Somatostatin receptor scintigraphy in localization of pancreatic neuroendocrine tumors: A preliminary study.

Objective: To study the ability of somatostatin receptor scintigraphy using Tc-99m-hydrazinonicotinyl-Tyr3-octreotide (Tc-99m-HYNIC-TOC) for localization of pancreatic neuroendocrine tumors. Methods: Five patients (3 female, 2 male; age range: 53 to 80 years; mean age: 65 years) with either histologically proven or clinically suspected insulinoma were studied. Ten mCi of Tc-99m-HYNIC-TOC were intravenously injected. Whole body scans were obtained 2 and 4 hours after injection. SPECT/CT studies of areas of interest were performed after the 4-hour whole body image. Scintigraphic findings were correlated not only with the results of conventional imaging methods, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound but also through 1-year clinical follow-up. Results: The Tc-99m-HYNIC-TOC study showed true-negatives in two patients suspected of insulinoma proven by intraoperative ultrasound in one case and 1-year clinical follow-up with no evidence of hypoglycemia in the other patient. Abnormal Tc-99m-HYNIC-TOC accumulation was demonstrated in three patients with pancreatic tumors. Additional metastatic lesions to lung and bone were detected in one patient formerly diagnosed of malignant insulinoma with multiple liver metastases. Conclusion: Tc-99m-HYNIC-TOC SPECT/CT imaging may provide more accurate staging of pancreatic neuroendocrine tumors than conventional imaging. It is an optional technique to recruit patients for somatostatin analogs therapy.

Congenital hypothyroidism following maternal I-131 therapy in unsuspected pregnancy.

The authors report a term infant with congenital hypothyroidism following maternal radioiodine (I-131) treatment for papillary thyroid cancer in unsuspected pregnancy. The woman received 150 millicuries (mCi) of I-131 during the second trimester of pregnancy. Antenatal care was done in the other hospital without the awareness of previous I-131 treatment during pregnancy. The child presented with congenital hypothyroidism and recurring attacks of postprandial bilious vomiting due to midgut malrotation and Ladd bands. This case reminds physicians of the importance of obtaining an accurate menstrual history and providing information on conception in fertile woman before receiving I-131 treatment.

Scintigraphic detection of active bleeding into the intra-abdominal hematoma after percutaneous transabdominal biliary drainage using Tc-99m labeled red blood cells: A case report.

Although Tc-99m labeled red blood cells (Tc-99m RBC) imaging has been well established for localization of acute gastrointestinal bleeding, the use for detection of bleeding sites outside the gastrointestinal tract has not been widely used. The authors present a case of hemorrhage from a liver laceration successfully demonstrated using Tc-99m labeled RBC. This technique appears to be sensitive and accurate in detecting active extraintestinal hemorrhage.

Treatment outcome of Graves' disease in Thai children.

BACKGROUND: Graves' disease is the most common cause of thyrotoxicosis in children. Treatment of Graves' disease consists of anti-thyroid drugs, radioactive iodide and thyroidectomy but the optimal treatment of GD in children is still controversial. OBJECTIVE: To review treatment outcome of Graves' disease in Thai children. MATERIAL AND METHOD: Retrospective review of 32 children with Graves' disease, diagnosed between Jan. 1994 and Dec. 2004, at the Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand was performed. RESULTS: All patients (median age 10.5 yrs, range 2.85-15 yrs) presented with goiter and increased serum T4 (median 18.4 mcg/dL, range 8.8-30 mcg/dL), serum T3 (median 443 ng/dL, range 206-800 ng/dL) and suppressed TSH levels (median 0.009 mU/L, range 0-0.18 mU/L). Anti-thyroglobulin and Anti-microsomal antibodies were positive in 70% and 82% respectively. All patients except two were initially treated with propylthiouracil (PTU). Two patients were initially treated with methimazole. Adverse reaction of PTU occurred in two patients (One girl had arthralgia, positive pANCA, nephritis and another girl had skin rash and arthralgia). Clinical course of 32 patients after treatment with anti-thyroid drugs mainly PTU for 3.4 (range 0.3-11.2) years is as follows: six (18.8%) underwent remission (cessation of PTU > 2 yrs), three (9.4%) relapsed, one (3.1%) underwent subtotal thyroidectomy, and seven (21.9%) had I131 treatment. All patients (6 of 7) who received I131 dose of 100 microCi/g of thyroid tissue required more than a single dose of I131 treatment. Further outcome in fifteen patients (46.9%) is yet to be followed. Among these patients PTU was just discontinued in four and eleven had never been off anti-thyroid drugs (four still had biochemical hyperthyroidism and seven were biochemically euthyroid). CONCLUSION: PTU was the most common first line therapy in the presented patients with Graves' disease. Remission rate was only 18.8% after an average 3.5 years of treatment with anti-thyroid drugs. I131 or thyroidectomy was used as second line therapy in the present study. They were offered to those who developed side effects, had poor compliance or failed medication. For those who received I131, higher dose (200 microCi/g of thyroid tissue) seemed to be more effective than the lower dose (100 microCi/g).

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.

Treatment of hepatocellular carcinoma by injection of iodine*131-labelled lipiodol into the hepatic artery.

