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OBJECTIVE: To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia. ME-THODS: In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses Ⅰ-Ⅱ,aged 19-66 years,scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS),respectively. Invasive blood pressure (BP),heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction,immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure pro-duct (RPP) was calculated. RESULTS: After anesthetic induction,BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values,and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000. CONCLUSION: During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.

Cancer screening is a major healthcare issue. Screening modalities are constantly changing due to improvements in technology. Whole body positron emission tomography (PET) with 18F-fluoro-2 deoxy-D-glucose (FDG) and the additional help of the serum levels of tumor markers have been considered as non-invasive methods for cancer screening in asymptomatic subjects. A total of 1283 subjects underwent whole-body FDG PET studies with the additional help of the serum levels of tumor markers in our center for cancer screening. The final diagnoses were confirmed by other imaging modalities or pathological findings in subjects with positive FDG-PET findings, and follow-up for at least 6 months were held in subjects with negative FDG-PET findings. Among a total of 18 (1.4%) subjects with cancers, FDG-PET detected cancers in 15 (1.2%) subjects but with false negative studies in 3 subjects with hepatoma (AFP = 129.6 ng/ml), prostate cancer (PSA = 25.1 ng/ml), and breast cancer (CEA and CA-153 were normal). False-positive FDG-PET studies were found in 24 (1.9%) subjects. However, none had abnormal serum levels of tumor markers. Whole body FDG-PET with the additional help of tumor markers could reduce the false negative and false positive results of FDG-PET only.

The aim of this study was to evaluate practice usefulness of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based on asymptomatically elevated tumor marker (CA-125) serum levels. Whole-body FDG-PET was performed in 28 patients with suspected recurrent ovarian cancers and asymptomatically increased serum levels of tumor marker (CA-125 antigen) but negative or equivocal other imaging modality results. All of these 28 asymptomatic patients had serum levels of CA-125 antigen35 U/ml. The final diagnosis of recurrent ovarian cancer was established by operation/biopsy histopathological findings or clinical follow-up longer than 1 year by additional morphologic imaging techniques. Among the 28 patients, the final diagnoses of recurrent ovarian cancers and benign lesions were established in 20 and 8 patients, respectively. FDG-PET accurately diagnosed recurrent ovarian cancers in 19 patients and benign lesions in 7 patients. When asymptomatically elevated serum levels of CA-125 antigen, the diagnostic sensitivity, specificity, and accuracy of FDG-PET to detect recurrent ovarian cancers were 95.0%, 87.5%, and 92.9%, respectively. FDG-PET is a useful technique to detect recurrent ovarian cancers for patients suspected of recurrent ovarian cancers due to asymptomatically elevated serum levels of CA-125 antigen.

Despite advances in morphological imaging, some patients with non-small cell lung cancer (NSCLC) are found to have non-resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using conventional technetium-99m methylene diophosphate (Tc-99m MDP) whole body bone scan (bone scan), which has a high sensitivity but a poor specificity. We have attempted to evaluate the usefulness of whole body positron emission tomography with 18F-2-deoxyglucose (FDG-PET) for the detection of malignant bone metastases of NSCLC, and to compare FDG-PET results with Bone Scan findings. Forty-eight patients with biopsy-proven NSCLC and suspected to have stage IV disease underwent whole body bone scan and FDG-PET to detect bone metastases. The final diagnoses of bone metastases were established by operative, histopathological findings or clinical follow-up longer than 1 year by additional radiographs or following FDG-PET/Tc-99m MDP bone scan findings showing progressively and extensively widespread bone lesions. A total of 138 bone lesions found on either FDG-PET or Tc-99m MDP bone scan were evaluated. Among the 106 metastatic and 32 benign bone lesions, FDG-PET and Tc-99m MDP bone scan could accurately diagnose 99 and 98, as well as 30 and 2 metastatic and benign bone lesions, respectively. Diagnostic sensitivity and accuracy of FDG-PET and Tc-99m MDP bone scan were 93.4% and 92.5%, as well as 93.5% and 72.5%, respectively. In conclusion, our data suggest that FDG-PET with the same sensitivity and a better accuracy than those of Tc-99m MDP bone scan to detect metastatic bone lesions in patients with biopsy-proven NSCLC and suspected to have stage IV disease.

The purpose of this retrospective study was to evaluate the efficacy of positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to differentiate benign from malignant pulmonary lesions. Fifty-five patients, suspected of having primary pulmonary neoplasm based on chest radiographic findings, underwent FDG-PET scanning. Pathological diagnoses were obtained in 41 patients with a total of 43 pulmonary lesions. The other 14 patients (14 lesions) were followed-up clinically for at least four months. The standard uptake value (SUV) was determined in each patient. The SUV of the 15 benign and 40 malignant pulmonary lesions were 1.60+/-0.42 and 6.14+/-2.67, respectively. If SUV was2.50, the pulmonary lesion was considered as a malignant pulmonary lesion. FDG-PET could correctly detect 34 true-positive and 15 true-negative pulmonary lesions. However, 6 false-positive and one-false negative pulmonary lesions were misdiagnosed by FDG-PET. The sensitivity, specificity and accuracy of FDG-PET to differentiate between benign and malignant pulmonary lesions were 94%, 71% and 86%, respectively. FDG-PET can accurately detect malignant pulmonary lesions with a high sensitivity. However, false-positive FDG-PET findings caused by some inflammatory processes may decrease its specificity.

