Sentinel node detection failure due to defective labeling and large particle size of Tc-99m antimony sulfide colloid

Many radiotracers have been used for sentinel node mapping with acceptable results. The main difference between these radiotracers is the particle size. In the current study, we reported defective labeling of Tc-99m antimony sulfide colloid which resulted in large particle size. Tc-99m-Antimony sulfide colloid was used for axillary sentinel node mapping of 45 breast cancer patients. The prepared kits were turbid and were used for the first 15 patients. For the remaining 30 patients, we used a filter [GyroDisc CA-PC Cellulose Acetate Membrane; 30 mm; Pore size: 0.2 micro m] after labeling to remove the possible large particles of the prepared kits. On the lymphoscintigraphy images, at least one sentinel node could be identified in 5 and 29 patients of the unfiltered and filtered groups respectively [p=0.00001]. Sentinel node detection by gamma probe was successful in 5 and 30 patients in the unfiltered and filtered groups respectively [p=0.000001]. Tc-99-Antimopny sulfide colloid is a suitable radiotracer for sentinel node mapping of the breast cancer patients. In case of any unusual turbidity of the labeled kit, it should not be used or at least be filtered before injection

Echocardiographic left ventricular functional changes in acute hypothyroidism vs. subclinical hyperthyroidism in patients with differentiated thyroid carcinoma

In order to assess echocardiographic left ventricular functional indices in patients with differentiated thyroid carcinoma [DTC], after L-T4 withdrawal [short-term overt hypothyroidism] and during TSH suppressive therapy, we have evaluated cardiac hemodynamics in a single cohort study. 24 patients with DTC were studied in two phases: 1: at least 4 weeks after L-T[4] withdrawal, 2: at least 8 weeks after beginning TSH suppressive therapy. All patients underwent conventional, Doppler and tissue Doppler echocardiography. Although early diastolic mitral inflow velocity [E wave] [p=0.033], and early diastolic velocity of mitral annulus [E[m]] [p<0.001], were lower in overt hypothyroidism, there were no differences among left ventricular [LV] Dimensions, LV mass and LV mass index, LV Ejection fraction, late diastolic mitral inflow velocity [A wave], E/A ratio, deceleration time [DT], peak systolic velocity of mitral annulus [S[m]], late diastolic velocity of mitral annulus [A[m]], E[m]/A[m] ratio between the two phases. Pulse rate [p<0.001], LV end diastolic volume [p=0.011] and LV end systolic volume [p=0.003] were higher, while QTc Interval was shorter [p <0.001] during TSH suppressive therapy. E/E[m] ratio and pulmonary capillary wedge pressure [p=0.042] were higher in hypothyroidism phase. Three patients developed mild pulmonary artery hypertension and 2 of the patients had mild pericardial effusion during TSH suppressive therapy. Short-term overt hypothyroidism or L-T4 suppressive therapy in patients with DTC may have undesirable cardiovascular effects. So in patients with known history of cardiovascular abnormalities, the caring physician should be aware of the cardiovascular complications during hypothyroidism or suppressive therapy