Objective: Thallium-201 chloride single-photon emission computed tomography (²⁰¹TlCl SPECT) has been widely used in brain tumor studies. This study aimed to estimate ²⁰¹Tl abnormal uptake, frequency of abnormal uptake, and retention indices with ²⁰¹TlCl SPECT for patients with gliomas.

Materials and Methods: Each patient was intravenously injected with 74—148 Mbq of ²⁰¹Tl-chloride, and SPECT images were obtained

after 20 min (early imaging) and 4 h (delayed imaging). In the hospital system, 51 patients (54 cases) between January 2015 and August 2019 were enrolled and grouped into three: low-grade glioma (grade II) in 11 patients (12 cases), anaplastic (grade III) in 9 patients (9 cases), and grade IV in 31 patients (33 cases).

Grade classification was classified according to the 2016 World Heath Organization (WHO).

Radiologists placed the region of interest (ROI) on the abnormal uptake on early images, which were drawn on corresponding areas on delayed images. This was evaluated using three different ²⁰¹Tl uptake and retention indices according to the previous report¹⁾.

(1) average early ²⁰¹Tl uptake=Avg.Le/Avg.BRe; (2) ²⁰¹Tl retention A=Avg.Ld/Avg.Le; and (3) ²⁰¹Tl retention B=(Avg.Ld/Avg.BRd)/(Avg.Le/Avg.BRe) where Avg.Le is the average count for lesions, Avg.BRe and Avg.BRd are the average early and delayed counts for contralateral normal brains, and Avg.Ld is the average delayed counts for lesions.

Results: Abnormal uptake was seen in 44/55 cases. Grade II were seen in 6/12, Grade III, were seen in 7/9 Grade IV was seen in 30/33. (Table 2) The average early ²⁰¹Tl uptake of grade IV was higher than that of grade II (P＜0.05), The retention B of grade II was higher than that of grade IV. (Table 3)

Conclusion: When there was abnormal uptake, high grade was likely.

In cases with abnormal uptake, if both average early and retention B were high, glioblastoma was considered. If retention B was high, and average early was not, grade II may be considered based on anatomical images.

This case report describes a case of serous adenocarcinoma of the umbilical region in a woman in her 60s with a history of breast cancer. The patient presented with a 1.5 cm umbilical nodule 3 years after breast cancer surgery; FDG-PET and MRI findings showed no findings other than the umbilicus that suggested a development of a new malignancy. The diagnosis of breast cancer umbilical metastasis (commonly referred to as Sister Mary Joseph Nodule), peritoneal cancer umbilical metastasis, and primary umbilical tumor required differentiation. However, it was difficult to make a diagnosis as histology showed papillary growth of atypical cells and was similar to the pre-existing breast cancer. Ultimately, primary peritoneal cancer was considered as the first possibility based on comprehensive findings combined with immunohistochemistry. In this case, treatment with chemotherapy was initiated after diagnosis, but after 10 months the nodule showed a tendency to enlarge. Resection of the nodule was considered, but surgery was not possible due to the patient's deteriorating general condition. Approximately one year after diagnosis, the patient developed ascites effusion and had a poor prognosis leading to death. The clinical, imaging, histological and immunohistochemical findings suggest the importance of combining these findings in the diagnosis of this case.

As the cardiopulmonary resuscitation (CPR) time increases, patient prognosis and neurological outcomes are expected to worsen. Although the effectiveness of introducing ECMO in CPR has been discussed, there are currently no definitive criteria for the use of extracorporeal CPR with a lack of evidence. Here, we report a case of a 12-year-old female with severe myocarditis who survived out-of-hospital cardiac arrest with ventricular tachycardia and ventricular fibrillation due to the introduction of extracorporeal CPR after long-duration conventional CPR (total conventional CPR time: 73 minutes). Inter-hospital transport under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was performed after extracorporeal CPR by the previous hospital. On admission to the pediatric intensive care unit, the patient's pupils were severely dilated with sluggish light reflexes. The condition of the pupils immediately improved after increasing the flow of VA-ECMO from 1.7 to 2.4 L/min/m². The patient received medical support, including systemic steroids, immunoglobin, and 48 hours of therapy for mild hypothermia, and she demonstrated recovery of cardiac function in the first 6 days after admission. The patient was discharged from the hospital with a normal functional status. Extracorporeal CPR has to be considered even for long-duration CPR, and in which case it is important to make careful assessments of the presence of factors (e.g., initial rhythm, the quality of conventional CPR, the time to conventional CPR initiation) before starting extracorporeal CPR. In neurological evaluation, ECMO flow should be sufficient to ensure cardiac output. The present case also suggests that good-quality CPR with ECMO may compensate for its CPR length.

In patients with atrial standstill (AS), a lack of atrial contraction will likely cause blood flow stagnation in the atria. Thromboembolic complications are highly prevalent in such cases. We present a case involving a ten-year-old boy diagnosed with AS after presenting with a cerebral embolism. Subsequently, the patient underwent a successful endovascular thrombectomy and pacemaker implantation. Atrial electrical activity recovered six months following dual-chamber pacemaker implantation. Prompt recognition and management pose challenges in patients with previously undiagnosed AS who present with acute ischemic stroke. Additionally, anticoagulation therapy and monitoring of atrial activity are crucial for preventing thromboembolic events.