose dual-head gamma camera in asbestos lung diseases.

The purpose of this study was to evaluate the performance of 18F-fluorodeoxyglucose (18FDG) imaging via coincidence detection emission tomography (CDET) in identifying malignant lesions in subjects exposed to asbestos. A total of 30 patients exposed to asbestos underwent 18FDG-CDET between January 2000 and June 2003. A CDET scan of the thorax and abdomen was performed 60 min after injection of 18FDG in fasting patients, and results were obtained in slices in three axes. The CDET results were compared to those from computed tomography (CT), and pleural or surgical biopsy in patients with positive 18FDG-CDET results. All primary malignant mesotheliomas accumulated 18FDG (n=6), and, in two patients, CDET findings were superior to those of CT, allowing early detection. In two cases, lung carcinomas with malignant pleural effusion were also detected. There were five false positive CDET results: three unilateral pleural thickening, one rounded atelectasis, and one benign lung nodule. All patients with pleural plaques showed no significant 18FDG uptake. Malignant diseases were detected by 18FDG-CDET imaging with a sensitivity of 89% and specificity of 71%. Coincidence detection emission tomography can identify malignant mesothelioma in selected subjects exposed to asbestos. Coincidence detection emission tomography appears to be a useful noninvasive method for the follow-up of subjects with exposure risk of asbestosis.

[Value of 18FDG-CDET in the evaluation of operable bronchial cancer]. / Intérêt du 18FDG-TEDC dans l'évaluation du cancer bronchique opérable.

The purpose of this study was to investigate the utility of 18fluorodeoxyglucose (FDG) coincidence detection position emission tomography (CDET) in the evaluation of metastatic mediastinal lymph nodes in patients with potentially operable non-small-cell lung cancer (NSCLC). A prospective study was performed in thirty patients with newly suspected NSCLC. Thoracic computed tomography (CT), FDG CDET, and invasive surgical staging were performed in patients. Blinded prospective interpretation was performed for each test and compared to pathological staging obtained by mediastinoscopy and/or by thoracotomy. Patients were followed for six months to detect occult metastases. The sensitivity and specificity of CDET for the detection of mediaStinal lymph nodes were 75% and 94.4% respectively. The corresponding value for CT were 50% and 80.9%. Three patients with N1 disease were classified as N0 by CDET. With regard to definitive surgical node staging, CDET could identify nodal disease in 26 patients and CT only in 18 patients (n = 30). FDG full-ring positron emission tomography (PET) is the most accurate non-invasive method for the detection and staging of lung cancer. In addition, FDG CDET shows high accuracy for the detectability of pulmonary lesions with a diameter at least 2 cm and the evaluation of lymph node in NSCLC.

Study of blood flow parameters measured in femoral artery after exercise: correlation with maximum oxygen uptake.

To study the recovery periods of blood flow parameters in muscles after anaerobic exercise, instantaneous and mean blood flow velocity curves were recorded in the femoral artery in 22 sportsmen at rest and during the first 4 min of recovery after exercise (Ruffier-Dickson test). A flat ultrasonic probe connected to a Doppler system (Flow-Tester) was fixed on the skin at the level of the common femoral artery. From Doppler recordings, we calculated periods of recovery (return to baseline) of femoral blood flow velocity (FBFV RP), heart rate (HR RP) and femoral stroke distance (FSD RP). Also, Ruffier-Dickson index (RDI), VO(2)max in mL/kg(-1)/min(-1) and number of training hours were determined. We observed a high correlation between FBFV RP and VO(2)max (p = 0. 0002), and significant correlation between FSD RP and VO(2)max (p = 0.0238) and RDI (p = 0.0451). In conclusion, there is a excellent correlation between blood flow velocity recovery period in femoral artery after moderate exercise and VO(2)max in high-level sportsmen. The method of testing is simple and based on conventional Doppler technique. It can be used for the follow-up of training levels in sportsmen.

[Role of vitamin C on adrenocortical effects of etomidate]. / Rôle de la vitamine C sur les effets corticosurrénaliens de l'étomidate.

This study was carried out to assess whether the adrenal inhibition induced by etomidate could be prevented by associating ascorbic acid with etomidate, as a protective effect of ascorbic acid administered three hours after etomidate has been described. Sixteen ASA 1 or 2 patients, less than 65 years old, free of endocrine disease, were included. At induction of anaesthesia, eight of them (group B) were given an infusion of ascorbic acid 1 g, in 500 ml of 5% glucose. Group A patients (n = 8) were given 500 ml of 5% glucose. Anaesthesia was induced with etomidate 0.3 mg.kg-1, fentanyl 0.005 mg.kg-1 and vecuronium 0.1 mg.kg-1. Maintenance was carried out using a continuous infusion of etomidate (0.1 mg.kg-1.h-1 for 10 min, followed by 0.01 to 0.02 mg.kg-1.h-1). Additional boluses of fentanyl or diazepam (10 mg) were administered when arterial blood pressure or heart rate were 20% greater than preanaesthetic values. The number of injections required was the same in both groups. Plasma cortisol concentrations were measured by radioimmunoassay (RIA) before anaesthesia (T0), 4 h (T4) and 24 h (T24) after the end of surgery. Blood ACTH levels were also assessed by RIA at T0 and T4. The adrenal insufficiency at T4 had completely ended at T24. In fact, the relative decrease in cortisol levels was greater in patients treated with ascorbic acid (T4/T0: 47.6 +/- 9% in group A vs 76.5 +/- 33% in group B, p less than 0.05); this was suggestive of a higher degree of adrenal inhibition in patients receiving ascorbic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

[Antithyrotropin receptor antibodies in a series of Basedow's disease]. / Les anticorps anti-récepteurs de la TSH dans une série de maladie de Basedow.

