Chun-Yi Lin

Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nation-wide population-based cohort study.

Background:To evaluate the possible association between paediatric head computed tomography (CT) examination and increased subsequent risk of malignancy and benign brain tumour.Methods:In the exposed cohort, 24 418 participants under 18 years of age, who underwent head CT examination between 1998 and 2006, were identified from the Taiwan National Health Insurance Research Database (NHIRD). Patients were followed up until a diagnosis of malignant disease or benign brain tumour, withdrawal from the National Health Insurance (NHI) system, or at the end of 2008.Results:The overall risk was not significantly different in the two cohorts (incidence rate=36.72 per 100 000 person-years in the exposed cohort, 28.48 per 100 000 person-years in the unexposed cohort, hazard ratio (HR)=1.29, 95% confidence interval (CI)=0.90–1.85). The risk of benign brain tumour was significantly higher in the exposed cohort than in the unexposed cohort (HR=2.97, 95% CI=1.49–5.93). The frequency of CT examination showed strong correlation with the subsequent overall risk of malignancy and benign brain tumour.Conclusions:We found that paediatric head CT examination was associated with an increased incidence of benign brain tumour. A large-scale study with longer follow-up is necessary to confirm this result.

Diminution of basal ganglia dopaminergic function may play an important role in the generation of akinetic mutism in a patient with anterior cerebral arterial infarct.

We report the clinical features and dopamine transporter [2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3.2.1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato(3-)-N2,N20,S2,S20]oxo-[1R-(exo-exo)]-[99mTc] technetium([99mTc]TRODAT-1) image finding in an 86-year-old woman with akinetic mutism due to infarction of bilateral anterior cerebral arterial territories. TRODAT-1 is a cocaine analogue that can be labeled with technetium-99m and bound to the dopamine transporter (DAT) site. It reflects primarily the integrity of presynaptic dopamine neuron terminals. With the evolution of the clinical features, the TRODAT SPECT images change from bilateral diminution of radioactivity uptake at the 81st-day check point to normal pattern at the 6-month one when the akinetic mute manifestations were nearly gone. This novel illustration suggests that the akinetic mutism caused by anterior cerebral arterial infarct is closely linked to the perturbation of the subcortical dopaminergic system. And the amelioration of the clinical features concordantly evolved with the restoration of the dopaminergic function.

Effect of intragastric balloon on gastric emptying time in humans for weight control.

Purpose This study evaluated the effect of fluid-filled intragastric balloon treatment on the scintigraphic gastric emptying times in humans for weight control. Patients and Methods Ten obese patients were prospectively recruited in our study. Three participants followed a solid food diet, and 7 participants followed a liquid meal diet to evaluate their scintigraphic gastric emptying times before and 3 months after fluid-filled intragastric balloon treatment. Results The participants included 3 males and 7 females. The mean age, body mass index, and body weight before intragastric balloon treatment were 36.8 ± 9.16 years, 35.91 ± 8.86 kg/m2, and 93.9 ± 24.09 kg, respectively. The mean body weight, body mass index, and body weight loss 3 months after the treatment were 80.2 ± 21.32 kg, 31.50 ± 8.90 kg/m2, and 13.7 ± 6.60 kg, respectively. The solid gastric emptying times before and 3 months after intragastric balloon treatment were 114 ± 18.52 minutes and 375.33 ± 207.04 minutes, respectively. The liquid gastric emptying times before and after intragastric balloon treatment were 38.71 ± 15.91 minutes and 318.71 ± 168.07 minutes, respectively. Statistically significant differences were observed in the solid and liquid gastric emptying times before and 3 months after intragastric balloon treatment using the Wilcoxon t test (P = 0.027, P = 0.001). Significantly positive correlations were observed between body weight loss and solid and liquid gastric emptying times after intragastric balloon placement using the Spearman correlation (&bgr; = 1.0, P < 0.001; &bgr; = 0.95, P = 0.001). Conclusions The solid and liquid scintigraphic gastric emptying half time is significantly longer after intragastric balloon treatment in humans. A significantly positive correlation between body weight loss and scintigraphic gastric emptying time was observed after intragastric balloon treatment. We can predict the effect of intragastric balloons on weight control through scintigraphic gastric emptying times after the treatment. The effect of intragastric balloons on weight loss may be reinforced by combining intragastric balloon treatment with medication that can reduce gastric motility.

Risk of Breast Cancer in Patients with Thyroid Cancer Receiving or Not Receiving 131I Treatment: A Nationwide Population-Based Cohort Study.

