Early-phase pelvic bone SPECT: Simulation and comparison of several acquisition protocols to reduce bladder artifact and improve image quality

Tomoscintigraphic reconstruction in nuclear medicine assumes that the distribution of the tracer is unchanged in the volume of interest throughout the duration of the acquisition. This condition is however not met in early-phase bone scintigraphy and early-phase pelvic SPECT may display helical artifacts due to the filling of the bladder. Those artifacts may hamper proper interpretation of surrounding bone areas. The aim of this study was to construct a 4D digital pelvic phantom to simulate different acquisition protocols and optimize the acquisition.A 4D digital pelvic phantom was generated with a dynamic component consisting in an expanding bladder with 2 ureters and a static part consisting in the 2 kidneys, bone structures, and soft tissues. Projection data were obtained using an attenuated Radon transform function. Four acquisitions protocols were tested: 32 projections of 16 seconds (32-16-1), 32 projections of 8 seconds (32-8-1), 2 consecutive SPECT of 32 projections of 4 seconds (32-4-2) and 2 consecutive SPECT of 16 projections of 8 seconds (16-8-2). The optimal protocol was then tested on one patient.The amplitude of the artifacts was reduced with the 32-8-1, 32-4-2, and 16-8-2 protocols. The 16-8-2 protocol had the highest signal to noise ratio among those 3 protocols. The bladder artifact was visually markedly reduced on the patient acquisition with a 16-8-2 protocol.Two successive early-phase bone SPECT, with a lower number of projection than the usual protocol reduce the impact of the helical artifacts around the bladder.

Intra-uterine fetal death following maternal varicella infection

The association of varicella and pregnancy is very rare since 90% of women of reproductive age are immune. In the literature, a fetal varicella syndrome has been described characterized by multiple congenital malformations. We report here a case of intrauterine fetal death following maternal varicella at 17 weeks amenorrhea, with virological proof of fetal contamination. Because of the rarity of this association and by the same token of the fetal contamination during maternal varicella, the management during pregnancy rests essentially on a valid ultrasonic surveillance.

[Vaginal sacral-spinal fixation or Richter's procedure. Experience of a surgical team with 54 cases]

Vaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimal trauma and is effective in correcting pelvic static disorders. There seem to be few complications. Results are very promising. The functional and anatomic improvements induced by the operation persist over the long term. Although the main indication is treatment of prolapse of the vaginal vault, Richter's procedure is also useful for the prevention of prolapse. Based on the experience acquired by a surgical team, the technique, indications, complications, and results of Richter's procedure are discussed.

[Ovarian cancer and pregnancy]

The authors report 6 cases of carcinoma of the ovary presenting during pregnancy in the Department of Gynecology and Obstetrics of La Grave University Hospital, Toulouse, between 1972 and 1994. Analysis of this series is followed by a review of the literature which reveals that carcinoma of the ovary fortunately remains a rare event during pregnancy. All reported series conclude that the diagnosis is made at an early stage. Management depends in great part on the age of the pregnancy and stage of malignancy. During the first 6 months, immediate surgery is essential, with sacrifice of the pregnancy, except at stage IA1. During the final 3 months, surgery is delayed until fetal maturity. This classical attitude is currently being questioned. This classical attitude is currently being questioned. Some teams feel that conservative treatment followed by chemotherapy is possible, thereby preserving the pregnancy. The choice of the couple must always be taken into account when making these management decisions.

[Gelatinous peritoneal disease]

Gelatinous degeneration of the peritoin is an unusual disorder which inevitably takes the surgeon by surprise during laparotomy. Three cases are reported. The diagnosis, pathogenesis, prognosis and possible therapies are discussed. The tumoral pathogenesis usually appears to be non-malignant and to originate in the ovaries or appendix. However, gelatinous degeneration of the peritoin must be viewed as a disease with attenuated malignancy. The pattern of development is slow, with repeated peritoneal recurrences. The survival time is long. Treatment is essentially surgical even when recurrences occur.