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By ignoring the root causes of disease and neglecting to prioritize lifestyle measures for prevention, the medical community is placing people at harm. Advanced nations, influenced by a Western lifestyle, are in the midst of a health crisis, resulting largely from poor lifestyle choices. Epidemiologic, ecologic, and interventional studies have repeatedly indicated that most chronic illnesses, including cardiovascular disease, cancer, and type 2 diabetes, are the result of lifestyles fueled by poor nutrition and physical inactivity. In this article, we describe the practice of lifestyle medicine and its powerful effect on these modern instigators of premature disability and death. We address the economic benefits of prevention-based lifestyle medicine and its effect on our health care system: A system on the verge of bankruptcy. We recommend vital changes to a disastrous course. Many deaths and many causes of pain, suffering, and disability could be circumvented if the medical community could effectively implement and share the power of healthy lifestyle choices. We believe that lifestyle medicine should become the primary approach to the management of chronic conditions and, more importantly, their prevention. For future generations, for our own health, and for the Hippocratic Oath we swore to uphold (“First do no harm”), the medical community must take action. It is our hope that the information presented will inspire our colleagues to pursue lifestyle medicine research and incorporate such practices into their daily care of patients. The time to make this change is now.

A need exists to reduce care variations by standardizing the practice of thyroid and parathyroid surgery. During the course of a year, a task force developed algorithms representing decision points and workflows based on American Thyroid Association guidelines and three internal studies of surgical practices in the Northern and Southern California Regions of Kaiser Permanente conducted in collaboration with Health Information Technology Transformation & Analytics (HITTA).

Since 1981, intraoperative bone scanning has been used at Stanford University Hospital to assist in the localization and excision of skeletal lesions in the surgical suite. The utility of bone scans to detect lesions not otherwise "visible" is valuable in guiding the surgeon to the pathological site. In addition, intraoperative scanning can define the exact amount of tissue to be excised, averting excessive surgery near joints or along weight-bearing bones. Seventeen cases are presented.

Approximately 250,000 cases of acute appendicitis are diagnosed each year in the United States and many more patients with abdominal pain masquerading as appendicitis are evaluated in emergency departments and doctors offices. Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention, and carries an associated mortality of 0.8% to 8%. 1-5 The incidence is highest in the second and third decades of life, but appendicitis may occur at any age. 4 In the presence of classic signs and symptoms of acute appendicitis, a quick and accurate diagnosis can be made based on history and physical examination alone. 5-7 However, as many as 50% of patients do not exhibit characteristic signs and symptoms. 4,6 In these equivocal patients, the diagnosis of appendicitis is difficult, delayed, and frequently inaccurate. 4 Complications including perforation, peritonitis, and death may occur with delayed diagnosis, particularly in the very young and in the elderly. 6 As many as 45% of cases are misdiagnosed, resulting in unnecessary hospitalizations and sometimes unnecessary surgery. 6 Surgical exploration has been reported to be negative in 10% to 30% of patients with a preoperative diagnosis of appendicitis. 8,9 More accurate diagnosis and reduction in unnecessary hospitalization or surgery in patients with an equivocal presentation would result in improved clinical outcomes and conservation of hospital resources. The currently available radioisotope infection imaging technique using 99mTc-HMPAO labeled white blood cells (WBC) is very sensitive for detecting appendicitis. 10-13 The primary disadvantages of radiolabeled WBC imaging include a lengthy preparation time of 2 hours and sometimes longer if an off site radiopharmacy is used, the requirement of ex vivo white blood cell radiolabeling, the potential for external blood contamination and misadministration, personnel exposure to blood borne infection such as hepatitis and HIV, and the relatively high cost and technical demand of the procedure. Because of these disadvantages, very few medical centers are capable of using radiolabeled WBC imaging for the diagnosis of appendicitis. Monoclonal antibodies specific for surface antigens on neutrophils address many of these disadvantages and may be useful infection imaging agents when labeled with a radionuclide. 14 99mTc-labeled anti-CD 15 monoclonal antibody (LeuTech; Palatin Technologies, Inc., Princeton, NJ); also known as 99mTc-anti-stage-specific embryonic antigen [SSEA]-1 monoclonal antibody) binds avidly to surface CD 15 antigens that are expressed on human neutrophils in large numbers. 15-17 As a result of the in vivo systemic administration of radiolabeled LeuTech, radioactivity becomes concentrated in areas of infection or inflammation; thus, the need to withdraw blood from a patient to label WBC’s ex vivo is eliminated and the time required to perform the test is reduced significantly. In a prospective pilot study, we performed LeuTech scans on 49 patients with equivocal presentation of appendicitis. 18 The results were encouraging with sensitivity and negative predictive values of 100%. A multicenter clinical trial was undertaken to confirm these preliminary results. This paper reports the results from this prospective, multicenter trial. The aim of this study was to further evaluate and confirm the efficacy and safety of LeuTech scintigraphy for diagnosis of acute appendicitis in patients presenting with equivocal signs and symptoms at multiple centers and in a larger population. In addition, the potential impact of LeuTech imaging on intended patient management was assessed.

Follow-up evaluation of patients who have undergone radical prostatectomy routinely consists of serial bone scintigraphy and, more recently, prostate-specific antigen (PSA) levels. The utility of serial bone scans in combination with PSA levels is retrospectively reviewed in 118 men treated by radical prostatectomy for clinical Stage A or B disease who, at the time of surgery, had no evidence of metastatic disease. Of the 118 patients, 75.4% had no abnormality on either test (mean follow-up 32.4 mo), 9.3% demonstrated a detectable or rising PSA level with negative bone scan (mean follow-up 35 mo), and 8.5% exhibited a detectable and or rising PSA level and positive bone scan (mean follow-up 30.7 mo). Follow-up bone scans were read as either positive or indeterminate with undetectable PSA levels in 6.8% of patients (mean follow-up 27.3 mo). Critical review of the equivocal studies suggests that postoperative PSA levels more truly represent the clinical situation than bone scans. Following radical prostatectomy, routine bone scintigraphy provides little additional information when PSA levels are negative. If PSA becomes detectable or the patient develops symptoms, bone scintigraphy should then be performed.

Since 1981, intraoperative bone scanning has been used at Stanford University Hospital to assist in the localization and excision of skeletal lesions in the surgical suite. The utility of bone scans to detect lesions not otherwise "visible" is valuable in guiding the surgeon to the pathological site. In addition, intraoperative scanning can define the exact amount of tissue to be excised, averting excessive surgery near joints or along weight-bearing bones. Seventeen cases are presented.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in nuclear medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers, or scholars to stay abreast of these items of progress in nuclear medicine that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Nuclear Medicine of the California Medical Association, and the summaries were prepared under its direction.