Classification of Physiological 18F-fluorodeoxyglucose Uptake in the Large Intestine: a Preliminary Study.

Varying degrees of physiological uptake of 18F-fluorodeoxyglucose (FDG) are often noted in the large intestine and can be problematic when interpreting positron emission tomography (PET) images. In relation to colorectal tumor detection with FDG PET, we tentatively classified physiological FDG uptake in the large intestine according to its patterns and intensity. Subjects were 144 asymptomatic individuals (109 men, 35 women; mean age 57.5 ± 10.1 years) in our cancer screening program who underwent total colonoscopy within 24 days of FDG PET study and showed no evidence of colonic lesions on colonoscopy. Distinct FDG uptake on FDG PET images was classified into four types: focal, defined as distinctly nodular and visible on at least 4 axial; localized, 2 to 8 cm with SUVmean ≥ 4; diffuse, > 8 cm with SUVmean ≥ 4; and mixed, of more than one type. SUVmeans were examined by placing multiple circular regions of interest of 1 cm in diameter on the axial images. We found 21 distinct FDG uptakes matching our criteria in 20 of 144 subjects (13.9%): focal (n = 4), localized (n = 1), diffuse (n = 14), and mixed (n = 1; focal and diffuse). With regard to colorectal tumor detection, 6 subjects (4.2%) with focal or localized type of uptake were considered at risk of false-positive tumor identification, and 15 subjects (10.4%) with diffuse type of uptake were considered at risk of their tumors being missed at the site of FDG uptake. To confirm the feasibility of our criteria, this classification should be tested with a larger number of subjects.

The effect of glucagon on FDG uptake in skeletal muscle.

Glucagon is used as an anti-motility agent during gastrointestinal tract examinations. We experienced subjects with enhanced 18F-fluorodeoxyglucose (FDG) uptake in whole-body skeletal muscle when conducting positron emission tomography (PET). The subjects had been administered glucagon during gastroscopy just prior to PET. This observation prompted us to perform the present retrospective study to determine whether or not glucagon enhances FDG uptake in skeletal muscle. We randomly selected 30 cases, including subjects who had undergone PET and gastroscopy on the same day as cancer screening procedures, and classified them into three groups. In the NO group (n = 10), no medications were used prior to PET. In the SC group (n = 10), scopolamine butylbromide (10 mg) was intravenously administered during endoscopy. In the GL group (n = 10), glucagon (0.5 mg) was intravenously administered during endoscopy. Both drugs were administered 45-60 min prior to FDG administration. The mean standardized uptake value (SUV) for gluteal muscle was 0.7 ± 0.14, 0.69 ± 0.15, and 0.99 ± 0.7 in the NO, SC, and GL groups, respectively. The SUV in the GL group was highest, but the difference was not statistically significant. In the subject with the highest SUV (3.04; GL group), the quality of the oncologic PET image was impaired, perhaps because of a relative decrease of FDG distribution in the chest and abdomen. Because previous literature showed that via hyperglycemia and hyperinsulinemia glucagon has the effect of increasing FDG uptake in skeletal muscle, the use of glucagon should be avoided just prior to FDG PET, although in our subjects, no statistical proof that glucagon enhances FDG uptake in skeletal muscle was obtained.

Solutions for retention of female cardiologists: from the survey of gender differences in the work and life of cardiologists.

BACKGROUND: To prevent a future shortage of cardiologists, it is important for female cardiologists to continue working. Gender differences in the professional and private lives of cardiologists, as well as the barriers to work for female cardiologists, were surveyed. METHODS AND RESULTS: In August 2007, a questionnaire was mailed to all 195 faculty members/fellows and 155 alumni of the Department of Cardiovascular Medicine at Nippon Medical School. More female cardiologists were dissatisfied with their job than male cardiologists (34% vs 17%, P<0.005). Women reported greater career limitation by family responsibilities and housework. Men and women both reported that long working hours was the most problematic issue, but significantly more women reported this than men (76% vs 94%, P<0.05). Female cardiologists were more concerned about occupational radiation exposure (88% vs 59%, P<0.01) and wanted opportunities for retraining after childcare leave (100% vs 76%, P<0.01). CONCLUSIONS: The following measures should be taken: (1)establishment of more family-friendly working conditions in hospitals, (2)provision of various work positions that allow more flexibility and predictability for women, (3)establishment of a retraining system, and (4)development of work and research opportunities that are attractive to women. The Japanese Circulation Society is expected to establish a retraining system at certified institutions.

