Frequency of superscan on bone scintigraphy: A systematic review.

INTRODUCTION: Bone scintigraphy (BS) is an important tool for detecting bone metastasis. BS with diffuse increased skeletal radioisotope uptake with absent or faint urinary tract and soft tissue activity is defined as a superscan. In this review, we investigate the different etiologies causing superscan and the reported frequency of superscan among different disease entities. MATERIALS AND METHODS: The search terms were 'bone' AND 'superscan' OR 'superscan' in the PubMed database from 1980 to November 2020. Eligibility criteria included the following: Peer-reviewed studies containing original data using 99mTc-phosphate-analogue BS reporting a superscan pattern. Unretrievable papers, imaging modalities other than BS or with insufficient information to assess the aetiology were excluded. The abstracts of every paper and full texts of potentially eligible papers were assessed independently by three observers. RESULTS: Sixty-seven papers were included (48 case reports and 19 cohort studies). Studies conducted in patients with osteomalacia or skeletal fluorosis revealed superscan in all patients. Other benign causes of superscan were hyperparathyroidism and kidney disease. Among papers with malignant cause, prostate cancer was the most common cause, followed by gastric cancer. The frequency of superscans ranged from 1.3% in a cohort of mixed cancer types up to 2.6% in patients with gastric cancer and up to 23% in a cohort of prostate cancer patients. CONCLUSION: Superscan is most frequently seen in prostate cancer, but numerous other cancers and metabolic bone diseases can cause superscan, which should be kept in mind when encountering an unexpected superscan on BS.

No gender differences in patients with eosinophilic oesophagitis.

INTRODUCTION: Gender difference in the incidence of eosinophilic oesophagitis (EoE) is well-known as more men than women are affected. However, knowledge of gender differences is lacking for most other aspects of EoE. In this population-based adult EoE cohort, the aim was to study if gender differences exist with respect to 1) clinical phenotype, 2) treatment response and 3) complications. METHODS: This was a retrospective, registry-based DanEoE cohort study of 236 adult patients with EoE (178 adult men and 58 adult women) diagnosed in 2007-2017 in the North Denmark Region. Medical registries were searched for patient records and pathology reports. RESULTS: No statistically or clinically significant differences were recorded in the phenotype regarding symptoms reported, macroscopic or histological findings at diagnosis (all p > 0.3). A comparable number of men and women were followed up symptomatically and histologically (all p > 0.3). More men than women reported "no symptoms" on proton pump inhibitor (56% men versus 39% women, p = 0.04), although the histological response was similar between genders (p = 0.4). The proportions of food bolus obstructions and dilations were comparable (all p > 0.4). CONCLUSION: This study found very few gender differences. Results suggest that men and women with EoE may receive the same treatment. FUNDING: none. TRIAL REGISTRATION: not relevant.

Risk factors of cardiac device infection: Glove contamination during device procedures.

BACKGROUND: Infections in cardiac implantable electronic devices (CIEDs) constitute a serious complication. We sought to identify contamination of gloves before handling the device in primary and replacement CIED procedures. METHODS: Two groups of 30 patients underwent primary CIED implantation or replacement. Before the device entered the surgical field, surgeon and assistant imprinted their outer gloves on aerobe and anaerobe agar plates, and a wound swab was performed. Samples were cultured, and the presence of bacteria was identified, counted as the number of colony forming units, and characterized to the level of genus and species. RESULTS: Samples from 40 (67%) procedures revealed bacteria on surgeons' or assistants' gloves. Contamination occurred in 80% of replacements and 67% of primary implantations (risk difference, 13%; 95% confidence interval [CI], -8.8 to 35.5). Contamination of surgeons' and assistants' gloves occurred in 55% and 44% of procedures, respectively. Coagulase-negative Staphylococcus (CNS) occurred in 52%, and Propionibacterium spp (PS) occurred in 84% of positive cases. For every 15 minutes of procedure time, colony levels increased by 7.4% (95% CI, 1.4%-13.4%). CONCLUSIONS: Contamination of gloves is common during CIED procedures before handling the device. Therefore, devices are often handled with contaminated gloves. The most prevalent bacteria were PS and CNS, which are associated with clinical CIED infections. Changing outer gloves before handling the device might improve sterile state and lower infection risk.