Functional imaging with PET and PET/CT continues to play an important role in the staging and treatment of lung cancer patients. It can determine the extent of the disease at initial diagnosis. PET is more accurate than CT in determining tumor stage and provides a cost-effective tool for differentiating operable from inoperable disease. In addition, it is effective in ascertaining lung tumor response to therapy and in detecting recurrence in successfully treated lesions.

Contemporary Memoir

by Kerry Grinkmeyer

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New research from Boston and Germany this month suggests that adding respiratory gating to a standard whole-body PET/CT scan delivers superior data in the form of more accurate tumor volume measurements and standardized uptake values (SUVs). This data is critical for monitoring therapy response and assessing tumor viability. In addition, it can deliver better patient care in treatment planning before radiation therapy as irradiation target volumes can be more precisely defined.

From Japan comes promising news of a new amino-acid tracer for PET imaging, fluoro methyl tyrosine (FMT). Researchers at Gunma University Graduate School of Medicine have found that PET imaging with the compound seems to deliver a stronger prognostic factory for pulmonary adenocarcinoma than does FDG-PET imaging.

In other news, if you want to find out more about the possibilities for molecular imaging in your practice head over to our Healthcare TechGuide and check out the variety of systems offered there.

Lastly, if you have a comment or report to share about the utilization of molecular imaging and nuclear medicine in your practice, please contact me at the address below. I look forward to hearing from you.

Jonathan Batchelor, Editor
jbatchelor@trimedmedia.com
PET Scans

Activity has been increasing in Europe and Central and Western Asia, signaling an unusually early start to the winter flu season. Early reports from China had indicated that the H3N2 strain of seasonal flu was circulating along with swine flu, but more recent reports indicate that swine flu now predominates. That does not mean, however, that the seasonal flu will not come back after this wave of pandemic influenza passes.

– What appears to be an outbreak of swine flu is sweeping an isolated whaling village on a remote Alaska island. The Alaska Army National Guard has been called in to transport an emergency medical team from Nome, 135 miles away, because so many of the 130 residents of Diomede have been stricken. Most of the residents of the town are Ingalikmiut Inuit, who depend on subsistence fishing to survive. Anecdotal reports have previously suggested that indigenous peoples may be more susceptible to influenza, but there has so far been no firm evidence of such an association.

– Ukraine has been suffering an outbreak of swine flu, and officials now say that a January presidential election may have to be postponed until May if it is not brought under control.  The WHO and European health authorities have sent in emergency teams to help with the situation, but the outbreak has become a political football, with recriminations being traded by the two main presidential candidates. Some authorities have estimated that as many as 750,000 Ukrainians have been infected with the virus, but only 30 cases have been laboratory-confirmed so far. At least 86 people have died of what appears to be swine flu.

– Officials from the European Center for Disease Control and Prevention are predicting that, in a worst case,  as many as 40,000 Europeans could be killed by the swine-flu virus and a similar number by a succeeding wave of seasonal flu. The ECDC said 389 deaths had so far been linked to the virus in Europe, including 154 in Britain, 73 in Spain, 25 in Italy and 22 in France.

– The U.S. military said it had begun receiving swine-flu vaccine and will begin immunizations soon. Vaccination is mandatory for all military personnel and highly recommended for civilian employees and family members of service people. The Department of Defense has so far ordered 3.7 million doses of the vaccine.

– Thomas H. Maugh II

Exercise helps us feel and look better, but in fact it helps shape up our cardiovascular system as well.  The heart becomes very efficient in its function and the arteries become healthier.  In fact regular exercise helps in improving hypertension and even delay diabetes.  This is why we need to be engaged in routine exercise.  My definition of an athlete is anyone that does routine exercise whether it is at the professional level or basic level.  In general exercise can induce and bring to light hidden cardiovascular disease states.  If the athlete is older, then he may have a hidden underlying coronary artery disease that can suddenly manifest itself in sudden cardiac arrest. If the athlete is younger than 35 years of age, then there may be a hidden underlying structural heart disease such as hypertrophic cardiomyopathy that can lead to sudden cardiac death. 

