Effect of Amifostine to prevent radiotherapy-induced acute and late toxicity in head and neck cancer patients who had normal or mild impaired salivary gland function.

BACKGROUND: Amifostine has a potential role for salivary gland protection in head and neck cancer patients who had radiotherapy. MATERIAL AND METHOD: Sixty-seven head and neck cancer patients were randomized to receive radiotherapy or radiotherapy plus Amifostine. The efficacy of the treatment was determined by a questionnaire evaluating dryness of mouth and the oral comfort, the RTOG/EORTC acute/late radiation morbidity scoring criteria, collection of the whole saliva and the 99mTc-pertecnetate scintigraphy of the salivary glands. RESULTS: Amifostine significantly reduced the mean questionnaire scores from 6.49 to 3.73, the incidence of grade > or = 2 mucositis from 75% to 36% and acute xerostomia from 82% to 39%. The salivary gland function returned to normal at a rate of 36.3% in the Amifostine group versus 9.1% in the control group. CONCLUSION: Amifostine is effective in reducing the incidence and severity of acute mucositis, acute and late xerostomia in head and neck cancer patients.

How the dose of iodine-131 should be determined in the treatment of graves’ and toxic nodular hyperthyroidism.

Despite the wide use of radioiodine treatment for hyperthyroidism, the best approach to radioiodine dose selection in the treatment remains controversial. The objective of our study was to evaluated factor affected treatment of hyperthyroidism with radioactive I-131, the result of radioactive iodine treatment in our department and the average number of radioiodine treatment. Material and Method: A database of 387 patients were retrospectively reviewed. The therapeutic activity administered was calculated by the equation Administered I-131 dose= 100 ตCi X Thyroid gland weight X 100 -------------------------------------------------------------------------------- % 24hr. I-131 uptake The thyroid gland weight was estimated by palpation. Results: The failure rates of I131 treatments of Graves’ disease in our study for first dose, second dose and third dose are 43.51%, 33.98% and 12%, respectively. The failure rates of I131 treatments of toxic nodular goiter in our study for first dose, second dose and third dose are 39.22%, 58.82% and 33.33%, respectively. The average number of treatments of Graves’ disease and Toxic nodular goiter were 1.45 and 1.58, respectively. There was not a significant between Graves’ disease and Toxic nodular goiter in the averge number treatments. The %24hr. I-131 uptake and gland weight were higher in the group of Graves’ disease patients who had hyperthyroidism in comparison with Graves’ disease patients who developed euthyroidism and hypothyroidism. The gland weight was higher in the group of toxic nodular patients who had hyperthyroidism in comparison with toxic nodular patients who developed euthyroidism. Discussion: The factors affecting the treatment of hyperthyroidism by the equation in this study are Thyroid gland weight and %24 hr. I-131 uptake. Large thyroid gland mass had a lower success rate from radioiodine treatment than small thyroid gland mass. The mean I-131 24 hours uptake of the patients with persistant hyperthyroid for Graves’ disease and Toxic nodular goiter is significantly higher than the mean percent uptake of I131 of the patients who developed euthyroid and hypothyroid. The description this finding may be from the administration I-131 dose is inversely proportional to the measured 24 hours radioiodine uptake.

Tc-99m stannous colloid-labeled leucocyte scintigraphy in the evaluation of brain abscess.

99mTc stannous colloid-labeled leukocyte scintigraphy was used to investigate brain abscesses in patients with underlying arteriovenous malformation or other brain abnormalities. 99mTc stannous colloid-labeled leukocytes are radiolabeled neutrophils and monocytes. The radiolabeled colloid is phagocytosed by the white cells. Six patients with underlying arteriovenous malformation (AVM) post embolisation with clinical diagnosis of brain abscess were studied. The 3 patients with positive 99mTc stannous colloid-labeled leukocyte scans were diagnosed as a cerebral abscess in all cases. One patient who had a negative 99mTc stannous colloid-labeled leukocyte scan did not have a brain abscess. Another with a negative scan had a pathologic diagnosis of chronic inflammation and foreign body reaction. The third with a negative scan was studied after treatment with antibiotic and debridement. In Summary 99mTc stannous colloid-labeled leukocyte scintigraphy is useful in conjungtion with CT scanning in investigating patients with brain abscess who have other underlying brain abnormality or who have an early brain abcess, or in the follow up of patients who have already received treatment in order to evaluate infection is still present and it is appropriate treatment.