Only in certain cases are recurrences detected more reliably than with conventional techniques. Due to the lack of studies, there is currently no proof that patients with ovarian cancer can benefit from positron emission tomography (PET) alone or in combination with computed tomography (CT). As regards diagnostic accuracy, in certain cases, recurrences can be detected earlier and more accurately with PET or PET/CT than with conventional imaging techniques. This is the conclusion of the final report by the German Institute for Quality and Efficiency in Health Care (IQWiG) in Cologne that was published on 23 May 2012.

Ovarian cancer is the fifth most common malignant tumour in women. Every year 15.9 women in every 100,000 are diagnosed with the disease in Germany and it claims the lives of 8 in 100,000 women per year. Since the ovaries lie deep in the abdomen and an ovarian tumour normally causes no symptoms for a long time, it is often only discovered at a late stage.

Many experts hope that an investigation using PET or PET/CT alone or in combination with other methods would be better able to distinguish between benign and malignant tumours when ovarian cancer is suspected. It could also help classify cancerous tumours into the correct stage, make it easier to assess whether they respond to treatment and to show earlier and with greater certainty whether a recurrence or secondary tumour (metastasis) has occurred. This information should then enable patients to be given better treatment recommendations.

IQWiG therefore searched the international literature for studies investigating the effects of diagnosis using PET or PET/CT on health aspects of direct relevance to patients. For example, the results of this research – and an appropriately tailored treatment – could contribute to patients having better chances of survival, spare them unnecessary operations or other diagnostic procedures, or improve their quality of life. However, the search for such studies was unsuccessful, so the question as to the patient-relevant benefit of PET or PET/CT had to remain unanswered.

In addition, IQWiG searched for studies in which the diagnostic accuracy and prognostic power of PET or PET/CT were compared with other diagnostic methods. The basic question is how often a PET investigation gives a correct result. On the one hand, it should overlook true, cancerous tumours as rarely as possible, but on the other, it should not awake any false suspicions.

The results of a total of 40 individual studies on this topic were evaluated. However, these studies permit a robust conclusion only in respect of the detection (or exclusion) of a recurrence, where PET or PET/CT appears to be more reliable than other methods. Nevertheless, it remains unclear whether this only applies to patients in whom symptoms (e.g. pain) have already occurred, or also to those in whom routine screening has shown an abnormal blood test result. This is because only very few studies give precise details on this point.

Since even the above patients have not been investigated to determine whether the higher test accuracy of PET or PET/CT has positive effects on mortality, the burden of disease or the quality of life, IQWiG assumes that a patient-relevant benefit of PET or PET/CT is not proven. For instance, it is particularly questionable whether a recurrence detected by PET or PET/CT can actually be better treated – and the patient thereby has a noticeable advantage.

It is therefore essential that doctors fully inform their patients not only of the possible benefits in the form of an earlier diagnosis, but also of the possible harms. The latter can arise from an earlier start to second-line treatment associated with considerable side effects, but not with a prolongation of survival. Hence studies are urgently needed to investigate the patient-relevant benefit of PET or PET/CT in the diagnosis of ovarian cancers in direct comparison with conventional diagnostic techniques.

The ‘bubble’ at the top of the picture is a tumour growing on Leyna’s mouth
Surgeons have removed a tumour from the mouth of a foetus, in what has been described as a ‘world first’ procedure.
After a scan at 17 weeks, mother Tammy Gonzalez said she ‘could see a bubble’ coming out of her baby’s mouth. Doctors said it was a very rare tumour called an oral teratoma and there was little chance her daughter would survive.
After the pioneering operation, baby Leyna was born five months later.
Doctors at the Jackson Memorial Hospital in Florida, said this type of tumour was so rare it had been seen only once in 20 years at the hospital.
In the procedure, Mrs Gonzalez was put under a local anaesthetic as a needle was pushed through the protective amniotic sac around the foetus.
A laser was then used to cut the tumour from Leyna’s lips. The operation lasted just over an hour.
Tammy told a press conference in Miami: ‘When they finally severed the whole thing off and I could see it floating down, it was like this huge weight had been lifted off me and I could finally see her face.’
She described the surgeons as ‘saviours’.
The doctors said: ‘To our knowledge, this is the first successful treatment of a foetal oral teratoma in utero.’ Leyna Mykaella Gonzalez was born in October 2010 weighing 8lb 1oz. She is now a healthy 20-month-old child.
The only sign of her life-saving surgery is a tiny scar on her mouth. BBC

Genesis Digital Imaging, Inc. (Los Angeles, CA), a privately-held imaging software developer and distributor of diagnostic imaging systems, has been acquired by Carestream Health.