Research in Europe, particularly in Italy has shown that this phenomena can be reduced by 85 % if the athlete is screened appropriately.  Unfortunately, lack of leadership and lack of budget set for this in schools have hindered us from reducing this.                                                                                                                                                    

My advice to  all who are athletes is to be a smart athlete. Know your body.  If you have any symptoms of chest pain, shortness of breath that is beyond normal, sudden passing out spells, feeling of palpitations with or without exercise, dizziness, a family history of heart disease or sudden death, then make sure that you ask for assistance from a physicians who is well versed in the field of Cardiovascular medicine

Dr. Manshadi is multi board certified Cardiologist who has a private practice in Stockton, California supplemented with an academic position as Associated Clinical Professor of medicine at UC Davis Department of Cardiovascular Medicine. His main area of practice is in interventional Cardiology and in Athletic Heart. He also serves as the Chair of Media Relations for American College of Cardiology for California. He has been voted as America’s Top physicians by Castle Connolly and his picture has been featured in American Airline Magazine as such. He has degree in Physiology from UC Davis followed by MD from The Chicago Medical School. He has done his training in internal Medicine and Cardiology at California Pacific Med Center in San Francisco and UC Davis in Sacramento respectively. He has lived in the Sacramento, Elk Grove, and Stockton area for the past 32 years.

First procedure to discuss is Miitral valve clip. There are certain criteria that needs to be met in order to receive this surgery. For example, the valve can not be heavily calcified making it difficult to attach the clip. The procedure involves reaching the valve through the femoral artery located in the groin much the same way the cardiologist places coronary stents in the heart. The immediate results are excellent, and patients can be back home in just few days or less. On the other hand, the actual mitral valve repair done through open chest surgery is a much more involved surgery. The two sites that are involved are UC Davis Medical Center in Northern California and Cedar
Sinai in Los Angeles for this procedure.

The percutanous Aortic valve surgery is performed in the same manner.  This involves placing a preloaded valve on a balloon that can be delivered into the old stenotic aortic valve. Then the balloon is dilated. This takes a great deal of precision to be able to place this exactly in the right place. The immediate result for this valve procedure is also excellent. Performing the valve procedure in this manner can also immensely improve the morbidity associated with this
procedure compared to the open chest surgery.  The aforementioned minimally invasive surgeries will be widely available by spring of 2011.

The last surgery that I would like to mention is surgery for the failing heart. It is called the Heat Mate II which is a left ventricular assist device which in essence takes over the failing heart. Congestive heart failure (CHF) in general carries a 50 percent mortality within 5 years of initial diagnosis. There are multiple well researched medications that can help improve the survival rate for CHF.  When the patients are getting closer to their end stage of their disease process and the heart start to fail even with optimum medical therapy, then the option is to let go or start thinking about heart transplant. Unfortunately, not everyone is a good candidate for transplant. Heart mate II now is fully approved. It is a device where  it takes over the function of the heart and pumps for the heart. The device is implanted inside the chest cavity and the tube comes out of
the upper abdomen and is attached to a battery case.  A smart patient is a knowledgeable patient. Patients should always be aware of the new technology out there can help extend their lives and
be able to live longer and happier.

Dr. Manshadi is multi board certified Cardiologist who has a private practice in Stockton, California supplemented with an academic position as Associated Clinical Professor of medicine at UC Davis Department of Cardiovascular Medicine. His main area of practice is in interventional Cardiology and in Athletic Heart. He also serves as the Chair of Media Relations for American College of Cardiology for California. He has been voted as America’s Top physicians by Castle Connolly and his picture has been featured in American Airline Magazine as such. He has degree in Physiology from UC Davis followed by MD from The Chicago Medical School. He has done his training in internal Medicine and Cardiology at California Pacific Med Center in San Francisco and UC Davis in Sacramento respectively. He has lived in the Sacramento, Elk Grove, and Stockton area for the past 32 years.

 www.drmanshadi.com

Auxilium Pharmaceuticals secured a two-year revolving line of credit for working capital from Silicon Valley Bank. With $30 million committed at initial closing, the financing includes an accordion feature, which could secure the company an additional $10 million on the parties’ mutual agreement.

