We treated a case of paraesophageal hiatus hernia by laparoscopic repair. The procedure included a reduction of the gastric fundus and duodenal bulbus, closure of the diaphragmatic defect, mesh wrapping of the closure, gastropexy to the diaphragm, and a gastrostomy. Preoperative monitoring of the pH for 24 h showed no reflux. Intraoperative intraluminal manometry of the esophagus after hernia reduction showed the pressure of the lower esophageal sphincter to be normal, and thus an antireflux procedure was not deemed to be necessary. The patient was put on a soft diet from postoperative day 2. A postoperative upper gastrointestinal series showed no gastroesophageal reflux. No complications or recurrence of the hiatus hernia have been observed in the 12 months since the operation. Laparoscopic repair of a paraesophageal hiatus hernia with normal pressure of the lower esophageal sphincter, so that fundoplication is not needed, is thus considered to be possible.

The brain uptake ratio (BUR) is useful for non-invasive cerebral blood flow measurements. To obtain this ratio requires setting an ROI on the aorta to draw the time-activity curve (TAC). Previously, the ROI has been manually set, in order to avoid two undesirable positionings: 1) protrusion from the aorta and 2) overlap in a vein or lung. However, these manual methods are affected by operator subjectivity, which results in individual variations in TAC. In calculating the area under the curve (AUC), gamma fitting of TAC is also affected by operator subjectivity. These subjective operations are considered to be an important impediment to the reproducibility of AUC. Better reproducibility of AUC would lead to improved measurement of brain perfusion. In this study, two newly devised trials were undertaken: 1) defining a system for setting ROI on the aorta; 2) and automatic gamma fitting for TAC. As a result of these trials, the individual variation in AUC among operators decreased, and the reproducibility of AUC was enhanced.

During examinations using radionuclide methods, technicians sometimes need to interact directly with patients. The initial point of contact is when they assist patients onto the examination table, the second is when the patients are positioned for radionuclide examination, and the third occurs if the patients experience a sudden change in condition and assistance is deemed necessary. The dose of radiation increases proportionately to the size of the area being treated. Therefore, we verified that the lateral area received a lower dose of radiation than the anterior areas because of their smaller surface area. The doses in the anterior and lateral areas of the patients were measured following administration of (99m)Tc-hydroxymethyl enebisphosphonic acid (HMDP), (131)I, (18)F-fluoro-2-deoxy-d-glucose ((18)F-FDG), and (99m)Tc-galactosyl-human serum albumin-diethylenetriamine-pentaacetic acid (GSA). The lateral/anterior (L/A) ratio was defined as an approximation of the ratio of measured values of the lateral and anterior areas; it was calculated as follows: L/A (%)=[(lateral dose-BG)/(anterior dose-BG)]×100. In all patients, the radiation dose rate from the lateral areas was lower than from the anterior areas. L/A was 52% with (99m)Tc-HMDP, 51% with (131)I, 58% with (18)F-FDG, and 33% with (99m)Tc-GSA, and radiation doses were found to be reduced by approximately 50% when interaction with patients was from the lateral side rather than the anterior side. Therefore, we confirmed that when interacting closely with patients undergoing radionuclide examinations, it is best to approach the patients from the lateral side in order to reduce radioactive exposure of the technicians.

A stable quality of delivery 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) requires suitable acquisition time, which can be obtained from an accurate true count of 18F-FDG. However, the true count is influenced by body mass index (BMI) and attenuation of 18F-FDG. In order to remove these influences, we have developed a new method (actual measurement method) to measure the actual true count rate based on sub-pubic thigh, which allows us to calculate a suitable acquisition time. In this study, we aimed to verify the acquisition count through our new method in terms of two categories: (1) the accuracy of acquisition count and (2) evaluation of clinical images using physical index. Our actual measurement method was designed to obtain suitable acquisition time through the following procedure. A true count rate of sub-pubic thigh was measured through detector of PET, and used as a standard true count rate. Finally, the obtained standard count rate was processed to acquisition time. This method was retrospectively applied to 150 patients, receiving 18F-FDG administration from 109.7 to 336.8 MBq, and whose body weight ranged from 37 to 95.4 kg. The accuracy of true count was evaluated by comparing relationships of true count, relative to BMI or to administered dose of 18F-FDG. The PET/CT images obtained by our actual measurement method were assessed using physical index. Our new method resulted in accurate true count, which was not influenced by either BMI or administered dose of 18F-FDG, as well as satisfied PET/CT images with recommended criteria of physical index in all patients.

No abstract