This acquisition enables Carestream to expand its customer base by leveraging the expertise Genesis has in serving U.S. dealers that primarily call on the value tier market and specialty medical practices. Carestream offers a proven portfolio of products and services designed specifically for these types of healthcare customers.

With this acquisition, Carestream is uniquely positioned to serve customers across the U.S. With its direct sales force offering large hospital customers the latest high-end digital radiography systems and healthcare IT solutions, its Quantum Medical Imaging organisation serving customers in the mid-tier hospital, orthopedic and imaging centre segments, and Genesis focusing on customers in the value tier segment, Carestream has innovative products and services and attractive pricing for customers in all areas of the U.S. market.

A team of engineers at Stanford has demonstrated the feasibility of a super-small, implantable cardiac device that gets its power not from batteries, but from radio waves transmitted from outside the body. The implanted device is contained in a cube just eight-tenths of a millimeter in radius. It could fit on the head of pin.
In their paper, the researchers demonstrated wireless power transfer to a millimeter-sized device implanted five centimetres inside the chest on the surface of the heart

Mayo Clinic researchers have found a novel way to monitor real-time chemical changes in the brains of patients undergoing deep brain stimulation (DBS). The groundbreaking insight will help physicians more effectively use DBS to treat brain disorders such as Parkinson’s disease, depression and Tourette syndrome.
Researchers hope to use the discovery to create a DBS system that can instantly respond to chemical changes in the brain. Parkinson’s, Tourette syndrome and depression all involve a surplus or deficiency of neurochemicals in the brain. The idea is to monitor those neurochemicals and adjust them to appropriate levels.
　
‘We can learn what neurochemicals can be released by DBS, neurochemical stimulation, or other stimulation. We can basically learn how the brain works,’ says author Su-Youne Chang, Ph.D., of the Mayo Clinic Neurosurgery Department. As researchers better understand how the brain works, they can predict changes, and respond before those changes disrupt brain functioning.
Researchers observed the real-time changes of the neurotransmitter adenosine in the brains of tremor patients undergoing deep brain stimulation. Neurotransmitters such as dopamine and serotonin are chemicals that transmit signals from a neuron to a target cell across a synapse.
The team used fast scan cyclic voltammetry (FSCV) to quantify concentrations of adenosine released in patients during deep brain stimulation. The data was recorded using Wireless Instantaneous Neurotransmitter Concentration Sensing, a small wireless neurochemical sensor implanted in the patient’s brain. The sensor, combined with FSCV, scans for the neurotransmitter and translates that information onto a laptop in the operating room. The sensor has previously identified neurotransmitters serotonin and dopamine in tests in brain tissue. This was the first time researchers used this technique in patients.
Tremors are a visual cue that the technique is working; researchers suspect adenosine plays a role in reducing tremors.
Researchers also hope to learn more about conditions without such external manifestations.
‘We can’t watch pain as we do tremors,’ says Kendall Lee, M.D., Ph.D., a Mayo Clinic neurosurgeon. ‘What is exciting about this electrochemical feedback is that we can monitor the brain without external feedback. So now, we can monitor neurochemicals in the brain and learn about brain processes like pain.’
DBS has been used successfully worldwide to treat patients with tremors. However, physicians do not fully understand why DBS works in patients. They know that when DBS electrodes are inserted before electrical stimulation, there is an immediate tremor reduction. Known as the microthalamotomy effect, it is reported in up to 53 percent of patients and known to last as long as a year.
Researchers hope to use the study findings to create a self-contained ‘smart’ DBS system. Mayo Clinic