The new funds come as Auxilium anticipates approval of Xiaflex™, which is under FDA review for the treatment of Dupuytren’s contracture, a condition that affect s the connective tissue that lies beneath the skin in the palm of the hand. The review date has been set for September 19.

Xiaflex is also in Phase IIb development for the treatment of Peyronie’s disease, which manifests as a plaque or hard lump on the penis that can reduce flexibility and cause the penis to bend during erection. Separate Phase II trials with the drug are under way for treating frozen shoulder syndrome.

Harvard Medical School, Boston, MA, USA.

As testosterone (T) has been shown to influence wound healing, and serum T declines in the age group at risk for Peyronie’s disease (PD), we explored the possibility that low serum T may be associated with PD. AIM: The purpose of this study was to evaluate the relationship between serum T concentrations and features of PD.

Medical records were reviewed for 121 consecutive patients with PD seen over a 2-year period. All patients were assessed for sociodemographic data, medical history, comorbid medical conditions, findings on physical examination, and severity of curvature. Laboratory testing included serum concentrations of total testosterone (TT) and free testosterone (FT). Testosterone deficiency (TD) was defined as TT values less than 300 ng/dL and/or FT less than 1.5 ng/dL.

Prevalence of TD in men with PD and correlation of TT and FT with severity of curvature and plaque size.

Mean patient age was 53.9 +/- 10.6 years (range 28-77). Penile curvature was 50.2 +/- 23.6 degrees (range 10-120). Mean TT was 411.6 +/- 203.6 ng/dL (range 69-877), and mean FT was 1.12 +/- 0.58 ng/dL (range 0.13-5.06). Low T was identified in 29.5% by TT alone and in 74.4% overall. Severity of curvature was greater for men with TD compared with men with normal T (54.3 vs. 37.1 degrees, P = 0.006). Men with low FT had greater penile curvature than men with normal FT (37.5 vs. 55.9 degrees, respectively, P = 0.003). Severity of penile curvature correlated significantly with FT (r = -0.314, P = 0.016) and estradiol/T (r = 0.476, P = 0.0001) but not TT (r = -0.199, P = 0.138).

This pilot study suggests a possibly important relationship between low T and PD. Further prospective studies are needed to confirm this relationship.

Written by:
Moreno SA, Morgentaler A.

So, how do you tell if a spot on your skin is a melanoma? There is no sure method. A lot of times, even doctors cannot tell a benign mole from a malignant melanoma, especially when it is still early and small. That is why dermatologists do so many shave biopsies in the office. The piece of skin is then specially stained and looked at under the microscope by pathologists to look for melanoma cells – then and only then can anyone be sure.

However, there are some helpful common sense guidelines. First, you should pay attention to your skin. Any new mole is more suspicious than one that has been around without change for years. Any mole that is very dark or grows quickly in size and thickness should sound off alarm bells. The experts do offer some helpful warning signs to look for – summarized as ABCD as follows: (A) asymmetry, (B) border irregularity, (C) color variation, and (D) diameter greater than 6mm. In men, melanoma occurs most commonly on the trunk, followed by arms, and head and neck areas. In women, it is found most commonly on the legs, followed by arms and then the trunk.

Some people are at particular high risk for developing melanoma. These patients should see a dermatologist at least once a year. High risk factors include family history of melanoma, previous skin cancer, childhood radiation, and dysplastic nevus syndrome. There is now a genetic blood test for a hereditary type of melanoma. You may consider this test for yourself or your family member if: a) you have had 3 separate melanomas, b) 3 or more members of your family have had melanoma, or c) 3 or more members of your family have had melanoma or pancreatic cancer. Unfortunately, because there is no drug proven to prevent melanoma, high risk essentially just means more vigilance and more care to avoid direct sun exposure.

Dr. Mai Brooks is a surgical oncologist/general surgeon, with expertise in early detection and prevention of cancer. More at http://www.drbrooksmd.com, and thecancerexperience.wordpress.com

Good health is the most important asset you own. Bad health becomes your largest liability if you lose your health, thus who you get advise, treatment, and direction from becomes the most important decision that you make for the balance of your life. You must research your doctors before you place your life in their hands.

