Indications for diagnostic use of nuclear medicine in rheumatology: A mini-review.

Nuclear medicine techniques allow important insights not only into oncologic, neurologic, and infectious conditions, but also for the assessment of rheumatic diseases. This review provides a brief, update on the potential role of nuclear imaging in rheumatology, especially on 18F-fluorodeoxyglucose (FDG) positron emission tomography for the diagnosis of giant cell arteritis and other large vessel arteritis according to international recommendations. Besides, the potential role of this and other nuclear imaging techniques for the rheumatologic practice are summarized. With 18F-fluoride as tracer for positron emission tomography, a new option for bone scintigraphy comes up, whereas the use of a semiquantitative sialoscintigraphy is no more supported for classification of Sjögren's syndrome according to current recommendations. Other techniques are used for different organ manifestations in systemic rheumatic diseases like for myocardial infarction and apoplectic insult.

[The Therapy of Malignant Thyroid Disease from ENT-Perspective]. / Die Behandlung von Schilddrüsenmalignomen aus HNO-ärztlicher Sicht.

INTRODUCTION: Malignant tumours of the thyroid gland show a rising incidence. As in the ENT-department Bad Hersfeld the management of thyroid disorders has been in focus for a longer period, we want to share our experiences in this field. MATERIAL AND METHODS: The investigation started in the year of 2014 till July 2020. All patients who underwent thyroid surgery were evaluated concerning important demographic and medical parameters such as age, sex, histology, calcium, recurrent nerve palsy etc. RESULTS: So far 63 patients with a malignant thyroid disease were enrolled in this study. The sex ratio showed a preponderance of the female patients with 42 and 21 males. Age had a wide range from 11 to 95 years. Patients with a differentiated cancer were in average younger than those with anaplastic disease. Histologically the papillary variant dominated with 65 % (n = 41) the other tumours as the follicular (n = 6), the medullary (n = 5) and the anaplastic carcinoma (n = 6). In two female patients with primary hyperparathyroidism a carcinoma of the parathyroid was found surprisingly. All patients underwent surgery; those with an advanced differentiated carcinoma were treated with radioiodine additionally. To our knowledge there was just one tumour related death in case of a differentiated carcinoma, whereas all patients with an anaplastic disease died of their malignancy. CONCLUSIONS: The otorhinolaryngologist is involved in the management of thyroid malignancies. As well as in the benign diseases of the endocrine neck organs the interdisciplinary collaboration is mandatory for a high medical standard.

[Prospective Evaluation of the Quality of the Results of Thyroid Surgery in an ENT-Department]. / Prospektive Untersuchung zur Ergebnisqualität von Schilddrüsenoperationen in einer HNO-Klinik.

Although the thyroid gland is located in the neck it is not a matter of fact that it is a clinical issue for the otorhinolaryngologist in Germany. Probably due to historic reasons general surgeons usually perform operations on the thyroid. As at our department this kind of treatment is an established procedure we prospectively evaluated our thyroid cases in order to present our results.The prospective study started in the year of 2014. So far 231 patients were enrolled with an average age of 53,5 years (16-89). The sex ratio showed a preponderance of the female patients with 187 and 64 males. In 155 cases we didn't insert a Redon-drainage. The mean operation time was 133 min. The preoperative concentration of calcium was 2.44 mg/ml with a postoperative decrease to 2.21 mg/ml. In cases of malignancies revealed in histology a second procedure with complete thyroidectomy and neck dissection took place immediately afterwards.Many symptoms of disorders of the thyroid become manifest in a genuine region of our speciality. Therefore we cannot detect any convincing reason why head and neck surgeons should not perform thyroidectomies. Skills like the specific clinical examination, the preoperative diagnostic work flow including sonography, the precise surgical management of soft tissue and neural structures and the postoperative care are typical features of our discipline. However, besides the surgeon's expertise a close collaboration with the colleagues of nuclear medicine and the general practitioner respectively the endocrinologist is mandatory in order to achieve a high quality of treatment.

Locomotor-Respiratory Coupling in Wheelchair Racing Athletes: A Pilot Study.

PURPOSE: In wheelchair racing, respiratory muscles of the rib cage are concomitantly involved in non-ventilatory functions during wheelchair propulsion. However, the relationship between locomotor-respiratory coupling (LRC: the ratio between push and breathing frequency), respiratory parameters and work efficiency is unknown. Therefore, the aim of the present study was to investigate the LRC in wheelchair racers over different race distances. METHODS: Eight trained and experienced wheelchair racers completed three time-trials over the distances of 400, 800, and 5000 m on a training roller in randomized order. During the time trials, ventilatory and gas exchange variables as well as push frequency were continuously registered to determine possible LRC strategies. RESULTS: Four different coupling ratios were identified, namely 1:1; 2:1, 3:1 as well as a 1:1/2:1 alternating type, respectively. The 2:1 coupling was the most dominant type. The 1:1/2:1 alternating coupling type was found predominantly during the 400 m time-trial. Longer race distances tended to result in an increased coupling ratio (e.g., from 1:1 toward 2:1), and an increase in coupling ratio toward a more efficient respiration was found over the 5000 m distance. A significant correlation (r = 0.80, p < 0.05) between respiratory frequency and the respiratory equivalent for oxygen was found for the 400 m and the 800 m time-trials. CONCLUSIONS: These findings suggest that a higher coupling ratio indicates enhanced breathing work efficiency with a concomitant deeper and slower respiration during wheelchair racing. Thus, the selection of an appropriate LRC strategy may help to optimize wheelchair racing performance.