Thyrotrophin binding inhibiting immunoglobulins (TBII) were tested in 40 Graves' disease patients with hyperthyreosis, by an isotopic receptor assay (TRAK-Assay Behring). The samples were taken before, during and at the end of the hyperthyroid treatment. TRAb were present in serum of 86.67% of the patients before the treatment and in none of the 20 healthy control volunteers. There was no correlation between TRAb values and either the clinical signes of the disease neither the other thyroidal antibodies. After discontinuation of the antithyroid therapy (18 to 24 months after the onset) TRAb were negative in 71.4% of the patients; among this group 33% had a late relapse of the disease. In the positive TRAb group after discontinuation of the antithyroid therapy, 83.3% had a relapse of the disease and this relapse occurred shortly. There is a significant correlation between the TRAb values and the occurrence of relapse. In conclusion, TRAb values at the end of hyperthyroid treatment in Graves' disease patients seems to be a useful predictor value of the clinical course of the disease. This may be also a good help in the decision to continue or discontinue antithyroid therapy in Graves' disease patients with hyperthyreosis.

[Automatic quantitative analysis of myocardial tomography thallium-201 scintigraphy]. / Analyse quantitative et automatique de la tomoscintigraphie myocardique au thallium 201.

An automatic and quantitative analysis method for tomographic scintigraphy was applied to 104 patients with myocardial infarction (anterior 37, inferior 67, lateral 20, involving 2 territories in some cases). All patients underwent exercise and redistribution scintigraphy and coronary arteriography which served as reference. Two types of tomographic sections were used: 2 short axis sections exploring the left ventricle at different levels, and 1 apical section at a right angle with the first ones. A circumferential analysis program studied the isotopic activity of each section and drew an activity profile curve which was compared with those obtained in normal subjects. Exercise curves proved superior to redistribution and wash-out curves and were therefore used exclusively. Two sectoring methods for territories with infarcts were defined: conventional sectoring, which gives a 90 degrees angle to the anterior region and a 180 degrees angle to the inferior lateral region, and real sectoring established from the scintigraphic abnormalities observed in patients whose infarction was not accompanied by significant lesions in other territories. Real sectoring divides the territory into two regions (anterior and infero-lateral) and determines the extension territory and the territories specific to each necrotic region. The sensitivity and specificity of these two methods for the diagnosis of necrosis and the detection of a significant abnormality (greater than 70% stenosis, or necrosis) in a territory other than the one with infarct were compared. In the diagnosis of infarction: conventional sectoring sensitivity 92%, specificity 46% for anterior infarcts, 94% and 25% for inferior and lateral infarcts; real sectoring 94% and 63% respectively for anterior infarcts, 92% and 68% for inferior infarcts.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of captopril on myocardial perfusion in patients with coronary insufficiency: evaluation by the exercise test and quantitative myocardial tomoscintigraphy using thallium-201.

Nine patients with coronary insufficiency were investigated using an exercise test coupled with quantitative myocardial tomoscintigraphy with thallium-201 before and after 48 hours' treatment with captopril. After captopril treatment, an improvement in ST segment depression was noted during exercise. The quantitative tomoscintigraphy showed a reduction in the ischaemic zone with captopril during exercise. However, in three patients, although there was an overall improvement in myocardial perfusion during exercise, aggravation of wash-out was observed in some regions, reminiscent of a coronary steal effect.

[A case of electrically and mechanically stunned myocardium]. / Une observation de sidération électrique et mécanique du myocarde.

The authors report the case of a 72 year old patient with ECG changes of anterior myocardial infarction complicated by left ventricular failure and shock which has a favourable outcome with regression of the pathological Q waves on the 7th day. Radionuclide investigation and coronary angiography showed no myocardial sequellae and the coronary arteries appeared normal. This case, an example of stunned myocardium, confirms that severe myocardial ischaemia, even of short duration, may induce reversible but prolonged metabolic disturbances. The practical implications of this concept are discussed.

A simple radio-isotopic method for the detection of bronchial inhalation during intensive care.

The high incidence of pneumopathy in intensive care units might be due to the pulmonary aspiration of gastric juice following gastro-oesophageal reflux. The paper describes a radio-isotopic method using material easy to install at the patient's bedside. This technique demonstrated aspiration of gastric juice in the lungs of 8 of 25 intensive care patients investigated. Such a method might be useful later to demonstrate that silent bronchial aspirations of gastric juice are responsible for pulmonary complications.