Good Standing with the AMA – It’s easy to go to the American Medical Association and do a search by name or by specialty to find out if the doctor that you are considering is in good standing. The site will also give you his hospital affiliation, his education background, and his or her residency training. Here is the link to the AMA’s website: http://www.ama-assn.org/ama/pub/patients/patients.shtml Click on the You and Your Doctor tab, and then Is your Doctor a Member.

Board Certified – The American Board of Medical Specialties (ABMS), is a not-for-profit organization, that assists 24 approved medical specialty boards in the development and use of standards in the evaluation and certification of physicians. Board Certified physicians make a commitment to keep current in their area of specialty. With the rapid changes in the medical profession it is critical the your physician be Board Certified. Here is a link to the ABMS site where you can learn more: www.abms.org/

Peer Recognition – The best source of a medical referral is the physicians peer group. The Best of the US is a website that recognizes the best in ten professions, including doctors. They search the medical field for those physicians are in good standing with the AMA, are Board Certified, have been recognized as leaders in their field, and in many case the teachers of their area of specialty. Physicians can also become listed by being nominated for inclusion by other physicians. Here is a link to the Best of the US site: http://www.BestofUS.com.

Search the Internet – The internet will tell you everything you need to know about the physicians that you are considering. If he or she has written books, papers, or articles you’ll find it on the internet. If he or she is or has been sued you’ll find it here. If he or she has been recognized as one of the best of class you’ll find it here.

If you’d like assistance in finding the best doctors in your community go to www.BestofUS.com. If you have a doctor that you feel is one of the best of the United States be sure to submit a nomination. This website lists the best of class in ten professions, doctors, lawyers, dentists, financial advisors, chiropractors, physical therapists, accountants, mortgage brokers, real estate agents and veterinarians. Best of the United States LLC searches for the best educated, most peer recognized, and most industry recognized authorities in each of the professions. Listed professionals cannot pay to be included on the BestofUS listing. BestofUS.com is the most complete listing of the best professionals on the Internet.

In the past, we didn’t have the ability to choose our care givers with any level of authority because of the lack of information that was available. We depended on the recommendations of friend, relatives and other care givers. With the introduction and expansion of the Internet our ability to make informed decisions about the quality of our health care has changed. We can now check a doctors standing with the American Medical Association, we can check on this level of education, we can check on their disciplinary records.

The medical field is changing so fast that if our doctors are not pursuing their education on a continuing basis we are virtually guaranteed that they are working without all the information relative to our condition, and thus we are getting something less then the best medical care. In the past, the likelihood of our full recovery was left to the luck of the draw; if we got a knowledgeable doctor we recovered, if we didn’t we suffered and often died.

The burden thus falls to the patient to search for the best doctor and medical facility that is most qualified to provide the care that we need. Here are the steps that you should take in finding the best care for your needs.
1. Research your condition. This involves knowing what’s ailing you. Go to Google and search your condition with the proper medical terms, and gain a full understand of what you have. This will arm you so that you can ask intelligent questions.
2. Ask informed questions. What is your experience with my condition? How often have you preformed this operation? What level of research have you done on my condition? Have you written any papers or given any presentations on my condition? You might think these questions are threatening, but who do you want providing you care the expert or the practitioner? If you had a valuable antique car; who would you want to work on your car?
3. Locate the expert. Again on Google read what the expert has written on your condition and use this information to determine if your doctor is the best doctor for your recovery. If not, contact the expert and ask him or her to review your case. The expert isn’t going to be looking for business; they’ll give you a true assessment of your condition and advise you on how to proceed.
4. Control your destiny. If your local doctor objects to your proactive action you probably have the wrong doctor. It’s your life, it’s your body, and ultimately it is only you that will have to live with the consequences of your decisions. Everyone else will move on.

If you’d like a starting point for finding the best doctors in your community start your search on www.BestofUS.com. This website lists the best of class in ten professions, doctors, lawyers, dentists, financial advisors, chiropractors, physical therapists, accountants, mortgage brokers, real estate agents and veterinarians. Best of the United States LLC searches for the best educated, most peer recognized, and most industry recognized authorities is each of the professions. Listed professionals cannot pay to be included on the BestofUS listing. BestofUS.com is the most complete listing of the best professionals on the Internet.