Background-Disturbances of autonomic function after infarction are associated with both total mortality and sudden death. Although many imaging techniques for assessing the cardiac autonomic nervous system have been studied, the clinical usefulness of these techniques remains uncertain. This exploratory pilot study examined the relationship between abnormalities of ventricular sympathetic innervation delineated by scintigraphic imaging with Clinical Perspective see p 140123 I-mIBG is a norepinephrine analogue, and myocardial uptake reflects the extent of sympathetic innervation. Reduced myocardial uptake of 123 I-mIBG is observed in asso- ciation with most diseases that result in left ventricular (LV) dysfunction and potentially lethal ventricular arrhythmias. [5][6][7][8][9][10][11][12][13][14][15] In small observational studies, dysfunction of the myocardial autonomic nervous system as evaluated by using 123 I-mIBG has been shown to be associated with the occurrence of arrhythmias. 16 -18 However, the explanation for this association is not yet clear. One potential link between abnormalities of sympathetic innervation and the occurrence of potentially lethal ventricular arrhythmias is the fact that denervated myocardium may be viable and hyperresponsive to circulating catecholamines. 3 It is also possible that denervated but viable myocardium on the border zone of infarctions is prone to the development of reentrant ventricular tachycardia circuits. Both single photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging have been used to demonstrate the presence of denervated but still viable myocardium (as can be observed after myocardial infarction) that could contribute to the development of ventricular arrhythmias. 18 -26 The present exploratory pilot study was designed to examine whether alterations in cardiac sympathetic innervation as measured by 123 I-mIBG scintigraphy were related to the inducibility of ventricular arrhythmias during EP testing in patients with previous infarction. The primary objective was to evaluate results by using planar 123 I-mIBG imaging and the combination of SPECT 123 I-mIBG innervation and 99m Tctetrofosmin perfusion imaging (providing information on extent of denervated myocardium and infarct size, respectively). Methods Patient SelectionThis was a phase 2, open-label, multicenter exploratory study conducted at 13 centers in Europe and one center in the United States, investigating the association between findings on planar and SPECT 123 I-mIBG imaging and the results of cardiac EP testing. The protocol was approved by the ethical committees or institutional review boards at each participating institution. All patients provided written informed consent before the performance of any study procedures.Primary inclusion criteria at the inception of the study included a history of myocardial infarction, LV dysfunction (left ventricular ejection fraction [LVEF]Յ40%, measured within 30 days of study entry), and referral for a clinically indicat...

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BACKGROUND: Aim ot the study was to assess the role of planar lymphoscintigraphy and fusion imaging of SPECT/CT in sentinel lymph node (SLN) detection in patients with various types of tumours and to estimate some factors influencing detection success -age and body mass index. MATERIAL AND METHODS:Planar scintigraphy and hybrid modality SPECT/CT were performed in 550 consecutive patients

Objective To test the hypothesis that, in the initial evaluation of patients with suspected coronary artery disease (CAD), stress myocardial perfusion imaging (MPI) would result in less downstream testing than coronary computed tomographic angiography (CCTA).MethodsIn this international, randomized trial, mildly symptomatic patients with an intermediate likelihood of having CAD, and asymptomatic patients at intermediate risk of cardiac events, underwent either initial stress-rest MPI or CCTA. The primary outcome was downstream noninvasive or invasive testing at 6 months. Secondary outcomes included cumulative effective radiation dose (ERD) and costs at 12 months.ResultsWe recruited 303 patients (151 MPI and 152 CTA) from 6 centers in 6 countries. The initial MPI was abnormal in 29% (41/143) and CCTA in 56% (79/141) of patients. Fewer patients undergoing initial stress-rest MPI had further downstream testing at 6 months (adjusted OR 0.51, 95% CI 0.28-0.91, P = 0.023). There was a small increase in the median cumulative ERD with MPI (9.6 vs. 8.8 mSv, P = 0.04), but no difference in costs between the two strategies at 12 months.Conclusion In the management of patients with suspected CAD, a strategy of initial stress MPI is substantially less likely to require further downstream testing than initial testing with CCTA. Trial registration: clinicaltrials.gov identification number NCT01368770.Electronic supplementary materialThe online version of this article (doi:10.1007/s12350-016-0664-3) contains supplementary material, which is available to authorized users.

PurposeThe aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy.MethodsThis study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604). With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with 99mTc-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection. Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated.ResultsIn all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5±10.0 minutes (mean ± standard deviation) in the Roux-en-Y group and 89.4±37.8 minutes in the “J-pouch” group; the difference was statistically significant (P<0.001). Emptying of the J-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106±18.8 points (mean ± standard deviation) in the Roux-en-Y group compared to 122±22.5 points in the J-pouch group; the difference was statistically significant (P=0.0016). There were no important adverse events.ConclusionAfter total gastrectomy, a J-pouch reconstruction empties more slowly and is associated with higher quality of life compared to Roux-en-Y reconstruction. Whether these two observations have a direct causative link remains unanswered.

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Aims: To evaluate the incidence of parametrial involvement in women with early-stage cervical cancer with tumour <20 mm and with negative sentinel lymph nodes (SLN). Methods: We reviewed the cases of all women who underwent radical hysterectomy and pelvic lymphadenectomy with SLN biopsy for invasive cervical cancer between April 2004 and December 2009. Parametrial involvement was defined as direct extension, nodal disease or spread through vascular channels. Results: From the 204 women who underwent radical surgery with SLN biopsy, 63 (FIGO stage IA2-10, IB1-53) met the inclusion criteria: tumour <20 mm in the largest diameter regardless of the depth of stromal invasion (less or more than half stromal invasion) and negative sentinel lymph nodes. Median age was 44.3 years (range 24-72). Lymph-vascular space invasion was present in 25 women. The histology identified squamous carcinoma in 50 women, adenocarcinoma in 11 women and adenosquamous carcinoma in two women. Tumour grade 1 occurred in 41, grade 2 in 16 and grade 3 in 6 of the cases. No parametrial involvement was observed. The false negative rate of SLN biopsy was 0%. Conclusion: No parametrial involvement was observed in women with early-stage cervical cancer with tumour <20 mm in diameter and negative sentinel lymph nodes regardless of the presence of lymph-vascular space invasion, histology subtype and grade of the tumour. Radical removal of the parametrium in this low-risk group is questionable.

The aim of this study was to compare the treatment results between radiosynoviorthesis and reradiosynoviorthesis of knees. Before the radiosynoviorthesis, an ultrasonography, X-ray, and three-phase bone scintigraphy were done. The treatment effect can be expected if a synovitis is proved by these examinations. To knees, 200 MBq of the yttrium citrate was injected for the first radiosynoviorthesis or for reradiosynoviorthesis. After an application, it is possible to do the scintigraphic examination, when information about a tracer distribution in joints is obtained. The treatment effect was evaluated by the clinical examination, the ultrasonography, and the three-phase bone scintigraphy with some lapse of time. If the effect of the radiosynoviorthesis was not satisfying, it could be repeated no sooner than 6 months later. Among our patients we had a high percentage of the repeated radiosynoviorthesis. The authors applicated the yttrium citrate to 1243 knees. A rate between single radiosynoviorthesis and reradiosynoviorthesis was 11:8. Repeated radiosynoviorthesis were as effective as the initial ones, and their repeated use does not decrease the expected therapeutic effect.