68 Ga-Oxine-Labeled Erythrocytes as a New PET Tracer for the Localization of Gastrointestinal Bleeding

ABSTRACT

A 69-year-old man presented with recurring drops in hemoglobin levels and suspected gastrointestinal bleeding. Endoscopy did not show a site of bleeding so further examinations became necessary. Scintigraphy and SPECT/CT with 99m TcO 4- -labeled red blood cells were performed without evidence of a hemorrhage. Based on an established protocol for splenic PET/CT, autologous erythrocytes can be labeled with 68 Ga-oxine and used as a tracer for the localization of active bleeding sites. In the patient, PET/CT with 68 Ga-oxine-labeled undamaged erythrocytes was performed successfully and revealed a hemorrhage of the gastric corpus that was confirmed and treated by endoscopy.

Image-Guided Fine-Needle Aspiration Cytology for BRCA Mutation Assessment of PSMA-Positive Lymph Node Metastases in a Patient With Metastatic Castration-Resistant Prostate Cancer

ABSTRACT

A 64-year-old man with metastatic castration-resistant prostate cancer presented for prostate-specific membrane antigen (PSMA) PET/CT in preparation for 177 Lu-PSMA radioligand therapy. For precedent BRCA mutation assessment, fine-needle aspiration cytology of 2 PSMA-positive lymph node metastases was conducted. The acquired material was suitable for next-generation sequencing-based gene panel diagnostics and did not show a BRCA1 / 2 mutation, thus PSMA radioligand therapy was initiated. Fine-needle aspiration cytology of lymph node metastases may be a viable option in evaluating further therapeutic alternatives.

Excellent Response to Multimodal Therapy Approach in Hyperfunctioning Metastatic Follicular Thyroid Carcinoma Diagnosed on 123 I-SPECT/Ultrasound Fusion Imaging

ABSTRACT

An 83-year-old woman presented with new-onset hyperthyroidism and suspicious thyroid nodules on ultrasound (US). Conventional 99m TcO 4 thyroid scintigraphy showed hyperfunctioning areas that could not be clearly assigned to the US findings. With the aid of 123 I-SPECT/US fusion imaging, suspicious nodules were unambiguously identified as autonomously hyperfunctioning lesions. Additional 123 I whole-body scan revealed iodine-avid lymphonodular and pulmonal metastases. Clinical diagnosis of hormone-active thyroid carcinoma was made and histologically confirmed. Because of significant hyperthyroidism as well as multiple partially iodine-negative metastases, a multimodal treatment regime consisting of 131 I radioiodine therapy, surgery, and radiation therapy was conducted, leading to almost complete remission.

De Quervain Subacute Thyroiditis With Moderate PSMA Uptake Mimicking Thyroid Metastasis of Renal Cell Carcinoma

ABSTRACT

PSMA-targeted PET/CT can be used for diagnosis and staging of clear cell renal cell carcinoma. A 68-year-old woman with suspected hepatic metastases from clear cell renal cell carcinoma underwent PET/CT with 68Ga-PSMA, which showed a focus of moderately increased tracer uptake in the right thyroid lobe. Sonography displayed a correlating hypoechogenic, ill-defined node (TIRADS 5). Right hemithyroidectomy was performed in the assumption of a solitary metastasis of renal cell carcinoma. Histologic examination revealed subacute granulomatous thyroiditis (De Quervain thyroiditis) without evidence of malignancy.

[A survey of the psychosocial situation of homeless men in Frankfurt am Main]

In a current field-study a sample of 71 homeless men (mean age 35.4 years) was investigated with a semi-standardized interview. Sociodemographically, a low education level, a high unemployment rate and low income were noted. The income was gained mainly through regular social welfare support. Mostly unmarried and without children, the participants seldom lived in a stable partnership during their life. Psychosocial conflicts (59.2%) were one of the most important causes for homelessness at an average age of 28.1 years. Interpersonal conflicts, release from jail and loss of job were the most frequently reported causes of current homelessness. 42.3% had been treated in psychiatric hospitals in the past, the majority because of alcoholism. In summary the current findings indicate that homeless men experience social isolation early during their maturation and that the frequency of psychiatric disorders is high.

Determinants of sustainable CD4 lymphocyte count increases in response to antiretroviral therapy

OBJECTIVE

HIV-induced CD4 lymphocyte depletion is partially reversed by antiretroviral therapy but it is unclear if the degree to which the CD4 count rises depends on viral suppression (if so, the extent of viral suppression required to achieve a maximal CD4 count rise), whether the rise is sustainable and whether it occurs in patients with CD4 count <10 x 10(6) cells/l. We aimed to address these issues.

METHODS

We studied CD4 count and plasma HIV RNA values every 4 weeks for 72 weeks in 154 patients starting indinavir-containing regimens.

RESULTS

Mean baseline HIV RNA and CD4 count were 4.8 log10 copies/ml and 180 x 10(6) cells/l, respectively. Overall, there was a mean increase in CD4 count of 143 x 10(6) cells/l by 72 weeks. The adjusted mean increase (adjusted for initial viral load, CD4 count and age) was strongly related to the mean viral suppression over the follow-up period (P < 0.0001). Importantly, there was a highly significant difference (P = 0.0004) in the rise in CD4 count between those with 2-3 log suppression (161 x 10(6) cells/l) and those with > 3 log suppression (314 x 10(6) cells/l; mean 3.6 log suppression in this group), suggesting that with even greater suppression the rise in CD4 lymphocytes may be still larger. We also studied whether CD4 counts were still rising after 72 weeks in patients with sustained suppression of at least 3 log in viral load. There was a significant (P = 0.004; paired t-test) rise in count of 43 x 10(6) cells/l between weeks 64 and 72 in these patients, suggesting that regeneration continues at least up to 72 weeks after therapy, provided virus replication continues to be suppressed. Patients with initial CD4 counts < 10 x 10(6) cells/l experienced no smaller rises than those at higher levels, even after adjustment for other factors.

CONCLUSION

These results strongly support a direct causal relationship between HIV replication and CD4 lymphocyte count depletion. The rise in those with > 3 log suppression provides the best available indicator of the potential for natural CD4 regeneration in HIV-infected patients. However, since still greater CD4 count rises may be seen with more suppressive regimens, it may not be possible to study the intrinsic CD4 regenerative capacity until such regimens are available.