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Fulltext PET/CT analysis of 21 patients with breast cancer: physiological distribution of 18F-choline and diagnostic pitfalls

Ahmad Saad FF, Zakaria MH, Appanna B

J Int Med Res, 2018 Aug;46(8):3138-3148.
PMID: 29781364 DOI: 10.1177/0300060518773019

Objectives 18F-choline is a useful tracer for detecting tumours with high lipogenesis. Knowledge of its biodistribution pattern is essential to recognise physiological variants. The aim of this study was to describe the physiologic distribution of 18F-choline and pitfalls in patients with breast cancer. Methods Twenty-one consecutive patients with breast cancer (10 premenopausal and 11 postmenopausal women; mean age, 52.82 ± 10.71 years) underwent 18F-choline positron emission tomography (PET)/computed tomography (CT) for staging. Whole-body PET/CT was acquired after 40 minutes of 18F-choline uptake. Acquired PET images were measured semiquantitatively. Results All patients showed pitfalls unrelated to breast cancer. These findings were predominantly caused by physiological glandular uptake in the liver, spleen, pancreas, bowels, axial skeleton (85%-100%), inflammation and benign changes (4.76%), appendicular skeleton (4.76%-19.049%), and site contamination (61.9%). In <1%, a concomitant metastatic neoplasm was found. The breast showed higher physiological uptake in premenopausal compared with postmenopausal woman (18F-choline maximum standardised uptake values [g/dL] of the right breast = 2.04 ± 0.404 vs 1.59 ± 0.97 and left breast = 2.00 ± 0.56 vs 1.93 ± 1.28, respectively). Conclusion 18F-choline uptake was higher in premenopausal women. Physiological 18F-choline uptake was observed in many sites, representing possible pathologies.

Matched MeSH terms: Menopause/physiology
Managing Hot Flushes in Menopausal Women: A Review

Mallhi TH, Khan YH, Khan AH, Mahmood Q, Khalid SH, Saleem M

J Coll Physicians Surg Pak, 2018 Jun;28(6):460-465.
PMID: 29848424 DOI: 10.29271/jcpsp.2018.06.460

Hot flushes during menopause are distressing for women and result in poor quality of life. Purpose of the current review was to evaluate the available treatment modalities that should be utilised for the management of hot flushes. Menopause refers to last menses of women life and can be declared after amenorrhea of 12 months. Vasomotor symptoms including hot flushes and night sweats are common after menopause, affecting almost 50 - 85% women older than 45 years. The mean increment in core body and skin temperature is 0.5°C and 0.25 - 3°C during a hot flush attack. Low level of estrogen during menopause and its association in triggering episodes of hot flushes, is still under debate. The most accepted hypothesis is a narrowing of the thermoneutral zone (TNZ) triggered by estrogen fluctuations. Although, hormone replacement therapy (HRT) remains the standard treatment for the alleviation of such symptoms, incidence of life threatening side effects restrained medical professionals from its use. Complications associated with the use of HRT can be avoided by appropriate evaluation of patients before initiating therapy. Several guidelines have also recommended HRT (estrogen and progesterone) to be safe for up to a period of seven years. Both hormonal and non-hormonal treatments are used for the management of hot flushes. Since hot flushes are the least appreciated and neglected complication of menopause, current review provides detailed information on its background, pathophysiology and management, and emphasises the need of its treatment.

Matched MeSH terms: Menopause/physiology*
The Asian Menopause Survey: knowledge, perceptions, hormone treatment and sexual function

Huang KE, Xu L, I NN, Jaisamrarn U

Maturitas, 2010 Mar;65(3):276-83.
PMID: 20018469 DOI: 10.1016/j.maturitas.2009.11.015

To provide current insights into the opinions, attitudes, and knowledge of menopausal women in Asia regarding menopause and hormone replacement therapy (HRT).