The therapeutic efficacy iodine*131-labelled Lipiodol was studies in the treatment of hepatocellular carcinoma (HCC). The results of the treatment were evaluated for four aspects: size of the tumour; serum alphafetoprotein level ; the quality of the patient’s life;and the survival rate. The hepatocellular carcinoma was diagnosed by evidence of mass in the liver using either computed tomography or ultrasonography with tissue biopsy and/or a high level of alphafetoprotein of more than 500 U. Twenty patients were randomized into two groups for comparison. The patients in group A were treated by intrahepatic injection of iodine*131-labelled Lipiodol 60 miliCuries(mCi). The patients in group B were treated by intra-hepatic injection of a mixture of Lipiodol and chemotherapeutic agents, mitomicin c 20 mg. and 5-fluoracil 500 mg., followed by selective hepatic artery embolisation of small pieces of gelatin sponge (gelfoam). Both groups were evaluated by computed tomography (CT) and the possible repeat of treatment protocol after two months. There were no serious side-effects or major complications in either group of patients. The patients’ conditions worsened by 40 percent in both groups. The tomours’ sizes remained unchanged by 50 percent in both groups. The serum alphafetoprotein levels had increased by 40 percent in group A, and remained unchanged by 50 percent in group B. The survival rates at one and two years in group A were 20 and 20 percent, and in group B there were 30 and 0 percent, respectively. Satisfactory results were obtained in the treatment of small HCC, size less than 5 cm. with intra-hepatic artery injection of iodine*131-labelled Lipiodol. In large HCC (>10cm) no response by the tumour was seen in either group. This was the first study of this type performed in Thailand.

Effect cisapride on gastric emptying and dyspeptic symptoms in children with non-ulcer dyspepsia.

The aim of our study was to determine the effect of Cisapride on gastric emptying and dyspeptic symptoms in 10 non-ulcer dyspepsia (NUD) children with delayed gastric emptying during and after stopping treatment. Five boys and five girls aged 5-11 years underwent upper endoscopy which showed normal appearing mucosa and histology. Solid gastric emptying was measured by scintigraphy before and after an eight-week course of oral Cisapride. The dose of cisapride was 0.2 mg/kg/dose (maximum 5 mg) three times before meals for eight weeks and then gradually decreased and discontinued when the symptoms improved. Symptoms were show to be 87.4+3.4 percent and 82.9 (4.5 percent at 60 minutes and 90 minutes, respectively. After eight-weeks of treatment, repeated gastric emptying studies were shown to be 69.1+10.6 percent and 56.7+14.1 percent respectively. This was statistically significant (P=0.001, 0.0001). In all 10 children the symptoms improved after eight-weeks of treatment. Seven children were followed up after stopping cisapride for 3 to 17.5 months. The overall response were excellent in four patients, moderate in two Cisapride is effective in improving dyspeptic symptoms and gastric emptying in children with NUD.

Primary hyperparathyroidism due to parathyriod carcinoma: Report of a case and review of literature.

A 21-year-old male with a history of bone pain for four months is described. He lost 2 cm of his height and also had polyuria and weight loss. Physical examination revealed a cachectic and mildly pale man with a firm mass of 0.8 cm in diameter on the fight side of his neck, generalized muscle wasting and proximal muscle weakness. kyphoscliosis and deformed thoracic cage. Skeletal X-ray showed finding compatible with the changes found in primary hyperparathyroidism. Biochemical parameters revealed a serum corrected total calcium of 15 mg/dl (8.5-10.5 mg/dl), inorganic phosphate of 3.7 mg/dl (305-5.0 mg/dl) and alkaline phosphatase of 1,008 U/l (39-117 U/l). Primary hyperparathyroidism was confirmed by a serum parathyroid hormone level of 1,733 pmol/l (0.100 pmol/l), Ultrasonography and computerized tomography of the neck showed a right neck mass with a diameter of 2 x 2.2 x 3 cm cm which was visualized by 99mTc-sestamibi scan. The patient underwent an uneventful surgical exploration of the neck. Histopathological study of the excised neck mass showed findings consistent with parathyroid carcinoma.

Perchlorate discharge test.

A variety of perchlorate discharge techniques was performed and the criteria for interpretation varied according to the techniques employed. The modified technique, 10 microcurrie of Na131 I was injected into the patient with a 10 minute serial recording for 1 hour ; KC 104 300 mg/25 ml was given orally and continued with 10 minute serial recording for 30 minutes. This technique can identify the iodide transport defect and organic binding defect of the thyroid gland, and trapping function of the gland. In 25 mormal subjects, the thyroid131 I- content increased during a 60 minute serial recording and after KC 104 was given. The discharge observed during 90 minutes ranged from 1% to (- 55.7%). The range at the 20 – minute uptake is from 4.70% to 11.66% (X ฑ 2 SD). In 15 patients, 3 patients had iodide transport defect, 9 patients organic binding detect, while such defects could not be found for the remaining patients. However, it is possible that the remaining three may have other kinds of defects such as iodotyrosine coupling defect, iodotyrosine dehalogenase defect or abnormal secretion of iodoprotein.