Blood and starch in cardiac surgery.

, the tumor did show up as a focal " hot spot " on subsequent PET scanning (Fig 1). A gated MRI of the hot spot gave further, accurate localization. PET scanning therefore localized the tumor when other modalities had failed. In the second case (patient 2), an atypical carcinoid (moderately differentiated neuroendocrine tumor), the tumor was localized with a CT scan of the chest but subsequent PET scan revealed an unsuspected metastasis in the lumbar spine (Fig 2). The lumbar metastasis required orthopedic fixation before the surgery to remove the mediastinal tumor. Octreotide scanning was not performed in patient 2, but MIBG scanning revealed the same distribution of metastases as the PET scan, and the patient received radioactive (I 131) MIBG treatment. As far as we are aware, PET scanning has not previously been described as a useful investigative tool for neuroendocrine tumors of the thymus. However, on the basis of our limited experience with this condition, we would suggest that in addition to CT, MRI, octreotide, and MIBG scanning, PET may be a valuable tool. Where available, it could be used and evaluated further in patients presenting with thymic neuroendocrine tumors. The sensitivity and specificity of PET compared to oct-reotide and MIBG scanning is unknown and requires further investigation. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]). Wangberg B, et al. Comparative studies on the expression of somatostatin receptor subtypes, outcome of octreotide scintigraphy and response to octreotide treatment in patients with carcinoid tumours. Recurrent ectopic adrenocorticotropic hormone producing thymic carcinoid detected with octreotide imaging. The recent article by Avorn et al (October 2003) 1 purports to show an association between the use of hydroxyethyl starch (HES) and excessive postoperative bleeding after coronary artery bypass surgery (CABG). This article resurrects the unresolved controversy regarding the use of HES in cardiac surgery and the emerging concern of clinically significant bleeding. Several prospective randomized trials, 2–9 observational studies, 9 –11 and meta-analyses, 12,13 have investigated the suspected association between HES use and bleeding after CABG. Most randomized studies on HES and bleeding have failed to show any clinically significant bleeding differences. The published retrospective studies showing an increased incidence of blood loss have received the most press but are inherently limited due to study design. Cope et al 11 retrospectively reviewed the use of hetastarch infusion based on perioperative exposure …