Matched MeSH terms: Menopause/physiology*
The menopausal experience among indigenous women of Sarawak, Malaysia

Syed Alwi SA, Lee PY, Awi I, Mallik PS, Md Haizal MN

Climacteric, 2009 Dec;12(6):548-56.
PMID: 19905907 DOI: 10.3109/13697130902919519

OBJECTIVES:
To document the common menopausal symptoms and quality of life in indigenous women of Sarawak in Malaysia.

METHODS:
A face-to-face interview using the Menopause-specific Quality of Life questionnaire was conducted with 276 indigenous Sarawakian women aged 40-65 years to determine the mean age of menopause and common symptoms (divided into vasomotor, psychosocial, physical and sexual domains) associated with menopause.

RESULTS:
The mean age at menopause of postmenopausal women was 50.78 +/- 2.47 years (range 47.3-58.2 years). The most common symptoms reported were aching in muscles and joints (82.6%), lack of energy (77.5%) and low backache (77.2%). The typical menopausal symptoms of hot flushes, night sweats, sweating and vaginal dryness were experienced by 42.4%, 34.8%, 29.7% and 49.3%, respectively of the women studied. Perimenopausal women (n = 114) experienced the most physical and psychosocial symptoms, while postmenopausal women (n = 102) experienced most sexual symptoms. Perimenopausal and postmenopausal women were reported to suffer more than premenopausal women (p < 0.001) within the four domains of symptoms (vasomotor, psychosocial, physical and sexual).

CONCLUSIONS:
The menopausal symptoms in this study correspond to those in other studies on Asian women but the prevalence of typical and classical menopausal symptoms was lower compared to studies on Caucasian women. The perimenopausal women had the most significant decrease in quality of life, followed by postmenopausal women and premenopausal women. Vasomotor symptoms had a predominant influence on the quality of life.

Matched MeSH terms: Menopause/physiology*; Postmenopause/physiology
Prospective follow-up of changes in menopausal complaints and hormone status after surgical menopause in a Malaysian population

Collaris R, Sidhu K, Chan JM

Menopause, 2010 Mar;17(2):351-8.
PMID: 19890223 DOI: 10.1097/gme.0b013e3181bcd6f8

Surgical menopause, in comparison with natural menopause, has traditionally been claimed to lead to faster onset of more severe menopausal symptoms. There is little prospective research to support this view. We aimed to evaluate the speed of onset and magnitude of climacteric symptoms after oophorectomy and whether they relate to serum hormone changes. This would aide in counseling women before surgery.

Matched MeSH terms: Menopause/physiology*
The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study

Loh FH, Khin LW, Saw SM, Lee JJ, Gu K

Maturitas, 2005 Nov-Dec;52(3-4):169-80.
PMID: 16257608

To describe the prevalence of menopausal symptoms, define the mean age of menopause, and determine contributory factors, which influence the experience of symptoms among Singaporean women of different racial groups.

Matched MeSH terms: Menopause/physiology*
Fulltext Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

Juhan N, Zubairi YZ, Zuhdi AS, Khalid ZM, Wan WA

Ann Saudi Med, 2018;38(1):1-7.
PMID: 29419522 DOI: 10.5144/0256-4947.2018.1

BACKGROUND: Coronary artery disease (CAD) is one of the leading causes of death in Malaysia. However, the prevalence of CAD in males is higher than in females and mortality rates are also different between the two genders. This suggest that risk factors associated with mortality between males and females are different, so we compared the clinical characteristics and outcome between male and female STEMI patients.
OBJECTIVES: To identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients.
DESIGN: Retrospective analysis.
SETTINGS: Hospitals across Malaysia.
PATIENTS AND METHODS: We analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender.
MAIN OUTCOME MEASURES: Differential risk factors for each gender.
RESULTS: For the 19484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P < .001). The univariate analysis showed that the majority of male patients < 65 years while females were >=65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group.
CONCLUSION: Gender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI.
LIMITATION: Retrospective registry data with inter-hospital variation.

Matched MeSH terms: Menopause/physiology