다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

Objective: The aim was to provide guidelines for evaluation, treatment, and genetic testing for multiple endocrine neoplasia type 1 (MEN1). Participants: The group, which comprised 10 experts, including physicians, surgeons, and geneticists from international centers, received no corporate funding or remuneration. Process: Guidelines were developed by reviews of peer-reviewed publications; a draft was prepared, reviewed, and rigorously revised at several stages; and agreed-upon revisions were incorporated. Conclusions: MEN1 is an autosomal dominant disorder that is due to mutations in the tumor suppressor gene MEN1, which encodes a 610-amino acid protein, menin. Thus, the finding of MEN1 in a patient has important implications for family members because first-degree relatives have a 50% risk of developing the disease and can often be identified by MEN1 mutational analysis. MEN1 is characterized by the occurrence of parathyroid, pancreatic islet, and anterior pituitary tumors. Some patients may also develo...

/pdf/clinical-practice-guidelines-for-multiple-endocrine-iebfm32j0y.pdf

Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1)

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/cen.12515

Guidelines for the management of thyroid cancer

Paraneoplastic neurologic syndromes are incited by a tumor outside the nervous system that produces a characteristic antigen of the nervous system. An immune response against the ectopic tumor antigen not only damages nerve tissue but also inhibits growth of the tumor.

Paraneoplastic Syndromes Involving the Nervous System

Molecular imaging is the visualization, characterization and measurement of biological processes at the molecular and cellular levels in humans and other living systems. Molecular imaging agents are probes used to visualize, characterize and measure biological processes in living systems. These two definitions were put forth by the Sociey of Nuclear Medicine (SNM) in 2007 as a way to capture the interdisciplinary nature of this relatively new field. The emergence of molecular imaging as a scientific discipline is a result of advances in chemistry, biology, physics and engineering, and the application of imaging probes and technologies has reshaped the philosophy of drug discovery in the pharmaceutical sciences by providing more cost effective ways to evaluate the efficacy of a drug candidate and allowing pharmaceutical companies to reduce the time it takes to introduce new therapeutics to the marketplace. Finally the impact of molecular imaging on clinical medicine has been extensive since it allows a physician to diagnose a patient’s illness, prescribe treatment and monitor the efficacy of that treatment non-invasively.

Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) were the first molecular imaging modalities used clinically. SPECT requires the use of a contrast agent labeled with a gamma emitting radionuclide, which should have an ideal gamma energy of 100-250 keV. These gamma rays are recorded by the detectors of a dedicated gamma camera or SPECT instrument and after signal processing can be converted into an image indentifying the localization of the radiotracer. PET requires the injected radiopharmaceutical to be labeled with a positron emitting radionuclide. As the radionuclide decays it ejects a positron from its nucleus which travels a short distance before being annihilated with an electron to release two 511 keV gamma rays 180° apart that are detected by the PET scanner (Figure 1). After sufficient acquisition time the data are reconstructed using computer based algorithms to yield images of the radiotracer’s location within the organism. When compared to SPECT, PET has greater advantages with respect to sensitivity and resolution and has been gaining in clinical popularity, with the number of PET-based studies expected to reach 3.2 million by 2010.1 While SPECT and PET technology has been around for decades, its use remained limited because of the limited availability of relevant isotopes which had to be produced in nuclear reactors or particle accelerators. However, the introduction of the small biomedical cyclotron, the self-contained radionuclide generator and the dedicated small animal or clinical SPECT and PET scanners to hospitals and research facilities has increased the demand for SPECT and PET isotopes.



Figure 1

Cartoon depicting the fundamental principle of Positron Emission Tomography (PET). As the targeting group interacts with the cell surface receptor, the positron emitting radio-metal decays by ejecting β+ particles from its nucleus. After traveling ...



Traditional PET isotopes such as 18F, 15O, 13N and 11C have been developed for incorporation into small molecules, but due to their often lengthy radio-syntheses, short half-lives and rapid clearance, only early time points were available for imaging, leaving the investigation of biological processes, which occur over the duration of hours or days, difficult to explore. With the continuing development of biological targeting agents such as proteins, peptides, antibodies and nanoparticles, which demonstrate a range of biological half-lives, a need arose to produce new radionuclides with half-lives complementary with their biological properties. As a result, the production and radiochemistry of radiometals such as Zr, Y, In, Ga and Cu have been investigated as radionuclide labels for biomolecules since they have the potential to combine their favorable decay characteristics with the biological characteristics of the targeting molecule to become a useful radiopharmaceutical (Tables ​(Tables11 and ​and22).2



