This study documents the long-term outcome of [(90)Y-DOTA]-TOC treatment in a large cohort. Response to [(90)Y-DOTA]-TOC is associated with longer survival. Somatostatin receptor imaging is predictive for both survival after [(90)Y-DOTA]-TOC treatment and occurrence of renal toxicity.

Indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.

Pulmonary hypertension during exercise is common in severe chronic obstructive pulmonary disease (COPD). It was hypothesised that the use of the endothelin-receptor antagonist bosentan can improve cardiopulmonary haemodynamics during exercise, thus increasing exercise tolerance in patients with severe COPD.In the present double-blind, placebo-controlled study, 30 patients with severe or very severe COPD were randomly assigned in a 2:1 ratio to receive either bosentan or placebo for 12 weeks. The primary end-point was change in the 6-min walking distance. Secondary end-points included changes in health-related quality of life, lung function, cardiac haemodynamics, maximal oxygen uptake and pulmonary perfusion patterns.Compared with placebo, patients treated with bosentan during 12 weeks showed no significant improvement in exercise capacity as measured by the 6-min walking distance (mean¡SD 331¡123 versus 329¡94 m). There was no change in lung function, pulmonary arterial pressure, maximal oxygen uptake or regional pulmonary perfusion pattern. In contrast, arterial oxygen pressure dropped, the alveolar-arterial gradient increased and quality of life deteriorated significantly in patients assigned bosentan.The oral administration of the endothelin receptor antagonist bosentan not only failed to improve exercise capacity but also deteriorated hypoxaemia and functional status in severe chronic obstructive pulmonary disease patients without severe pulmonary hypertension at rest. KEYWORDS: Endothelin-receptor antagonist, exercise capacity, pulmonary hypertension, treatment P ulmonary hypertension (PH) at rest and during exercise is a very frequent complication in the natural history of chronic obstructive pulmonary disease (COPD) [1,2]. Correspondingly, this condition has been reported in 20-91% of patients with severe COPD and/or emphysema [3,4]. The presence of PH is commonly associated with more frequent use of healthcare resources and worse clinical outcome [5]. Remarkably, pulmonary artery pressure has been suggested to be the single best predictor of mortality in COPD [6].In COPD, PH is generally of moderate severity, but the range of mean pulmonary artery pressures varies substantially [7]. Moderate and severe PH are present in 9.8 and 3.7%, respectively, of the patients undergoing right heart catheterisation before lung volume reduction surgery [7]. Despite many uncertainties, studies indicate that 35% of all patients with severe COPD have pulmonary artery pressures of .20 mmHg at rest [8]. In addition, pulmonary pressures during exercise are greater than predicted by the pulmonary vascular resistance (PVR) equation in COPD, suggesting active pulmonary vasoconstriction on exertion [9]. Hence, of those patients without PH at rest, a further 52% are estimated to develop PH during exercise [5].There are many pathological similarities between idiopathic pulmonary arterial hypertension (PAH) and PH related to COPD. Like idiopathic PAH, pulmonary arteries in patients with COPD show evidence of fibromuscula...

SPECT/CT is a promising diagnostic modality in patients with painful total knee arthroplasty (TKA). The purpose of this study is to introduce a novel standardized SPECT/CT algorithm and evaluate its clinical application and reliability. A novel SPECT/CT localization scheme consisting of 9 tibial, 9 femoral and 4 patellar regions on standardized axial, coronal and sagittal slices is proposed. It was piloted in 18 consecutive patients with post TKA pain. The tracer activity on SPECT/CT was recorded using a color-coded scale (0-10). The inter- and intra-observer reliability was assessed for localization and tracer activity. The prosthetic component position was assessed in the CT images after 3D reconstruction using standardized frames of reference. The median inter- and intra-observer differences and ranges of the measured angles were calculated along with the ICC values for inter- and intra-observer reliability. The localization scheme showed very high inter- and intra-observer reliabilities for all regions. The measurement of component position was highly reliable in all cases with sufficient visibility of anatomical landmarks. The median inter-observer difference between alignment measurements for tibial and femoral components was less than 3 degrees (range 0 degrees -6 degrees ). The median intra-observer variability for these was less than 2 degrees (range 0 degrees -5 degrees ). The SPECT/CT algorithm presented is both reliable and useful in the management of patients with painful TKA. It combines biomechanical and metabolic data (tracer localization) providing an extra dimension to the understanding of this difficult condition. The clinical value of SPECT/CT in patients with unexplained pain following TKA should be further investigated.