An increased risk of second primary malignancy after 131I therapy has been reported. The objective of this study was to determine the risk of breast cancer in patients with thyroid cancer receiving or not receiving radioiodine treatment in Taiwan. Methods: This nationwide population-based cohort study was conducted using data obtained from the Taiwan National Health Insurance Database from 2000 to 2011. A total of 10,361 female patients with thyroid cancer (3,292 did not receive 131I treatment and 7,069 received 131I treatment) were enrolled, and 41,444 female controls were frequency-matched to the thyroid cancer patients in a 1:4 ratio by age (5-y age group). A Cox proportional hazards model was applied to estimate the risk of breast cancer in thyroid cancer patients receiving or not receiving 131I treatment in terms of hazard ratios and 95% and 98% confidence intervals. Results: The incidence rates of breast cancer in patients with thyroid cancer receiving 131I therapy, those not receiving 131I therapy, and controls were 18.9, 17.7, and 13.1 per 10,000 person-years, respectively. Compared with patients with thyroid cancer treated with a cumulative 131I dose of 4.44 GBq or less, the risk of breast cancer was not significantly increased in those treated with a cumulative 131I dose of more than 4.44 GBq (adjusted hazard ratio, 0.78; 95% confidence interval, 0.50–1.21, P = 0.26; 98% confidence interval, 0.45–1.33, P > 0.02). Conclusion: The greatest increased risk of breast cancer in patients with thyroid cancer is associated with the fact that the patient has thyroid cancer regardless of 131I administration. However, 131I further increased that risk but not as much as just having thyroid cancer.

Evaluation of Schmorl's nodes using F-18 FDG PET/CT

AIM To evaluate the image findings of Schmorls nodes on combined 2-[(18)F]-fluoro-2-deoxy-d-glucose positron-emission tomography/computed tomography (FDG PET/CT). MATERIALS AND METHODS Twelve patients who were diagnosed with Schmorls nodes and had undergone magnetic resonance imaging (MRI) and FDG PET/CT were retrospectively recruited for this study. The period between the MRI and the FDG PET/CT examinations was within 1 week. The demographic data and clinical history were reviewed. The relationship between MRI findings and the values of maximum standardized uptake value (SUVmax) on FDG PET/CT was analysed. RESULTS The mean values of early and delayed SUVmax of Schmorls nodes without MRI enhancement were 1.14 ± 0.28 and 1.09 ± 0.32. The mean values of early and delayed SUVmax of Schmorls nodes with MRI enhancement were 1.73 ± 0.49 and 1.75 ± 0.54. There were significant differences in the early and delayed SUVmax between Schmorls nodes with and without perifocal enhancement on MRI with Wilcoxons rank-sum test (p = 0.012; p = 0.006). There was a trend of positive correlation, although not statistically significant, between delayed SUVmax on FDG PET/CT and age in Schmorls nodes with Spearmans rank correlation (B = 0.86, p = 0.056). CONCLUSIONS Schmorls nodes demonstrated low to moderate uptake on FDG PET/CT images. Schmorls nodes with perifocal enhancement on MRI result in higher FDG uptake. The possibility of false positives caused by Schmorls nodes should be considered when interpreting FDG PET/CT images of bone metastases, especially in the aging population.

Prevalence of genital human papillomavirus infections in patients at a sexually transmitted diseases clinic

The human papillomavirus was detected in cervicovaginal cells by the polymerase chain reaction in 14 of 37 (37.8 %) patients attending a sexually transmitted disease (STD) clinic and in 6 of 43 healthy young women (14.0 %) undergoing routine gynecologic examinations who served as controls. The results indicated that even the more malignant types of human papillomaviruses were not uncommon among the control group, and that the prevalence of human papillomavirus infection was significantly higher in STD clinic patients than in the control group. These findings confirm the suggestion that factors other than human papillomavirus infections may be involved in the pathogenesis of cervical cancer.

Ga-67 scintigraphy in primary cervical lymphoma.

Isolated lymphomatous involvement of the female genital organs is rare, accounting for approximately 1% of extranodal non-Hodgkin lymphoma. Ga-67 is the classic radionuclide for detecting malignant lymphoma. In the current report, the authors describe an unusual case of primary cervical lymphoma detected by Ga-67 scintigraphy.

Ga-67 Scintigraphy in Multicentric Castleman’s Disease

Castlemans disease is a term applied to a group of lymphoproliferative diseases of uncertain origin and histogenesis. Castlemans disease can occur at any age and in both sexes. Most of the lymph node enlargement is central (hilar-mediastinal}, although the disease may occur anywhere along the lymphatic chain. Based on histologic criteria, Castlemans disease is divided into two main types, the hyaline-vascular type and plasma cell type. Castlemans disease has also been divided into a solitary and multicentric form. In the current report, the authors describe an unusual case of multicentric Castlemans disease demonstrated with Ga-67 imaging, which has rarely been reported, especially in the hyaline-vascular type.

Association between radioiodine treatment for thyroid cancer and risk of stroke

The purpose of this study was to evaluate the association between radioiodine (I‐131) therapy for thyroid cancer and the risk of stroke in Taiwan.

Different scintigraphic patterns of testicular lesions on dual-phase tl-201 scan.

Tl-201 is becoming a recognized tumor imaging agent for adults. Tl-201 has rarely been used to image testicular lesions. The authors describe three patients with testicular masses in whom cancer was considered likely. Dual-phase Tl-201 scans revealed different scintigraphic patterns in these patients.