Table 1

Gamma- and Beta-Emitting Radiometals





Table 2

Positron-Emitting Radiometals



The number of papers published describing the production or use of these radiometals continues to expand rapidly, and in recognition of this fact, the authors have attempted to present a comprehensive review of this literature as it relates to the production, ligand development and radiopharmaceutical applications of radiometals (excluding 99mTc) since 1999. While numerous reviews have appeared describing certain aspects of the production, coordination chemistry or application of these radiometals,2-18 very few exhaustive reviews have been published.10,12 Additionally, this review has been written to be used as an individual resource or as a companion resource to the review written by Anderson and Welch in 1999.12 Together, they provide a literature survey spanning 50 years of scientific discovery. To accomplish this goal, this review has been organized into three sections: the first section discusses the coordination chemistry of the metal ions Zr, Y, In, Ga and Cu and their chelators in the context of radiopharmaceutical development; the second section describes the methods used to produce Zr, Y, In, Ga and Cu radioisotopes; and the final section describes the application of these radiometals in diagnostic imaging and radiotherapy.

/pdf/coordinating-radiometals-of-copper-gallium-indium-yttrium-3clup681fj.pdf

Coordinating Radiometals of Copper, Gallium, Indium, Yttrium and Zirconium for PET and SPECT Imaging of Disease

In obsessive-compulsive disorder (OCD), the success of pharmacological treatment with serotonin re-uptake inhibitors and atypical antipsychotic drugs suggests that both the central serotonergic and dopaminergic systems are involved in the pathophysiology of the disorder. We applied [123I]-2beta-carbomethoxy-3beta-(4-idiophenyl)tropane (beta-CIT) and a brain-dedicated high-resolution single photon emission computed tomography (SPECT) system to quantify dopamine transporter (DAT) and serotonin transporter (SERT) availability. By comparing 15 drug-naive patients with OCD and 10 controls, we found a significantly reduced availability (corrected for age) of striatal DAT and of thalamic/hypothalamic, midbrain and brainstem SERT in OCD patients. Severity of OCD symptoms showed a significant negative correlation with thalamic/hypothalamic SERT availability, corrected for age and duration of symptoms. Our data provide evidence for imbalanced monoaminergic neurotransmitter modulation in OCD. Further studies with more selective DAT and SERT radiotracers are needed.

Serotonin and dopamine transporter imaging in patients with obsessive-compulsive disorder.

Background: Since patients with thyroid cancer have a very good prognosis overall, clinicians may often assume that their quality of life is comparable to the general population. We hypothesized that quality of life of thyroid cancer patients is lower compared with the general population while controlling the effect of age and gender. Methods: At the beginning of their stay at an inpatient rehabilitation clinic, a cohort of n=121 patients with thyroid cancer were assessed using the quality of life core questionnaire of the European Organisation for Research and Treatment of Cancer (QLQ-C30). Data for comparison were derived from a representative German community sample with n=2037. Results: The patients reported significantly more problems than the community sample participants independent of gender and age effects in all but two domains, namely constipation and diarrhea. The strongest effects of the group (patients vs. general population) were found in the following domains: insomnia (B=−43.7, p<0.001), ...

Quality of life in patients with thyroid cancer compared with the general population.

Objectives To review and expand the existing literature of magnetic resonance imaging (MRI) and positron emission tomography (PET) of paraneoplastic limbic encephalitis (PLE). Methods We performed serial MRI and18F-fluoro-2-deoxy-D-glucose (FDG)–PET in a patient with anti-Ma2–positive PLE. In addition, we reviewed the relevant literature by conducting a search in the MEDLINEdatabase. Results We found a total of 7 published patient studies of possible or probable PLE containing both MRI and PET data. In 1 of these reports, the diagnosis of PLE can be regarded as proven. The results of the previous studies are controversial. Epileptic activity and inflammation are assumed to be underlying mechanisms of increased FDG uptake. In our study, we found a focal tracer accumulation in the left medial temporal lobe, which increased during the first 9 months of follow-up and corresponded with an increase of serum anti-Ma2 antibody titers. The MRI findings showed a hyperintense signal change in the left medial temporal lobe without contrast enhancement, which remained unchanged over time. Conclusions The results of functional and structural imaging in PLE may differ substantially. Results of FDG-PET can demonstrate focal hypermetabolism over a long time, which may indicate therapeutic potential. A prospective study with more patients will be needed to clarify the relevance of PET as a possible outcome measure in PLE. Future studies should include scalp or semi-invasive electroencephalographic recordings during PET acquisition.

https://jamanetwork.com/journals/jamaneurology/articlepdf/787039/nob30135.pdf

Serial 18F-fluoro-2-deoxy-D-glucose Positron Emission Tomography and Magnetic Resonance Imaging of Paraneoplastic Limbic Encephalitis