Although many cancers can be detected by whole-body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG), there has been limited clinical experience with FDG-PET for the detection of recurrent ovarian cancers. Therefore, the aim of this study was to evaluate the clinical value of FDG-PET in the detection of recurrent ovarian cancer. Whole body FDG-PET scans were performed on 24 women who had previous histories of ovarian cancer and treatment with surgery and chemotherapy. All patients also underwent physical examination, laboratory testing of serum CA-125 level and pelvic-abdominal-chest computed tomography (CT) or magnetic resonance imaging (MRI). The results of FDG-PET scans were correlated with serum CA-125 level, CT/MRI and operative pathology results. The diagnostic sensitivity was 90.9%, 90.9% and 90.9%, specificity was 92.3%, 76.9% and 46.2% and accuracy was 91.7%, 83.3% and 66.7% for FDG-PET, serum tumor marker of CA-125 level and CT/MRI in detecting recurrent ovarian cancer, respectively. FDG-PET is a useful diagnostic tool in detecting recurrent ovarian cancers with high specificity as compared with the serum tumor marker CA-125 level and the conventional CT/MRI morphological imaging methods.

To evaluate the clinical value of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) in recurrent cervical cancer, the records of 20 patients who underwent FDG-PET scans were reviewed to detect local recurrence, pelvic/para-aortic lymph node metastases and distal metastases. The final diagnosis was based on operative, histopathological findings or clinical follow-up for longer than one year. FDG-PET accurately detected 18 patients with recurrent diseases (12 patients with local recurrences, 16 patients with pelvic lymph node metastases, 14 patients with para-aortic lymph node metastases and 4 patients with distal metastases of other sites). However, 2 patients with local recurrences had false- negative FDG-PET results as well as 1 patient without local recurrence and 1 patient without pelvic lymph node metastases who had false-positive FDG-PET results. The overall sensitivity and specificity of FDG-PET for patients were 90% and 100%, for local recurrence were 86% and 92%, for pelvic lymph node metastases were 100% and 94%, for para-aortic lymph node metastases were 100% and 100% and for distal metastases were 100% and 100%, respectively. In conclusion, whole body FDG-PET is a useful diagnostic tool in the evaluation of recurrent cervical cancer. It appears to be promising for detecting recurrent cervical cancer, lymph node metastases and distal metastases.

Radionuclide esophageal emptying test using a solid meal is a simple, noninvasive, and physiologic test of esophageal function.In this study, we evaluated esophageal emptying using an isotope-labeled solid meal (an egg salad sandwich labeled with 99mTc-MAA) in the assessment of pneumatic dilatation treatment in achalasia. Twenty achalasic patients (12 males, 8 females, age: 51.4 +/- 13.0 years) underwent esophageal emptying measurement before and after pneumatic dilatation. After treatment, the dysphagic symptoms of all patients improved.In comparison with the pretreatment test, the posttreatment retention fraction at 1, 5, 10, and 15 min were significantly lower (P0.001).The results suggest that radionuclide esophageal emptying test using a solid meal remains a useful objective study of esophageal function and may have an important future role in the follow-up evaluation of treatment for achalasia.

The aim of this study was to investigate the relationship between Technetium-99m (Tc-99m) tetrofosmin accumulation in tumors which may represent the expression of multidrug resistance (MDR)--mediated P-glycoprotein (Pgp) and multidrug resistance-associated protein (MRP) as well as response to chemotherapy in patients with untreated small cell lung cancers (SCLC). Twenty patients with SCLC were studied with Tc-99m tetrofosmin lung scintigraphy before chemotherapeutic induction. Tc-99m tetrofosmin lung scans were interpreted both visually and quantitatively. Response was evaluated upon completion of chemotherapy. Patients with good chemotherapy response had a significantly higher incidence (93%) of positive Tc-99m tetrofosmin lung single photon emission computed tomography (SPECT) findings than patients with poor response (33%) (p value0.05). The tumor/background ratios (T/B) were 1.8 +/- 0.4 and 1.2 +/- 0.3, for patients with good response and poor response, respectively (p0.05). However, other prognostic factors (tumor size and stage) were not significantly related to Tc-99m tetrofosmin lung scan findings and chemotherapy responses. Tc-99m tetrofosmin lung scintigraphy can predict chemotherapy response in patients with SCLC.