Internal medicine education in dentistry: knowledge required varies according to dental specialty.

BACKGROUND: With recent increases in the number of elderly and medically compromised patients, dentists are required to have a more comprehensive understanding of medical problems. There is, however, little awareness of the importance of internal medicine at dental schools in Japan. OBJECTIVE: The aims of the present study were to examine whether dentists need medical knowledge, to examine how often they experience difficulties regarding internal medicine in dental practice, and to determine whether their specialty or career influences their needs or difficulties. DESIGN: A questionnaire based on the above objectives was designed and was sent to all the faculty members in the department of dentistry at Tsurumi University and all dentists who work at the university hospital. RESULTS: Of 408 surveys, 307 (75%) responded. Ninety-nine per cent of respondents recognized the necessity of internal medicine. The dentists specializing in gerodontology, dental anesthesiology or oral and maxillofacial surgery (group S) felt the need of knowledge of internal medicine more frequently than those of other specialties (group O) (Odds ratio 17.5, 95% CI: 2.4 approximately 129.9; P = 0.000). Seventy-four per cent of the dentists experienced difficulties in day-to-day practice caused by a lack of medical knowledge. Those in group S, experienced difficulties more frequently than those in group O (Odds ratio 5.3, 95% CI: 2.1 approximately 12.9; P = 0.000). While the more experienced dentists in group S encountered difficulties more often, the more experienced dentists in group O encountered difficulties less often. CONCLUSIONS: The need for instruction in internal medicine varies according to dental specialty. Even very experienced dentists might fail to find solutions because of a lack of knowledge of internal medicine.

Hyponatremic-hypertensive syndrome associated with renovascular hypertension: a case report.

Renovascular hypertension occasionally manifests clinically as electrolyte disorders and albuminuria in addition to elevated blood pressure. A 49-year-old man who had renovascular hypertension also had severe hypokalemia, hyponatremia, polyuria and polydipsia that were treated by an angiotensin-converting enzyme inhibitor and resection of an atrophic kidney with a compromised blood supply. This is a case of hyponatremic-hypertensive syndrome related to renovascular hypertension and occurring as an additional abnormality.

Use of cytosolic and myofibril markers in the detection of ongoing myocardial damage in patients with chronic heart failure.

PURPOSE: Measurement of serum levels of cytosolic and myofibril components of cardiac tissue could indicate ongoing myocardial damage in patients with chronic heart failure. METHODS: We correlated serum levels of a cytosolic marker (heart-type fatty acid-binding protein) and a myofibril marker (troponin T) with the severity of symptoms (based on the New York Heart Association [NYHA] class), neurohumoral derangement, and subsequent cardiac events in 56 patients with chronic heart failure. RESULTS: Mean (+/- SD) levels of heart-type fatty acid-binding protein were greater in patients with NYHA class III or IV heart failure (9.9 +/- 5.2 ng/mL) than in those with NYHA class II (4.9 +/- 1.9 ng/mL, P <0.0001). Detection of troponin T (> or =0.02 ng/mL) was also more common in patients with worse heart failure (81% [13/16] in class III or IV vs. 43% [17/40] in class II, P = 0.02). Significant correlations were found between heart-type fatty acid-binding protein levels and plasma levels of A-type natriuretic peptide (r = 0.45, P = 0.0004), B-type natriuretic peptide (r = 0.66, P <0.0001), and norepinephrine (r = 0.36, P = 0.006). Male sex (hazard ratio [HR] = 5.0; 95% confidence interval [CI]: 1.3 to 19), detectable troponin T levels (HR = 7.0; 95% CI: 1.1 to 44), heart-type fatty acid-binding protein (HR = 2.6 per 3.9-ng/mL increase; 95% CI: 1.1 to 6.5), and left ventricular ejection fraction (HR = 3.6 per 15% decrease; 95% CI: 1.2 to 11) were independently associated with subsequent cardiac events (8 deaths or 10 readmissions because of worsening heart failure). CONCLUSION: Heart-type fatty acid-binding protein and troponin T are markers of ongoing myocardial damage, and are associated with subsequent cardiac events in patients with chronic heart failure.