Our data support formulary guidelines recommending maintenance metronidazole for recurrent malodour. Dimethyl trisulfide, a product of anaerobic necrosis causes malodour and can attract maggot-producing flies to decaying tissues. Therefore, to reduce anaerobic malodour in vulnerable settings, we propose a ladder for metronidazole titration. High-risk patients should start with 400 mg thrice daily ×7 days and continue 200 mg once daily. The SNIFFF severity (Smell-Nil, Faint, Foul or Forbidding) can guide follow-up dosage: 200 mg once daily to continue for nil or faint smell; breakthrough courses of 400 mg thrice daily ×1 week for foul smell and 2 weeks for forbidding smell, followed by 200 mg once daily.The effectiveness and limitations of maintenance metronidazole and the SNIFFF ladder should be prospectively evaluated.
Aim:
Utility of Ga68 DOTATATE PETCT imaging to localise cause for oncogenic osteomalacia (OOM).
Materials and Methods:
Retrospective analysis between March 2015 to March 2018 of all patients with a clinical diagnosis (based on a combination of clinical history, hypophosphatemia and elevated FGF-23 values) of OOM who underwent Ga-68 DOTATATE PET/CT.
Results:
Total of 27 patients had undergone Ga-68 DOTATATE PET/CT imaging in our centre from March 2015 to March 2018. Of these 16 patients with clinically suspected oncogenic osteomalacia were included in our study. Age range 18-61 years of which 12 were males. Total of 13 (81.25%) patients were found to be positive on imaging for a possible mesenchymal tumour. Most common site of tumour was the lower limb (76%). Most common presenting symptom was bone pain (81%) followed by muscle weakness (19%). Overall, 10 patients underwent surgery, all of whose biopsy was reported as phosphaturic mesenchymal tumour. During the three month follow up, serum phosphorous measured in 15/16, post-surgical/ medical treatment had normalised in all except two patients who had undergone only medical therapy with neutral phosphate. Fall in FGF-23 was more pronounced in surgically treated patients as compared to those who received medical treatment.
Conclusion:
Ga68-DOTATE PET/CT is a useful investigatory modality for localizing cause for oncogenic osteomalacia.
An audit of audits at a children's hospital over a six year period showed that 27.8% fulfilled the criteria for a full audit and 22.2% were re-audited. It is recommended that newcomers to audit are given training on audit methodology and that all audit departments should audit their audits annually.
Background
Head and neck squamous cell carcinoma (HNSCC) accounts for 90% of head and neck cancers. There has been no established qualitative system of interpretation for therapy response assessment using PET‐CT for HNSCC.
Aim
To assess response evaluation of nodal status in post‐treatment PET‐CT scans in HNSCC using a 5‐point Likert scale (Deauville score [DS]).
Methods and Results
Retro‐prospective analysis was performed of the nodal status of pre and post‐RT PET‐CT in patients diagnosed with HNSCC (n = 43) from May 2013 to March 2018. All eligible patients underwent a pre‐RT PET‐CT scan before the start of RT. Another post‐RT PET‐CT scan was performed 12 weeks after the completion of RT. The median time from completion of radiotherapy (RT) to post‐RT PET‐CT was 92 days; 80% of the patients had their post‐RT PET‐CT scan between 77 and 147 days after therapy. Of 43 patients (M/33, F/10, age range 18 to 80 years (median 54 years) selected for the study, good concordance was noted between DS and clinical response in these patients. The change in SUV from pre‐RT PET to post‐RT PET was analyzed using a paired t‐test. The P‐value was found to be statistically significant while comparing pre and post‐RT SUVmax levels showing that RT had significantly reduced the SUVmax levels of the nodes in DS 2‐3 groups whereas the number of patients was too small to allow a reliable calculation in DS 4‐5 groups. It was found that 36/39 patients with DS 1‐3 had no nodal recurrence showing a high NPV of 92.3%. Of the four patients with DS 4‐5, all had active disease showing PPV of 100%. Applying Fisher's exact test, the P‐value was found to be .004.
Conclusion
DS seems to satisfy the requirements for a simple qualitative method of interpreting PET scans and for identifying patients requiring neck dissection. Consensus regarding qualitative assessment would facilitate standardization of PET reporting in clinical practice and enable comparative multicentric studies
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