Hepatocellular carcinoma (HCC) is usually a hypervascular tumor. Factor VIII-related antigens, including von Willebrand factor, are known to be expressed in HCC, which cause capillarization of the sinusoids of HCC. Capillarization of hepatic sinusoids may play a role in hepatocarcinogenesis and its metastasis. The aim of this study is to clarify the expression of Factor VIII in patients with hepatitis B or C (n = 18) and HCC (n = 16).All specimens were sufficient for immunohistochemical study of the neo-angiogenesis with regard to clinical results. Microvessel count per square millimeter (MVC) and hot spot of microvessel per square millimeter (HSV) were measured from the histochemical study.In the patients with hepatitis group, the positive staining on the vessels of the portal triad was 11.1% (2/18) but in the non-neoplastic tissue of HCC patients the positive rate was 68.7% (11/16) showing a significant difference from the hepatitis group. The amount of vasculatures was easily found in the surrounding capsule of resected HCC. The MVC of the capsule was 10.17 +/- 2.78 and 13.66 +/- 5.42 for the HCC with non-direct invasion and direct invasion during operation, respectively. The HSV of capsules were 7.51 +/- 2.09 and 9.14 +/- 4.02 for the non-invasion and invasion, respectively. Therefore, in our study, it is clear that the high MVC or HSV scores were found in patients of direct invasion. However, there was no relation between hepatitis B or hepatitis C to the tumor invasiveness. The median survival times were 21.5 months for the non-invasive group and 14.5 months for the invasive group (p0.05). The positive rate of Factor VIII in the vessels of the portal triad were 60% and 83.3% for the non-invasive and invasive groups, respectively. However, the lower values of MVC and HSV showed a trend toward a longer recurrence time.It is pertinent to prove that the high score of neo-angiogenesis has a high risk of recurrence. In addition, it is wise to pay more attention to the interval of the follow-up study to detect the recurrent lesion earlier, where possible, in the patient with a high score of microvascularity.

Technetium-99m-tetrofosmin has emerged as a new radiopharmaceutical for myocardial imaging, in competition with 201Tl and 99mTc-MIBI. In this study, 99mTc-tetrofosmin was evaluated for its ability to detect malignant and benign lesions from single solid lung masses.Forty-nine patients with a single solid lung mass based on chest radiograph findings received 99mTc-tetrofosmin SPECT of the chest to evaluate the value of 99mTc-tetrofosmin SPECT for detecting malignant and benign lesions.Only 61% of the lung malignancies were detected by 99mTc-tetrofosmin SPECT of the chest, including 53% of epidermoid carcinoma (ca), 67% of adeno ca, 75% of small-cell ca, 0% of undifferentiated large-cell ca and 100% of other lung malignancies. In addition, 50% of the benign lesions were detected by chest 99mTc-tetrofosmin SPECT. The probability of tetrofosmin uptake in the mass was not related to mass size. The diagnostic sensitivity, specificity and accuracy were 61%, 50% and 59%, respectively, for differentiating malignant and benign lesions when diagnosing a single solid lung mass.Technetium-99m-tetrofosmin SPECT of the chest is of little or no value for the detection of lung ca from single solid lung masses.

Lung damage after radiation therapy in 39 female patients diagnosed with right breast cancer was measured by Tc-99m DTPA radioaerosol inhalation lung scintigraphy (DTPA). The clearance rate of Tc-99m DTPA in the lungs was presented as the clearance rate (k; %/min) of the time-activity curve of the dynamic lung images. All patients underwent simple mastectomy, and postoperative radiation of approximately 50 Gy. We divided the patients into three groups according to the interval of time between the date of irradiation and the lung scintigraphy: group 1 included 12 patients who were examined within three months after irradiation, group 2 included 16 patients who were examined 3 to 9 months after irradiation, and group 3 included 11 patients who were examined more than 9 months after irradiation. In addition, 10 age matched normal women were included as the control. The clearance of the right lung was 0.73 +/- 0.13 for normal controls, 0.94 +/- 0.24 for group 1, 1.11 +/- 0.39 for group 2, and 0.69 +/- 0.21 for group 3. In this small series of patients with breast cancer, the results suggest that lung damage may occur within the first three months after irradiation. After three months, lung damage becomes more significant and the clearance of Tc-99m DTPA in the lungs becomes faster. However, the clearance rate declines markedly after 9 months, which is assumed to result from the recovery of lung tissue from acute irradiation damage or from pulmonary fibrotic change after radiation therapy, or from a combination of both.

Serum interleukin-2 receptor (sIL-2R) level activities of natural killer cell (NK) and lymphokine activated killer cell (LAK) cells were determined in 60 patients with advanced carcinoma (AC) before and after treatment with Shenmai injection (SMI), 40 healthy persons were taken as non-carcinoma control (NC). The results showed that: Serum sIL-2R level in AC were much higher than those in NC (P0.05) and activities of NK and LAK cells in AC were much lower than those in NC (P0.05) before treatment. There was no significant difference among gastric cancer, colonic carcinoma and lung cancer (P0.05). After treatment with SMI we also found that the level of sIL-2R in all patients were obviously lower (P0.05) while the activity of NK and LAK cells were significantly higher than that prior treatment (P0.05). Linear correlation was not found between sIL-2R and NK, LAK cells. These data suggested that the immune function was compromised in AC. The mechanism of the inhibitory effect of SMI on carcinoma might be related to the activity of biological response modifier.