Tomography and Magnetic Resonance Imaging of Paraneoplastic Limbic Encephalitis

Papillary and follicular thyroid carcinoma account for 80–84% and 6–10% of all thyroid carcinomas, respectively. Both of these tumor types arise from the thyroid follicular epithelial cells; together, they are designated as well-differentiated thyroid carcinoma. They differ histologically from the rarer poorly differentiated and undifferentiated anaplastic carcinomas, which together account for 5–7% of thyroid carcinomas, as well as from medullary carcinoma of the thyroid, which arises from the parafollicular C cells and accounts for 3–5% (1).

Well-differentiated thyroid carcinoma is the most common endocrine neoplasia, accounting for 1.2% of cancer incidence in Germany (1.9% in women, 0.7% in men) (2). The incidence of papillary thyroid carcinoma in the USA rose by a factor of three from 1973 to 2009, with similarly marked rises around the world; in Germany, the incidence of thyroid carcinoma was about 50% higher in 2010 than in 1998 (age-adjusted incidence in 2010: 3.5 per 100 000 men and 8,7 per 100 000 women per year). Small papillary thyroid carcinomas, in particular, have become much more common (2, 3). Most of the increased incidence is traceable to more frequent diagnostic evaluation, with improved technology (2– 4). In contrast, the standardized mortality of patients with thyroid carcinoma has remained constant over the years; in Germany, in 2009 and 2010, the figure was 0.5 deaths per 100 000 patients per year (2). The good prognosis of well-differentiated thyroid carcinoma is also reflected in high 5-year survival rates: 93% for women, 88% for men. Survival is poorer for patients who are over age 45 when diagnosed and those who present with distant metastases (2, 4, 5).

Well-differentiated thyroid carcinoma often remains clinically silent for many years, and half of all cases come to medical attention as incidental findings on physical examination or ultrasonography, or as a previously unsuspected histological finding after surgery for benign thyroid disease (4). In the systematic investigation of thyroid nodules, risk stratification is performed on the basis of the physical, ultrasonographic, and scintigraphic findings, and the diagnosis is generally established by fine-needle biopsy and cytology (6). In rarer cases, thyroid tumors present with symptoms and signs such as:


persistent hoarseness due to involvement of the recurrent laryngeal nerve,


dysphagia,


a growing nodule that is noticed by the patient,


symptomatic cervical lymph-node metastases.



Thyroid carcinoma is generally initially classified with the “tumor-nodes-metastasis” (TNM) scheme on the basis of tumor size, infiltration of neighboring structures, lymph-node metastases, and distant metastases (Union internationale contre le cancer [UICC]/American Joint Committee on Cancer [AJCC], 7th edition, 2009).

Prognostically relevant clinical staging takes account not only of the TNM classification, but also of the age of the patient and the histological type of the carcinoma. Most patients under age 45 have a very good prognosis and are classified as having UICC stage I disease, or stage II if they have distant metastases. The prognostically unfavorable stages III and IVA–IVC are reserved for patients aged 45 and older with primary tumors that are larger than 4 cm in size. Patients with undifferentiated (anaplastic) thyroid tumors of any size are generally classified as having stage IV disease, which carries a very unfavorable prognosis. In the clinical guidelines, the TNM stages are broken down into three risk groups (Table 1). Further prognostically relevant factors that are not incorporated in the TNM system have been identified recently, including positive BRAF mutation status (B-Raf proto-oncogene, where Raf stands for “rapidly accelerated fibrosarcoma”), which is an unfavorable molecular tumor marker in papillary thyroid carcinoma, and the depth of tissue invasion and extent of vascular invasion in follicular thyroid carcinoma (7, 8).



Table 1

Well-differentiated thyroid carcinoma of low, middle, and intermediate risk, as classified by the ATA and BTA (American Thyroid Association, British Thyroid Association). The ATA and BTA categories are identical, except where additional BTA criteria are ...

/pdf/the-treatment-of-well-differentiated-thyroid-carcinoma-o95za48aho.pdf

Thomas Lincke

Papers

Serotonin and dopamine transporter imaging in patients with obsessive-compulsive disorder.

Quality of life in patients with thyroid cancer compared with the general population.

Serial 18F-fluoro-2-deoxy-D-glucose Positron Emission Tomography and Magnetic Resonance Imaging of Paraneoplastic Limbic Encephalitis

Tomography and Magnetic Resonance Imaging of Paraneoplastic Limbic Encephalitis

The Treatment of Well-Differentiated Thyroid Carcinoma